Bilateral TKR Halfway there...transitioning issues<<

[jaschembra]

All I can say is... I'm really glad to know the tight band is normal.

 

[mpj200]

Wanted to update my recovery, or lack there of it seems like. I'm just over 5 months post op on both knees TKR.

I feel like I have gotten progressively worse the past two months. I stoped PT and exercising and PT over a 6 weeks ago ago and now have trouble just walking. My knees seem to have gotten tighter and tighter over the past 2 months. And they are like that from the time I wake up in the morning until I fall asleep. Day after day. They are tight when I wake up, but but the time I brush my teeth and head for my coffee, they are clamped down like a vice grip. One knee feels like a baseball is inside. Both knees have burning on the outside of the knee that comes and goes.

The only thing I do each day apart from elevating and icing both knees with ice pump machines, is go to my office for about 3 hours a day. And sit a little. Walk a little and recline in my office recliner the rest of the time with ice. Good thing I'm the boss.

It's getting to bad that I can't walk much at all, and have started wearing knee braces during my transition from home to work (take them off) and then back on from work to back home. Or if I have to stop for groceries, etc.

The brace really helps, but I don't want it to make things worse than they are. I'm just not sure where to go from here.

I've tried some gentle heel slides and can manage that OK. But I can no longer bend my knees enough to complete a circle and ride my stationary bike. 2 months ago I could go 15 minutes easily.

I know this rubber band feeling is common, but it is common to last all day, every day, and be so tight that I can't walk?

I had good ROM before 115/0 on both knees, but I was also taking strong pain meds. I'm off them now. I'm
guessing my bend is about half of what it used to be.

Does any of this sound like I would need a manipulation or scope? I have 3 more weeks to my 6 month post op follow up with my Surgeon where they do X-rays. I have a VERY important business trip to Europe in 2 months and I concerned my surgeon is going to want to do another procedure and mess up my trip.

Sorry for the rant but I don't know how much longer I can stand this. Does this sound common or should I make a strong request to see the surgeon sooner and have X-rays? Between the 24/7 pain (on an average scale of 4/5) and not knowing if I should wait for my 6 month post op appointment or try to get in early.....I have found myself at wit's end. @Josephine or anyone with experience, and suggestions would be greatly appreciated.


Sent from my iPhone using BoneSmart Forum

 

[kneeper]

I would call your OS to get it checked out. Are you taking Tylenol or anything? I took took it for quite a while for my knees.

 

[mpj200]

Can't take Tylenol because of interaction with another medication I'm taking for another illness. They have tried 3 anti inflammatory meds, including ibuprofen. Nothing has helped. They tried Tramadol and it doesn't help.


Sent from my iPhone using BoneSmart Forum

 

[sistersinhim]

I am so sorry to hear of your pain and tightness. Hopefully, Josephine will have some idea what's going on. In the meantime, I'd try to see my OS as soon as possible!

 

[Josephine]

Given you are 5+ months, I think you may be moving into an area of chronic pain issues which is very sad for you.

270 reps per day

Your principle problem was, in my opinion, that you were doing far too much in the way of exercise and activity and at the same time, were unable to adequately manage your pain because of drug compatibility issues. This amount of exercises was part of your problem.

I'm guessing my bend is about half of what it used to be.

Can you get a photo of your leg so I can measure it? It needs to include the hip and foot like one of these

As for extension, you can assess that yourself using these instructions Extension: how to estimate it .

What are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine) Don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

And tell me about any pain meds you are taking just now. What pain medications are you taking, how much (in mg please) and how often?

And how swollen are your knees now?

 

[mpj200]

I will get this info when I get back home in a few hours. Thank you so much for responding again.


Sent from my iPhone using BoneSmart Forum

 

[mpj200]

I will have to get someone to take a photo of my bend. Will get that tomorrow. But here is the rest of the info:

My pain gets worse usually at the end of the day. Even though I elevate and ice off and on all day. For hours at a time. Morning pain is probably about 4. Evening about 5. IBut these are just numbers to me. I'm guessing. My main pain is the rubber band tightness/clamping which on the left side of the pic below and feels like a baseball is clamped in there. And burning on the side of both knees, but more on the knee on right side of the pic. See below.

I'm doing no exercises, very little walking and lots of resting, elevating and icing.

I am weaning off Dilaudid now. Taking 2 MG a day this week. 1 a day next week. Then will take 1MG every other day for a few days before I go completely off.

I am also taking 100 MG a day of Tramadol at night but it doesn't seem to be working so I'm going to start going off it once I'm
off the Dilaudid.

Here is a pic of my knees. Can't tell if they look swollen.

Bi-Lateral TKR February 7, 2017
Sent from iPhone
Excuse typos

 

[mpj200]

@Josephine see above for info on the rest of your questions.

Below is my knee bend. I took this first thing in the morning, before I got out of bed. I realized my bend is much better before the rubber band tightness sets in. So perhaps that is the major culprit of my pain? I do also have some burning pain on the outside of my knees. But that's more of a shooting pain and comes and goes. The rubber band comes once I get up and start walking. And doesn't go away unless I'm elevated and iced or asleep.

I hope I did these photos correct. I had bi lateral so here are both knees. The first is the knee that is tightest. Feels like a baseball is inside being clamped.

Thank you so much for any estimate you can provide on my bend. And any suggestions moving forward. I can't get in to see my surgeon for another 2 weeks. I am 5 months and one week tomorrow post op.

I have not been doing any exercises for about 6 weeks apart from walking in the pool one day. And a few days I did some gentle heel slides with no resistance. Neither of these seemed to activate my knee or cause pain.

Bi-Lateral TKR February 7, 2017
Sent from iPhone
Excuse typos

 

[Josephine]

Morning pain is probably about 4. Evening about 5. But these are just numbers to me

Hmm I wouldn't mind betting it's stronger than that! Perhaps I should have left you this chart!

My main pain is the rubber band tightness/clamping which on the left side of the pic below and feels like a baseball is clamped in there. And burning on the side of both knees

To me that would be more like a 7 or an 8 in pain scoring. And the burning, have you discussed this with your surgeon or GP? Because that sounds like nerve pain which should be treated with a drug called gabapentin.

I am weaning off Dilaudid now. Taking 2 MG a day this week. 1 a day next week. Then will take 1MG every other day for a few days before I go completely off.
I am also taking 100 MG a day of Tramadol at night but it doesn't seem to be working so I'm going to start going off it once I'moff the Dilaudid

I don't think you are using your medications properly. If you don't take it regularly, then you're not allowing the med to build up in your system and work to its peak efficiency.

To start with, you need to be taking one type regularly during the day and I would suggest the Tramadol which is a rattling good pain med! This was the chart I used for both my knees and I believe many others have used this and found it helpful.

Here is a pic of my knees. Can't tell if they look swollen

Thank you for these - they are excellent pics!

I made your flexion 80 degrees left which appears to me moderately swollen and 90 degrees right which is grossly swollen.

But you're still 'only' 5 months out so still have oodles of time to get there.

 

[mpj200]

Thanks again for the feedback @Josephine! With your pain chart, I'm sure I'm hitting at least a 6 by the end of the day.

I think part of my frustration is that I have this pain everyday, day after day.... after day. For over 5 months now. It's starting to wear me down.

My flexion is better than I thought. Before I get out of bed in the morning it's not bad. I think it's the tightness I get (rubber bands) once I get up and about that really restricts my bend.

Perhaps when that tightness goes away I will get more of my bend back? I was around 115 on both knees earlier in my healing.

That's also a good point on the meds. I could take them more regularly. I'm trying to get back to work now and wonder if that would effect my driving? I may need to take another month off and hope I will be more healed in August.


Sent from my iPhone using BoneSmart Forum

 

[kneeper]

I used to massage my knee before/during trying my morning heel slides & stretches. I'm not sure if I got more bend, but it felt better.

 

[mpj200]

I'm doing a few heel slides. It makes my knees tighter, but I feel like I need to be doing something. I start pool walking next week.

And I find myself massaging my knees all the time, too, but without thinking about it. I kinda do it organically while I'm sitting down and not elevated sometimes.


Sent from my iPhone using BoneSmart Forum

 

[Josephine]

I'm sure I'm hitting at least a 6 by the end of the day.

I would imagine that to be far more likely.

I'm doing a few heel slides. It makes my knees tighter, but I feel like I need to be doing something.

Please don't. It will only make matters worse.

And I find myself massaging my knees all the time, too, but without thinking about it.

That's okay up to a point but it's not the answer really.

I think part of my frustration is that I have this pain everyday, day after day.... after day. For over 5 months now. It's starting to wear me down.

This give me pause to think you have something more serious than just post-op pain going on.
Everything you've said thus far, plus this

I do also have some burning pain on the outside of my knees. But that's more of a shooting pain and comes and goes.

Makes me think you probably have Complex Regional Pain Syndrome (CRPS or RSD). I really think you need to ask your surgeon or your GP to refer you to a neurologist for further investigations.

 

[mpj200]

Thanks @Josephine! I see my Surgeon in 11 days. I will ask him about the CRPS. They are going to take X-Rays at this appointment as part of my 6 month evaluation. I'm not exactly what X-rays will tell them. But that's what they do.


Sent from my iPhone using BoneSmart Forum

 

[Josephine]

I doubt the xrays will show much and he'll come back with the wearying 'everything is fine'. Then you tell him you would like a neurologist's opinion.

 

[mpj200]

I have a neurologist. I can see him anytime. I had spinal fusion on my neck a few years ago. Major nerve pain in my shoulders and neck. Surgery took care of that.

My knee pain doesn't feel like that nerve pain did. My knee pain is more the near constant (except when my knees are elevated) rubber band tightness and occasional sharp pain mainly on the outside of both knees. Perhaps burning is not the right word. But one thing I have noticed is that it gets worse after I have been out and about and on my feet for a few hours.

I will set up an appointment with my neurologist @Josephine. I'm just wondering if I'm just healing slow and suffering from the same rubber band tightness that seems so common?

My knees feel best when I first wake up. But as soon as I start walking, they get rubber band tight. Like they are in a vice grip. And they are tight all day if I'm not elevating. When I elevate, the feeling goes away.

And I had both knees done and they both have the same issues. It just seems odd to me that I would have the same complications with both knees.


Sent from my iPhone using BoneSmart Forum

 

[Josephine]

I have a neurologist. I can see him anytime.

That is excellent!

My knee pain doesn't feel like that nerve pain did.

No it won't because it's in a different place!

I'm just wondering if I'm just healing slow and suffering from the same rubber band tightness that seems so common?

It might be common but it's not the only thing you have described and all of that together makes me suspect something more.

 

[mpj200]

I think I will get some second opinions. I have been waiting for the 6th month post op appoint with my surgeon to evaluate how I feel I am progressing.

Maybe I will see Neurologist and a Pain Management center? It seems that 6 months post op, I would have decreased pain. Mine has increased over the past 2 months.


Sent from my iPhone using BoneSmart Forum

 

[DebM]

Not to lessen your issues with pain that are obviously deeply affecting your life but I, at 6 months still have pain everyday. It worsens as the day goes on, particularly on the days I work, and my knees get super tight. It is relieved by elevating. But compared to how much pain I had in the early days it is so much better.
Because this is such a long slow journey, more so for some of us, the recovery wears us down and we lose sight of the small improvements.
My OS is very pleased with my results and says it takes 12 months up to 2 years for total recovery. I try to keep this in mind when the slowness of recovery gets me down.