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TKR Possible 2nd MUA and possible referral needed

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Re: 2 Weeks status post TKR

Hi Jill and welcome to BoneSmart!

A physical therapist should have a plan that starts out slowly, and then works their way up depending on what YOUR knee is able to to do!

My PT adjusts my workouts every time, and as I get stronger I do more reps and things that build the muscles in my legs. I have not had a PT at this facility who has "bent" my knee for me! They come and massage the kneecap and get rid of the scar tissue, and watch as I am doing the exercises for signs of pain. If pain occurs, they know to readjust the kneecap again.

So Please don't let your PT just push your leg for ROM! ROM will come with time and RICE.(Rest, Ice, Compression, Elevation.)

We care about you!:cnsl:
 
Re: 2 Weeks status post TKR

Hello Jill,
I'm sorry to hear your having such a hard time...
Please listen to the advice that everyone is giving you concerning PT!
I had a RPKR on Feb 19 2010 & had a lot of trouble with my ROM... I was in the same situation your in now, except for your extensive surgery.
I couldn't move my knee or extend for nothing & all I heard was you have to bend that knee constantly from my family & my PT!
I finally told them to leave me alone, it will come when it does if not they can do something about it later!
PT was constantly trying to push a knee that didn't want to bend causing me more pain! My family was trying to push it as well!
Everyone heals differently so please slow down & listen to your body & the advice everyone gives you on hear! I just wish I had found this forum a lot sooner than I did.
I ended up having to have a manipulation in the hospital & at that point I actually welcomed it! I knew that it wasn't going to go by itself! Scar tissue tends to build up on me faster than most people! This is a long recovery & I'm still recovering!
As far as your surgeon wanting to do a manipulation this early is obsurd... Your knee is still in the early stages of healing! Talk to your surgeon & don't be afraid of hurting his feelings! This is your body & your pain!
I hope everything works out for you!
Will keep you in my thoughts & prayers for a speedy recovery.
Nicole

RPKR Feb 2010
Right Knee Manipulation April 16th 2010
 
Re: 2 Weeks status post TKR

Jill, I am so sorry for what you have gone through. No one deserves that!

Welcome to Bonesmart, listen to what everyone is saying, they know what they are talking about! Take care of you, rest, ice and elevate!
 
Rash and INR/Coumadin ?

Hi Everyone,

I am 3 weeks s/p LTKR and am currently taking Coumadin 5 mg q day. I have a nurse coming twice a week to check my INR which has been steady at 1.1, and have been told by my OS office to remain on the 5 mg of Coumadin. What is the typical INR range for someone on Coumadin? I'm finding conflicting info on the internet.

This morning I woke up with 10-12 red spots on the skin on the inside of my left knee. At first I thought they looked like bug bites, but they don't itch - and I'm not sure what kind of bug would be biting this time of year. It's just ironic that these spots are on the same knee that I just had replaced. I'm sure it's probably nothing, and I'm certainly not "looking" for issues.... I just don't know if it is something I should be concerned about.

Thanks for any advice/comments.
 
Re: Rash and INR/Coumadin ?

Had to look up INR - International Normalized Prothrombin Time! New one on me! (which is to say the INR is new to me!) I'm afraid I can't answer your question but I know someone who might be able to @brs0660:

As for the spots, that's also got me stumped. I think you should speak to your GP.
 
Re: Rash and INR/Coumadin ?

Jill, I took Coumadin (Warfarin) for years for irregular heart rhythms. During that time, my INR was kept between 2.0 and 3.0. Has your nurse or doctor told you what their range is for you? I would be comfortable with whatever they are prescribing. The target numbers might be different for different people depending on the individual situation.
 
Re: Rash and INR/Coumadin ?

Jill...Welcome to Bonesmart!!! I am a microbiologist by trade. I am putting a chart below that tells how the normal value is calculated when one is on warfin. Hope this helps. The values do vary somewhat depending upon the lab doing the testing

Normal

Normal values may vary from lab to lab.
A method of standardizing prothrombin time results, called the international normalized ratio (INR) system, has been developed so the results among labs using different test methods can be understood in the same way. Using the INR system, treatment with blood-thinning medicine (anticoagulant therapy) will be the same. In some labs, only the INR is reported and the PT is not reported.
Prothrombin time (PT)Normal:
10–13 seconds
International normalized ratio (INR):
1.0–1.4

The warfarin (Coumadin) dose is changed so that the prothrombin time is longer than normal (by about 1.5 to 2.5 times the normal value or INR values 2 to 3). Prothrombin times are also kept at longer times for people with artificial heart valves, because these valves have a high chance of causing clots to form.

This is from broken link removed: https://www.questdiagnostics.com/kbase/topic/medtest/hw203083/results.htm website.
 
Re: Rash and INR/Coumadin ?

My husband also sometimes gets a rash from his coumadan--he is allergic to everything. If the coumadan causes a rash, why not take the injections--I only had to use them for 10 days, which was much easier than taking coumadan.

But, if you do have a rash, I also agree with Jo that you should see your primary care doc to make sure it is from a medication. Kelly
 
Re: Rash and INR/Coumadin ?

Thanks, Barb. Another gem added to the Library!
 
Back to OS - CT scan & EMG nerve studies

Hi All,

I wrote last week regarding some issues I have been having s/p TLKR (I am one month out tmrw). My PT was here yesterday and I lost another 5 degrees of flexion since my last visit with her... which was now a 15 degree loss in one week, still mind blowing pain, the total inability to lift my leg from my knee or in a straight leg raise - even the tiniest bit, and the feeling that there was "nothing" there when I tried.

She was very concerned and called my OS office while still here and spoke directly to my surgeon at that time. She told him about my issues and the fact that I now had a rash and he made an appointment for me to be seen today.

On his exam he did express great concern over my loss of flexion, my pain level even now a month later and my total inability to lift any part of my leg. He said my quad muscle was not "firing" and he couldn't feel anything when I tried to work the muscle. He went over the things that could be wrong. His biggest concerns were - a possible quad/patella rupture, a mechanical issue and possible nerve damage caused by the tourniquet during surgery. He did x-rays in the office which he said looked good, which was a good thing, but feeling that something is definitely wrong, he would have liked the x-ray to have shown something. He sent me for an immediate ct scan to be done by an MD trained in orthopedic ultrasound and not an ultrasound tech.

The MD doing the scan said that CTs at this point are an imperfect test as there is inflammation, blood, fluid etc and that is difficult to see around it all, and he had to "piece" the various parts of the test/pictures together. I haven't gotten the official results/report from my OS yet, but the doctor doing the ultrasound did mention to me he noted a tear/rupture in the tendon along the inside of my knee, as well as asking if anyone had mentioned my kneecap being situated particularly low (which was news to me). I told him no, and he said he needed to get a copy of my xrays to compare his ultrasound photos to, before he could write up and get the report to my surgeon.

My OS also wants me to undergo EMG nerve studies to see if there is damage to the nerves themselves and hopes to get those set up for next week.

So for now, he has taken me off the Coumadin and PT and just wants me to relax until we find out what is wrong. Friends and family keep asking me what is done for ruptured tendons or nerve problems or mechanical issues, and I have to say that I didn't ask him that today during my visit. I figured it best to find out exactly what IS wrong before I start worrying about how to fix it. Tonight my power was out for about 5 hours so I had lots of time to think... and now I am wondering how these issues are resolved, and I turn to all you BoneSmart Smarties who know far more than I to get your thoughts.

As always.... thank you for sharing your thoughts with me.
 
Re: Back to OS - CT scan & EMG nerve studies

Sorry to hear you are struggling with this.

You are quite right to try not to worry about what might be wrong and what could be done until you have the facts. Imagination is an enemy at times like this, but I'm sure you know our imaginings are always worse than actually happens.

Fingers crossed for next week:flwsm:
 
Re: Back to OS - CT scan & EMG nerve studies

Oh Jill, you poor lassie!

Well, ruptured tendons can heal themselves if they are not completely separated, but if they are, then they need to be repaired with suturing.

But nerve damage, well it depends what's causing it. If it's pressure from something like a muscles in spasm then obviously, the treatment is to get the spasm to abate. But if it's more than that, it needs the attention of a specialist.

But best not to dwell on all that until you get more results. Hope they come soon and show something easily remedied. And don't worry about your ROM. It will come back eventually!
 
Re: Back to OS - CT scan & EMG nerve studies

Hi Jill. I have no knowledge, but wanted to wish you the best. Take care of yourself.
 
Re: Back to OS - CT scan & EMG nerve studies

Jill, so sorry you are having to go through this. I agree that it's not productive to start worrying "possible" things wrong. Hopefully you'll have some answers soon and you can go from there.
 
Re: Back to OS - CT scan & EMG nerve studies

Jill, I started having the same problems as you when I was at PT. I could not do straight leg lifts, or lifts with my knee bent. What we are working on is getting the kneecap in position because it is not sitting in the groove do to scar tissue in my case, and swelling. When the PT comes over and manipulates the knee, I am able to do the leg lifts again. Have you or your PT tried moving the kneecap to see if that was part of the problem?
 
My complications s/p LTKR

Hi All,

I hope everyone is staying safe and comfy during the holiday rush. I have to say that while I'm out running errands with my family (either in a wheelchair or with two crutches) I am finding people going out of their way to help me out, hold doors, etc... it really is wonderful to see.

I am 5+ weeks s/p LTKR. I saw my surgeon yesterday who is still very concerned about both my issues - my inability to bend my leg (flexion is only 30-35 degrees) and the probable nerve issues (I can't lift my leg from the hip or the knee even the slighest bit). The not bending part he explained is a more common issue after surgery and will be doing the MUA soon after Christmas. After all I've read here and online regarding MUA I asked him if I was going to be sent home with GOOD and adequate pain meds after. He said in this case I would be admitted for a day or so and that he would do the MUA under both local anesthesia as well as a spinal and I would wake up with both the spinal still and with my leg in the machine to keep it bending overnight and into the next day.

I am scheduled for nerve conduction studies/EMG this Tuesday. He's hopeful that this will show something. If not then the next thing he will do is look at my spine and see if there is something wrong there causing the issue with my leg. He said that nerve complications happen to less than 1% of joint replacement patients. (I fell into this same category of patients after my cervical spine surgeries having had nerve damage there too) Perhap I should start playing the lottery... hmmmm. Having already dealt with and continuing to deal with cervical spine issues and two major surgeries to go along with those issues, I am keeping my fingers crossed that the tests on Tuesday show something, as I am really hoping NOT to have any more problems with my spine.

I'm just curious if anyone here has had any experience with nerve issues after a total knee replacement. Without knowing what the issue is yet, I don't know what might be in store... or what I have to look forward to. Thanks for any thoughts or guidance. I really appreciate it.
 
Re: My complications s/p LTKR

Goodness Jill,

You are my age and having such difficulty. I haven't dealt with the nerve issues, but sounds like your doctor has a good plan of action to find the problem and deal with it.

I have had the ROM issues and had a MUA, then a total cleanout and finally a total revision 10 days ago. My right knee didn't do well from the beginning. Multiple problems but boiled down to the way my body healed too quickly. Scar tissue/adhessions crippled my joint and virually made the new knee useless. My latest surgery has left me with hope that I can live without pain and have success this time around. Did all the tests, additional PT and precautions including steroids and antibiotics to be proactive.

Not saying this is your problem, just encouraging you to keep pushing and seeking to find the answers until things can be made right. Ask your doctor about steroids during and after surgery to help stave off the scarring. Has helped me thus far. It's amazing how simple things and the right meds can make all the difference.

Praying you get relief and victory soon and are pain free!
 
Re: My complications s/p LTKR

Oh dear, Jill. I am so sorry it's turned out like this. Actually this is one occasion when I would concur with the need for an MUA. But can't say much about the nerve damage. Depends what the nerve tests show. Hope it's something easily remedied.
 
Re: My complications s/p LTKR

:cry2: Jill, so sorry you are having these challenges. However, I am glad that you are not allowing them to enjoy the Christmas season.

After the nerve studies, you docotor will know more about what come next.

Although my experience is nothing likeyours, after my second surgery, I was unable to lift my leg because my quad muscles had a mind of their own. They were obviously atrophied because of all the abuse and misuse. The recovery has been slow, but I am progressing each day.
 
Re: My complications s/p LTKR

Jill,

Sorry to hear about your complications! So frustrating when you expect to be up and around after a surgery. It does sound like your doc is on the ball, though. I hope everything is solved with the MUA. Kelly
 
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