Revision TKR Motherbone's Recovery Thread
- Thread starter Motherbone
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OP
OP
Motherbone
senior
Well, I measured 90 degrees of flexion today so technically I have met that PT goal. We continue to work on stair training. She is also focusing on something that has been driving me nuts, which is my seeming inability to position my pelvis in a stable manner and in such a way that it supports my torso in an upright position. I walk hunched over and when I try to straighten up, I can't balance my torso any more than one or two minutes before I wobble forward again. I suppose this is a byproduct of my immobilization for so long. It is a bit discouraging and I hope we can turn it around. Otherwise, things seem to be moving along. My unoperated knee has been more painful lately, probably because I'm asking it to do more in conjunction with working on the operative knee. Sigh. But I remind myself that five months ago I couldn't do anything!
OP
OP
Motherbone
senior
My rheumatology labs all came back good. Inflammatory markers are not elevated. So for now I'm to remain off the biological. A bit of relief actually. I get concerned about the long term effects of those infusions. I am a little anemic, not sure why unless I had more blood loss than I know during the two surgeries.
That's really good news. The anemia can happen after this surgery. Maybe even not from blood loss. We don't eat well for the first month or so. That can affect out iron intake. Did they tell you what to do about it? You can google it and find out what foods to eat that are high in iron.
OP
OP
Motherbone
senior
Thought I'd post an update though nothing earth shaking has happened. I'm moving to once weekly PT while focusing on strengthening exercises in between sessions. I have a problem with hyper extension of the operative knee that I need to talk to my doctor about because it throws me off balance when it happens and I almost fell last night. I was trying to use my cane at the time. I may need to wear my brace with the cane until the problem improves. Otherwise things are just moving along. I walk with my walker most of the time and flexion is not a problem. It does indeed come with normal activity and does not need to be forced! I just don't like to use the walker in public and I need to be less dependent on the wheelchair so I can build up my endurance and stamina. We had a little celebration last night for my end of employment (I'm not calling it retirement yet!) which was enjoyable.
donnag1108
senior
I have had severe anemia since 2000 to the point of needing blood transfusions on two occcasions. I take an inexpensive over the counter iron supplement once a day and that works just fine but if I don't take it my level plummets quickly and I can definitely tell. It's easy to manage as long as I do my part.
OP
OP
Motherbone
senior
Well, here I am, six months after my right TKR and almost five months after my injury. I had an appointment with my surgeon this past week. He expressed satisfaction with my progress. He commented that the goals that had been set were "modest" and that I had met most of them. I showed him my difficulties with hyper-extension of the operated knee, how it tends to bow back and results in my locking my knee, and told him how, if I try to resist the motion, the knee then buckles. He said he was unsure of the reason for that happening, as he had not noted any posterior joint capsule damage during the surgery back in October. I did feel a little better hearing that, as I had some concerns that something was missed. He mentioned that another surgery to revise the implant could be done to try to correct the hyper-extension, but it was not his recommendation and it is definitely not what I want. There is so much scar tissue in my knee right now that most of the time I feel like there is a big rubber band encircling it, so the last thing I want is for it to be cut open again!
My physical therapist thinks that my muscles are still out of balance and that my quads and glutes are not firing properly during the part of my gait when my leg swings forward and my heel makes contact with the ground, resulting in hyper-extension backwards and locking of the knee. She has broken my gait down into several phases and has me focusing on consciously contracting quads and glutes when I step forward, which does in fact keep the knee in a more neutral position without locking in extension. The idea is that eventually this becomes less conscious and more entrained; I guess that is why it is called gait training. The doctor suggested that in addition to this, I wear the brace briefly during the day with the hinge set so as to prevent any extension, in order to give myself a sense of what the leg should feel like during my gait, and something to aim for without the brace. I've done that twice so far and it does help as well.
Overall I came away from the visit feeling a little more pessimistic than usual because the doctor didn't seem to have anything additional that he wanted me to achieve. I go back in three months. I sincerely hope that this isn't as good as it gets. I want to at least be able to stop using a walker. On the plus side, I am doing better with stamina and have graduated to riding the little scooters that the grocery and Costco provide, instead of using my wheelchair. I know my knee will never be normal, never be what it was before the replacement surgery, or never feel as good as it did before it was wrecked by the first PT program. But hopefully there is still room for improvement.
My physical therapist thinks that my muscles are still out of balance and that my quads and glutes are not firing properly during the part of my gait when my leg swings forward and my heel makes contact with the ground, resulting in hyper-extension backwards and locking of the knee. She has broken my gait down into several phases and has me focusing on consciously contracting quads and glutes when I step forward, which does in fact keep the knee in a more neutral position without locking in extension. The idea is that eventually this becomes less conscious and more entrained; I guess that is why it is called gait training. The doctor suggested that in addition to this, I wear the brace briefly during the day with the hinge set so as to prevent any extension, in order to give myself a sense of what the leg should feel like during my gait, and something to aim for without the brace. I've done that twice so far and it does help as well.
Overall I came away from the visit feeling a little more pessimistic than usual because the doctor didn't seem to have anything additional that he wanted me to achieve. I go back in three months. I sincerely hope that this isn't as good as it gets. I want to at least be able to stop using a walker. On the plus side, I am doing better with stamina and have graduated to riding the little scooters that the grocery and Costco provide, instead of using my wheelchair. I know my knee will never be normal, never be what it was before the replacement surgery, or never feel as good as it did before it was wrecked by the first PT program. But hopefully there is still room for improvement.
Let’s ask @Josephine about this.
Why do you feel you won’t heal to a better place than what you describe here? Did they tell you that?
jboles
graduate
I hope you continue to improve. I’m going to be facing some serious gait training as well. We’ll just work on it together, we can encourage each other along on this site. 
traceys
graduate
@Motherbone
I have gaitvtraining twice a week for past 3 mnths in my 6mnth journey
I understand the feeling like “this is the end” but I still am sticking with his homework and exercises and see micro improvement daily still. Each journey is nothing more than a million steps of whatever size. You can only affect the step you are currently taking.
You got this
I have gaitvtraining twice a week for past 3 mnths in my 6mnth journey
I understand the feeling like “this is the end” but I still am sticking with his homework and exercises and see micro improvement daily still. Each journey is nothing more than a million steps of whatever size. You can only affect the step you are currently taking.
You got this
PegGar16
Former BoneSmart Staff Member
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I think it took about 6 months before my gait felt normal. It was a concentrated effort with the stepping. Now it all feels natural. The only time that I limp a little is if i have done too much walking or standing and I am tired.
Josephine
NURSE DIRECTOR EMERITA
How do you know this? Was it something you were told by someone, something discovered by investigations like ultrasound or MRI?
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?
OP
OP
Motherbone
senior
@Jockette: I just had a morose moment because the surgeon has been very enthusiastic till now and at the visit last week he gave me the impression that I had reached all the milestones he had envisioned for me. Perhaps he was tired and I am reading too much into his demeanor, or perhaps I need to adjust my expectations. I do have 90 degrees flexion, which was unimaginable to me back at the beginning of the year, and which I achieved by just gradually walking more and more - not by doing those heel slides, which I quietly stopped doing once I realized that I got better flexion by just sitting down or walking around than I ever managed to eke out with a heel slide. I just want to be able to stop depending on the walker, but my gait is not balanced and I almost fell when trying to use a cane.
@PegGar16 and @traceys: How long did it take for your gait training to translate into a gait that you did not have to consciously break down into its component parts? I notice that I am hyper-extending a little less when I walk but I have to think about my walking pattern with each step and sometimes I forget to do that. When I forget, it goes back to the hyper-extension.
@Josephine, I'm not really having pain, just tightness and stiffness. It was my surgeon who told me about the scar tissue. He said that once he got inside the knee to look at the injury, he found that the internal incision had been ruptured and the patella was in several pieces (he called it a "terrible injury"), which did not allow for a neat and clean repair. He reminded me at several visits that he had not been able to completely approximate all the pieces, that the recovery goals would be modest, and that we would have to depend on some scarring as part of the repair, so perhaps I am the one who has to adjust my expectations. At some points my external scar is also puckered and appears to be adherent to the underlying tissues but he did not want PT messing with scar massage so we just leave it alone.
@PegGar16 and @traceys: How long did it take for your gait training to translate into a gait that you did not have to consciously break down into its component parts? I notice that I am hyper-extending a little less when I walk but I have to think about my walking pattern with each step and sometimes I forget to do that. When I forget, it goes back to the hyper-extension.
@Josephine, I'm not really having pain, just tightness and stiffness. It was my surgeon who told me about the scar tissue. He said that once he got inside the knee to look at the injury, he found that the internal incision had been ruptured and the patella was in several pieces (he called it a "terrible injury"), which did not allow for a neat and clean repair. He reminded me at several visits that he had not been able to completely approximate all the pieces, that the recovery goals would be modest, and that we would have to depend on some scarring as part of the repair, so perhaps I am the one who has to adjust my expectations. At some points my external scar is also puckered and appears to be adherent to the underlying tissues but he did not want PT messing with scar massage so we just leave it alone.
OP
OP
Motherbone
senior
Well, I've been walking more and longer distances. Still using the walker but in the kitchen I balance between the counter and the island without it. Re-educating my muscles not to bow backwards when I take a step has been a challenge, but they are doing better. The knee is still not as stable as I would like and when I've used it a lot during the day it's definitely stiff and a bit sore by bedtime. With a little ice this is usually resolved by morning. I have a tens unit I'm using on my un-operated knee to help with the chronic pain there. The most troubling pain I now have is in my lower back, which I've had for years, so that's nothing new. Still going to PT, now once a week, with practicing their assignments in between sessions. Tomorrow I will see my primary care MD for annual physical. We'll see if this little adventure has had any impact on my overall health. I am definitely going to talk to her about my bone density. Will report back!
OP
OP
Motherbone
senior
Well, I have iron deficiency anemia, which might explain why I sleep so much and my hair seems to be falling out. My PCP wants me to rule out a tumor with a colonoscopy, which I will schedule, though after some research I think that intraoperative blood loss could explain the anemia. I was able to get my labs from back in August 2018 before my RTKR as well as the post op CBC and the CBC following my second surgery to repair my tendon and patella on Oct. 16. My pre op hemoglobin in August 2018 before any surgery at all was around 12. My post op hemoglobin following the TKR in September 2018 was 9.5, so I apparently lost significant blood during that first surgery. The hemoglobin following the second surgery four weeks later in October 2018 was also around 9.0, so blood loss continued with the second surgery, or my blood count just did not have time to recover before I had to have that second surgery. My hemaglobin this week was about 11, so there is an upward trend. I will make sure she has this information as well. Otherwise, I am just walking around the house, practicing the gait and trying to overcome the low back pain. I cooked a chicken dinner with roasted vegetables and new potatoes tonight. It was good!
jboles
graduate
Dinner sounds fabulous. My husband is trying, but I’m missing some variety in meals. I’m ready to get back to a little cooking. I struggle with low iron count, it can really make you feel tired. Hopefully yours is just low due to the surgery and nothing else is going on.
OP
OP
Motherbone
senior
Had quite a PT workout today, stair training and walking out in the building with my cane. Ended up having a nap with my dog when I got home!
OP
OP
Motherbone
senior
I tried some over the counter iron supplements this week. I took them twice a day for a few days. I ended up with terrible diarrhea so I've scaled back to once a day. Hoping that will be more tolerable. I had a lot of pain in both knees after my PT session this week, so I'm being more careful about what I do now. You'd think I would have learned my lesson, but I was feeling frisky and really wanting to be able to ambulate without that darned walker. I'm sure other people have discovered that when you use a walker, it's as if you become invisible as a person.
