TKR Fractured patella/quad repair 3 years post TKR

[Majella]

Hi Kim
Welcome to bonesmart. Sorry you are in so much pain and swelling, it comes with the TKR that most of us here have experienced at some point. If you can't stand anything touching your knee like ice packs, perhaps you can try to apply a cool wet towel however icing is so important at this stage of recovery.
I agree with @Tabbycat, perhaps an xray will help sort out the clicking and sliding feeling.
Don't worry to much about your ROM, it will come when the swelling starts to subside. I too was always in a hurry to get over all the post-op complications, but realized that my knee had it's own agenda!
Good luck with your f/u appt. all the best to you

 

[jmdearras]

At some point during surgery, I woke up.

I did on my first TKR, because of sleep apnea. They decided to wake me first to see if that would solve it. I was fine with it, and had a similar experience to yours. Sounded like a machine shop on the other side of that drape.

DO NOT let PT hurt you in any way. I opted out of PT after 2 weeks for my first knee and have none scheduled for my current knee. 3.5 weeks out, I am driving, walking stairs and generally back on line, with just endurance issues. Knee is past 120 flexion, and under 10 extension. Took me 8 months to reach 0 on the other knee, so I'm not worried.

Minimal exercises not to pain and just use the knee is my best advice.

Jim

 

[Suz]

DO NOT let PT hurt you in any way. I opted out of PT after 2 weeks for my first knee and have none scheduled for my current knee. 3.5 weeks out, I am driving, walking stairs and generally back on line, with just endurance issues. Knee is past 120 flexion, and under 10 extension. Took me 8 months to reach 0 on the other knee, so I'm not worried.

Minimal exercises not to pain and just use the knee is my best advice.

This is EXCELLENT advice from Jim. It takes time Kim but if you'll follow the BoneSmart mantra's closely you will begin to see improvement soon! I had quirky pains also in my first weeks but at 3.5 months out I hardly ever feel any discomfort! Hang in there and know better days are in your near future!

 

[Poohstew]

Thanks all. I am realizing that @Majella is right about the knee having it's own agenda.

I had PT yesterday and discussed my level of pain and stiffness with her. I am lucky, in that my therapists have agreed to the Bonesmart way of healing all along, and have never pushed me. After talking with my therapist, she paid close attention, and felt gently around while I moved my knee. She said there is quite a lot of crepitus behind and around my knee cap that she can feel. Something to discuss with my OS. She said she was not concerned at all by my range of motion, and is in fact quite happy with it. The swelling and stiffness and pain may just continue for awhile. She also feels that I may have some adhesions forming, as well as significant IT band tightness. All in all, outside of having Xrays to confirm there are no structural issues, she really feels like it is more of a soft tissue concern for now. She spent the entirety of the appointment working gentle on my scar, kneecap, and the IT band. She was very careful to not cause anything beyond tolerable discomfort in stretching.

So...it's me, with ice and pain meds, for now. Tennis ball to work on IT band tightness, and working on the scar as much as I tolerate. I am looking forward to my 6 week followup with my OS Tuesday. After that, I will meet with them at work to see what my return should look like...eventually.

Thak you all so much. I still have concerns, but all I can do is what I am doing!

 

[Poohstew]

....AND....I am soon to be able to discontinue my Aspirin and Iron therapy, which means I can add back the anti-inflammatory that I take for RA and for my other knee. (The other knee was actually worse than my TKR knee, but less symptomatic), I am hoping this makes me feel better overall!

Kim

 

[newlybionic]

You are still fairly early in your recovery. It isn't abnormal to feel or experience your knee moving the way you describe. I've been told by my OS that swelling can last up to 18 months and should slowly dissipate as time goes by. You don't need to have your scar or knee cap 'worked on'. Just be normal movement your kneecap will move on its own. Xrays will make sure that structurally everything is good. I hope the anti inflammatories help your old knee to feel better.

 

[Poohstew]

I should clarify...
"Working on my scar"...I should have said...she was using gentle massage on either side and up and down the scar. It feels much better for having done that, and I am continuing it at home. All very gentle, and with a lotion/oil to help. My scar is unusual in that is criss=crosses my kneecap...hence the working on my kneecap side to side. The "working on" my IT band...it is a gentle way to stretch out the IT band by rolling a tennis ball up and down the outside of the knee/leg at the point of insertion and up the leg. This is a hurt so good kind of a thing for me, but it should help in the long run, and IT band syndrome an be quite painful. I also have some IT band stretches to do at home. This has been an ongoing problem, even before surgery.
Just didn't want you to think they were doing any hardcore digging around there!
Kim

 

[KarriB]

Your soft tissue will continue to be sore and compromised for a while after the surgery. It'll take a another month or so to work through it. I believe that it is typical for adhesions to form behind your scar in order to heal and close the incision, so be careful working the scar. My PTs waited a good two months before putting anything on the scar or massaging it especially as I had two surgeries using the same incision within a month. Once they did there was no pain at all, just pure wonderfulness!

I'm glad that your PT put your fears to rest and you'll see your OS next week.

 

[KarriB]

The tennis ball has helped many people with IT band issues. I hope it helps you as well.

 

[Tabbycat]

Hi @Poohstew, we've got a few things in common. I've got RA too and had chronic inflammation in the joint lining of the knee I had replaced, although like you my other knee has always been more problematic in terms of flare ups and crepitus. It is really complaining at the moment .It was quite a shock when my right knee suddenly developed severe pain last October which led to the TKR in April. I think sometimes with RA this recovery can be a bit more challenging and is why my OS told me it can take a year to 18 months for the knee to become fully functional. He also said I was starting to build up scar tissue under the scar because it was healing so fast and encouraged me to massage it every day from about 7 weeks on in the same way that your therapist has done. Some on the forum don't advocate massage, but I like it, and it has helped the scar to be more mobile and less tight. I use PurOrganica scar cream, but there are several on Amazon.
I wonder how that pain is now, and that sliding feeling. I really hope your OS can reassure you when you see him on Tuesday. Don't forget to keep us posted.
Tabby xxx

 

[Poohstew]

Hmm...new development here.

I came home after a too-long day today...hit two stores for school supplies with my daughter...

My scar...which has been well healed for awhile now...was itchy. I also noticed a small blackish spot towards the bottom. Tonight I was inspecting it a bit more, and some pus and blood squirted out. Mind you, it sa a very small spot, but it was certainly cause for alarm to me.

My appointment with the surgeon is Tuesday, but my fiance is insiting I call tomorrow. I suppose I should.

Ugh.
Infection at this late date? What is protocol for something like this?

Kim

 

[smarttoys]

So how did your Tuesday appointment go?

 

[KarriB]

What did the OS say?

 

[Suz]

Thinking of you Kim, @Poohstew, and hope to hear soon how you are doing~

 

[Poohstew]

So...
Had my six week follow-up with the surgeon Tuesday! Things are progressing well. I had Xrays of my prosthetic, and everything looks well aligned. I was assured that the pain and swelling I am having are normal, and was reminded that they say to allow a full year for final recovery. I was prescribed a step-down med to help with pain (50 mg tramadol), and was told to continue with icing and elevating when I can. She looked at the area in my incision that has opened back up and has been draining, and she thinks it is an internal stitch working its way out. If it continues to be a problem, I'll call. I will still be going to physical therapy for quite awhile yet to continue to gain flexibility and strength.
And....
I can drive! And I can go back to work soon, though I will have some restrictions for awhile yet...she said sit down work for the next six weeks.
Will see the doctor again in 6 more weeks!
Still having a lot of pain, but trying to rest and do small things each day. I do feek better after my appointment.

Now work is wanting me to return to 8 hour days, and I am going to stand strong against it. I told them I had to do a phased return, and I am sticking with it!

The tramadol sucks, but I am combining it with tylenol and that helps.

Thanks all!
Kim

 

[Tabbycat]

Hi @Poohstew, I'm so pleased to read that you had a good report and that you got reassurance that everything is progressing as it should. My OS keeps saying full recovery takes a year as well. I think you are being sensible about your work situation, you stick to your guns, your knee will thank you for it.
Tabby xxx

 

[Majella]

Kim.
Glad you had a good report from your OS, but think twice about going back to work so soon.
I agree with @Tabbycat, stick to your guns and don't start back full time...after all your knee is your first priority

 

[sistersinhim]

You can drive...free at last! What a wonderful feeling that is!

 

[Poohstew]

So...a few updates...

Driving is ok. I get sore after long distances. My car makes my knee sit at an awkward angle. I keep working at it though...

I stuck to my guns with work...I am a Medical Assistant, and am therefore on my feet a lot. I told them I needed to return to partial shifts (4-5 hours), and that I could not start with 2 days in a row. Told them (3 times), that I cannot go against my doctors advice. So...they scheduled me for one 4 hour shift. Sheesh. For the whole week. Whatever. I am also supposed to be doing sit down work for 6 weeks.

Pain....ugh. still quite a lot. I am trying to shift from hydrocodone to tylenol during the day. Still using the hydro at bedtime yet. They wanted to discontinue it, and gave me 50 mg tramadol to take at night. Needless to say...it doesn't help. Icing a lot. Still having a lot of kneecap pain and swelling. If it is this bad after another few weeks, I am going to call again. It still feels like it is more pain than I should have there.

Stitches...I had an internal stitch that had been working it's way out for a few weeks, and it finally just came out. Just a tiny thing, but nice to have it gone. The other spot I had been dealing with seems to be healing well. Overall the scar is healing well, but is SO sensitive, and is developing a keloid appearance.

I took a tub bath! I HATE showers, and am a daily bath kind of gal. I cannot tell you how wonderful it was to soak in the tub. Getting out was...a challenge! But I did it!

And the not so good...my other knee is screaming at me. My original intention was to have it done next summer. We'll see if I can make it through another Wisconsin winter with it or not!

Thanks all!
Kim

 

[uva55]

Kim, it looks like you still have some challenges but also some victories.

Going back to work is is not easy, specially if you are on your feet and not are not able to ice an elevate, I went back at 7 weeks, I have a sit down job so I was able to ice and semi elevate and the first two weeks were terrible. I find that the Tramadol with the Tylenol combo helps me a little, if I have pain.
I hope you feel better soon...remember patience, you are still very early in your recovery