TKR Puffin is soaring into the sky

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Thanks @RestAssured - my PT has me doing one leg work in the pool so I will keep doing that for balance. I have no idea how I would do yoga on "dry land" as I cannot get down on the ground myself and I don't think there are any yoga classes or teachers around here that would cater for my needs as I live in such a small rural area - just to get to PT my DH has to take time off work to drive me over 10 miles to the nearest PT centre - luckily it has its own rehab pool but the pool closes late June-midAugust so I won't be able to do my water workout during that period :bawl:
 
The OS has arranged for me to use a TENS machine so see if it can reduce the level of nerve-type pain around my knee - not sure if it is working or not yet but it is a very strange tingly feeling :spider:
 
I was wondering if anyone had any thoughts or ideas about how to get rid of major swelling and inflammation around my knee cap that is causing me huge problems with pain and is also affecting my gait which given my existing balance issues is a major problem. The level of swelling is also making the knee sensitive and painful when touched by clothing/bedding etc

I had a cortisone shot almost 2 weeks ago (May 28th) for a synovitis problem below the knee. Last time when I had the same shot in February it also resolved excess swelling on the knee but this time the knee has remained swollen - I have done all of my usual RICE (i've rested it, Iced it, used a compression sock and spent hours elevating) but to no avail this time. It is agony when I have to sit in a chair/car for any period of time

Does anyone have any ideas of what to do? @Josephine ? Anyone?

I have tried to take some photos to show you what I mean (warning they are not very pretty)

The swelling is on the left side of the scar forming a mound of fluid as you look at it and extends around to the outside of the knee. The fact that the swelling is on one side of the scar is making it even more painful.

Thanks
[Bonesmart.org] Puffin is soaring into the sky
[Bonesmart.org] Puffin is soaring into the sky
 
@puffin

What does your PT say about the swelling. Would it help if I posted a video showing how to get to the ground and back up in the beginning stages? I can have Abby or Jill shoot it for you. Do you have a low bench or step inside the house that you can use?
 
@RestAssured
Thanks - I would love to see how you get up and down. I have a bench that is about 18 inches (ish) - I used to use it for flexion exercises after TKR. A vid would be great

I saw my PT today and she thought that the soft tissues look very inflamed. She thought it possible that when the OS gave me a cortisone shot 2 weeks ago that he most of it went under the knee and not under the knee-cap (in Feb he put some under the knee and some under the knee-cap). I'm not sure as I didn't look:swoon:

She thinks the OS needs to look at it (given that I have tried RICE and cannot take NSAIDs). However this is not easy as my OS is very busy as he is the head of TKR surgery and handles complex primaries and revisions (the other knee surgeons there seem scared to touch my knee :bolt:However he is *very* hard to track down - the clinic uses a system where you need to book a time even to talk to his receptionist :banghead:. So whether I can track him down is another matter. The PT says that if I can't get him in a couple of days to take myself to A&E/emergency room to force them to act
 
She thought it possible that when the OS gave me a cortisone shot 2 weeks ago that he most of it went under the knee and not under the knee-cap
I'm sorry but there no way a 10ml syringe of fluid is responsible for that swelling! I would have been nice if you'd photographed both your legs so I could compare!

It could be anything - excess fat, synovium, synovial fluid or just tissue fluid. I do think it needs to be seen by a doctor, preferably an orthopaedic doctor rather than an ER doctor who might not be so experienced in things like this.

Sorry, can't be more specific than that.
 
I agree w Jo. Force the OS to see you. ER docs are not experienced in knees.
 
@Josephine
oops i think we have a misunderstanding here - I didn't mean that the fluid in the cortisone shot had caused the swelling - rather the opposite - that the swelling has not gone down as expected from the shot. When I had a cortisone shot in February that the OS put it both under the knee and under the kneecap and both areas reduced dramatically in swelling - but this time the OS seemed to focus on under the knee only so the kneecap remains swollen (this was the way my PT was thinking that some extra cortsone may help - as I didn't get the "rooting around" under the kneecap sensation this time)

My knee is mis-shapen and swollen since the accident - partly the swelling from the accident never resolved/partly there is some loose skin from the weightloss. Currently my TKR knee is 5-6cm bigger at the knee joint than the other and 3-3½cm larger mid-calf. The PT has said that the TKR knee might never look normal because of the extent of the accident and effects of walking on a knee without ligaments and a 20-30 valgus for 2½ years waiting for TKR may have caused deformity. However I also have a general tendency to odema/swelling

Where I live in Sweden we don't have A&E doctors - if you go in with an orthopaedic problem you see the orthopaedic acute on-call team - usually junior doctor/consultant OS for complex cases
 
Puffin--what a mess---you must get so tired of all this stuff!!! It does not help if your doc is hard to reach.

Swelling is a complex issue---I do get some swelling if I ski on my left knee for two or three days in a row. I have adjusted my activity level and so try to ski every other day---and of course, that does not always work.

When I know that I am more active and the knee might swell I do a few things---I wear a compression stocking. If you have trouble fitting into the women's sizes, try the men's. The stocking do seem to help quite a lot, they are worth the aggravation of wearing them! Also, I use Aspercreme---I am not sure you can get that in Sweden. It is a creme for the joints which has aspirin in it. I cannot usually take aspirin since I have asthma--but the creme does not bother me since it is not absorbed systemically. Finally, I go home and just go to bed with ice and elevation for the knee. It is a pain in the neck--I am tired of lying in bed, but I keep a good book on the bedside and sometimes watch old "Call the Midwife" PBS series.

Most of all, I think you are going to have to be patient. You already know that you have more issues with swelling---and you are still only one year out from MAJOR surgery after almost three years of inactivity.

What shoes do you wear? I find that my Birkenstocks or Dansko work best for me. Also, have you tried Nordic poles for walking? My husband has some balance issues--he has heart disease. He finds that the poles really work for him.

Finally, I hope I have not added to your stress. Sometimes suggestions just seem like more work! Most of all, I think time will help all of this. Most docs are reluctant to give you more than one cortisone shot every six months---it sometimes weakens the tendons and muscles---so I don't think that cortisone will be a savior for you right now.

I am an impatient person---I want to be better now. Also, I have had to accept that my left knee is not going to ever be normal---that is normal as though I were 20. Instead it is a 70 year old knee that has had 8 surgeries on it. I do not have pain and I can ski although not every day. Most people would ask--"Why are you complaining?"
but, it is hard for me to accept imperfection. I feel that since I exercise and take care of myself, everything should be perfect!!!

For you---your weight loss was partially muscle tissue that needs to be rebuilt. Right now, since your muscles are not strong, you have to put your weight more fully on the joint---you are depending on it to hold you up. Once your muscles get stronger and help hold the joint in place, I think there will be less swelling. For now--do you do quad sets? That is when you tighten the quad muscle and hold it for 10 seconds. I used to do them forty times a day.l

It is frustrating, but your joint cannot take much in the way of exercise---no wonder you have balance issues---your poor muscles are still not fully functioning. Take it slow and easy. quad sets, leg lifts---David, one of our members got together with Jamie and developed a great progression of exercises:

Exercises for TKRs: do-it-yourself exercises from basic to advanced

You will have to stay with the basic exercises until your muscles wake up. Frustrating? Of course. But, relax, things will happen in time. Right now you are doing more than you hoped to do----another year and you will be further down the road---Sonja did not walk a marathon the first year after her surgery either. Nor did I----one year after my surgery, I used to be so tired when i came home from skiing that I would go right to bed. I felt that I could not live like that---and now, I don't. You will move forward just like we did----slowly but surely.
 
@puffin
Hello Puffin :wave:
:goodpost:I agree with Kelly. You need to build up your thigh muscles, they support your knee.
You where inactive for so long, it will take awhile to build the muscle back up. But, you will
Do it :) You have come so far & haven't given up & I admire you for that.:friends:
@RestAssured Sonja will have you walking a marathon in no time at all :heehee: She is one determined
Woman:walking:
Do you still :swim:?
The only way to go is Forward :SUNsmile::SUNsmile::SUNsmile:
Love,
Diana :loveshwr::loveshwr:
 
oops i think we have a misunderstanding here - I didn't mean that the fluid in the cortisone shot had caused the swelling
As my dad used to say, well dash my rags! Of course it was! Silly me!
The PT has said that the TKR knee might never look normal because of the extent of the accident
That I missed too. :sad:
Where I live in Sweden we don't have A&E doctors
I must have been half asleep - I also forgot you were in Sweden!
 
@skigirl
Thank you so much for posting such a long and informative reply. I think you have hit the nail on the head that I cannot really do things several days in a row at the moment because the swelling and pain makes it impossible. I am OK if I stick to my own schedule of exercise followed be a couple of hours rest and making sure that the walking training is alternated with pool/gym-type – but if anything out of the ordinary occurs which means I have to be out and about or sitting long periods then the swelling takes over. What seems to have brought it to a head this time was that we had visitors staying for several days and even though I thought I was pacing myself I wasn’t always able to rest the knee as often to head off the pain/swelling.


Thanks for the tip about Aspercreme – I have a serious allergy to NSAIDs (they cause liver inflammation) so cannot take them for this. Aspercreme is not available in Sweden but I have ordered some from Amazon UK – so hopefully it comes soon. Compression stockings are tricky as my distorted knee does not fit standard sizes and I find that the top tends to roll over when I walk around in the ones I have – the specialist fitter said that the best option would be made to measure but I didn’t have $300 to get this done


I have been using Hotter shoes which I find really good as they are marketed for Arthritis with multiple airbubbles in the soles and they also have a Gore-tex range. I am still making progress with the Nordic poles and can do around 20-30 minutes but my balance issues can be problematic so if I am alone I feel safer with my ultra-lightweight sports walker (Trustcare – Let’s Go Out) I just use it for balance. I will increase the quad exercises – thanks for the link


Thank-you so much for understanding the terrible tiredness that this pain and swelling brings – I also just have to go to bed and elevate sometimes I struggle to make it up the stairs – it is tough to still to living like this after almost 4 years. Still not driving is a big issue until the quads recover


Thanks again
 
I do get it----it is such a wonderful thing to feel well and be able to move when you want to and without pain. I think that better times will come for you as your muscles adjust to their new role in your life. Just keep on keeping on until it is better!
 
Feeling very exhausted today after a long day yesterday :yawn: my youngest daughter took her Swedish compulsory school certificate exam yesterday and I was up for 22 hours only getting to sleep at 4am :tiredwheel::mcoffee:

So I was pretty tired when the alarm went before 9am :alarm: as I had to be at the rehab pool at 11am. However it went ok and I managed just over 2 hours in the pool - approx 1 hour strengthening exercises and an hour of deep water running
:swim:
 
@puffin
You are doing wonderful with all your exercising :) Between the pool & walking, you are
Doing much more than I am. I tend to get lazy :heehee: Good luck to your daughter on her Exam :yes!:
I know it's been a long recovery for you, We are with you all the way :friends:Remember, a long
Journey starts with a few steps :walking:
Thinking of you :loveshwr::loveshwr:
Diana :flwrysmile:
 
I love to "run" in the deep water of the pool---I still do it often, five years later---I just like the feeling of getting all sweaty and out of breath while in a swimming pool!!
 
Puffin I don't know how on earth I managed to miss your thread for a year, but it seems that I did. I'm also a June Sunbeam, having my surgery at the end of june 2013. I also have lasting issues but nothing as severe as yours! I would like to know why you have balance issues?
 
Hi @scaredinCA - sorry to hear that you are having issues as well. As for the balance issues - in part it seems to be a proprioception issue (or loss of automatic walking function as the Swedes put it). In part it may be to do with the original accident and the extent of the nerve/ligament/muscle damage from dislocating my knee - also spent 2½ years waiting for my TKR and attempting to balance on a knee that was essentially unattached to my lower leg as all 4 main ligaments (both cruciates/both collaterals) were ruptured
 
hi @skigirl - just wanted to let you know that my big tube of Aspercreme that you recommended arrived today (snappy shipping from the US) so as i type this I am lying with my knee slathered in the cream - it looks like the swelling might be reduced a little :thumb:. Am also doing lots of quad exercises which are leaving me a little achey

Trying to make the most of the warm water therapy pool :swim:as it closes for summer after next week and does not reopen until mid-August :bawl::bawl:
 
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