Revision TKR HELP - 16 months out and in pain<

[Josephine]

1. when walking on stairs or getting up or down from a seat, 7; otherwise a 4.

Gosh that's high for how far you are.

2. I don't take pain medications but have been taking 1000 mg naproxyn daily for the past 4 years.

For something else, I presume? You do know that Naproxen is an NSAID which is not only bad for your stomach but also a very poor pain killer. Is there any reason you can't take Tylenol? If it's okay, I suggest you take 1,000mg 4 times a day and you can take that with the Naproxen.

3. swelling is between slight and moderate.

Okay

4. My extension is 0, my ROM is about 110

That's kind of okay. Could be better.

5. I don't ice my knees as they have become quite sensitive to cold.

I trust you were using a cloth or towel between your skin and the ice pack, yes?

6. I elevate every night and when seated for more than 20 minutes.

Okay

7. For me, my activity level is very restricted. Although I can go shopping and do light housework, I can no longer do laundry (because of the stairs) and am very restricted in terms of going anywhere where I need to be ambulatory (or upright) for more than an hour.

Oh not good!

8. I am not doing any exercises.

Nor any PT?

 

[Josephine]

So that is what you are doing now but can you answer those questions again for the 6 weeks after the revision? Best as you can, of course. And I will need to know all the exercises and PT you were doing too.

 

[Scheherazade]

I am not doing any PT and I didn't do any after the revision.
I just initially did heel slides and then leg lifts on my own. I was doing quite well until about the 7 month mark.

At the 6 week mark I had already begun only relying on a cane occasionally. Progress was very much on target until 7 months.

 

[SusieShoes]

I'm so sorry to hear of the trouble you've been having. It boggles my mind that you could be doing well until seven months and then have so much trouble. Did the second opinion OS have anything to say? Also, have you been tested for metal allergy? Just wondering, because that is the sort of thing that can show up later.

 

[Scheherazade]

I was tested for allergies before the second surgery - and was not reactive to the metals. The explanation given by my revision OS, that my tendons around the knee cavity stretched out, is consistent, or at least not inconsistent, with being initially okay and then becoming unstable. The components were not unstable, but there was laxity nonetheless, according to the operative report, and it was the same in both knees.

 

[Josephine]

I just initially did heel slides and then leg lifts on my own.

Well those are exercises! So how many were you doing and how many times a day?

 

[Scheherazade]

10 heel slides on each side, twice/day
5 building to 10 leg lifts once/day I stopped both of these after about 5 weeks, as I was progressing so well.

When I was five months out I began working first ten, then 15 then up to 30 minutes/day at a slow pace on a rowing machine 3 to 4 times/week, but I stopped doing this because my left knee began to hurt (that is the problematic one).

 

[Josephine]

10 heel slides on each side, twice/day
5 building to 10 leg lifts once/day I stopped both of these after about 5 weeks, as I was progressing so well.
When I was five months out I began working first ten, then 15 then up to 30 minutes/day at a slow pace on a rowing machine 3 to 4 times/week, but I stopped doing this because my left knee began to hurt (that is the problematic one).

Building up to? And then 10, 15 as well as a rowing machine! Honey, at that stage you supposed to be reducing them! So no wonder you have/had this pain. Stands to reason. Definitely you joined the ODIT (over did it club)!

 

[Scheherazade]

That doesn't make any sense, as I was fine after I stopped doing the heel slides and leg lifts, and was fine for another 4 months, walking easily for many blocks. I didn't start experiencing pain at all until 6-7 months after the revision surgery.

 

[sistersinhim]

Wasn't that when you started using the rowing machine?

 

[Scheherazade]

Wasn't that when you started using the rowing machine?

I started using the rowing machine at 5 months. But I stopped that after a month and haven't done it or anything else other than walking a block or so a few times/week for the past 3 months.

 

[Scheherazade]

Also, I did quite a bit of reading about rowing machines and knee replacements (including here on BoneSmart https://bonesmart.org/forum/threads/4-wks-rowing-machine-workout.9653/) before I started rowing and all reports were glowingly positive as a good exercise for people like us.

 

[SusieShoes]

Knee pain is a sign of inflammation and rest is the best treatment. It sounds like you did a good job of healing your knee early on, because you said for 4 months or so you were easily walking several blocks. The rowing machine appears to be the exercise that derailed your recovery.

I personally loved rowing machines before my knees got bad. I haven’t used one since my surgery, but I understand the appeal. They really work the leg muscles. You wanted to get those muscles working and stronger to help stabilize your loose tendons. That’s understandable. However.... I think the machine was too hard on your knee and the result was the return of inflammation.

If your OS has pronounced your implants to be in good order, then your best bet is to rest that knee. Ice it, elevate it, and get the inflammation down. Let it heal. Walk as your knee tells you is enough, but not too much. Once your knee settles down again, you can resume gentle exercise and very gradually build up those muscles you need for greater stability.

 

[Scheherazade]

Thank you for that response. I still don't understand why my knee continues to get worse three months after I've stopped all exercise, and begun to once-again experience an ever-shrinking world. If I have to walk more than one block, it does help if I wear a knee brace. Does that suggest anything?

 

[Celle]

Also, I did quite a bit of reading about rowing machines and knee replacements (including here on BoneSmart https://bonesmart.org/forum/threads/4-wks-rowing-machine-workout.9653/) before I started rowing and all reports were glowingly positive as a good exercise for people like us.

That is a very old thread (2011).
Now, we tend to advise not to use the rowing machine so early - it does put quite a strain on your knees.

 

[Scheherazade]

Third OS says it is tendons surrounding knee cavity ("rubber bands") which became lax and the only option left, other than taking everything out and starting with a whole new much more restrictive replacement, is to wear a hinged knee brace all the time. Maybe the tendons will retract, eventually, or else I will be wearing the brace pretty much for the rest of my life. Sigh. But not my fault, just how my tendons were constructed, according to the docs.

 

[Celle]

That sounds liked a lot of baloney to me - the explanation of a surgeon who doesn't want to get involved in doing anything to help you.

But not my fault, just how my tendons were constructed, according to the docs.

No, I'm not buying that.

Take a break for a little while and then I think you need to seek yet another opinion.

 

[Scheherazade]

To be clear, the doc didn't say it wasn't HIS fault, I was saying it wasn't MY fault.

 

[Celle]

I agree. Of course it isn't your fault.

 

[Scheherazade]

I'm baaaaaaaack. Still miserable. Last time I checked in here I realized that my revision (larger spacers put in) failed, and I didn't know what to do. Since that time I've seen quite a few new doctors and tried several different approaches, but so far no success. I went to a doctor at the Hospital for Special Surgery, and he suggested having a complete revision, this time using the Smith & Nephew bicruciate stabilizing component. Given my past experience having the tendons stretch out and then the same thing happening, he suggested I might need stability from the implant itself. That made sense, but I was very wary to go back to surgery without exhausting every other possibility. Another orthpod, unrelated to the first two, thought to check my spine to see if I possibly was having referred pain. In fact, an x-ray and MRI revealed that I have slipped vertebrae which might mean there is nerve compression which could be the source of pain down into my knees. To test this I had a spine injection with steriods, but, sadly, absolutely no changes. I've also tried neurontin and cymbalta for the pain, but neither had any effect on me. So now I'm ready to try acupuncture or medical marijuana, and if I don't get any relief from those, I guess it will be back to surgery for me. I'm only going to do the really bad knee this time - I can't bear the idea of going through this (again!) bilaterally and have no relief. Thought I'd check in and share my tale of woe, in case anyone has any thoughts/suggestions. The only way I walk at all anymore is by wearing a strong brace. I can't even walk across the room without it.