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Revision TKR HELP - 16 months out and in pain<

Thank you! I hadn't seen anyone mention this (about damaged cartilage behind the patella causing pain) before.
 
Boy, shredded cartilage not related to your pain? I'm finding it hard to believe that assessment! It does sound like you're going to need patellar buttons, though.
 
Revision scheduled for June 8. The revision OS will be operating first on the right knee, which is the most painful (almost akin to having broken glass in my knee, at times). He will first check to make sure the replacements are in tight - which tests show they were . If they are not tight, he will replace that. Otherwise he will simply replace the spacer and resurface patella. Then, unless the total revision is necessary, he will replace the spacer and resurface the patella on the left side.

Assuming I don't need to have the whole replacement replaced, any thoughts on length of recovery? This doctor, unlike the first time, was very reluctant to say how long the recovery would take, saying "yes, it could take two months and yes, it could take 10 months."

I'm really hoping :beg: this does the trick as my world and functioning has been dramatically reduced over the past 8 months.
 
Glad to hear your revision is scheduled. Generally when the knee is right, you should feel better. How long recovery will take is anyones guess. Many (not all) members have had easier recoveries after the knees were done right.

Keep us posted on how you are doing.
 
KarriB said:
Is the OS thinking the spacer has cracked?
Click to expand...
He wouldn't speculate, but kept saying he'd know once he's in. Makes sense. I remember reading @Celle 's horrible experience - I don't remember any critical moment or impact when my right knee began changing from pretty fine to increasingly awful, so I just don't know what to think about why this has happened.

The left knee, which is less horrible than the right (although it was the real reason I originally went to an OS about having a replacement), periodically gets quite swollen and I have painful Baker's cysts, but it's not nearly as painful as the right knee which hurts with just about every step.
 
It may be that the spacer isn't cracked, but is simply a size too large or too small. The wrong size spacer can cause instability and pain in a TKR.
 
I'm now post bilateral revision surgery. Can an administrator please change my designation (i.e. Revision, not BTKR)?
 
We don't have a bilateral revision button, I will let Jo know that we need one!! But, I thought the revision label was better for you right now. I assume by the fact that the doc did both knees that you did not need a full revision. I had a spacer change and a lysis of adhesions (removal of scar tissue---adhesions). I had pain for about a week, then after that, I had to deal with the swelling.

Also, my doc urged me not to exercise on a hot, inflamed knee. So recovery was very slow--for the first three weeks I spent a lot of time on the couch with my knee up on three pillows. I did only table exercises---quad sets, leg lifts. At 4 weeks, I began a series of gentle exercises which were increased very slowly. I did a lot of n on weight bearing exercises like biking. At 8 weeks, I began a real exercise program. I have not had any more problems with my knee--so far!!
 
Thank you Kelly.

The OS replaced the spacers and resurfaced the patellas. He said he had to try three different spacers, going up 3 mms, in order for the tendons to be in place properly. He explained to my husband (during surgery, in between the first knee and second knee) that the tendons were too loose because the spacers were too small, and that had caused instability. Does that make sense to others? Should/could the first surgeon have realized the spacers were too thin?

I feel as though I am still recovering from this surgery, so I have no way of knowing yet whether this time did the trick and I'll be soon nearing that blissful state of "being unaware of my knees" for which I so fervently yearn. But the recovery is certainly quicker than from the BTKR. I'm already not using either walker or cane. I still need to rest a lot, though, and am certainly following the BoneSmart mantra of not overdoing exercises, just heel slides and knee lifts so far.
 
Yes, it does make sense that the too small spacers created instability and pain in your knees.

Picking a spacer size is tricky. My own doctor admitted that he had put too small a spacer in my knee. He said that if he had known how limber I am, he would have put in a bigger spacer. (Makes you wonder why he does not ask a few questions, doesn't it!) My knee felt so much more stable the first time that I got up, I was surprised.

I thiink that now that your ligaments are balanced that you have a fairly swift recovery. It is good that you are resting---I was on the couch for about 3 weeks. I read a TON of books and watched Downton Abbey al the way through!! Take it easy now, I think you will be happy with this recovery and a start to a new life.
 
I'm glad your revisions went well, @Scheherazade .
Here is your post op reading, as a reminder:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Saw the OS for my 5 week post-op check-up. This time the explanation was clearer - my tendons loosened after the initial surgery, not that the spacers were too small to begin with. The doctor said there really wasn't any clear consensus on why, in a very small percentage of people and not only with knee replacement surgery, tendons surrounding a particular surgical site loosen. I hope this doesn't mean it is going to happen again, but at least I didn't have to have the extender rods for the revision and there is no reason to think I evernwill.

Five weeks out and no walker, no cane, lots of short walks (inside the house and around the outside) and I'm doing well. I am able to bend to 110 degrees on the right and 105 on the left. Not bad.
 
so here I am, 10 months after my bilateral revision and 2 years and 6 months after my BTKR and I'm practically back where I started.:bawl: After each surgery I had a few months following the initial recovery periods of fairly decent relief, and then an increasing descent back into horrible knee pain. At least this time one knee is better than the other, but the one feels as bad as before the initial surgery and I'm back to extreme limitations on what I can do. I am pretty sure the same thing has happened this time as did after the first surgery - loosened tendons surrounding the knee cavity, making it completely unstable. Has anyone else had this problem, or know of anyone who has? I really, really need help :beg:in figuring out what to do/where to go next.
 
I’m so sorry to hear this my old BTKR buddy. I’ve never heard of loosened tendons and can only wish you the best. I had horrendous IT band problems with my BTKR but again never heard of tendon issues.

I’m still on my journey as well but the end of the tunnel is close at hand. I have continued to have tremendous pain below my patella on both knees. I had a LTHR 18 months ago that relieved all the pain in the left knee. When I then asked to have the right hip done, my OS said I still had several years left on it. Even though I was hobbling in pain. My husband and I moved to Florida where I saw a new OS who said I needed a knee revision and sent me to a revision specialist in Orlando. After MRI’s didn’t find loose components or infections, he gave me a hip injection at a weird spot and the knee pain vanished...for 3 weeks. Referred pain from a bad hip. So he will be doing an anterior THR the end of May.

Wish you could find something as easy as a THR. I’m assuming you’ve gone for a second opinion?
 
Oh my - that sounds horrible!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
@Josephine -yes; of course!

@BusterBeans - I am going for another opinion tomorrow. My former OS did say it was possibly referred pain from my hip which showed some deterioration two years ago, but when he did an x-ray last week he said it didn't show any further deterioration, but did schedule me for a needle-guided novocaine shot in the hip to see if that is the problem. I don't think it is the case as the pain feels exactly as it did before my revision and the insertion of thicker spacers, but we'll see what happens next, and I'm waiting for Josephine's questions and thoughts.
 
Here y'go then!

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. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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?
[Bonesmart.org] HELP - 16 months out and in pain<


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

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

6. are you elevating your leg. 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., and

8. are you doing any exercises at home? If so what 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 you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
1. when walking on stairs or getting up or down from a seat, 7; otherwise a 4.

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

3. swelling is between slight and moderate.

4. My extension is 0, my ROM is about 110 (the OS did not measure it and I can't find my goniometer).

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

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

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.

8. I am not doing any exercises.
 
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