TKR One year anniversary and still struggling somewhat

[Carolina girl]

I had a LTKR July 3, 2013 and felt my recovery went quite well. I had six weeks of PT twice a week and had an excellent physical therapist. I saw the surgeon in late December and told him I had tightness and pain from back of the knee along the side when I walked. He said, "Something must be pinched back there. Come back in July."
The pain continued and in May I took myself back to see the same PT. He evaluated me and said he thought I had hamstring tendonitis. I did four more weeks of PT and felt better.
Now, the pain is back and I can actually see a bruising along the path of where the pain is. I am walking well and have no pain while at rest. I still have a very hard time going down stairs.
I was scheduled to see the surgeon for my final visit tomorrow but I received a phone call that I would be seeing the Physician's Assistant since my doctor has recently left the practice.
I am wondering how to approach this with the P.A. Does anyone have advice or experiences to share? Thanks.

 

[Jamie]

I'm going to tag @Josephine to see if she can offer any advice about what may be going on.

As for dealing with the Physician's Assistant....that's another matter. You have two choices. You can contact the clinic and tell them you want to be seen by a surgeon as you are having problems. Or you could go and discuss your pain with the PA first, then ask to see a surgeon if you were not happy with the outcome of your meeting.

The bottom line is that you need the attention of someone who can accurately diagnose what is going on and get you on the path to improvement. Be assertive. You deserve to have this dealt with.

 

[Carolina girl]

Thanks Jamie, I am going to keep the appointment with the P.A. because I want to find out where my surgeon is now practicing.

 

[Jamie]

That makes sense. Who knows.....the PA may be just fine to deal with. It's worth a try.

 

[tiredwife]

@Carolina girl Sorry you are having problems! I hope the PA will be able to help. Keep us posted.

 

[Josephine]

The pain continued and in May I took myself back to see the same PT. He evaluated me and said he thought I had hamstring tendonitis. I did four more weeks of PT and felt better. Now, the pain is back and I can actually see a bruising along the path of where the pain is.

I find this puzzling.

I'm going to ask you some questions and it would be very helpful if you would answer each one individually 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?

2. what pain medications are you taking (in mg please) and how often?

3. what kind of exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition
Doing 5 reps and then a brief rest = 1 set of 5
And doing 5 sets and finishing = a session

 

[Carolina girl]

Josephine, thanks for getting back to me. The PT gave me three exercises to do at home. I was pretty conscientious about them at first and in last few weeks have been less consistent.
One is lying on side and lifting leg straight out for 20 reps (2 sets) This is to strengthen the quads. This one does not hurt the knee
The second is to stand on toes and back to floor for 15 reps and two sets. Not hard on knee buts hurts lower back
The third is knee lunges. I am to do two sets of 20 reps each. This one is painful and the knee hurts more the day after.

I have just returned from seeing the PT. They did x-rays and he spent a lot of time comparing them with the one done shortly after the surgery last summer. He clicked back and forth and said he wasn't sure but there appeared to be some eroding of the bone at the implant site. He is sending me tomorrow to have a CT scan done and then will call me. He says that either way, he will refer me to a joint specialist.

I am experiencing some pain when walking and especially when I stand from a sitting position. The pain is in two locations. I will do my best to tell you where. Below the knee and to the outer side in kind of an arc. There is a clear swelling there along the line of the painful site. He said it was soft tissue swelling. The other painful site is the medial side of the kneecap.

I am not taking any pain meds except for 1000mg Tylenol now and then.

Thank you for your concern. JJ

 

[Carolina girl]

I have not heard from the PA since my Ct scan Tuesday. I called today and his nurse said she would get the scan and have him call me about it. That was 11:00 and she called back at 4:45 and, of course, I missed the call.
I did go by today and got a copy of the written report and the good news is that there is no erosion, fracture,dislocation, or loosening. So, I am breathing a bit better! Here are two notations I am not sure about.

"There is considerable artifact from the total knee replacement hardware. This does significantly limit the examination" ( I guess this means the radiologist could not see everything.)

" There is some increased density in the subcutaneous fat particularly in the pretibial space of the proximal tibia. This is likely scar." (I am guessing this means right below the knee cap is a formation of scar tissue. Is it expected that there would be some?)

I would welcome any comments or information.

 

[kneeper]

@Josephine should be able to translate.

 

[Josephine]

I guess this means the radiologist could not see everything.

correct.

" There is some increased density in the subcutaneous fat particularly in the pretibial space of the proximal tibia. This is likely scar." (I am guessing this means right below the knee cap is a formation of scar tissue. Is it expected that there would be some?)

Correct but hardly surprising as the patellar tendon is considerably involved in the TKR surgery as you can see here where the tendon is actually everted or turned over. So having scarring at that point is normal.

 

[Carolina girl]

Jo, Thanks for your reply.

 

[Josephine]