TKR Fractured patella/quad repair 3 years post TKR

[Tabbycat]

Hi @Poohstew
Good to hear you are making some progress, though it is no fun to still be in a lot of pain. I asked my physio on Friday about the fact that I still have some pain and feel I need painkillers now and again, and he said it's a very individual thing, if you are in pain you need them, of course if you are still worried in a couple of weeks a call to your OS would be a good idea.
I'm amazed you got in and out of the bath, I couldn't even attempt it though like you I love a long hot soak especially in the winter when my joints are stiff and sore.
Ditto with the other knee too, it's been complaining loudly at bearing all my (substantial) weight for the last year.
Glad your scar is healing well, that sensitivity will gradually decrease until you don't notice it anymore. My OS recommended KeloCote for my hypertrophic scar, but I haven't bothered, the physio says it will flatten and fade in time.
I hope you have a comfortable day today and enjoy the
Tabby xxx

 

[greatlakes]

Glad to hear all is going well, although more slowly than you would like. Interesting discussion on when to do the next one. I'll be sure to post about how my nonop knee reacts to the new knee.

 

[Poohstew]

I am in so much pain. Still, at 8 weeks! It just isn't getting better. Took my daughters to Walmart tonight...shopping for a birthday present for their step-brother. 20 minutes in the store, and the right knee is hurting so bad I felt that I was going to pass out! Not to mention, the left is screaming at me and is so much worse. Honestly...I do not know how I am going to function going back to work...or how I am going to get through winter with the other knee!!

Ugh...what to do, what to do!!

Kim

 

[uva55]

Ughhhhh Kim, I'm sorry you are still is so much pain, are you still taking pain meds?? Do you have much swelling??

I really understand your frustration, but remember this is a long journey and we need to be patient!!

I hope you feel better soon!!

 

[greatlakes]

Kim, I'm so sorry. We really do feel each other's pain. Wish there was something I could say to help. Might you want to consider going back to using a walker to spare the left knee until you can get it replaced?

 

[Tabbycat]

Hi @Poohstew
I feel for you too. There's no magic answer, I wish there was, we are in this for the long haul and really 8 weeks is not that long. This healing process takes a long time, and can't be rushed. The thing is, we want to get back to doing normal things, and our knees say "no". Give your knees as much TLC as you can. Clara is right, we have to try to be patient.
Tabby xxx

 

[Celle]

Only 8 weeks post-op and a visit to Walmart - sounds like a recipe for increased pain!
I know it's hard when you have children, but you are probably trying to do too much, too soon.
Your knee is still just a baby, so treat it to lots of rest, ice and elevation for a few days, until it stops crying.

With looking after your children, I suspect that you are possibly doing too much for a good part of your day. I'm going to ask @Josephine to advise you. She will probably ask you a lot of questions. Do try to answer them as fully as possible, so that she can advise you appropriately.

Do stick to your guns about a Phased return to work - and try not to go back at all until at least 12 weeks.

It's not unusual to still have pain and need pain medication at 8 weeks. Some people need pain meds for as long as 4 months, although they are generally not still taking the heavy-duty narcotics by then.
I see that you have been prescribed Tramadol. Have you tried the Tramadol-Tylenol combination?

The first table is more useful if you are taking your medications four-hourly, the second if you're taking them six-hourly.

If you are just taking 50 mg of Tramadol each time, you can still supplement that with Tylenol (also known as Acetaminophen, Paracetamol and Panadol), as long as you don't exceed the recommended safe daily total of 4,000 mg of Tylenol in each 24 hours.

 

[Josephine]

20 minutes in the store, and the right knee is hurting so bad I felt that I was going to pass out! Not to mention, the left is screaming at me and is so much worse.

That is a classic case of you not listening to your knees! You really have go to slow down and allow your knee to heal. If you don't, you will risk having this develop into an acute pain syndrome.

So I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. What is your ROM - that's flexion (bend) and extension (straightness)

6. are you elevating your leg, how often and for how long?

5. are you icing your knee at all? If so, how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home: (how many sessions each day)
enter exercise then enter number of reps and sets
etc., etc.

At PT (how many times a week)
enter exercise then enter number of reps and sets
etc., etc.

 

[Poohstew]

Thanks all. Here we go...

1. Well....pain level goes from 1-2 just sitting around at home...up to 6-7 after things like my Walmart trip and too much driving.

2. Originally, I was taking 2 hydrocodone 10 mg every 4 hours. At 6 week check up OS said "we really want you off of those by now"...so they prescribed 50 mg tramadol 1 at night. 30 pills. No refills. And did not refill the hydro. My GP however knows how bad my other knee is, so he continued to refill for me. So...I've been taking 2 hydrocodone 7.5 mg at night before bed if it was a rough day (most nights). Trying not to take often during the day. If I can get by with Tylenol, I will take 1000 mg about 3x per day. If I need the hydro during the day (just once other than bedtime), then I adjust Tylenol dose to not go over 4000 mg per day total.

3. Moderate, always. Used to be huge.

4. ROM 120 (wall slides) and 0. Therapy is thrilled with progess, and any extra flexion is just gravy at this point. Knee is very stiff though.

5. Icing, yes...at least 3x a day if home...over an hour each time.

6. Have gotten lazy with elevating. Only when pain is severe now. Rarely.

7. Activity Level: I am not doing much housework at all...picking up a few stray items here and there. Occasionally making kids breakfast or lunch. Getting kids ready for school. Driving kids to school. A Walmart trip here and there.

8. Exercises at home:
Quad sets and Butt clenches whever it feels good. I'd say 3 sessions each, 10 reps. Thats it.

PT: 1x per week now.
I sometimes do 5 minutes on the Nustep machine to warm up.

5 lunges on the steps

Balance on surgical leg for 30 seconds without too much support

Wall Slides to check flexion...probably 3-5.

Lately some gentle massage on my scar as itnis a bit "knotty", and some gentle massage on my patella as the tendons are very tight.

That's it!

Kim

 

[Celle]

I think you might have understated your activity level. You're driving. I saw a trip out, to buy school stationery a few pages ago, and then your trip to Walmart. It's all too easy to do too much, without realising it.

 

[Josephine]

1. Well....pain level goes from 1-2 just sitting around at home...up to 6-7 after things like my Walmart trip and too much driving.

I don't wonder at it!

2. Originally, I was taking 2 hydrocodone 10 mg every 4 hours. At 6 week check up OS said "we really want you off of those by now"...so they prescribed 50 mg Tramadol 1 at night. 30 pills. No refills. And did not refill the hydro.

My GP however knows how bad my other knee is, so he continued to refill for me. So...I've been taking 2 hydrocodone 7.5 mg at night before bed if it was a rough day (most nights). Trying not to take often during the day.

If I can get by with Tylenol, I will take 1000 mg about 3x per day. If I need the hydro during the day (just once other than bedtime), then I adjust Tylenol dose to not go over 4000 mg per day total.

All good. Glad you have a nice GP!

3. Moderate, always. Used to be huge.

Okay, thanks

4. ROM 120 (wall slides) and 0. Therapy is thrilled with progress, and any extra flexion is just gravy at this point. Knee is very stiff though.

But stiff? That's not good.

5. Icing, yes...at least 3x a day if home...over an hour each time.
6. Have gotten lazy with elevating. Only when pain is severe now. Rarely.

I usually recommend icing for at least 40-60mins and more than 4 times a day and the same with elevating. If you have swelling, then you need to elevate.

7. Activity Level: I am not doing much housework at all...picking up a few stray items here and there. Occasionally making kids breakfast or lunch. Getting kids ready for school. Driving kids to school. A Walmart trip here and there.

Driving and Walmart should be OUT at only 3 weeks. That's part of your problem - you're doing too much! Activity progression for TKRs

My comments in bold
Exercises at home:
Quad sets and Butt clenches whenever it feels good. I'd say 3 sessions each, 10 reps - too much, much too much. Stop it all.

PT: 1x per week now.
I sometimes do 5 minutes on the Nustep machine to warm up - Nustep is not a good idea at three weeks out. I suggest you give that a miss
5 lunges on the steps - lunges are also not good, check in the article above
Balance on surgical leg for 30 seconds without too much support - not a good idea so early out. Really is asking for trouble
Wall Slides to check flexion...probably 3-5 - once is plenty!
Lately some gentle massage on my scar as it is a bit "knotty" and some gentle massage on my patella as the tendons are very tight - I am not at all surprised that your tendons are tight!

I am not much in favour of all this exercise so early. It is so counterproductive I cannot find the words to express it! I suggest you read this and take it one board BoneSmart philosophy for sensible post op therapy.

Because it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and does more harm than good. Normal activity is the key to success.

There are plenty of us on here who have done NO exercises at all and have all got really good outcomes with little or no pain and such.

 

[zzevi]

@Poohstew I'll only chime in about icing and elevating. I never did good elevation in the beginning, sat in a recliner with my leg up on pillows but to find out in the end I really wasn't getting it high enough to do much good with the swelling. I have since moved to laying on the couch with my legs elevated nice and high. I've seen good results with decreased swelling, less swelling, less pain, better movement. Your ROM and flex is much better than mine, at 10wks I still don't enjoy shopping like I did prior to surgery.........saving the hubby some money.......although there is online shopping....lol.
Right now I make all my outings short, go get what I need and head home, do what I feel I can get done in a day and leave the rest go for now, sometimes I feel very lazy yet, but it's not really laziness but needed rest for healing.

 

[Poohstew]

@Josephine I am at 8 weeks out...

Thank you for the advice though. Just surely feel stuck. Supposed to go back to work this week.

Kim

 

[Celle]

KIm, it's too soon to go back to work, especially since you are still having pain and stiffness. Can you ask your surgeon or PCP to certify that you need at least another month? Going back to work while you still have these problems will only prolong them.
Phased return to work

 

[greatlakes]

Just checking in to see how you're doing and say good morning. Hope the pain has eased off a bit.

 

[Josephine]

I am at 8 weeks out...

oops - a typo!

Just surely feel stuck. Supposed to go back to work this week.

So you're planning to return to work at 9 weeks? Given that your recovery is being a bit slow, I think you really do need 12 weeks out and then, as Chris said, a phased return.

 

[Poohstew]

I'm back.
Doing well...as far as my surgical leg goes. I have been back to work for 4 weeks now, and despite a bit of soft tissue pain, and still lacking some strength, I feel I am right where I should be for almost 11 weeks.

But....

A lot to decide coming up regarding my "other" knee..

To new friends who don't know, on July 12th, I underwent a total knee replacement on my right knee, due to debilitating osteoarthritis...at only age 46. I'm still in the healing phase, though getting better every week.

And now....a mere 11 weeks later, I am again finding myself in even worse pain (how is that possible??) with the LEFT knee.
So, I have a lot of decisions to make.

I am blessed in that my dear, dear employer is SO kind and understanding, that I no longer have to worry about being without my job, which I ADORE...
AND my coworkers who are filling me with LOVE in how they have taken up my slack, been my "legs", and have watched out for me. But...our buay season starts about the aexond week in January...and lasts until April.

The question is...do I do this again so SOON?
Am I crazy? Honestly, I dont even think the matter is even in my hands any longer. In the last week alone, I have lost the ability to climb stairs (again), and the ability to get out of the bathtub (again). I almost didn't make the walk back out of a large store after grocery shopping.

So hard to muster the courage, and rally to do this AGAIN.
ALREADY.
This was NOT in the original plan, but my
"life-word" seems to be "spontaneity".
For better or for worse...I never know which, lol.
I have my 12 week follow-up on Tuesday with my OS.
Blah.

Kim

 

[ACDCJen]

Hi Kim,
I think you are asking an important question, one that I am dealing with as well! If your non-surgical knee is so bad that your new knee can't function the way it is able to, having the other one done seems like a good idea. For me, I am just over 2 weeks out from my first TKR and my other knee is already holding me back. So, at 39 years old, I'm hoping to convince my OS to do the other knee by Thanksgiving. I too am lucky that my work is keeping my job for me and I'm receiving disability while I'm off. I say go for it so you can go back to your life better than ever!!

Jen

 

[KarriB]

A few people decide to get their second TKR not long after their first. It helps because they've already met their deductible and some just need to do it close together for work purposes. @FlaGranny just had her second done close after the first and @sheliac will be having her other TKR in a few weeks after her first was done in August. I am sorry you're in pain. The other knee had to do double duty while you were recovering from TKR and sometimes it can be just too much. Let us know what you decide. Glad to hear you're TKR is doing welll though.

 

[sheliac]

Hi Kim,
I think you are right -- the decision may being made for you.

I am having my second knee done next week (week 7). I was originally scheduled for week 4, but OS had to reschedule. I went into knee 1 planning for the staged bilateral . I choose that because I want to have both knees fully rehabilitated in 1 year instead of taking a year for one now, then another year later. I'm 59, so I don't have decades of years to give to my knees. I want to get them both fixed so I can enjoy moving on. This also works best for my work situation and as Karri said, for insurance purposes.

It's a hard decision, with pros and cons on both sides. I don't think I was ready at week 4, but I do feel ready now. This time next Octobet I hope to have 2 good knees, be hiking, biking, traveling and working-- pain free in the knees. Best of luck with whatever you decide.


Shelia
RTKR - 8/23/16
LTKR - 10/11/16