Lounge Doctor

TKR Knee Wobble Question

OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Hi @patriciad,

I know you are right. I need to relax more. I have had much success recovering that I am grateful for.

On the x-ray question I had a lot of time to figure out the bulge. Both Docs are in and out in like 10 min. At most they look at an x-ray for 30 seconds. Typically, I am still asking questions as they are walking out the door. The x-ray file they give you has all the tools Docs use. You can take measurements and manipulate the image characteristics (contrast, zoom, brightness, ...). The bones are bright of course but all the soft tissue is observable too. I simply compared the image measurements with my real knee and pinpointed the bulge dead on center bulge. I am probably accurate to a mm on this.

Yea Doc1 has a good reputation. He fixed my wife's broken ankle a year ago and was excellent. I went with him because of course he does knees as well but we had direct positive experience. Doc2 has the best reviews I could find but I have no familiarity. They are in different practices.

I don't think I have an infection but sure wonder about a mis-alignment (bulge+wobbling knee).

I am wondering if he built the tibia plate first, then discovered I was going to be too lax and compensated by using a large femur component (causing the bulge). That would account for all the things I am seeing and experiencing.
 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
I should add one other thing about me that is probably causing what must appear as panic.

I am a life long competitive runner. One year ago I was considering running my 4th marathon now, this Fall.
 

Pumpkin

MODERATOR
Moderator
Joined
Oct 27, 2011
Messages
27,104
Location
United States, West
Gender
Female
Country
United States United States
I simply compared the image measurements with my real knee and pinpointed the bulge dead on center bulge.
Your natural knee shape is unlikely to match the implant shape. The geometry of knee implants have been designed to allow as much normal knee movement as possible.
I don't think I have an infection but sure wonder about a mis-alignment (bulge+wobbling knee).
The bulge is swelling, you need to give it a full year+ before it will go down. Wobbling knee is your quads, hamstrings, adductors, and abductors are not ready to do their job. As you heal your muscles will support your knee and the wobbling should go away.
Praying all my analysis is wrong and everything is fine.
This is the most likely scenario, you are still very early in recovery from a TKR and are experiencing the challenges a TKR can throw at you. Have patience and give your knee a chance to heal, be happy about all the gains you have made since your surgery.

 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Music to my ears @Pumpkin !

I pray you are right.

Did I mention how awesome you people are? Well you are.

As I said before I hope to one day to be able to offer hope rather than seek it.
 

Jamie

OneStep AMBASSADOR
Senior Administrator
Joined
Mar 24, 2008
Messages
65,194
Age
73
Location
Kansas
Gender
Female
Country
United States United States
OneStep Ambassador Icon
I guess you've figured out that you shouldn't be running any marathons this Fall. Give yourself a year or two with your new knee and see where you are. Many runners either go back to running in some fashion once they've totally healed or find another sport that is just as rewarding.

It's perfectly normal for your new knee to have some "wobble" in these early months of recovery. Your soft tissues need time to readjust to your new normal alignment with the prosthesis in place. Your muscles must strengthen. You are going to make yourself crazy trying to analyze every ache and pain. Your knee appears a little swollen to me and your x-rays look just fine. Swelling is quite normal for up to a year in some patients, especially as you begin to add more of your normal activities.

All this stress you're creating for yourself can be counter-productive to your recovery and to your health in general. When your body has to deal with constant stress, it subtracts energy needed for healing - not to mention the constantly elevated levels of cortisol that occur. Try to find something else to do with your free time besides researching potential problems with knee replacements....reading, yoga, mindfulness training. Shift your thinking so you are celebrating the things that are better from week to week rather than trying to find something wrong. Two experts have told you the same thing. Trust them and let it go.
 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Yea @Jamie you got that right ... no marathon for me! If able I do plan on learning to run mainly so I can avoid being run over a bus .... haha... but maybe for a run around the block once a week for old times sake.

You are very correct about he cortisol and thank you for the reminder there.

Expert #2 got me going when he made the "you are a little loose" comment. I didn't think (stupidly) to quiz him more on that. So now I am alerted to all the wobbling and it is a lot and seems to have gotten worse. Every time I move that leg in any way it clunks.

I'll bug Doc1 and have him see how loose I am now and go from there.
 

Jockette

MODERATOR
Moderator
Joined
Aug 29, 2017
Messages
24,810
Age
65
Location
Delaware
Gender
Female
Country
United States United States
Every time I move that leg in any way it clunks.
Clicking and clunking is completely normal after this surgery.
 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Thankyou @Jockette.

I believe you on the clicking and clunking. It is the degree of it and observable wobble that has me spooked (along with that bulge). I am going to ask for an x-ray of that bulge from the top down so it can be settled what it is.
 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Well this could be me: https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.96BSUPP_12.CCJR2014-063

"These patients, with a more spacious or lax flexion gap, initially do extremely well following surgery, achieving flexion rapidly and comfortably. They progress within months however, to a condition of chronic swelling and tenderness of peri-articular soft tissue, recurrent effusion and a feeling of unease up and down the stairs, as well as getting up out of a chair: anything that stresses the knee in the flexed position."

It isn't a 100% match as I go upstairs pretty well. My ROM suffers somehow going down (even though my passive ROM>130). Yep, getting up from a chair w/o the use of my arms is pretty painful.
 

Painpaingoaway

new member
Joined
Jun 11, 2021
Messages
14
Age
59
Gender
Female
Country
South Africa South Africa
Well done! You are doing so well. I am just on 4 months and still experience the tightness around my knee and pain on moving in bed. Keep posting on this forum- the wise souls here will give you good advice.
 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Thank you @Painpaingoaway. I really like your member name and I agree!

I am actually doing one more thing to verify/see if I am going on the right track. I am visiting a revision Dr Wednesday for a second, 2nd opinion. My first opinion was in our same town and I have read that you really need to create some distance.
 

Pumpkin

MODERATOR
Moderator
Joined
Oct 27, 2011
Messages
27,104
Location
United States, West
Gender
Female
Country
United States United States
Glad you have sought out an opinion from a surgeon who has no relationship with your present surgeon. It will be interesting to hear what he has to say about your knee.
Good luck,
 

patriciad

member
Joined
Jul 19, 2015
Messages
177
Age
67
Location
Tampa
Gender
Female
Country
United States United States
Good luck with your consultation on Wednesday. Hope you get good news and reassurance.
 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Thank you @Pumpkin and @patriciad. I can't thank you enough for "being there."

I think I came to an understanding that I hadn't figured out yet until recently. Basically for the first 6 months (or more maybe) unless puss is draining from your knee or you suffer a complete dislocation everything is "normal" with the surgery; literally everything (pain, swelling, clunking, wobbling, ...). I would tell my Doc symptoms hoping he would use as clues for what is happening and how I am doing and what I should do to aid but that's not what is going on. They basically have the rushed appointment to check a box, collect a check, and unless puss is draining from your leg in his office "it's all good."
 
OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
I have a related question for anyone who wants to chime in.

At what point can/should your expect to get out of a chair without arm/hand use?

For me if the chair is a little high I can do it but the lower chairs I can't.
 

Susie-Q

graduate
Joined
Jul 20, 2010
Messages
774
Age
54
Location
Washington
Gender
Female
Country
United States United States
For me it would definitely depend on the height of the chair. I can do it at PT from the bench when she raises it to the right height for me but I can't do it at home yet without using my arms from any chair. I am tall though so this will take me awhile yet (5'10") and only 4 weeks post-op.
 

beesknee

member
Joined
Jul 13, 2021
Messages
109
Age
61
Gender
Male
Country
United States United States
I just got back from the doctor and asked about the bulges. He said compressed swelling on the bend and will go away. X-rays show no problems.

As for your wobble, most likely that is quad muscle weakness. My legs are getting like noodles and my doctor wants me focusing as much on quad strength as bend.

Attached is an X-ray of my knee at bend. This is during week two and as much as my knee would bend at the time but it shows nothing that could cause a bulge with the hardware. All the parts line up perfectly with the previous bone.

One thing he did tell me was to look at my knee caps. My knee cap on PKR knee looks to be a good quarter inch wider than on my normal knee. Both knee caps are the original. Just inflammation.
 

Attachments

OP
OP
H

HokieGCC

junior member
Joined
Jul 18, 2021
Messages
62
Age
60
Gender
Male
Country
United States United States
Ok, I went to 2nd Opinion #2 Doc today. He confirmed the bulge and judged my knee to be in the normal range for wobble but upper-normal. There is something scary though...

They took an x-ray and I am showing bone resorption under the tibia plate. He said it looked like stress-shielding but an unlikely alternative would be infection and asked when my next visit is to my surgeon. That will be in November. He said that's fine to look again then. When he showed me the x-ray I also noticed the resorption and was puzzled because it was only 5 days ago when I visited 2nd Opinion #1 Doc and it didn't show any resorption then. I showed him this x-ray and he said maybe it is a slightly different angle altering how things look but also this had the possibility of happening in the last 5 days as well ... the same time period where I am noticing greater wobble.

I need some advice. Unless the tibia plate falls out or something like that this sits like this until mid November when I meet with my actual surgeon again. Recall on Monday of this week he dismissed my concerns already and was quite annoyed I made an oppointment. Do I call him and admit I have these two x-rays from different Doctors and see if he will test me for infection?

If it would help I can post the two x-rays if anyone has expertise here.

Thank you all.
 

patriciad

member
Joined
Jul 19, 2015
Messages
177
Age
67
Location
Tampa
Gender
Female
Country
United States United States
How do you feel about going back to the original surgeon now? If you are comfortable you will definitely have to share the further sets of x-rays and opinions with him so he can act on the information. If you feel he will be defensive or dismissive then perhaps you need to switch surgeons to get taken seriously going forward.
I am sorry that you didn’t get the news to stop the worry. Waiting for November will seem like forever.
 

New

OneStep App

BoneSmart #1 Best Blog

Forum statistics

Threads
57,178
Messages
1,463,310
BoneSmarties
35,163
Latest member
Carolyn67
Recent bookmarks
0

Top Bottom