Revision TKR Here I go again - round three

Sending a ((hug)) to help get you through this phase....
Had the ultrasound on Tuesday and it does show a quadriceps tendon tear. Radiologist couldn’t determine how much of a tear and suggested a CT scan. Report and ultrasound images were sent to surgeons office. Still waiting to hear from them. Still waiting…..
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With a tear, you should be very gentle with your knee. That tendon will take a while to heal and will need lots of TLC.
@sistersinhim my leg is in a brace that is locked at 0°extension. Still use a walker even with using the brace. With a lot of walking it slides down and then my knee tends to buckle. Surgeon will decide if the tear is bad enough to warrant surgery to repair it. The fact that I can’t do a straight leg raise at all or kick my leg forward to reposition my lower leg, to me indicates a lot of the tendon has torn. I think he’s leaning towards surgery. But that was before the ultrasound. It’s a waiting game until he decides
Well it’s moving at a snails pace to move forward with my knee. Ultrasound last Tuesday (9/5) showed a quad tear, but also noted edema and tendon thickening so radiologist recommended CT. Waited days to hear from surgeons office. Never heard from them all week. And I called. Over the weekend I saw in the patient portal an MRI has been ordered. Today a message from the PA, through the patient portal, says they need an MRI because ultrasound wasn’t definitive. She wrote that the order was sent to hospital imaging. Call hospital, they haven’t received an order. Call Dr office and left voice mail saying they don’t have an order. Waited an hour called hospital again and they just received the order but waiting for pre-authorization from insurance, that surgeons office has to do with insurance. Call surgeons office again, goes to voicemail, again. Ask them about pre-authorization. Get a message through the portal. It was submitted waiting on insurance. Which I know for a fact that my insurance does online pre-authorization, so there’s no waiting on insurance. They give me the number of the person at the hospital who does authorizations. Call her, goes to voicemail, no return call. So I’m still waiting.

In one of the last portal messages I thanked them but also said I know there is something wrong with this knee. Still can’t do SLR. Still buckling. And also said that once they have MRI results I would like an appointment with the surgeon as I want to discuss in person a plan for moving forward.

I know with quad tendon tears time is important. Last time I met with surgeon was 8/31 when I told him something was wrong and he suspected the tear and ordered the ultrasound. First time I think there was an initial tear was 8/4, which i reported to dr office. Second time where I think it tore again and I lost quad strength was 8/18. So know we are 5 weeks out from the beginning of this mess and 3 weeks since I lost some quad function. Quad tears are usually repaired within 48 hrs.

So tomorrow I’ll start again with getting an MRI scheduled. I hate being that patient that has to call all the time. It makes me feel like I’m nagging when I call and leave voice mails. And it’s really irritating that they don’t return calls, but send messages through the portal. At least by that method it’s documented. Although every time I leave voice mails it’s documented that I spoke with someone.

I’ve also noticed the last few days they my knee is getting pretty achy again. Bedtime is the worst. I think when I’m sleeping in one position for awhile and then move, my knee is so stiff and painful. And then I work the stiffness out. I’ve just noticed subtle changes since I had to quit PT do to the injury. So I hope things get resolved this week. To get out of this waiting game. I have to move on with my life. Make plans. I’m not liking this in limbo status. Makes me wonder if the surgeon is even aware of what’s going on. When I saw him on the 31st, imaging orders were stat. He said we need to get it fixed soon. The MRI was ordered as regular urgency. Plus he’s leaving the country end of the month. Just feeling really frustrated tonight.
What an awful runaround you have been getting. I can understand your frustration. I pray that your knee's problems will be found and settled quickly.
I'm so sorry to learn of these delays. Frustrating and scary. I hope you can break this impasse today.
I am sorry for the frustration you're feeling and it is certainly understandable. It is like you're being forced to jump through hoops to get appointments to learn what's going on. I hope all starts falling into place soon and you receive answers and ultimately resolution of the pain. Best Wishes. Please stay in touch.
@midwest girl
Sept 12th late into the night I sent a message to my surgeon thru the patient portal. Basically saying I need to move forward. We’re waiting on an MRI that hasn’t even been sent for pre-authorization. I thought there was an urgency with repairing a quad tendon tear. Said I would like to meet with him to form a plan so I can plan for things like returning to work.

Well he must of read that the next day because by that afternoon I received a phone call saying if I would like to meet with him that I sure could the next day. But not necessary. And to plan on surgery the next week (9/20). What??? I wanted an Appointment. It was worth the 90 mile drive to talk with him.

Met with him Thursday. I asked about the MRI. I thought he wanted that before surgery. He said he can proceed without. He wanted it to get a clearer pic of what’s going on before opening up the knee. If it gets done before the 20th, great, if not, we can still proceed. So we talked about what he’ll do, and the recovery and rehab. He said he was also going to check the poly insert and exchange it for one that is 1-2mm taller or short (can’t remember which). Have to wear a full leg brace, locked at 0° extension, 24/7 for 6 weeks. And then will add degrees of flexion each week. and then will be doing PT. I asked if I’ll get back my ROM. He said yes. He said the pain with this recovery isn’t like a TKA. I should only have pain for a couple of days. Can drive when Im off narcotics. Can return to work when I want. I haven’t been to work since my TKA So I need to get back soon. It was a good visit. Im glad I made the trip.

So everything moved fast. Had my pre-op physical last Friday. Never did get the MRI. Had to get everything ready at my house again. My concern will be the brace. I hate the one I have. He said he would look into getting me a better fitted one with a different company but I doubt he’ll remember that. Also getting up out of my recliner with my leg locked straight. I think I’m going to have to sit on a pillow or two to help. Since my quad injury I’ve been back to using a walker and my shoulders are taking a beating. Especially my right shoulder which has a rotator cuff tear. In a couple of weeks I’ll get in to get cortisone shots.

Not going to lie, this surgery and recovery is giving me anxiety. I trust my surgeon and I know he can fix it. It’s the long recovery and how careful you have to be. That’s the one thing he said to me when I asked about returning to work etc. He said just be careful. My knee - it’s doing great. We had to stop PT because I needed to save my insurance covered sessions for therapy for my quad. Only thing I’m noticing is during the night I sleep with my leg bent at the knee. It gets really stiff and painful. Ive Also been having some IT band pain in my thigh. By the end of the day my knee can get achy. I know my knee is going to hate being straight for 6 weeks. Ugh.
I’ll give an update once I get home from the hospital.
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Prayers for a successful procedure and smooth uneventful healing journey.
I will look forward to following your thread for updates and offering support if you need it, midwest girl.
Lots of comfort to you, and peace of mind as you await the 20th. :console2:
@midwest girl
Please let us know how you are doing as soon as you can. We are here for you and yes, this is a knee forum, but your quad is connected to your knee, so you belong here! Besides, you are still healing from your revision surgery.

Don't worry about your bend. I was put into an immobilizer with each of my kneecap removals for 6-8 weeks and my ROM came back fine even without PT! Your daily activities around the house are PT.
Oh that got fast tracked!!!! Good news!!! Looking forward to hearing from you post op!
Well it’s been awhile since I have posted. Quick recap - I had my total knee revision in July and things were going well. Got to a ROM of 0-122° by week 6. And then I suffered a quad tendon tear. Had my surgery to repair that on Sept 20th. While he had my knee open he noticed that my knee seemed a bit loose. Noticed it hyperextended a bit. He replaced the poly insert with a bigger one and he said it’s super stable now. My leg has been in a full leg brace locked at 0° extension since I left the OR. I have to wear it 24/7. And it’s a pain. Still use the walker to get around but have graduated to using one crutch occasionally.

Today was my 3 week follow up with the PA. The day I was to get my stitches out. Sadly it didn’t happen. She noted that there was some small areas on the incision, especially in the middle, that the incision wasn’t quite closed. She could see some separation. I couldn’t see it because of the scabs. But she inspected it for quite a few minutes. She wants to wait another 4 weeks to remove them, when I have an appointment to return to have Xrays taken to check my hardware for my knee. So at least 4 more weeks in the locked brace and MAYBE they will allow the brace to be unlocked. She didn’t know if it will be completely unlocked or set at a certain degree of flexion and grad work towards fully unlocked. She thought PT may start in December. Or maybe wait til 3 months in January. Surgeons decision. He assured me I would get my ROM back.

Im part of a Facebook group that is for people who have had quad tendon tears and their recovery. It is a long recovery. And slow. So far I have found this recovery to be harder than total knee recovery. Because my knee revision is fairly new it is also still going through the healing process. The first week the urge to bend my knee was pretty strong. It just felt so achy and stiff because it needed to be bent. That urge isn’t so bad now. But I’ll still get knee aches and pains. And then I have quad muscle pain just from the process of the surgeries, have those muscles retracted. And of course the area that had the repair. It doesn’t help that the grace straps are tightened right over the sore quad and right at the base of the kneecap, sitting right at the top of the tibia. I’ve ordered a different leg brace that is telescoping and you can place the straps where you want. I’ve got to get it off the top of the tibia. Plus the straps on top of the stitches doesn’t feel great either.

Next week I‘m going to try going back to work. I’m restricted to half days. I’ve noticed that most in the quad recovery group don’t return to work before 6 or 8 weeks and I’m going back at 3.5 Weeks. With two back to back surgeries, I’m running out of leave. So I’m going to try it. If I can’t handle it I’ll stay home longer and make it work. So thats where I’m at. Recovering for a knee revision and a quad tendon tear repair, together.
When each of my kneecaps was removed, my patella tendons had to be shortened. this required me to be in a full straight knee immobilizer for 6-8 weeks. I, too, had strong cramp-like pain because my knees wanted to bend. What I found that helped was to gently push down the back of my knee into the back of the brace. It was uncomfortable to do, but it did help to reduce that crampy feeling. Ask your doctor before you try this!!!

My immobilizer was made out of a tough, thick foam that had about 3" of internal bars on each side. I had four straps to secure it. In my painful areas, I left the straps a little bit looser with the other straps holding tightly, I was still completely straight. Maybe you could do this.

I was concerned that my bend would not come back, but it did, and it did it without PT! I was divorced and had no one to drive me to PT so I had to recover on my own. I just used my legs as I could doing my daily duties at home. Some days I did too much and would hurt for the next few days. Some days I did normal things and made out just fine. You will find your sweet area of rehab, too. Just listen and obey your knee and things will work out and the bend will return!
I am sorry midwest girl. You have a lot going on all at once and I'm guessing this all tests your patience some days. My wish for you is perfect healing and the stamina and patience to endure the slow process back to normal.
I hope work isn't too difficult for you and your co-workers show you some grace considering all you've been through. Please know we're here for you and stay in touch with updates on your progress!
@midwest girl
Thank you @Layla for kind words and well wishes. It definitely has been a journey. I’m a firm believer that everything happens for a reason. Don’t know what that is yet in regards to the quad tendon injury. I’m questioning if it’s too early to return to work. I won’t know unless I try. I just know that if I leave my house to go anywhere requires a lot of energy and just the desire to do it. Walking with the brace and using an aid (walker or crutch) is just a pain. It hasn’t gotten any easier with time. I have a different type of brace coming in next week and I hope it will work better than the one I have. I absolutely hate this brace. And with my leg muscles already showing signs of atrophy the brace just now feels too big and the Velcro straps (which are not adjustable) are too long. Well it’s 3:15am and I need to try and get some sleep. Thanks again!

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