TKR Now two years post op and still recovering from nerve damage

[Celle]

Hi Margaret,

Although it has been slow, you have been making steady progress. You've been so patient! I do hope that it turns out that there is nothing wrong and it will just be a matter of more time needed.

Hugs!
Celle

 

[Orthodoc]

Those of you that have been with me over the past seven months will know that I've had extensor lag from immediately after the surgery. I've been doing all the right exercises, with some improvement. Yesterday the physio measured the lag still at 30degrees. Over the months we've tried elect stimulation and I'd feel the tingling but the quads just stayed dead. Yesterday we tried again and WOW the lazy quad tensed. Didn't do it every time the stimulation was active but it maybe every 2nd or 3rd.

Physio is wondering if something hasn't reattached properly after surgery. I go back to see her in a couple of days and then we'll decide if (a) she's going to phone my surgeon to discuss on my behalf and/or (b) have ultrasound as she and another physio both feel this might showup something.

In the meantime, no exercises except quad sets and riding my bike and walking.

Any comments gratefully received, particularly from Josephine and Orthodoc as to whether it could be a surgery related issue. Josephine; Orthodoc; There was some thought in the past about femoral nerve damage and I have great info above somewhere from Orthodoc.

Margaret,

I just want to make sure we are on the same page as far as the terminology being used. I remember a post a couple of months ago when we talked about a femoral nerve palsy as well. When you say a 30 degree lag, do you mean:

1) The knee goes completely straight when someone else lifts your lower leg. However, when you try to use your quad muscles to lift the leg, it lacks 30 degrees from getting straight.... or
2) The leg lacks 30 degrees from getting straight regardless of whether someone else tries to straighten you leg or you try to lift your leg straight with your own quads

The first scenario is an extensor lag (which is what it sounds like your describing). The second is a flexion contracture.

Orthodoc

 

[shr]

Glad to see the progress. I suspect that it is related to the surgery. Some nerve damage seems to be the norm and the healing tends to be slow and highly variable. It's important to keep working at it because, as you've experienced, the nerves can suddenly "wake up" quite a long time after the trauma.

 

[Campervan]

Margaret,

I just want to make sure we are on the same page as far as the terminology being used. I remember a post a couple of months ago when we talked about a femoral nerve palsy as well. When you say a 30 degree lag, do you mean:

1) The knee goes completely straight when someone else lifts your lower leg. However, when you try to use your quad muscles to lift the leg, it lacks 30 degrees from getting straight.... or
2) The leg lacks 30 degrees from getting straight regardless of whether someone else tries to straighten you leg or you try to lift your leg straight with your own quads

The first scenario is an extensor lag (which is what it sounds like your describing). The second is a flexion contracture.

Orthodoc

Hi Orthodoc, its the first one. Thanks in advance for advice. Orthodoc;

 

[Orthodoc]

Hi Orthodoc, its the first one. Thanks in advance for advice. Orthodoc;

Ok... So we have established that you have good passive motion (extension of your knee). The next info that is important is to determine the cause of the extensor leg. I know that you have posted and discussed that the quads are the cause of the problem. However, I think it is important to discuss some other causes. This can help to make sure you are not on the wrong path.

First is muscular/nervous. This what you are describing as your problem. Specifically the femoral nerve is not working causing your quads to be weak.

Second is a problem related to the surgery (as opposed to the regional block). These reasons include any source of discontinuity between the quad tendon and the patella such as a tear in the quad tendon. Another is a problem with the patella such as a fracture or problem with the patella "button." Another is a problem with the patella tendon where it inserts into the patella or where it inserts in the tibia. Any and all of these problems are complications that could directly impact your ability to actively straighten your knee. Has your surgeon ruled these problems out?

Third is component malpostioning (the knee not being put in correctly). This is less likely as a cause for an extensor lag, but should be mentioned. X-rays would show this.

I look forward to your response.

Orthodoc

 

[Campervan]

Orthodoc, thats great information. Thank you so much. I'll take a printout with me tomorrow to my physio and I think she's going to talk to the surgeon for me.

Immediately after surgery and at 5 months I had XRays and surgeon said components are positioned correctly. I think the reason I've always gravitated towards the nerve block is because it was beeping on the day after surgery and the nursing staff had to play around with it.

Also, at 7 weeks my physio did think about the patella and we did McConnel taping for 24 hours. I think it did make a difference.

 

[Orthodoc]

Happy to help. I hope you get through this well. Keep us updated.

Orthodoc

 

[Diney]

Hi Margaret
Have sent you a message re visit. Hope you find it! Let me know.

 

[Campervan]

Hi Diane, yes just seen your message and PM'd you back.

My physio wrote to my OS last week and got a reply today. He requested she organise an Ultrasound to look at my quads to see if there was any disruption to the medial parapetellar approach. So that's happening sometime next week.

 

[Pumpkin]

Margaret,
Finally, somrthing is being done to get to the bottom of your quads not working! Keep us posted on the results.

 

[Randi]

I'm sooo anxious to hear what's going on since I'm in mystery land as well...And hope it's something that is easily fixed !

I'm just curious. Do you know what type of knee you have ? I found out yesterday that I have the one that has many lawsuits pending against it which isn't making me comfortable .

 

[Pumpkin]

Randi, looks like it is the uncemented model. If you are cemented you should be OK.

 

[Randi]

Not sure. i'm off to physio soon so will check

 

[Campervan]

Yep, mines Zimmer NexGen CR not the high flex one and it is cemented. And the lawsuits relate to pre-2011. I'm going to tag Josephine; because I know this conversation has spiralled in other threads and she's able to give peace of mine.

 

[kneeper]

Good to hear you will be getting some more things checked out Margaret.

 

[Campervan]

Sometimes not living is a big city doesn't help! Ultrasound has to be done by a special person who only comes to my town every 6 weeks. She's next here two weeks today and fortunately I can get an appointment on that day. So now its a waiting game. I'm going to the physio for elect stimulation as many days as I can. So far, I've been 4 times. I'm not sure whether its improving things but today my quad did react better to the shocks, so maybe just maybe it is working and my problem is just weak quads. I live in hope.

 

[Randi]

Keep up that hope. Looks like you'll get some answers soon. I'm hoping for you , too.

 

[Celle]

Sometimes not living is a big city doesn't help! Ultrasound has to be done by a special person who only comes to my town every 6 weeks. She's next here two weeks today and fortunately I can get an appointment on that day. So now its a waiting game. I'm going to the physio for elect stimulation as many days as I can. So far, I've been 4 times. I'm not sure whether its improving things but today my quad did react better to the shocks, so maybe just maybe it is working and my problem is just weak quads. I live in hope.

Hi Margaret,
I hope the Ultrasound shows nothing is wrong - or that it shows nothing that can't be fixed. 2 weeks' wait is hard, but even if you lived in a large city, you would probably have to wait that long for a non-urgent appointment. If it was urgent, would you be able to get it done in Dunedin?

When we are at a conference in Queenstown, my husband developed symptoms that caused the emergency doctor in Queenstown to think he had a detached retina. He had us in the car and driving down to Dunedin (me driving, of course) straight away. The eye specialist came in at the weekend to see hubby. I was impressed! (No, fortunately not a detached retina - something less serious.)

 

[Campervan]

Thanks Celle. I did look at going to Invercargill, 2 hour drive but couldn't get an appointment there until the day after my Queenstown appointment. Haven't tried Dunedin as I don't think I could face almost 4 hours drive each way. Also I have so much work to do with a deadline next Wednesday that I wouldn't be able to go until after then anyway so I might as well wait for one more week after that. But Dunedin does have good medical people as it has a training hospital.

 

[Celle]

Thanks Celle. I did look at going to Invercargill, 2 hour drive but couldn't get an appointment there until the day after my Queenstown appointment. Haven't tried Dunedin as I don't think I could face almost 4 hours drive each way. Also I have so much work to do with a deadline next Wednesday that I wouldn't be able to go until after then anyway so I might as well wait for one more week after that. But Dunedin does have good medical people as it has a training hospital.

I see what you mean! New Plymouth, although bigger than Queenstown, doesn't have specialists in every area. A couple of months ago, I had to go to Hamilton, to see a specialist. That's about 4 hours each way and I didn't think my knee would like that, so I went on the bus. It was a long day, but at least I could rest my leg (had a double seat to myself).