TKR My Journey as of 12/16/13 - Over 1 Year and Still Trying

[Josephine]

So your pain is here?

There are many reasons why you can have pain there but I'll speak to that later.

My pain levels will vary anywhere from 2 to 6 and I haven't figured out what exactly prompts the worse pain as it can happen 1st thing in the morning as well as after a long day

Okay, got that.

As I'm almost 10 months out, my pain meds have changed. Most recently I was on Gabapentin 300mg x 3/day, Celebrex 500mg x 2/day as well as Tramadol and/or Tylenol as needed. None of these effectively touched this specific pain and as all the meds were beginning to throw off my equilibrium and cognitive functions, I stopped them all a week ago. Yes, I know, not the brightest of things to do. The specific pain I'm asking about hasn't changed though, it was just the same while taking everything.

No, not at all. If they weren't touching this pain then you did the right thing.

I no longer ice my knee

Okay.

I do elevate my leg whenever I can and yes, it's toes above nose. Probably an hour or two a day on most days. Longer on days that I am not working.

And does it help?

I haven't been properly measured in months since I stopped PT but it was 140/-3 a while ago. I may actually be losing my ROM as it just seems like my leg won't bend as far as it used to.

That's pretty good.

My activity level is probably medium. I live alone, so I cook and shop always. Not the best housekeeper. No stairs in my house aside from the sunken living room (1 mini step down and then back up). I do have a physical job in that I cater, but I only work a few days a week and only a few hours at a time. I do not go to the gym anymore or even take my dogs on walks as it hurts too much. No walks around the block or hikes or anything like that.

Ah, that's interesting ...

I have had issues with pain and swelling since the beginning. Odd thing is, although all of my swelling is on the lateral side of my knee, but all of the pain is on the medial side. I also have bone pain in my Tibia (I assume right where the bone was cut) right below the implant and about an inch to the medial side.

Not so odd but no exercises? None at all? What did you do in the early days, like the first 2-3 weeks?

I am coming to the conclusion that whatever you did in those early days gave you this pain. Where you indicated there are a couple of structures that could be responsible for this. These are the Pes anserinus and the MPFL (medial patello-femoral ligament). Both can be irritated into tendinitis, especially with things like squats or leg lifts with weights. Did you use either of these in the early weeks?

 

[DogLoverx3]

Hi @Josephine. Thank you so much for your quick response! That picture makes it look like exactly where my really sharp pain is - right at the little circular meeting spot!

No, elevating does not help, but it makes me feel like I'm doing something right. It couldn't hurt, so I do it?

Nope, I don't exercise at all right now aside from walking to where I need to go and working. I will bend my knee when lying in bed just to see how far I can get it to go, but that's about it. My knee just hurts too much to do anything - I tried taking my dogs for a walk the other day and paid for that brilliant idea for 2 days. Early on I did PT 3 days a week for probably 4 months. I didn't do anything with ankle weights until probably about the 3rd month. They did have me do the leg press machine though, but as I recall, I never went above 75 lbs and used both legs. My PT wasn't one of those 'gung ho' types and, for the most part, listened when I told him to stop. I never did squats. Tried to once and that was enough for me to ixnay those. I did have to go back to work MUCH too early on, but I didn't have this pain back then.

I did develop what they thought was Patella Tendinitis early on, but the pain was actually about an inch off center to the medial side, so was later told by someone that's not the Patella. So would both of these pains be connected as the Pes Anserinus wraps around the front of the knee?

Edited to add: for the front leg pain, I did used to wear a Patella strap, but always wore it off center (about an inch off center) so that the pressure points pressed on where it actually hurt and not directly under the patella....

 

[Pumpkin]

Ellen,
When did you move to your new house? That had to be hard on your knee too.

 

[Josephine]

Yep, it surely would! There are some things you could try though

1. TENS machines for pain management
2. Acupressure massage
3. chiropractic treatment
4. use a topical NSAID gel

 

[DogLoverx3]

Hiya @Pumpkln , I moved on May 1st. Lovely day. NOT! ;-) Although I didn't do much in the way of lifting, squatting or actually helping much, I know I did more than I should have at 5 1/2 months.

WOW! This is so amazingly exciting to get at least one (actually 2) of my pain issues hopefully figured out! I'm ridiculously happy at the moment. Thank you SO MUCH @Josephine ! I do have a topical compound that my OS had ordered for my nerve pain but know it has NSAID properties that didn't work for what he gave it to me for and just made my knee into fly paper, so will try that (get excited everyone, that means the 'what's stuck to Ellen's knee' game will start back up). I'm also going to hop onto Amazon and check out TENS machines. I had thought about getting one earlier on, but for some reason, ruled it out.

Will this pain go away eventually? I know that bursitis and tendinitis take forever to go away, but they DO actually go away, right? I'm so appreciative of all you do and the insight you provide. I've been asking doctors and surgeons for months to help me and none would listen and I was resigned to either getting lumbar nerve block treatments (which creeped me out as they made my entire leg numb) or having to take pain meds forever. Thank you!!

 

[Pumpkin]

Ellen,
I use Voltaren Jel on my knees, works well. You have to get a script from your MD.
Glad you are finding some answers here.
Take it easy, an look up those TENs units.

 

[DogLoverx3]

I'm on Amazon right now looking up TENS units ..... they seem to be a love it or hate it thing - kinda like blue cheese .....all are either rated really high or really low ....

Hopefully some of the Bonesmarties will weigh in on which ones they have/like. I think @icep707 bought one on Amazon, hopefully he'll see his tag and let me know ...

 

[Chihuahuan]

@DogLoverx3 Hi Ellen. My pt used massage and it worked wonders. I wonder if the massage Josephine is suggesting would be covered by your insurance. I don't know who does that kind of treatment in the U.S....
perhaps a chiropractor?

 

[Chihuahuan]

I'm on Amazon right now looking up TENS units ..... they seem to be a love it or hate it thing - kinda like blue cheese .....all are either rated really high or really low ....

Did you have this treatment in pto?

 

[DogLoverx3]

Hi @Chihuahuan , yes, TENS was part of PT (but I had to ask for it). I haven't gone to PT for ages though. Might be counterproductive to have them help me aggravate the issue and then fix it. ;-) Amazon has some units for less than $50 ... I wonder if they're any good?

 

[Pumpkin]

The less expensive ones will work for awhile then fail in about a year. Spend a little more and it should last longer. I know I have a TENS graveyard. Read the reviews.

 

[DogLoverx3]

Thanks @Pumpkln - I have been reading the reviews but there are so many of them! Thanks for the advice on getting a 'good one' and not the most economical one. I tend to make that mistake often. In men too apparently

 

[Jamie]

Most recently I was on Gabapentin 300mg x 3/day, Celebrex 500mg x 2/day as well as Tramadol and/or Tylenol as needed.

Is this correct that you were taking 500mg of Celebrex twice a day? That would be a very large dose...."normal" dosage of this NSAID is 200mg once a day.

 

[DogLoverx3]

Sorry @Jamie, the Celebrex is 200mg BID ..... is that still a lot? I was going to start taking that one again

 

[Chihuahuan]

Sorry @Jamie, the Celebrex is 200mg BID ..... is that still a lot? I was going to start taking that one again

Mine was 200 mg once per day. Then I went down to 100mg 1-2x per day

 

[Jamie]

The normal recommended dose is 200mg once a day. You always want to take the least amount to get the job done. I take Celebrex now and then but usually only for a day or two and then stop for a while. Like any NSAID, you want to use it with great care.

Who prescribed it for you? Your GP?

 

[DogLoverx3]

My new OS did and then my primary refilled it for me. I've noticed since I stopped taking it that not only does my TKR knee hurt more, but my 'good' one does too. I've taken either Naproxen or Diclofenac for,years and thought that Celebrex was better? It does help me. The tight feeling in my TKR is less when I take it

 

[Jamie]

The belief is that by being a COX2 inhibitor, Celebrex is a bit more gentle on your stomach than other NSAIDs. For many people it does wonders with arthritis-type pain and general inflammation. It does for me. There are side effects possible and you should be aware of what to look for. If you plan to take it for more than a few weeks, you need to talk that over with your GP. You might try just one 200mg pill a day and see if that will do the job. That would be a lot safer than the 400mg.

 

[DogLoverx3]

Thank you Jamie, I will start back taking just one a day and see if that helps. Odd that 2 different surgeons and my primary had me on Naproxen 500 mg twice daily for years. I do get annual blood work done though. I appreciate all your help and advice.

 

[Jamie]

Naproxen and Celebrex aren't the same (although they are both NSAIDs). For arthritis, the 500mg (even twice a day) is considered a "normal" dose. But.....my personal opinion is that I would not want to take that high a dose very long and would be definitely trying smaller amounts to see if it would do the job. Glad you are on Celebrex instead of the Naproxen now.