Revision TKR Motherbone's Recovery Thread

[Motherbone]

I am a 66 year old woman with rheumatoid arthritis and bilateral knee joint destruction who had a right TKR on 9/17.

During a PT session on October 10 my right patella broke (yes, you read that right). I am now awaiting surgical repair, which could not be done immediately because I was on aspirin therapy at the time of the fracture. I have been told this is a rare complication of TKR.

Any additional information or words of encouragement would be welcome. I had been making good progress with ROM but wonder if I was pushed to gain strength before my bones were ready.

Now I am almost completely dependent on my husband and lie around with the right leg immobilized from hip to ankle. Anyone who has also been in recovery for a broken patella, your feedback about what helped and didn't help would also be welcome. Thanks.

 

[Gingercat]

Hi @Motherbone and welcome to the forum! I don't have any advice as I am waiting on a TKR later this month, but it won't be long before a forum advisor will connect with you. So sorry that you have had to go through this.

 

[sistersinhim]

Welcome to Bonesmart! On my goodness, what an awful thing to happen to you. I will tag @Josephine, and head orthopedic nurse to answer your questions. In the meantime, I'll leave our after surgery articles. These are short, but very helpful.

Knee Recovery: The 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 a 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 history before providing advice.

 

[Jockette]

Welcome to Bonesmart!

Wow, I’m so sorry you now have a broken patella! I hope this was documented at the PT place.

What exercise were you doing when it broke?

 

[Motherbone]

I was doing sit to stands. My understanding is that the various tendons exerted enough force pulling in opposite directions that the patella snapped. It was a sensation of snapping and a pain so severe that I thought I would throw up and faint at the same time. I was a little shocky while being evaluated so my comprehension of the mechanics involved could be wrong.

 

[Celle]

Did this all happen this year, @Motherbone ? I'm asking because you wrote the date as 2017.
I'm pretty sure you meant 2018, or you wouldn't be worrying about it now.

Yes, there's every possibility that your fractured patella happened because you were asked to do too much during PT. When the damaged cartilage at the back of your patella is removed, it leaves the patella thinner and potentially weaker, even though the cartilage is replaced by a plastic button.

It was too early in your recovery to be doing anything for strengthening - that should wait until about 3 months post-op.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

@PolarBear60 suffered a fractured kneecap after her knee replacement. She may be away at the moment, but she may be able to offer you some practical experience.

I'm also going to ask @Josephine , our Nurse Director, to advise you. She has many years of experience in orthopaedics.
If she asks you a lot of questions, do try to answer them as fully as possible, so she has all the information she needs, to advise you appropriately.


I do hope you can soon have your kneecap repaired and I wish you well. Do let us now how you get on, won't you?

 

[Josephine]

During a PT session on October 10 my right patella broke. I am now awaiting surgical repair, which could not be done immediately

What you had was actually a fracture of the patella. Can you tell me, would I be correct in assuming you had a patellar button (resurfacing) installed or not?

I have been told this is a rare complication of TKR.

It certainly is.

It was a sensation of snapping and a pain so severe that I thought I would throw up and faint at the same time.

Yep, that was a patellar fracture alright!

 

[Motherbone]

Celle, the TKR was on Sept. 17 of this year.

Sorry for the abbreviation! Josephine. I was told the patella was resurfaced but the word "membrane" was used.

I'm not real tech savvy so I don't know how to respond to you individually, hope you get this message. If there is a how-to posting on this site regarding the technical details of responding, point me to it.

I was just informed that they feel it is ok to move surgery up a few days. Will report back as it unfolds.

Thank you again for your attentive support. It helps to communicate with others who are traveling this path.

 

[sistersinhim]

Here is a link to help you learn how to navigate this site.

 

[Motherbone]

I was discharged from the hospital this afternoon. Hobbling with a walker and limited weight bearing with no knee bending. Got a shower with help tonight and I feel more human. The name of the procedure I had is on my papers which are in another room so I will post that later. I do recall that the words revision and extensor reconstruction were used. Anyone who has had to have their knee immobilized, please forward your favorite method. I have this crazy brace that tends to slide down my leg. I have seen other types of immobilizers that look like clamshells. And there is talk of a leg cast in two weeks. Sigh.

 

[Jockette]

@KarriB had an immobilizer.

So did @sistersinhim.

And there is talk of a leg cast in two weeks. Sigh.

I’m so sorry you are going through this.

 

[Motherbone]

I so appreciate your support and that of other members. I felt really lonely and down in the hospital, worst around 4AM in the dark. Better now. I'm glad I found this forum.

 

[beachy]

Hi! I just read your thread from start to finish.
My goodness!

I hope your recovery goes well and you start to feel better every day.

 

[sistersinhim]

I have this crazy brace that tends to slide down my leg.

Is there a way you can tighten it? My immobilizers had about 2" wide metal rods down each side. The overall brace was made with thick foam, with four velco straps to tighten it up. It was permanently straight. I wore one on each leg for 6-8 weeks after my kneecaps were removed. I could take it off only to shower. I even had to sleep in it. When I was finally allowed out of it, the bend came back on its own. It took about a month, but they came back with no therapy; just using my knees in my daily life brought the bend back in easily. You'll be surprised how easy it can be!

 

[Motherbone]

Beachy, thanks! Sisters, yes it has fasteners but when I get up it still slides down. DH went to Joanns and bought some faux sheep fleece and we wrapped my leg in that and then fastened the brace over it. Still some sliding but less, and no more painful pressure points at the buckle closures. Surgeon said it should be worn over pants but getting into and out of pants is just beyond me right now, I'm living in cotton terry gym shorts with an elastic waist and t shirts. DH also installed a faucet bidet so I can have some personal cleanliness without the ordeal of getting in and out of the shower while keeping my leg straight. I have a transfer bench and a hand held shower but it's still a challenge. I had tramadol around the clock in hospital and let myself go all day today without anything so I ended up taking one Norco tonight and feel a little better. One aggravating thing is that I seem to need to pee every 3 hours which interrupts our sleep at night. Hope that abates.

Reading through my hospital papers, I have the official labels:

October 16, 2018 - right total knee replacement revision, extensor mechanism reconstruction
October 10, 2018 - right extensor rupture and patella fracture

I've been instructed to schedule an appointment with a plastic surgeon as well as with my own surgeon. I was not told why so I'll ask on Monday.

This is Day 4 of my recovery. Prayers and positive thoughts to all of us.

 

[sistersinhim]

Peeing is a sign that you are getting rid of swelling. That's a good thing! Sleep whenever and wherever you can and keep getting that fluid out!

My immobilizer was a full leg one, from my upper thigh to my ankle. Yours must not be that long. I can see where a shorter one would keep falling down while walking.

Your husband sounds like a keeper! A bidet is a fantastic idea! I have one, too, and they work well between showers. Amazon sells waterproof wraps that I used when I broke my ankle. I never had a leak!

 

[beachy]

Same here with the "water works". At first it was ridiculous. But, I was drinking a lot of water and gatorade. Those first 3-4 days it was excruciating to get up and hobble to the bathroom much. I figured it was helping with swelling and it did make me move around. It's settled down now.

 

[Josephine]

Sorry for the abbreviation! Josephine. I was told the patella was resurfaced but the word "membrane" was used.

I don't think I complained about an abbreviation, did I? But do you mean the patella was resurfaced during the TKR? In which case, you haven't mentioned a further surgery since the patella snapped - is that right? So does this mean they are just trying to treat it with the immobilizer?

Can you get hold of an xray taken after the patella snapped?

 

[kneeper]

No advice to add here but just

 

[Motherbone]

@Josephine, I was referring to the way I had abbreviated the date, it was misleading.

Yes, I had more surgery, a right TKR revision and extensor reconstruction on October 16, 2018 (last week) and I'm on Day 5 of at least an 8 week immobilization. My shoulders were painful this morning because I am permitted only 25% weight bearing on my operative leg, so my upper body is carrying more of the load than it is used to. I neglected pain control yesterday and now I recognize its importance.

On the plus side, I was able to steer myself in the wheelchair halfway across the house this morning. The next few days I plan to work on using the walker and my upper body to ambulate maybe five more feet than before, to gradually build up my strength and stamina. I'd like to be less reliant on help from the wheelchair but this knee immobilization makes it hard work to get anywhere.