TKR Loosening of implant.

[bookread]

I have been following these forums for eight weeks now, but I’ve never made an account. I had my surgery on December 13, 2018. I am in week eight of my recovery.

I had an horrific experience so far. The pain was so intense in the first couple weeks after surgery, I could barely take it. The second I woke up I said, “It hurts.“

I cannot take any pain medicine because it made me too sick.

Then I ended up back in the hospital overnight because I was severely dehydrated. I received 4 Liters of fluid and felt a whole lot better.

Anyway, the intense pain has left. I had to return to work as a kindergarten teacher after my fourth week of recovery.
I did my six weeks of physical therapy. They were gentle. There was no pain associated with PT. I had 129 ROM and 0° on extension.

Everything was going pretty well although still painful. Two weeks ago I woke up with a searing burning pain on the left side of my knee and the pain is on the lateral side (outside).

My doctor had me take a blood test to rule out a blood infection, ultrasound to rule out a blood clot, and x-rays.

Everything looks perfect with my replacement. He diagnosed the pain as nerve pain.
He put me on Gabapentin and an anti-inflammatory called Meloxicam. I think the Meloxicam is helping with the inflammation. However, the Gabapentin hasn’t helped at all.
Of course, I’ve only taken it three days and maybe it takes a week or two to get into my system.

I am quite worried because this pain is so bad. It happens when I straighten my knee from my bending position or sometimes it happens just when I bend my knee. But then the pain in that one little spot on my lateral side of my knee takes hours to go away.

I had 129° extension, but now I can only bend my knee to 117°. I feel like I’m going backwards instead of forwards.

Has anyone else experienced horrific, burning, searing, excruciating nerve pain in one little spot on their knee?

 

[grandma chris]

@bookread I have not experienced this pain but I wanted to welcome you to this site. You know you'll get a lot of good info and support here. One of the advisors should be along soon to respond. Good luck!

 

[Jockette]

Hi and Welcome to Bonesmart!

I’m sorry you are having such a difficult time.

I do believe that part of that is your return to work at only 4 weeks post op. That is very early to do all that pertains to going to work, getting ready, walking to the car, to the building, everything involved in dealing with small children, I’m sure you’re on your feet much more than you are ready for. I’m sorry you were not able to take more time off.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only
ONE Recovery Thread.
This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[bookread]

Thank you. Believe it or not but I have read every single one of these articles before I joined BoneSmart today. They have been helpful.

 

[Celle]

Hello @bookread - and

I'm sorry you're having so much pain with your knee but, given your circumstances, I think it's entirely understandable.

It's simply a case of doing too much, too soon for a wounded knee.

A TKR is a very major operation, one of the most disruptive you can have. It causes a lot of trauma and your body can't heal quickly from it. It takes a a full year for complete recovery, and you're not even at 2 months yet. Your poor knee is still just a baby.

It's not just your bones that have to heal. So many of your soft tissues were moved around, bruised and stressed during the surgery. Those soft tissues take a long, long time to recovery fully.
It really isn't the sort of surgery you can bounce back from in a month or six weeks.

When you read the articles before you joined up, it's a pity you didn't apply the advice in this one:
Activity progression for TKRs
If you had, you would have known that going back to work at 4 weeks post-op was ill-advised.
Read the article again, and see what you should expect to be doing even now.

We usually advise taking at least 12 weeks off work and then doing a Phased return to work, if possible. For an exacting job like kindergarten teaching, even longer might have been necessary.
I know that @KarriB took the full time advised before going back to a job like yours, and she still found it hard.

And you did PT for the full 6 weeks as well. That really wasn't necessary, once you were back at work.

Probably none of this was your fault. I expect you were told that PT was necessary and you just followed orders. But you were given bad advice.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

And your surgeon who cleared you for work (he did, didn't he?) probably didn't realise how active you have to be when teaching little children.

It's not surprising that your flexion has decreased. That's probably because your knee is more swollen and that swelling is preventing your knee from bending.
The pain isn't surprising either.
Your knee is letting you know that you're asking too much of it at this early stage of recovery. It's like a tired toddler, crying, "Mom, I need a rest."

However, all isn't lost, although you do have to do something to help your poor knee.
First: Rest. If you can get more time off work, please do (you probably can't). If you can't, you need to rest your knee all the time you aren't working. Come home, grab a quick meal and then do nothing except rest.
Stop going to PT, if you're still going.
Stop doing all exercises - work itself, plus your normal activities of daily living, is enough exercise.

Second: Elevate your leg every minute you're sitting down. Elevation: the do's and dont's

Third: Ice your knee all the time you're elevating it. Ice to control pain and swelling

The rest, elevation and icing are to help your knee to calm down, and to reduce the swelling. Consider them as "time out" for an upset child, not as discipline, but as time to regain his/her composure.

I hope this helps.

 

[KarriB]

I cannot imagine going back to my first grade classroom at 4 weeks. It was just at 4 weeks that I was able to stand long enough to put chicken in a crock pot for a meal. My OS suggested 12 weeks away from school and I needed everyone of those plus when I did return at 12 weeks I went back part time to mornings only for a month. I spent those free afternoons resting and elevating my knee.

As Celle said, it’s very likely your pain is from doing too much too soon. Frankly I’m surprised your dr signed a release to work note. I needed one to return part time and another when I went back to full time. Do you not have enough sick days? Does your district have a sick day bank you could use?

So if you aren’t able to take more time off try taking ice packs to school so you can ice during lunch, planning and even the drive home. I’d stick an ice pack up my pant leg for my 30 minute drive home. My colleagues would walk my students to special classes, recess, and even lunch for me before my surgery, so if your colleagues are willing to that for you please let them. If you can order groceries on line and just pick them up (Walmart often does this) that will give some time off your leg. While you’re working this early in recovery any time you can spend NOT on your knee is important.

 

[bookread]

Thank you to both Celle and Kari. My doctor never even told me anything about when I should return to work. There was a release form I signed myself and the front office at the doctor’s office just signed off on it. However, I could not have changed my circumstances. I was out of sick days and I have bills to pay. I had to go back to work. Believe me, if I had additional sick days I would’ve gladly taken another week off before returning. My colleagues are not as kind as your colleagues, Kari. I use my walker at school so I can sit down during recess duty and after school duty.
Wow! Okay, I won’t do anymore PT. I will try to let it rest as much as possible. It’s strange though because I have very little knee swelling. The only swelling I have is like a band of swelling right above my scar. The back of my knee has a Baker cyst also. But the rest of my leg is not swollen at all. Even the bottom of my knee where my scar ends is not swollen. I will try to elevate and ice more often than I am.

 

[Celle]

I'm going to ask @Josephine , our Nurse director, to advise you. She has many years of experience as an orthopaedic nurse. She will probably ask you a lot of questions. Do answer them as fully as possible, so she has all the information she needs, in order to advise you appropriately.

I will try to let it rest as much as possible. It’s strange though because I have very little knee swelling.

You must rest your knee. It needs that rest, so it can heal properly. If you continue to overwork it now, you might end up with permanent pain and less-than-optimal function.

Your knee may not look swollen, but it is telling you in other ways - pain and loss of flexion - that it needs extra consideration.
It's not always obvious swelling that affects your knee. There's a very small space inside your knee's joint capsule and it only takes a minimal amount of swelling in there to affect your knee. You won't see it, but it's there.

My colleagues are not as kind as your colleagues, Kari. I use my walker at school so I can sit down during recess duty and after school duty.

Have you asked? It's too late now, but it might have been better if you had prepared them for this before your surgery.

Your colleagues have a duty to accommodate your physical needs after this major surgery, whether your disability is permanent or only temporary. At this stage, you should definitely not be doing playground or after-school duties. You have a legitimate reason why you need extra help at this stage.

Right now, you are physically handicapped. Do you have access to a handicapped parking space, so you don't have to walk as far? Ask your own doctor to support your application for a temporary handicap sticker or card.

Can you schedule an appointment with your school's Principal, to discuss the help you need? A letter or certificate from your doctor might help.
Stress that your situation will not be permanent, but you have had major surgery and need help for a short time.

Showing this article may help people who feel you are just swinging the lead:
TKR surgery - WARNING: real life photos
Did you realise how much your knee was wounded?

 

[Jockette]

I’m so sorry that your surgeon was not involved in the decision about when you went back to work. He needs to be looking out for your best interest.

Any time you can elevate your leg at school will be good, even a little height will help. In class maybe you could use those shorter chairs the kids use, to put your leg up on.

I’m glad you take your walker to school.

I hope you will be able to make some changes that will help you through this part of the recovery.

 

[KarriB]

I agree with Celle, talk to your principal and let her/him know the situation. The day I took my return to work part time my superintendent asked where I wanted my handicap parking space because the only designated spaces were far from my entrance. Also, there may be a way to move your duties (recess or bus) to the later part of the year when you’re feeling better. My school and many others in the area have a sick day bank for teachers who are ill but have run out of sick days. Of course there are requirements to be met, but many teachers in my school have taken advantage of the bank.

Ice is good for swelling, but it’s also a great pain reliever. I was still icing at 3-4 months post op.

 

[bookread]

Thanks for replying. Our school district does not allow light duty. When you come back to work, you have to fulfill all your responsibilities no matter what. So, when I am at recess and afterschool duty, I mainly just sit on my walker (it has a little seat). This is as far as I can go and still fulfill my duties. I cannot sit down during lunch duty though, but that is just 10 minutes a day. I will try however, to elevate my leg more during the day. I will also start bringing an ice pack to school so I can apply ice during my half hour prep period.
I just recently, two days ago, saw a YouTube video of a knee replacement. It was not a real person (I couldn’t take that), but a doctor showed what was done to the bones, using fake bones. Man, is TKR surgery violent! Wow. No wonder my leg hurt so bad after surgery!
My school does have a sick bank, but I didn’t contribute because I didn’t understand how it worked. I will certainly contribute a day, next year!
I will honestly try to rest my knee as much as possible. I guess I didn’t realize how much rest I need. I’m such a go getter, resting doesn’t enter my thoughts as much as it should.

 

[dmichael21]

I feel your pain, we are almost the same age and same surgery date and I as well even today have pain and swelling and only now just lasted 5 hours in a bed. I like you had to return to work early, just finished a 6 day 66 hour week and today is total recovery. I was on teamsters short term disability pay in which is based on 1970’s pay so I was loosing about $500 a week in pay and not contributing to 401k etc. so I know how you feel, your not alone and Ihope you heal quickly.Side note , guys came up to me at work who were able to pull off Workman’s Comp. and told me I made them look bad because I was back to work in 7 weeks and they were out 8 months for the same procedure.

 

[Lindylee]

I had a pain very similar to what you are describing every time I bent or straightened my leg getting on or off the bed or trying to lift my leg. Mine was right on top of my kneecap, just a small area, and I wondered if it was due to a staple. I used a therapy band to lift my leg to avoid the pain and one day I could lift my leg unaided and it no longer hurt. That was after the staples were out so unsure whether that had any bearing. It felt incredibly sore, took my breath away. I hope yours resolves soon.

 

[bookread]

@Lindylee,

Was this pain a sharp burning pain like your muscles were ripping in half? I woke up again last night from the pain. Apparently I had my leg bent and tried to straighten it. It’s just such horrific pain. If it is the nerve pain, like my doctor thinks, then I’m going to wait another week for the medicine to work. If it doesn’t, I will seek a second opinion.

 

[Jockette]

It is really early to consider a second opinion, and most likely you won’t find a different surgeon willing to see you this early, as many pain issues resolve over the first year of recovery.

Due to unavoidable circumstances, your activities are over stressing your new, healing knee and it is rebelling.

Try the best you can to do as little as possible when you are not at work. I know that’s easier said than done, but it’s important.

Josephine will have excellent advice when she comes to talk with you. Please trust her advice, she’s been working with joint replacements for many years, and has had both of her knees replaced.

 

[Lindylee]

@bookread It was sharp, burning, not so much as if the muscles were being ripped, more as if I had a very sore, inflamed kneecap that something sharp was pressing into and for a while after it felt most peculiar in that area when I walked, almost as if something wasn't quite where it should be.

 

[KarriB]

Really the ongoing pain is most likely due to your level of activity. It is usually recommended to take 12 weeks from work and even then it can take a whole year or longer to entirely heal.

 

[bookread]

But this pain is not surgical pain. I know how surgical pain feels like. I had three previous arthroscopic surgeries (menisectomies) on the same knee, before my replacement. I never had such burning pain — it’s coming from a small area on the lateral side of my knee. It’s very disconcerting. I’m a bit worried about it. So far, the Gabapentin hasn’t helped at all. If this pain persists, I will have to call my doctor again. Perhaps I need a higher dosage of the Gabapentin, or it’s not nerve pain.

 

[Celle]

Let's ask @Josephine about your pain.

You say it's not a surgical pain, but did you realise the extent to which your muscles are manipulated during the surgery, even though they aren't cut?
Muscles and tendons are all irritated and upset by this surgery and they often take a long time to heal and calm down.

 

[Josephine]

He put me on Gabapentin (but it) hasn’t helped at all. Of course, I’ve only taken it three days and maybe it takes a week or two to get into my system.

Dead right! It can take 3-4 weeks and more before it takes full effect.

You never said what dose you are on. I need to know that. Most people are started on a fairly small dose and it is increased gradually until it takes effect. That can take another couple of weeks.

I had 129° extension, but now I can only bend my knee to 117°

That can't be. You can't have 129 degrees of extension! It's not possible!
But then you said 'now you can only bend to 117' which makes me think you are confusing the two!
Flexion is bend. Straightness is extension. Here is an image to explain it more.

With extension there is also an extra dimension to extension.
If you can't get your knee flat on the bed, it's a +.
If you can get your knee flat AND lift your heel off the bed at the same time, it's a -