TKR First Goal After Serious TKR Complication

[Neecey]

TRKR on 1/26/23. All seemed to be going well when during my fifth PT session while bending at 70 degrees I hear a horrible crunch and pain that caused me to almost pass out. Went to surgeon and I have an avulsion fracture of the inferior pole of the patella. In layman’s terms, a piece of bone at the bottom of the patella broke away from the tendon. Incidence of this after a TKR is less than 1%. The result is I can’t lift my foot from the knee joint. Doctor now has me in an immobilizer for the foreseeable future, hoping that scar tissue will form around the injury to secure the patella again so I can lift my foot normally.

I’m so worried about my ROM after being immobilized for weeks or months. Also worried about it happening again once I resume PT. Wondering if anybody had to be immobilized only a couple weeks after surgery and eventually had a good outcome. Or if anybody has had a similar injury.

 

[Jockette]

Hi and Welcome!

I‘m very sorry to read that you broke a piece of your patella during a PT session. What were you doing when that happened?

Try not to worry about being in an immobilizer, we’ve had other members like this and their ROM came out fine when they healed. Try not to worry about ROM at all, seriously. Our medical teams sometimes over emphasize the ROM.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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.

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.

 

[sistersinhim]

I had both kneecaps removed, the left in '91 and the right in '93, which required the shortening of my patella tendons. Each knee was put into an immobilizer for 6-8 weeks so the tendon could heal. I never took PT after having these removed, just did my normal daily activities and my ROM came right back in. The only problem I had was the first doctor to do the patellectomy on my first after-surgery visit pushed my knee to try and bend it, and I passed out because of the pain. I did not go back to him! The doctor that did my next patellectomy was wonderful and never pushed me or had me go to PT. I wouldn't have gone anyway because I knew how to rehab my knees myself because I had already had 7 knee surgeries by then.

I said all that to say you don't need to worry about your ROM. It will come in naturally as you use your knee naturally. It is best to not try and force anything. If you do, you're just setting yourself up for more pain and swelling and that causes a setback in your recovery.

 

[Neecey]

Thank you SO much. My concern about my ROM is because this happened 13 days after TKR surgery. My new knee wasn’t even bending at 90 degrees yet and now it’s immobilized. Even my surgeon said rehab will be long and arduous and I may not gain full ROM.

My ROM was poor before surgery and then my knee locked up two weeks before surgery and it was even worse. As I told the surgeon, at this point I’d be happy with a 90’ ROM if I were pain free.

 

[Jockette]

Even my surgeon said rehab will be long and arduous and I may not gain full ROM.

This sounds like a painful rehab, which is not necessary, though many believe it is. Maybe you won’t get full ROM, but there is no need to try to painfully force it. Gentle stretches when the brace comes off will be fine and there is no “window of opportunity“ to regain ROM. Mine continued to improve well into my second year, so don’t let them cause you a lot of stress over your ROM.

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

My ROM was poor before surgery and then my knee locked up two weeks before surgery and it was even worse. As I told the surgeon, at this point I’d be happy with a 90’ ROM if I were pain free.

Since you had poor ROM before surgery, that is even more reason to do a gentle rehab and be very patient, as it will probably take longer for you than for someone who had better ROM before TKR. It is my understanding that a TKR is supposed to give you an improved ROM than before.

Try not to worry, and don’t let your medical team cause you stress about it. If you don’t find that your current PT is supportive of your particular healing needs, then look around for a different office who will. You may have to call around but it would be worth it. You don’t have to stay with the first one you go to.

 

[sistersinhim]

My new knee wasn’t even bending at 90 degrees yet and now it’s immobilized.

Most OSs don't expect 90 degrees until 6 weeks out from surgery. You were almost there at only a little over 2 weeks. That was fantastic and you will be fine. Your knee has already proven it will bend. Since your bend was lower than normal before your tkr, be patient and give it a chance to overcome that previously low bend. Try not to worry. I've been through that immobilizer twice and came out fine. You will, too! It will just take time and patience and gentle, unforced movements.

 

[WFD]

@Neecey , a year ago when my father was 91, he fell on concrete and shattered his kneecap into multiple pieces. He was put in an immobilizer and sent to therapy, and recovered very quickly. Nowadays he says that is his good knee.

Be optimistic, this can work.

 

[Neecey]

Thank you for sharing your father’s story. I’ve been in this immobilizer for one week now and I seem to become more scared and depressed every day. When I shower and take the immobilizer off my knee feels more unstable than before. I don’t try to bend it for fear of damaging anything further. I see the doctor tomorrow and am praying for something to give me hope. I just don’t understand how this will heal so that once I resume PT the same thing doesn’t happen again. I feel so hopeless, as it’s not just an avulsion fracture but also a TKR on a 70-year old woman.

 

[Neecey]

I’m still trying to figure out the logistics of this site and hope I’m posting in the right place……

I’m suffering from an avulsion fracture (no, I didn’t fall!) that happened in PT less than 2 weeks after TRKR. The leg is now immobilized and I see the surgeon weekly. I’m so scared and worried that I may not be able to recover from this without further surgery. Yesterday a “friend” told me the story of her father who she said had “the exact same thing” happen to him and “he never walked again”. That story only served to upset me more, and sent me right back to reading everything I can find on the Internet in search of hope.

I am asking for any success stories after a TKR complication that someone in this group might be able to share. My injury apparently only happens less than 1% of the time but ANY complication related to TKR that you overcame would be most appreciated.

 

[Jamie]

@Neecey ….. I’m so sorry to hear your story about the fracture. I’m hoping that you will not be returning to that PT once you are over this hump. The risk of this type of thing happening is the primary reason we caution members about aggressive therapy (anything that causes more than mild discomfort), especially early in the healing process.

Believe me, that is no friend who shared such a horrific story with you. Please put what she said out of your mind! IF her father had an avulsion fracture and IF he never walked again, it was not because of the fracture. Bones and tissues heal with care and a little time. You will heal and progress on with your recovery. Your surgeon has done the correct thing by immobilizing your leg so the healing can take place and he’s watching the progress by seeing you each week. Trust him. He knows what he’s doing. It sounds as though the fracture was fairly minor since he just braced your leg rather than having to do repair surgery.

Hang in there. Some of us do have these little extra challenges, but in the end thing will work out. Good for you for getting this diagnosed and treated so quickly.

As for your eventual ROM, this slight delay in your ability to move your leg will not mean less ROM. Even if you had poor ROM before surgery, it is possible to do well in recovery. By “long and arduous,” your surgeon is just trying to advise you that it may take some time to achieve good movement. Lots of soft tissues have to gradually stretch and realign to allow your leg to bend and flex properly. It will be important to take things slow and never allow anyone to push you in therapy. In fact, my suggestion would be to never allow any therapist to put hands on your leg and bend it. It’s perfectly acceptable for you to make the bending and stretching movements yourself (active motion) rather than depend on a therapist to push the bend (passive motion). You know your limits and it’s important for you to be in control.

Please go back and read all the posts in your recovery thread. There should be some reassurance for you there. And don’t hesitate to express your concerns to your surgeon. He needs to know you’re worried and he won’t think any less of you for admitting your fears.

 

[sistersinhim]

Hello @Neecey,
You'll notice that I have merged your two threads together as it's best if members in recovery only have one thread. We find it much easier for everyone.
This is because:

• That way, you have all your information in one place. This makes it easier for others to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions for finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.

 

[EalingGran]

Yesterday a “friend” told me the story of her father who she said had “the exact same thing” happen to him and “he never walked again”. That story only served to upset me more

We all have so called friends like this, who delight in either telling us complete horror stories or alternatively how everyone they know who has had the same surgery is doing way better than us.
Some of them are what I believe is called frenemies- people who are supposed friends but for various reasons ( maybe they are jealous of us for some reason) delight in putting us down or upsetting us. Others are sweet but daft people who just open their mouths to change feet!.
Try and work out which type this person is and act accordingly. I would stop seeing the mean ones permanently and the dopey ones temporarily. You don't need unhelpful comments on this tough journey. Good Luck!

 

[Layla]

It is your one month anniversary and while you may not be where you'd like to be at this point, you are one day closer to the freedom that recovery from this surgery will bring you. It was poor judgement of your friend to make such thoughtless comments at a time when you're in need of encouragement and support. Please know that we're here if you need us...always. Happy One Month Anniversary, Neecy.
@Neecy

 

[Neecey]

Thank you. Sadly, I don’t have much to celebrate. Oddly enough, I don’t know anybody who had a bad TKR. Of course they suffered through the PT but in the end we’re glad they did it. I feel so alone through all this as I haven’t found anybody in a similar situation.

 

[EalingGran]

People who have had a good outcome may be forgetting/ minimising the early weeks.
It's a bit like the fog/ sleep deprivation after having a baby. After a few months you forget the terror/ exhaustion and may
overestimate how well you coped.
I know you had a nasty complication but it can still be OK longer term.
I have a friend who had two early dislocations post her hip replacement recently. She was in a hip brace and immobile for a while but is now back on track driving/ going out/ walking up to a mile/ pain free. Only listen to your surgical team and staff here and ignore the doomsters. Good luck!

 

[beachy]

Oh Neecy, please hang in there. You've had a big setback through no fault of your own.

I have a good friend who is a bit of a know it all. About nothing LOL. She visited me about 1 week post op first tkr and told that a friend of hers had BILATERAL tkr and was at the university basketball game 2 weeks later. I called BS of course. But she said it in a way that I should be able to do things like that since I ONLY HAD ONE KNEE done.
Your knee is going to heal and be better than ever. Have faith.

 

[Axx72]

Sorry to hear about your patellar issue. Believe in yourself… don’t let anyone tell you you can’t do it.

We are architects of our own successes!

 

[Neecey]

After almost 6 weeks in a knee immobilizer (which started 2 weeks after TKR due to an aversion fracture of the patella) my surgeon gave me the OK to resume PT next week. My extensor mechanism is functional again and I’m able to do a straight leg lift again -yeah!!
But I’m SO scared because I fear that as I try to regain my ROM the same thing might happen again -the patella breaking off at the same place near the tendon. I asked the surgeon how to avoid that and he said just do what my body allows me to do -no machines and no PT pushing to bend my knee. He couldn’t guarantee it won’t happen again but the alternative is wearing this brace for the rest of my life.

Wondering if anybody has had the experience of being immobilized shortly after TKR and then trying to regain ROM. I’m thinking of only doing PT twice/week since the PT isn’t supposed to do much with the knee. Plus, of course, home exercises. Suggestions?

(I can’t figure out how to attach this to my thread in the recovery section. Or does it attach automatically?)

 

[Jaycey]

@Neecey I moved your latest post to your recovery thread. Just bookmark this thread and continue to post here.

I fully understand your concern about a repeat of the trauma you have been through. But your doctor gave you good advice - listen to that knee and NO forcing anything. In fact, you really don't need PT to regain ROM. Gentle stretches and daily activities will help to regain ROM. Easy does it on he home exercises as well.

As we have found here - the slow and steady approach works every time.

 

[benne68]

Glad you are doing better, @Neecey, and have permission to resume activity. You might think about doing your own rehab for a bit, rather than jumping right into PT. That way you can control what is happening.

We have members who have recovered successfully without PT at all, just by walking and doing ADLs (activities of daily living). As a reminder, here is the BoneSmart view on the right kind of exercise for recovery:

Post-operative exercise – the BoneSmart view

Post-operative exercise – the BoneSmart view Post-op exercises target the gaining (or regaining) of - Mobility and range of motion (ROM)*, during and after healing - Strength and fitness, after healing is complete The exercises required for these are quite different, and it is essential...

bonesmart.org