TKR LindaO's second verse - Both Knees Done Now<

[LindaO]

Oh bless, two lateral releases must be rough! So you have had both a lateral AND a medial release! Wow! I am not that familiar with the dynamics of those releases. It would be interesting to find out why he did the medial, unless it was just not lining up since you received the new knee!
I will definitely try to get my reports to see as you indicated, if he did the same for me ...maybe that is what is causing my pain. Thank you for clarifying!!

 

[sistersinhim]

It would be interesting to find out why he did the medial, unless it was just not lining up since you received the new knee!

Oh no, you misunderstood. I had the first two in 1983, one on each knee, and the second two in 1988. Neither kneecap would track right without them. Then, I had the kneecaps removed in '91 & the other in '93. When I go back to my current OS, I'll ask about the medial release at the time of the tkr that I read about on his report.

 

[LindaO]

Hello everyone! It's been a while since I have been on. Life has been busy as I have made two moves since my knee surgeries!

I continue to have an issue with my right knee and wonder if anyone else has had the same issue.

I have had continued pain on the medial part of my right knee since surgery. I did fall when I tripped over a garbage bin back in March 2019, which caused the pain to get a little worse. Pain occurs when trying to lift my leg/knee to turn over at night, seems to catch at times causing a sharp stabbing pain, swells when I try to do anything like mow the lawn or walk too far. I finally decided to go to see a doctor when the pain became a constant reminder something was wrong.

The doctor I saw is not the original surgeon since I moved 5 hours away. I did a lot of research and he received great reviews and when I saw him, I really liked him. He believes the pain is caused by MCL strain. I do wonder if this was caused during my initial surgery and subsequent MUA since I have had the pain since the surgery two years ago.

His other thought was the right knee still has my PCL and he said it could be failing which puts a strain on the MCL. My knee is not unstable, only painful.

We are trying to see if a brace will help the MCL heal. I am in a hinged brace with cross straps to be worn constantly except for showers for 4 weeks then off for two to see it is better. If not, he wants to revise the femur portion of my right prosthesis removing the PCL.

I am wondering why the compression of the brace is causing pain on the MCL area? I have only been wearing the brace for a few days but the compression pain is worse than the initial pain as it is more constant than when I just lift/twist my knee or leg.

Has anyone else experienced this or does anyone have any recommendations?

Many thanks!

 

[Jockette]

I’m sorry you’re having issues that have required the use of a brace. I’ll tag @Josephine for you.

Maybe the extra weight of the brace is bothering your leg.

Even so, pain that you’ve had all along since your surgery is disappointing. We have this surgery to stop pain!

Wow, 2 moves in less than 2 years! I moved 4 years ago and hope to never move again, but I bet there’s at least one more in my lifetime.

 

[sistersinhim]

I had pain in pretty much the same area that you are talking about. I saw my PA and she said I had an inflamed tendon and sent me for ultrasound. I doubted that it would do any good, but it did! I had 7 sessions and not the pain is almost completely gone. I have no idea if this is your problem or not, but it wouldn't hurt to mention it.

 

[LindaO]

That is a great help! Ultrasound probably wouldn’t hurt to try! Thank you!

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[LindaO]

Absolutely! Thank you!

 

[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.

 

[LindaO]

MCL strain s/p TKA April 4, 2017 and MUA May 16, 2017

1. Two years post-op. Right knee pain is a range from 0-7 depending on the position of my knee. Worse on twisting or lifting sideways.

2. Prescribed Celebrex 200 mg bid
At night I take Tylenol/paracetamol prn

3. Slight the majority of the time but gets up to medium at times when mowing the lawn.

4. Flexion is now limited; worse with the brace on, but I can bring my feet under my chair. Extension is no issue.

5. I am not icing my knee.

6. Yes, I elevate my knee in my recliner 2-3 time a day for 30 min to an hour or longer each time.

7. No limits on my ADL’s.

8. Exercises done at home – Just started
basic foot slides which causes pain but I do what I can 5-10 slides
standing hamstring curl 10 reps twice
Thigh lift 10-20
No PT


Hope this helps.
Thank you Josephine!!

 

[sistersinhim]

@LindaO, your symptoms sounds so similar to what I had. It was called pes anserine bursitis. The ultrasound really did help it. You might ask your doctor if this could be your problem.

 

[Josephine]

I need some extra detail please

At night I take Tylenol/paracetamol prn

What dose?

4. Flexion is now limited; worse with the brace on, but I can bring my feet under my chair. Extension is no issue.

I'm afraid I do need numbers

6. Yes, I elevate my knee in my recliner

Are you elevating according to these recommendations Elevation: the do's and dont's

basic foot slides

By which do you mean heel slides?

 

[LindaO]

@sistersinhim That sounds very close but mine is more medial meniscus area (which I no longer have) but I do have an ultrasound machine and have started using it - just in case!! Thank you for the suggestion!!

@Josephine I will need to get a compass or something to measure the angle of my knee. I don't currently have one.
Tylenol 500mg 1-2 tablets prn (usually take 1 at night but lately 2 tablets)

Yes I am elevating according to the do's and don'ts

Yes, I meant heel slides.

Thank you for your insight! I will get back to you!

 

[sistersinhim]

I didn't realize we regular people could buy these ultrasound machines. I've looked through Amazon and have found several. Have you found any benefits from using yours for different aches and pains? I want to get off of Diclofenac and this might help me do just that.

 

[Jockette]

I didn't realize we regular people could buy these ultrasound machines. I've looked through Amazon and have found several.

What do they do for you?

 

[sistersinhim]

What do they do for you?

I suggest you google a pain relief ultrasound machine. All I know is, is it worked for my tendon problem I have quite a few other aches and pains that I would love to get rid off. If this will work for those, yippee! The reviews on the one I'm looking at on Amazon were great.

 

[LindaO]

I initially bought my ultrasound machine as well as a TENS unit for my back. It would help for short term relief of my sciatic pain but surprisingly, I had bad sciatic pain down my right leg before they performed my MUA and now it is totally gone after the MUA!!
I have just started using it on my knee so fingers crossed it will help!

 

[Josephine]

I will need to get a compass or something to measure the angle of my knee. I don't currently have one.

@LindaO I can do your flexion for you so long as you can get someone to take a photo of your leg in one of these positions, taking note, please, of the shorts and including all the body from the waist and the foot. Then post the picture and I can measure it for you

A good way to check extension yourself is like this:

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's 0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

 

[Josephine]

1. Two years post-op. Right knee pain is a range from 0-7 depending on the position of my knee.

That's high for 2 years out!

2. Prescribed Celebrex 200 mg bid
At night I take Tylenol 500 prn

I suggest you take the Tylenol 1,000mg 4 times a day at 6hrly intervals

I know the FDA has ruled that 3,000mg acetaminophen is a safe maximum but that would be assuming that the patient is taking another medication that also contained it and thereby inadvertently take an overdose. Assuming that this is not the case, the maximum safe dosage per 24hrs 4,000mgs.

3. Slight swelling the majority of the time

Well that's good though I would have expected no swelling at this stage

5. I am not icing my knee.

Perhaps you should.

6. Yes, I elevate my knee in my recliner 2-3 time a day for 30 min to an hour or longer each time. I am elevating according to the do's and don'ts

Good

7. No limits on my ADL’s.

I would imagine


Exercises done at home – Just started - who told you to do these?
basic heel slides which causes pain but I do what I can 5-10 slides - if they cause pain then don't do them!
standing hamstring curl 10 reps twice - so do you actually have hamstring pain? Don't do them unless you do
Thigh lift 10-20 - not necessary

In summary:
amend the pain meds
stop the exercises

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[LindaO]

Thank you Josephine! Sorry I just found your response.

Since I moved, the new surgeon put me in a brace for a month day and night. I had a follow up today explaining how painful the brace was and how my knee cap didn’t look like the left. After an assessment, he showed me when he pulled my knee into the correct position, the knee cap slid into place.

He feels I have a failed PCL in the right knee and recommends revising the femoral prosthesis and removing the PCL (which is how my left is). It makes sense once he showed me so I will plan a revision in October.

Unfortunately commitments prevents me from doing it prior but I am ready to have the pain taken care of - hopefully for the final time! I will let everyone know the results in case anyone else is experiencing the same thing!