Revision TKR PT Post revision surgery

[dislocate]

Left TKR 03-13-2018, Right TKR 01-06-2021.
I’d like to address the issue of TKR and Range of Motion (ROM) or lack of. Following TKR on both knees the emphasis at physical therapy (PT) was to increase ROM. My accomplishment of attaining 120 degrees of knee motion delighted my therapist, but must be qualified that it could only be accomplished following one-half hour of rigorous warm up exercises of bike riding and bending exercises, and was very painful. When the PT session expired my ROM was again limited. Normal healthy knees generally bend and straighten between 0 – 135 degrees. I will never see that again.
The list of things I can no longer do with my prosthetic knees is very long. One example; I stocked up our bottom kitchen cabinet the week before my TKR with canned food and today I cannot retrieve the cans in the back. If I could sit on the floor I could reach the cans but my knees don’t bend enough to allow me to sit, and once on the floor I cannot stand because I must kneel and kneeling is too painful. Lacking those last few degrees of ROM that we take for granted can really take a toll on quality of life.

 

[ski_bum]

@dislocate
I'm sorry, but I am 8 months and 18 months post surgeries and while my ROM is 151 & 141 I cannot do anything on my knees. If I lay on the floor, I roll to something to pull myself up.
My father had bad knees, work related and I watched him and learnt.
People are not given any information before they do Carpenter work.
All the best and Merry Christmas.

 

[Mustang Shazzy]

I am really sorry, I can hear your frustration.

I am 7 mths post op and haven't got past 105 degrees. I remember the first time I had a bath, I was afraid I couldn't get out. I am thankful that I do a lot of upper body strength work because the other knee is painful thanks to OA. I can only get out with a one leg squat and heavy reliance on my upper body to lift me out clutching the bathtub walls- the operated knee is dead weight that contributes nothing and just gets in the way.

I am on the list for the other knee but I don't think I will get it done for the reasons you have experienced. This stuff wasn't in the brochure! I went off my Mum's experience and she had different expectations and a different lifestyle. I committed to physio, am very active, but my ROM is rubbish. I can't imagine kneeling on my new knee, so I think I will just have to keep the old one no matter how painful.

 

[Jockette]

The list of things I can no longer do with my prosthetic knees is very long. One example; I stocked up our bottom kitchen cabinet the week before my TKR with canned food and today I cannot retrieve the cans in the back. If I could sit on the floor I could reach the cans but my knees don’t bend enough to allow me to sit, and once on the floor I cannot stand because I must kneel and kneeling is too painful. Lacking those last few degrees of ROM that we take for granted can really take a toll on quality of life.

I have many issues, also. My partial is almost 6 years old. No one has an answer for me. I manage as best I can and I’ve come to a point that I’m thankful my knee isn‘t any worse.

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

 

[dislocate]

The BoneSmart home page agrees with the many knee replacement facilities of a 95% satisfactory rate. I've always questioned this number because my first TKR in March 2018 was unsatisfactory and my second January 2021 was no better than fair. Some of my fellow company retirees share their knee replacement stories. My contact list of knee replacement recipients is now up to 17 with only 2 completely satisfied and the rest having issues of varying degree. Not one, including myself, has ever been surveyed on their level of satisfaction. This raises the question on advertised statistics.

 

[benne68]

@dislocate. I have moved your latest post into your Recovery thread. We ask that members maintain just one for continuity.

You might want to bookmark it to make it easier to find in the future.

If you would like to change the title of your thread, please just let us know.

 

[dislocate]

I have moved your latest post into your Recovery thread. We ask that members maintain just one for continuity.

You might want to bookmark it to make it easier to find in the future.

If you would like to change the title of your thread, please just let us know.

I'm not computer savvy. I don't know what/where my "Recovery thread" is nor how to bookmark it.

 

[Layla]

Hi dislocate,
That's okay, we'll help you, many aren't computer savvy. We're on your recovery thread now and I'll leave an article explaining how to find your thread. If you need help after reading it, or have questions, we'll be happy to help you!
Click on blue type to open article -> How can I find my threads and posts?
Have a great evening! @dislocate

 

[Jamie]

There are specific surveys that the medical community uses to measure the success rates of both hip replacements (Hip Disabity and Osteoarthritis Outcome Score or HOOS) and knee replacements (Knee Injury and Osteoarthritis Outcome Score or KOOS). Normally these surveys are done within an orthopedic clinic to give doctors and patients some common measures of the functioning of the new joint or as a pre-op tool. Not all surgeons take the time to do this, but we have a number of doctors we work with who do. It's certainly not mandatory.

Then there are thousands of published studies on outcomes using these survey tools that are usually done through universities and hospitals. These are the numbers that are more likely to make it into a report that lands on the internet.

"Success" does not necessarily mean that someone is thrilled with their new joint. It's a relative thing to each individual, so instead of asking someone how they like their new joint, the surveys measure a number of functional details related to activities of daily living, pain, and mobility. If they didn't do it this way, the surveys would be pretty much worthless as you'd have nothing but people's opinions. There needs to be a scientific basis for the questions. So when you see numbers like a 95% success rate, it generally means that a high number of people report things are better after surgery than before the procedure. If you read some of these studies like we do, you get many more details about how people function after joint replacement. It varies widely sometimes. Besides, it doesn't really matter what the published statistics say. It's what's going on in YOUR life with YOUR joint that matters to you. Depending upon what issues you have, you do have options to seek additional opinions and try to resolve the problems. The fact is that your replaced joint will never be just like your natural one. You need to think of "success" in terms of what you can do now that you could not before your surgery. And it is true that sometimes accommodations need to be made in a person's life to work successfully with a new joint. That can be challenging, which is part of why BoneSmart is here.

If you find yourself with a mobility or pain problem, post about it here and you'll get a bunch of people who will step up with ways you might be better able to cope with it. Sometimes another trip to a couple of surgeons for opinions is needed just to make sure the actual joint is okay. Therapy can help if it's soft tissue problems. Perhaps we can help you and your friends improve their outcomes if you'll give us some details.

 

[Layla]

Hi again dislocate,
I am sorry if you're unhappy with your result and for any pain or limitations you're struggling with since your surgery.

I noticed your age and I marvel at your courage to undergo a procedure in your eighties. My mom had her second hip replaced at eighty and did very well. My dad may be facing a TKR soon at the age of 85-86. You must be an active adult in good health that was courageous enough to move forward for a better quality of life and to maintain independence rather than surrendering to the results of aging joints. Thankfully technology continues to improve in the areas of health care including anesthetics, medications and surgical techniques.

Joint replacement surgery is one of the most prevalent surgeries performed worldwide and the outcomes of these surgeries have become excellent based on a number of techniques changing over the years. The implants are durable and long lasting, with longevity much greater than before offering an increase in the likelihood you’ll never have to experience this procedure again.

While the great majority are pleased with their outcome and improvement in quality of life, there will always be exceptions. Sometimes we take a chance in life with a brighter future as our focus, but unfortunately not everyone is satisfied with their result. My surgeon's PA reminded me early on that our prosthetic hip will never match our natural hip, but it can get pretty close. I am truly sorry if you fall into that category of those unhappy with their outcome and hope that you're able to find enough comfort to continue engaging in all that you love.
Thanks for sharing your journey here. We'll be here for support and encouragement if ever you're in need.
@dislocate

 

[dislocate]

There are specific surveys that the medical community uses to measure the success rates of both hip replacements (Hip Disabity and Osteoarthritis Outcome Score or HOOS) and knee replacements (Knee Injury and Osteoarthritis Outcome Score or KOOS). Normally these surveys are done within an orthopedic clinic to give doctors and patients some common measures of the functioning of the new joint or as a pre-op tool. Not all surgeons take the time to do this, but we have a number of doctors we work with who do. It's certainly not mandatory.

Then there are thousands of published studies on outcomes using these survey tools that are usually done through universities and hospitals. These are the numbers that are more likely to make it into a report that lands on the internet.

"Success" does not necessarily mean that someone is thrilled with their new joint. It's a relative thing to each individual, so instead of asking someone how they like their new joint, the surveys measure a number of functional details related to activities of daily living, pain, and mobility. If they didn't do it this way, the surveys would be pretty much worthless as you'd have nothing but people's opinions. There needs to be a scientific basis for the questions. So when you see numbers like a 95% success rate, it generally means that a high number of people report things are better after surgery than before the procedure. If you read some of these studies like we do, you get many more details about how people function after joint replacement. It varies widely sometimes. Besides, it doesn't really matter what the published statistics say. It's what's going on in YOUR life with YOUR joint that matters to you. Depending upon what issues you have, you do have options to seek additional opinions and try to resolve the problems. The fact is that your replaced joint will never be just like your natural one. You need to think of "success" in terms of what you can do now that you could not before your surgery. And it is true that sometimes accommodations need to be made in a person's life to work successfully with a new joint. That can be challenging, which is part of why BoneSmart is here.

If you find yourself with a mobility or pain problem, post about it here and you'll get a bunch of people who will step up with ways you might be better able to cope with it. Sometimes another trip to a couple of surgeons for opinions is needed just to make sure the actual joint is okay. Therapy can help if it's soft tissue problems. Perhaps we can help you and your friends improve their outcomes if you'll give us some details.

My statement that my fellow TKR friends and myself were never surveyed on their satisfaction is exactly my point. Any surveys within any orthopedic clinic are "hands down" bias. After months and months of excruciating pain and thousands of dollars, there should be only one criteria "are you satisfied?"
I listened to several doctors to resolve my knee problem from 1. I can't find anything wrong. 2. There's nothing I can do. 3. Maybe you expect too much. 4. Revision doctor refused to do surgery when original was performed by another doctor. 5. Traveling out of state (a financial disaster) to see revision orthopedic only to be disappointed.
What other profession can you botch things up and make a windfall?

 

[Jamie]

Sorry to disagree with you, but asking a patient if they are "satisfied" with their new joint might be a good customer service move for a surgeon, but it will not produce any information from a scientific perspective. Science is behind those survey numbers you're seeing, not someone's personal opinion. The surveys I mentioned in my post measure specific aspects relating to mobility and pain levels that are measurable and comparable from one patient to another in any clinic or hospital around the world (and they are the standard for the world actually). These surveys are designed to minimize bias and opinions and allow the orthopedic community to arrive at statistics for the "success" of joint replacement surgery as a whole.

Since I don't know exactly what your problems are and why you are so disappointed with your knees, it's pretty difficult for me to say whether you might have "botched" surgeries or not. I'm sorry you're so unhappy. If you're interested in the surveys I mentioned, you can Google them and take them for yourself to see what your score would be. It sometimes is helpful to take a completed KOOS survey to any doctor you consult with about your problems. It's a good starting point for discussion.

If you would like to explain exactly what is bothering you, perhaps we could be of more help.

 

[dislocate]

Sorry to disagree with you, but asking a patient if they are "satisfied" with their new joint might be a good customer service move for a surgeon, but it will not produce any information from a scientific perspective. Science is behind those survey numbers you're seeing, not someone's personal opinion. The surveys I mentioned in my post measure specific aspects relating to mobility and pain levels that are measurable and comparable from one patient to another in any clinic or hospital around the world (and they are the standard for the world actually). These surveys are designed to minimize bias and opinions and allow the orthopedic community to arrive at statistics for the "success" of joint replacement surgery as a whole.

Since I don't know exactly what your problems are and why you are so disappointed with your knees, it's pretty difficult for me to say whether you might have "botched" surgeries or not. I'm sorry you're so unhappy. If you're interested in the surveys I mentioned, you can Google them and take them for yourself to see what your score would be. It sometimes is helpful to take a completed KOOS survey to any doctor you consult with about your problems. It's a good starting point for discussion.

If you would like to explain exactly what is bothering you, perhaps we could be of more help.

I've written to BoneSmart many times in the past but I'll repeat myself again about my left TKR.
1. I haven't had a pain free day since my surgery on March 13, 2018.
2. My pain and limited range of motion effects my quality of life, e.g.,
A. poor sleeping from knee discomfort.
B. falling down because I can't lift my left leg to regain my balance.
C. can no longer mount my ATV with my left leg.
D. many movements like putting on a pair of pants is a challenge.
E. prior to surgery I could easily ascend stairs, now I take painful baby steps with the aid of my right leg.
F. can't stand too long, going to the mall is out of the question.
G. no more dancing.
H. limping - my left knee knocks with every step reminding me I have a prosthetics knee. My wife can hear it when I walk across the room.
I've related the above and more to several orthopedist without a resolution. My last two doctor visits recommended a bone scan exam that showed all is good followed by a recommendation for a "Genicular" nerve block for pain. The doctor advised me there is no guarantee and the risks.
My right TKR on Jan 06, 2021 turned out relatively good with little to no pain.

limping
Prior to surgery I could all the above

 

[Jockette]

There are a lot of things I can’t do now, that I could before my PKR 6+ years ago. I regret having it done. 3 second opinions found nothing to fix. I totally understand how you feel.

 

[Fluttershy]

I’m sorry you’ve had such a disappointing outcome. Sounds like your PT’s were all focused on just meeting their TKR outcomes, rather than taking a more “whole body” approach? E.g, it would focus on overall body function, core, hip, ankle strength, etc….not just how much one body part bends!
I’m guessing you are probably sick of doing rehab or exercises…but I wonder if maybe you didn’t have the right fit with your PT. A good one would take a look at your list of concerns above….and then get to work assessing and analyzing your balance, gait, soft tissue feeling, muscle imbalances and loads of other things that make up a generally good global assessment. So much of balance comes from hips and ankles, and undiagnosed deficiencies or imbalances elsewhere can transfer extra load onto an already painful knee. It sucks that your knee is still so painful. It would be great if you had a rehab professional who would take a holistic approach to problem solve and maybe be able to salvage a bit more function for you…or at least be an advocate for better answers as to why you have so much pain.

 

[CatieViv]

I get it too. I am fortunate that my OS was willing to do a revision.

 

[Jamie]

Thank you so much for detailing for us again. It is helpful to read exactly what your problems are with the worst knee. Fluttershy gave you a good recommendation. Sometimes finding the right therapist is like hunting for a needle in a haystack, but it can make all the difference in the world. So many times problems like you're describing are the result of soft tissue problems. Surgeons are good at joint replacement and bone issues, but most aren't so good at diagnosing soft tissue shortcomings or other issues like gait. You might give that a try.

I'll address the elephant in the room too. If all the imaging and tests show that your implant is fine, is it possible that these doctors are giving you less attention because of your age? I would like to say that doesn't happen, but I believe it is possible they think you're "good enough" for this stage of your life. If you think this might be the case, there is nothing to do but to just keep looking for either a doctor or therapist to listen to your complaints. I think if you could find the right therapist, at least some of the problems could be helped.

Here are two surgeons in Nashville that may be able to offer different opinions. If they found no bone or implant issues, perhaps they could recommend a therapist that does gait analysis and can work with balance and soft tissue issues. Another possibility is to see a podiatrist. If your body is out of balance, it's possible that some orthotics may help. Gait and alignment problems can make all of your body hurt so it would be worth it to see if this is contributing toward your complaints. If you do opt to see a therapist or another surgeon, take the KOOS test for both knees and bring it with you to the appointments. This helps the person properly diagnose what may be going on.

Here is a link to the KOOS test for you.... https://orthotoolkit.com/koos/

 

[sistersinhim]

I'd like to add that you should be looking for a revision specialist while seeking another OS. These doctors know what to look for in 'problem' knees.

I pray that you find a solution to your pain. Life is meant to be lived, not endured.

 

[dislocate]

Thank you so much for detailing for us again. It is helpful to read exactly what your problems are with the worst knee. Fluttershy gave you a good recommendation. Sometimes finding the right therapist is like hunting for a needle in a haystack, but it can make all the difference in the world. So many times problems like you're describing are the result of soft tissue problems. Surgeons are good at joint replacement and bone issues, but most aren't so good at diagnosing soft tissue shortcomings or other issues like gait. You might give that a try.

I'll address the elephant in the room too. If all the imaging and tests show that your implant is fine, is it possible that these doctors are giving you less attention because of your age? I would like to say that doesn't happen, but I believe it is possible they think you're "good enough" for this stage of your life. If you think this might be the case, there is nothing to do but to just keep looking for either a doctor or therapist to listen to your complaints. I think if you could find the right therapist, at least some of the problems could be helped.

Here are two surgeons in Nashville that may be able to offer different opinions. If they found no bone or implant issues, perhaps they could recommend a therapist that does gait analysis and can work with balance and soft tissue issues. Another possibility is to see a podiatrist. If your body is out of balance, it's possible that some orthotics may help. Gait and alignment problems can make all of your body hurt so it would be worth it to see if this is contributing toward your complaints. If you do opt to see a therapist or another surgeon, take the KOOS test for both knees and bring it with you to the appointments. This helps the person properly diagnose what may be going on.

Here is a link to the KOOS test for you.... https://orthotoolkit.com/koos/

I’m hanging in there. I didn’t see the surgeon names. Please forward them to me. Thank you.

 

[EalingGran]

sorry you’ve had such a disappointing outcome. Sounds like your PT’s were all focused on just meeting their TKR outcomes, rather than taking a more “whole body” approach? E.g, it would focus on overall body function, core, hip, ankle strength, etc….not just how much one body part bends!

Really agree with this.
I have overall had a good result from surgery but by no means perfect- and I have other joint issues. I use pilates and it is a constant battle to maintain my knee rehab and manage back and hip issues.
I have used the Oxford knee score ( available on BoneSmart) to monitor my knee symptoms.
I have very good bend ( 150 degrees) but some residual pain due to a long overstretched MCL and some arthritis in the unoperated patellofemoral compartment. I can kneel with padding and get up and down from the floor and in and out of a bath with just minimal pain ( 1-2/10). So overall I count my surgery as a success but it is an ongoing process.
Today I had a private pilates lesson mainly working on my medial quads to help protect my knee when going downstairs.