TKR JLP's Recovery<

[referee54]

I am sorry to read of your issues! I am going to tag @Josephine so that she can see exactly where the pain is and get you the advice that you need!

Have you investigated the possibility of having IT Band issues?

 

[Josephine]

Any thoughts on why it is still so painful?

I could have but before I offer an opinion.

Can you tell me the exact site of your pain using this chart?

I'd like to ask you some questions if you don't mind, and 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 just now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)
Please also include for other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. are you using any pain medications? If so, what, how much and how often?

3. do you have any swelling in your knee? If so, how does it compared to these examples?

4. What is your ROM - that's flexion (bend) and extension (straightness)

5. are you sill icing your knee at all? If so, how often and for how long?

6. are you still elevating your leg. If so how often and for how long?

7. what is your present activity level? EG, work. housework, cooking, cleaning, shopping, etc

8. are you still doing any exercises? If so, what, how much 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!)

Please list these exercises, say how many times you do each one and how many times a day.
Have you been doing these consistently from the date of your surgery?

 

[JLP]

Location of pain is D RF1 and RF2.

1. Pain level is 4-5 and sometimes much worse on the outside of the knee area.
2. using ibuprofen and tylenol but it not very effective
3. The knee is about 2.5 inches bigger than the non surgery knee and always much warmer than the non surgery knee
4. My last measured ROm was 125 and 4 but that was at about 2 months after surgery and it has not been measured since. My leg straightens completely and I think I probably can bend it (with pain) just about as far as my non surgery leg
5. Not icing any more. Stopped icing at about the 6 month mark
6. Still elevating leg whenever I am just sitting around
7. I can do just about anything I want as long as I am willing to tolerate the ensuing pain including housework, walking, riding a motorcycle. I even did a moderate hike in September
8. I am not doing any specific exercises at this time

I do have a point when I bend my knee where I encounter a good amount of pain. I can bend past this point and the pain stops. I have a hard time sleeping at night because the knee is so painful. The pain on the outside of my knee is like a burning sensation and the pain in the knee joint itdself is just plan of pain and stiffness. Even though it feels stiff, it still bends well.

 

[newlybionic]

Sorry to hear that you are still having pain with your knee. I'm 8 months out today and I still need to elevate and ice during the evening after a long day of activity. I find that helpful.

 

[JLP]

Not sure what IT band issue is. My fake knee joint does feel like a vise is squeezing it all the time and the pain on the outside of the knee has been there since surgery. It is now painful to go down stairs and I have had no issues with that until recently.

Thanks to all for the kind words.

 

[Celle]

Not sure what IT band issue is.

ITB (ilio-tibial band) issues and treatments

 

[Josephine]

Location of pain is D RF1 and RF2.

I think that's probably an IT band issue. If you look in the article Celle left you, you will see the IT band wraps right around the side and front of the knee there.

I'm afraid your answers are lacking detail. If you would add that into the questions I have marked in blue, I can get to answering them

1. Pain level is 4-5 and sometimes much worse on the outside of the knee area.

Much worse like what?

2. using ibuprofen and tylenol but it not very effective

You haven't told me what doses you were taking and when (how often)

3. The knee is about 2.5 inches bigger than the non surgery knee and always much warmer than the non surgery knee

That still doesn't tell me how your knee compares to those in the picture

4. My last measured ROm was 125 and 4 but that was at about 2 months after surgery and it has not been measured since. My leg straightens completely and I think I probably can bend it (with pain) just about as far as my non surgery leg

Okay

5. Not icing any more. Stopped icing at about the 6 month mark

Can't comment on this until I get the answer to Q3.

6. Still elevating leg whenever I am just sitting around

okay

7. I can do just about anything I want as long as I am willing to tolerate the ensuing pain including housework, walking, riding a motorcycle. I even did a moderate hike in September

Not good.

8. I am not doing any specific exercises at this time

Jolly good.

Please tag me when you have provided the extra information I asked for.
Thanks muchly!

 

[referee54]

Not sure what IT band issue is.

Many of us had IT Band issues---due to my BTKR, I had them in stereo. Gentle stretching and icing---ice massage---are the key components in recovery, but IT Band issues can be little boogers and take some time to go away.

I would like to see you do the IT Band stretches and see if those help. One thing that helped me was, that, after the stretches, I used an ice massage on both IT Bands. I put water into Dixie Cups, froze them, and then applied the ice directly to the sore area. as the ice melted, I simply tore the paper away.

 

[JLP]

Hi Josephine. Here are answers to your questions

Pain on outside of knee can be about a 7 for a short period of time (less than 10 minutes) and then it drops down to 3-4 level.

1000 m g Tylenol plus 400 mg ibuprofen 3 x a day. Sometimes 1 tylenol pm at night when I am desperate for sleep.

Knee looks like middle picture with moderate swelling and it is warm all the time

 

[Josephine]

Thank you!

Pain on outside of knee can be about a 7 for a short period of time (less than 10 minutes) and then it drops down to 3-4 level.

That's still far too high for how long it is since surgery. 10 months, I believe.

1000mg Tylenol plus 400 mg ibuprofen 3 x a day. Sometimes 1 tylenol pm at night when I am desperate for sleep.

I suggest you take the Tylenol 4 times a day and never just take one! 500mg is not an effective dose.

I also think you are doing too much as indicated by the pain scores and the swelling. There is something you are doing that is irritating your knee and you need to figure this out.

 

[JLP]

Thanks for all the advice. I appreciate it.

 

[sistersinhim]

@JLP, my worse pain is also on the right outside. At times mine is as high as yours, but ice helps me better than anything. It is still partly numb there, especially the skin, but the inside is waking up. The rest of the knee isn't bad at all. I can go up and down steps without pain, but if I try and lift my leg sideways and up, it's extremely painful. So know that you are not alone with that pain up the side of the knee.

 

[JLP]

So I had an appointment with the ortho this week and there does appear to be something wrong. It is just way too painful after a year and the pain is mostly in the joint itself. I have bursitis on the I left side of the right (TKR) knee and my X-rays show a luminescent line between the implant and the tibia that was not there in previous X-rays. It could mean the implant is coming loose but there was no indication during the physical exam. First step is to rule out infection which seems unlikely to me at this point but I did have a blood draw. Have an appointment next week to see what blood work results are and the ortho will decide after that.

Question, how is a revision done on a revision? My initial surgery was a revision because of avascular necrosis (not arthritis) and I have a long spike in my tibia.

I tried the stretching exercises for IT band but they really gave me no stretch at all. I have always been pretty flexible and have a hard time feeling any stretch in my legs.

Good news is that my range of motion is great.

I swore I would never have this type of surgery again.

 

[JLP]

Is a revision on a revision any different than regular revision surgery?

 

[Celle]

I'll tag @Josephine for you. She's the best person to answer your question about a revision on a revision.

 

[Josephine]

Not in the least. It's exactly the same.

 

[JLP]

Do you know any other info about the luminescent line on my X-ray between the tibia and the new knee?

The existing long spike is not removed and replaced is it?

 

[Celle]

Do you have a copy of the X-Ray that you can post, for Josephine to look at?

 

[JLP]

Sorry no copy of the X-ray. The ortho said the lumenscent line was not there in previous X-rays. I was not shown the X-rays. Really do not see much info about this in line either.

 

[Celle]

It's a pity your surgeon didn't show you your X-Ray. My surgeon always does that, and he points to things on the X_Ray, to explain what is going on.
Next time he tells you something, do ask to be shown. The more you learn about the problem, the better you will be able to understand it.