Revision TKR Four Months Out and Still Can't Walk

[Mensamama]

This is not only my first post here, but my first post on any forum.

I had right TKR on November 3rd. For two weeks, all was well, I was walking with barely using the walker. Then in week three, a pain started. It was a sharp stabbing pain on the inside edge of my knee. That pain has never totally gone away, I still have an ache and occasional stabbing pains.

The worst issue, however, is my knee being so stiff. I have had two MUAs and the surgeon was able to do good extension and good bend at each. After the first, I didn't notice much difference, but at first at PT I was getting some fairly good extension and flex. After a few days, though, the knee stiffened right up.

After the second MUA, two weeks later, I did notice the knee was much more flexible and PT went great for a few days. The MUA was Tuesday, PT got an extension read of only 9 degrees off (best ever for me) on Friday, and on the following Wednesday, it was back to 14 and by Friday about 20. This was with daily PT and using a CPM machine for a total of 6 hours per day!

I am unable to walk without a walker, I can't drive, I am on the edge of losing my job and can't believe my husband hasn't packed up and left by now. We didn't bargain for this -- everyone we talked to had 6 - 8 weeks, then were back to work, maybe using a cane.

I was on oxycodone for a few weeks, switched to hydrocodone and stopped all pain meds Feb. 6. Went through about a week of feeling like I had the flu, which I am assuming was withdrawal. I went off gabapentin on Feb. 17 per doctor's orders, but he didn't tell me I could have withdrawal symptoms from that, as well, which I did.

After all that and a course of antibiotics for diverticulitis, which I completed last Wed, March 1, I think I am finally starting to feel better, both physically and mentally. However, the knee remains stiff and aches most of the time.

I got a second opinion on Feb 17, the doctor saying stop PT, stop CPM and do just gentle stretches at home. To date, that has not helped, except for maybe reducing the pain overall.

Has anyone else had this type of problem? If so, was there ever a diagnosis and/or fix for it? My doctor is stumped, hence the second opinion, and we are getting another second opinion with a doctor out of town next Wednesday. I fought with my doc and finally, just today, got a CT scan and an MRI, hoping maybe they will showing something that can be corrected concerning the soft tissues. I had only had x-rays until today, and the implant appears to be fine.

Since I can't drive the 35 miles to work, I am on the verge of losing my job. I've already lost my independence and confidence, my birthday, my winter holidays and likely my upcoming camping and boating season. I am more mentally stable since off the meds, but suspect I may have the beginnings of depression. I am aware of it and doing things to combat it. I am tired of figuratively being patted on the head and told to just hang in there, or work through the pain. There has to be an issue and a fix. I don't know what I will do if this can't be fixed and I am left half crippled for the rest of my life.

If anyone has any information, experience or ideas relative to my problem, please post.

 

[JusticeRider]

Hi @Mensamama I’m so sorry for what you’ve been going through. It sounds like it’s been a rough go ): I can relate to the things you’re feeling. I had a huge setback at 4 weeks that took me months to come back from. I also haven’t been able to work and felt I was putting a big burden on my husband. I got really depressed, the lowest I’ve ever been. I get it. (Though I’m happy to say I’m doing MUCH better now at 7 months!)

It’s awful you had to go through two MUA’s and still didn’t get any lasting improvement in your ROM. I’m not saying you have Arthrofibrosis, but I know that @WFD has struggled with this and has had challenges similar to yours. He is an inspiring individual and can maybe offer some words of advice and/or encouragement.

You’ve come to the right place. So many people here have gone, or are going through, similar experiences and can sympathize and provide support, both practical and emotional. We’re here for you to lean on

 

[Layla]

Hello and Welcome to BoneSmart. Thanks for joining us.
I am sorry you’ve had such a rough start in multiple ways. At this point your knee is not only healing from the TKR, but also the two MUA’s and possibly overly aggressive PT. I agree with your doctor that it will be in your best interest to stop the PT, CPM and engage in gentle stretches, easy walks and the activities of daily living only. Also, consider adding icing to your routine if you’re not already as it will help with pain and swelling.

I realize it’s been approx three weeks since you began an easier, more gentle routine, but it may take longer for you to notice a difference. While you are four months post op, it is likely some of what you’ve engaged in has been counterproductive to the healing process. This recovery can take a full year for most and even longer for some noticing improvement into their second and third years post op.

With any luck the results of the CT scan and MRI don’t reveal anything serious and you won‘t need a third opinion / consultation with a new OS. If it’s soft tissue, it needs to heal and stopping the CPM, and PT will hopefully allow that to happen naturally given more time. It is good to hear your are beginning to feel better physically and mentally.

I understand how this is stressful with all you described you’re missing out on and your concerns about your job. Wondering if you feel a few visits with a mental health professional may help as a bridge to get you back to where you want to be, someone to help you sort this all out so it doesn’t feel as heavy. My heart goes out to you in trying to heal, but also feeling as though you may be sinking into depression. Please stop back here often, we’ll be here to offer support and encouragement whenever you’re feeling the need. I wish you comfort and peace of mind.

I will leave our Recovery Guidelines below as some of the info will still apply.
Best Wishes for brighter days ahead!

 

[Layla]

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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​

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 a 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 history before providing advice.

 

[Jockette]

Hi and Welcome!

I am so sorry to read about your struggles. Unfortunately, your story is a familiar one. Your medical team used an aggressive rehab approach for you, which left little time for your knee to actually heal. Did I read correctly that you had 2 MUAs, 2 weeks apart? If so, that’s a lot of trauma your leg.

This was with daily PT and using a CPM machine for a total of 6 hours per day!

This also causes a lot of trauma to a leg that is struggling to heal.

I got a second opinion on Feb 17, the doctor saying stop PT, stop CPM and do just gentle stretches at home. To date, that has not helped, except for maybe reducing the pain overall.

I agree with this second opinion, but it’s going to take a lot more than a few weeks for your knee to be able to relax from all the previous aggressive rehab.

but suspect I may have the beginnings of depression. I am aware of it and doing things to combat it.

Yes, temporary depression is very common after this surgery.

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

 

[CricketHip]

Hi @Mensamama , I am so sorry about the difficulties you are struggling with. I can't imagine just how frustrated you must be. I agree with everything Layla and Justice Rider posted to you, so won't repeat what was said so well.

Please consider resting, elevating/ icing your knee/leg and let it heal. I love that your second opinion offered you that same advice.. it's good advice!
Wishing you the best, I wish I could give you a hug!

 

[Jockette]

I’m not saying you have Arthrofibrosis,

I think it’s a bit early to mention arthrofibrosis, especially after all your leg has been through. I would do as this second doctor suggests, cut out your list of exercises and just do gentle bends and short walks and give your body time to recover from all it has endured.

I fought with my doc and finally, just today, got a CT scan and an MRI, hoping maybe they will showing something that can be corrected concerning the soft tissues.

Hopefully these tests will show that all is generally well and that your pain is from the aggressive rehab. The correction needed to fix this is a change of course in how you recover and rehab going forward, by taking a much gentler approach.
Saying no to therapy - am I allowed to?

 

[Jockette]

Please tell us the dates of the MUAs so we can add them to your signature.

 

[WFD]

Hi @Mensamama ,

As others have mentioned, I have had a tough time of it as well.

I see from your profile that you are 66. Is retiring an option, to let you focus on your recovery? I retired the year before I had my TKR and everything went sideways, and that gave me peace of mind, knowing that I could focus on getting better. I don’t know what you do for a living, but is working part time from home an option? I consulted part time after I retired and that was very helpful for my attitude, knowing that I could still contribute.

The next thing I recommend is to, as much as possible, take charge of your recovery. My experience these last few years has left me pretty disillusioned with the US medical system and I realized that if I am to succeed at this I will have to move the ball forward myself. Taking charge, as you are now doing, will help your attitude as well.

Seeking out a second opinion from the new doctor was exactly the right thing to do and it sounds like he gave you good advice. As others have pointed out, it could take a while to get better. Good luck.

 

[JusticeRider]

I think it’s a bit early to mention arthrofibrosis, especially after all your leg has been through

I hope I didn’t give the wrong idea there. I did NOT mean to imply that it could be Arthrofibrosis, only that our friend WFD has had long struggles with multiple procedures trying to increase ROM and having to keep up the fighting spirit. As I hoped, he had some very good advice to share
Again, did not mean to imply it was the same issue, only that there were similar struggles. Thanks for pointing that out @Jockette! And thanks WFD for commenting!

 

[LaJudes]

Just a caution , be sure they check for infection . That can cause pain and stiffness . l am glad you stopped the PT .

 

[Layla]

Justice Rider, please don’t question the support you offered. You clearly stated you weren’t implying arthrofibrosis is the issue. I am certain anyone that reads your post understands that. We come here in good will, relating to others through personal experience, sharing thoughts, offering consolation and making suggestions to help one another. I feel it’s clear your intentions were heartfelt and innocent in every way.
@JusticeRider

 

[sistersinhim]

I got a second opinion on Feb 17, the doctor saying stop PT, stop CPM and do just gentle stretches at home. To date, that has not helped, except for maybe reducing the pain overall

Oh, your poor knee. It has never had a chance to heal. You didn't have a sports injury, you had a major, traumatic surgery where two bones were sawed off, drilled and foreign material was hammered into your two bones. Would you aggressively exercise a broken leg? Of course not, you'd only end up harming that healing bone. Well, you have two cut-off bones that have to heal, and numerous layers of soft tissues that were cut or pulled out of the way. All these have to heal, too, and your medical team has not given them a chance to do that. The more up-to-date OSs and PTs know that you treat a joint replacement very gently. Your latest OS is one of those. My doctor was one of those, too, and I never even took PT, and my OS was always happy with my after-surgery appointments.

I agree with the others to stop all these exercises and just do gentle walks while you do your normal daily activities. Read many threads while you're here and you'll see that for the vast majority, the gentle rehab worked much better for them and it will for you, too. This means more than just a few weeks of gentle movements, but at least 4-6 months of them to let your knee heal.

 

[Geoffa]

Well said sistersinhim.
After two very successful TKR i resonate with your words of wisdom.
I always note a singular focus on the knee structure.
Any TKR recovery has to also accommodate the supporting muscle structure around the knee. This has most likely deteriorated leading into surgery thru the simple fact of knee not working correctly. The trauma of surgery only makes it work.
Patience time and light exercises over a couple of years will most likely be required to get all these muscles working.
After a very good recovery and 2 1/2 years i feel i have finally got the structure of my leg pretty good!
And it is well worth it.

 

[EalingGran]

got a second opinion on Feb 17, the doctor saying stop PT, stop CPM and do just gentle stretches at home. To date, that has not helped, except for maybe reducing the pain overall.

Agree with everything above.
You really have been through it and the MUAs are further surgery. Driving 35 miles to work is a tough one a few months after knee surgery- even without the extra MUA surgery. I am 19 weeks post PKR and my knee would protest at that.
Rest and ice will help if you stick with it. You just need very gentle movement not PT right now. Don't be afraid of rest. I had a week of enforced rest recently in hospital for an unrelated illness and my knee loved it. No pain or swelling whatsoever and I didn't lose any ROM.

 

[Mensamama]

Thanks for all the support. I just got a call from my surgeon with results of the MRI and CT scan I had yesterday, both of which point to a ruptured quadricep tendon, keeping in mind there is magnetic disturbance due to the metal in the replacement. This means a brace to walk pegleg or a replacement of the tendon with a cadaver tendon, which should give "functional" use, but not as good as a successful knee replacement. I am to have an ultrasound ASAP, which may give more detail. Either way, it sounds like I will never walk normally again. I am simply gutted.

The only consolation is that I am likely NOT crazy, there is pain, and I couldn't just "work through it." I am angry that I have been complaining of the pain and asking for testing for months, and no one really listened until I got desperate and just sort of demanded the scans. Just because it's rare doesn't mean the doctor shouldn't have been considering that option. Did I further damage the tendon or have I now impeded any recovery due to the long time this has been going on? It started 2 weeks after the surgery, around November 17th!

Per a prior post, my MUAs were on January 17 and January 31.

 

[EalingGran]

So sorry to hear this. You have every right to be angry and gutted. You were right to demand the tests and just sorry that vindication gave such a problematic result.

 

[Layla]

I am so sorry to read this news. It is understandable you're feeling devastated and it is obvious your pain is real. Your struggle is heartbreaking. I understand it's early, you need to learn more and internalize it all before making a decision. Until then, I pray you can hold out hope that the end result will be better than you're anticipating currently. Hopefully when you meet with a third surgeon next Wednesday, with all of the information you've received to date, he is able to offer you some reassurance.

Please know we're here for support if you need us. We do care. Wishing you comfort and peace. @Mensamama

 

[sistersinhim]

point to a ruptured quadricep tendon, keeping in mind there is magnetic disturbance due to the metal in the replacement.

When I had my first kneecap removed, he cut and shortened my patella tendon. I was braced for 8 weeks while it healed. I think you should seek another opinion and see if that quad tendon can be repaired and have a revision with a metal-free implant. I don't believe things are as hopeless as you fear.

Please don't give up and seek out a revision specialist. They deal with problem knees that other doctors can't or won't deal with.

 

[Mensamama]

The first second opinion was with a revision specialist nearby, the second second opinion will be from another revision specialist, but near Columbus. My doc advises that if any surgery is done to repair/replace the tendon, it would likely be done in Columbus or Cleveland, not in my immediate area.

Thanks for all the support. I am trying to remain positive.