Revision TKR Instability Question

[rah2435]

First - thank SO MUCH to everyone here!!!! The support is fantastic.

At no time is your knee left with only the external ligaments and muscles as its only support.

ok - I had lax ligaments so I had a "cruciate sacrificing" implant, at least on the left knee. Also - this is a revision (my second) that is supposed to help with the lax ligaments "in front" of my knee (according to the OS)

Ordinary ADLs will restore your strength and balance.

I hear @Josephine but methinks I'm having some trouble. I do have an LLD - but not as bad as it was. It was over 2 cm after my first replacement but only 0.9cm following last years TKR of my right knee. Left knee still longer and I can feel the difference still it without any lifts in my shoe. It may be "perceived" difference but it's there.
Anyway - I'm not doing any formal PT - just around the house stuff and a bit of walking. But my gait feels very off! When I stand I feel like a slight breeze could knock me over. (exaggeration but you get the point). I find it hard to lift things. hard to walk and stand. Off balance. Weak.

I took a bit of a longer walk yesterday and my left hip started hurting me. May 1/4 mile. I can't really stand or walk with much stability. Left knee hurts when I try and I feel like I have a slight limp. My right foot and ankle seem to be weak.
It just seems to me that my whole body has been thrown off a bit when I walk. It doesn't feel natural. Every time I get up I just want to sit down again. The new knee itself is still sore when sitting, maybe a 2 out of 10. It jumps to a 5 or 6 when standing or walking for just a few minutes.
However, the new knee does fell more stable , solid and reliable but NOT as lax as before the revision.

so much a part of me that I usually forget they're artificial

. My left NEVER felt that way. My right does.
UGH!!!! I'm feeling so down and frustrated. I want to believe in all you are telling me and try to feel more positive but ... I've been through so much. Six years and I haven't been able to stand and walk with any real confidence. I feel like a broken man :-/

bad day.....

rah

 

[Jockette]

Try to hang in there, it’s still very early days.

Recently I compared this recovery to baking cookies. My chocolate chip cookies take 12 minutes to completely bake. If I take them out earlier, at 2 minutes, 4, 8 or whatever, they will only be partially baked, and not all that tasty, because they’re not done yet.

The same is true of our knee at 2 months, or 3 months, etc. It needs time to finish healing.

 

[Josephine]

I'm not doing any formal PT - just around the house stuff and a bit of walking.

Those ARE ADLs - activities of daily living.

Activities of Daily Living are assessed in hospital as a means of assessing your fitness to be discharged home. Your domestic circumstances will be taken into account as in if you are living alone, etc.

ADLs include:

Personal hygiene and grooming
Dressing and undressing
Functional transfers, e.g. Getting out of bed
Voluntarily controlling bladder and bowel elimination
Ambulation (Walking or using a wheelchair)
Housework
Meal Preparation
Care of pets
Meal preparation and cleanup
Walking and other activities​

 

[rah2435]

Thanks for all your advise everyone. Starting to get tingling in my foot. I've read elsewhere in bonesmart that I'm not alone on this one. It's really bothersome though. Also have burning nerve pains along my scar. Both of these increase when I walk. UGH!!! SO frustrated.

I see my OS on the 19th. I was thinking about going back into the office too.... I have a desk job but I can telework most of the time.

This foot tingling is scaring me!

I am also noticing that I seem to be over-pronating (I think that's right ) my foot when I stand or walk - especially noticeable with shoes on. My foot seems to turn outward from my ankle. This can't be right.

rah

 

[Josephine]

Sounds to me like you could do with some gait analysis. See if you can find a PT clinic that has the equipment to do that.

 

[rah2435]

You know @Josephine - I haven't been able to stand or walk right for 6 years. Ever since my first TKR. So, if this corrects things, as I'm SO hoping it will, methinks it will take a while for my body to adjust. Even to these simple things so many of us take for granted. Already I feel more stable standing. But....too soon to know for sure how it will turn out.
You've been there for me for the last 6 years. I can't thank you enough. ... and everyone else at bonesmart.



rah

 

[Josephine]

You've been there for me for the last 6 years. I can't thank you enough

Oh rah, that is such a sweet thing to say!

 

[rah2435]

Hi everyone, 7 weeks. It's still hard to stand for too long and walk more than ¼ mile. ROM is good, I'd say about 5/130 or so. Trying to get to zero with gentle stretches.

Concerns: left leg still feels longer. I get numbness in my knee after standing/walking for a bit.

Also tingling in my foot especially after standing for just a few minutes. It seems worse when I put socks on if that makes any sense whatsoever! I had one really good day - two days ago. I felt like I could stand for ever. That hasn't come back yet sadly.

Plus still have nerve pain from lower back every now and then. Sciatica. Knee is more stable than before the revision BUT it still feels like it slips forward a bit, kind of forward toward the inside. If I tense my quad while I'm standing I'm ok though???

Why does this weird stuff happen to me???? lol!

Biggest concern right now is the foot and ankle. I don't know if this is a nerve thing or not but it's starting to feel that way. any ideas?

Still planning a big trip July 6th.

Thanks
rah

 

[Celle]

Why does this weird stuff happen to me???? lol!

I think that much of what is happening to you happens to most people.

You're not quite 8 weeks into a recovery that takes a full year. How you feel now is not how you're going to end up.
Time will take care of most of your concerns.
At this early stage of recovery, your tissues are still mending and your body is still adjusting to the new dynamics imposed by the surgery.

The ankle and foot tingling may settle down, given time. The nerves may be irritated because of the surgery. Like the rest of your soft tissues, they were moved around during the surgery.

 

[rah2435]

The ankle and foot tingling may settle down, given time. The nerves may be irritated because of the surgery. Like the rest of your soft tissues, they were moved around during the surgery

OMG I hope you are correct @Celle

thank you

 

[sistersinhim]

Sometimes if I stand in one position for a longer than normal time my foot will feel like it has gone to sleep. Once I move it will quit that tingling. I think this surgery affects all of the body, not just the knee. As time goes on you should see little improvements. As we have said, it definitely takes as much as a year to get back to normal. Even after 3 years I still have some pain. But, what's good is it's better than it was before the replacement.

 

[rah2435]

I think this surgery affects all of the body, not just the knee.

I couldn't agree more.

 

[rah2435]

@Josephine - a question. I saw somewhere in Bonesmart that you had suffered from Piriformis problems. I know I'm a pain in the butt (pun intended) but I'm also wondering if I might be having a bit of the same. I definitely get sciatica like symptoms and have the requisite back issues, but I also get a tightness and pain in my butt/hip and now I've been getting some tingling/numbness in my foot - and also my knee sometimes. How would I know if this could be an issue for me as well?

I'm so frustrated because otherwise I am SOOOO close to being better than I have been in 6 years. My leg length discrepancy is down to 1cm. from 2.7. I just had a scanogram done following my OS appointment Wednesday.

The appointment btw went well I suppose. I had an xray done of the new knee, which I guess he looked at. He could see (I was wearing shorts) I have very little swelling and was happy with that. However, I'm still having buckling, instability and trouble walking and standing for any significant length of time. He told me.. well... it's not the knee. It's your back or.. something else but not the knee. the knee looks good.

I was told the buckling should go away as my quads strengthen but I'm wondering if it's weakness from sciatica.

thanks again!!!!
rah

 

[Josephine]

I saw somewhere in Bonesmart that you had suffered from Piriformis problems . I definitely get sciatica like symptoms and have the requisite back issues, but I also get a tightness and pain in my butt/hip and now I've been getting some tingling/numbness in my foot - and also my knee sometimes. How would I know if this could be an issue for me as well?

All of which are classic piriformis symptoms. The muscle goes into spasm and presses on the sciatic nerve which is lying immediately beneath it. This gives you classic sciatica symptoms of radiating down the leg even as far as the foot.

You have the link, so did you read the article?

 

[rah2435]

You have the link, so did you read the article?

thanks! No - the link doesn't work. I get

Not Found - 404

:-/​

rah

 

[rah2435]

Well @Josephine I think piriformis symptom is what I have. I've been doing the stretches.
Weird I was fine all day today at home - wearing my shorts and sneakers without socks. I was standing and walking and felt pretty good. Then I went to show a property with my wife tonight. Put on long pants, socks and sneakers. Took a short car ride and then ... walking and standing in that apartment was awful. I got a knot in my left butt/hip and numbness / tingling in my left foot and leg. UGH!!!
... not too happy.....

frustration!!!

rah

 

[Josephine]

Yep, sounds about right! You have my sympathies.

 

[rah2435]

@Josephine I hate to keep bothering you but, I am freaking out about this. The revision I had was to fix lax ligament that were making my leg unstable - it was loose. My femur and tibia were wobbly and it was hardly able to keep me upright. The doc told me he didn't know how anyone would put up with such a condition.
Now - it is bucking forward and feeling loose when I put weight on it. My big fear is that the op didn't work. But maybe it's the piriformis syndrome or just weakened quads... i don't know.
I have almost no swelling - at least visually. I still have some pain but very minor most of the time. Maybe a two or three. BUT I do have the nerve pain from sciatica which have minor pain in the knee. I do have the sciatica pain however which is not constant.
So - in you opinion - do you think my buckling knee could be due to the sciatica from piriformis or weak quad strength? I hate to think the op failed.

thanks,
rah

 

[Josephine]

I can't really see why piriformis syndrome or weakened quads would result in your knee buckling. Did you ever get a second opinion on this? Because I feel it needs a 'hands on' exam and some investigations to get to the bottom of it. Sorry I can't help more.

 

[rah2435]

Did you ever get a second opinion on this?

Interesting - the doctor's office told me that weakened quads usually are the culprit. I haven't gotten a second opinion since this last operation - just two months out, no one will see you for that until you are a year out.

Or are you being facetious? When I google buckling of the knee all I find are things like nerve issues and weak leg muscles.....


thanks
rah