TKR Fall during exercise session

[EalingGran]

Have you had a look at the Oxford Knee score which is avaliable here on BoneSmart?
It is a really useful score chart to see exactly how bad your knee is. I would recommend doing it before you see your surgeon. It is widely recognised and surgeons understand the ratings.
Have you had an MRI? For me that was so bad that it made me realise, that even though my pain wasn't that bad- there really wasn't a choice about doing surgery.

 

[Jtmav]

I will chime in here as Dr Hany Bedair did both my TKRs last year, 3 months apart. I can’t speak more highly about him and his team. Interaction with the him is direct and to the point, while his team is very supportive and responds quickly to any questions. It’s important to remember that surgeons do surgery so that can be the first recommendation. In my case the X-rays and my day to day experience with my old knees were enough to convince me to go forward with the surgery. Dr Bedair was very confident that 3 months was enough time between surgeries given that I was in decent shape with no real health issues. I am 73 years old just for perspective. I did get 2 opinions and both were the same, replacement on both knees. Now a little over a year on my left and almost 10 months on the right I am satisfied with my decision. Still working on recovery and have been diligent with exercise. As important as the surgeon choice your PT can have a significant impact on your recovery. It wasn’t easy but I’m am so glad I did them close together, for my personality that was appropriate . Dr Bedair is out of Mass General but also works at Newton Wellesley several times a month, which is where my surgeries were performed. Wonderful hospital and both were day surgeries. Good luck

 

[mendogal]

Having had various knee surgeries from orthos who only do knees and shoulder procedures from orthos who only do shoulders, my own policy is to avoid general orthopedic surgeons and only go with those who fully specialize on one joint.
It’s no guarantee of course, but I believe an obsessive focus on one joint leads to more engagement with what’s happening in terms of research and advancement, as well as way more experience in the thing I need done!

 

[EalingGran]

Having had various knee surgeries from orthos who only do knees and shoulder procedures from orthos who only do shoulders, my own policy is to avoid general orthopedic surgeons and only go with those who fully specialize on one joint.

Agree that it is a good idea to go with a surgeon who specialises although my own excellent surgeon does hips and knees.
For those of us in the UK it is a good idea to check your surgeon on the National Joint Registry. This shows how many operations the surgeon has done and how they compare.

 

[FraidyCat]

I actually had a prior surgery, a hip replacement, about eight years ago, with one of the surgeons on your short list. I had a good outcome, not counting an error by the hospital's nursing staff, who failed to give instruction about how to prevent a compression stocking from acting like a tourniquet, which could have been a disastrous complication. I returned for a consult about my knee pain a few years later. I'm sorry to say I felt rushed and dismissively treated at that appointment. Therefore, I used another ortho surgeon, at another hospital, for the LTKR that I had six months ago--he had already done my second hip replacement--but this is now the doctor with whom communication has become so confusing and stressful. Perhaps I'm hoping for the impossible in an ortho surgeon, i.e., someone with top-notch surgical skills who is also respectful, even toward an anxious patient, which I acknowledge that I am. The need for three (and approaching four) major surgeries within a short timeframe hasn't done wonders for my stress and anxiety levels.

 

[Layla]

Perhaps I'm hoping for the impossible in an ortho surgeon, i.e., someone with top-notch surgical skills who is also respectful, even toward an anxious patient, which I acknowledge that I am.

Hi! Wondering if you caught the recommendation left by (Jtmav) above?
I hope you'll check out the surgeon on, Jamie's, list that BoneSmart forum member (Jtmav) also left his thoughts on, through personal experience, back up in Post # 22 above.

I will chime in here as Dr Hany Bedair did both my TKRs last year, 3 months apart. I can’t speak more highly about him and his team. Interaction with the him is direct and to the point, while his team is very supportive and responds quickly to any questions.

Dr Bedair is out of Mass General but also works at Newton Wellesley several times a month, which is where my surgeries were performed. Wonderful hospital and both were day surgeries

Good Luck, FraidyCat!

 

[Jamie]

Obviously, there is no “perfect” surgeon out there. And it is tricky sometimes to find one that you click with. The surgeon’s skill is the most important thing and should be number one on your list when picking a doctor. Whenever you meet with someone, be sure to tell them up front in the appointment that you have tremendous anxiety about the possibility of surgery and go from there. Don’t be afraid of your emotions and try to cover them up. I’ve even known a few tears to work and get through that communication barrier.

Just keep posting here. Talking through any fears you may experience will help. Knowledge is power, so be sure and ask about any concerns you have.

 

[EalingGran]

Whenever you meet with someone, be sure to tell them up front in the appointment that you have tremendous anxiety about the possibility of surgery and go from there. Don’t be afraid of your emotions

Agree with @Jamie that it is good to be upfront about your anxiety.
I am naturally anxious. I find that when I am worried I can talk a lot and sometimes my thoughts get a bit mixed up. I find it really helpful to rehearse the key points I want to make and make a list- so I don't forget things. It also really helps I find to have someone with you if it is a stressful appointment.
Surgeons can be very forthright people who are more used to action than soft talk. My surgeon is a good communicator, but ultimately the most important thing is their technical skill. I find that trying to be really clear in what I want helps. That is where doing the Oxford Joint Score helps. It is something surgeons use and understand- so you are talking their language.

 

[FraidyCat]

Thanks for everyone's input. I'm scheduled for a second opinion in early April (with one of the surgeons on the "short list") and may seek a third opinion as well.

I am only six months' out from my LTKR and still having recovery challenges. The prospect of having to undergo a RTKR as soon as next summer (to try and avoid recovery overlapping with winter--it's been icy here several times over the last couple of months, plus I only have on-street parking and can never predict how far I might need to walk from car to house and vice-versa)--feels overwhelmingly stressful. I had a great deal of difficulty getting household help when I needed it for the LTKR, despite having enlisted a $$$ "care manager" to help with this and other challenges. If I had to list my top concern, it's whether the R knee, which my current ortho surgeon told me, last week, is "gone" (after having said, a few months' prior, that "it has a long way to go before needing surgery"), would tend to need a more complicated surgery and undergo a longer/more difficult recovery if I tried to buy myself some extra time. Though if there's a recurrence of the several episodes of excruciating pain and locking that I experienced a few months ago, I won't feel like I have any choice than to forge ahead.

I hope what I've written above is coherent. :(

 

[FraidyCat]

Whenever you meet with someone, be sure to tell them up front in the appointment that you have tremendous anxiety about the possibility of surgery and go from there. Don’t be afraid of your emotions

I'm not sure how the "quoting" feature works. I've not found that physicians react well to admissions of anxiety; often it seems quite the opposite.

I find it really helpful to rehearse the key points I want to make and make a list- so I don't forget things. It also really helps I find to have someone with you if it is a stressful appointment.
Surgeons can be very forthright people who are more used to action than soft talk. My surgeon is a good communicator, but ultimately the most important thing is their technical skill. I find that trying to be really clear in what I want helps. That is where doing the Oxford Joint Score helps. It is something surgeons use and understand- so you are talking their language.

I don't know that I'd be comfortable having even a close friend in the exam room with me, as the notion of someone seeing me in a state of emotional meltdown feels embarrassing. I always go into medical appointments with a list, but the surgeon generally rushes the dialogue to the point where it falls by the wayside. As for the Oxford Joint Score, if this is the questionnaire that I was given prior to both my L hip replacement and my LTKR with the current surgeon, most of the questions didn't seem applicable. If memory serves me correctly, questions were phrased in a hyperbolic way, e.g., "I always have extreme pain when doing X-Y-Z." Since my extreme pain was intermittent, I was at a loss of how to answer--and the surgeon used my answers to discount the need for surgery. Yet within a short period, those two joints suddenly merited surgery--the surgeon's nurse said my L knee x-ray was "one of the worst" they'd seen. So something seems out of sync with how this survey is regarded as so pivotal and the reality of the situation.

 

[FraidyCat]

Having had various knee surgeries from orthos who only do knees and shoulder procedures from orthos who only do shoulders, my own policy is to avoid general orthopedic surgeons and only go with those who fully specialize on one joint.

Agree that it is a good idea to go with a surgeon who specialises although my own excellent surgeon does hips and knees.
For those of us in the UK it is a good idea to check your surgeon on the National Joint Registry. This shows how many operations the surgeon has done and how they compare.

Here in the US, and specifically, in Boston, where I live, there's a facility (New England Baptist Hospital) that does virtually no surgeries other than joint replacements, so all of its surgeons are specialists. That said, I'm increasingly hearing of patients' dissatisfaction with this hospital; there's a suspicion, it seems among many, that the hospital is "resting on its laurels" while not necessarily providing superior care.

 

[EalingGran]

The questionnaire attached
Tegner Lysholm Knee Scoring Scale
OKS (Oxford Knee Score)
These are specific for knees. I agree it can be difficult when symptoms are intermittent - but may be useful to rate yourself at different times

 

[Jtmav]

Having had various knee surgeries from orthos who only do knees and shoulder procedures from orthos who only do shoulders, my own policy is to avoid general orthopedic surgeons and only go with those who fully specialize on one joint.

Agree that it is a good idea to go with a surgeon who specialises although my own excellent surgeon does hips and knees.
For those of us in the UK it is a good idea to check your surgeon on the National Joint Registry. This shows how many operations the surgeon has done and how they compare.

Here in the US, and specifically, in Boston, where I live, there's a facility (New England Baptist Hospital) that does virtually no surgeries other than joint replacements, so all of its surgeons are specialists. That said, I'm increasingly hearing of patients' dissatisfaction with this hospital; there's a suspicion, it seems among many, that the hospital is "resting on its laurels" while not necessarily providing superior care.

I had my first appointment with the head knee surgeon at the Baptist. While his reputation is amongst the best available I learned from a friend that while he may be in the operating room that the actual surgery could be done by one of his assistants. My eventual arrival with the surgeon I chose came from two friends who had the same surgery with the same surgeon and were both very happy with their results. I understand that this is anecdotal but in the end you only have so much to go on. Good luck with both the decision and the eventual outcome.

 

[Jamie]

@FraidyCat …. I feel like you may be overanalyzing the questions on these evaluations. You don’t have to be in pain all the time for it to count as the pain they are describing. Try to be confident in expressing that you are having pain and loss of mobility for your daily life functions.

Since you’ve pretty much struck out with this surgeon, I suggest you get at least one more opinion from someone totally unconnected with this practice. I can help you find a surgeon if you need it. I do believe you need someone in the meetings with you. The idea is not for the person you bring to just sit there while you do the talking and possibly get emotional. You want to pick someone who can speak for you if needed and have a discussion prior to the appointment where you tell them of your fears and hesitancy to be assertive with the surgeon. This person should keep the situation from getting to the “meltdown” stage.

How about taking the quizzes EalingGran posted for you and let me know the scores. It would also be helpful to snap a photo of the printed quiz and post it. You can do that via DM to me if you prefer.

 

[Layla]

I don't know that I'd be comfortable having even a close friend in the exam room with me, as the notion of someone seeing me in a state of emotional meltdown feels embarrassing.

View having a friend or loved one at the appointment with you as another set of eyes and ears. These appointments can feel overwhelming and it's easy to miss or forget important details, especially if you're looking at your list for the next question, because you feel hurried, then not fully grasping all that's being said by your OS.
There is nothing wrong with feeling emotional. Breaking down isn't something to be ashamed of, it's human, especially if you have concerns and fears. Having a friend or loved one there should be comforting if you're feeling overwhelmed.

I always go into medical appointments with a list, but the surgeon generally rushes the dialogue to the point where it falls by the wayside.

At the beginning of the appointment, consider saying something like this - I understand your time is valuable, but I have some important concerns that I want to make sure we discuss before my appointment ends.
All the best, FraidyCat.
@FraidyCat

 

[FraidyCat]

I'm 6.5 months out from LTKR and have had a slow recovery, mainly with regard to improvement in ROM (still around 100), stairs, and gait. I'm a long-time member of a health club, where I work with two different personal trainers, twice a week. This morning I was doing step-up/step-down exercises with one of the trainers. He had me stepping off and onto blocks comprising approximately the height of a normal stair, eight repetitions at a time, alternating each set of eight between which foot contacted the ground first. During a third or fourth set (I lost track), eighth repetition, my left foot--same side as the TKR--evidently tripped on the platform and instead of a smooth stepdown I went sprawling onto the floor. Pain immediately shot through both legs--worse on the side of the TKR--and the trainer had to pull me to an upright position. Now, two hours later, there's still a slight, dull ache on the L side, mainly in the knee area. I iced it for awhile and am hoping there's no real damage. But I'm now very concerned about how I can better ensure my safety during these "muscle-strengthening" exercises. Both the gym trainers and my PTs (I've just begun with a new one, at a third facility) keep stressing that the knee and quad muscles *must* become stronger--but an uncontrolled fall seems like an unacceptable risk to try and achieve this. I should add that, a couple of months ago, while doing step-down exercises at the gym, that time with a PT, I lost my balance and would have hit the ground had the PT not been standing right behind me and caught me. She'd given me a skinny (to my mind flimsy) wooden pole for "balancing," but it was useless. I'm at a loss as to how to set limits with my trainers and PTs so that on the one hand I'm not exerting myself with zero benefit while on the other protecting myself from injury. I'm not someone who is prone to falling; it's never happened to me during an exercise session before, and the few times it has occurred in the household setting it's been due to circumstances such as a loose rug pad. Any input will (as always) be much appreciated!

 

[Jockette]

Now, two hours later, there's still a slight, dull ache on the L side, mainly in the knee area. I iced it for awhile and am hoping there's no real damage.

I’m so sorry you fell. It’s a fear we all have. You most likely have “only” upset the soft tissue, and it might take a while for it to settle down. Is there any swelling? As always, get it checked out with your surgeon, if you continue to be concerned.

I fell, 6 years post op. It swelled a lot, I could hardly bend my knee, because of the swelling, and it bruised quite a bit several days later. In my case, it was all soft tissue damage.

I wonder if maybe different strengthening efforts would be better for you, at this stage of recovery, than using the steps. This is a year long recovery and you still have lots more time to heal.

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Best wishes on your continuing recovery!

 

[benne68]

Oh no, @FraidyCat! That must have been very frightening. I agree with Jockette that it's likely soft tissue and will improve with some rest, icing and elevation.

I'm at a loss as to how to set limits with my trainers and PTs so that on the one hand I'm not exerting myself with zero benefit while on the other protecting myself from injury.

This is a challenge for so many of us. But, I urge you to have a heart-to-heart talk with your trainer(s) since you are not someone who was prone to falling before and this is your second fall doing the same exercise, it seems as though your trainer(s) are pushing you to do too much too soon.

Also, keep in mind that a personal trainer does NOT have the same education in physiology and body mechanics as a physical therapist. And they certainly are not trained in how to rehab someone after a joint replacement.

If it was me, I'd schedule an appointment with a physiatrist or physiotherapist to get a formal assessment and figure out why you've fallen twice. A qualified expert can provide guidance on what you should -- and should not -- be doing that you can take back to your trainer. to help them make adjustments to your program.

 

[Jamie]

Step ups, like squats, are considered "normal" exercises for quad strengthening. So I'm not surprised that your trainer would have you doing them. But what you're describing sounds like an awful lot of reps and sets (if you were doing more than 3 sets) if you're just beginning to strengthen. Was there a rest in between each set? There should be at least a couple of minutes. What you describe occurs with muscle fatigue. You were right at the end of the prescribed workout and your muscles just gave up and allowed you to trip.

In order to prevent this, you'll need to be mindful of how many of these exercises they are asking you to do. You should be starting very slow with maybe 5 reps and 3 sets. You would do those for a week or two each day and then add one rep. The next week, another rep. For safety, since you had the fall, the step up blocks should be placed so you could gently balance by holding on to the back of a chair. Or even better would be to do the exercise on a stairway with a railing or two railings you could gently hold on to, but grab quickly if you started losing your balance.

Another alternative would be to do wall squats for a while until you began getting some strength back. The quads are still worked, but you have the security of your back flat against a wall.

Let me tag @Pumpkin and see if she has any additional thoughts. I'm so sorry you're dealing with a fall. But I don't think you did any real serious damage, although your soft tissue pain won't feel like that's the case for a few days and maybe even a couple of weeks.

 

[mendogal]

That's really scary! I agree it's likely soft tissue. Our implants are mighty tough.

A real staircase with real handrails is much safer.

And yes, too many reps and sets.