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TKR Fractured patella/quad repair 3 years post TKR

Has been a while aince I posted..I am on week 3 since my TKR, and am continuing to have a lot of pain on and around my kneecap. It is SO sore and sensitive that I can't even tolerate icing it any more. My incision looks ok...not totally heald, but even the blanket barely touchinf my knee hurts. Is thia normal??

The phyaical therapiat dis not seem concerned, and has been happy with my range of motion. I am at more than 0 degrees extension and pedigrees question. Not doing a whole lot of exercising at home. Seems to take me 2 days to recover from my therapy session. Walking and out of bed but have quite a lot of fatigue.

I have put more steri-strips on as some parts of the incisions are not healing evenly. Even the steri-strips hurt!
 
I think all the things you mention are quite normal for the stage you are at, I remember my scar being extremely sore and sensitive for about six weeks, it will become less so as time goes by. The fatigue is also normal as your body is working very hard to heal your knee. Your ROM is very good, you are right not overdo exercise at home. Get extra rest after therapy, elevate and ice if you can with some layers between the ice and your knee, if you can tolerate it. It's a difficult time, but it will get better.
Tabby xxx
 
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I agree with Tabby that everything you are feeling is normal. There are still times that I, even after 9 weeks, have a lot of discomfort touching my knee. But the times are fewer than they were before! Your times will be getting better. You won't see changes daily, but you will weekly! It's slow, but worth it. Be sure to follow the mantras here. You won't be sorry!
 
That sounds about right for three weeks, this is a long, slow process, soon you should notice improvement, be patient!
 
Poohstew said:
Hi all!!

Admitted yesterday, July 12, for RTKR.
Prepped and went into surgery schedule for 82 minutes at 7:30 am. Ended up being 75 minutes. Spinal anesthesia with IV sedation. They had some difficult placing my spinal, took a few tries as I have degenerative disk disease, but was not painful. Scooted over onto the surgical bed and I was out.

At some point during surgery, I woke up. I could hear the doctors talking. I asked the nurse if I should be awake. She said "Are you ok? Do you want to be awake?" I told her I didn't care, and that I was fine. I am in the medical field, so ok for me...it was interesting. They let me know they would put me out if I wished.

They had a drape up, of course, so I couldn't see anything, but I could hear the surgeons discussing implant size and such, though their specific words are kind of a blur. At one point I could hear the drill then later the hammer. It was so cool, and I am glad for the experience. I drifted back in and out, and awoke fully as they were taking me to recovery. I have to say, I felt great. I had no drowsiness, no nausea at any point, and zero pain. I was in recovery for about a half hour. During this time they got my TED hose on, my pressure cuffs on, placed an ice pack.and took vitals. Worst part was my itchy nose. They gave meds for that, which eventually made me very drowsy and the itching stopped. I have since had a few more doses of that as the itching has returned.

Once I was back to the room, my family was waiting, and said I looked great! I felt great! PT came within the hour for heel pumps, glut squeezes, and got me up with the walker and into the chair. Various checks by the nurse, and got up to use the bathroom. No issues there, though I am still having to push a bit to get the flow going, which is normal. Visited with family, and eventually had a dinner of jello, raspberry ice, chicken broth, and my diet coke I had been asking for.

They have a nasal cannula placed with a sensor to monitor co2 levels. This has been the biggest annoyance so far, constant beeping as the placement moves. Respiratory therapy has been in off and on checking that I am doing my breathing. Stupid nasal cannula has to be left in for 24 hours. Gah!! Oxygen was set at 2 liters, reduced to 1 liter in the evening, and discontinued late night.

Had a great night...slept off and on pretty well. Norco 5/325 was started at midnight every 4 hours for pain. Aspirin therapy was begun. Norco will be increased to 10/325 before therapy session today. I got up and got washed and dressed. I have individual PT in the room this morning at 9 am (basically heel pumps, glut squeezes, and getting into the chair.) I have OT coming at 11 am (how to manage at home) then group therapy from 1 to 3 pm.

I posted my incision pic on the photo page. It goes across my knee at an angle, like half of the letter X. Hadn't seen one like that before! I counted the staples. Worst pain right now is from the tourniquet that was placed during surgery above my knee.

Will update as I go through the next few days! Everything went VERY smoothly! Much better than expected!!

Kim
RTKR July 12
Click to expand...

I also woke up three times during my procedure despite specifying to both anaesthesiologists that I did not want to be remotely aware. The first was the hammering, and I could feel the impact (no Pain, obviously) and hear the surgical team chatter. The other two times was because my mouth was bone dry. I was really angry about. I'm glad it didn't unnerve you like it did me! :)
 
I don't think I'd want to wake up, in fact that's a fear for me. You mention needing a few days to get over a pt session. Please don't let the PT or anyone push or hurt your knee. If it hurts don't do it. I wasn't on BS for my TKR recovery but my first out patient PT wanted me doing squats at 2 weeks, I tried them, then told the PT there was no way I was doing that again. :bignono:
 
@Poohstew, I just read through your recovery journal and want to first and foremost wish you more comfortable days ahead. I can't tell you how much I felt torn between doing as advised by my OS & PT's and what I read here on BoneSmart. I had the hardest time with this but after seeing how long it took me to recover from a one hour session of PT, I decided to 'finally' give the BoneSmart mantra's 100% of my attention.

I completely ended PT about my 3rd week into recovery to let the soft tissue around my new knee joint heal.

Amazingly, the swelling began to decrease and long story short- I'm 3 months out today with no swelling, no pain & back to doing most things I did before WITHOUT the arthritis pain!

It's OK to manage your own recovery. It is after all.. YOUR knee! The surgeon and therapist' might look at you funny when/if you choose to step back and let your knee & body heal, but trust me, you will be so much better for doing so. All I said to them was- I am choosing a passive approach to my recovery. And I wouldn't let NO one push on or better put, 'manipulate' my knee for a better flexion. If you can't do it by your own ability it isn't an honest number. In fact- them pushing it in to increase your flexion is further damaging the surgical site, causing more swelling and pain. Setting you back!

It's OK not to allow this! So many here are testaments that your knee WILL recover by following the BoneSmart mantras. You have enough on your plate just managing the pain- so do not allow guilt for taking care of yourself by insisting on rest. This is after all major surgery you've been through.

We're all here for you. I spent most of my recovery time reading in this forum and posting so others could help me fight my battles against aggressive (abusive) PT, lol!

Wishing you the very best!

[Bonesmart.org] Fractured patella/quad repair 3 years post TKR
 
Physical therapy should not be painful, I think it can beneficial if done correctly but it can be harmful if it is aggressive.

I agree with @Suz follow the BS mantra!!!
 
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  • Agree
Reactions: Suz
Another therapy day today. Officially 4 weeks out from surgery. Range of motion is coming along nicely...at 114 degrees flexion and 0+ extension. Have dealt with an increase in pain this week...it morphs from incision pain to kneecap pain to hip and low back pain. Therapist said to remember that you are not expected to feel back to "normal" for up to a year or so after surgery, so there is a long time yet for healing to occur. They are very gentle in what they are having me do...simply checking range of motion, balancing on tkr leg as tolerated, suggested going back to quad strengthening...simple stretches, etc.

Strange thing...i have some odd sideways movements occurring along with some mechanical sounds that are concerning. Almost like the joint is slipping out of place on the lateral side of my knee. Not painful, but aort of siajointed. The therapist has not seen this before, and suggested I contact the surgeon, so that is next on the list. Also, she believes I am dealing with IT bans pain...man, does that hurt...from my hip down to my knee. She gavw me some ideas for atretches, but wasn't sure my knee was in a good state yet to do the most effective stretches for the IT band.

This is a long hard recovery. I am now realizing this fully. Showers are hard. My fiance has to help me in and out of the tub. I am SO worried that I will slip and fall. I don't have a lot of strength or stability of the muscles back yet, and I tire easily. Want to get back to work, and yet I feel like that is worlds away yet. I worry on this daily. Not sleeping well between pain and thoughts running through my head.

Didn't mean for this to turn into a person story! This is tough surgery to recover from!

Any thoughts on the odd.movement or how to help the IT band pain?
 
I'm sorry you are feeling rough at the moment, you are right in the middle of the worst part of the recovery. It can feel as if it will take forever at this stage, but healing is going on slowly but surely all the time. You are right to be extra careful in the bathroom, I slipped and overextended my knee at 4 weeks and pulled ligaments which took weeks and weeks to recover from. I can't advise about the feeling of the joint slipping out of place, this might improve as the muscles strengthen, but you would be wise to ask your OS. I don't have experience of IT band pain, but there are articles in the library and posts in the forum you could have a look at. The fatigue and not sleeping are all part of the recovery too, so take it easy and nap as much as you can. On the positive side, your ROM is very good for four weeks out. Be kind to yourself. We are all here to support you.
Tabby xxx
 
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This is the place for person stories! Some one here has usually felt the same way and can help you or at least give a shoulder. This is a long recovery and patience is a huge requirement. I think getting in/out of a tub qould be difficult, scary and hurt a bit so I'm glad you have help. My home has a walk in shower so I had to lift over a 4 in step, very fortunate for me.
As a first grade teacher my OS suggested I plan on 12 weeks before returning to work. I thought I could do it in 8, but ended up taking every one of the 12 weeks, plus I went back part time for 6 weeks. The phased return was helpful because that energy drain was still present at 12 weeks and I was exhausted after just getting ready for school let alone teaching! Depending on what you do, you may want to think about a phased return.

I can't speak about IT issues, but take a look at these stretches and suggestions.

https://bonesmart.org/forum/threads/itb-ilio-tibial-band-issues-and-treatments.18936/
 
Poohstew said:
Strange thing...i have some odd sideways movements occurring along with some mechanical sounds that are concerning. Almost like the joint is slipping out of place on the lateral side of my knee. Not painful, but sort of disjointed.
Click to expand...

If your ligaments were not balanced just right during surgery and if the spacer is on the loose side you can get some sideways movement and more mechanical sounds. My OS didn't get my ligaments balanced perfectly and my LCL is a little tighter than my MCL. Early in my recovery I would get a bit of a sideways shifting feel once in a while. Like when I put my foot down when stepping over something. For example, like when leaping or stepping over a puddle. I don't have that sensation anymore now that I am further along in my recovery.

My Uncle had bilateral knee replacement about 14 years ago. I saw him a couple months after his surgery when he was just starting to get around better with a cane. I asked him how his knees were doing at that time and he said that he was still getting used to the wobbly, shifting, side to side feeling of the knees. I saw him about a week ago and asked him more about it. He said he was getting around really well by 6 months and it took a year or two for his knees to feel more stable which sounds pretty normal to me. He had an otherwise uneventful recovery. He is in his mid 80's now and his knees are doing great. He stays active, walks a lot, goes fishing, etc.
 
Of course your knee feels a little wobbly right now---your ligaments and muscles just had major surgery!! It will take a while for your muscles to recover and learn to work again. Do lots of quad sets to help them get back to work!!
 
Hi. Me here again.

Something just isn't right with my knee. Something is giving me terrible pain in my surgical knee. It feels like a deep bone pain located on the lateral (outside) of my knee at the top of the tibia, in addition I am also having fairly severe pain and great tenderness over the kneecap. While my range of motion is great, I do have pain on the outside of my knee with walking that does not seem to be changing or improving. My knee also seems to kind of...well, as I am walking, it seems like there is mechanical sound as well as a disjointed feel...like it is not lining up correctly when it bends. I am still taking painkillers, and I am very diligent about icing and elevating. It does help while I have ice on, but the pain continues even at rest.

I am not exercising at home, other than some simple quad stretches while in bed, as my quad feels better for it. No housework, and I ride along for short rides in the car. Therapy 1x a week where they have me doing some balancing, 5 or so wall slides to check range of motion, and about 5 minutes on the nu-step machine. We pratice walking, do up and down 5 stairs...gentle stuff. Just can't shake the feeling that something is wrong. I showed the therapist what I feel as far as the knee pushing out to the right with a bend...best seen while sitting on the bed with legs hanging down. She said she had not seen that from a patient before. My six week follow-up with OS with xrays is next week, so I will know more then. Just can't shake the "something is wrong" feeling.

Thoughts? I cannot fathom going back to work anytime soon, but I want to feel good to be able to go back I am a Medical Assistant, and had hoped to be back at 6 weeks after surgery. I dread talking with y employer, though I know they will be understanding...feel like I will be letting them down.

Ugh. Just want to not have this persistent pain.

Kim
 
My OS told me not to return to work for 12 weeks. I thought I could go back at 8...I needed every day of the 12 weeks plus more. I went back to a phased return, my OS insisted on 6 weeks part time.

I can't speak to your pain, but I can tell you I had pain for 2-3 months after surgery and took pain medication at times even through month 4 (after a long or rough day). Your new knee is just 5 weeks old, the soft tissues are probably still tender from surgery. The knee may click for a while and many knees stop after a while, mine did. Of course, mention your concerns to the dr next week and an x-Ray will show if there are issues. But 5 weeks is still very early.
 
I agree with KarriB--you are still early in your recovery and can expect both weakness in the leg since the quads are probably still not firing properly. Clicking is also common in new knees---it generally stops when the muscles are stronger and support the knee.

However, it is great to bring the issue to your doctor.
 
I hope everything works out OK for you, you must be extremely worried. Make sure you get an x ray, to see if there is anything mechanical going on. My knee has just developed a strange creaking noise/sensation, it seems that these things do happen, but they are very disconcerting.
I wish you all the best. Keep us posted.
Tabby xxx
 
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