Getting Desperate - please read...

[Dedicated_Dad]

Hi all.

I'm new here, found this while Googling, trying to find something to help me.

I had a TKA on March 4, 2008. Ever since, it "clunks" loudly with every single step.

Further, when I just stand there and bend/straighten it pops loudly in each direction, every single time. This is where it gets hard, and I've not been able to get a Doc to understand: it's not the noise, it's the sensation. This is VERY UNCOMFORTABLE.

I'm getting much stronger -- I'd really allowed myself to deteriorate before surgery, to the point that my muscles were totally atrophied -- but this isn't getting better.

It did not do this when I'm on the bike, steps, or whatever -- any sort of "closed chain" exercise and I'm fine, but when I pick up my leg to walk it's "cli-CLICK/CLI-click" with every bleeding step.

When I am active as I was yesterday, it really hurts when it does this. Right now my whole kneecap is on fire.

I've tried to talk to my OS about it several times. The last time he actually asked me if I had a history of OCD.

I am not crazy. I wanted to SCREAM.

I've done enough mechanical work in my life to know that THIS IS NOT RIGHT.

I understand that they may make a noise sometimes, that this may come and go, etc. but I also know that it's not supposed to do this with every d*** step.

I went to see another doctor, who examined me thoroughly then told me he would not get involved. "Come back in 6-12 months and we'll see."

How can I make anyone understand?

I'm getting desperate.

I put this off for ~2 years at my employer's (repeated) request. I finally broke down and told them I was getting it done on Feb. 18th. 11 days later they "let me go." I called my Doc on Friday afternoon and he did my knee on Tuesday morning so I could still collect on my disability insurance.

I don't have a job, and am terrified - once I am released go back to work I am going to be SCREWED.

I could just sit here and cry.

I've spoken to dozens of people -- everyone I meet who has a TKA -- and noone has ever had anything like this. I've posted on (2) other "knee geek" websites with hundreds and thousands of members and noone has anything like this.

I'm losing my mind here -- this simply cannot be how it is supposed to be, and I don't know what to do.

Any and all input appreciated...

Thanks in advance for your time!!

DD

 

[JenniferG]

Hey DD, Welcome to the forum. Have you seen the thread about clunking knees. It's older but it talks about how alot of us hear and feels Klunks. I'll try to find it and bring it back to the top. How awful about your employer. Do you have any recourse?, as if dealikng with a healing knee isn't enough... Also watch for josephine our Moderator and expert nurse. Keep posting, if nothing else, we might make you smile!

 

[JenniferG]

Thread is called "Knees crack?" You click on search and type in klunk and you shoould find it. It is closed so no more posting on it but at least you can read. And I am sure people will chime in here as well. Stick with it. Jen

 

[JudyS]

Hi DD,

I am a hippy so I don't know about knee problems.
I sure can relate to you on the doc frustration as I had a few years of it in Atlanta concerning endocrine issues.

I sure can relate about the job thing too. I am a special ed. teacher and the same thing happened to me. I am very screwed too and have spent a lot of time crying over that one.

I hope the posts the others have talked about help you.
Judy in So Cal

 

[JackieS]

Everyone I've talked to from my OS to my PT to other TKR folks have said some clunking is perfectly normal and will decrease in time.

My LTKR was 5/14/08. It often to usually clunks with each step, but doesn't clunk on the bike. I'm not finding it painful -- perhaps a bit weird, odd, even a tad annoying at times. I was told if it is actually painful (not just weird and annoying), it might be a sign of loose components and to contact my OS. However, the usual reason behind the clunking which isn't outright painful is that the muscles have to build up more.

I wish you the best with the problem.

--Jackie

 

[Doug]

I was warned by my Dr. prior to my TKR that I might have the clunking to one degree or another. There is no rhyme or reason for when my leg decides to start klunking. At first it was annoying but never painful. Now I am aware of it when it happens but I must be used to it. I may go a couple of weeks w/o klunking and then it starts up for a couple of days. I had to quit using a elliptical trainer and switch to the Cybex Arc Glider for my workouts. On the elliptical it klunks at every revolution.
I think the Dr. should at least X Ray the knee on DD and put to rest the potential of a loos component. Other than that, perhaps some aggressive exercise for the thigh muscles might offer stability and support for the joint, allowing less movement.

 

[Dedicated_Dad]

Clarification...

First, thanks again for the input.

I've been working my hind-end off on exercises. I can now stand with my foot on a 9" step and lift my (185#) self using only my leg. My right heel is only allowed to barely touch the ground, all weight is carried on the new knee.

I do this 7 times in 10 seconds -- 10 on/10 off -- for 10 minutes, no pain.

In other words, I do this 21 times per minute, 210 times in 10 minutes, at minimum once every day. I don't think my muscles can get much stronger.

I ride the bike for an hour -- no pain.

This clunking has happened every step since literally the day of my surgery. When I first got out of bed for the first time it clunked and has gotten no better as I have gotten infinitely stronger.

I have a very different clunk that happens when I am walking down the stairs -- I can feel it separate then come back together when I put weight on it. This really doesn't bother me, as it's not painful like my walking clunk is.

I know they squeak or clunk from time to time, once in a while, but not with every single step. I'm literally worse off walking than I was before discomfort-wise. I can't stand this. Did I mention it HURTS?

It seems like when gravity pulls my joint apart, then my kneecap gets caught and pops free when I bend the leg, then again when I straighten it, but it only happens when I lift it off the ground. I can stand up, lift my foot up and it will clunk in both directions every time I bend and straighten my knee.

EVERY TIME.

I seem to be having the same problem here that I've had with my Doc. It's not the noise that bugs me, it's the feeling.

At best it's like some little person is banging on my bones with a little metal hammer. When I've been active at all, and it gets heated up, it's like I'm being stabbed with an ice-pick. Yesterday I probably walked a total of 1/4 mile and was seriously in ~8/10 pain with each step. My kneecap is on fire today, and each clunk is excruciating.

I really don't think it is a loose component, although I guess it could be, but it won't do it when I'm sitting or lying down, only when I am standing/walking.

I also tried using a thera-band under my foot and tied to my belt, thus keeping it jammed together. No clunk.

Previous x-rays haven't shown anything amiss...

Is it possible to do flouroscopy while standing?

How do I make the Doc understand ? I'd happily start all over again if this can be fixed. I wonder if a thicker spacer would do it? But how to get him to...

Thanks again...

DD

 

[JenniferG]

Well DD, what do YOU think it is? Another xray may be helpful even though you said previous have shown nothing. You know the old addage, if at first you don't suceed. With that in mind maybe an opinion of a 3rd DR, pain management or OS. Hope you find some relief.

 

[Linda2]

I would go to a different doctor for his/her opinion. Anything that is bothering you so much needs to be addressed.

 

[Josephine]

DD, it sounds to me like the patellar may be misaligned somehow. Did you have a patellar button put in? If you did, it's entirely possible that they didn't use the correct size button to tension the quads tendon correctly. This would account for it maybe catching on the top of the femoral component then jumping into the correct track as you straighten your knee.

I suggest you keep getting second opinions until you find someone who is prepared to take this seriously. It needs sorting as I don't think what you are describing is the usual popping which doesn't happen to this degree from day one to over five months post-op.

Sometimes you have to be really pushy with these guys (but politely) even to the point of letting them see just how distressed you are by it. I wish you well on it, friend. You deserve better than this.

 

[Gretchendz]

Dad,

As for the job thing--was your employer large enough to be under Family Medical Leave Act (FMLA) and did you work full-time more than a year? If so, you may want to see an attorney about being let go if the reason was your surgery....

If so, see one quick as there are timelines for filing a complaint...

 

[Dedicated_Dad]

DD, it sounds to me like the patellar may be misaligned somehow. Did you have a patellar button put in? If you did, it's entirely possible that they didn't use the correct size button to tension the quads tendon correctly. This would account for it maybe catching on the top of the femoral component then jumping into the correct track as you straighten your knee.

Great minds think alike... I did get a button, and wonder if I have "patella baja" or "infera" or if I'm having a patella impingement -- it really does feel like it gets stuck.

My quads were atrophied (pre-surgery) to the point that they would only spasm if I tried to do a quad-set. Not even vibrate, but spasm 1-2 times per second in big jerks.

For ~6 years I'd been stuck ~15 degrees from straight. I still have a bit of extension lag.

It really seems to me that this only happens when gravity is able to pull the joint apart. No problem on the bike, no problem doing squats, etc. -- this stuff is like a miracle as I have (usually) no pain. I haven't had a pain-free minute in 6 years. But then I get up to walk across the room and

"po-POP PO-pop" Every step. It's uncomfortable at best, excruciating if I'm on my feet for any length of time.

My MCL/LCL are too loose, thus allowing the joint to separate. I have some instability as well, but it's not bothersome -- the way my patella pops and the pain from it, though...

For clarity, when I lift my leg I can feel the joint "separate." When I bend my knee and start to swing my leg forward I get the double-click "poPOP" then when I continue swinging my leg forward and straighten it, I get another double-click "POpop" Sometimes it seems the pain is in the top edge of my patella, sometimes it seems on the bottom/medial side. I'm guessing it is both.

If I just stand and swing my leg, it pops loudly at ~25degrees in both directions. This too is uncomfortable but more tolerable than when I'm walking.

Lastly, when I come down the stairs I can feel it separate when I step down with it to put my foot on the next step. Of course when it smacks back together it makes an audible "pop" but that one doesn't bother me.

This walking thing, though, is excruciating. I'm literally worse off than I was before surgery.

I did this because I'm tired of being a cripple at 42. I was told "you should be able to forget you have a knee." I could -- right now -- if I didn't have to walk. Unfortunately I can't ride a bike everywhere...

I suggest you keep getting second opinions until you find someone who is prepared to take this seriously. It needs sorting as I don't think what you are describing is the usual popping which doesn't happen to this degree from day one to over five months post-op.

Sometimes you have to be really pushy with these guys (but politely) even to the point of letting them see just how distressed you are by it. I wish you well on it, friend. You deserve better than this.

Thanks. I'm going to try him one more time. I don't know what to say since he's just blown me off every other time. I guess I'm just going to have to get crappy with him to make him understand. Last time he asked me if I had a history of OCD -- as if I should be able to ignore it and am just obsessing about it.

You know how hard it is to recover from a TKA. I've toughed through a TKA which required cutting my horribly-atrophied quads then building them back up to the point I can do 210 one-legged squats on my new knee in 10 minutes.

I would happily -- HAPPILY -- start all over again if it could make this go away. That's how bad it hurts me. I've read hours of **** found via Google, posted on three sites like this one and noone has heard of anything like this.

I'm losing it. There's no way I can work like I am, and I'm going to lose my disability on 8/1. If it needs work I need it to be done now, I can't wait...

G*d help me...

DD

 

[Dedicated_Dad]

Is it possible that the edge of the button could be curled up and is catching on other stuff in there? Still, I can't see how that could cause the click in both directions...

/thoughts...

DD

 

[Dedicated_Dad]

Dad,

As for the job thing--was your employer large enough to be under Family Medical Leave Act (FMLA) and did you work full-time more than a year? If so, you may want to see an attorney about being let go if the reason was your surgery....

If so, see one quick as there are timelines for filing a complaint...

Yeah, I could nail them. I also found out that they should have been paying me OT for the literally thousands of OT hours I worked in the last ~5 years.

I'm an odd duck -- I'll be the first to admit it. If it doesn't feel right to me, I won't do it. I am very rigid about my integrity and the "Golden Rule." I've never taken a dime in my life that I didn't earn, and to sue them is something I'd rather avoid.

Further, I've been through the custody-battle from hell. She accused me of molesting my girls but I was finally awarded sole legal custody... I REALLY just don't want to deal with the courts again or have all that mess in my life for the time it will take to get it done.

Further, I'm a pretty high-end guy in my field. Any job I go for will have a background check. If they see I sued my previous employer they're probably not going to hire me.

For all of these reasons, I really don't want to sue them. I wrote and offered to settle for the OT pay they owe me. The woman I've been talking to has been very nice and agrees "there's been an inequity here" and says she wants to make it right. If they want to jerk me around I'll have no choice but to cut the shark loose on them but would prefer to settle amicably and not have to go to "the hard way."

Still, even if I get a settlement from them I'll lose ~45% in taxes and the rest will go to pay bills incurred while I have been on disability. It's not going to pay me for another few months of fooling with this later. I'm panicking now because there's just no way I'm able to go back to work with this the way it is, and apparently no way I can get anybody to fix it.

Prayers appreciated -- I'm about out of other options...

DD

 

[JudyS]

DD
You have prayers from Southern California
Judy

 

[AlaskanTKR]

Prayers from Alaska too!
Marianne

 

[Nursepair]

Welcome Dad, sorry I have no advice for you myself. I hope you get things sorted out both with your OS and your ex employer. Good luck, Sue

 

[Josephine]

Is it possible that the edge of the button could be curled up and is catching on other stuff in there? Still, I can't see how that could cause the click in both directions...

/thoughts...

DD

Unlikely - more likely, as I said, that it is misaligned meaning it hasn't been placed quite properly or is not the right size.

The thing with patellar buttons is that they come in about 4 sizes, just like shirt buttons! Each is different in depth as well as diameter. This means that if one is chosen that is on the small size, then it might be able to become unseated from the track on the femoral prosthesis where it is normally retained by the natural tension of the quads tendon. The double click could be when it slips off the top of the prosthesis (where I have marked it in red) and then back onto it again.

Please remember this is just me presuming - I could be way off here, but I have heard surgeons discussing such occurrences whilst teaching their junior doctors during surgery so I know something similar CAN occur. Trouble is, if your surgeon has never been introduced to the possibility (and surprising how many can not be) then he won't have it on his list of probabilities. I'd find another surgeon who is inclined to be more sympathetic.

My MCL/LCL are too loose, thus allowing the joint to separate. I have some instability as well, but it's not bothersome -- the way my patella pops and the pain from it, though...

You mean here your medial and lateral collateral ligaments, yes? And the surgeon told you this? Then I am doubly intrigued he doesn't see the need for further investigation. To be honest, I really wouldn't waste my time going to him again, certainly not after he tried to dismiss you with the OCD crack.

 

[mms]

Prayers From Michigan!

 

[Dedicated_Dad]

Unlikely - more likely, as I said, that it is misaligned meaning it hasn't been placed quite properly or is not the right size.
...then it might be able to become unseated from the track on the femoral prosthesis where it is normally retained by the natural tension of the quads tendon. The double click could be when it slips off the top of the prosthesis (where I have marked it in red) and then back onto it again.

Hmmm!!

This could be... I was stuck at ~15 degrees from straight for ~6 years. He loosened things to get me back to full extension. Further, my Quads were atrophied to almost uselessness - all I could get when I tried to flex was a big jerky spasm 1-2 times per second while I pulled with all my might. I was using my hip flexors to lift my leg... Obviously I had a pretty terrible limp as well. I went up steps one at a time with my good leg. I stood with all my weight on the good leg -- I did nothing with the bad one except walk, and then usually without bending my knee, using my hip flexors to swing my leg.

Even now, with all the work I have done, I have a ~10 degree extension lag. When I try to do a straight-leg-raise it is ~10 degrees in my knee before it begins to lift my foot off the table.

Basically I don't HAVE any tension in the quads tendon.

...You mean here your medial and lateral collateral ligaments, yes? And the surgeon told you this? Then I am doubly intrigued he doesn't see the need for further investigation. To be honest, I really wouldn't waste my time going to him again, certainly not after he tried to dismiss you with the OCD crack.

Yes. I've figured this out for myself, but the 2nd OS I talked to agreed. I had thought my MCL was too loose but he thought the LCL was the looser of the two. He said "the joint is a bit looser than we really like to see, but..." then gave me the "i'm not messing with it/come back in a year and we'll have another look" speech. Bottom line he doesn't want to get into a malpractice mess -- I'm sure you know how Docs here are all scared of getting sued... Even though I assured him that would never happen - I am nothing but grateful to my OS for what he did for me. If mistakes were made that's OK -- I make them every day. I just need this FIXED!!

DD