Hinged Joint PT hates me

[LaJudes]

I just had the hinged knee replacement surgery on June 28 . I was battling an infection in my TKR done January 2018 , since August of last year . On April 19 they took out the knee hardware and put in a spacer with antibiotic , l went home with a pic line and IV for 6 weeks . I finally got the whole thing put back together again June 28 , had no idea that they were going to use the hinged replacement , never heard of it . I was told that it’s for complicated cases , and unstable knees . During the coarse of the 6 weeks IV and leg immobilized , the spacer dislocated , and l had to go back to surgery to fix it , that’s why they said it was unstable . One good thing I learned is with the hinged replacement you do not need PT . My orthopedic surgeon says it will bend really easy . For the first 3 weeks after the last surgery I have a leg brace , need to keep it straight . That’s to let it heal straight , because the knee tends to want to bend slightly . So seems like it is kind of opposite of the regular knee replacement that PT works so hard to bend. I am looking for any information about the hinged knee replacement so will watch this for updates and can add more info here as l get it , since l am only 11 days out of the surgery . My surgeon really gave me li information . I go back in about 12 days to have the staples removed .

 

[Jockette]

@LaJudes Hi and Welcome!

I’ve copied your post from another thread to start a Recovery Thread for you. Best wishes as you recover from an infection and revision. We are here to support you.

One good thing I learned is with the hinged replacement you do not need PT . My orthopedic surgeon says it will bend really easy .

This is interesting, I‘ve never heard this specifically.

Actually, no knee replacement needs formal PT, just movements to keep the knee mobile, which can be done at home, on one’s own. We have members with non hinged TKRs who don’t do formal PT and they have had great outcomes. We have found that some PTs just don’t understand what is involved with TKR surgery, and they give an inappropriate rehab protocol. I’m glad you did not have to experience that.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[LaJudes]

My original TKR was January 30, 2018. Four weeks after the surgery I took a bad fall and tore some muscle away from the knee bone, had to go back to surgery and it was repaired. Then a brace for 4 weeks to let it heal. It never was good, always painful, if I sat too couldn’t walk. So stiff. I tried exercising and nothing really helped. Then last summer I started getting small lesions or sores just below my knee cap.

The orthopedic doctor treated me with antibiotics and it went away but came back every month or so. They decided to open up the lesion in surgery and clean it out. It came back as a staff epiderm infection. The orthopedic said it was not in the knee hardware. I was on antibiotics for a few weeks and all was good for several months, then the sores appeared again. They tried antibiotics and seemed to work but the infection came back and made a big red “egg” on my leg. I was sent to a revision specialist. He said the infection was in the joint replacement and had made a trail, called sinus track down to below my knee cap where it could surface.

They took out all the hardware and put in an antibiotic spacer. I was hospitalized for 8 days, went home in a leg brace and pic line for vancomycin IV for 6 weeks. I had a home nurse PT, OT coming over, was in a wheelchair, and used a walker to get from wheelchair to bed, toilet, etc. Had to “hop” on my good leg, no weight on the surgery one. ln spite of following directions, the knee spacer thing dislocated and l had to go back to surgery to fix it, on June 2. Then I returned to the hospital for the new implant done on June 28. I was in the hospital for 4 days, mostly because I couldn’t keep food down.

Found out after the surgery that I have a hinged knee replacement. Never heard of this. I was told by the orthopedic doctor that l will not need PT because the hinged knee will bend really easily. I have to keep a straight leg brace on for 3 weeks to let it heal straight. I read that hinged knee replacements are given to people with unstable knees and that there are things you can’t do like with a regular replacement. So far I have hardly any information, l go back in 12 days to get the staples out and hopefully more information. Does anyone have this type and how does it work without the brace? I am tempted to try to bend it but scared since they said the wound must heal or it will pop open, being cut open so close together.

 

[LaJudes]

Thank you l hope to hear from others about the hinged knee replacement , l did read that it’s not as durable as the regular one and there are certain activities that you cannot do .

 

[Jockette]

It seems we were both posting at the same time. To avoid confusion, I’m going to merge the two recovery threads, the one you started, and the one I started for you. There will be some duplicate words, but all your history will be in one thread.

 

[Jockette]

Wow, you have really been through a lot. We’ve had a few members with hinged knees. You can use the search feature, upper right part of this page, and do a search for other members who have one.

We‘ve also had quite a few members with an infection, and those are usually treated very successfully. Best wishes that yours will, too!

Here is a list of other recovery threads with infections:

Knee Surgery Recovery Area

For post-operative knee patients, on the "other side"

bonesmart.org

 

[Cjackso21]

Hello, I am so sorry for all you have been through! As you can see in my signature, I have been at it for awhile as well. I was so fortunate to not get an infection. I was advised by one doctor to get a hinged knee for my last TKR revision a few years ago due to my lateral ligaments stretching but the final doctor I found felt he could do the TKR without needing that. I was not sure of the limitations except potentially needing new joint hardware every 7 yrs if they used a specific model. I did not get the hinged knee but did have a successful TKR using robotics. Unfortunately my ligaments stretched again so I had another revision a little more than a year ago to put in a thicker spacer and try to add support to the worst ligament. This was successful for about 6 mos but once again my ligaments have stretched. I have been in a knee brace (ACL type) for the last 6 mos and am now awaiting work to be done on my atrophied muscles that they believe are causing the instability before they will do another surgery. In retrospect, I wish I had gotten the hinged joint but still do not understand the limitations and I believe I do not have enough bone left to get another TKR. Hopefully you can find more information from folks here about the hinged joint. Good luck and will pray for healing for you.

 

[Jamie]

@LaJudes ... you'll notice that your thread title was changed slightly to add an "Infection" prefix and shorten the title. We find that the longer titles are not as easy for other members to read as they scan the index list for threads to read. All the information you had in the title is contained within your posts, so it won't be overlooked.

It's always unsettling to learn that your joint is infected, but we do see a fair number of these on BoneSmart. You'll find as you read through some of the other threads that in most cases, the antibiotic treatment and and revision takes care of the problem and recovery proceeds just fine after that. The two-step revision like you're having is the one that is most likely to give you the best result, so I'm glad to hear that your surgeon went that route. All the best to you and please continue to update us on how you're doing. We're here for you.

 

[LaJudes]

I read my operative report , it seems the surgeon put in the regular type but he didn’t like the stability of it , stated it wanted to move back where it had dislocated, so he went to the hinged replacement , they always use a “trial” piece for fitting before the real thing is put in .The name of it is in the report , l will put it on here tomorrow , need my laptop for that . I questioned them about it and saw my X-rays today , the hinge part seems really small , like a little finger . They said I won’t need PT , but are having me meet with one in 2 weeks when I get my staples out . Pt will go over the difference with the hinged knee . I am still not to bend it and have a brace because of my staples, and knee cut open twice close together . They had me bend it a little for the X-ray . It barely hurt at all .

 

[Jockette]

@LaJudes I noticed you posted the above in a pre op thread, so I copied it to your recovery thread, so it will be part of your history.

I also read my operative report, but I didn’t get it until I was one year post op, and I learned a lot from it.

 

[Flowerfloosey69]

I wonder if they use a hinged knee for a loose tibial plate? My issue is " ligament laxity" the revision went bad with a fall within 6 mos. I've been babying it for 8 years.

 

[LaJudes]

Update on hinged replacement , done on June 28 . Nice to say that at this time I have no pain , getting around good with the walker , was able to ditch the wheelchair Yay ! I have no pain when I put weight on the operation leg / knee . I still have the brace for 2 more weeks because they want the wound to be healed well before I bend it . They did bend it some yesterday when I had X-rays , it didn’t hurt at all . I get the staples out in 2 weeks and l will have a one time meeting with a PT person just to go over stuff particular to the hinged knee replacement. I will not have to have Physical Therapy !Yay ! I keep the brace on at night , and have no problems sleeping . I am anxious to try out the new knee , but have to be patient and let the wound heal . This saga has been going on since mid April , so its hard to believe it is coming to an end !

 

[LaJudes]

Update on my journey. I got the staples (80) removed 2 days ago. There was some surface bleeding over the knee area where the very top of the skin separated. The Doctor pulled it shut with sterile strips and it’s fine now. Before taking out the staples he had me bend it, and said I was at 90% already. He canceled the PT visit today because of the wound separating and bleeding. I go back in 2 weeks for X-rays and will meet with PT then. I have hardly any pain, heat, or swelling in my knee. The knee is smaller than it’s ever been since the original TKR, it was always so swollen after that. Getting around easily with a walker or cane or holding onto cabinets and counters when I can. After 4 months, I feel so free when I can move from one place to another without an assistive device. I also have been able to drive this week. Not needing pain meds anymore.

 

[Jockette]

You are doing really well!

 

[sistersinhim]

 

[LaJudes]

sorry I couldn't figure out how to get this on my original thread . l had a hinge knee replacement after a 2 stage revision due to infection . Right from the get go , no pain and very easy bending etc . l was encouraged to do a bit of PT for muscles strength .
I agreed with this since the knee felt sort of wobbly .So I went x2 , scheduled for every 2 weeks for l hours . Since I started significantly improved my walking as I was walking like a peg leg , now way better . Home exercise is easy but to strengthen certain muscles around the knee . How ever , since starting this , l developed a strange grinding noise in my joint when l bend it , and it started giving me pain , especially at night . l imagine it's the muscle reaction to the exercise . Don't know if i should continue or just stop . l have 2 more appointments in the next 3 weeks . My walking has improved dramatically , but nothing else really , and now my knee hurts as well .

 

[Jaycey]

@LaJudes I've merged your latest post into your recovery thread.

If you are having pain after PT sessions I would stop and wait for all this to settle. It is a bit early to be working on strengthening - especially after all you have been through with that knee. Go back to icing regularly to get this under control.

 

[ski_bum]

I just had the hinged knee replacement surgery on June 28 . I was battling an infection in my TKR done January 2018 , since August of last year . On April 19 they took out the knee hardware and put in a spacer with antibiotic , l went home with a pic line and IV for 6 weeks . I finally got the whole thing put back together again June 28 , had no idea that they were going to use the hinged replacement , never heard of it . I was told that it’s for complicated cases , and unstable knees . During the coarse of the 6 weeks IV and leg immobilized , the spacer dislocated , and l had to go back to surgery to fix it , that’s why they said it was unstable . One good thing I learned is with the hinged replacement you do not need PT . My orthopedic surgeon says it will bend really easy . For the first 3 weeks after the last surgery I have a leg brace , need to keep it straight . That’s to let it heal straight , because the knee tends to want to bend slightly . So seems like it is kind of opposite of the regular knee replacement that PT works so hard to bend. I am looking for any information about the hinged knee replacement so will watch this for updates and can add more info here as l get it , since l am only 11 days out of the surgery . My surgeon really gave me li information . I go back in about 12 days to have the staples removed .

I want to follow you to get the real truth about Hinged Knees.
Thank you.

 

[LaJudes]

Here are my x-rays of the hinged knee replacement . ski-bum- l want to find out the real truth too. At this point ,10 weeks out , all l know is that l had no pain or discomfort until l started very minimal PT 4 weeks ago to strengthen the muscles only . Since starting that it hurts to bend and makes horrible crunchy noises that l can feel when l put my hand on my knee while bending . Don't know if it's because the muscle is changed from the exercise ? l just started using the exercise bike this round for 10 minutes a day , per PT instructions , it's a nice recumbent bike, we have at home . l have 3 other simple exercises that l can do while laying on the bed , and the last one PT gave me was a semi- squat l that l am unable to do correctly because it hurts my knee . l only see the PT for 45 minutes every 2 weeks and tomorrow will be my 3 rd visit . Not sure what to do , continue ? I do feel the muscles have gotten much stronger and l walk a lot straighter than before , no limp . The PT seems to want me to do step foot over foot , and l always do one foot at a time . l worry so about falling , don't know why it's so important to do stairs foot over foot . l haven't done it that way since before my original TKR in 2018 , because l didn't feel stable . l don't need to do many stairs anyway . I have one more scheduled appointment with this PT after tomorrow , unsure if l should continue . lt's a 1 hour drive for me one way , is why l go only every other week .

 

[LaJudes]

Something strange happened today . Hubb had a Dr appointment so l went with to shop at a favorite discount store in the area. l got a ton of stuff , mostly groceries in cans and glass jars . l loaded the many bags in my trunk and picked up hubby at his Drs . No problem there . l drove back home and when l went to get out of the car a sharp pain in my lower back , took my breath away . l could barely get into the house , so painful . Now it's settled to be a nagging painful area in my right lower back . l have never had any back problems so this is scary . l don't think the bags l moved from the cart to the trunk were that heavy , the put smaller amounts in each bag for me . Not sure if lwas sitting weird when driving home . The minute l got out of the car it hit big time , felt a huge cramp. l have PT tomorrow , couldn't do any of the exercises today , l only see the PT every 2 weeks , so don't want to cancel . Any ideas what l did to my back .? l worked ambulance as an EMT for 12 years and lifted a lot of heavy people . never had anything like this happen . Of coarse l was a lot younger . l am icing it now and that feels good . Any ideas ?