TKR From 30 - 90 rom and wanting more

[skigirl]

Your poor knee---it had everything done to it!!! Remember RICE---rest, ice, compression and elevation. You can use your ted hose to get compression on your leg---I cut off the foot part and then they were easier to get on.

 

[Pjmc]

skigirl Super mod
They never gave me the hose ever throughout this whole ordeal . I thought that was odd. My leg was wrapped first day , they cut wrap of then gave me the Imoblizer brace for the two weeks . I just read where it is usually worn for six weeks with the tibial tubercle . I am thinking nothing about my surgery and recovery is normal . I have to repeat I am so disgruntled that 90 is the best my OS sys I should strive for . I fel like why go through all this for 90 rom ? Thanks, Pam

 

[skigirl]

I wore support hose for a few months to help with the swelling. I bought them on Discount Surgical stockings.com--but, your leg sounds like it is too swollen right now.

You can call your gP and ask if they know of anyone who does lymphatic massage. I was skeptical at first myself, but after this last surgery, I also had a lot of swelling. I went to her and she massaged my leg--taught me how to do some of the massage myself and gave me a "Wrap". It looks like foam with ridges and I was very skeptical.

I only put it on the first night because she had been so nice and I did not want to just take it back without trying it. I was absolutely amazed the next day---it made a huge difference. I wore the wrap at night for almost a month.

I would not worry about your rom right now---what does he really know after All? Unless he means that your kneecap does not track properly after 90 of flexion? At any rate, your focus right now is to get the swelling down. So, elevate on three pillows--toes above the nose. Use ice whenever you are lying down and try to get someone who specializes in lymphatic massage. I just looked in the yellow pages--and there she was!

It is important to eat something with every pain med. It can be crackers and peanut butter, but you need to put something into your stomach. If you don't want to eat right now, I bought Naked Juice high protein smoothees and drank at least one per day = your body needs protein so that it can heal. This is not a good time to avoid eating.

 

[Pjmc]

Thank you skigirl For the excellent advice . Yes , that is exactly what the OS reports says my knee does not track well after 90. I had about 30 rom before surgery according to report . I will see GP Monday if all goes well .

 

[skigirl]

So, you will have to wait and see. I would not feel pessamistic as this early stage---if your quads are strong, they will help the knee cap stay on track, for instance. So, at this stage, I would not worry---there are too many possiblities and we cannot know which will happen and which will not.

 

[Pjmc]

Thanks @ Skigirl . The right quad weak now because of cut tendons a is my guess. I asked PT today if he was seeng improvement very slow going . I try my hardest though and refuse to give up . Rom is 87 This week .

 

[skigirl]

87 is really good for this time and for all that you have gone through. Just take things slowly and easily and see how things work out.

 

[Pjmc]

Saw family doctor she put me on Keflex 500 mg . She did not like the looks of the insicion site . She also told me to stop the Ibuprofen since I still had swelling and fluid . Try Tylenol instead , OS today said do not take Tylenol it is in pain meds . Oops . I really had only taken one so all should be fine . I rarely take pain meds . My. GP also said to use warm water and epsoms salts on wound site . Seems to help .
My husband scheduled surgery for Friday . I needed him to take me to PT . I was ready to scream . Will get through this too .

 

[Pjmc]

I had called My Orthopedic Doctor Monday also phone tag no answers . Really have not been happy with him or his office . Would love to change Doctors. The inscion site opening over. Month after surgery should have alarmed Doctor . I feel if GP had not seen me I was heading for serious infection . I think she caught it soon enough.

 

[Josephine]

OS today said do not take Tylenol it is in pain meds

Well, he's not entirely correct! All you need to do is check the box so you know how much acetaminophen is in each tablet. Add up how much you take each day, subtract it from 4,000 and that's how much Tylenol you can spread out over the day. Just don't exceed 4,000mg per 24hrs. BTW, acetaminophen is the generic name for Tylenol.

 

[judgar]

why stop the ibuprofen . I thought this helps the swelling. My dr. said its helps inflamation

 

[Pjmc]

Thanks judgar That's why I continued taking it. My GP said she ended up having swollen ankles when taking it and why she said it may be causing my extra swelling.

Josephine, I think the OS nurse was miffed that my GP gave me meds and advice. Well she may have saved me from a horrific infection. My leg was getting hot, there was pus and I ended up getting sick again. I truly have not been well since the surgery. I am ready to find a new doctor, not sure one will take me on at this stage.

I cancelled my husband's surgery with my doctor and found him another one. Hopefully this new doctor will take me on. I had second and third thoughts going into this. My surgery did not go as was told it would. I had the quad snip, the tibial tubercle moved in addition to knee surgery. I wanted to post surgeon's report so much I do not understand.

PT was tough today wanted to cry. I am so upset that OS says 90 is success for me. I feel like why did I go through all this?

 

[judgar]

oh pimc I think the same way some days why did I do this. I can not take any pain pills just mortin and Tylenol. every day I wake up and say maybe it will be better today. I hate to see night I cannot sleep at all. I just pray everyday will be better for all of us

 

[Josephine]

had to perform a quadriceps snip as well as tibial tubercle elevation in order to get exposure of right knee revealed.

To explain this, I first need to give you a short lesson on anatomy. The quadriceps muscle at the front of the thigh is the principle muscle used when straightening the leg. It starts high up in the thigh and pelvis, becomes the huge muscle at the front of the thigh, narrows just above the knee to become the quads tendon. At this point is the patella or kneecap. It then continues as the patellar tendon where is is attached to a small bony prominence on the tibia we call the tibial tubercle. This prominence can easily be felt with the fingers.

A quadriceps snip is like in the image and is a technique used on rare occasions when access to the joint proved to be difficult. If the quads structure is tight, the surgeon can't move it and the patella aside to get access to the joint which makes the entire procedure very difficult and even, in extreme cases, almost impossible.

Tibial tubercle elevation is performed for exactly the same reason but in this case addresses the root of the quads muscle. Apparently the surgeon cut into the bone under the tubercle so the patellar tendon and the tubercle could be moved aside more easily in concert with the quads snip thus giving him the extra access to the joint he needed. But from what he said later, it still wasn't really enough.

all osteophytes of fibula as well as proximal tibia removed, all scar tissue from

Osteophytes are irregular bony outgrowths caused by arthritis, they usually occur around the edge of the joint. So it appears he removed these osteophytes and scar tissue from the area here ....

The patella still had a little bit of tracking issues beyond 90 degrees and also performed lateral release. Despite doing this patella did not track well after 90 degrees flexion.

It appears - and confirmed by the above - that he had considerable difficulties in doing your replacement due the the very tight muscles and excess of osteophytes and tough tissues around the joint. This happens on occasions and may not have been due to lack of skill or experience on his part. Every surgeon meets a tough case like this from time to time and can only do the best they can to get the job done.

I am so upset that OS says 90 is success for me.

In respect of his saying that during and at the end of the procedure he found if he flexed the knee more than 90 degrees the patella came out of its proper tracking, then I think it understandable he advised you about this but it would appear he didn't explain why which I think was an omission.

Short answer is that your knee turned out to be extremely complicated and difficult and it sounds like he had a real battle to get it as good as he could. In that event, you had a great deal more tissue handling, stretching and so forth along with the extra cuts in the muscle and the bone. In which case it's hardly any wonder you are having all these problems with excessive pain, difficulty in management and exercising.

I don't envy you one little bit and I hardly know what else to say. Fate dealt you a really bad hand of cards, so far as we can tell from the notes you've posted. It would seem he did his very best but it just wasn't good enough on the day which was, so far as I can ascertain, not his fault.

Should he have explained all this to you? Yes, I think he should have but there are occasions when a surgeon wonders if a short course on anatomy and explanations such as I have just given you is really going to be helpful. I don't know if all I've posted above is going to be helpful to you. It doesn't change where you are at right now but perhaps it helps you to understand why you are in such a state. I do think his nurse should have been in the know and therefore been more sympathetic.

as well as the subtalar pouch.
Made a tibial punch.

Sorry, I have no idea what he means by these.To the best of my knowledge, 'subtalar' pertains to the foot. Did he operate on your ankle or foot too?

Perhaps Orthodoc could chip in on this point for me

 

[Orthodoc]

Jo,

Excellent explanations for this difficult problem with the extensor mechanism.

As for a "subtalar pouch" I am not sure what that means as well - pertaining to a knee. You are correct that subtalar would generally refer to the joint between the calcaneous and the talus (in the hindfoot). Was this phrase taken directly from the op report?

Orthodoc

 

[Pjmc]

Josephine Thanks yes, thanks for clearing so much up for me . @ Orthodoc " states removed all scar tissue from medial and lateral gutters as well as the subtalar pouch and then using the computer navigator device, I was able to make a distal femoral cut, it measured to be a size 5 .
". I do recall when my GP saw me Monday and read this report aloud to my hubby myself and her intern . She did think one item had been mixed up by transcriber , to be honest I am not sure which wording it was now though . I also know that the OS said my bones had fused not in the report but he said it to me . Not sure which bones had fused though . He also left my original hardware in place the plate and screws in femur . Which he did think at least one Miller screw would have to be removed .

 

[Pjmc]

Even though I am a complete dummy when it come to using the forum properly. I have never been so impressed with any group with supplying information as this forum has . The Administrators have have aided me in so many ways from explaining my surgical report completely . Also providing the library of varied helpful topics . The members each have been so wonderful . I have felt so down , disappointed in my slow recovery . This forum has really been a Blessing keeps me going . I am so grateful .

 

[Orthodoc]

She did think one item had been mixed up by transcriber

I would agree with this. I believe that your surgeon probably dictated "suprapatella pouch" not "subtalar pouch." Good pick op by your primary care.

Orthodoc

 

[Josephine]

I believe that your surgeon probably dictated "suprapatella pouch" not "subtalar pouch."

Of course! Perhaps the secretary been doing a lot of work with foot surgery of late!

I remember an occasion where a secretary typed up the operating list for the next day and put "prostatectomy" for a case but as the patient was wheeled into the theatre, it became obvious that he was to have a proctectomy which was an unusual term for the more common "bowel resection"! It wasn't her fault - the list she had been given by the registrar was (badly) hand written and she'd never heard of a proctectomy before.

 

[Campervan]

A bit off pjmc's thread but I can relate another secretary story. Bank Manager dictates "...... plus accrued interest of ....". Secretary types ".... plus a crude interest of ....."