Revision TKR Hmm. Not thrilled with the revision yet

[Jockette]

more patience needed as always.

That sure is true!

 

[eaglemom]

I have an odd question. Is there any reason to not ice? Can you ice too much? I'm at 11 months and have started icing again. I'm not sure if its doing too much for the swelling, but mentally the knee feels better while and after icing.

Thanks guys.

 

[Mutti3]

I just wrote about this in another thread. No swelling, I don’t ice like that for hours! Also the prosthesis got so darn cold!

 

[eaglemom]

I still have plenty of swelling going on. Enough to share!!!

 

[Celle]

If icing feels good, keep on doing it. As long as you protect your skin from "freezer burn" , no harm will come of icing.

 

[eaglemom]

Ok guys, I'm needing some information. Last week was the 1 yr mark for the revision. It's been a long haul, and I'm not where I want to be. Still issues with swelling and tightness.

Fast forward 2 days ago and while in the kitchen taking a step it felt like my leg went out, for lack of a better explanation. It didn't hurt, just startled me. By that evening I was walking stiff legged and hurting, a 6 on the pain scale. Ice elevate and medications were done. Today, Monday I'm having to use my cane in the house. The knee feels like it has a tight band around it just below the kneecap. Since I'm walking wonky my back hurts. This is starting to scare me like the revision needs a revision.

Idea's suggestions? I have to teach one last class tomorrow morning. I will sit and elevate during that time frame. This just feels off.

 

[sistersinhim]

Oh my goodness. I'm so sorry to hear of your misstep. Does icing help? I'm two years and sometimes do have some strange discomforts. I bet you stepped a different way and something pulled that you hadn't had before. I pray it gets better.

 

[KarriB]

I have weird feelings too and even at a year post op my knee would feel as though it popped out of socket but didn’t really. At night my knee would get stuck while I was in bed, it didn’t hurt too much, just felt strange.

 

[eaglemom]

I just have a sinking feeling something is going on with this knee. I've not contacted the surgeon, not sure I want to hear bad news. (I'm not usually a downer type of person, but this knee business has worn me down.)

When walking the pulling my leg back is just fine, its the motion when the leg goes forward that is bothering me. Sadly that was part of what happened prior to the revision. Thus the reason I'm nervous. I've stopped riding the recumbent bike thinking that was aggravating the knee even more. Just doing DL and calling it good for now.

In case someone's wondering, yes the knee is swollen, I do ice it usually 2x's daily, and yes I'm taking tramadol prn.

Sure wish I had a magic wand to wave and we'd all have good knees.

 

[SusieShoes]

It's tempting to avoid finding out bad news. None of us want it, but avoiding bad things doesn't unmake them. If there's something wrong with your knee, avoiding it just puts off the inevitable... and can make it worse.

If only for your peace of mind, you should call the surgeon and see about getting an X-ray. You might find out something good: that your implant is fine. Then you can stop worrying about that and start looking for the actual reason you are having pain. It's most likely a soft tissue matter, but you need to rule out any problem with the implant or your bones.

I hear you about getting worn down. You've had such a drawn-out recovery already since your synovectomy. Dealing with another backward step just feels wrong, and unfair. Your knee might settle down if you continue to rest and ice. Ice even more if you can. But if the pain continues after more time has passed, do call the surgeon.

 

[eaglemom]

Thanks SusieShoes for your response. My surgeon is a BoneSmart surgeon, that's pretty cool to me. Anyway, they (PA at his office) says even though the calendar says its been a year and a week, this knee has been through a lot. Its not totally healed yet. Around 18 months and more before it 'should' settle down.

I'm trying to ice & elevate as much as possible. Without telling me to but inferring (meaning the office didn't want to tell me and its not totally accepted) but I'm to try Tramadol as needed but at bed time do Tramadol, Meloxicam and Flexeral. That's to get swelling down, help pain, and stop muscle aches. And ice, of course. I did it last night - I will say I slept through the night very soundly. I do think the muscle pain is a tiny bit less today, but not much. What do you think of that combination of medications? During the day I'm doing Tylenol, and a Tramadol if needed.

So glad this forum exists. Thanks so much.

 

[SusieShoes]

I’m tagging @Josephine to give advice on your meds. I’m not a nurse, so can’t really comment on drug combinations.

I do, however, take Flexeril for occasional back spasms. One thing I can vouch for about Flexeril is that it will put a person to sleep! Knocks me out. It also makes me drowsy and fuzzy-headed for the first few hours after waking the next morning. So no wonder you slept well! It is also a good muscle relaxer. When my back acts up (much less often now that my knees are good and I walk a lot!) Flexeril really helps.

 

[kneeper]

Hoping some TLC gets that knee feeling better soon.

 

[Josephine]

What do you think of that combination of medications? During the day I'm doing Tylenol, and a Tramadol if needed.

Before I can advise you on this I really need to ask you some questions. Are you willing for me to do that?

 

[eaglemom]

Of course, ask away.

 

[Kimberley]

Hi Eaglemom. I had a revision on my knee after 4 years of hell and nobody listening to me that my knee felt unstable and wasn't straight. Eventually I had revision surgery and that was 12 weeks ago. They found the new knee had been screwed in to the tibia at a crooked angle and on one side of the femur it wasn't shaved enough and too much on the other side. I have found my recovery to be much better this time around. I didn't do too much in the first 3 weeks. Just got up had a shower and made cups of tea etc and put ready meals into the microwave sitting down while waiting. I would say that at 6 weeks I took no painkillers at all and I did my exercises to the best of my ability. I didn't worry about the bend at all. I did the heel slides but never pushed anything. I certainly never did anything that hurt me. My bend is getting better all the time just doing normal things now. In fact, I did a 7 mile walk the other day using a stick for my hip but nothing for my knee and it was fine. No pain or extra swelling at all so I am pleased. Just take one day at a time and it will come and hopefully, like me, you will find a big improvement.

 

[Josephine]

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?

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.

 

[eaglemom]

Here you go.
#1 - pain. Sitting in a chair I'm usually around a 4.
Around the house doing daily living 5ish. Walking like a trip to the grocery store around a 6.

I have soreness on my shin also. It has woken me at night numerous times. It is always stiff, of course the longer I'm in a position the stiffer it gets. My knee feels puffy to me. I have muscle pain in my thigh right above the knee.
#2 - medication. I'm working on this one.
I have Tramadol 50 mg I can take. I only it occasionally take during the day. Right now I'm taking 1 at bedtime.
I also have Meloxicam 10 mg I can take.
Every night I take Flexeral 10 mg and this helps me during the night. I also take 1 Meloxicam at bedtime, along with the Flexeral. I think the Melocicam does me the most good stiffness wise.
During the day I take Tylenol 1000mg usually 2x's daily, or 3 depending on how the knee feels.

#3 - swelling. My knee is between huge and moderate.

#4 ROM - Flexion. I can get to past 90 degrees. Extension - not so good. I can't get the leg straight and flat. If there are steps anywhere I go I have to do one step at a time.
During the evening I put my heel on the coffee table and let the weight of the leg hang down for as long as I can stand it - 20 to 25 minutes. Then I have to walk around to even bend the knee.

#5 - I'm icing I'm elevating.

#6 - icing. Yes with an ice machine but not as much as I should be I'd guess. Usually at least 45 minutes and try for an hour. At night if I have it on I leave it on until I wake up to use the restroom.

#7 - I'm doing housework, laundry, cooking, etc. Doing it all, shopping, etc.

#8 - exercise.

recumbent exercise bike 3x 's a week for 25 to 30 minutes.
I do up on my tippy toes 20x daily
sideways walking for 20 minutes daily
I'm suppose to be walking backwards per surgeon, but I only do that 2x a week
Outside walking I'm not good about because it's so hot here, but 20 minutes 2x a week

There you have it. While typing these responses out I've had to get up and stretch my knee/leg because of the stiffness/soreness that occurs. I probably should add that I'm not walking properly because of some back issues. I seem to wobble walk side to side until I get going for a bit then it turns into a limp.

Thanks so much for all you do. I look forward to what you have to say.

 

[Josephine]

#1 - pain. Sitting in a chair I'm usually around a 4.
Around the house doing daily living 5ish. Walking like a trip to the grocery store around a 6.

Gosh, that's a lot of pain for 12 months out.

#2 - medication.
Tramadol 50 mg I take only it occasionally during the day and at at bedtime.
Meloxicam 10 mg does me the most good stiffness wise.
Flexeral 10 mg at night which helps me
During the day I take Tylenol 1000mg usually twice daily, or 3 depending on how the knee feels.

You need to be on a better routine with these medications.
I suggest

Tylenol 1,000mg 4 times a day
Meloxicam 20mg twice daily​

#3 - swelling. My knee is between huge and moderate.

Did you factor in swelling as a form of pain as per this?

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

#4 ROM - Flexion. I can get to past 90 degrees. Extension - not so good

During the evening I put my heel on the coffee table and let the weight of the leg hang down for as long as I can stand it - 20 to 25 minutes. Then I have to walk around to even bend the knee.

I recommend you don't do this right now. It's too late at a year out to be doing this exercise and will only cause increased swelling.

#5 - I'm icing I'm elevating.

Good!

#6 - icing with an ice machine but not as much as I should be I'd guess. Usually at least 45 minutes and try for an hour. At night if I have it on I leave it on until I wake up to use the restroom.

That should be plenty at this late stage.

recumbent exercise bike 3x 's a week for 25 to 30 minutes.
I do up on my tippy toes 20x daily
sideways walking for 20 minutes daily
I'm suppose to be walking backwards per surgeon, but I only do that 2x a week
Outside walking I'm not good about because it's so hot here, but 20 minutes 2x a week

I don't think you should be doing any exercises at this point. They are primarily responsible for your pain and your stiffness.

 

[eaglemom]

I'm reporting back in on my progress / lack of progress. I've really tried to follow everything Josephine suggested. (Ok I'll admit to not icing like I was, but I am starting back icing today.) Everything else I've followed, thanks.

I've just been living life and not doing any scheduled exercises. What I'm noticing is that I wobble, for lack of a better word. My entire leg is quite stiff - like VERY stiff. After I take several steps its better, but still tight / stiff. My lower calf just never relaxes. Sitting in a chair I'm okay, but standing is where the issue begins.

Today we were running errands and hubby very kindly 'suggested' that "if you want your cane I think you should use it." Ugh. But I did use it and I do walk better with it. Yes I still have the lower calf tightness, but I don't seem to wobble as much using a cane.

I have another orthopedic appointment in about 3 weeks. It will be interesting what he has to say. When walking it's not when I pull the leg backwards but when I extend it. Frankly sometimes with the calf pain I've started getting shin pain. Feels like my bones want to pop out. Of course I know that can't happen, but that's how it feels.

I certainly appreciate all of the help and support this website provides.