TKR Patella Tendonitis after TKR - Have you had this?

[Orthodoc]

This is a great topic for discussion. Here are a couple of my thoughts.

First - Jo, you have mentioned 90 degrees as being the minimum. That is the number that most orthopaedic surgeons (based on studies and clinical experience) believe will enable the patient to return to most activities. Stair climbing is usually good at 90 degrees. Descending stairs requires a bit more flexion. In general, most OS will consider MUA if the flexion does not get to 90 degrees. I have, however, experienced several patients being satisfied with even less motion (the reduction in pain and deformity trumped the lack of motion). If knee motion only gets to 90 degrees there will be some limitation in function. Some patients compensate well for this, others do not.

Second - It is important to remember (I have stated this before) that the best predictor for post-operative ROM is pre-operative ROM. This has been shown by numerous large well controlled studies. The question has come up about implants. The type of implant may have some influence on motion. There are studies that show that PS (posterior cruciate substituting) implants have slightly better motion long term than CR (cruciate retaining) implants. However, I must stress that that there are many factors that can influence this. My experience is that whether I use a CR or PS implant (I determine this in the OR depending on several factors), the final ROM is not effected by the implant, but rather soft-tissue balancing, etc.. Additionally, studies have not found that rotating platform knees (which I use as well from time to time) provide any additional ROM compared to fixed bearing devices.

Third - As far as specific manufactures are concerned. I do not feel that one manufacturer has any significant advantage over another as far as ROM is concerned. There are so many other factors that are more significant. Much of what patients see is marketing hype (but effective none the less). What I will say is that the technology that continues to advance from the manufactures will continue to make TKA one of the most successful surgeries ever done.

Fourth - (You still with me?) As far as too much flexion. This is much less of a typical problem, but can be of a concern. As the patient hyper-flexes the knee, the back of the femoral component can pinch up against the back of the polyethylene. Here is one of the instances where component design does make a difference. Some polyethylene inserts are relatively flat (non-conforming), others are more dished (more conforming). If there were to be too much "edge" loading with hyper-flexion than the poly could prematurely wear down in that spot.

Orthodoc

 

[jenkneefur]

Thank you all, especially Josephine and Orthodoc, for your thoughts and input. I am hopeful that my ROM will increase with more time because my pre op ROM was quite high. The best decision I made was to buy a recumbant bike that I use every day -- don't think the ROM would be as high without it.

 

[jenkneefur]

...or really close to pain-free? Just wondering...for those of you who have made it to the other side, how long did it take before you were pain-free?

I'm 5 months out from the first TKR and was really hoping to be off the pain meds by now. While I'm doing very well in PT and have great ROM, pain is still a big problem.
Yes, I'm quite antsy to get to the fun part already. :cocktail:

 

[ChrisO]

Jen,

Well your post is a little discouraging to me as I'm only at 10 weeks and want to ask the same question.

I don't have pain when sitting (0/10) But when I stand, the pain literaly stops me cold (6-7/10). It takes me about 20 seconds to rise, cope, adjust and move. Once I'm moving it eases up and is tolerable 2/10. It really gets to nagging when Im forced to stand still for any reason (3-4/10). The situation is challenging... I have to prepare myself for the idea mentaly. Right now I dread door bells, phone calls and getting out of the car or getting up in the middle of the night for a potty break. Since the pain is bad only for about 20 seconds there isn't any reason to use narcotics for it. Others on this board talk about stiffness, boy oh boy if this is "stiffness" I don't really want to know about pain.

Im looking forward to hearing when this "stiffness" goes away.

Thanks for asking the ?

Chris O

 

[Campervan]

Still not totally at 7.5 months, but not enough to take pain meds. Just occasionally if I overdo it I take voltaren 25 or paracetemol (tylenol).

 

[bottomshollow]

I think this is the truly definitive answer to your question. It will come at different times for different folks, but for most it will be at least 9 months or longer. I am at 9 months post op, and I am not totally pain free; but the pain for the most part, when I have it, is minimal and only needs a couple of Tylenol to take care of it.

 

[jerseychick]

I think I was just about pain free at 6-7 months. Now two years out I have no pain at all in my knee only if I overdo it and then its just muscle and soft tissue pain.

 

[Lynne Cleveland]

Hi Jen! I completely understand. I will be 4 months postop on the 3rd of August. My ROM is good and PT is going okay. I still struggle with pain and my gait is off because of the pain, with some back pain. I am taking Tramadal, which is a non- narcotic script and helps I fill in with Tylenol and Advil which helps. I struggle with more pain in my quad. We just have to look at the long term and know it will get better!
My Physical therapist just keeps reminding me that everyone is on a different time schedule for recovery.

 

[Limpin'Lizzie]

I'm glad you asked this ? b/c I was going to ask the same thing. My leg has really been hurting me last night and today. It's below the knee, where I would imagine they did sawing...ugh! I'm about 13 weeks out. So nice to hear that I'm "normal." Mine does hurt enough to take my lortab.

 

[referee54]

I guess I still had minimal pain at about five months; at six months I was pretty much pain-free and at about eight months I was pretty darn close to being totally healed.

As has been already stated, it depends on each individual---it is a destination that all of us reach, but the length of time that it takes to reach that "pain-free" status is up to each individual---er , make that the individual's knee.

 

[tashia]

I'm glad you ask that. I am barely 2 months and my doctor is already wants me to get off them. I am much better than before at this time but I still need them. I sure hope he doesn't. It is really causing me a lot of anixiety. I just wish they would let you heal and not put any pressure on you. Six months sounds so far. The thought of getting into pain really scare me. So far so excellent. This is a slow process and a real big operation. I sleep for a whole 8 hours and when I woke up I was a little score. WOW That was Great. Tashia

 

[Dmgkag]

There is such a wide range of when the pain free state arrives. I was walking unassisted at 8 days and off all meds at 12 days. There was no pain, just the stiffness while trying to increase the ROM and some tightness.

 

[Dulcimer Diva]

At nearly 6 weeks out, I have no pain at rest (except elevating too high without thigh support--and that pain is my hamstring). I have some numbness, tingling. burning in L iliotibial band (dealing w/ gait adjustment due to leg length discrepancy), but it's merely an annoyance. I get about a 2 turning on to my right side to sleep (espec. if the leg is straight). About a 1 standing up too long;maybe 1-2 walking on the flat (cane or no cane), 2-3 climbing stairs foot-over-foot with a rail and no cane (0-1 if I take it one step at a time). And--mercifully momentarily--a 5-6 standing up from a low chair, banquette, sofa or getting out of a cab. On my last (I hope) day of BID half a Norco 10/325 along with the "cocktail" of 2 Aleve and one arthritis-formula Tylenol. Tomorrow, I will take the Norco ONLY 1/2 hr pre-PT, sticking with the OTC Aleve & Tylenol otherwise. IT DOES GET BETTER---faster for some, slower than others--but BETTER.

 

[megbabyrn]

Hi Jen, for me, it was 6 months to the day till I was pain free. I was taking pain meds till then. I had added Celebrex for my left knee, which helped the RTKR . Now it gets stiff if I overdo it.

 

[jenkneefur]

Thank you all for your input. This sure is a different journey for everyone.

I should probably clarify that my new right knee (RTKR 5 months ago) doesn't hurt anywhere near the amount of pain I have with the new left knee (2 months ago). Although, I don't know how the right one would feel without pain meds, as I'm still on the narcotics for the left. The right one doesn't hurt much at all, except when I go up and down stairs, or while doing PT exercises.

My pain doc is reducing my long-acting pain meds from 4 times per day, to 3. Normally, they are supposed to last 12 hours, but they only lasted 6 for me. I'm a little scared about it. I will probably have to rely more on the short-acting pain killers, which I haven't really used much, except just one before each PT session.

 

[jenkneefur]

There is such a wide range of when the pain free state arrives. I was walking unassisted at 8 days and off all meds at 12 days. There was no pain, just the stiffness while trying to increase the ROM and some tightness.

HOW on earth?!!! Wow. Just wow.

 

[Dmgkag]

Jenkneefur...I agree..It certainly was not what I expected. I was just taking it day by day. I was using the walker for the first week. The next day, my neighbor came by and asked if by any chance I had a Susan B. Anthony dollar as her daughter had just lost a tooth and she thought it would be a nice thing for the tooth fairy to bring.I got excited because I did have one of these and I went into the next room and got it. It wasn't until I got back that I realized that I forgot to take my walker with me! My husband laughed and from that point I walk unassisted. A few days later, I was thinking that I didn't like the way the pain medicine was making me feel....I fell asleep while talking to my son on Skype. I was taking Norco and I just stopped that day. I found that there was really not any pain, just stiffness. I can't explain why my experience was like this. I do know that I had an excellent surgeon. He uses minimally invasive surgery with computer assistance. My scar doesn't look like most of the pictures posted here. It is not a straight line over the kneecap. It is a small scar that curves to the left of the kneecap. Perhaps there was less trauma and therefore a quicker recovery and minimal pain? I really have no Idea. I just feel so blessed to now be able to keep up with my 5 Grandchildren, something I was really struggling with before...I coundn't even take them to the playground!

 

[LucyBelle]

I am 24 days out from my tkr. I ran out of oxycodone at exactly two weeks. At that point I wasn't really feeling a need for pain killers anymore. I had been missing doses and not regretting it at all. The doctor then gave me a prescription for hydrocodone, to be taken whenever I felt like I needed something. I have taken 4 or 5, but only because my other knee hurts! I am still taking aleve because of the swelling. If the darned swelling would just go down, I'd be a really happy camper.

 

[Josephine]

Healing can take up to a year and in that time it is entirely possible to still experience some form of pain - one type of which is STIFFNESS, Dmgkag!

 

[Josephine]