TKR Mariposa's Journey

[Mariposa]

Hi all,
Long time lurker of this forum. I have read all your articles about recovering from a TKR. Very useful, thanks. And thank God I found this forum, otherwise my recovery would have been mentally much harder I think! There is no such a forum in my native country (Spain).

Sorry about my long following message but I prefer to provide the context..

I am a 53 year old Spanish lady who had RTKR on the 21/07/2022, so a bit more than 6 months now.
It's being a slow and fairly tough recovery I had 2 previous knee surgeries: the 1st one a few years after a ski accident which broke my ACL.. that surgery was apparently a failure for ACL and meniscus in 2007 in France, my country of residence for the last 16 years.. I had a second surgery due to increasing pain on the knee in Spain with stem cells in 2015. The surgeon then warned me then about the first "failed job" which seriously damaged the cartilage.
That 2nd surgery provided relief for a good 6 years.. in 2021 the pain cameback and I had PRP injections for over a period of 1 year.. (every 6 months) they had worked in the past but not anymore.

Forward to a few months before the surgery: the French consultant who I was seeing for it (a renowned one in the region) accepted through his assistant secretary to fix a surgery date over the phone for TKR (June 2022.. I'm a MFL teacher, I could ideally have the surgery in the holiday term). I see him in May 2022, after waiting for 5 months in real worsening pain BUT he announces me that HE WON'T DO IT because my knee can still resist, I'm too young blablabla..

I protested of course, as I had been waiting to see him for 5 months and I knew I needed this TKR.

I left feeling desperate and quite angry.. I decided to ask for a second opinion over there (thank you to the surgeon who had made me wait 5 months for nothing!). The appointment with a second OS was only possible for mid August.. i could not wait that long under the intense pain.. so I contacted the efficient Spanish surgeon who I was also seeing and traveled here to Spain on the 14/07/2022. Only a week later I was having the surgery! Hurrah.. I had to go private though and paid for it.. but I know it was the right option then.

He confirmed the appalling state of my cartilage and knee and the need to have it done after the surgery. It was worse that what could be seen on X-ray.

But unfortunately, due to all the previous journey before the actual TKR, I arrived at the clinic with a significant muscle atrophy on the right leg.. which I do believe it has really hindered my progress.
I had to use a crutch until the 4th month..

My knee ROM is now good (125), extension 0 from day one..

I made a mistake of overdoing with a weight at 3 months
And I had a small pocket of swelling under the kneecap just after that (which hasn't disappeared but doesn't really hurt.. I showed to my OS here and he didn't seemed concerned.. at my 5 months' visit)..

Since then I have concentrated on working at the pool (walking, a bit of swimming with a gentle kick and a bit of aquajogging with a floating belt) 3 times a week..

A bit of walking everyday (not recently because of the pain on left knee) 30 minutes.. and I have started doing a bit of stationary cycling.. about 10 minutes for now with low resistance.

My problem over the last month it's been my other knee. I'm concerned because it hurts.. I thought it would be due to compensating.. so I'm trying to strengthen both legs (slowly as otherwise it hurts the next day) and watching my gait (a physio said it was correct).. but I'm getting a bit worried.

Is this pain on the other side considered "normal" and more than likely would be temporary or should I worry?

I have sent a message to my OS asking him about his opinion. He hasn't replied yet.

Thank you very much for your advice. I really like this forum!

 

[Layla]

Hi Mariposa,
Welcome to BoneSmart. Thanks for coming out of the shadows to join us! We're happy you're here. It sounds like it was quite the journey to TKR for you, but you seem to be doing well.

Is this pain on the other side considered "normal" and more than likely would be temporary or should I worry?

I have sent a message to my OR asking him about his opinion. He hasn't replied yet.

Difficult to say. It could be from over compensating, but your surgeon may want an x-ray to diagnose. I wouldn't worry since you're being proactive in communicating with your surgeon. I am sure he'll get back to you soon. Please keep us posted.

Since you're six months post op and mentioned you've read all of the Recovery Guidelines I don't see it necessary to leave them for you. I hope you hear from your surgeon soon and your knee pain eases. We will watch your journey with interest.
Until next time, take good care, Mariposa!

 

[Mariposa]

Hello Layla and thank you very much for your kind reply!

I'll keep you posted, not sure the surgeon will propose to do X-rays but I'll keep you posted.

Gracias! ;-)

 

[Mariposa]

Hi again,
I have been thinking about my recent increasing pain in both knees.. and I was wondering:
- Could this also be due to lack of muscles (weak quads) ?
I think it could be related?
I feel I am in a sort of vicious circle right now:
I need to strengthen my quads.. but to do that I also need to do frequent exercises to strengthen.. and I feel the pain comes back after that.

If you have any advice about that please?

This week I think that I am going to take it really easy and limit myself to some walking in a shallow pool every morning.

 

[sistersinhim]

I need to strengthen my quads.. but to do that I also need to do frequent exercises to strengthen.. and I feel the pain comes back after that.

Actually, the more you use your knee naturally, the stronger it will become. It sounds like what you are doing is having the opposite effect on your knee and inflaming it. You are only halfway through this year-long healing and doing these strengthening exercises are not working. Try stopping those exercises and just use your knee the way it was intended to be used and I bet the strength will come right back.

Your old knee is suffering because you are putting a lot of strain on it right now with the recovery of the new knee. As your new knee gets stronger and less painful, then your old knee should be less painful.

 

[Mariposa]

Hi sistersinhim,
Thanks for your suggestion. I'll follow your advice as it makes sense indeed.

I'm praying that you are right about the old knee!!

I'll be back

 

[Mariposa]

Attached a pic of my pocket of swelling.. it's not huge but it's not diminishing and it feels a bit sore..

 

[sistersinhim]

I suggest you ice and elevate more to get that swelling down. Make sure your toes are above your nose. You can ice for hours at a time as long as you have a cloth between you leg and the ice source.

 

[Mariposa]

Thanks again sistersinhim, since this swelling appeared, after a wrong exercise with a little weight around 3 months in recovery, I have continued icing and elevating everyday for hours.. but it's not going away.. I hope one day it will (!)

I shouldn't worry, should I?

 

[sistersinhim]

Have you sent a photo of that to your OS? I think as long as it's not increasing in size or pain, I think it's OK, but it's best to see what your doctor says.

 

[Mariposa]

Thanks for reply. Yes, I did and he has just replied saying that it's "normal" and shouldn't worry..
I did because it doesn't seem to go down, no matter how much icing and elevating I do, but I'll try to put it aside and concentrate on getting better with ADL and pool walking for a few weeks and see how it goes.

 

[Jamie]

Post op swelling with knee replacements can continue for a year or more. Some of our systems are just wired that way. Just be sure you're not overdoing it in the pool. The water makes it very comfortable to exercise and that makes it easy to do too much. Be sure and have at least 1 or 2 days in between exercise sessions. Obviously, you need to be up and around during the day every day, but it is not necessary to do formal exercises on a daily basis if you are fighting swelling. Pay attention to the messages your body will send you. If you get pain and swelling in the 24-48 hours after an exercise session, then you're not ready for that level of activity. Scale it back and try again in a few weeks.

I actually have a "pocket" like yours on one of my knees that was replaced years ago. It doesn't really hurt but can be a bit tender sometimes. It never changes and doesn't impact the way my knee works. So, it's really not a worry for me. So I would say your surgeon is correct....no need for worry as long as things don't worsen.

Your scar appears to maybe be a keloid or hypertrophic scar. It may lighten with some time. You can read more about this in our wound care section located under the "Postop Care" link in the blue tool bar at the top of the page. This series of articles will explain the many stages your body goes through in the healing process.

 

[Mariposa]

Hello Jamie,
Thank you for your long and instructive message.

I think that I might have overdone it recently as I had started to feel better.. the water is a bit of my element.. but I am learning in a hard way that the knee (s) are definitely in command and I should listen to it/them.

Interesting to know about your own experience with a pocket of swelling too. I'm glad things are fine for you now, It helps to know we are not alone

About the scar:
The surgeon mentioned something during my last visit.. it's been red for a while.. I'm just hoping it will lighten with time.. I'll read the article you mention, thanks.

About my daily activity: (I'm not back to work yet) so I do a bit of walking:

I might have to go back to use a crutch for a while as walking is becoming now painful on both knees..

I am taking again a bit of medication (paracetamol+ antiinflammatory) now.

All I'm doing this week (in the morning) is walking in the pool and icing and elevating the rest of the day. But I'll go only 2/3 times/week for now.

I'll try to really slow down for a few weeks.

Thanks again, I'm hoping the pain will slowly fade

 

[Mariposa]

@Jamie and @sistersinhim :

hello again,

what do you think about getting a lymphatic drainage massage for the pocket of swelling, please?
I asked my PT and he said "no useful, otherwise I'd have suggested it myself"..

I would like to know the general opinion at Bonesmart please.

Would there be a risk of damaging the soft tissues?
Thank you

 

[EalingGran]

I haven't tried massage but I know @JusticeRider finds it very helpful for swelling. I have just done the hashtag so hopefully they will see this- otherwise you might go to their posts and ask directly.

 

[Mariposa]

@EalingGran thanks a lot!

That's a very kind thought
I will check with @JusticeRider

 

[JusticeRider]

Hi Mariposa, yes I get lymphatic drainage massage and find it very helpful! My knee’s default seems to be swelling. As my PT said at one point, “your knee just really likes to swell!” Getting the swelling under control was what finally got me progressing in my recovery. The less swelling, the less pain and stiffness and the better ROM and gait. I give my massage therapist loads of credit for that!

I’m flabbergasted that your PT would say it’s not helpful. I’ve gone in with a big fat pot roast leg and walked out with an almost normal knee more than once! It most definitely should not harm the soft tissues, on the contrary it helps release blocked fluids and gets things flowing so your soft tissues are less tight and inflamed. It could also help with your scar as a knowledgeable therapist can gently release small adhesions and increase blood flow to the area to promote healing.

I found my therapist by going online and searching for massage offices in my area and then reading the bios for the individual therapists. Skills to look for are ‘medical massage’, post-surgical massage, lymphatic drainage, and ‘myofascial release’. When you talk with them, emphasize that you’ve had a major surgery and you want someone with experience working on surgical patients.

 

[Mariposa]

Thank you very much @JusticeRider for your explanation about your experience! And encouragement to do it. I think that I will give it a try after what you are saying. In my case it's not "natural swelling" .. it was a reaction from a too aggressive exercise too soon through my PT.

But from what you are saying it could well work too.

I'm glad it has worked out well in your case.
I will definitely warn the PT about my tkr surgery before having it done.

I really like the good vibes and solidarity in this forum.
Gracias!

 

[JusticeRider]

De nada!

 

[Jamie]

JusticeRider is correct. Lymphatic massage can be very beneficial for swelling and there is no risk to your body in having it done. One of our staff members, @CricketHip, is a specialist in this area so hopefully she can give you some additional good words.

I say go for it! And if it helps, you can train your PT!