Revision TKR Here I go again - round three

@sistersinhim thanks for the suggestions. The urge to bend my knee only lasted about 7-10 days. I’ve gotten use to it being straight now. I’ve ordered a different brace that is telescoping so I’ll be able to raise or lower the straps so they won’t be over the incision or around the quad area that is so tender. I believe my PT will start in December and I highly doubt he’ll let me forego formal PT. And I don’t really want to. I don’t want to risk doing something wrong that will re-injury the quad tendon. He has a very specific rehab protocol that he will be giving my therapist to follow. I talked with the PA this morning about activating the quad muscles by doing quad tightening exercises or even simple things like raising my leg an inch to slide it over. Absolutely not. They don’t want me doing any activation of the quad at all. Obviously I’m using my quads when I walk but they don’t want me doing anything that will put a strain on the repair.
I highly doubt he’ll let me forego formal PT
He can not force you to go, but since you want to go, I think you should. You know your knee and leg better than anybody else, so just listen to it and you should be fine!
I have had my rigth quad tendon torn 100%, and then re-tore 30% of it this July. AND then I developed MRSA (From the surgery) 8 weeks post op. All tendon repair that had been done, had to be removed due to infection and dehiscence. The patella was also removed due to severe arthritis and infection.

Quad tendon tears are THE worst. I have torn other tendons, and had a myriad of injuries in my athletic career. The quad tears are by far the most difficult. I can provide you with a wealth of knowledge on how to deal with this, if you want. A lot of the information I had to research myself and trial and error. For example: as I am sure you have experienced the brace sliding down: bungee cord to a belt around your waist- works great.
@oncebuilt think you for the response. Yep, I’m finding that the recovery for the quad tear repair is so much harder than recovery for a TKA. Being locked straight in a brace for weeks (it will be 7 weeks) is a challenge. And yes, the falling down all the time drive me nuts. One of the main differences between quad tendon repair recovery and a TKA recovery is the waiting game. With a TKA you start right away working on getting your knee to bend and you see little improvements each day. You feel like you’re progressing. With the quad tendon it’s a waiting game. Waiting for the tendon is healed before you start doing anything. There isn’t that daily progress. And having back to back surgeries and recovery has been challenging and depressing. I want a full nights sleep. I want at least one day when I’m not in pain nor need any kind of meds. I want one day where I don’t cry. Every single day. It’s hard. And I haven’t even done the hard work yet! But I’ll make it through! Yes, any info you can give me I’d be grateful. Thank you!
With a TKA you start right away working on getting your knee to bend

And I haven’t even done the hard work yet!

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
@Jockette my surgeon doesn’t allow forceful bending of the knee to get ROM. He had it written in the orders when I had PT for my TKA revision. He did say with the quad tendon tear rehab PT is a bit different than for a TKA. He said I’ll get my ROM back. He’s all about gentle rehab. I’ll follow his rehab plan so that I don’t re-injury my quad tendon. I’d still rather have formal PT for this repair than going it on my own. I don’t want to do something that will cause a re-rupture.
Good Morning midwest girl,
You've been through a lot with that knee, I'm so sorry you're dealing with the quad tear causing you pain, sleepless night and tears. It has to be difficult and feel like you're in slow motion much of the time as far as the healing process goes. It's great to know your surgeon is all about gentle rehab. It sounds like he's involved in the therapy process since he's giving the PT specific protocol to follow. Since you have confidence in him and you seem to be doing well, given your circumstances, I'm sure you'll be safe following his directions for therapy once he sees the time is right. Wishing you lots of comfort, patience, sleep and perfect healing. I hope today is a good day!
@midwest girl
Wow! You have been though quite a journey. I hope your healing continues and you are able to get life back. I am 3 weeks recovery for revision on my right knee. Reading your journey and seeing your perseverance is helpful. Not that I am expecting anything to happen in recovery. It helps to know what could happen.

I injured my patella tendon at physio after my first replacement in 2018. I am not being pushed this time although physio is at the same place.

All the best to you. I look forward to hearing you are healed and able to go dancing! @midwest girl
Hi midwest girl!
Today marks two months since your tendon repair and we haven't heard from you in awhile.
How are you doing? Please let us know as time allows. It may be a busy week for you, like many others residing in the US with the holiday on Thursday. Understandable if we don't hear from you, but in case you stop by...have a Happy Thanksgiving!
@midwest girl
That two months went by fast and yet feels like forever. I’m still in my full leg brace. I saw my surgeon on 11/9 for follow-up X-rays. He said the implant looks stable. I asked about the daily pain I’m having on the medial side, usually in the evenings. He said it’s normal as the knee is still healing and from the trauma from two surgeries. Since we were at 7 weeks post op from quad tendon repair we’re going to start unlocking the brace and doing PT. I’ll be unlocking my brace 10° a week for the first three weeks and then starting on week 4 will increase by 20° a week until full ROM. But it’s only unlocked while sitting. If I’m up and walking the brace has to be locked at 0° extension. PT is essentially nothing. But it’s what he wants. All I do is heal slides to the point of resistance. First time measuring I had a flexion of 42°. I only go to PT once a week moreso to check flexion. My knee is pretty tight and I’m super cautious about bending it too far. My brace still stays on 24/7 and I’m tired of it.
Had my second outing with friends last Friday night and went to a movie with friends. I agreed because I know the theater seats are recliners. What I didn’t think of was the degree of slope of the aisle. A lot more steep than I thought. And as you know ramps, slopes etc puts strain on quads. I could tell when I got home my knee was weak and noodley and wanted to buckle. Had to use my walker. But when I got up Saturday my knee/quad was fine.

At three weeks post op I was allowed to return to work with restrictions. And I’m limited to 4 hrs working on site. They didn’t really want to release me to go back but I’m running low on leave so I asked if I could please go back. At my appointment he asked how it was going at work. I said it’s been hard. Harder than I thought. So he extended the restrictions and modifies the note saying up to 4 hours of work on-site. So if my knee has had it after 2 hrs I can leave.
Overall everything is going fine. Just incredibly slow. I’ve noticed my scar is so thick. 3 incisions over the same scar I guess will do that to you. He is being very cautious and slow because he doesn’t want me risking a re-rupture. And I don’t want that either. I think I’d lose my mind if I suffered another injury to this knee. Still a lot if “stills”. Still in a brace 24/7, still having to use aids (walker, cane, crutch, shower chair). Still not going out except to work and dr appts etc. I’ve been dealing with this since mid July so it’s been a long 4 months.
You have been dealing with this a long time and have my sympathy for sure. It has to be difficult.
Thanks for the update you shared above. I hope you have a lovely Thanksgiving!
@midwest girl
@Layla thank you! And thank you for checking up on me. It has been a long road. But I’ll get there. Happy Thanksgiving to you and yours if you celebrate this holiday!
That is a long slow journey for sure. I hope that you're able to enjoy some kind of special pampering over the coming holiday weekend... you surely deserve it.
I have a question regarding my scar. So I had the original TKA in 2015. The scar healed nicely. This past July I had my revision and the scar was healing. Didn’t feel particularly thick. I had my quad tendon repair in September. So that incisional scar has been opened three times. This time I’m noticing it’s so very thick. And on each end of the scar there is a hard nodule of what I assume is internal fibrosis. My physical therapist just started doing scar massage last week. And I will gently massage the entire scar with Bio-oil once a day for about 5 min. I’m just wondering if this scar will ever soften and be pliable over time. I’m wondering how tight it will be when I hopefully get my full ROM back.

I’m still in the full leg brace 24/7. Locked straight anytime I’m ambulatory. When sitting I can unlock to 30°. Tomorrow I’ll start advancing by 20° each week. Last week in PT my flexion was measured at 72° although if I pushed myself I got it to 77°. I’m hoping tomorrow I’ve at least reached 80°. My goal is at least 95° by my next appointment with the surgeon on Jan 4th. This recovery has been so different than TKA rehab. This is incredibly slow. And requires a lot of patience. I’m stilled limited to close chain exercises. Really only heel slides and quad sets. My ultimate goal is to get my full ROM back. I hadn’t even achieved that yet with my revision when I had the quad injury. I was at 122° when that happened. So I hope that won’t be my new “normal”. Pre-revision I was at 140° I guess time will tell in this long recovery.
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So that incisional scar has been opened three times.
Is it still opening up or has it finally closed up?
This time I’m noticing it’s so very thick. And on each end of the scar there is a hard nodule of what I assume is internal fibrosis.
These should go away with time. With it opening up three times, it has had to create more scar material to close it back up.
Yes, with massage, continued movement, and any antioxidant type oil it will soften and shouldn't affect your eventual ROM. Hang in there!!!!
@sistersinhim im saying that knee has had three open surgeries. The incision healed closed each time. This third surgery has resulted in a pretty thick scar. PT did say today she thought it felt more pliable than last week. Definitely big ball of fibrosis at the ends of the scar though. At the top it feels about the size of a marble.
im saying that knee has had three open surgeries
Oh, I misunderstood! :flabber: Thank God it wasn't opening on its own! With the same area being opened for your surgeries, no wonder it has thickened. I don't have that experience. Even with 6 surgeries on each knee, my doctors used new areas. Of course, these were 5 different doctors and I'm sure each had their own way of doing it. But, it makes sense that your scar will smooth out as your healing continues.
Today I sent a message to my surgeon via the patient portal and asked if I could unlock my brace or even not wear my brace at bedtime. I’m 12 weeks post op. He said no. Still wants it locked while sleeping. Doesn’t want to risk any type of re-injury. If things are looking good by Jan 4th appointment he may start weaning me from the brace. That answer was a bit disappointing. I just want a decent nights sleep. My rehab is incredibly slow. I’m basically limited to heel slides and quad sets. I’m part of another group whose members are those who have had quad tendon ruptures. It’s hard to not compare your progress with others. And I know that having gone through three knee replacements. But you have to trust the process and trust the surgeon. And I trust my surgeon. But oh boy it’s tough taking things super slow. So I’ll keep plugging along. Just a bit discouraged today.
As you are plugging along, we have your back! Just remember I was one of those that was in a totally straight immobilizer for each leg for 6 and 8 weeks and my bend has turned out just fine! Yours will, too!

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