TKR Fall during exercise session

[FraidyCat]

Checking in to see how you are feeling this week, @FraidyCat. Please give us an update when you have a chance.

Thanks for checking in with me. I saw another surgeon--the one who did my first hip replacement 8 yrs ago--on Tuesday, to get his take on the knee surgeon's assessment (based solely on an x-ray) that the non-surgical knee was "gone." (I never succeeded in getting the knee surgeon to respond to why he had such a dire opinion, mere months after he'd told me I was "a long way from needing surgery" on the second knee.) This other surgeon didn't feel there was any rush to operate. When I asked if waiting to a point where there was further deterioration due to the arthritis could compromise the operative result, he said no. Other than that, I have daily mild throbbing in the knee and hip-groin area. The knee throbbing could be due to the exercises that I do at the PT facility and/or my health club. The hip throbbing is more worrisome, as I had a hairline fracture after this hip was replaced three years ago and wonder if it could be recurring--though my PT says if so, it'd be more painful than just mild throbbing.

 

[Layla]

Hello and Happy Friday FraidyCat,
Arthritis can cause joints to deteriorate more rapidly. There is inflammation which can break down cartilage. Loss of cartilage means your bones may start rubbing against each other leading to pain, stiffness, swelling and more damage. Then the reduced movement weakens the surrounding muscles and that too can speed up deterioration. Progression varies from person to person. Some experience a slower progression while others can decline more rapidly. I am wondering if you asked the surgeon on Tuesday about your hip since its a concern of yours. If so, what were his thoughts?

Other than that, I have daily mild throbbing in the knee and hip-groin area. The knee throbbing could be due to the exercises that I do at the PT facility and/or my health club.

You may consider stepping back for a couple of weeks and see if you notice any relief.
Thanks for stopping by with an update. Wishing you a great weekend!

 

[Jamie]

While I agree with your surgeon that waiting until there is further arthritic damage in your “good” knee won’t impact the successful outcome, it can impact your recovery from that surgery when it’s needed. The more damage done when you are bone on bone can make the surgery take longer. In recovery this can translate to additional pain and swelling because of the amount of soft tissue manipulation that has to take place to get the job done. And…another potential recovery issue is related to the fact that a deteriorating knee can cause your body to be out of proper alignment when you walk. This puts pressure on the rest of your body’s soft tissues and joints to compensate. It can take a while once you have the knee put back into proper position for the body to readjust back to normal.

So, while it’s true that you shouldn’t rush into surgery, if you are bone on bone in your other knee, I wouldn’t wait too long to get it replaced. Sometimes people don’t have a lot of pain even with a trashed joint. And, quite the opposite, some folks have fairly good looking x-rays and yet have a lot of pain. Just remember that your knee will never get any better - only worse. So if you are experiencing pain in that knee or your x-ray showed bone on bone, you really do need to consider not waiting too long to have the joint replaced.

 

[FraidyCat]

So, while it’s true that you shouldn’t rush into surgery, if you are bone on bone in your other knee, I wouldn’t wait too long to get it replaced. Sometimes people don’t have a lot of pain even with a trashed joint. And, quite the opposite, some folks have fairly good looking x-rays and yet have a lot of pain. Just remember that your knee will never get any better - only worse. So if you are experiencing pain in that knee or your x-ray showed bone on bone, you really do need to consider not waiting too long to have the joint replaced.

I'm at about 8 months postop with the L knee and still not recovered either with stair navigation or walking gait. I feel that if I were to undergo surgery on the R knee as soon as within the next four months--I can't risk recovery that would have its earliest stages in the wintertime, so any planned surgery would need to occur before end of summer--I have only street-parking, which forces me to walk on potentially icy surfaces in wintertime--I will have an emotional breakdown. The x-ray does show bone-on-bone when the knee is in the bent position, though apparently not in the extended position. But I haven't had any severe-pain episodes since November. Perhaps I need to seek a third opinion. The surgeon who replaced the L knee is hopelessly uncommunicative, so I'm not going to get any useful input from him.

 

[FraidyCat]

Hello and Happy Friday FraidyCat,
Arthritis can cause joints to deteriorate more rapidly. There is inflammation which can break down cartilage. Loss of cartilage means your bones may start rubbing against each other leading to pain, stiffness, swelling and more damage. Then the reduced movement weakens the surrounding muscles and that too can speed up deterioration. Progression varies from person to person. Some experience a slower progression while others can decline more rapidly. I am wondering if you asked the surgeon on Tuesday about your hip since its a concern of yours. If so, what were his thoughts?

I am still confused about how to quote only part of a message in a reply?

I am wondering if you asked the surgeon on Tuesday about your hip since its a concern of yours. If so, what were his thoughts?

I neglected to ask that the hip be x-rayed last week at the second-opinion appointment. Probably the surgeon who actually replaced that hip three years ago--the same one who replaced the knee last August who has been so uncommunicative--should order the hip x-ray. I will call his office to see about arranging it. His staff are always unfriendly, so I tend to delay contacting them whenever possible. Wondering how many others on this site have had problems with uncommunicative surgeons and unhelpful support staff? I can't recall reading other such accounts. (The communication problems add stress to the concerns about the hip and knee problems.)

 

[Layla]

Hi FraidyCat, Happy Monday!
To quote only a portion of a message - if you highlight what you want to quote, there will be a pop-up that reads "quote this message" and all you need to do is click / tap on that.
Or you can simply tag the member you're responding to and I'm sure they'll read back to their last post to confirm why you've tagged them and then respond.

Thread 'How to use the quote feature'

Dec 8, 2019

BoneSmart has the ability for you to easily and quickly quote comments from another member in your post. The quote function is useful when:

• The message to which you wish to reply is not the last one on the thread and may not be visible to the readers
• You want to respond to only a portion of someone's post

It's a way of making sure your readers don't have to scroll up and down over several, even many, posts to pick up the essence of a conversation.

The following explanations look quite complicated but don't be intimidated, quoting is in fact pretty straightforward. But...

• BoneSmart
• Replies: 1
• Forum: How To Use This Forum

I am sorry you're dealing with a less than friendly surgeon and support staff. You may need to politely / calmly be more direct with them. Let them know that you'll appreciate if they spend more time discussing your concerns or or topics impacting your recovery. Ask if they need more clarity in your explanation. Bring a short list of questions. It will show that you are organized and have legitimate concerns.

Is there a patient portal that allows you to ask questions? If so, you may have better luck there and you won't feel rushed. If the interactions you have with the support staff and your OS are consistently cold and informative, consider looking for a new OS rather than allowing the stress it places on you to grow.
Wishing you a good week, FraidyCat!
@FraidyCat

 

[Jamie]

If you’re this unhappy with your current surgeon, then definitely seek another opinion. I can help you locate possible surgeons if you like. Just let me know. However, it may take a while to get in to see someone new and then (if you wanted to do it) schedule surgery. So you may be getting into the winter recovery window. However, nothing is lost by at least trying to find a surgeon who is more attuned to your needs.

I understand and appreciate your car parking and worries about winter recovery. I think you’re wise to consider that situation in your planning.

 

[FraidyCat]

@Jamie, thanks, much appreciated. I actually did meet with a second-opinion surgeon last week--he's the surgeon who replaced my hip eight years ago, but not the hip that was replaced three years ago that's currently having discomfort. I'm going to have a hip x-ray ordered by the surgeon who did the most recent hip replacement, despite my communication problems with him and his staff, since he's the one familiar with the hairline-fracture complication that developed after the surgery. Hopefully, there's not any loosening of the implant that's accounting for the discomfort. I asked when I had the surgery if osteoporosis was a contraindication for hip replacement and was told it wasn't. Yet my reading tells me it can be--that it can hasten implant loosening. If I'm lucky (for a change) the discomfort is attributable to residual arthritis and/or the more strenuous PT exercises that I've been doing for the last couple of months.

 

[sistersinhim]

If I'm lucky (for a change) the discomfort is attributable to residual arthritis and/or the more strenuous PT exercises that I've been doing for the last couple of months.

With a joint replacement, there is no area for arthritis. I imagine that the increased, strenuous exercises are the cause. I suggest you back-off of these for a week or so, and see if your pain decreases. You can also increase your icing and elevating to help.

 

[Jamie]

I agree with sistersinhim. It would be worth a try to see if reducing the exercises for a week or two makes a difference. That plus the X-ray and consultation with the surgeon should determine what, if anything, is going on.

The fact that you have osteoporosis wouldn’t stop you from having a hip replacement, but it is a factor that must be considered in everything that is done and the post-op monitoring. Are you on medication for the osteoporosis? And are you having regular bone density tests with one of your doctors monitoring any changes? If not, that certainly might be something to consider for you.

Your plan of action is a good one and I’ll be watching to see how your next consultation goes.

 

[FraidyCat]

The fact that you have osteoporosis wouldn’t stop you from having a hip replacement, but it is a factor that must be considered in everything that is done and the post-op monitoring. Are you on medication for the osteoporosis? And are you having regular bone density tests with one of your doctors monitoring any changes? If not, that certainly might be something to consider for you.

I've refused medications for osteoporosis for almost 25 years. They were first recommended to me for osteopenia, which the FDA no longer considers an appropriate indication for the meds. My last bone-density scan was eight years ago; it showed stability with the scores since the previous scan, but the endocrinology team said they were recommending that I start the meds anyway, since stability may not last. At that point I lost all confidence in their recommendation, as they were clearly hellbent on getting me to consent to the medication. I've done much reading about the risk/benefit ratio of these drugs as well as their adverse effects. The meds have a half-life of ten years, which means they hang around in one's system for that long, so a patient who has a major side effect may be stuck with it indefinitely. The doctors like to claim that adverse effects are "very rare," but based on what I've read I don't believe that to be the case.

 

[Layla]

Hello and Happy Monday FraidyCat,
I appreciate you sharing your perspective on this topic and it's clear you've done your homework and you're thinking critically about your health choices. I respect that. You've made an informed decision through thoughtful research. Everyones journey is unique and I'm glad you seem comfortable with the path you're on.
Have a great week!

 

[FraidyCat]

Hello and Happy Monday FraidyCat,
I appreciate you sharing your perspective on this topic and it's clear you've done your homework and you're thinking critically about your health choices. I respect that. You've made an informed decision through thoughtful research. Everyones journey is unique and I'm glad you seem comfortable with the path you're on.
Have a great week!

Thanks, @Layla. Hope your week is good as well!

 

[Jamie]

There are some serious possible side effects to the drugs for osteoporosis and I appreciate your approach to deciding what is best for you, given that diagnosis. It’s been 8 years since your last bone density scan and you might want to consider getting an updated reading. I don’t have any bone density problems, but my GP still sends me for a new scan every 5 years in order to ensure something doesn’t sneak up on us. You don’t have to go to the endocrinologist that is pushing the meds to get it. Your GP can order the test and then you’ll know where you stand with that.

I suspect you are correct in thinking that the stronger exercises have contributed to what you’re experiencing now. You’ll know that for sure after a couple of weeks of reduced activity and exercise.

 

[FraidyCat]

It’s been 8 years since your last bone density scan and you might want to consider getting an updated reading. I don’t have any bone density problems, but my GP still sends me for a new scan every 5 years in order to ensure something doesn’t sneak up on us. You don’t have to go to the endocrinologist that is pushing the meds to get it. Your GP can order the test and then you’ll know where you stand with that.

I was close to agreeing to get a new bone-density scan for a baseline, as the endocrinologist with whom I met last year (I'm being monitored for a parathyroid nodule) was mild-mannered and not pushy about it. It didn't come up, until after that conversation, that I had two hip replacements, at which point he said that a scan of the hips wouldn't provide reliable data. My PCP mentioned that a scan of the back would likely show arthritis, which would also confuse the data. Which would leave one wrist for scanning. (The other wrist has a plate in it due to fracture from a fall on black ice.)

My parents, each of whom lived to age 92, never had bone-density scans. My mother had a fall when she was around 90; she picked herself up off the ground, perhaps shaken but none the worse for wear. My father had several falls, which did cause a traumatic brain injury but not hip fracture. Chances are that one or both of them would have been "diagnosed" with osteoporosis on BMD scans. Yet they lived long lives, each dying from something unrelated to osteoporotic complications. The scanning machines were developed by Big Pharma and the osteoporosis drugs rake in tons of $$$. This is another reason why I distrust the "diagnoses" and bone-density "scores."

 

[Layla]

All I'll say is "I'm with you, FraidyCat!" I think we could have some interesting conversations over coffee.
My hope is that if you step away from the exercises, you'll notice improvement. I wish you speedy relief and hope today is a good one.
@FraidyCat

 

[Jamie]

You certainly have logical reasons for deciding to just live your life and not worry about bone density scans. I respect your choice to just skip this at least for the time being. When a patient has had hip replacements, a bone scan is done on the forearm and not the wrist. But depending on where your metal plate is located, it could interfere with the test if it was done on that arm.

Hopefully you have good strong bones that will hold your hip implants beautifully for the rest of your life.

 

[FraidyCat]

I'm sorry to report that I've sustained a foot fracture (3rd and 4th metatarsals) due to a freak accident in the house. I've had a grab bar at the top of my staircase for quite a few years and have always felt secure gripping it and then the stair rail before descending. A week ago, however, my ankle on the side of the LTKR turned inward on the top landing and I lost my grip on the grab bar, resulting in falling down several steps and landing in an awkward, precarious position. (I'm fortunate not to have fallen down the entire flight, which might have had a dire outcome.) An x-ray revealed "subacute fracture," and yesterday a foot doctor told me to avoid walking as much as possible, at least until a one-month follow-up. He said I should refrain from physical therapy for the knee, which had seemed to be helping, and gym exercise as well. This ends whatever progress I was making toward the knee recovery, now entering its ninth month. Moreover, he hesitated to give me a walking boot--one of those clunky, stiff devices--because he thought it might adversely affect knee biomechanics. Instead I have what looks to be a flimsy, sandal-like shoe with Velcro straps. His instructions were contradictory, terse, and discouraging. He seemed oblivious to the effect that the accident and his comments were having on me.

Within a few days after the mishap, I had a second stair rail installed on the opposite side, including a section that angles around the turn in the last few steps and a second grab bar also on the side opposite the existing one.

I am in a state of despair and anxiety. If anyone has experienced a foot fracture whilst in the middle of TKR recovery, I'd be very appreciative of any input.

 

[sistersinhim]

I stepped in a hole and rolled my foot inward, like you did. It resulted in a broken ankle and 2 bones in my foot. It happened in May and my TKR was a year old in June, so I was just shy of being a year out from my surgery. I was put into a cast for 7 weeks with no weight-bearing at all. My new knee did not like this! It wanted to be used! Not using it did not cause any setbacks in my recovery and kept the knee's swelling down. I had to go back to my walker inside and a wheelchair outside in public. I hated it. Once my cast was removed, and I was partial weight-bearing, my knee loved it and all its discomfort disappeared.

I think you'll be fine not doing any PT. Don't be surprised if your knee complains about not be used as much as it's used to, but since you are not non-weight-bearing, you might not have any knee problems at all.

 

[Layla]

Oh goodness, FraidyCat, I am so sorry. How frightening it must of felt to lose your grip and feel yourself tumbling.
Thankfully you didn't fall further and do more damage. I'm glad you reached out here. It's understandable that the foot fracture feels like a huge setback. Feeling despair or anxiety is normal, but please know this will not ruin your recovery. Your knee has already gone through months of healing and strengthening. You won't lose that foundation. It is important to protect your foot right now, and its only temporary. Once the fracture heals you can resume rehabbing your knee safely, and likely with minimal work only you'll be back on track. You can keep your knee mobile with quad sets, or straight leg raises or other seated exercises, if it will make you feel as though you're still proactive in your TKR recovery. View this as a "pause" that's all. I'm also sorry you were disappointed by the physician you dealt with. You deserved kindness, patience and encouragement at a time when you were hurting physically and emotionally. Please lean on us when you feel the need, we are here for support always and we do care. Wishing you a peaceful Sunday.
@FraidyCat