TKR Pulled Ligament in Week 6 recovery

[BlueSkiesHere]

Hello @ChillTime . Yes, the pulled ligament set me back for sure and also aggressive PT did not help. My PT experience was not so great and I have had fantastic PT in my past. As for the bone pain, I also have read that the bone pain/shin is not uncommon and if there is no medical problem can take up to 12 months to resolve. I will not mention the name or link of this PT expert since they have asked us not to.

Again, even this posting you've written sounds like my "diary". I still have to really manage my steps and activity or I get the aches and popping/nerves or dull burning. Like you - I've been counting steps and trying to slowly build my steps which is difficult since I'm a very active person. I'm a landscape photographer so I like nature and hiking and I miss so much. It is still stressful for me to have to continually gage how much I can do before the threshold of overdoing. Like you - I'm slender and pretty active. I find also that just ADL does up the steps quite naturally. Walking up hill is not my friend right now and walking DOWN...trouble usually follows. I walk zig zag down for now.

I've recently gotten fed up with all this and just REALLY pulled back on my daily PT exercises I do and concentrate on ADL and trying to work in more walks with my camera outside. I am finding my knee is managing much more because I do not have the stress of continually bending and strengthening exercises to keep it agitated. I actually have just gone back to the normal morning exercises I did before all this that I did to keep my knees healthy and flexible. The only thing I've added is I do more prone knee bends 3xs a day - but gentle and only 10 reps at time. I do my stationary bike and have continually set the bike seat lower as my knee tolerates. And that is just 20 minutes once a day. All this they have been telling me from the beginning but I guess I'm just sick and tired enough to do it more.

It is gradually but slowly getting better, the pain is less and I'm taking less Tylenol. The stiffness and swelling is still there and always at the end of the day. Again- slowly getting better. I found @Jockette is a very helpful read on all this and she had quite a time of it, too.

Keep the faith and I hope you know I really do know what you are going through. Keep me updated and I wish you a slow and steady continual, complete recovery.

 

[ChillTime]

Hi @BlueSkiesHere. I understand the emotions tied into being fed up with lack of knee progress and therefore cutting back on activities -- been there, done that! As a matter of fact, STILL doing that at 28 weeks. On those days, I do only ADLs, and that's it (I do see my doctor this Wednesday to discuss my lack of progress and constant low-grade achiness/soreness).

I think you are right to work your current routine as you feel is necessary and to get outside in the fresh air with mini-hikes and take your camera. Your creative work as a landscape photographer must give you a huge boost? I am a graphic designer still working part-time for a biotech company and can identify with the creative boost! Is your photography for business or purely for enjoyment? We do have much in common!

Something that jumped out at me from your entry above: do you feel it's necessary to ride your stationary bike for 20 minutes every day? At this point, I could do 20 minutes on a good day and every day that I am not too active, but not on a day after walking a lot or doing something strenuous. Just a thought. You absolutely know your knee best and what feels right.

Good luck with your progress. I am thinking of you, and it helps to know that there are those of us together in this "special club." I wish you the best!

 

[BlueSkiesHere]

Well @ChillTime ...were you a foreboder of what was to come last night and today. I just can't get it in my head what "slowing" down is because what I do in a day now is SOOO much less than what I use to do on a normal day. Just the dull bone ache at the shin and lower knee cap. ARRGGGGHHH. I will be interested to see what your Doctor says to you on Wednesday, so please update us! It is quite discouraging, isn't it?

Yes, when I do more walking I need to skip the 20 minutes cycle or at lease modify it to 10 minutes that day. I do the cycle mainly for keeping the flexion going and I feel I need some kind of exercise...geez. Yes, my camera and nature definitely give me a boost. I think I'll take your advice and on extra walking days...skip the cycle.

Good luck on the doctor's appointment and I hope you find some resolution or advice. Keep us posted.

PS: when I say extra walking day - that is just over 4,000 steps a day. So that is nothing in my book.

 

[BlueSkiesHere]

Okay update..x @2chains and @ChillTime
So I saw my surgeon today for the 6-month (which is really almost 7 months) checkup with X-rays, etc. I had my questions ready to ask because I usually forget.

Even before I get my questions out...he says...let me tell you what is typical at 6 months or so. He described the achiness, tight band, warmth in knee cap you could still have, stiffness still there...all the things I was about to ask him about along with my nerves occasionally "singing" and the lower knee cap sensitivity. He said my X-rays look great, my knee bend is good and I am all on schedule. He explained it takes a YEAR from surgery to completely recover and all that is happening now is the knee still healing. He said it takes time and that it will slowly keep improving and one morning I will wake up and forget my "knee". To keep pushing myself just a little and everything will keep gradually getting better up to the year mark. My tiredness and inability to walk for an extended amount of time without resting the knee, because of aches or stiffness, are totally normal.

He said I do not need to come back and to just wait for that year mark. He said when I hit the year mark that should be an indication of how the knee will be. If I am not happy at that year mark with the knee - come back and see him. He said even my bend should keep improving a bit as time goes by. His main message was to be patient, let it keep healing, push myself just a little bit to keep doing more. I don't need to see him again unless it is because of some concern.

SO...I'm going to calm myself, be patient with the healing and basically keep doing what I'm doing. Be gentle, push myself a little bit at a time to walk more as I am able. From my last post...I can now do 4,500 steps or so without discomfort IF, and I mean IF, I break them up in periods of time. I'm still doing my cycle at 20 minutes with some resistance added. Stationary cycle. I gradually keep adding 2 minutes every two weeks or so.

Another improvement - unlike @ChillTime - I can walk UP the steps but walking down has been a major ouch factor for the lower knee cap later on in the day after attempting. I am now able to walk down the steps maybe 4 or 5 at a time once a day. I'll take the small improvements. I also believe that even after that 1 year mark - my knee will still keep getting better. That was @Jockette 's experience.
Girls, let's hang in there.

 

[ChillTime]

Woo hoo @BlueSkiesHere!! I am so happy for you and the positive results of your doctor visit! I know it is a relief for you to hear that what you’re experiencing is completely normal and that you shouldn’t worry and should be patient (but easier said!!). As I mentioned to @2chains, this past weekend I was feeling really good and walked 1.5 miles all at one time. Immediately afterwards I knew I had overdone it — so frustrating! But for me, that’s all my knee can do for now, and I should be patient. And, my surgeon, at my last visit over a month ago, said I would most likely keep improving on into the 2nd year (like @Jockette has mentioned). Let’s hope so! Cheers to you @BlueSkiesHere, and we will push through and make it to the other side!!

 

[InkedMarie]

I like your surgeon @BlueSkiesHere ! Glad you had a good visit!

Marie

 

[2chains]

@BlueSkiesHere sounds like your surgeon has listened to their previous patients and progression through the first year. I'm going to take your great advice...

"SO...I'm going to calm myself, be patient with the healing and basically keep doing what I'm doing. Be gentle, push myself a little bit at a time to walk more as I am able."

 

[BlueSkiesHere]

Okay. Its been awhile since I've updated but I've caught up on @ChillTime and @2chains since we all three seem to be circling the same "drain" at times in this recovery. I have had marked improvement with walking and then a set back or two when I over do. I am constantly readjusting.

I just had another over do session this past Saturday on what I considered a very easy and very short hike to a waterfall which absolutely set me back with the lower knee cap discomfort and irritation! Still five days later. It was very rooty and rocky and slippery and all steady up hill and therefore steady down hill which REALLY gets my lower knee cap area. It was just .7 miles total! Not even a mile but the rub was the downhill. Very stressful on the side of my knee and that lower knee cap area.

I have been getting up to almost 5,000 to 6,000 to 7,500 steps a day (ADL style) with pretty much comfort however still the stiffening knee is there. However, for the most part the limp is gone unless I'm feeling tired. I do break all these steps up throughout the day. I will am unable to comfortably walk for an extended amount of time on a regular basis. It's better though. I do a set of knee and lower body exercises almost everyday in the morning - nothing stressful to build and maintain what muscles I have.

I live in a very up and down hill area...even my yard. Our house is three storied so I do lots of steps a day because I have to unless I just want to live in the kitchen area. I can do up the stairs normally but going down the steps STILL no way. It so irritates my lower knee cap. For now I've just surrendered and do the walk down the steps backwards (carefully) so I don't irritate the left knee by all the step stress. The up the steps I've begun counting as building quad muscles like step-up. No need to do step-up exercises for me!

I've been doing my stationary cycle 22 minutes a day at low resistance (4 out of possible 10 on this cycle). However, after reading @2chains post - I'm wondering if I need to back off doing it as much and just do it 3 or 4 times a week. I'm also thinking of just backing off my daily leg/lower body exercises to 3 or 4 times a week. The thinking is...I've been to the mountains on a roadtrips with my camera and I've scrambled down some rocks and roots to reach water streams (nothing crazy) and it did not irritate me at all. The steps counted at the end of those days are at least 7,000. You see the hotel has NO STEPS.

I get back home and return to my daily schedule of exercises, house steps and cycle and the irritation starts back more. It is such a balance. I want to get stronger but as I read in a Josephine post...more exercise does not heal pain.

I still have to take extra strength Tylenol twice a day. I am down from three times a day and sometimes can space it out to 7 or 8 hours between. I need it to get me comfortably through the day. I'd like to be able to stop this eventually!

Anyway. I have to tune my husband out at times when he says "it does not seem right" and know that it takes time. I'm at 8 1/2 months, it is a slow recovery, keep positive, keep adjusting, have faith. My surgeon said a full year and give it time. Keep pushing myself a little...so I am...and backing off when I over do.

 

[2chains]

This could be my twin post!! I'm testing out 4 min cycling on my floor peddler! 3x day!
Also I've got the stairs at home...I feel this is an issue. I feel like I am not doing much but when in fact I'm probably underestimating how may more trips a day I'm doing. Do you find the same?

 

[BlueSkiesHere]

@2chains ...I know, right? When I came back on to the website I caught up with you and @ChillTime and saw your posts about the steps. And yes, I feel the same. What I have worked out so far is I consider my trips up the stairs as part of a "workout" on building quads. I try to not over do my trips but it is a strengthening, right? That helps my head. Our whole house is built on three different floors and I HAVE to access all of them. Our steps happen to be "tall" steps, also. I'm 5'4" so it's a big step up. Therefore a BIG step down.
I've totally surrendered to not being able to walk those steps down normally (for now). I very careful walk DOWN the steps backward, making sure the tip of my foot always touches the steps so I do not lose balance. We also have rails on the steps. My PT guy taught me that. Once that lower knee cap is healed more, I'll start attempting again. But for now it irritates the **** out it and always shows up the next day and will last for days.
Yes, thanks to YOUR post I think I'll slow down a bit with the cycle and do a bit less for now. I have to exercise somehow since I can't go for walks comfortably. So I'm going to do what you did and lessen up on my time and definitely not increase the resistance for now.
If I compare it to August - I'm doing WAY more, walking more comfortably and able to do a bit more. It is slow but it IS improving.

 

[BlueSkiesHere]

Hi friends...been awhile. I have been present but not vocal. So I am at 18 months now with the RTKR and I can't say that this has been the best time of my life. My knee still does not feel normal to me but I still have the left knee to be done which slows down my walking outside a lot.
I do have a question for someone "out there". My way of life is at one year and a half is my right knee still has a bit of a tight band feel and navigating going down a hill is still a walk sideways process. I have yet to comfortably walk DOWN steps. Thank heaven walking had not been such a problem. Thought I don't walk at long distances comfortably before the knee still becomes stiff and tired. So this is where my adventure has begun...again.
Because I was feeling a bit better I thought I would just tackle this walking down the steps head on. I live in a three storied house. Steps are a way of life and I'm not moving. .
So just over 6 weeks ago - I started to walk down the steps more consistently and the familiar low knee cap pain/discomfort appeared that I associate with over doing it. A couple of days later I was walking up the steps and felt my knee cap POP, CATCH and SLIDE (dramatically) back into place! Scared the heck out of me and I immediately went to my Orthopedic urgent care. They took x-rays and said all the hard ware looks good and could not see anything. Said to rest a bit and go ahead and ride my stationary cycle if I wanted. However, my knee cap has remained very tender and subject to lower knee cap pain or that inner knee tendon pain like it rubs my knee bone.
Long story longer...my knee now clicks when I walk or bend - this is new. Doesn't hurt but clicks. However, since that mishap...my knee "tires" when I walk and I have circulating pain and discomfort. It feels as if I went back a year and I'm recovering again. Sometimes it is that inner knee ligament pain...goes away. Sometimes it is that pinging nerve sensations...goes away. Sometimes and more consistent is that lower knee cap pain that hovers there if I'm just walking or standing a bit. Sometimes that tight outer knee feel.
I went back TWICE to the Surgeon's PA and have had x-rays TWICE more and he says the movement and bend and strength look fine. He says - the clicking happens and is normal. It is plastic and metal. This last time - since I"m planning on having a LTKR in January 2024...I was insistent it just feels weird and stiff. The band across the knee is more prevalent. I expressed my concern on having another knee replacement if this one hasn't recovered enough to support me as I recover from another. PLUS - something just doesn't feel right. I can't walk comfortably - it feels weird and uncomfortable.
I now have an appointment with a PT in a couple of weeks for him to evaluate my knee - see if I'm walking incorrectly and if he has run across this with other knee replacments...
I mean folks - I have consistently kept up exercises for my knee and core, ride the stationary cycle most days for 30 minutes. Walking as an exercise at long distances are NOT doable because of my left knee. However, my replacement has yet to let me walk comfortably long distances without getting stiff and tired. The pain/discomfort is new.
Help. Anyone had this experience? I'm slight freaking out.

 

[Jockette]

I immediately went to my Orthopedic urgent care. They took x-rays and said all the hard ware looks good and could not see anything.

I went back TWICE to the Surgeon's PA and have had x-rays TWICE more and he says the movement and bend and strength look fine.

It might be time to actually see your surgeon and get his opinion.

Or, it might be time for a second opinion, from a surgeon who has no association with your current one.

I have consistently kept up exercises for my knee and core, ride the stationary cycle most days for 30 minutes. Walking as an exercise at long distances are NOT doable because of my left knee. However, my replacement has yet to let me walk comfortably long distances without getting stiff and tired.

These things have not improved your knee, so maybe you should consider cutting back and letting your knee rest. Try just letting your daily activities be your exercise for a while and see if over time your knee improves a bit.

I do understand feeling like something is wrong and not finding answers, I’ve had 3 second opinions in the 6 years since my PKR and my X-rays look fine, but my knee sure doesn‘t feel fine. I hope you fare better than I have in finding an answer.

 

[BlueSkiesHere]

@Jockette ...thank you for your reply and sage wisdom. As we speak and as you suggested - I am on the phone waiting to make an appointment with the surgeon and I do have another surgeon in mind to call at another doctor's office to do a second opinion, also.
And to further follow advice while I do all this...I'm just going to do ADL until Monday to rest and see if this helps. That will ease my "mind" having a set time so I can stop this exercise they all keep recommending but has not helped!
I agree - it just feels really irritated right now. So what I'm doing is not helping and the stress of it all further complicates it.
I'm aware of your story, also since I follow you. I'm sad you have not found answers in your situation. I know you have been struggling with this for awhile. I hope you finally find resolve, also.
Thank you. I'll keep you guys posted.

 

[2chains]

This incident sounds concerning. Glad you will be able to see your surgeon and taking it easier until then!

I’m at 18 months and still have significant issues also with walking over 30min, standing over 20min, going downstairs stairs (two storey home).

I can definitely feel your frustration with constant x rays that indicate "everything looks fine”. The implants are only one piece of the puzzle as the soft tissues also have to be rebalanced, tourniquet use limits flow temporarily to muscles, if lower leg re-alignment is required from bowed leg etc.

 

[Jockette]

I'm just going to do ADL until Monday to rest and see if this helps.

I suspect it will take more than a week of this to see an improvement, especially with this new pain you have.

I fell back in December and landed on my PKR leg, which really upset it. It swelled and I couldn’t hardly bend it. I didn’t do any ROM exercises, I knew it would bend when the swelling went down. It took 2 months to begin to improve, then continued to get better until it was back to it‘s normal (normal for me!) Of course I did go to an Ortho urgent care center, and of course my X-ray looked just fine. I was really hoping the fall would have done enough damage to require something that would fix my issues, but it didn’t.

 

[BlueSkiesHere]

@2chains and @Jockette ... I hear you both. I have an appointment today at 3:30 pm with the surgeon and will keep you posted. @2chains - we have kept "step in step" if you pardon the pun. Kind of strange.
I hear you @Jockette and will give it more time. Sometimes I have to trick my mind into stopping and those small goals help. It makes sense it will take more time. I think it has to do with soft tissues and ligaments myself but we will see. At this point...what do I know!
Sorry about your fall...falls are not good!

 

[skiforever]

This is such a struggle for you. I hope your surgeon addresses these issues. If not, seeing another surgeon would be my approach. PAs would typically not have enough knowledge to be able to help. It would have to be an unusually good physical therapist to be able to identify what is wrong.

I find cycling quite stressful on my knee and recommend limiting that to as little time as possible. For strength, try wall squats and vary the position each time so that you build strength across your full range of motion. The squats will work your muscles without stressing the knee. Skip any other exercises you may have been given; your knee needs more rest.

When you focus on the stairs, work hard to try to find a pain free way to move down the stairs facing forward. When my knees are unhappy with going down stairs I find the a kind of hop with each step makes it work pain free. It is a fast way down, kind of fun, using the railings for support.

 

[BlueSkiesHere]

@skiforever ... thank you for your suggestions. I see you have just had your left knee done recently. As @Jockette suggested... ADL for awhile and I will just rest and do my BEST to ignore my head on strengthening exercises until this knee area recovers a bit and rests. @skiforever - Great advice on the stairs. I can go up - even though it still just feels "weird" but it does not hurt and since we live in the 3 storied house, it gets some practice with that. For now I go down steps backwards (very carefully) and that is how I manage getting down them. The continuous side step down aggravates the left knee which is still osteoarthritis. I am scheduled for LTKR January but...this is what my surgeon said yesterday. Not too reassuring on another knee replacement in my opinion.
I saw the surgeon yesterday and the long and short of it...what you see is probably what you get. Double whammy with that honesty.
I made him LISTEN to my full story, recovery so far and concerns from my latest incident. He did the usual checks of bending, strengthening tests and showed me that the clicking is "natural" and is because of the plastic and metal. Duh.
He said I have beautiful movement and the X-rays look perfect (of course). However, I still pushed him on it doesn't "feel" right and the lower knee ache, the inability to do steps and difficulty going down hills. The lower knee cap ache and inner knee periodic pain has occurred since the pop, catch, slide knee thing 6 weeks ago. He said that could possibly be from a small ball of scar behind the knee cap and caused that but he does not see that any further surgery would be called for and he does not really see any scar tissue issue. He said that the lower knee ache and inner discomfort will just probably go away in time. Nothing to worry about and gave me his cell phone to call him in a month and update him. He said PT might help and to be sure to tell the PT to give me quad strengthening exercises and that if anything - PT will be good pre-surgery strengthening. I see a PT in a couple of weeks.
He said as far as how my knee had been before this mishap...that it is possible that will be the best my knee gets. Wham. My head exploded. That's it? I'll never be able to walk longer that 20 to 30 minutes without my knee being fatigued? Just no hope it steadily improves?
Now tell me again..why would I do my left knee? I think the PT suggestion is just to pacify me. I am so depressed today.

 

[JusticeRider]

He said as far as how my knee had been before this mishap...that it is possible that will be the best my knee gets.

@BlueSkiesHere please, please get a second, and even third, opinion before you accept this.

 

[skiforever]

Bummer! That is easy for him to say when he has no insight into what is wrong. Another surgeon might have some insight, but good doctors are hard to find. Look around. Do not go back to this one for a second knee operation.

My husband used wall squats before his knee surgeries and was back to skiing 2.5 weeks after his second TKR surgery and mountain trail hiking 5 miles 5 weeks after his first TKR (worse knee). His knees were strong. They have so little impact on the joint they will aid healing while strengthening. PTs will not give you these exercises because they are not in the ROM book. PTs are trained to seek ROM and make you move too much.