PKR I'm Here.... PKR left lateral complete!

[mcirish]

Still having quite a bit of pain with activity under and around my kneecap which is concerning me. I was making progress with leg lifts and flexibility, but the pain in the joint has stopped me dead in my tracks today. Until I read the surgical report I didn't understand why, but it makes sense now that I know that a lateral release was done along with the quadplasty to install the implant.... it's always something. I start formal PT on Tuesday, so hopefully we get it worked out quickly....or maybe it's something that I just lay off of it and give it more time....that's probably the bonesmart answer

 

[mcirish]

Your scar will settle down perfectly well all on it's own if left alone! It needs no help from us at all!

lol. Thanks Ma Bear. I think that's good advice. Just like me to want to do too much!

Well, off to get the Wrap & Seal!

 

[Josephine]

Until I read the surgical report I didn't understand why, but it makes sense now that I know that a lateral release was done along with the quadplasty

And jolly good reason not to overdo the exercises on your 2 week old knee! Neither of these will be healed up until at least week 6! Don't exercise fresh cut muscles!

The lateral release is done where the blue line is.

 

[mcirish]

@Josephine

So I should postpone my PT? I'm all ears. The pain improved a little bit today, but still hard to do leg lifts because of the pain in the kneecap area. I think I still need to work on my quads. The leg is looking pretty stick-like right now......I still have passive full extension, but I cannot get 0 degrees with a leg extension. Muscles are too weak/too much swelling. Flex is still around 110 degrees. Very painful to try to get beyond that. Not forcing anything, but just trying to maintain the progress I have achieved so far.

Also, when I massage my quads I get a weird achy pain in different areas of my thigh and especially in the IT band area. Is this normal?

 

[Jaycey]

In some cases PT can help this process. The most important thing to remember is PT should not hurt. If PT is pushing you then it's all counterproductive. I would see what it's like and stay firm if they try and push you past your comfort point.

 

[jeano]

IT band issues seem to be pretty common--remember the entire leg's alignment has been effected. Sigh. I started having IT band issues 8-10 years ago as the knee deteriorated, now it's protesting because its gone back in the other direction. SSDD. Only now it doesnt seem able to pop over the condyle and settle down, just stays tight. I got a whacking huge foam roller to try to iron it out--helps quite a bit when I do it, but this involves getting down on the floor and wallowing and dragging my very large lower end with my somewhat weak forequarters. It IS always something, especially as one gets to be a certain age. Or worse, has been that age for a while. Have fun at PT--I actually did find it to be good fun. They will enjoy having somebody they need to pull back from doing too much.

 

[referee54]

lso, when I massage my quads I get a weird achy pain in different areas of my thigh and especially in the IT band area. Is this normal?

IT Band issues are all part of the normal issues that may pop up. There are IT Band stretches that you can do, but, considering where you are in recovery, it may be too early to do the stretches. I did have great success with using an ice massage to the sore area. You fill Dixie Cups with water, freeze them, then apply the ice directly to the sore area. As the ice melts, you simply tear the paper away.

When you get to the appropriate point, here are some IT Band Stretches:

think I still need to work on my quads. The leg is looking pretty stick-like right now......

What you want to do and what you should do are two different issues. You are putting the proverbial cart before the horse. Strength and stamina are two of the last to return to the muscle. How can you adequately work on gaining strength in the quads when you are lacking the necessary ROM to truly work the entire muscle? In building strength, you are supposed to work the muscle's full range of motion, right? You are not there yet. Trying to rebuild the Quads' muscle mass at this time is counter-productive.

I know that the muscles atrophy very quickly, but now is not the time to attack the atrophied muscles---they need to be gently stretched to gain the necessary ROM, and that may take a while. Be gentle an gain the ROM first.

 

[RedRider]

mcirish, glad to hear you're progressing well...
So did they explains why he had to trim up your medial compartment? Was your knee "catching" or anything? There must have been a particular reason for it since I imagine you wouldn't want to tamper with the shock-absorbing capability of your good compartment.

 

[RedRider]

...also something to keep in mind as you begin your PT regime is your total alignment. Years of compensating for a "bad" knee can throw everything else off inthe process. Case in point is my mom, who had dual TKR's last year: her knees were amazing but her hips started becoming an issue as she returned to her normal walk, stride and alignment. She refers to that as the most difficult challenge of her PT. Im not trying to freak you out, but being aware that there are things beyond your knee that will be painful as you progress back to health is important to know.

 

[mcirish]

@RedRider

I think I mentioned this before, but we had a standing agreement that, short of doing a total knee, he would fix anything that needed repair. I had occasional pain on the medial side, but it was unknown as to what was was causing the pain. I think even the day before the surgery I had some pain on the medial side of my knee, but I massaged it out and determined that it was tendon pain from overdoing the pre-surgery conditioning. I thought that he might have to do some micro-fx or paste grafting, but he said, other than the meniscus tear, it looked pretty clean in the medial compartment, which surprised both of us a bit.

I had thought about what complications the readjustment in gait might cause for about a second. I will gladly take any of the problems and work through them happily.

 

[icep707]

Hey mcirish. You did it ! Geez time is a flying . Keep up the great work. You will be enjoying this beautiful California weather this spring and summer pain free. Just dont get too soft on me later !!

 

[kneeper]

Continue to keep in mind that your improvement will come over the long haul--lots of healing left to do.

 

[mcirish]

yep, I decided to postpone my formal PT for 1 week. I actually had a nice bounce back yesterday from the pain I was having. I just gave my knee about a day off and focused on my rest and sleeping. The next day it was fine. I was able to do some good work with heel pumps, quad sets, heel drags and leg lifts. Doing some massage as well. I feel like I am doing enough right now and I might even take another week to start formal PT depending open how I feel at the end of this week.

Energy level is back up and I started back to work today. Going to try to put in 6 hours. Been here almost 4 hours now and feel fine. I have about 4 ice bags in the freezer that I am rotating. I just close my office door and put my leg up on the desk! Using my crutches to get around.....hate to say this, but I think I am actually getting more rest at work than at home! lol Don't tell my wife ...actually it's my little girl that keeps me on my toes. She is such a little sweetie, but still wants horsey rides and gets very upset when daddy can perform...anyway, here I am and it ain't that bad. Will let ya'll know how it goes.

 

[mcirish]

Came home last night and I was EXHAUSTED. Partly my fault for eating a minimalist lunch (almonds, pretzels, apples and oranges) like a dum dum, so I overstocked my work fridge today....I am finding that I hit a wall in the mid-afternoon, but all I do is close my door, put my yahoo messenger on DND, roll out my "yoga" mat and "meditate" on my back for about 30-40 mins lol. I told the guy I contract with that I may need to do that from time to time since I came back early. He is a pretty cool guy so no problems there....I am able to ice my knee on demand....everything seems to be going well so far.

On that note, I am reaching that point where my knee is starting to "turn the corner". The swelling is diminishing rapidly and almost overnight I have noticed a pretty good increase in flexibility, strength and dexterity. I am flirting with 120 deg. flexion and a couple of subtle movements I was having problems with are are coming back.

One was just being able to lift my left leg into the car without pain and without using my hands to physically lift my leg into the car. The other is when I am sitting in a chair with my legs at about 90 deg. I was having great difficultly lifting my foot and extending/stretching my leg forward. This morning was the first time I could do this pain free since the surgery.....I am definitely not going crazy doing it, but it is nice to know that normal function is starting to comeback to the knee.....every time I re-read the surgical report it seems I learn something new. One of the reasons I was having so much pain in the knee cap area was the lateral release. Another was the newly discovered fact that Dr. Sisto had to do a little "resurfacing" of the patella (patelloplasty) in order to help it track correctly. It also looks like there was some thinning to the articulating cartilage so some of it was also to "promote healing" according to the notes . The report does not give enough detail to know how much was done or where the actual resurfacing was so I guess I will find out at the next appointment. One of the bad things about Sisto being so good is that he is in such demand, he has a very limited amount of time to spend with each patient. That was obvious during the last appointment as I think he was actually with me in the exam room for MAYBE 2 minutes, even though I was at his office for over 1 hr! Oh well, that's modern medicine for you I guess.

 

[kneeper]

Sounds like you're figuring out ways to adapt at work. Just be sure to rest when you're at home.

 

[mcirish]

@kneeper We find ways to adapt when we have to. Back in the mid 1990s I worked for a company called AMGEN who had terrific employee benefits. I had my first ACL reconstruction done and it was great. I took 6 weeks off from work and my short term disability package with the company actually paid me more than my normal salary while I was out. They had a couple of temps slide into my position to hold things together and there was no pressure to come back early.....times have definitely changed, for me anyway. I am hanging in there. Last night I was definitely tired when I got home, but it is manageable. One benefit is that I suffered from insomnia before the surgery. Not any more! Once I hit the pillow I am out within 5 mins

 

[mcirish]

Thursday, 12:00p and I am drained. I am really just treading water at work. I am trying my best to rest at all times. I put my knee up and relax as much as I can at work. Moving around the office mostly on instinct. Had a BD/marketing meeting about an hour ago and I actually did well, good energy and passion, but I need to recharge now.

Knee seems to be progressing nicely, but I was very sore last night. The pain under my kneecap fluctuates, but the overall trend seems to be upward and improving little by little everyday. Still having some intermittent, dull toothache type pain where the implant is, usually when I wake up and occasionally throughout the day with activity and when I exercise the leg. When will it start to fade?

Still only averaging about 5-6 hrs of sleep at a clip because of the pain management issues. Always wake up between 4-5 am take a norco with a snack, ice for about 30 mins and try to sleep for another 2-3 hrs. Seems to be working fine. Can't wait for the pain to subside so I can sleep through the night.

Welp, time to head out for lunch and refuel. Take care folks.

 

[jeano]

Just rest ice elevate etc as much as you can. I just hate it that you are back at work so soon. That waking up at 4AM stayed with me for about 6 weeks iirc...being short slept doesnt make working any easier. Ihe two whole shifts I worked--evening Mon and Tues have wiped me out for this whole week, pretty much--because I couldnt get home, wound down, and in bed before 2AM, and then the dog daughters woke me up each day at 7 wanting to play.

Are you taking Tyenol or anything besides the Norco? I was on as much Tylenol as the law allows until this week. Today is the first day I havent had anything for pain this late in the day--its been about 18 hours in fact. Hmm. I iced most of yesterday and a good bit of today, though. Hello my name is Jeano and I'm an iceholic.....

 

[mcirish]

@jeano
I kind of put myself in this situation about 12 years ago when I decided I wanted to be an entrepreneur. It has been a bumpy road. I make more money, but one of the drawbacks is that the buck always stops with me. No work, no pay. I have found a good situation right now with this company I contract with. I am also working on a few consumer products, trying to get those to market. Once that happens, if the market likes what I am selling, we should have very few financial worries in the future and I will be able to take as much time off as I need next time I have surgery.

Last night was the best night sleeping I have had since the surgery. Zonked out about 11:00, was semi-conscious around 6:30 and just stayed in bed until 8:00. Did not have to get up for ice nor pain meds. I actually could have slept longer, but I needed to get in the office and advance some deals I am working on. I made a concerted effort to sleep on my back (sort of) with my leg elevated. It seems that every time I would roll over to my side and tuck a pillow between my knees I would start to feel that ache in my knee shortly after. This time I stuffed a bunch of pillows under my left side and kept my leg up on the wedge elevated, this way I was still able to slept on my side, but also keep my leg elevated and straight. Will do it again tonight to see if it works again. I really think it helped to keep the swelling down and just kept my knee more happy overall. Maybe I'm onto something here. This morning the swelling was down remarkably. Really starting to see the definition in the kneecap. The scar is healing up nicely. Very pleased with that.

With the Norco I am also taking 2 aspirin a day and I usually take about 3 tylenol mixed in there throughout the day. The pain I am having at the implant site is a manageable dull toothache type of pain. The pain under and around my knee cap is quite intense and feels like someone is rubbing sandpaper in there, but only with certain leg movements, like when I raise the leg and try to straighten it.....puts a lot of pressure on the kneecap and tendons. I am sure the articular cartilage is just rebuilding itself and the knee as a whole is getting used to tracking correctly for the first time in years. I just need to keep working through it, but at the same time, not overdoing it. I start therapy on Monday and then the fun really begins!.....btw, I have become an iceholic too, especially at work. Really helps keep the swelling down.

 

[1ELISEA]

become an iceholic too

Isn't it the best! Helps for just about everything knee related.

Appreciate the detailed updates; helps the other members to hear from those who are in post op healing.

And no letting anyone cause pain in PT tomorrow, that a definite no no.