PKR My Drama Queen Patellofemoral Knee

[Jockette]

Thank you. That lower lateral side is where most of my discomfort is.
I’m getting closer and closer to making that second opinion appointment.

Here are my one year X-rays

 

[Jockette]

Susie, my season is over. When I bowled yesterday it had been a week. It also hurts when I pick up my coffee cup. But only those 2 activities.

Maybe I should take some more time off bowling.

I had acute Tendonitis a week after surgery in my left shoulder, the pain was a 100! and the dilaudud I was on didn’t touch it!

 

[sistersinhim]

I had 'tennis elbow', which sounds like what you have, years ago. You can buy a brace for it. You can also make your own. Just tie a strap around your arm at your bicep muscle. This helps to keep the tendon from being stressed. I had to wear one for about 6 months at work. Of course, my work was very physical and I was the first woman to do the job I did! You probably would have to wear it for only a short time until that tendon calms down.

 

[Jockette]

@Josephine What do you think of my X-rays?

 

[Josephine]

@Josephine What do you think of my X-rays?

I've never liked taking someone's description about their pain. I prefer they show me on the chart because it's more accurate

 

[Jockette]

Pain in general- LF4 - D and E

Going down steps, right in the center where the lines of LF 3 and LF4, D and E all cross each other.

 

[Josephine]

So like this?

I suggest you read this and tell me if there are any similarities TKR: symptoms of a loose implant

 

[Jockette]

Well, there is definitely still stiffness. I can’t really see any outer swelling, it doesn’t look much different than my non operated knee.

There is definitely pain going down steps foot over foot. I had started to practice that a few weeks ago but gave up on it because it hurt too much. I ended up hurting my arm by grasping my cane handle too tightly and leaning too heavily on it because I was trying not to put all my weight on my knee.

It does not hurt to go up steps, if they are only 4-6” high. The feeling I get then is just a weird unnatural feeling, which I’ve always thought was “normal” because I have an implant in my knee and I don’t have to do steps often enough to get used to it.

The discomfort in the
Lf- d and e is most uncomfortable when I lean forward or turn, especially when working in the kitchen or in my small sewing room.

I don’t have pain walking, but I am very aware of feeling my knee anytime I am on my feet. If I sit on my couch with my feet on my ottoman, I am comfortable and can forget about my knee.

I still sleep every night with both legs elevated.

Also, I still have that nasty reaction whenever I put pants on, or knee length shorts or Capri length, it feels like something very hard swells up inside the knee. Immediately upon putting these clothes on.

It almost feels like the implant has slid over and down into that lateral spot and is just hanging there, though I don’t truly believe that can happen.

Once in a while my knee buckles very slightly.

 

[Josephine]

Okay, next phase - the Spanish Inquisition!

Please answer for now

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Jockette]

1. Pain level:
Zero when sitting with my feet up,
2-3 when on my feet,
4-5 sitting with both feet on the floor and knees at a 90 degree angle after less than a minute. The higher the seat of the chair, the more pain and quicker it starts.
6-7 when I was practicing going down steps a few weeks ago. And the steps were only about 5-6” high.

2. Ibuprofen, 800 mg twice a day, I take a third dose in the evening, 600 mg.
I do understand the risks but it really does help the arthritis I have in my non operated knee, spine and neck. I hurt a lot if I didn’t not take this much.
An occasional dose of 1000 mg Tylenol.
(I did take 4000 mg a day earlier in recovery)

3. No visible swelling.

4. ROM: At my one year check, sitting in a chair, I was able to bend to 122 on my own. I tried again with more effort and he measured 124, another try and he said 128.
However, I am not comfortable maintaining this bend for even a whole minute. I usually sit with my foot out so I have much less bend to my knee.
Extension is zero

5. No icing. I stopped icing at 6½ months post op, when even with a cloth the ice hurt. But I didn’t have any visible swelling then, but was still icing because it still felt stiff, so I figured it was inner swelling.

6. I elevate all night, every night, about 7 hours, using the same elevating wedge the hospital sent home with me. Also, any time I’m home and sitting, my legs are up on an ottoman. 4-6 times a day, about an hour.

6. Activities:
I bowl twice a week, 3 games, using an 8 pound ball, which is very light for an adult. Most of the women I know use 10 or 12 pound balls.
Grocery shop about twice a week, usually for about an hour, sometimes longer.
Light cleaning,
some vacuuming but not much as it hurts my back.
Simple meals, preparation and clean up,
laundry for two of us.
Sewing here and there, using a sewing machine. I work about 15-20 minutes at a time then take a break, half hour maybe, then back to the sewing room.
Yesterday and today I planted flowers in pots for my back deck and front porch.

8. No exercises at home, no PT.

 

[sistersinhim]

I hope Jo can lead you in the right direction. Enough is enough! You have been through enough!!

 

[Jockette]

Thank you, @sistersinhim !

But if I’m headed for revision then I haven’t been through enough yet.

To be honest, a loose implant would explain a few things. Oh my. I think it hurts more just thinking about that possibility !

 

[sistersinhim]

But, knowing what needs to be done to have a successful tkr will be a blessing. You've not had a good outcome. A tkr, with a different OS will give you that. Your choice is to live like you are for more years or get a new one when you are still young enough to enjoy it.

I completely understand your feelings about a revision. I was so afraid I was facing that. Mine still isn't right, but I will believe my OS, that the implant is OK. I really don't know about yours, but it doesn't sound right.

 

[Josephine]

1. Pain level:
0 when sitting with my feet up
2-3 when on my feet
4-5 sitting with both feet on the floor and knees at a 90 degree angle after less than a minute. The higher the seat of the chair, the more pain and quicker it starts
6-7 when I was practicing going down steps a few weeks ago. And the steps were only about 5-6” high.

When you were 'practicing' going down steps? What does that mean? Could you not do it normally and so were forcing yourself? If so, very bad! Remember #1 in our guidelines? If it hurts, don't do it!
And the chair thing: Sitting like that means you are putting excess pressure on your knee

2. Ibuprofen, 800 mg twice a day, I take a third dose in the evening, 600 mg.
I do understand the risks but it really does help the arthritis I have in my non operated knee, spine and neck. I hurt a lot if I didn’t not take this much.
An occasional dose of 1000 mg Tylenol.
(I did take 4000 mg a day earlier in recovery)

Okay, I understand for the ibuprofen but why aren't you taking Tylenol more often? I suggest you take it 1,000mg 3-4 times a day.

3. No visible swelling.

Jolly good!

5. No icing. I stopped icing at 6½ months post op, when even with a cloth the ice hurt. But I didn’t have any visible swelling then, but was still icing because it still felt stiff, so I figured it was inner swelling.

If you have no swelling then no icing is fine.

4. ROM: At my one year check, sitting in a chair, I was able to bend to 122 on my own. I tried again with more effort and he measured 124, another try and he said 128.
However, I am not comfortable maintaining this bend for even a whole minute. I usually sit with my foot out so I have much less bend to my knee.
Extension is zero

So it's probably about 115 then? But your 0 extension is good!

6. I elevate all night, every night, about 7 hours, using the same elevating wedge the hospital sent home with me. Also, any time I’m home and sitting, my legs are up on an ottoman. 4-6 times a day, about an hour.

"on an ottoman" is not elevating! You need to elevate properly to help dispel the pain

6. Activities:
I bowl twice a week, 3 games, using an 8 pound ball, which is very light for an adult. Most of the women I know use 10 or 12 pound balls.
Grocery shop about twice a week, usually for about an hour, sometimes longer.
Light cleaning,
Some vacuuming but not much as it hurts my back.
Simple meals, preparation and clean up,
Laundry for two of us.
Sewing here and there, using a sewing machine. I work about 15-20 minutes at a time then take a break, half hour maybe, then back to the sewing room.
Yesterday and today I planted flowers in pots for my back deck and front porch.

Hm, well, you should be able to do this now.

8. No exercises at home, no PT.

Good.

Not much to offer you here (except the pain meds!) so would you show me the site of your pain using this chart?

And do you have a copy of your most recent xray? That would help too.

 

[Jockette]

When you were 'practicing' going down steps? What does that mean? Could you not do it normally and so were forcing yourself? If so, very bad!

No, I cannot do steps normally, but it’s rare that I have to. I have a couple of steps from my deck to the ground, so I started going up and down them 2 or 3 times once or twice a day, to get my new knee used to doing them. I did stop because it hurt a lot.

So like this?

I suggest you read this and tell me if there are any similarities TKR: symptoms of a loose implant

I did read that article and I do have some of those symptoms and if indeed my implant is loose, it explains a lot, the discomfort when I lean forward and also when I turn, and a pinching feeling I have in the knee.

The X-rays above are my most recent, done on 3-13-18, at my one year check up.

I will go back on the Tylenol 3 times a day.

Do you think it might be a loose implant? My knee often feels out if joint, but I thought that was because I have an implant and the knee is not fully healed. But it’s been almost 15 months since surgery.

 

[Josephine]

The X-rays above are my most recent, done on 3-13-18, at my one year check up.

Ah, gotcha! No, I am unable to see anything meaningful in those xrays, sorry.

Do you think it might be a loose implant?

There is every chance it is

My knee often feels out if joint, but I thought that was because I have an implant and the knee is not fully healed. But it’s been almost 15 months since surgery.

These procedures should feel sound from the get go. There's no 'healing' period to be entertained.

 

[Jockette]

Ok, then. I guess it really is time for that second opinion.
Thanks, @Josephine
Please say a prayer for me.

 

[Josephine]

Of course!

 

[Hood1980]

I’m praying for you too @Jockette. [emoji1374]. Do you have any second opinions scheduled yet?


Sent from my iPad using Tapatalk

 

[Jockette]

Hi, @Hood1980 Thank you for your prayers.

No, I haven’t called anyone yet.
I just realized tonight that it truly is time.

On Monday I will call my insurance to see if my 2 choices are in my network. They are in the Philadelphia area. My husband agrees I should get 2 opinions.

I am so sad.