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TKR My TKR Nightmare

Pamlico

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First I want to say thank you. I've followed this forum for some time, and I should have registered a long time ago.

In December of 2017 I had my TKR done. Within 24 hours post surgery I felt like something was wrong. I was in PT with a group TKR's that had surgery the same day. Most of those in the room were 20-30 years older than me. Sports did my right knee in early. After 10 surgeries to repair everything from the ACL to meniscus it was time for TKR. When PT started the day after the surgery I had a hard time getting any movement in the knee. They paged the surgeon, and he told me I wasn't pushing it hard enough. His exact words to the therapist were 'push him to tears, and then push harder'. He told me it would come. Where I had come from you didn't push something that swollen this way. Just the opposite. Elevate and ice.

Fast forward to 3 days post discharge. I had a therapist coming to my home. My knee was still huge as expected from the swelling. The therapist had gotten direct instructions from surgeon. 'Push him!' The therapist didn't agree with pushing too much with so much swelling, so he was removed from my care. The next day I had the manager of the division come to my home, and immediately we were pushing the knee for movement as hard as we could. Suddenly a spot formed above the knee that was very hot. I was taken via ambulance to our local hospital. Nobody knew what was going on other than the area was getting larger and you could feel the heat coming off the knee.

I was held for observation for 2 days after fighting to not to get discharged. My wife and one nurse pushed for the hospital to transfer me to main hospital 30 miles away. The ortho on call kept blocking my transfer, and said I should be discharged and follow up with the surgeon the following day. Luckily I ended up getting transferred in the middle of the night 2 days later. By this time my knee and lower leg were in bad shape.

Once arriving at the main hospital I was taken for xrays. Before getting back down to the ED there was a stretcher waiting for me to take me to the OR. I had a hematoma, and by this point from the knee down my right side was purple and black. They opened me up and the hematoma was fixed. This time I spent 9 days in the hospital. PT started again, but I still couldn't bend the leg past 70 degrees. The pain was so intense, and after PT much worse.

Fast forward a month, and I started having major pain in my stomach. This is when things got really bad. The medications I was on including the pain killers caused major issues with my stomach. I ended seeing a GI specialist and I was put on a host of meds.

Every other day it seemed like we were back at the ED because I was throwing up non-stop that included blood. More meds were added to alleviate the issues. By this time I was worn out.

My knee still wasn't progressing and now my stomach was a mess from all the medications. It got worse. One of the meds I was now taking for the stomach caused a small heart issue. The GI doc had me a high dose of something that along with the pain med caused this according to the cardiologist. I was at urgent care when this happened, and rushed back to the hospital. Again during this time my knee was still huge, and I wasn't progressing.

After getting somewhat stable the surgeon suggested doing an MUA. We were 2½ months out from the TKR by this point. The MUA was done and yeah, I was up to 85 degrees.

Fast forward another month and 85 degrees was as far as I could move the knee. He suggested another MUA, and it was done. Now I was at 95 degrees. Progress!!! Everyday I followed my therapist's instructions and hoped my nightmare was ending. I was on meds now - the knee, stomach, and heart. I'm in my early 40's, and I felt like an old man.

3 months later, and no more progress. Finally the surgeon said I'm going back in. I had a couple of studies done, and the thought was the lower prosthetic was loose, so a revision needed to be done. It explained the high white cell count possibly and the swelling.

When I came out of surgery the surgeon spoke to my wife and said he'd never seen anything like it. He said I had 10 years of calcification in the joint that he had to remove.

The good news was he didn't have to replace the hardware. He set me up to have a round of radiation on the joint. I started PT again, and 2 months into PT I was at 125 degrees. Happy was an understatement. Finally I was allowed to go back to work. BTW, I work in healthcare. ;-)

At this point the knee was doing better. I was off the meds for the heart, but still taking meds for the stomach and knee. Pain management was now involved. I was put on a low dose of Oxy and they tried a few different things to help with the pain. Now I have a numbness from the knee down. Often it goes to sleep after a series of spasms.

My wife has convinced me to see another surgeon and my docs at pain management support this. I cannot walk without sharp, shooting pain and the knee is still more than twice the size of the left knee. However my flexion and extension are really good now (+2 and 125) We will see what happens. 17 months post TKR.

I typed this up quickly, so I'm sure there are typos. Without this forum and using the search function I would have been lost often. I know many have similar experiences.
 

Jockette

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You certainly have been through a nightmare. I’m so sorry. That’s not the way things should go.
When PT started the day after the surgery I had a hard time getting any movement in the knee. They paged the surgeon, and he told me I wasn't pushing it hard enough. His exact words to the therapist were push him to tears, and then push harder.
This was the beginning of your problems. Not all surgeons/PTs have this mindset. I was not asked to do any exercises in the hospital. No one bent my knee. All they had me do was a few short walks with my walker, and do a few stair steps.

Add in 2 MUAs and your poor knee has been beyond traumatized and not allowed to heal early on.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

All new post op members get our Recovery Guidelines, so here they are. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
5. At week 4 and after you should follow this
6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Spex10

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You poor thing. What an appalling time you've had. I can't add anything more useful than my sympathies and best wishes for a major improvement soon.
 

Jockette

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Also, please give us the exact dates of your TKR and MUAs and we’ll make a signature for you.
 
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Pamlico

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Right knee TKR-12/12/2017
Hematoma Surgery-12/19/2018
MUA-02/21/2018
MUA-03/26/2018
Surgery to clean out scar tissue and calcification 07/09/2018
Radiation-07/10/2018

Thank you.
 

Jockette

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Thank you for those dates, we’ll get your signature done.
 

Izabel

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There are no words to express the torture you had to endure ... at the instructions and hands of these sadistic morons! I would not have let anyone treat my knee in that way.

I hope you find a sympathetic and human surgeon soon and that recovery comes to you as you so justly deserve.

Have a peaceful weekend.
 

Roy Gardiner

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...the surgeon ...said he'd never seen anything like it. He said I had 10 years of calcification in the joint that he had to remove
The same surgeon? Why didn't he do it in the first place?!
My wife has convinced me to see another surgeon, and my docs at pain management support this.
So it WAS the same guy! My goodness yes, see another doctor. In another town, not connected in any way to your original doc.
 

Celle

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My goodness, you poor chap! Your poor knee has been tortured and you deserve better.
That surgeon should never be allowed near another knee.

I agree with your wife.
You need a surgeon in a larger city, and one who specializes in fixing problem knees and doing revisions.
This surgeon should have no connection, either professional or social, with your original surgeon. That way, he/she will be able to look at your knee with new eyes, and form his/her own opinion, without being influenced by the opinion of your original surgeon.

You can start looking for a surgeon by using our Surgeon Locator (in the blue band at the top of the page). Make a list of possibles, and then phone their office and ask if each one specializes in problem knees and revisions.

Or, you could tag @Jamie and tell her your zip/post code and how far you are prepared to travel to find the right surgeon.
 
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Josephine

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Every other day it seemed like we were back at the ED because I was throwing up non-stop that included blood. One of the meds I was now taking for the stomach caused a small heart issue.
I would guess that these meds were NSAIDs which could have been ibuprofen or diclofenac. Both very dangerous drugs. Read these
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study

My wife has convinced me to see another surgeon and my docs at pain management support this.
as do I!
 
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Pamlico

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Don't ever give up hope. The right surgeon makes the biggest difference.

My wife was right.

Shortly after my post I saw a new surgeon. We had to go through test after test after test. It took several months before the new surgeon agreed to go in. As he put it he was cleaning up someone else's mess. He was also scared for me because of the risk knowing how much trauma the joint had been through.

Fast forward September. He tells me it's time to go in. Instantly I felt relief. I was also scared because after 2 years I was beginning to wonder if all this pain was just in my head. Don't ever doubt yourself.

My surgery was set for November.

The big day came and I was excited. By the time I went in my ROM was less than 90 degrees. Worse was I couldn't sleep more than a few hours a night because of the pain. Depression was getting to me more than anything.

How did it go? My expectations were minimal because I didn't want to be disappointed.

I remember waking up in post op, and my surgeons PA was beside me. Immediately that set off some alarms. She didn't have bad news however. Just the opposite. She first let me know the surgery took much longer than expected. The surgeon and her had never seen such a mess when they got into my knee. (More in the morning)
 

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