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TKR Four months post-op and little improvement

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Jazzhands

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Thanks everyone. I did see my doctor. Since restarting PT 2 weeks ago, my life has been hell - pain, stiffness, and swelling. The doctor sent me for blood work to see if there is an infection. Those results were fine. He may have me get tested for metal sensitivities. I was in a car accident back in 1983 and my body didn't like the metal, and it was all removed within 1 1/2 years. But I never had pain like this. But the doctor said that the metal wasn't in my knee joint back then. So perhaps there is some sort of sensitivity. In the meantime, he wanted me to continue PT twice a week. I went yesterday and the PT and I agreed that I should stop PT as it was only making me worse. I'm waiting for a call from the doctor to see about getting tested for metal sensitivity. In the meantime, I am so limited. Any and all activity starts a never-ending cycle of pain, swelling and stiffness.
 

sistersinhim

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I think it's a good idea to get the metal test. For anyone who would like to get a full metal allergy test, you can get the test done in the USA by ordering the test kit from ttps://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP (or any lab) can do the blood draw and send it in for testing. You will have to have a doctor's order for the lab to run it.
 

Jockette

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I’m glad to see that you are taking a break from PT. Some of us just can’t handle all the things they ask us to do. I sure couldn’t.

The best way to reduce your pain is to try not to do the things that increase the pain.

I had pain and stiffness my whole first year, though everything looked fine from a medical standpoint. Things improved in the second year, and even continued to improve even more, now in my third year. I hope you will see the same.
 
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Jazzhands

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Just an update....I had blood work that showed no indication of an infection. YAY! The next step is to see if I have a metal sensitivity. I am not getting an MUA because there are times when I can bend my knee to 115. Other days, it's at 90. But the doctor does not suggest an MUA, especially because it can bend at times. He wanted me to continue with PT twice a week. I went one more time, and I discussed this with the therapist. We both agreed I should stop PT since it only aggravates my knee and causes me a lot of pain.

Has anyone had a metal sensitivity issue? How did you determine this, and what did you do about it? If you have a metal sensitivity and don't do anything about it, will it ever feel better?
 

capecoral

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I have a metal sensitivity I went to an allergist He did a patch test on my back He put several metals on patches Then I had to go back 3 times and he looked at my back to see which spots were red and blistered I am allergic to nickel and a slight allergy to gold I am have my knee replacement on July 9 and doctor is putting a nickel free implant in
 
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Capecoral, you and your doctor were smart to test you before the replacement surgery! I wish I had thought of that. Good luck on July 9.
 

Dizzy

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I had my RTKR in July 2018 and most days I still feel like there's a "boa constrictor" around my knee. It doesn't really affect my walking or anything so I just live with it.
 
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Jazzhands

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Just an update...I am now five months post op, and I feel like I am beginning to turn a corner. I can finally walk a little bit more without having a ton of swelling and pain. This is a big step forward from a month ago. I did take a Metal LTT (metal sensitivity test), and it showed I have mild sensitivity to three different metals, one of which is nickel. Would a mild sensitivity make any difference? I do not want to have surgery to change out that metal unless I am sure it has to be done. Since I am finally making a little progress, I feel like I should wait at least a year to see if I continue making progress.
 

lovetocookandsew

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Hi, @Jazzhands I do have an allergy to nickel. We aren't positive that the nickel was the cause, or at least part of the cause, of my problems after my TKR, which needed to be revised, but I am not having the same issues now after getting a new nickel-free implant.
My recommendation is to wait a while and see how it goes. As long as your OS is aware of your allergy, and will take that into consideration in the future if you do turn out to have problems, I'd wait until you're at, say a year, and see how your knee is doing. There are people who have a reaction to nickel but have no problems with the implant, and others who do have problems. Let's hope you're in the "no problem" camp!
 
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Interesting @lovetocookandsew . I will be seeing my surgeon tomorrow morning to see what his opinion is on the matter. I have a feeling that since it is listed as a "mild sensitivity" rather than "moderate" or "high," he may advise me to wait.
 

sistersinhim

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I think waiting is the right thing to do, also. You don't seem to be having any real problems so I think you're OK.
 
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Jazzhands

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@sistersinhim, I've had nothing but problems actually. Up until last week, I could walk a very short distance, and my knee would immediately swell and stiffen. The pain I've had for five months is incredible. Then suddenly last week, I began having some good days. I can walk a little more now. I still have swelling, but the recovery is a lot shorter. So my hopes are up for the first time in five months that perhaps I will eventually be able to lead a somewhat normal life. Until last week, I feared being in a wheelchair at 61. This knee replacement has been an incredibly tough road, and I'm nowhere near the end of it. I'm still far worse than I was before I had the surgery. Sorry to be a bummer, but it's the truth.
 

sistersinhim

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Since I have no way of 'feeling' how bad your pain is, I can't state that it's normal. But, pain and swelling off and on is normal for the first year or so for the average tkr. I hope you can find some relief for yours.
 

kneeper

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It's good to hear you can walk a bit more without trouble. Though there are "typical" recoveries, as I'm sure you're tired of hearing, really it is an individual thing. I think your plan of taking it slow with activities is a good one. Frustrating perhaps, but hopefully in the long run it will pay off.

I can tell you with my first knee, at 5 months if I was on my feet for a half hour the knee would stiffen up. It would recover after I sat for a while but it did make me wonder if something was wrong. It also would get a bit warm. But as the months went on, it became more and more normal.

Oh and FWIW, years before the surgery I found I could no longer tolerate the metal in earrings.
But both knees wound up great.

Hoping you just have a "tortoise" knee--where slow and steady wins the race. :console2:

Let us know how it goes with the doc.
 
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Jazzhands

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Hi everyone, thanks for the replies. It really does help to know that others have had the same issues I've had. I did see the surgeon yesterday, and he does not suggest any surgery due to the metal sensitivity. I'm mildly sensitive to three metals, including nickel, but he feels it is not enough to warrant the risk of further surgery. I agree, especially because for the first time in five months, I am seeing a LOT of improvement! He is not happy with my lack of flexion. He said it is only 95 - 110. It may be an issue with scar tissue, but he does not want to do a manipulation and set me back with more swelling, especially since the swelling is finally getting better. So I am to walk and do some heel slides at home. He also suggests swimming and riding a stationary bike. I don't have access to either (I'm not going into a gym during a pandemic). I'll see him again in six weeks. I am THRILLED to say that I can now walk a full mile!!!

I did notice that after standing for too long the other day, it swelled right up. I had to ice off and on the rest of the day and no walking. So I believe all of you when you say there are setbacks, and I really need to listen to my knee.
 

Celle

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He is not happy with my lack of flexion. He said it is only 95 - 110. It may be an issue with scar tissue, but he does not want to do a manipulation and set me back with more swelling, especially since the swelling is finally getting better. So I am to walk and do some heel slides at home.
Your surgeon sounds sensible.

I know it probably feels like forever, but it is only just over 5 months since your surgery. We know that ROM, both flexion and extension, can continue to improve for a year or even longer, so there is still plenty of time for your flexion to increase.

Here's a reminder about Heel slides and how to do them properly
 

eaglemom

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Like the others have said, I think you need to wait on any decisions concerning the knee. Take a month and totally focus on recovery. I know it seems like a step back, but I think you can truly benefit from it.

You said you sit and read. Is your leg elevated when you're reading? If it's on the ground that in and of itself will cause stiffness and swelling. Ice and elevation are your new BFF's. Make your easy meals, have things delivered. Whatever it takes to help the healing process. We don't think we're over doing, until we have. None of us wants to hear it, but time is what it takes. Lots and lots and lots of time.
 

NewToMe

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I had my TKR Sept 2019. My biggest improvements in stamina (cooking the entire meal), walking a decent length and time; and standing for minutes all happened around 6 months and later! That included the elusive full night sleep which for me was really debilitating.

I returned to work 3 months post op for a desk job and things really improved during SIP because I took short walks multiple times a day.

Now I find stretching more helpful and I don't care about ROM because I CAN go up and down stairs without pain...it's just slow and hard on my lazy muscles!
 

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