Bilateral TKR New pain 10 mths post op

[Josephine]

Sorry I've not replied sooner - I was at work Thurs and Fri.

Indeed it does mean something to me. It's most likely tendinitis of the patellar tendon or could even be a prepatellar bursitis.

I'm now going to ask you some questions and 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 compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include 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 often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT exercises and exercises at home are you doing? How much and how often?

Can you detail it like this

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Strait leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[conroesin]

I am happy to answer these questions, but I am 10mths post op so am well-beyond PT etc. My pain is completely dependent on my level of activity. I had a back spasm this week, so did very little, and my knee is almost pain-free, unless I squat or climb stairs. 2 weeks ago, when I was living normally (attending pilates class, walking up and down stairs in my home) I was having constant pain ranging 5-8.

1. what are your pain levels right now? 0 at rest, 7 when squatting/stairs. After lots of activity, 5-8

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
Celebrex 200mg every morning, prn at night. Tylenol 500mg X2 every morning; Tylenol Arthritis formula 650mg X2 at bedtime. I take these routinely for arthritis in multiple joints. When pain is more acute, I take Tramadol 50mg prn.

I also took Medrol dosepak after OS appointment, but there was no change in my pain after taking full course.

3. how often are you icing your knee and for how long?
1-2X daily for at least 30 mins

4. are you elevating your leg, how often and for how long?
2-3 X per day, at least 30 mins

5. What is your ROM - that's flexion (bend) and extension (straightness)
Excellent range of motion, hyper mobile, fully straight and can almost put heel on my bottom.

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
Prior to this acute right knee problem, I was doing Pilates class 1-2 X per week, and working with very knowledgeable/safe personal trainer 1X per week, and walking in my neighborhood. Doing laundry and stairs in my 3 story home with ease.


7. what kind of PT exercises and exercises at home are you doing? How much and how often?
I do straight leg raises when seated, whenever I think about it, usually a couple of times a day, in addition to other gentle exercises in pilates class including squats.

 

[Josephine]

Thank you

1. 0 at rest, 7 when squatting/stairs. After lots of activity, 5-8

okay

Celebrex 200mg every morning, prn at night. Tylenol 500mg X2 every morning; Tylenol Arthritis formula 650mg X2 at bedtime. I take these routinely for arthritis in multiple joints. When pain is more acute, I take Tramadol 50mg prn.

Okay but you do realise that Tylenol only stays active in your system for about 4-5 hours, don't you? Therefore, you are going from lunchtime to evening with no medication cover at all.

3. icing 1-2X daily for at least 30mins
4. elevating 2-3 X per day, at least 30mins

You accomplish little or nothing in 30 minutes. Ice and elevate for at least 40-60mins and more than 4 times a day.

Excellent range of motion, hyper mobile, fully straight and can almost put heel on my bottom.

okayyyy

6. activity level:
Prior to this acute right knee problem, I was doing Pilates class 1-2 X per week, and working with very knowledgeable/safe personal trainer 1X per week, and walking in my neighborhood. Doing laundry and stairs in my 3 story home with ease.

okay

7.
I do straight leg raises when seated, usually a couple of times a day
squats.

Why? you have excellent ROM and are over 7 months post-op. No need for any exercises now so stop them.

But this doesn't explain your tendinitis so I would very much like to know what you were doing at Pilates please. Also an assessment of how much walking you were doing.

 

[conroesin]

I am a pharmacist (no longer practicing), so I do realize the gap in the relief. I can't take more Tylenol because of risk of liver damage. I like to have a glass of wine at night, and the Arthritis 8 hr formula is 1300mg, plus I take 1000mg every morning. I take this every day for other arthritis issues, even before the recent knee issue. But that only treats symptoms anyway so shouldn't impact my recovery from tendinitis, correct?

Pilates, its all very gentle on the knee and the focus is core strength and mobility to help me fight my arthritis in back and shoulders primarily. Although there is some strengthening of quads and feet. Is hard to describe if you haven't ever done it, but its the best/safest thing I have found and the instructors have much more training than most exercise teachers/trainers. I continue to do leg raises to continue to strengthen my quads. I don't understand why I should stop exercises? except that I have suspended squats due to this recent pain issue.

Walking varies, but usually 20-30 minutes. Nothing aggressive. I work from home and try to get outside and walk to give myself a break.

 

[Josephine]

I take this every day for other arthritis issues, even before the recent knee issue. But that only treats symptoms anyway so shouldn't impact my recovery from tendinitis, correct?

If you're a pharmacist you should know this. Analgesics don't target one painful area exclusive of others - unless you believe Nurofen/Diclofenac ads! The permeate the entire body so that the nerves in any area are blocked the same as in painful areas. For instance, I had bilateral rotator cuff impingement, piriformis and trochanteric bursitis and one short of Depomedrone in the bursa sort all the other pain as well.

I don't understand why I should stop exercises?

Because it's overrated, overplayed and unnecessary. I've proven that twice now. Read my recovery articles in my signature. A knee or a hip can acquire an excellent outcome with no exercising at all. Gentle stretches yes, normal activity yes but not exercises. Rest is all you need to heal, that#s how nature has deemed it. Did you ever see a wounded animal doing clam shells or squats?

 

[conroesin]

At almost 11 months postop, am I really still in healing/wounded animal mode? I am only 54 and mild exercise IS my normal activity. I need quad strength so that my knee tracks properly, which by the way, I think is probably why the tendon is inflamed. Make sense?

 

[Josephine]

Well it probably would if you gave me more information. For instance, who said you would still be in the "healing/wounded animal mode"? are you having pain?

Have a look at this chart - it might give you a lead