TKR Post-op Spasms

[Jamie]

Should the tenderness and pain continue to increase, contact your surgeon’s office for guidance.
They may want to take a look. If there is no redness, new swelling, or heat in the area, it is most likely nothing to worry about. Your knee has been through a lot in these past few weeks.

 

[BionicMama]

6 Week Update

It seems so long ago but also like it was yesterday that I had surgery. I was pretty arrogant going into this with my thinking. I assumed because I was on the “younger” side, was still mobile and working and fairly strong in my leg muscles that it would be an easy recovery. Wow how this past 6 weeks has humbled me.

Pain wise - I’m still taking Tylenol every 8 hours, sometimes stretching it to 12. About two or three times a week, usually after a busy day or physio, I require one Oxycodone to settle the pain. The middle and right side of my knee remains numb but it’s been slowly decreasing in the area affected. Using my TENS machine daily helps a lot. I find when I’m sitting, lying down, it doesn’t hurt, just mobilizing still and only at first and then when I start to fatigue.

Incision - I still have four stitches in from the repair done at 4 weeks. There remains a small 5mm diameter circular area that isn’t healed but has dried out. It’s likely slough and I’m not sure what the next steps will be in dealing with it. I see my surgeon this coming week for my post op follow up and will discuss it then. Using silicone healing scar strips has really flattened my scar and seems to have advanced healing to it, otherwise that the one spot. Highly recommend it.

Mobility - Haven’t used the cane in a week and a half. Still need to have the raised toilet seat and I just rigged up my sitting chair in my office with a small ottoman to make it higher because every night I was having trouble getting out of it. My ROM is slowly improving - flex is between 90-100 and extension is 5-7. Pre-op I had measured with the Curovate app and my flex was 107, extend 2, so I’m pretty close. Every once in a while I can manage to do stairs “normally” but only for a few. I suspect until I have the matching set of new knees that stairs will still be an issue! I’ve not used any shower aids but it is much easier getting in and out of the shower by myself and I only sit sometimes to shave my legs on the edge of the tub.

Swelling - still significant. Today I was puttering around the kitchen and my craft room and being up on my feet brought on pitting edema to the knee and lower leg. Wrapping it in a tensor, ice and elevation mildly help reduce the swelling but typically after a good nights sleep it’s gone again.

Sleep - since about the second week I’ve been sleeping well, usually aided with some Clonazepam but often I get 8 or more hours which is amazing considering pre-op my insomnia was in full force and I was often only getting 4-6 hours a night. I tried my best to sleep with my leg elevated but it’s never comfortable so I end up on my side most nights. Occasionally I’ve slept in my hammock - which I am thrilled to be able to use again as I wasn’t sure if I could manage to get in/out safely - I don’t really move off my back and stack three pillows under my leg with really helps with the swelling.

Overall, I’m reasonably happy with the progress. I’m certainly a long way off from retiring to work at the bedside in ICU but hopefully with continued physio, walking/standing and time, I can return in the fall as previously planned. Time will tell of course!

 

[EalingGran]

Every once in a while I can manage to do stairs “normally” but only for a few. I suspect until

Sounds like you are doing really well for 6 weeks. I wasn't doing stairs normally for months!

 

[benne68]

Yes, the intensity of this recovery catches most of us by surprise, @BionicMama. But I'm glad to read that you are doing so well at just six weeks post-op. Every bit of progress makes that light at the end of the tunnel a bit brighter, doesn't it?

Please let us know how your post-op with your surgeon goes!

 

[Layla]

Wow how this past 6 weeks has humbled me.

I think it humbles us all. It certainly makes us grateful for the little things once again that can be difficult to impossible in early recovery. I was amazed by all of the activities of daily living that I just took for granted.

You're doing well and I wish you all the best for your post op appointment. Please let us know how it goes.
A great weekend to you!

 

[BionicMama]

So my incision drama continues, I’m starting to wonder if it will ever heal. It’s been 7 weeks since my surgery and the area on the distal part of the incision was healing nice once the stitches came out and I debrided it. My surgeon said to just use steri strips but that was a mistake and it set it back. So I’m once again using the hydrocolloid bandages to help further debride and heal it. Above that however, my incision scar was slightly dry (my fault) and when getting out of my chair it split open like a paper cut. It was very superficial and I thought since the hydrocolloid bandages worked so well on the other area I would give it a try. Unfortunately I had my daughter by the Shoppers Life Brand to save a few dollars and after 12 hours I had a rash under the bandage with a large blister that broke as soon as it was removed. So now I have that area to deal with also.

Honestly, has anyone had a similar experience like this? My skin is so overly sensitive that I seem to react to everything I try - even products labelled as hypoallergenic. I’m going to try to keep it covered with just gauze me cling gauze for now as to not aggravate it more for a few days.

All I’ve wanted to do was go swimming to relax and help exercise this knee but summer will soon be over and my silly incision won’t allow me to submerge yet!

 

[mendogal]

The hydrogels like the type they sell here are great for wound healing - they provide the right amount of moisture needed to heal and discourage growth of bacteria.
For covering ... my skin reacts very badly to most tapes and bandages but a product I originally bought for my mom when she was alive (her skin was so.papery it would slough off... it was terrible) has proven equally effective for me. Telfa Island Dressings - essentially a thick non stick pad surrounded on four sides by an ultrathin flexible fabric that sticks but doesn't lift skin on removal; I often trim that outer edge to be smaller.

 

[Jamie]

I’m so sorry to hear you’re still struggling. These complications just simply require a lot of time to get resolved. It doesn’t look like the pool is in your near future and you wisely recognize that. Your wound needs to be absolutely and completely healed to prevent any new infection.

The sensitivity you’re experiencing is not uncommon. Our bodies are turned upside down with any surgery and things that were never a problem can suddenly become an issue. Getting any type of infection (even a superficial one) can intensify reactions to different things. As you’ve found out, it’s never a good idea to try and economize when you’re dealing with your health. Manufacturers use cheaper adhesives to these “bargain” products and you’re more likely to have problems with these products. Please stick with name brands that you can trust.

Hang in there and hopefully your knee will continue to improve. The open area certainly looks better than your previous photo, so this is a good sign.

Mendogal is correct about our recommended wound healing product, ACTIVE Antimicrobial Hydrogel. It is hypochlorous solution, which is a well studied and proven way to keep an open area or surgical incision sterile. If you’re interested, you can click on the link on this page to learn more about the product or purchase it.

 

[Layla]

It's only been five days since you last posted, but stopping by on this two month anniversary of your TKR to say and hope you're seeing an improvement in healing over the past several days. Please stay in touch and know that we're here for you always. I hope today is a good one!
@BionicMama

 

[BionicMama]

It's only been five days since you last posted, but stopping by on this two month anniversary of your TKR to say and hope you're seeing an improvement in healing over the past several days. Please stay in touch and know that we're here for you always. I hope today is a good one!
@BionicMama

Thank you Layla, that’s very kind of you.

I wish I had better news for being the two month anniversary, however I have a third infection of my surgical site and have had to restart antibiotics. My family and I are away at a cottage and so thankfully my surgeon was able to make an assessment via emailed photos and prescribe something to a local pharmacy.

This time around though is different. I had to take pain killers a few times and despite that the pain remained. I also lost some mobility to the knee which is still reduced from what it was a few days back. I see the surgeon next week and he’s also arranged an ID consult because of the repeated infections. I’m just praying that this one didn’t make its way into the joint. I don’t think I have the mental capacity to go through that. As it is, my husband and kids seem to be annoyed with me and this latest set back has only exacerbated that for them. I’m trying to just keep to myself and not say anything about how I’m feeling but that’s only making me feel more isolated and wishing I had not went through with the surgery and just lived with the pain.

 

[mendogal]

I'm so sorry you're going through this and that your family is acting as if you have chosen or are responsible for these nasty complications.

I'm very heartened that an ID doc is being brought in to consult, and hope that it's a purely localized infection s/he can identify and treat.

Sending a virtual ((hug)). Vent here; we're here for you.

 

[sistersinhim]

’m trying to just keep to myself and not say anything about how I’m feeling but that’s only making me feel more isolated and wishing I had not went through with the surgery and just lived with the pain.

Come here and vent with people that understand what you are going through. We care and someone is here 24 hours a day. We know how hard this recovery is without having an infection and you have that on top of a regular recovery. I am so sorry your family is treating you the way they are. Could it be that they are used to you waiting on them all the time and are upset that you don't feel like it now? No one understands this recovery unless they have been through it. What might help is if you tell them to go to youtube to watch a live TKR. This might open their eyes a bit. I was disappointed in my recovery time and did that. Seeing what is done to our knees is truly an eye-opener. After seeing that I was praising every little improvement!

Having an ID on your case now is a very good thing! I'm sure you will be seeing improvement very quickly!
I'm praying for your complete healing and for you to have an understanding family.

 

[Layla]

Hello BioincMama, Thanks for responding.
I am so sorry to read this news and that you’re struggling with pain and feeling isolated. My guess is that your husband and kids aren’t annoyed with you, but instead annoyed with the current situation, because they love you and they’re concerned. It is difficult to see those we love in a vulnerable position and you may be confusing loving concern with them being annoyed. Try to hold out hope until you meet with your surgeon next week. I trust that with an infectious disease specialist on the case, whatever decision is made will be in your best interest. Please stop by here for encouragement when you’re feeling isolated, we will be available for support whenever you’re feeling the need.
Sending a hug and best wishes. We care!
@BionicMama

 

[BionicMama]

10 Week Update:

Mobility: my flex is now averaging 110 degrees and my extension remains at about a 5. I’m getting around much easier most days and have even been able to do a short set of stairs with normal one foot per step pattern.

Pain: most of the pain I experience is either in my outer calf or directly behind the knee. Some days I don’t even remember to take Tylenol however with too much activity or overly aggressive physio, I have occasionally required a dose of Oxycodone.

Scar: here is where it all falls apart. My incision site is still quite a mess. I saw my surgeon last week and he thinks that it is small abscesses from where the internal sutures were. Despite antibiotics, various dressings, and rusting it, several open areas remain. Thankfully, it does not look to be infected at this time after completing my last course of antibiotics last week. Infectious disease saw me at the same time as my surgeon and didn’t feel there was any cause for concern. They are referring to it as simply delayed healing.

One thing I have found is when I stand for a long periods of time such as in the shower, the outer part of my knee develops what looks like a giant bruise. There’s no pain because that area remains numb. It goes away after resting and having my leg up for a bit. Has anyone else experienced anything like this?

 

[mendogal]

Re weird bruising with standing: yes, though not specifically with standing post knee surgery... I along with my mom and others in the maternal lineage have a very strong tendency to initially delayed and then quite prolonged painless bruising after very minor trauma. I had mine worked up 20 yrs ago. My coagulation is normal and my bleeding time is normal, so by the process of elimination it meant a problem with the capillaries' basement membranes allowing that slow leakage. Along with my somewhat hypermobile joints, it points to a minor genetic flaw in the same general class as the more serious EDS.
My nonspecified variant (didn't bother going for expensive testing as I am not childbearing) does not include slowed healing but many variants exist so I do wonder if your two issues are connected. Might check with your primary care doc.

 

[Jamie]

Your leg does appear to have some bruising in the second photo. You say this happens when you stand for a while? I suggest you try to minimize that as much as possible and see if that stops the bruising. You may have a small vessel or two that are continuing to bleed slightly and, if that’s the case, they may heal up. You need to notify your surgeon that this is occurring, though.

At any time did the surgeon or infectious disease doctor take swabs or do an aspiration of the fluid coming from your incision and send it out for testing? And, if so, what was the result? I’m glad you’re under the care of both doctors. Please continue to let us know how you’re doing.

 

[BionicMama]

Well, I had to tell my work today that I wasn’t going to be able to return at the beginning of September as planned. I know it was likely delusional that I was going to be tip top in three months, but I truly felt that was going to be the case being only 43. Having to admit that I couldn’t safely function as an ICU nurse right now was a sucker punch to the stomach. My whole identity is made up of my “career” and even the faint possibility that I may never return to work as I previously had sends me spiralling so far down that I have a hard time feeling any optimism.

I have one going off to uni this September, three others at home and have been the bread winner my whole marriage. The weight of everything just feels crushing right now.

 

[mendogal]

I'm so sorry.
It's super hard when you're the breadwinner, also when professional role = identity.
You can't return to it when planned, but you WILL return to nursing, sez this retired RN. Sending a hug.

 

[Finallydone]

@BionicMama, I’m also a retired nurse, and, like you, the bread winner and general care taker/giver of the family. I understand the devastation when something occurs that threatens our self image as well as our and our family’s livelihood. Take a day to be miserable, and then start thinking of possible options. Nursing offers a wealth of viable job options, maybe your unit needs some QA, chart review, continuing education you could present. Things you can do until you’re able to return to the bedside, and you will be able to. If you have available time, maybe you could benefit from a little more time off. It’s so hard when all you are told is “be patient” when emotionally you need to be up and taking care of things. Make lists, things you can do now, things to do when you’re physically able, all the things you hate most about being post op and not progressing as you want (hand shred and burn that list!). It feels like progress and helps to have a plan. Keep coming to this site for support, emotional support is as key in TKR recovery as ice and elevation. And try to rest. Blessings and may your recovery be smooth and recognizable!!!

 

[Jamie]

I know this was a tough task. You certainly aren’t the only BoneSmartie who felt youth was on their side for a quick recovery. Sadly, even though a person’s mind thinks that is the case, your body has other ideas. Healing is a time-sensitive process. There are some things that just cannot be rushed and this is one of them. Being younger and in good health may contribute to a good recovery, but it would be rare to have it be the reason for speeding up the healing that must take place. I’m glad you’ve reached the understanding about this and are in the process of accepting your body’s healing schedule.

One other factor that so many people don’t take into account is the possibility that they may have problems of varying degrees of seriousness during recovery. Most people don’t, but for some there are things than can slow the recovery process. However, people can and do recover from some of the most serious problems like infection or a revision surgery. So, there is every reason to believe that - no matter what is going on with your knee - you will be able to return to the work you love.

If you are the main income earner in your household, it might be a good idea to get with your husband (and maybe even your older children) and brainstorm what might be done to help should you need to be off work for an extended period. Having a Plan B and even a Plan C will make you feel more in control of whatever arises. And….you might be surprised at how well your spouse and children step up to help and learn from the experience of planning for a problem and helping to resolve it. You don’t have to carry all this on your shoulders. It’s okay to seek support and help from those who love you and are part of your family.

@Finallydone has offered some excellent suggestions for you. I hope you choose to explore your possible options rather than just letting this prey on your mind. We’re here for you! You aren’t the first person to have this challenge.