Revision TKR Hmm. Not thrilled with the revision yet

[kmak81230]

Hi Eaglemom: both my flexion and extension have been slow to come - I'm almost at 8 weeks - and I have noticed that I have had a little more improvement since I cut back on all the exercises and have allowed my knee to rest and heal. Rest up and as you feel like it, do some walking around the house. You may find that walking for ADLs is as good as any of the exercises.

 

[Pheebs52]

I didn't think an MUA addressed extension problems at all, only flexion, and Josephine just clarified that. As such, why on earth would your surgeon suggest it? I am in the opposite boat to you with relatively poor flexion, but zero extension. My PT has told me I'm "lucky" because good extension often takes much longer to achieve than good flexion. You and I are only a day apart in terms of surgery, so really, it's early days to expect great extension and for those of us who have it, it just seems to be luck of the draw.

Initially, at 2 weeks post-op, my extension was at -5, and though this sounds odd, what helped it get to zero quickly was walking as one would for a "Field Sobriety Test," but with the longest stride I could manage. PT always has me do it and I do it for about 5 minutes, 3x a day. It's certainly not exhausting or painful and it's also good for balance, so a win on all counts. When I do this, I can really feel those hamstrings stretching in a good way. Along with time, I feel it's also what has helped me begin to walk in a *normal* fashion again as of this weekend; exciting stuff!

So, all this to say, don't despair, stick to your gut instincts, and don't let your OS intimidate you. If you're not up to a confrontation with him, just tell him you need more time to see how things develop naturally.

 

[Josephine]

good extension often takes much longer to achieve than good flexion

Very true but on the plus side, there is no exercise for extension. If left alone, it will come back on it's own with normal walking.

my extension was at -5, and though this sounds odd, what helped it get to zero quickly

Actually minus 5 is good. And plus 5 isn't that bad either. In fact, it's so near it really makes no difference whatsoever.

Here's a graphic to explain how we measure ROM and you can see the difference between the blue 10 (-10) and the red 10 (+10)

 

[eaglemom]

I do appreciate everyone's helping me out. A revision is a totally different critter than a replacement - that I do get. My being indecisive about what my next steps are is very out of character for me. I think somewhere in my mind I'm scared - scared of doing too little or too much. Then add in the exhaustion and its easiest to do nothing - again very out of character for me.

I'm 6 weeks out and through this message board I think I'm doing more than I should be, on a daily basis. The surgeons office wants things "normal" and I know I'm no where near "normal" since the surgery. I think I understand a saying my mom used to say: my get up and go is broken!! I rest every afternoon - and frankly I don't see that changing anytime soon. Its just such a delicate balance between doing enough to get my stamina / energy back and doing too much and the swelling / pain take over.

I wish I had a magic wand to make us all feel better - wouldn't that be lovely?!!

 

[KarriB]

Truly, you can do nothing to "get your stamina back", especially at the 6 week mark. You're exhausted because your body is working hard, exhausting itself to heal bones and tissues from the surgery. My bff has had many many surgeries and I never understood her tiredness, afterall, she was just laying around in the hospital and at home. How could she be tired? I've since apologized numerous times. When your body is done healing in few months you can get on with things, but until then I advise following the Activity progression for TKRs. It's written for that exhaustion that is present and allows you to discover stamina and normalcy slowly.

 

[SusieShoes]

Your exhaustion is normal and expected, though not by you. I don't think any of us ever expect the degree of exhaustion we feel. I'm two months out now and some days I think maybe my old energy has returned, but that feeling only lasts until I go on a trip to the mall, or reorganize my office. Then the tiredness knocks my legs out from under me and I have to nap. Or I want to go to bed early. Or I'm simply too tired and want to lay around like a slug. It's best to give in and say, okay, today I rest. We do a lot of resting. It's a good thing, but for a person who wants to be on the go, it can be frustrating.

I wish you did have that magic wand!

 

[kmak81230]

Ditto to what KarriB and Susie just said. I would err on the side of doing less (if you are worried about too much or too little). This can be a hard transition or decision if you were very active or heard all the messages about having to work hard after this surgery. I did not start having more energy or start have more improvement in ROM until I rested more and I still am prone to overdoing it which leads to little setbacks. As for "normal," who knows when that will happen?

 

[Canada35]

I agree with all of you. I can do one short outing like lunch or dinner out or a grandchild's sports activity. After that, I can't seem to find the energy to do anything except hang out on the couch or lay on the bed with my feet up. I haven't even been to the grocery store since pre surgery. My husband has done all of that as well as 95% of the food prep and clean up. I can't wait to have my energy back!

 

[Josephine]

Its just such a delicate balance between doing enough to get my stamina / energy back and doing too much and the swelling / pain take over.

Trust me, if you try using effort to get your stamina back, you're on to a no win situation! Likewise, with the pain and swelling. Effort=bad karma!

 

[eaglemom]

You guys are so helpful. Over the weekend I cut back on everything - I sat more, rested more & napped. I just worked on walking - around the house, a little bit then would rest. With this recovery it is certainly true - doing less is better.

I have swelling still, but the swelling on the back of my knee is the most troublesome to me. It interferes with walking, for sure. I also started back using the walker a couple of times a day. When I use it I stand straighter, take more even steps and my gait is 'normal.' If I'm using the cane those things just aren't correct. (Around the house I don't always use a cane - I'm ok on my own. Except I notice that I don't move smoothly.)

 

[sistersinhim]

You need to use assisted devices until you can walk normally. You don't want to develop a bad gait!

Great that you found out that less is really more! It works, that's for sure!

 

[Josephine]

the swelling on the back of my knee is the most troublesome

If that's the case, then put your ice pack on the back of your knee.

I also started back using the walker a couple of times a day. When I use it I stand straighter, take more even steps and my gait is 'normal.'

A very wise move! Well done!

 

[eaglemom]

Tomorrow is week 7 from my revision. I will say this recovery has been different than my original replacements. It is certainly slower, my body slower to recover and frankly it just feels different.

My gait isn't good, but I'm working on it. My extension is a tiny bit better, but not what it needs to be. I've been told that my kneecap is almost glued down, probably by scar tissue. I've been instructed to rub the area multiple times a day. On the inside of my knee there is a very sore spot - its even still bruised in that area. I'm getting nervous about the 'glued' knee cap. Swelling is still significant - I am icing several x's per day.

Anyone have any tips to help me with quickly developing scar tissue? I had the original replacement because of a pain issue. Then 3 yrs later the revision because of pain issue. My mind simply can't handle thinking of anything else being done to the knee. Idea's?

 

[Celle]

I don't believe that your kneecap has developed scar tissue (adhesions) because it just doesn't happen so quickly.
You don't have quickly developing scar tissue. What you have is swelling and inflammation and trying to move your kneecap around is just going to increase those.

I'd never encountered this obsession with mobilizing the kneecap that US PTs seem to have, and nobody ever mentioned moving my kneecap in all three of my knee replacement recoveries. My kneecaps move just fine and they do what they are meant to to do.

Frankly, I'd be inclined to leave it alone and let Mother Nature get on with her work of healing, which she is very good at doing. As your knee heals, your kneecap will mobilise, all by itself.

There is a difference between normal scar tissue, which is very necessary, and adhesions, which PTs seem to use as a threat. In spite of what they say, adhesions are actually quite rare and you don't have to work hard to keep the evil adhesions at bay.
Scar tissue and adhesions - what's the difference?

 

[eaglemom]

Man I'm struggling right now - pain & swelling. I know I will be told I'm doing too much. I'm trying to not do too much, and in my mind I'm not. But my knee certainly thinks differently!!

I have several more questions & concerns. I am doing PT - but the program I'm doing isn't strength, its movement. Movement to help the stiffness / tightness. I have an appointment with the surgeon tomorrow, Monday. I'm going to bring up my limited success & the theory even this light exercises are simply too much for my knee.

This past week I've noticed more & more discomfort in my leg. I have two particular areas: on is on the medial side right beside the knee cap. The other is along my lateral side - what I believe is my hamstring. It goes to the back of my thigh, to my knee and down my leg about inches. If I sit more than 30 minutes when I stand my revision knee feels sore, painful and tight. I am icing 2x's daily (will do more today) and relying on muscle relaxers (flexeral) & hydrocodone 2x's daily.

I'm apprehensive about my appointment as it was very casually mentioned at my last visit that if flexion / extension aren't "acceptable" they would do a MU. I don't want an MU - but equally I want a knee that bend and I can have my life back. I know 8 weeks out with a revision isn't much time - I guess I'm just feeling overwhelmed by not being further along. I have the energy of a newborn baby - as my mom once said: my get up and go and gotten up and went!!!

I don't mean to ramble on - I guess I'm concerned about everything and that makes me apprehensive. Any tips / suggestions?

 

[sistersinhim]

It's pretty soon to be thinking about a MUA. Your knee is still a baby and needs time to heal and get the swelling down. Even if you don't see much outside, inside your knee could be full of fluid. That keeps it from bending.

If you don't want to have a MUA, it's your decision and don't let anyone talk you into it. There is not a certain amount of time you have to do it in. It can be done at anytime. The window of opportunity is a myth. Just use you knee in your everyday activities and it will bend more and more as time goes on.

 

[eaglemom]

What a week...... I'll bring you up to speed. I was doing outpatient PT 3X's weekly & felt it was too much, but....

Over last weekend my knee just finally, I think, said I'm not moving, your doing too much, listen to me, and oh lets see how much I can really swell.

Last Monday I had very little bend, so I was walking stiff legged - talk about uncomfortable. I struggled to the car to go to PT thinking maybe they'd have an answer. They immediately were concerned and set me up on ice (which I'd been doing at home also). PT knew I'd been tight & was doing only simple stretching, nothing aggressive, but this had them saying no PT & see the surgeon, they were sending all my PT measurements to his office.

I saw the surgeon on Tuesday. He examined the knee and tested my ROM & extension. They were worse than prior to the revision I'd had 9 weeks prior. He said I need a MUA & he'd schedule it for Friday. I was VERY hesitant and started asking lots of questions about the procedure. He explained it and said if he could breakup the constricting tissue then my knee would immediately move. He said no PT - walk 20 solid minutes a day & ice at least 3x's daily until the MUA. Then after the MUA - the same thing, for 3 weeks then see him again.

I will say the knee did feel a tiny bit better not doing all of the PT, or was that just me thinking that? Who knows. Friday we arrived for the MUA, had a long chat with the surgeon who again reviewed what he wanted me to do at home. He added that he was ordering a Z-pac and wanted me taking 2 ALeve 3x's daily for 4 days. I woke up from the procedure with ice on my knee and a lot less pain. After I was awake we came home. Even the act of getting into the car was easier! At home I had some tea & toast & headed to bed. I was shocked at no pain and more movement. Sat when I got up I wanted to cry - I stood up and took steps like a real person!!! All day I was amazed - and followed his instructions. Today, Sunday no pain (I'd say the knee feels a little tender) and knee bending good. No its not bending perfectly, I'd guess my ROM is better as is my extension, but the extension needs farther to go to be correct. The swelling is still extensive but less than it was. I'm not using the walker or cane and that feel wonderful.

That brings you up to date on things. I did get on the exercise bike and see if I could go all of the way around - nope, not even close. I got off and did my 20 minute walk and iced.

What do you think?

 

[eaglemom]

I guess I'm surprised that no one comment on my posting. I'm adding a new detail, and hopefully someone can help me out.

The MUA was Friday & all had been good, until last night. We all know you don't sleep through the night, so some knee twinges last night were what I'd had before. This morning my knee felt good - still swollen, but not huge, and the bend in walking was good. After I'd been up just a bit the pain & swelling set in. It felt like post op pain with the knee, I was miserable. Of course back to bed with pain meds and ice, and that's where I'm staying. Is this usual for a MUA? I feel discouraged because I really felt I'd turned a corner for good, now I feel like I've slipped backward.

 

[sistersinhim]

When you have a MUA, your soft tissues are traumatized, almost as bad as a tkr. It is quite normal to have extensive pain after having the MUA for a few weeks. The BS guidelines are the same for it as for a tkr. Rest, elevate and ice. Only very gentle movements are the best way to rehab after this. No aggressive therapy now or your poor knee will continue to swell and hurt. Please treat it like a newborn baby for the next few weeks.

 

[SusieShoes]

Sounds like the MUA did help you. It's natural for the swelling to increase--post-surgery and post-MUA--for a day or two following the procedure, so that's the likely cause of your leg swelling more now. Like Paula said, the BS guidelines will help you just as much with this MUA as for your TKR. Lots of resting, icing, and elevating to help quiet down the swelling. Go light on the exercises, maybe do none at all, until the swelling subsides. That you could walk like a human being... I so identify with that! What a great feeling. You're back on the right path!