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[REVISION TKR] Motherbone's Recovery Thread

Discussion in 'Knee Replacement Recovery Area' started by Motherbone, Oct 14, 2018.

  1. Motherbone

    Motherbone member
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    My appointment went OK. The implant on the right is in place with no shifting and good alignment and no displacement of the repaired kneecap parts was observed. I have at least 90 degrees flexion and a little less hyperextension when walking. He was happy with the progress on that side. He then examined the ankle, which was no longer paining me, and told me that my left (unoperated) knee is becoming more "knock-kneed," (meaning it's bending inward more and more) and that I will continue to have trouble with the ankle/foot/knee joints on that side until the limb is straightened. We had a long talk about that and my prior experiences and concerns. Ultimately I decided to schedule a left TKR for July 22. He was optimistic that he could alleviate the bent-ness of my leg and indicated he will likely not do anything to my patella, given my history. I'm going to have a pre-op test for nickel allergy, which I don't think I had prior to my right TKR, at least I can't find any such results in my EMR. He mentioned the availability of some kind of nerve block injection of the nerves around the knee two weeks prior to surgery to reduce pain, but I'm not real interested in putting a needle in my knee electively and running the risk of infection or bleeding; it is optional and I will probably decline but if anyone reading this has had such a procedure pre-op, please give feedback on it. I tend to measure pain severity by the yardstick of my broken kneecap, which was agony. Compared to that, the pain of the TKR that went before it was much more manageable.

    Basically I've known I would have to do something about the left knee if I want to ever have the chance of walking without a bent over lurch and a one-inch lift strapped to my shoe, so I'm reasonably content with the plan. I have a better idea of what to expect and my ambitions are modest. I did tell him I wanted to be in the driver's seat when it comes to PT. He asked only that i promise to pay attention to range of motion, which he said is the primary goal of post-TKR PT. Hmmm, that is not what was being worked on with me when my poor knee cap got pulled into pieces last October. Wish I'd known then what I know now!
     
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  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Same here!

    But you do have a lot more knowledge now, as well as confidence to control things. (I do, too!)

    Best wishes for a very successful outcome on this next knee, and ultimately for your current knee that is healing. :console2:
     
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  3. Motherbone

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    Just checking in, nothing particularly new. I have to call to schedule my pre-op stuff. The nerve procedure I referred to in my previous post is called Iovera injection, and it is not an injection into the joint capsule. It involves subcutaneous injections, injecting the sensory nerves under the skin that innervate the knee with a solution that temporarily freezes them, disrupting pain signals. The motor nerves are not involved. It's described as wearing off by 90 days afterwards. The goal is to improve pain control peri- and post-operatively. My main interest in it lies with pain relief leading up to the surgery since I know I'll have to stop my usual antiinflammatory medications pre-op. Anyone had these injections?
     
  4. FCBayern

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    I have not but would have welcomed the opportunity, going off my anti-inflammatory meds before surgery torture!
     
  5. Motherbone

    Motherbone member
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    Had my pre-op appointment yesterday and have the labs back, all look pretty good. My hemoglobin is now within normal range although I'm sure my iron stores are still repleting themselves (that test is not in their pre-op battery). I'm waiting for EKG clearance from my PCP. I've decided not to do the Iovera injections. I don't want to do anything that might cause an unexpected complication and besides, yesterday they told me I can take Celebrex or Aleve up to 3 days before surgery, I just have to stop aspirin and fish oil supplements ten days in advance. I think I can make it through 3 days. I called my old PT place, the one that was so helpful in rehabbing my broken kneecap, and they will take me back after the surgery, but I won't start with them until I feel ready. Guess afterwards I'll have to change the header on my recovery thread and add the procedure date below, but I'm superstitious and I don't want to change anything until after it's happened in fact. Hope everyone is doing well.
     
  6. Motherbone

    Motherbone member
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    Aha, my upcoming procedure has appeared on the list below! Thanks!
    I've received clearance from my PCP about my EKG so my main job now is to stay healthy for the next two weeks. I've started wearing my brace on my right knee more often, setting it to 30 degrees extension and unlimited flexion. That's over-compensation on the extension but I find when I walk, I need it to be set that way or my leg over-extends even within the brace. It's a maneuver suggested by my surgeon. Hoping it re-sets those over-stretched back of the leg muscles and ligaments. Too much time with that leg sprawled straight out in front of me in a wheel chair. It was unavoidable since I couldn't bend the kneecap while it healed, I guess.

    Just started being able to sleep up to 5 hours at one stretch. I expect that to regress once I have this upcoming surgery but it's good to know that eventually sleep returns. Interesting that it coincides with my hemoglobin coming back up to normal.

    Good wishes to everyone!
     
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  7. Benay

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    Good wishes to you too. I'll watch for your updates.
     
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  8. Relle

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    I've just been reading your thread. Sounds like you've been through a lot. I agree that it is better knowing what to expect. My recovery was a steep learning curve especially in the beginning. Going in eyes wide open this time and knowing in advance hat to ask for and to stand up for myself. It seems you're much the same. My OS is easy to talk to, pretty young and keeps up to date so I'm lucky with that. Just looking for a kinder physio this time around. Wish me luck
     
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  9. Motherbone

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    Well, one step forward and two steps back for me, unfortunately. My left ankle began to pain me again last Thursday and by Sunday I could barely walk on it. The orthopedic practice fit me in with one of their foot and ankle specialists yesterday. I have a stress fracture of the left fibula and something called posterior tibial tendon dysfunction. I am in an aircast standard tall fracture boot on the left. I still have pain on walking but it is less and I guess it takes more than 24 hours in the boot for things to settle down. The ankle doc says the left knee severe valgus distortion and the load the left leg has had to take over the past eight months is probably responsible for the breakdown in the ankle joint on that side but, given the current injury, replacement of the left knee should be postponed until the ankle is healed. She also talked about doing surgery on the tendon. She said she would confer with my knee surgeon and I have a call into the knee doc's office asking for further instructions, but I presume the knee surgery is cancelled. I have an MRI scheduled for Monday July 22. Wild horses couldn't talk me into having foot surgery at this point, I am pretty soured on the whole orthopedic surgery process, but I didn't say anything yesterday. We'll see what the rest of this week brings.
     
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  10. Benay

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    Watching your thread and sending you good thoughts.
     
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  11. Jockette

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    I’m so sorry to read this. You have had way more than your share of difficulties since your knee surgery. :console2:

    I am dealing with plantar fasciitis, and when I went to the foot Dr about back in April he said I also had posterior tibial tendinitis. I was very surprised at that, as the tendinitis I’ve had in the past was extremely painful, and I’ve had very little pain other than my heel. I wasn’t sure I agreed with him, I would think I’d have pain higher up if I did have posterior tibial tendinitis.

    Thankfully just wearing shoes 99% of the time is helping me a lot.
     
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  12. Motherbone

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    Last Wednesday I began to have intense pain on the front of my ankle in the boot. By Thursday I could not bear weight on it and started to feel sick to my stomach and faint. We went to the emergency room of another hospital because my primary care hospital was on drive by/full. An ultrasound showed no clots in the leg. Xrays and a CT scan were reported to show a small hairline fracture in my lower tibia (I was never shown the films). I was told to remain in the boot and not bear weight if it was painful so I got no new input from the 8 hours I spent in the ER. The next day I reported in to the ankle doctor about what had happened. Her office then said I needed to be in a cast, not a boot, and to walk in Monday for this. So now I had two contradictory recommendations.

    Trying to function became a nightmare. I could not bear weight on my left leg and my right leg, with its broken and patched kneecap, has been a tenuous source of support to balance on. I put the brace back on my right leg so i could have some additional structural support. I didn't bathe for five days. I spent most of my time in bed with my left leg on pillows. I took the Tylenol #3 that they gave me because without it I felt like a railroad spike was being driven into my shin, and now I am hopelessly constipated even though I took stool softeners along with the pain med. I finally messaged my PCP and told her about the new fractures and the cancellation of surgery. She made an urgent referral to another orthopedist, noted that I will need to see a bone density specialist, called in a prescription for alendrolate (?spelling), and raised the question of admitting me to inpatient PT to gather some strength and recovery. i agreed to this and she arranged things for tomorrow, but today I found out I can't get the ortho appointment until Friday. I've told her I really want to see the ortho about my ankle for a definitive opinion and a treatment plan before I go anywhere. I hope she won't be mad at me for wanting to wait. Tomorrow I will see her and find out about what facilities are available to me.

    Getting around the house for even minimal ADL's has been horrible. I have to push myself up from the wheelchair on my right braced leg, grab the walker for balance, then pivot on the right foot until my butt is up against either the toilet or the bed, the two destinations which have ruled my life for the past five days. I do have grab bars and toilet arms, which are again proving invaluable, since I'm in the same position I was with the broken kneecap eight months ago - I can't raise up on only one leg. I pray every time that I am not screwing up the kneecap repair and joint replacement revision. I have a transfer board on order which I hope will help me get from the shower bench to the wheelchair but there is not enough room in either of my bathrooms to position a wheelchair next to the toilet to allow for use of the board there. Yesterday we wrapped my ankle, boot and all, in a trash bag and sealed it with duct tape, and I managed to get onto the shower bench and shower. I had great difficulty getting up and into the chair afterwards because there are no arms on the bench for me to use to push up with; basically my husband pulled me up himself.

    I really feel that, except for my PCP, the medical system has failed and abandoned me. Contradictory recommendations. So easy to say, don't bear weight on it. No one really looked at me as a whole person with only about 75% of the other leg to balance on. And getting the ortho appointments has been a joke. When I called the ortho my PCP referred me to, his office said he doesn't do ankles and I had to see their ankle doc - so that's who I'm scheduled with. All these folks want to do is take care of their own little sliver of anatomy. What ever happened to looking at the whole person???

    Today I decided not to take any painkillers because the constipation has become so bad that I fear impaction. So far the pain is less intense and occurs mainly if I move the leg in a twisting fashion (which is easy to do if you are not paying attention). I have some hope that maybe enough healing has started to take place that the pain will abate. I honestly just felt like an animal for the past five days, all I wanted was for the pain to end. I wonder if the boot had something to do with the new fracture.
     
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  13. Motherbone

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    I need to add that my interest in the rehab facility is mainly focused on their trying to help me complete ADL's and teach me any additional maneuvers. I'm not going to try to do a lot of PT that could hurt me.
     
  14. Benay

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    Very sad to read this, you have such a lot of pain. I hope you get all the help possible. Watching for updates.
     
  15. Jockette

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    The run around we get from doctor’s offices is so annoying. I’m so sorry you have another fracture. It seems the fix for one thing causes something else. Been there, done that. (That’s what led me to a knee replacement. )

    My non operated knee started hurting just reading your posts. It sympathizes with you. :console2:

    I’m sure you wonder when this nightmare will end. I wish I was close enough to help. :console2:
     
  16. Cementless

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    @Motherbone, have you tried Miralax twice a day? Ask your PCP about it.

    When was your last bone density DEXA test?
     
  17. Benay

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    Could be a Fleet candidate especially when you're starting to feel very painful. It's just one of those problems you can do without.
     
  18. jboles

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    I’m just heartbroken for you as I’m reading this. You’ve had so many problems and I understand the frustration that you must feel. I was terrified that my tibia or fibula would suffer a stress fracture from my valgus knee. The doctors act like that’s not possible, but I was really worried about it. I also have posterior tibial tendinitis and my foot pronates. If I walk without shoes- at all- I have a lot of pain in my foot and ankle and my calf. I wear orthotics all the time. This is something that I will have forever. I agree with your thoughts about the PT facility teaching you some ways to handle ADL’s. I admire your perseverance and your attitude.
     
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  19. sistersinhim

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    How sad to read all you are going through. My prayers are with you and that you have quick healing all over! I agree with the Miralax suggestion. It helped me during my pain meds days.
     
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  20. Celle

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    Have you asked your PCP for a prescription for an aperient to prevent/cure your constipation?
    The thought of you suffering pain but being afraid to take the pain relief you need upsets me.

    Narcotic pain medication is notorious for slowing of the gut and causing constipation. I got so constipated that I had to send my husband on a run to the urgent pharmacy for a do-it-myself enema. After that, my own doctor prescribed an aperient that I took every day and that ended my constipation but allowed me to take the pain relief I needed.
     
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