TKR Does anyone know of a Metal Allergy expert?

[Skybig]

After years of cortisone injections and having my Rt knee drained multiple times a year, I finally had had enough. So made the decision to get it replaced and I selected a new surgeon. Well on my first visit with him I mentioned that I could not wear a wrist watch because I got a rash underneath it. He said that I probably have a nickel allergy, so he sent my blood off to a lab in Chicago. Well my test results came back and it appeared that I was allergic to lots and lots of different metals, not just nickle! As it turned out, I was unable to use any of the FDA approved Knee Replacements in the USA. They all used a metal or alloys that was clearly allergic too. Having said that, there was one made by Smith and Nephew that was close. By that I mean the top part or condyle was made with Oxinum, which was supposed to be okay, but the bottom part that fits into the tibia was not. So my surgeon convinced the company to make me a custom knee replacement using 100% Oxinum. Then my surgeon had to approach the FDA and obtain "Compassionate Use Approval". This process took about an entire year to complete and I finally had my surgery the end of September 2021.

Well I'm 12 weeks post op from my right knee TKR and I'm worried about my progress. My knee is still very swollen and very painful. When I walk my knee clicks and bangs. It feels like I have rocks or pebbles inside my knee. I do have excellent range of motion (from 0 to 132 degrees), which is great. If I'm on my feet more than 15 minutes, my leg begins to throb. When I exercise in rehab I get lots of pain in my knee, all around my knee cap. Is this normal? I'm worried that I may be rejecting or having some adverse reaction to the Oxinium in my knee.

Your comments are appreciated.

 

[Scaredycat10]

I have 'the click' when I walk. It’s not uncomfortable at all and I’ve been told it quite common and should settle down.
I'm a member of the nickel allergy clan too, but nothing else as far as the new joint is concerned.
Hope someone can help you with the pain issue.

 

[Claire56]

Have you gone to an allergist? Could you be reacting to something else used in the surgery?

 

[CricketHip]

Hi @Skybig and to The Bonesmart Forum. What a time you've had getting to the point of scheduling your TKR.
Could you please post here the actual date of your surgery for your RTKR? Then one of the moderators will make you a signature, like you see under my post here. You will notice that it tells you about my history of joint replacements, etc.

 

[CricketHip]

I also will give you some wonderfully helpful reading material that might help you with your recovery, even though you are already 12 weeks out.

I can just imagine how you are worrying about the swelling and discomfort you are having. Were you able to discuss any of this with your surgeon? If so what does he/she say?

Okay I'll post your reading material for now.. please don't get discouraged just yet. I've seen many of our bonesmarties struggling for longer than they thought they would!


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

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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy

5. At week 4 and after you should follow this
Activity progression for TKRs

6. Access to these pages on the website

Oral And Intravenous Pain Medications
Wound Closure

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.

 

[CricketHip]

One more thing, if you don't mind, could you post a bit on how you are rehabbing your knee and some of the exercises that you are doing? Thanks again!

 

[Skybig]

My surgery was 9/21.

I'm in rehab with a PT. He has me doing exercises to strengthen my quad. Like straight leg lifts, side lifts, mild squats, leg extensions, exercise bike and a whole bunch more and I do them at home. My leg is getting stronger, but when I do some on the exercisesI I get a lot of pain in my knee and that worries me. I also get pain when doing nothing at all. As for waking, the crunching and clicking is very very very uncomfortable.

I saw the surgeon at 8 weeks post op and I see him again tomorrow. I will raise these issues.

No I have not seen an alergist.

 

[Scaredycat10]

@Skybig, I’m no expert at all but my rehab is going reasonably well so this is just based on my experience.

Before this wretched variant, i.e. this week, I was going to the gym three times a week, twice under the watchful eye of my physio. At no time would she allow me to exercise to the point of pain.

 

[Jaycey]

Like straight leg lifts, side lifts, mild squats, leg extensions, exercise bike and a whole bunch more and I do them at home.

Have you tried backing off all this exercise to see if that knee calms down? Sounds like you may be pushing that new knee. Plenty of time for strength training once your knee settles.

 

[Carol Anna]

I backed off my excercise when I had a bad sharp pain after overstretching something near the site of the op. I still improved and turned the corner last week. I think the advice of not pushing when in pain from this site was spot on for me.

 

[Skybig]

I hear what you all are saying, that I shouldn't exercise with pain, but almost every exercise causes some degree of knee pain. Even straight leg lifts cause pain. Having said that using the exercise bike is virtually pain free.

I virtually stopped exercising for over the past 2 weeks to see if my knee would calm down. Well it hasn't and neither has the swelling. It's so swollen that I can't wear most of my blue jeans.

 

[CricketHip]

Would you be willing to try some hands on lymphatic drainage? That swelling is inflammation and if you can get some of it to move away from that knee your symptoms just may improve.
The best alternative is to find a certified manual lymphatic drainage in your area but at least I can offer you some simple things to do at home.
I will leave the instructions here just in case.


****
Take deep breaths.. deep, as in breathing in to a count of 3 or 4, whatever is best for you. hold it for another count of 3-4, then blow out completely, still using the count that's comfortable for you. A series of at least 6 of these could help get your excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up.

Then, as you slowly breath out, to the same count of either 3, 4 or 5 gently press down and slightly upwards with the palm of your hand.
Do this whenever you feel up to it during the day or night. The more supine that you can get in the recliner or bed, the more effective this can be.. you have lymph nodes located in your groin and sitting up too much can cause a restriction of the lymph flow.

You can, after the breathing, place your hands lightly on your upper thigh, right where the crease is in your groin and lightly stroke upwards towards your naval.
I did this quite a bit post op and while it takes a while for the body to wake up and respond, it will and it will help get things moving.
The reason this can help is because our lymphatic system doesn't use our cardiovascular system to help lymph fluids move.. no assistance from the heart pumping. Our breathing and our physical (muscular) movements keep it flowing.
****In your situation you can also do very gentle strokes from the knee and upwards after you do the upper leg and abdominal area.

 

[Jaycey]

Are you icing and elevating? Ice for 45-60 minutes per session, several times per day. Many of our member ice around the clock with breaks to get up and walk around. Ice will reduce that swelling that is causing this pain.

 

[Skybig]

I just got home from the Surgeon. He wasn't pleased with the swelling, but he wasn't worried about it either. Apparently he had to do a lot of soft tissue work during surgery to get my leg straight, which probably caused a lot of scar tissue issues. That's why my knee is so "crunchy" and not smooth when I bend it. Just to play it safe, he drained some fluid out of my knee and sent it off to a lab for testing. He's looking for an infection or some other abnormality. The fluid was clear, but very reddish, which he said was normal and a good sign. He said the "red-ness" was due to me continuing to break up the scar tissue. He said he was happy that fluid was not cloudy because that usually indicates that there is an infection present. We also discussed the unlikely possibility that I could be rejecting the implant. He didn't think that rejection was and issue at this point, because I didn't have the other tell tail signs of rejection and that the fluid he drained was not cloudy. He also checked the X-rays and said everything looked as it should. He also fiddled around with my leg and said everything felt solid. As for rehab, he wants me to take it easy to let my knee calm down and only do exercises that don't cause pain.

I will keep you posted on my progress.

 

[DEL2022Jan-23]

@Skybig I am glad you have seen your OS and that he is listening to your concerns and running tests. According to your X-rays he said everything looked as it should be which should at least relieve you of one worry. Generally any type of massage should be beneficial to help break up scar tissue forming even just massaging the knee yourself, the lymphatic drainage suggested by CricketHip would be an excellent thing to try for the swelling as well.
I just wanted to ask if you are icing regularly- I had my LTKR seven days after you had yours and had a bad setback at week 4, which has finally started to come right. I am still icing daily and making sure I also elevate -both of which help me with swelling .
It is really important to continue stretching and exercising up to the point of discomfort but definitely not to the point you are feeling pain. The more you push through the pain the more you can aggravate the soft tissues which of course react by swelling.
You do say you can use your exercise bike without it hurting you, are you doing the motion slowly forward and backwards tensioning the pedals when appropriate or are you only pedalling forward at standard cycling speed?
I hope you get good results from your OS.

 

[kneeper]

Well, squats are pretty strenuous for a new knee even at 12 weeks. It can take more than 3 months for standing for a length of time not to provoke stiffness. I had that probably for 6 months (though diminishing over time). Certainly by a year it wasn't a problem and today I wouldn't even think about having "artificial parts" except for being part of this forum.

 

[FCBayern]

My surgery was 9/21.

I'm in rehab with a PT. He has me doing exercises to strengthen my quad. Like straight leg lifts, side lifts, mild squats, leg extensions, exercise bike and a whole bunch more and I do them at home. My leg is getting stronger, but when I do some on the exercises I get a lot of pain in my knee and that worries me.

Those exercises would have left me in serious pain at 3 months, and that's very early to be working on strength training, sounds like your knee is happier with the ROM gentle stretching that the exercise bike offers.

 

[Skybig]

Just to clarify, when I said "squats" I meant "mild-squats". Basically the PT had me doing the squat needed to sit in a chair without using any other support. Even though they were "mild" they still bothered my knee, so I didn't do them often. I'm thinking about going to another PT because I think the one that I was going to is tad too aggressive. I actually haven't been to PT in two weeks anyway because I was exposed to Covid 19. Luckily I didn't come down with it.

I agree that the exercises might be a tad too aggressive. So what types of exercises should be doing at this this point in my rehab?

 

[Jaycey]

So what types of exercises should be doing at this this point in my rehab?

Here is a link to an article from our Library on ROM and Extension stretches.

If you have access to a stationary bike that's great exercise for a new knee.

 

[Sara61]

@Skybig At 3 months I was not doing any exercises at all on my 1st knee replacement (2019) I had done a few gentle sessions at PT shorty after my surgery, with no pain whatsoever only because my best friend is a therapist.
I never did squats or any kind, sitting or standing, my Knee healed perfectly, I achieved a good ROM & Extension from my daily living activities just as my surgeon promised I would ( he is one of the few who believes PT is not needed after a replacement)
If you feel you need the exercise, then gently use your bike and enjoy a lovely walk in the fresh air, save yourself the unwanted grief & pain xx