TKR Recovering Great and Then A Loud POP

[Lmarshall]

LonghornNan I am just catching up with your thread. Gosh, Im so sorry you had to go through all this. I can relate somewhat. I had BTKR on June 10th and heard and felt a similar pop while brushing my teeth on July 28th. It ended up being a small tear, and that was painful...I cant imagine the pain you went through for the rupture. It took me a good 2 weeks to start feeling improvement, and needless to say it wasdepressing. I also cant find muc ingo out about tears after surgery. Im fee, ing much better now, have also started aqua therapy and LOVE it. I do however, often worry about over doing it. I try to push it away, but its a concern of mine. I wish you all the best and hope you are doing better day by day

 

[LonghornNan]

Lmarshall - thanks so much! What tore when you heard the pop? Your tendon? There just is not much information out there about it. I think the water therapy is fabulous - I've only had one session but it made the horrible ordeal of buying a swimsuit worth it. haha - I remember seeing your picture when I was searching for information. You had both knees done at the same time? I can't even imagine doing that. Looks like I had surgery 3 days before you. I can see where it would be easier to overdo a workout in the water because it feels so effortless when you're in the pool but the therapist warned me about just that. Good luck to you, Luisa. I hope both of our recoveries is problem free from now on. Nancy

 

[Lmarshall]

LonghornNan I heard and felt a pop...not loud though, and I was unable to bend or straighten my leg, or bear weight on it. Basically it was at about 30 degrees of flexion. I went right to the emergency room. After an xray to rule out problems with the implant, they did a sonogram where they found a small muscld tear on the lateral side, just above my knee. I saw my surgeon 2 days later, I had some movement of my leg by the, but my thigh was swollen and very painful. My extension was awful, prob about -30 degrees. Surgeon told me I could go back to therapy, but I wsited 2 weeks, elevating, icing and resting, with minimal weight bearing. Im now probably about where I was just prior to the tear both in strength and ROM. it probably set me back a whole month in recovery, but im grateful since it could have been worse.

I am currently doing aqua therapy in a tank. It looks like a large aquarium, with a built in treadmill. I do 10 minutes of walking, with slowly increasing speed at each session. I started SUPER slow as I was very worried about over doing it. Also, after walking, I have a set of exercises I do (ie lateral leg lifts etc). The water is at 98 degrees. I find the warm water and water exercises prepares my muscles well to use the bicycle , exercise on the mat, and use one other quad machine. Once done, the PT does some gentle stretching. She has remarked about my great improvement over the past 2 weeks, and has given me exercises to do home ( not ala lot). I have been trying to increase my walking daily, but admittedly, I still cant walk very far.

Im starting a new job soon, which will be less physically stressful, but we are still negotiating start date. Id like to postpone until 9/27. I used to work as an occupational therapust for disabled preschoolers, but will now be working at a college in the occupational therapy dept helping the students with the hands on tasks. Much less physical, but certsinly not a sitting job.

This setback had me quite depressed for about 2 weeks, but then I picked myself up and carried on. Feeling sorry for myself was NOT helping, and I was sliwly sapping all my energy. This surgery sure has had its challenges, but im still glad ive done it and look forward to great things ahead.

 

[LonghornNan]

Four and 1/2 months from LTKR, 3 1/2 months from the torn tendon surgery, and almost two months out of the immobilizing brace I wore for two months. On my last visit to my OS I had full, yes full range of motion that he thought I'd never get back after the tendon ordeal. I've discovered that "full range of motion" doesn't mean completely recovered. My left leg is taking forever to get any strength back even though the quad has healed. Today was the first I had done therapy in the gym - it's been in the pool since the brace came off - and it was hard. I'm not sure how much to push it. I feel like I won't get strength back if I don't and I have this fear of tearing that quadriceps tendon again. I still have quite a bit of swelling in my knee and had a bout of tendonitis and bursitis. I still have trouble sitting down and my right leg is doing most of the work. I'm not yet able to climb or descend stairs normally. Sometimes I can walk smoothly but the slightest thing can throw that off and I can't easily reposition in bed during the night. I'm still working with a PT twice a week and will exercise in the pool on my own. It helps to read the other threads on here just to remind myself how long it takes. I'm grateful for how far I've come and that I have really good therapists.

 

[skigirl]

I think that you need to proceed slowly--=-just take baby steps. I think it would be beneficial to work with a physical therapist who could help you increase your leg lifts very slowly. First without weight, then with a pound, then two pounds, etc. It never hurts to go slowly, when you are bored at one level, step up to the next level. I am also not sure about a tendon tear, I will tag kneesrus ---David is a PT and might be able to direct you better. However, I think your doc would give you another referral to a PT and you might need professional advice right now for at least a few sessions.

 

[LonghornNan]

skigirl Thanks for the info. When I tore my tendon it was during therapy with a home health therapist just doing an evaluation having me do straight leg lifts 5 days after surgery. I never let them come back! The place I go now is extremely cautious in what I do and I only saw physical therapists - not assistants. They don't have me do anything that hurts - I think they have a very similar philosophy to BoneSmart. It's me who feels like I should start "stepping it up" and after reading some of the threads last night it's a reminder of how long it really takes. I'd love to hear what kneesrus has to say. I don't think I'll ever do leg lifts again just because of the fear I have of it happening again - that was insane and what was that PT thinking asking me to do something that aggressive 5 days after my tkr and I have to say I'm an idiot for doing it. Where I go now - if it hurts I say so and they adjust how and what I'm doing. When I was looking online for "quadriceps tendon tear after knee replacement" there just wasn't any information so I'm trying to update this as I go just in case anyone else needs information maybe it can be of help.

 

[kneesrus]

Hi LonghornNan that is some adventure. In the 30 years of working with mainly knees and shoulders, I have never heard of such a case. Like you have said, you have not found any articles on this happening. I am very glad for you that you have gain over 90deg of flexion in your knee. I have work with several quad ruptures, but the rupture occurred below the knee cap. Patients lose a great deal of strength during the recovery. You cannot strengthen if there is sharp pain. The body will always protect itself, that is why the weakness.
Addressing performing straight leg raising post op, it is a standard method of measuring quad tone. If the patient is able to perform a quad set then the next test would to see if they could perform a SLR. Many patients cannot, as some have mentioned. In the eval, the quad tone would be documented as poor, which is not unusual.
The mystery to me is, how the quad had a full thickness tear when there is now detachment of quad during the procedure. When beginning rehab on an ACL reconstruction, using 1/3 of the patient's patella tendon for a new ligament, it is routine to have a patient attempt a SLR to see if the quad is firing.
The TKR and the ruptured tendon is in the past and you are doing very well. It is awesome to hear from someone that was not told by an OS or PT that there is just a small window of opportunity to regain your motion. If you keep the pain down to a minimum, it will come along. My more aggressive patients always fall behind the steady as you go patients.
Thank you for sharing this most unusual event. It has caused me to dig into the research bag. I always tell my residents, it is what you learn after you know it all, is what counts.
Best of luck from here on out,
David

 

[Jamie]

I agree that you need to take things very slowly. This is something that will take a lot of patience and time to heal completely. You don't need to be in a hurry. You will have time to work on strength training (gradually, of course) once you are sure things are completely healed. I think it's smart that you are finding ways to tell yourself that it is a good thing not to push too hard and that it's not necessary for this recovery. You have time.....take it and recover successfully!!!

 

[skigirl]

David kneesrus good post---useful info. I think the problem was that the person was not able to judge your quad strength and gave you something that was too much for your body. But, leg lifts are a good way to work that quad---when you are ready. I do leg lifts every day to keep this aging body moving!! One of the other ski instructors and I were laughing about being "tight" in our quads. As he said, everything is tight except the parts that are sagging.

 

[kneesrus]

Hi Nan, did you have steroid injections in your knee before you decided to have the surgery? If so, how many. Another cause for weakening tendons is long term anti biotics. Just throwing out possible variables of why such a traumatic event from a SLR
David

 

[LonghornNan]

kneesrus Thank you so much for the information. It's a great help in my understanding of the evaluation that I had and why it was done. I did have one cortisone injection about three years ago and one Synvisc injection about a year before the knee replacement. The cortisone helped at the time but the Synvisc didn't. I have rarely taken antibiotics other than after the surgery. I have been on Naproxen for years. I'm seeing the PT twice a week for strengthening (on land). I had been doing the therapy in the pool and will continue that on my own between visits. Thank you Jamie and skigirl for passing this on to David - I will take it slow! I guess we tend to forget that the worn out knee took a lot of years to develop so it's not going to heal overnight! Love this BoneSmart site!

 

[kneesrus]

Thanks for the information. It is not uncommon for tendon rupture from too many steroid injections. OS are very careful on how many injections they do to a joint. Your medical management was well under conservative treatment. I still feel sorry you had to go through two procedures. Try to get your confidence back and that you will return to a great quality of life.
Best of luck,
David

 

[LonghornNan]

I discovered something that might be helpful for getting in and out of cars. After my knee replacement in June I had planned to come home and not leave my house for three weeks but because six days later I tore my quadriceps tendon I had to go to no less than 10 hospital/imaging/doctor visits in the following two weeks. Getting in and out of our van was agonizing. The cloth seats didn't make "sliding" an option, I couldn't bend my knee as I was in a full leg brace, and the micro sheet I put down didn't help a lot. Anyway, to make a long story short which isn't possible at this point, months later when I first started driving myself to therapy I accidentally discovered a really helpful hint I wish I had known earlier. Leaving rehab with a coverup over my wet bathing suit and not wanting to get the seat wet I put a heavy type plastic department store bag on the seat with my towel over it. Getting in was sooo easy and getting out was like being on a swivel chair. I couldn't believe how easy it made it! Not sure if this has been hard for anyone else but for me it was a nightmare those first six weeks and I'm not sure where to put this so here it is for what it's worth!

 

[Jamie]

Thanks for posting this great tip. It's worth its weight in gold!!! It's something we've talked about many times over the years here on BoneSmart, but it's always worth repeating.