Revision TKR Complicated RTKR revision 2015, considering LTKR

[Randi]

@referee54... I get it. I don't like it, but I get it. Arghhhhhh

 

[referee54]

@referee54... I get it. I don't like it, but I get it. Arghhhhhh

There are issues that we have to deal with and issues that challenge our patience...this is indeed one of them---I had a slight little limp with my right leg for about five months.

 

[wings]

@Randi . Hugs and sorry you're having a bad day! As I've often read here, recovery is not a straight line, some zigs and zags with two steps forward, one step back. Hang in there!

 

[Pumpkin]

, Tomorrow is another day, hope it is brighter than today.

 

[Randi]

Thanks everybody. I think the thing I hate most is how sorry I feel for myself. But today I want to say this is just not fair. I hope soon I'll look back on this as just one of those bad days. I just dragged myself upstairs to try to sleep . Maybe tomorrow will be better - I sure hope so.

 

[Pumpkin]

Bonesmart is renown for its lavish pity parties.

 

[RunA42K]

My revision knee healed faster than my original TRK knee. I was up and doing things much faster after the revision. Every surgery is different. So I am having another revision on the same knee in 19 days. I can only hope that it heals as fast as the first revision but I am not counting on it...knee replacement hurts like heck, no two ways about it and no two surgeries are the same. I'll find out soon enough. Patience Randi...

 

[Randi]

I'm getting that message. Patience. Hard, though.
@RunA42K I'm so sorry you have to go through this again. I don't think I could.

 

[KneeAware]

Hi Randi, I just came across your thread, I sorta chuckled because you sound so much like I did with my lpk. I just just had a revision on the 8th, I am already at the stage wondering why I went through with it. I want to be done already, back to doing everything I could beforehand. I know I will have to reach down deep inside for the patience I need and know I don't really have...

Best of luck to you as you continue to recover.

 

[Randi]

Hi@JustmeT. Sorry that you have joined this Revision club, but nice to meet you. Good luck on your journey !

 

[Randi]

@Josephine. Is there any reason the pain should be getting Worse? I am taking oxycodone 2x 5 mg every 4 hours, even during the night last night (which I haven't needed to do before) and truly I can barely walk because of the pain. I've gone back to using the walker and mostly sitting in my recliner icing, elevating and not doing much of anything else. I understand the need for patience and that it's still early but I am concerned that I am going backwards. Have PT scheduled tomorrow and if I can get there I'll talk to them, again, but I suspect that they will tell me again that I just need to get strength back. But how cn I do that when I honestly can't put virtually any weight on this stupid leg ? I saw the OSS about 10 days ago and he was delighted , x Rays looked great etc.
We didn't even talk about the pain because it wasn't an issue. I feel like a whiny wimpy baby but I'm getting really upset and concerned.

 

[Josephine]

I'm going to ask you some questions 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!

) 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. how swollen is you leg? Slightly, moderately or hugely?

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

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 (or have you been doing)? How much and how often?

Can you detail it like this

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

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[kneeper]

A little soothing warm water in the shower should be ok. Hopefully Josephine would have some ideas; perhaps you've been doing too much. You can always call the OS too about the increased pain given that it seems to be ongoing and not just the random high pain day we all have gotten on occasion.

 

[Randi]

Thanks @kneeper. The shower does feel good though the relief is temporary.

@Josephine, here are my long and comment added answers. Thank you for your help in advance.

1) I have pain only in one specific spot on the inside upper quadrant of my knee. I have felt this since immediately after the surgery but it seems to be worse the last few days. I would say it goes from an 8 at the end of pain med cycle down to a 4 if I'm lucky. This prevents me from almost any weight bearing. I've started using a walker again though I was comfortably down to one cane a week ago.

2)n Though I admittedly tried to cut back last week I am now taking the maximum prescribed for me, which is 2x 5 mg OxyContin everyv4 hours. I find I get a bit more relief if I add 300 mg Advil, but the pain never goes away to a comfortable walking ability even at the maximum . One of the reasons I tried to cut back is that I'm having a terrible problem with constipation which I am working at diligently but without a lot of success.

3) I ice off and on all day . I use a Cryo machine for about an hour at a time, at least 4 times / day. I also have been using heat on that darn spot a few times a day for about 10 minutes each time.
It does provide some temporary relief

4) I sit in my recliner most of the day when I'm home. It tilts back so that my leg is elevated and when I ice I use several pillows to raise My leg higher.

5) to look at, my knee is hardly swollen at all and my leg not at all. It does feel swollen though and in that painful spot it feels to me there is a bump. Though my husband says he can't see or feel that.

6) my ROM about 120-123, extension has been 0 since right after the surgery.

7) activity level varies depending on my pain level. I have been very conservative. I pick up a few things that bother me as I move around the house. I may wash a few dishes at a time. I prepare simple meals for myself during the day and husband and I share dinner making, though he cleans up. I do have lots of stairs so I walk up and down on purpose a few times a day . Still doing one leg at a time though I can manage the normal way going up when the pain is lower. I walk around the house 10 - 15 minutes every hour or two, or outside if someone is with me. These past 2 days I have barely walked at all because it is too painful though right now it feels a bit better so I just did a few laps around the living/dining room. I have not been out very much except to PT twice a week, doctors' appointments, and to the supermarket a few times with hubby. I point , he picks up and carries
( poor abused man!) . AND IN 4 weeks I've been at my daughters' homes a few times for dinner but that means sitting up to 20 minutes, lying on couch,,and repeat...THIS IS SO MUCH LESS THAN AT THIS SAME POINT LAST TIME...

8) ExercisE - very little!

At home:
-heel slides every few hours , maybe 5 or 6 at a time, holding 10 seconds each and never past the point of any pain
- 2x per day - gentle quarter squats at the sink 10 times up and down, no holding
- up and down on tiptoes holding on to sink- 10 x, 5 second hold each
- calf stretch- 10 times, 5 second hold ( this one has really helped with calf spasms I was having)

And walking, as pain permits

At PT

- so,,while they are lovely, their expectation is silly, so to their chagrin I don't do much of what they'd like. They do use a cord to pull knee back , I tell them I have 120+ which is what OS says is likely my max, so I don't have to do that..I stpped doing straight leg raises and the like because I have been at 0 for 5 weeks now.. I tried balancing on the operated leg and off the side of a step but both hurt too much , and I suspect may have added to my pain, so I've stopped...
I do:
- stationery bike - 10 minutes (they only ask for 5 but I like this one and it feels good)
- getting up and down from sitting position - 10-15 times, hold on the way down for 5 seconds
- sink exercises as at home
- wall slides/ 1/4 squats - at the wall - 10x. Hold squat for 10 seconds
- supervised stair climbing for technique - up and down 2 sets of 8 steps once per session.
-quad strengthening lying down - 10 x holding 10 seconds each.

PT would like me to increase each rep to 15x and then 20 x but more reps = more pain so I just say no...

I have had 6 sessions and will be 'graduating' this week after 2 more sessions.

I hope to get back to water exercise in a week or two but have to wait until a) my incision is really , really closed after having to be restitched in week two and b) I can walk the distance from the parking lot to the pool,,change room,etc . I have also just ordered a recumbent bike which should arrive in about 2 weeks.

So, all good I think, but I can't walk because it is too painful....Grr...

 

[Josephine]

1) I have pain only in one specific spot on the inside upper quadrant of my knee. I have felt this since immediately after the surgery but it seems to be worse the last few days. I would say it goes from an 8 at the end of pain med cycle down to a 4 if I'm lucky. This prevents me from almost any weight bearing. I've started using a walker again though I was comfortably down to one cane a week ago.

Can you tell me the exact site of your pain using this chart?
Please note the instructions in the smaller image

2)n Though I admittedly tried to cut back last week I am now taking the maximum prescribed for me, which is 2x5mg OxyContin every 4 hours. I find I get a bit more relief if I add 300mg Advil, but the pain never goes away to a comfortable walking ability even at the maximum. One of the reasons I tried to cut back is that I'm having a terrible problem with constipation which I am working at diligently but without a lot of success.

Advil (ibuprofen) is actually not a pain killer but an anti-inflammatory. Gram for gram, it has about 40% of the pain killing power of Tylenol. So, on the understanding that the oxycontin does NOT have any Tylenol (acetaminophen) in it, try taking 1,000mg Tylenol every 6 hours and see if that doesn't help more. If the Oxy does have acetaminophen in it, then subtract that amount from the 24hr daily maximum of 4,000mg.

And the way to deal with constipation is to manage that, not give yourself less pain meds! Constipation and stool softeners

3) I ice off and on all day . I use a Cryo machine for about an hour at a time, at least 4 times a day. I also have been using heat on that darn spot a few times a day for about 10 minutes each time. It does provide some temporary relief

Never use heat to treat post-surgery pain. You'll just make it worse! Plus you're only 5 weeks out which is really, really early in the process.

4) I sit in my recliner most of the day when I'm home. It tilts back so that my leg is elevated and when I ice I use several pillows to raise my leg higher.

But is it high enough? It has to be "toes above nose" to be effective. Read this Pain and swelling control: elevation is the key

5) to look at, my knee is hardly swollen at all and my leg not at all. It does feel swollen though and in that painful spot it feels to me there is a bump. Though my husband says he can't see or feel that.

You are correct to say it feels swollen as not being visible doesn't mean there is none! The knee is peculiar in that it can contain swelling (or excess fluid, if you will) deep inside so you can be very aware of the tension even though there is no external puffiness visible.

6) my ROM about 120-123, extension has been 0 since right after the surgery.

Well that's good and allows me to say what I'm going to say later!

7)I may wash a few dishes at a time. I prepare simple meals for myself during the day and husband and I share dinner making, though he cleans up. I do have lots of stairs so I walk up and down on purpose a few times a day . Still doing one leg at a time though I can manage the normal way going up when the pain is lower. I walk around the house 10 - 15 minutes every hour or two

That's far too much. Walk around for as needed activities like bathroom and such. You need to read this again Activity progression for TKRs and follow them even more stringently since you have had a revision.

Exercises - my comments in bold
At home:
- heel slides every few hours, maybe 5 or 6 at a time, holding 10 seconds each and never past the point of any pain
- 2x per day - gentle quarter squats at the sink 10 times up and down, no holding
- up and down on tiptoes holding on to sink- 10 x, 5 second hold each
- calf stretch- 10 times, 5 second hold ( this one has really helped with calf spasms I was having)
- since your ROM is so good there is no need to do these! None at all. Though the last one is necessary of you have calf spasms. Though you might find better relief from a chiropractor

And walking, as pain permits - but you're doing too much! - see above!

At PT
- use a cord to pull knee back - absolutely NOT! Not necessary anyway as you commented
- I stopped doing straight leg raises and the like because I have been at 0 for 5 weeks now..
- I tried balancing on the operated leg and off the side of a step but both hurt too much and I suspect may have added to my pain, so I've stopped... good

I do:
- stationery bike - 10 minutes (they only ask for 5 but I like this one and it feels good) - that's okay but zero resistance and seat at maximum height please1
- getting up and down from sitting position - 10-15 times, hold on the way down for 5 seconds
- sink exercises as at home
- wall slides/ 1/4 squats - at the wall - 10x. Hold squat for 10 seconds
- supervised stair climbing for technique - up and down 2 sets of 8 steps once per session.
-quad strengthening lying down - 10 x holding 10 seconds each.
none of these are necessary and are possibly injurious, being the actually cause of your pain!
PT would like me to increase each rep to 15x and then 20 x but more reps = more pain so I just say no... Good!

I have had 6 sessions and will be 'graduating' this week after 2 more sessions. I hope to get back to water exercise in a week or two but have to wait until a) my incision is really , really closed after having to be restitched in week two and b) I can walk the distance from the parking lot to the pool,,change room,etc . I have also just ordered a recumbent bike which should arrive in about 2 weeks.

Don't be in too much of a hurry to get back to water work. It can be more punishing than anything. same with the recumbent bike. First allow your problems to abate and then just get on with life as it was normally!

Summary is
1. don't forget you're only 5 weeks out. You're still a newbie - or at least your knee is!
2. it's too soon for you to be dining out at your daughter's, going to the supermarket and doing housework, how ever minor
3. stop all exercising and PT - you really don't need it
4. see a chiropractor for your calf spasms
5. rest more - that's what you need right now
6. try the Tylenol instead of Advil

 

[leenie60]

Randi I had my right knee replaced 34 months ago and have had pain and stiffness for no apparent reason. My LTKR was perfect. How was your RTKR initially and at what point were you convinced something wasnt right?

Im returning to my surgeon in couple weeks bcuz something just isnt right. I shouldn't have pain while sitting in a meeting!

Continued good wishes with this surgery recovery


Sent from my SM-G920V using Tapatalk

 

[Randi]

@Josephine - thank you for all of that advice. It really is what I've been coming to believe though it still does feel 'lazy'... (It's an old record playing in my head) , and I am suffering from major cabin fever. I'm also committing the sin of comparing one surgery to the other. Somehow I was under the misunderstanding that a revision recovery is usually easier. Thinking about it, that doesn't really make sense. Your advice about Tylenol vs Advil is appreciated. I'll try that for sure.

So, I'm going to go to PT tomorrow and say goodbye. No point in continuing to go just to prove I shouldn't do what they're recommending . (. For all you who pay for PT, not to worry, mine is paid for by our medical insurance because it is given in hospital )

My pain is at DRf2. I understand that's the area of the initial cut but the pain is unrelenting and not being able to walk any distance without pain really doesn't feel right .

I look,forward to your thoughts about the pain.

 

[Randi]

@leenie60.. I think I knew early on that my RTKR wasn't right. One big hint was that my foot pointed out about 50 degrees. My ROM and extension were great and my OS thought everything was great. Over the nextv2 years I started to feel instability, didn't really have much pain until a few months before the revision
It just never felt right. I'd suggest getting an opinion from a different OS if you have concerns.

 

[Josephine]

My pain is at DRf2.

That's at the area of the pes anserine and the MPFL , medial patello-femoral ligament which can both get hammered doing things like squats, wall slides and tiptoes. I'll warrant there is nothing wrong with your knee and that your surgeon will be markedly disinterested in it. Or if he is, will simply recommend more PT! To which you will, if you're wise, say no!

You have another 7 weeks at least before things start to settle down. Resign yourself to lots of nothing till then!

 

[Randi]

Still don't understand why the pain is WORSE than a few weeks ago. I guess it has to be the small amount of exercise I was doing. Very confusing to be told competing advice . I will give the rest recipe a good try . I hope this works.