Metal Allergy Do revision surgeries take longer to schedule?

Robobob

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Hello all,

Had LTKR on June 28th and have been checking this site for info on and off since. I have been feeling very discouraged for days now as I’m at 10.5 weeks recovery and I feel my recovery is moving at a snail's pace, if at all.

TLDR: My range of motion is terrible (12-85). I’m still on crutches and using the walker. There’s pain when I put full weight on it and I feel ‘clicking’ when I move it. I feel like there is still too much swelling at nearly 11 weeks. I have included a pic of knees for comparison. PT and/or the surgeon don't seem concerned, but I've had some bad knee surgery recoveries before and am nervous. I’m looking for ANY advice and stories (positive or negative) from anyone who felt like this at this point and how it turned out for them.

IMG_20220911_192203107.jpg


FYI: I asked for a metal allergy test because I didn’t know my sister had a Nickel allergy. I am awaiting results on that. Has anyone found out they had a metal allergy or know of anyone that has had one?

Here are my basics at the moment for anyone with questions/similarities:

*Range of motion has improved from only 20 degrees extension to 12ish and 70 bend to just 85 and that’s after loosening up from PT. I hit that max over a month ago, and feel like I can’t go any further. I’m a former weight lifter and know how to push myself.

*I have pain in that knee when I put full weight on it, and can only take a few steps without assistance. I am still using crutches and a walker to get around. PT and surgeon know this, but don’t seem to care. Last time I complained I was prescribed muscle relaxers.

*Had a MUA on 8/16 and felt like that set me back 3-4 weeks. Doctor said “he didn’t feel lots of scar tissue so keep that knee straight.” My knee swelled up to almost 3x for a week with a big knot on the side of my quad area. I wasn’t on pain meds before, but have been on them since.

*Home PT was initially 3x a day, but now I do it once or twice a day combined with scheduled therapy because I figure I won’t see more progress until the swelling goes down.

Interesting knee related facts:

*My main issue was patellar cartilage damage from an old injury so my TKR included patella resurfacing.

*My fourth surgery on this knee: 1) micro-fracture, 2) OATS (which failed), 3) Chondroplasty (to remove failed OATS) 4) current LTKR

*My last surgery was in December of 2015. Since then I could only walk on it, couldn’t crouch or run. Took awhile to find a surgeon that would do knee replacement. I didn’t want to go back to the guy whose OATS surgery failed.

*I got my 2nd DVT after a few days from this LTKR even with elevation, blood-thinners, gallon of water/day, etc. 1st DVT was from first knee surgery in 2013. This DVT was in the calf and took me about 2.5 weeks to work through the pain to stand on it again.

*I sprained my ankle on the other leg 2 months before surgery…dog digging holes in the back yard :(. Had a twinge behind my left knee in high upper calf when I fell because I folded it hard, but that pain went away after a week. Right ankle felt fine 2 weeks before surgery. I probably should have pushed back TKR but hindsight is always 20/20. However, I have pain behind the knee in same spot when I try and stretch to extension, PT and surgeon know this.

Sorry for the big info dump. I figured if anyone had some similarities in their issues or recovery to share, then that might help. Thanks for reading and any advice is appreciated.
 
Hi and Welcome!

Please tell us the dates of those other surgeries, and we’ll put them all in a signature for you. :flwrysmile:

You‘ve had a lot done to your knee, over the years, and with the TKR and then an MUA. The best advice I can give you is to be patient, and give your knee time to heal. It really is as simple as that.
*Home PT was initially 3x a day, but now I do it once or twice a day combined with scheduled therapy because I figure I won’t see more progress until the swelling goes down.
You are correct that you won’t see more improved ROM until your swelling goes down. Icing and Elevating will help the swelling go down. Here are some articles from Bonesmart‘s Recovery Guidleines:

Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.

I’m a former weight lifter and know how to push myself.
 
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I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​


4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
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Thank you, Rockette.
I have some reading to do. :)

Rough dates for my surgeries:
June 2013: Microfacture Surgery : Left Knee Patella
December 2014: Osteoarticular transfer system (OATS): Left Knee Patella
December 2015: Chondroplasty of patella: Left knee
June 28, 2022: Total Knee Replacement: Left Knee
 
This recovery does take a long time, even for someone who hasn’t had all the surgeries you’ve had. Seriously, try to relax and take it easy. Working too hard in this recovery can backfire and keep our knee swollen and inflamed, which can actually hinder healing.

One of our top staff members, Josephine, often said we should give our knee the privilege of sorting itself out. It will, if we let it. There will be plenty of time in the future to work on strength and getting back to normal, but for now, try a gentler version of all your PT, spend more time icing and elevating, (all night, if you can) and let it just “be” at times, and I think you’ll see more improvement. Remember, this recovery is temporary.
 
One more thing, after a very difficult first year, I had a lot of improvement in my second year. Don’t lose hope! :flwrysmile:
 
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I’m sitting at 7 weeks and stopped PT because of severe swelling and pain. Found a Physical therapy doctor who uses every modality to get me walking normally and out of pain. I only go to PT twice a week and dry needling, cupping, massage, electrical stimulation, stretching, strength training, kinesiology tape and anything she thinks will help me not harm me. Sounds like your baby knee is ticked…

Rest, ice/elevate and get away from PT for a while. Then find someone who can truly help you get better. The people who are working with you are doing more harm than good. There is light at the end of this dark tunnel, so try to stay positive….
 
Thanks Doupie,
Sounds like you have an awesome Physical Therapist. Mine are ...Ok. They are pretty good with not pushing me too hard. After my MUA I was hurting so bad they told me to take a week off. When they realized the leg straightening "push-downs" (for lack of a better term) for extension were causing me pain they did back off. I was just frustrated because they didn't seem to have any answers for me... but maybe that's my problem. There are no answers, it's just still early and my knee has lots of healing to do.

What's weird is in the literature the surgeon sent me home with, it talked about walking with a cane by week 2 or 3. I heard stories of people who got both knees at the same time, which seems impossible to me. I hear stories about people who needed no pain medication. Even this site has most people walking by week 6. A lot of people plan on going back to work after 2 months. Here I am at week 11 tomorrow and still on crutches. So all of this builds up in my head and makes me think I'm months behind most people.

Then I have history of a failed OATS surgery that I walked on for a full year in extreme pain and swelling. That surgeon refused to do a MRI so when I finally got a second opinion the new Dr found that the OATS donor cartilage had fallen out and was preventing my knee for bending. When that surgeon removed it I was pain free and walking immediately with no therapy.

All this stuff festers in my brain while I'm sore, elevating and icing everyday. I guess I need to relax and just continue with light PT and hopefully start seeing improvements.
*crosses fingers*
Thanks for commenting.
 
So all of this builds up in my head and makes me think I'm months behind most people.
Your knee probably has a lot more history than all those others you are comparing yourself to, which is why we can’t compare ourselves to anyone else, though we all do. You are not behind. Your knee is trying it’s best to heal.

When they realized the leg straightening "push-downs" (for lack of a better term) for extension were causing me pain they did back off.
Bonesmart does not recommend letting anyone push down on your knee knee to straighten it, or push the bend further than you can bend yourself. Time to heal will straighten it and enable it to bend.

All this stuff festers in my brain while I'm sore, elevating and icing everyday. I guess I need to relax and just continue with light PT and hopefully start seeing improvements.
*crosses fingers*

I was just frustrated because they didn't seem to have any answers for me... but maybe that's my problem. There are no answers, it's just still early and my knee has lots of healing to do.
You are right. It’s just still early and your knee has lots of healing to do. This recovery takes an average of a year, which means for some of us, more than a year. Try to relax. I know that’s hard, I worried about every little thing in my recovery. It’s been over 5 years for me, and looking back, I really wasted so much energy worrying about my recovery.
 
Here I am at week 11 tomorrow
Actually, when you have an MUA, you basically "reset" your timeline -- so you are really only at 4 weeks post-op. I know it's frustrating when you read about others different milestones. But we all recover at different rates --don't compare yourself to others.

Try to be patient and let you knee be your guide.
 
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Benne68,
You are so right. A "reset" is exactly what the MUA felt like. Afterwards I was in as much as soon after surgery. Felt like I lost 4 weeks of progress.

Sidenote: how do you quote other's posts?
 
Quoting:
When you want to reply, rather than quoting the whole message, just go down to the reply box and type your reply. No need to quote if you are replying to the post directly above your reply. You can also mention the member you want to address by using the @ sign in front of their username (no space) and type your reply. Not quoting whole messages saves a lot of space on the page, and also saves duplicate reading.

If you want to quote just a line in a post, highlight that line.

At the bottom of the post you will see:

Like/ +Quote/ Quote this message.

Click the +Quote

When you get to the reply box, you will see where it says “insert quotes” Click that and it will put your highlighted area into your reply.

Happy Posting! :flwrysmile:
 
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Being a former weightlifter may well help you long term, but also might slow your recovery. I have big thick muscles and both my TKR OS and my HR OS warned me that heavily muscled patients often experience a more gradual recovery from joint replacement. TKR and HR surgery result in great damage to muscles, which get stretched, push and twisted in all sorts of ways during surgery. Also, during surgery a tourniquet was likely placed on your leg, starving your quads of oxygen and nutrients.

In short, a larger muscle mass suffers more damage and takes longer to heal than a smaller muscle mass. (Patients with poor musculature suffer their own set of issues.)

FWIW, I do not precisely recall my flexion numbers at 10 weeks, but I think it was around 80. It never got better than 100 or maybe 105, but my knee eventually became very strong and stable. (My flexion was only 100 pre-op and, fortunately, extension came came easier for me.) Notwithstanding my relatively limited flexion, I averaged 100 ski days each of the three ski seasons following my TKR and I eventually resumed my mountain travel on foot, albeit doing mellower routes than I had a decade prior to TKR surgery. My most recent ski season was truncated by a bad hip, which was replaced in April. My HR recovery was quite slow to start (see discussion re big muscles, above), but I'm now at 5 months post-op and finally on track to get back out there.

Patience is key. Hang in there.
 
@Jockette - thanks for the messaging tips. I'll test them out now. :)

Also, during surgery a tourniquet was likely placed on your leg, starving your quads of oxygen and nutrients
I'm just now remembering that tourniquet pain on that thigh for a couple weeks. That was pretty painful.

@DIYSteve - I think even being a former weightlifter made my muscle a lot tighter and harder to get the range of motion back.
 
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Ok. I have big news. My surgeon's nurse called me today and said my Metal Sensitivity tests came back and I am "highly reactive" to Nickel. So I have an appointment with my surgeon on Monday 9/19 to discuss a Revision to replace the artificial knee with one that is nickel free.
Also, got a test result back yesterday that I am "homozygous" for Factor 5 Leiden: a mutation where, in my case, I'm 3-8x more likely to clot then others. Yay for crappy genetics!
The Nickel sensitivity helps explain the increased pain and swelling 11 weeks out and probably why my range of motion was not improving. The funny thing is is that this test isn't standard (before putting big hunks of metal in your body) and I had to push for it because I know my mother had a hip replacement revision and wasn't sure if it was from a metal allergy. (that was 10 years ago and she passed away 5 years ago so I don't have access to all the information) I'm glad I pushed for it because now I know, but that means another surgery when the first RTKR wasn't very fun. On top of that I know I have a higher chance of clotting too.
A Lot of mixed emotions right now: angry, excited, nervous.
I'm wondering how many people out there having long or difficult recoveries could be due to a metal sensitivity that they don't know they have.
 
@Robobob So sorry you are dealing with metal allergy. But it's great that you pushed to be tested. They can now give you an implant that won't cause you problems.

Metal allergy testing is becoming more and more visible. I agree, it would have been a better route to have it done before your TKR. But at least they have identified the problem and can get the implant replaced before it causes any damage.

Please keep us updated!
 
I'm wondering how many people out there having long or difficult recoveries could be due to a metal sensitivity that they don't know they have.
I'm one of those people that have long and difficult recoveries, and I'm arranging to get the test now. The thought of another surgery makes me break in hives.
 
The thought of another surgery makes me break in hives
I'm feeling ya. Part of me wants to never go through that experience again because of the pain, the DVT business, the torturous MUA, and all the pain meds. But part of me wants to just finally walk normally again.

@WFD - make sure you ask for the blood test and not the scratch test. The blood test is more thorough. Good luck.
 
We’ve had other members who have had a metal allergy, but we just recently set up that prefix to the thread title, so they are hard to find. If you’re interested in reading other experiences, use the search feature, upper right corner of this page.

You are lucky you found out so early in your recovery. No one wants to go through this surgery again, especially when all the difficulties are so fresh, but if it is indeed the implant causing your issues, you‘ll feel much better with a different implant. And I agree, metal testing should be part of every pre op testing.

Here is one thread, but there are others:
 

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