Revision TKR Complicated Knee Revision pain and recovery<'

hopefulrevision

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Hi, I had a knee revision December 29 2015, three weeks ago, but I initally had a TKR in Feb 2013 that was messed up from day one. My incision with first TKR would not heal for over 4 months due to where the surgeon cut me in relation to a previous incision from a big surgery when I was 16. Also one of my components was on a recall list, severe pain, loose etc. The surgeons did not want to do a revision right away because they were worried that my incision may never heal etc and I could lose my leg or life.

My knee ended up so loose that I was at risk for dislocation which I guess can be very dangerous. So, I ended up having a revision on December 29 2015. Today is week three since surgery.

The surgery was 3½ hours long and they had to drill up into my leg and below as well to place a long stem rod component knee replacement. The pain has been horrible. I am icing a lot and elevating and doing PT exercises, but each time I stand (even not standing it hurts bad) or walk the pain is awful.

Sleeping is not easy due to pain. I realize this is just week three, and the surgeon told me this is way more complicated than a first time TKR and more painful, which I can vouch for since I had a complicated TKR too.

I was taking Lovenox blood thinner shots up until last night so I could not take vitamins or herbal supplements, but I am hoping to start taking some natural supplements tomorrow once the Lovenox has gone from my system.

I am wanting to look into natural pain relief, but I cannot afford acupuncture or doctor visits outside of primary care. I am worried I will not be able to start work for many months due to how difficult it is for me to stand for long or walk far without having to sit down and rest due to pain and exhaustion. My PT is concerned that my knee and hip are not aligned properly.

Has anyone else endured a complicated revision? Long stem rods in legs?
 
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@hopefulrevision ,
Welcome to Bonesmart, glad you joined us.
I had a revision with the long stems in my femur and my tibia. When I stood in the early days my leg hurt a lot, then it went away.
You are only 3 weeks out from your revision, very very early in this yearlong or more recovery.
What are you taking for pain? Sounds like you may be trying to come off pain medications too soon after this major surgery, your poor knee was subjected to a lot of trauma. You should be taking your pain medications as prescribed on schedule to keep you pain under control. Be sure to set you alarm at night so you do not miss a dose.

Here is the post op reading, the articles are short and will not take long to read.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock as prescribed
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
 
Hi @hopefulrevision

I agree with Pumpkln, that you need to continue taking your prescribed pain relief medications on a regular schedule, to the full amount prescribed. You've had extensive, painful surgery and it's much too soon to be trying to cut back.
Since you're taking these meds as post-op pain relief, there is little need to fear getting addicted.
Myth busting: on getting addicted to pain meds

I see that you'v created a signature. Please will you add to it the previous surgery to your knee? That wa, it will be easier for us to see that your knee has a complicated history.
Thank you. :flwrysmile:
 
I thank you both for your replies. I have been cutting back because I am afraid they won't keep helping me with pain medication due to how strict they are. Before my first TKR I have rarely ever taken any medication, and I am not addicted to anything, so I am hoping they honor my honesty and understand how painful this is, but not all nurses or doctors do. Have you both had doctors help you in this regard? So far it is ok, but I know they usually want you off medication sooner than you are ready. My entire leg hurts, and my knee is really bad. I will read the threads you posted here. Thank you both.... I am sleeping a lot too. I am up a lot, but seem to need to rest a lot too.
 
Hi and welcome to BoneSmart!
I was taking Lovenox blood thinner shots up until last night so I could not take vitamins or herbal supplements
Why on earth not? That's news to me.

In order to help and advise you, I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! :no-fin:) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?
ai63.tinypic.com_eta39s.jpg


7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2
 
I was on Lovenox shots for 28 days after surgery and was never told I couldn't take any vitamins or supplements with it.
 
Josephine~

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! :no-fin:) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

My pain level varies depending on whether I have taken medication recently or not. I would say anywhere from 5 to 7 in day, and sometimes to 8 or 9 at night. Sometimes burning, sharp pains, throbbing at times, a lot of aching and stiffness. Last night I was having a really hard time sleeping because although I was elevating, I could not find a comfortable place, and each time I moved my leg just a little, the pain was horrible. I am hurting pretty bad this morning, but not like last night.

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
3 5 mg oxy codone every 4 hours, 1 12 hour morphine at bedtime. 4 xy codone help muc h more, but I am trying to reduce. I also already cut out the 12 hour morning medication after 5 days home.
I sometimes feel bad I have to take this medication when I read about people taking very little, or none at all. I have no idea how they do this. This is the third major surgery on this knee, and 5th surgery on it overall, and they told me this revision was complicated lasting 3 1/2 hours and they had to drill pretty deep for the long stem component. Plus, my last TKR was very messed up.

3. how often are you icing your knee and for how long?

I am icing throughout the day, I would say 20 minutes icing, and then 20 minutes to one hour not icing.

4. are you elevating your leg, how often and for how long? I elevate every time I lie down on couch, or at night in bed. I elevate when icing too. I elevate and ice on and off throughout the day. I elevate at least for 20 minutes at a time, if not more.

5. What is your ROM - that's flexion (bend) and extension (straightness)

ROM 96, extension 100
6. how swollen is your leg? I am moderately swollen.
ai63.tinypic.com_eta39s.jpg


7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
I am up and cleaning out cat litter, doing laundry yet have children carry laundry into other room when I can. Loading dishwasher and emptying etc. No driving yet at all, or shopping. I can't imagine shopping yet. My pain is bad when standing or walking and I am not ready to walk through a store. I also still get really tired walking through the house.

8. what kind of PT exercises and exercises at home are you doing? How much and how often? I am doing PT exercises at least three times a day. They have a sheet of exercises I am doing: Ankle pumps throughout the day, Glute sets 5-6 a day 10 -20 reps, quad sets 5-6 a day 10-20 reps ( I am not able to do that much...
Leg lifts 8 3 xs a day, Short arc quad 3 a day 10 reps, heel prop I do throughout the day. Heel slides 8 at a time a few times a day, this one really hurts too.. I can't handle the pain of doing long arc quads in a chair. It really really hurts. Seated knee flexion 5 once a day. This one hurts really bad too.
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10
 
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I was on Lovenox shots for 28 days after surgery and was never told I couldn't take any vitamins or supplements with it.
I have no idea why they told me not to, other than they were concerned with interactions. I did not have good post surgery nurses, they seemed to know very little about ortho surgery as well.
I am now back to taking my vitamins etc...
 
I'm not surprised you don't feel like going shopping yet. I think at your stage the only time I went out was for PT and then I'd rest after.

How old are the kids? Good for you and them for having them haul the laundry. Can you have them do the dishes?
 
As a survivor of a very complicated revision (15 month ago) I feel your pain all to well. The best thing is rest, rest, more rest, elevation and ice. It took me a good 6 months to make much progress, but just followed orders and support on here. Dr always told me to listen to my knee, nothing more then mild discomfort was ok with him. I just has LTKR 3 months ago and will be having a revision on it in 2 weeks. Just hang in there, listen to your body and your knee. We are all here for u. Elevate your leg as much as possible
 
I would say anywhere from 5 to 7 in day, and sometimes to 8 or 9 at night. Sometimes burning, sharp pains, throbbing at times, a lot of aching and stiffness.
That's high!
3 x5 mg oxycodone every 4 hours, 1 x12 hour morphine at bedtime. 4 oxycodone help much more but I am trying to reduce. I also already cut out the 12 hour morning medication after 5 days home.
At 3½ weeks there is NO WAY you should be reducing your pain meds. You need them and must take them as prescribed.
I sometimes feel bad I have to take this medication when I read about people taking very little, or none at all. I have no idea how they do this. This is the third major surgery on this knee, and 5th surgery on it overall, and they told me this revision was complicated lasting 3½ hours and they had to drill pretty deep for the long stem component.
Don't feel bad. Other people never had your surgery and you never had theirs so you can't compare. Besides which, people often lie!
I am icing throughout the day, I would say 20 minutes icing, and then 20 minutes to one hour not icing.I elevate every time I lie down on couch, or at night in bed. I elevate when icing too. I elevate and ice on and off throughout the day. I elevate at least for 20 minutes at a time, if not more.
You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.
ROM 96, extension 100
That's not bad for 3½ weeks. Not bad at all.
I am moderately swollen.
I would imagine.
I am up and cleaning out cat litter, doing laundry yet have children carry laundry into other room when I can. Loading dishwasher and emptying etc. No driving yet at all, or shopping. I can't imagine shopping yet. My pain is bad when standing or walking and I am not ready to walk through a store. I also still get really tired walking through the house.
You're doing far too much. Read this Activity progression for TKRs

My comments in bold
I am doing PT exercises at least three times a day do them once a day and not at all on weekends
They have a sheet of exercises I am doing:
ankle pumps throughout the day - those are anticlots exercises and since you are so active, you really don't need to do them
glute sets 5-6 a day 10 -20 reps - don't do these, they benefit you nothing except pain
quad sets 5-6 a day 10-20 reps (I am not able to do that much) - very pleased to hear it. Keep it that way!
leg lifts 8 3 xs a day - a tip: once once you can do leg lifts you don't need to do them any more
short arc quad 3 a day 10 reps - these are punishing, stop doing them
heel prop throughout the day - heel props are agonising! don't do them
heel slides 8 at a time a few times a day, this one really hurts too - they do if you're not doing them properly. Read this Heel slides and how to do them.
I can't handle the pain of doing long arc quads in a chair. It really really hurts - then don't do them!
Seated knee flexion 5 once a day. This one hurts really bad too - same again

Assessment: you're just plain doing too much! The reality is that it's not the exercising that gets you your ROM, it's time. Time to heal, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and does more harm than good. Normal mobility and stretches are the key to success.

If you want confirmation that this works. I recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!
 
I struggled with pain terribly bad after my PT appt at home on Friday. I actually was beginning to worry something was wrong. I decided to stop exercising, except getting up and doing mild walking and a couple other movements. I laid low and iced a lot. It has eased somewhat, but I am taking medication and icing a lot too. Anytime I go to Bend it my knee hurt terribly bad. I am not sure there is anything the doctor can do, I am wondering if this healing process is just going to take a long time. The doctor's office wants to see me because of my pain, but do they have unrealistic expectations on how quickly my knee is supposed to heal and be pain free? How can I communicate with them so that they understand and do not discount my pain etc?? I am at 4 weeks from surgery today.
 
There should be a edit button at the bottom of the page, click on it and you can edit your information. If you have you are unable to edit it let us know and a moderator will edit it for you.

Sorry you are having trouble communicating with your medical team. My guess is your OS wants to be sure there is there is nothing going on causing your pain.
Your PT and your OS have not had TKR's or revisions, they both can take a year or more to fully heal. Many with uneventful TKR's are still taking pain meds at 3 - 4 months.
You are still very early in this year long or more recovery, your knee will heal on its own schedule, there is nothing you can do to speed it up. But doing too much can slow your recovery. Listen to your body and let your knee heal at its own pace.
Rest, Ice, Elevate, and Medicate on schedule as prescribed, and the walking your do at home are plenty right now.
 
If they are hesitant with pain medication, you can see your GP, or ask for referral to a pain clinic.
 
If they are hesitant with pain medication, you can see your GP, or ask for referral to a pain clinic.
Thank you. So far they have been supportive, but I know that with my TKR in 2013 I ended up being referred to a pain clinic. My incision was a gaping wound and oozing scab at 4months back then, and had a difficult recovery because of the surgery.
 
Thank you!!
So far they are great with communication, I just think that overall they discount the recovery difficulty. One nurse told me that he was surprised I was taking pain medication the day after my surgery, which I found so bizarre that some nurses are so ignorant. The nurses that were kind, were so incredible but there were others that were not kind.
I will be talking to the doctor's office tomorrow. The PA has been nice. I sent her an email with photos of my knee, and a detailed accounting of how I am doing.
 
PS~ I can edit my most recent posts, but there is no option to edit my first post.
 

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