TKR LTKR - My First Ever!

[Bigs]

wasn't the left knee replaced?

Front camera on my phone (S7) reverses the image.

Question - at night, sometimes the leg decides it doesn't like being semi-straight and decides to straighten by itself, in a little spasm, ie the quad' muscle jerks

If fully bent it's OK, if already straight OK, during the day OK, but while trying to nod off to sleep it's like a dog dreaming or something, with the occasional jerk. Sometimes 2 or 3 in quick succession.

Wouldn't mind so much but as you can imagine, it can be a bit painful. Not the muscle contraction, which is brief and not really tight, but the jerking on the still-tender knee.

Am tracking my calories and nutrients, can see I'm a bit low on potassium but not hugely so. Have a whole tub of Brazil nuts to tuck into tonight...

Progress update:

• Have now had a few 30 and 45 minute walks, including the milder hills of a hilly park
• Can now walk DOWNstairs normally, albeit with my hand hovering over the hand-rail, just in case.
• Removed the dressing yesterday. Looks a bit gory but clean, dry, no sign of infection
• Still being woken up in pain from the leg tangled around in the night
• The implant is pretty darn clunky and clonky; i'd think it was broken or something if I hadn't already read that this is quite common and should diminish over time
• The leg is strong enough for normal movement but still feels weak and tender for lifting sideways. Enough that I've actually yelped in pain while moving around in bed

Other than the tender sideways thing and the clunking I'm more or less back to normal.

Now that the dressing is off I'll be pushing harder, for my upper body as well as legs. Have returned to weight training a couple of times a week - no squats ;) - just to help get my body back into the idea of building muscle. Also amping up protein intake and calories; I can slim down later but my left leg muscles are pathetic, like wet noodles.

Having decided not to ice, I'm now getting all the knee ice things I ordered arriving. I have 4 of the things now *facepalm. Also have a huge jelly thing from Amazon, which I'm going to heat, for my calf muscle, which is still swollen and tender.

 

[sistersinhim]

Question - at night, sometimes the leg decides it doesn't like being semi-straight and decides to straighten by itself, in a little spasm, ie the quad' muscle jerks

It's possible that what you are having is what we call 'zingers'. They are caused by the nerves repairing and reattaching. My leg would also jump at times when these happened and hurt like the dickens! They felt like lightning bolts going through my knee. They lasted a month or so and then started lessening up with fewer frequency.

 

[Bigs]

Question - my new knee is as wobbly as the old one, which had nearly all the ligaments torn off.

Dunno why but I was under some rose-tinted idea that my new knee would be tight and solid, without the wobbling around thing?

So does this mean all new TKR peeps end up with knees as wobbly as mine has been, all these years?

Another thing i was hoping was that the new version wouldn't be as "sunk back" as the old one - but yeah, it pretty much is? Actually it's WORSE, because it seems the angle of the shin is more pointing forward than it used to be?

Is this some kind of natural, inevitable result of the surgery, or has my surgeon really badly screwed things up?

It seems like I AM getting good flexion on the knee, and the knee itself is bending pretty much as far as you could ask a knee to bend, really, but the shin is still angled forward so much that it's only something like 100 or 110 degree bend?

Perhaps I should get photos... Basically the knee is pointing backwards when my shin is pointing down at 90 degrees, if you see what I mean?

 

[Bigs]

They are caused by the nerves repairing and reattaching.

Mmm, I'm familiar with nerves reattaching and the little bolts of pain, but this is a full-on muscle contraction, where the only pain is from the sore knee suddenly extending.

I found a site where it said this is fairly common after the surgery, as the quad muscles are weak. Which reminded me of those 34 years ago after the accident, where the physio mentioned my shaking, quivering leg was because the muscles were weak, so I guess tied into that?

I should add that once in a while, maybe once in 6 months or so, I'd sometimes have the same kind of sudden leg twitch in bed anyway, so the sensation is something I'm somewhat familiar with, a kind of rising tension and then - KICK! I recall mentioning it to my mother before she passed away, a few years ago. However I've never known a spate of 3 or 4 kicks, even when I'm wide awake and trying not to, (because it's hurting the knee).

I'll make sure I'm getting plenty of magnesium and potassium in my diet. Should help, hopefully

 

[Roy Gardiner]

my new knee is as wobbly as the old one

Mine were too, it was most disconcerting. But as the soft tissue adjusted they just got better and better over time. The reason, I think for me anyway, was the soft tissue being 'used to' the old set up, and having to adjust to the new one.

Have returned to weight training a couple of times a week - no squats ;) - just to help get my body back into the idea of building muscle. Also amping up protein intake and calories; I can slim down later but my left leg muscles are pathetic, like wet noodles.

Squats may be a permanent no-no. It makes me squirm to think of angular stresses on the cement holding it all together. And please - I'm sure you know this, but just in case - ease your way in gently and watch out for swelling/pain and cut back if you get any.

 

[Bigs]

Well to clarify, after my motorcycle accident 30 odd years back, my lower leg could move around in relation to the the upper leg, ie the knee joint was missing a lot of ligaments.

I really don't know how or why I was expecting anything different, but the new knee is just the same, there are no new ligaments or other means of holding it in place, so I can still do my stomach-churning party trick of wiggling my calf around while my knee stays still.

(for fun and giggles I've been know to pretend to fall and then say "I broke my leg! Look, it's moving!", which is a great way of getting out of boring social situations...)

After a lot of hiking and generally getting fit, I could not do that trick nearly as well, as the muscles held everything in place quite nicely. I recall feeling silly once, trying to show somehow how the lower leg could move around, and the darn thing wouldn't move at all. Rock solid. So I'm confident I can toughen it up in future, I'm just wondering if everyone here has joined the Wobbly Knee of Bigs club?

Guess y'all must have done, if they cut the meniscus etc.

I do recall seeing an implant that seemed to have a long and sturdy peg rising up from the lower part, inserted into the upper part, so figured that would provide some stability. I don't think my Stryker Triathlon has any such funcy support though. It's just clunking and clanging around pretty awfully really.

Sounds like a bag of old spanners in there.

Seems to be working, I can move around, I just hope it tightens (loosens?) soon, before it does damage

 

[Jamie]

You're right that a knee replacement isn't suddenly going to replace ligaments that were a problem going into surgery. Your surgeon does some balancing on the new joint, but if the ligaments are really compromised, they isn't always a lot that can be done. Are you saying that you actually had ligaments that were totally damaged or removed following your accident?

I am a bit curious as to why, if your ligaments were in this poor a condition going into surgery, that your surgeon didn't elect to use a constrained implant which can provide a lot more stability. You might ask that question next time you see him, especially if you are still able to do wonky movements with your knee. That is not good for your implant, so please try to minimize that movement with your knee. It's still healing and you need to take care with it. Most people may experience their new knee clunking a bit with no pain as they move during the first months. But it is not a normal part of recovery to have a lot of looseness to the joint movement.

 

[Bigs]

Are you saying that you actually had ligaments that were totally damaged or removed following your accident?

Absolutely, the meniscus etc were totally torn away. I spent the last 34 years with just 2 ligaments at the side of the knee intact, nothing else. Hence it would wobble when tired.

I somehow presumed that with an entirely new knee they'd do something about that, especially since I see that for a normal person they have to cut the meniscus and other ligaments, yet here I am, with the same wibbly wobbly knee as before?

The surgeon is on holiday; am due to see him again on 7th January. Hopefully things will have tightened up by then.

I say tight, but when I spoke to the physio lady she said when the leg was tired the muscles would be tight, and that's why I had pain after a lot of hiking. I always thought it was the opposite, and that the knee hurt because the muscles were weak, loose and the knee could move around and grind, which it didn't do when the muscles were fresh.

Really not sure. She's the expert, but I have over 30 years experience with the knee and it was the moving around thing that tended to accompany the pain. I really don't recall ever feeling 'Hey, my knee is really tight, secure and hurts'. No, it was always when getting weak and wobbly.

a constrained implant

Mmm. That sounds intriguing. I guess it's too late to change it, though I am open to suggestions to what, if anything can be done to stabilize it a bit. I don't want the new one wearing out in a few months.

 

[Bigs]

Today's silly video:

 

[Bigs]

So what are some good exercises for a wonky knee?

Standing leg curls should be OK.

I've never been keen on weighted leg extensions... How about "air squats", ie squats with just my own bodyweight?

Lunges of some sort?

Am trying to devise a simple 3x a week workout...

 

[Roy Gardiner]

Dunno much about strength exercises, but I do know that training on a static bike (or a proper bike, even) will make your legs stronger and almost by definition keeps them straight. Maybe try it?

 

[Bigs]

Yeah I had a bash on my elliptical today, at resistance 8 of 24. Was going to go for 20 minutes by stopped at 15 mins as the quad muscle was pretty weak and burning by then!

Just impressed the wife mightily by pedaling my MTB from the living room to the kitchen. Had to do it twice, as the 1st time she was watching TV and totally unappreciative...

I think the elliptical at steadily higher resistance levels will be the way to go

 

[Celle]

How about "air squats", ie squats with just my own bodyweight?

Lunges of some sort?

No to both of these. It's much too early to be doing them. Both those exercises put a lot too much strain on a new knee, especially one that's loose.

 

[Bigs]

New question...

Here the answer was "no" https://bonesmart.org/forum/threads/knee-brace-after-tkr.26451/

to the question of wearing a knee brace after a TKR.

I'm thinking of experimenting with the basic tight squeezy type, see if it reduces the clunking and clonking?

Not for long-term, just to see if I can reduce the clonking while exercising and building up the muscles to hold it in place later.

Your thoughts, feelings and pointy pitchforks?

 

[Celle]

Some surgeons use a brace and some don't. Why not ask your surgeon what he advises?

Did we give you the article about Clicking/clunking knee joint after surgery ?

 

[Bigs]

Yes, I've seen that, though it doesn't cover the level or extent of the clunking and clonking?

With mine:

A simple, straighforward raising of the lower leg to straight - a single clonk
Walking downstairs - clonk-click
Walking upstairs - a double clunk followed by a clonk

If it were a matter of "Mmm, I can hear a click" I'd have no concern, but right now it feels just wrong, like something is completely out of place.

I have read that a single ounce of fluid is enough to jam the knee joint, and I understand that fluid cannot be compressed, merely squirted somewhere else with force, so I imagine swelling must play some part in this. Loose and weak muscles will also play a part. I'm still a bit surprised at just how clonky and clunky it feels, to the point it's putting me off exercising, as I feel I must be damaging the thing.

Happily the elliptical machine seems to work the muscles well without eliciting any clonking, so I'll certainly be working on that.

Why not ask your surgeon what he advises?

He's on holiday until early January.

 

[Jamie]

It sounds like you're talking more about a neoprene sleeve rather than a brace. The two are quite different in the way they function. We've had some active BoneSmarties who wore a neoprene sleeve at times (but much later in their recovery) and that may be okay. However, any device like this so early in your recovery needs to be coordinated with your surgeon for approval.

You are not even a month out from what you describe as a difficult surgery encompassing compromised and missing ligaments in your knee. If your gut feeling is the activity you do that causes this clunking and clicking is doing damage, then you need to trust your gut. Slow down and wait until you can meet with your surgeon in January. You won't hurt your recovery by taking things more slowly and you just might avoid a serious problem down the road with your knee by being more cautious. Your body is still healing. Please let it do that gently. Waiting only means a few weeks out of a lifetime with your knee.

I'm going to tag @Pumpkln who has expertise in this area to come talk with you in more detail.

 

[Pumpkin]

Bigs,
A knee sleeve may help with your position sense and swelling. Similar to the one Zensah carries,

Compression Knee Sleeve

The Compression Knee Sleeve relieves knee pain and runners knee while allowing a full range of motion. Running knee sleeve + silicone gripper = stays in place.

www.zensah.com

You can find this and similar products on Amazon.
Too early for neoprene, it may be too warm and is not stretchy enough to allow for swelling that may occur during the day.

I agree with Jamie, it your gut is telling you to be concerned, it won't hurt to cut back activities that result in clicking and clunking.

 

[Bigs]

Well I have to admit, the surgical scar still has some scabbing, so perhaps I'm being a tad impatient
After the original surgery 30 years ago I had 'external fixation', basically a series of long bolts connect to a bar outside the leg. Later I had what they called a 'caliper', which I think is what you mean by a brace?

I have a few of the tight, stretchy type of knee brace you can get from any pharmacy, some of which have a hole for the kneecap. Having said that I couldn't find any last night, but I know I have some somewhere.

I also have a couple that are the same, tight and stretchy, but also have alloy strips down the side, with a hinge. I was thinking maybe try those, just to see if it helps push and hold things in place while exercising?

Well for now and over Christmas I'll listen to y'all and slow down a bit, just stick with the elliptical and walks in the park. I just mowed the lawn without any troubles, so I'm not crippled or anything, I just want Nefty (New Lefty) to last a long time.

Fast recovery or not, none of this has been pleasant and I'm in no hurry to do it again


Changing the subject - normally I easily keep my weight under control by just not eating any carbohydrates unless they're a from above-ground veggies, nuts or berries. Plenty of fatty meat and eggs, no problem but carbohydrates? No.

Lately have taken the view that I'm eating for 2, as my new baby Nefty needs nutrition, right? And one good thing about carbs is they can help fight infection, so for the last month or so I've just eaten 'normal' food, without concern for carbs or calories...

Ka-plooey! I've gained over 5 kg of blubber!

Nefty or no Nefty, I'm going back to near-zero carbs.

Anyone else noticed weight gain after a TKR?

 

[sondrals]

I gained 5lbs after my first tkr, I literally ate everything in sight from the moment I woke up from surgery. I just keep telling myself the new knee weighs 5lbs

but seriously I think if you have any swelling that’ll account for some of the weight. You’re healing, your body will probably use up the extra calories. I figure things will even out in the end. Since I lost 95lbs in a year I figure I’ll tackle it again in a while. I did/do low carb kinda keto.