TKR First of two knees done

[alex_mom]

Update -

I had a session with the ortho-bionomy LMT on Monday She was very nice and I will go back for another session in hopes it will help. I am not sure that really made much improvement for my situation, so the second session will likely be the final for me and this new knee and I can say I gave it a good try.

I saw the new Physical Therapist today. My surgeon's PA and I both agreed more PT might help with my ongoing problems. This is a different PT clinic than where I had my post-op rehab and is part of my OS's group. The PT manually cross-massaged the patella tendon where it attaches to the shinbone and the pes anserine area as well, all the while explaining what he was doing and teaching me how to do it to this area. He said some heat might be helpful, as well, and would not hurt. Good to know.

He also applied K-tape over the same affected areas, explained what and how he was doing it, so that I could do apply the tape at home. He told me to avoid the k-tapes sold at big box chain stores, and instead to buy the kind he had from that big online place that delivers quickly and we all love. ;-) I took a quick pic on my phone and it has been ordered.

The PT Eval showed that overall my legs are quite strong but the quads and ABductors are weak, so PT exercise sheets were given with instructions.

What was new to me after decades of PT for various things, is that he told me to rest the muscles after each and every repetition/leg lift. He said my muscles need to learn how to relax after they've been used, instead of staying tightened up without end. And this would explain why my deep tissue massage therapist works so hard on my thigh muscles; TFL, IT band, etc.

On the plus side, ROM for the new knee is 135 today with no band pulling it, and the knee waiting to be replaced is 140, so yay! knees!

 

[benne68]

All this sounds very positive and hopeful, @alex_mom. You may find that these issues improve once the other knee is done and you are able to get your entire body back into balance.

When do you think you will have the second TKR? I know you've said it will probably be 2027.

 

[Layla]

buy the kind he had from that big online place that delivers quickly and we all love. ;-)

Does it begin with an A and end with a N, and it's so convenient that sometimes it arrives and you forgot what it was that you ordered I have a love / hate relationship with that place.

Sounds like you had a good PT taking the time to teach you the massage technique and explain the K-tape application as well as share some strengthening exercises to do at home. Productive session.
Thanks for the update, alex_mom.

 

[alex_mom]

When do you think you will have the second TKR? I know you've said it will probably be 2027.

I honestly don't know. I would like to have it done in early November, before winter's cold weather arrives, but using up my Medicare allotment for PT for 2026 and needing the current new knee to be reliable before TKR on the other knee are the two major factors.

 

[alex_mom]

buy the kind he had from that big online place that delivers quickly and we all love. ;-)

Does it begin with an A and end with a N,

Yes. I was not sure if we are allowed to name the business. ;-)

 

[Layla]

Hi alex_mom,
Stopping by on the six month anniversary of your Left TKR. I hope you're having a good month as we're closing out on August...and then Summer shortly thereafter. I don't mind because its been a hot one in my area.
Wishing you many pain free moments as you continue healing and working on your recovery. Stay in touch!
Happy Six Month Anniversary.
@alex_mom

 

[alex_mom]

Hi Layla and all. The recovery continues. The past six months are not what I expected. Especially after two THR recoveries that went smoothly with the same surgeon.

My three PT visits, this time, were with the PT rehab clinic affiliated with and in the same building with my surgeon's group, and were very productive. (this is not the same one I went to for post-op) Th new-to-me therapist has twelve years experience and has done me a lot of good. I have a suite of strengthening exercises, some new, some old, and I could quickly see a big difference after two weeks of doing them, including:

1) Getting down/up to/from a seated position without holding on to something (like a grab bar) is a big improvement. That has not happened in several years. Really.

2) The new knee no longer buckles randomly when walking; it "wobbles", and that is improvement.

I plan to cancel the October followup appointment with the surgeon's PA (where she would assess results of the PT I'm currently doing) and make an appointment with the surgeon instead. I've never been overly impressed with his PA. My operated leg will either be strong and reliable enough to discuss replacing the other knee, and if not, I will ask him to identify and explain the painful area on the front/medial area below the kneecap and why it persists.

I still am living on 100mg celecoxib 2x/day and 3,000mg acetaminophen/day and still have pain in the same area, especially when going down stairs or that area is pressed manually. No change there. However, all those same meds are keeping the painful still-bad knee functional, so that is the good news.

 

[benne68]

It sounds like this new PT is real find, @alex_mom, and I'm glad to read that you are already seeing improvement.

I plan to cancel the October followup appointment with the surgeon's PA (where she would assess results of the PT I'm currently doing) and make an appointment with the surgeon instead

I agree with this plan. When something isn't right, you want the person with the most expertise -- not the assistant.

I'm sorry you still need all the meds to manage your pain, but if they are helping you function, stick with them.

 

[Layla]

The past six months are not what I expected. Especially after two THR recoveries that went smoothly with the same surgeon.

I'm sorry this recovery is more of a struggle for you than your previous recoveries. We often read from members that have experienced both, that knee's can be more of a slog than hips. Thankfully you're enjoying some progress now!
I understand wanting to meet with the OS over his PA. It seems the days of automatically seeing the doctor are gone unless you have a new, complicated or unresolved issue. I hope even brighter days are ahead for you. Thanks for the update!

 

[alex_mom]

The latest in the saga journey of Left TKR recovery:

Nine days ago, I began an easy pace walk on flat street to see how my new knee is doing with all the renewed PT. Several minutes into the walk it suddenly started screaming at me, out of the blue, with no discernible trigger, and debilitating pain below the patella. I had my trekking poles and they kept me upright while limping back to the house. Ice was applied and that helped. The worst of it passed within an hour or two. The next day, I had a similar event when getting up out of a chair, though not as debilitating.

A couple days later after all this, I finally had to get off the Celecoxib I'd been taking for the past six months since the TKR. My intestines had finally protested, as happens to me after staying on NSAIDs for great lengths of time, so now I'm only on acetaminophen (Tylenol).

Miraculously, my ortho surgeon had office visit openings this past Friday, so I was able to get in and have it examined prior to the long Labor Day holiday weekend.

Diagnosis is --- Hoffa's Fat Pad impingement. This is probably what has been the ongoing moderate pain I've had since TKR six months ago. WHY it has presented with all the pinching episodes at this point in time is beyond me. OS said he has had some patients not present until 5 or 6 years post-op. Good grief.

OS said that my body must have a LOT of inflammation, since the Medrol Dose Pack his PA gave me two months ago did nothing for this chronic TKR knee pain in the same area. Friday, I accepted a fairly strong steroid shot in the glutes, instead of locally, and so far I can't tell it has helped, but .... still early days and staying hopeful.

This morning I had another excruciating Hofffa's "event" with this knee when going to sit down. Makes me wonder if ever getting the Right knee done will be worth it, as the new knee area is still more painful and unreliable. Clearly that won't happen in the near future with all this going on.

"Dr. Google" says PT will help, and all the exercises are the ones I've been doing, so there we have it.

 

[Jockette]

Diagnosis is --- Hoffa's Fat Pad impingement.

I’m sorry you’re dealing with this! Post #2 in the following thread talks about it:

https://bonesmart.org/forum/threads/patello-femoral-pain-syndrome-pfps-fat-pad-impingement.8855/

 

[alex_mom]

Thank you for that link, Jockette. This might help explain why going down stairs has been more painful? IDK

Taping supplies were ordered from amazon, arrived, and this morning I've taped it all up. Icing 3 to 4 times a day hasn't really helped, but I will continue. I may need to get back on the celecoxib. :-p

All flat-sole shoes are abandoned for now and running shoes will be worn, since the internet says low/no-drop shoes can enable hyper-extension and thus aggravate the fat pad.

What is particularly aggravating is the surgeon only offered (and I accepted) the cortisone shot. No taping instructions, nothing. Well, he's a 'carpenter' focused on surgery and nothing more, and I have to remember that. Thank heavens for the internet and knee recovery forums!!! Taking this one day at a time.....

 

[Layla]

What is particularly aggravating is the surgeon only offered (and I accepted) the cortisone shot. No taping instructions, nothing.

I read that taping isn't always effective. It might help with short term pain, when combined with exercise, but any benefit isn't necessarily going to last. So your surgeon may just be prioritizing PT? Difficult to understand though even if it brings you a small measure of relief, it helps! Consider calling to ask a member of your surgeon's care team whether taping was considered, and, if so, why they don't recommend it, or recommend it in your case. There must be a reason.

I've read, as you likely have, that treatment usually focuses on avoiding hyper-extension / rapid extension, improving patellar tracking, quad control and hip / glute mechanics.

Thanks for sharing the details of your recovery here. Someone may benefit from this information in the future.
Wishing you comfort and relief alex-mom.

 

[EalingGran]

All flat-sole shoes are abandoned for now and running shoes will be worn, since the internet says low/no-drop shoes can enable hyper-extension and thus aggravate the fat pad

I certainly can't wear totally flat shoes and trainers with some cushioning or soft insoles help with my residual patellofemoral arthritis pain.
I would be a bit wary about spending too much on orthotics- but having said that, getting the right shoes, withvthevright level of support, can make a big difference with problem knees.

 

[Layla]

Happy Seven Month Anniversary!
Hi there, Hopefully the taping and any other measures you're taking are bringing you some relief.
First full day of Autumn today...I hope this season is a good one for you, alex_mom.
Take care and stay in touch!
@alex_mom

 

[alex_mom]

Thank you, Layla. Yes, it is seven months on this date and things are getting worse; IOW *not* a normal recovery. The cortisone shot to the rear end did nothing except keep me awake that first night, all night, and gave absolutely no relief from pain and inflammation. Taping is hit and miss, and mostly it just peels off from friction with my shorts and pants as I move about. :-( The pinches still happen for no reason at all, some more brutal than others.

I'm now using a cane when away from home to walk any distance longer than 30 ft (10 meters) distance walk for stability and in case there is another pinch with debilitating pain and there is nothing to hold onto to help me walk. Not joking, not exaggerating.

It is all so odd that these awful pinch episodes began six months post-op, although the chronic fat pad pain behind the patellafemoral tendon has always been there since surgery. Add in the OA pain and injections ceasing to help pre-op, I am going on one year of nonstop pain that is truly affecting the quality of my life.

In the meantime, the unoperated knee is getting worse. I am "sick and tired of being sick and tired" with all this.

I don't blame the surgeon for any of this, but I put blame on him in that he does not seem too interested in all this ongoing pain (my husband agrees) and it is very disappointing. This week, I am taking steps on getting a second and possibly a third opinion elsewhere. Finding the right surgeon who might have the right experience, care, and concern is more difficult than just finding any old TKR surgeon on the internet who could be "more of the same."

We have talked with a PA (a friend of my husband) who works in orthopedics in a different healthcare system who gave us some names, and I also have an appointment tomorrow with my PCP, who is in yet another healthcare system, for a referral. Medical records must be sent over, and it could be a month or two before I am seen. And so it goes.

Fingers crossed.

 

[Layla]

I'm now using a cane when away from home to walk any distance longer than 30 ft (10 meters) distance walk for stability and in case there is another pinch with debilitating pain and there is nothing to hold onto to help me walk. Not joking, not exaggerating

I am so sorry, this sounds all consuming and understandably so. Pain is exhausting and not being able to engage as we once did can be demoralizing. It's unfortunate that you need to look elsewhere, but thankfully you are willing and I'm sure appreciative of the information hubby's PA friend and your PCP provide. Hopefully with a second and possibly even third opinion you'll find a surgeon with some insight that leads to a resolution.
Please know that we're here for you if you need us.

 

[Jockette]

I can relate to the difficulties of additional opinions not taking us seriously and actually looking past the standard X-ray, which in my case, looks fine. I recently came across some possibilities of what might be wrong, as well as why I have my symptoms. I have an appointment next month with a complex revisionist, and I’m armed with more knowledge than before, and what tests to request. I’m a little more hopeful for this appointment. We’ll see.

 

[EalingGran]

I am so sorry. I hope you can get some answers that help.
Hoffa Pad Impingement Syndrome - StatPearls - NCBI Bookshelf https://share.google/xAMtEmB3k8XDk4x2I
I found this interesting article on Hoffa's fat pad impingement which might be useful to read before your consultation.
It seems there is a test that can distinguish the pain of Hoffa's from other knee pain.

 

[Legseleven]

Oh @alex_mom I empathise completely.My recovery from last year went completely downhill with the left knee and I was referred at 7 m to a really lovely consultant who checked and double checked everything, including taking my case to additional knee experts.
Some people suggested that 7 m was too soon, but I knew my body wasn’t right and it eventually turned out the lateral compartment was in a terrible state, and here I am 3 m post revision.
I hope you find a supportive and informative orthopaedic specialist who can explain and help.
I hope you get answers and a suitable plan, delivered with empathy and understanding. Thinking of you.