Revised PKR to TKR Recovery

[sistersinhim]

My surgeon appt is April 18 and I’m scared that she’ll order me to do an MUA. I’m hoping my husband can come to support me with my decision to not have the MUA

YOU are the boss, not the doctor. Just say no, and don't listen to anything about a time-limit because there is no such thing. Your knee has been through the mill and requires gentle treatment, not forced movements, which just set you back. We know, we have all been there!

 

[jenm1970]

I have been experiencing a burning and lack of sensation of my thigh on my surgery knee.

Has anyone suffered femoral nerve damage?

 

[mendogal]

Femoral nerve palsy (weakness/dysfunction) can happen after a knee replacement, though it's rare.

Here on the forums it's rarely cited by members and then it's after hip, not knee, replacement (I checked in order to point you to members with this experience).

With the knee, potential causes include the perioperative femoral nerve blocks and the thigh tourniquet. These are generally experienced early postop and are usually temporary - the same as with other nerve damage, they are prone to zingers and paresthesias (odd sensations) as they start to heal.

If you've been experiencing the burning and numbness since early in the post-op period, just be aware it should resolve, which will be noticeable as subtle or even marked (zingers) changes in the sensations.

If your burning and numbness is of very recent onset, then I'd suggest checking in with your ortho about it.

If the burning is interfering with your recovery and quality of life, you can discuss with your surgeon trying a medication specific for nerve pain such as gabapentin or lyrica.

 

[Jamie]

Try not to get too alarmed with some numbness and burning pain this early in your recovery. It can happen and will usually resolve with some time (like months, not weeks). However, if you notice things worsening (more burning/pain or a numb area that gets larger), you do need to check with your surgeon or GP.

I’ll also support the previous comments that you don’t need to get an MUA if you prefer to try a slower route to improved ROM. There is no “window” and you know your body better than anyone.

 

[jenm1970]

There was some words of advice that helped. It talked about feeling down. Can someone for it? I can’t remember all the words

 

[Jockette]

@jenm1970 Inthink you might be referring to this article:

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

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?

How can I find my threads and posts?

There are a couple of ways you can find categories of threads on the forum. You are able to use links in the main forum toolbars at the top of the screen to quickly access certain types of threads: your own threads, threads with your posts in them, and watched threads. You can also use links...

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Best wishes on your continuing recovery!

 

[jenm1970]

I wish I had never done a revision from partial to total knee replacement. Heck, I wish I never did any of them at all.
I’m tired of being in pain. I’m tired of the Dr’s and PT always talking about ROM and where I’m at and how I’ll never get past 100° if I don’t push it. That I’ll never be happy with my knee if I don’t push it.

I’m just feeling defeated.

 

[Jamie]

Are you still being pushed in your recovery by your PT and surgeon? Or did you give slowing things down a try and see how that worked? If the push is still on, it sounds like you need to take a different approach to your recovery. Are you willing to try what we’ve suggested? I know it’s difficult to trust someone on the internet you don’t know, but believe me that we’ve helped thousands of people who just didn’t fit into the “push” recovery model.

If you did slow things down a bit and you’re still in pain, we can help with that too. You’ll just need to tell us some details about your pain, what you do in a typical day (activities, resting, housework, errands, etc.), what you’re taking for pain, and what exercises or therapy you’re doing. Once we know that, we can offer some suggestions.

 

[jenm1970]

@Jamie thank you for the reply. Let me gather my thoughts and reply. I appreciate your words.

 

[Jockette]

I wish I had never done a revision from partial to total knee replacement. Heck, I wish I never did any of them at all.

I can relate to this. I wish I’d never had my PKR, I have more problems now than I did before. Sending lots of hugs.

 

[jenm1970]

I did slow things down. I quit PT March 27 and then had a follow and talked to surgeon and decided on a different PT which I started May 10. Had follow up with surgeons PA and that was the day I wrote the message that I’m frustrated. This new PT seems to be listening to me.

The PA at the surgeons office said if I don’t push it I’ll never be happy with my knee said my husband needs to help with 2 exercises by pushing on my knee. He demonstrated the exercises and I was crying by the end.

I was supposed to have PT on 5/21 and cancelled. They have me on a recumbent bike for 5 minutes then I do flexion and extension exercises. They have said I need to do these 4 times a day.

What I’ve been doing is stretching the best I can, massaging my leg and knee as well as walk around the house and get on my recumbent bike.

My pain is from the outside over the my knee upwards to the inside. It hurts to bend it more than I do. Plus I have a burning and loss of sensation and numbness in my right thigh. ER Dr and the surgeon think it’s femoral nerve damage due to my symptoms.
When I saw the PA. I had been sitting about an hour from the car ride and waiting at the office. All he wanted to see was my bend, so after an hour of sitting no stretch, nothing, of course it’s stiff and won’t bend or straighten well. I’ve been at 0° extension since week 2 post op and stuck at 100° for the last almost 15 weeks. He said well you at my 15° extension and 90° flexion. He obviously hasn’t read my PT results. That was when he said you need to push it. Didn’t ask to see my walk, I use a cane for a few minutes then I can walk, not well but I can get around a bit. Didn’t ask about ADL’s, nothing but the knee ROM.

Most days I’m home and I do get up and walk around every few hours, I do some light house work and get on the recumbent bike for about 5 minutes a day.

On errand days, I will run a 3-4 short errands or do one long errand such as the store.

I take hydrocodone both immediate release and an extended release. I also take a muscle relaxer. I saw my GP on Tuesday about the burning pain and numbness on my surgery leg, she says any quad is not engaging which is most likely why I’m not able to walk well and said also could have nerve damage and referred me to a neurologist. I have chronic back pain so the meds listed above are for that as well. My GP put me on pregabilin to help with the thigh pain.

When I bend my knee past 100° it is very painful. Most of the exercises give me a bit of pain, so when at the PT I do what I can and let the PT know where the pain is and at home I stop and try again later.

I would love any suggestions so I can get better ROM (which I haven’t had good ROM in over 10 years, both legs).

When I asked the PA what was the pain going sideways over my knee he said it’s scar tissue forming and that why I’m not progressing and need to push it or you won’t be happy with your knee.

I hope I’ve given enough info for some insight here.

Thanks!

 

[jenm1970]

I went to PT yesterday and she asked if I wanted to do a certain exercise and I said no, she said you will be the one in control I won’t be doing anything. It was using a strap to help pull my leg to bend. She said there’s notes in my chart that says not to touch patient without consent. I’m so proud that I said something about my bad experiences and it’s noted to not touch me unless I ask for assistance or they ask and I give permission

 

[Jockette]

I‘ve been a Bonesmart member since I was 6 months post op, in 2017. I have been trained in joint replacement recovery, and I have literally read thousands of posts. (As you can see in my profile on the side bar next to my post, I have written 36,204 posts! This post will be 36,205.) So, with that knowledge behind me, if I am ever in your current situation in the future, I will not do hardly any formal exercises, just some gentle bending, and I will let my daily activities provide the “natural PT” that would help my knee settle down and heal, while still giving it enough mobility, which will encourage the healing bending progression. I have read many posts from members who found this to work very well for them.

I do wonder if all the PT you are doing, even in this new and better PT situation, has just not enabled your knee to settle down and recover and heal. PT can be helpful, but there are times to just let your knee “be.” Maybe the nerve pain will have a chance to settle if you cut way back.

Last year I fell on my PKR leg and my knee swelled big time, and I bruised quite a bit. Even my ankle swelled. I did get X-rays and had an appointment with an OS, and it was “just” soft tissue damage. No one mentioned sending me to PT, and I didn’t do any home exercises to regain the ROM I lost, due to swelling. My ROM was probably back to 90, if that. So, without any PT or exercises, my ROM came back to normal over the course of 2 months. Soft tissues take a very long time to heal when they are injured. And this was just from a fall. No surgery, no cutting, no manipulation of the soft tissue, just a hard fall for them. Think of what you are currently healing from, with all the trauma induced with the surgery.

I will never understand why a “rehab program” that only upsets our soft tissue further, is supposed to help. To me there is no logic in that theory.

I hope you can come to terms with your own common sense of how you should heal, and find a gentle rehab that will work for you. I’m so sorry for all you’ve been through and what you‘ve been told to do. Not all doctors and PTs have the same recommendations that you’ve had, which does make it hard to determine who to believe.

 

[Jamie]

One thing to consider when figuring out when you should have additional ROM is the fact that it has been poor for 10 years (according to your post above). This normally will mean that it might take an extended period of time (like years) to regain more flexion. Soft tissues must stretch out to the new normal gradually over time.

I’m glad you’re listening to your body now and communicating well with your therapist. This is so important because only you know your body and how it is responding to whatever therapy is recommended. It is good that you are stopping any exercise when you reach the stage of pain. Anything you’re doing should only bring mild discomfort or you risk inflaming the soft tissue. This will hinder your progress. The goal is to challenge the tissues but not cause enough pain as to trigger an inflammatory response.

I think your current schedule and approach to PT is a good one. Just realize that you may have to maintain this for quite a while before you see a lot of improvement. Try and measure your progress in weeks or months rather than day to day. You will go up and down with your progress.…that’s normal. Hang in there. Your knees have been through a lot in the past 10 years. It takes a while to come back from all those procedures. Don’t hesitate to post here when you have a success (we’ll help you celebrate), if you need a little mental boost, or just to have a good whine about things in general. We’re here for you and will understand your feelings. We’ve been there in some way, shape, or form.

 

[EalingGran]

The PA at the surgeons office said if I don’t push it I’ll never be happy with my knee said my husband needs to help with 2 exercises by pushing on my knee. He demonstrated the exercises and I was crying by the end.

This isn't right. I never pushed myself to pain and I have great ROM- almost as good as my unoperated side. Pain will just cause more swelling and stiffness

I’ve been at 0° extension since week 2 post op

That is really good. A lot of people find extension harder to recover than flexion.

Didn’t ask about ADL’s, nothing but the knee ROM.

I never understood this obsession with ROM. What you can do with your knee is more important. I have seen pictures on here of people with much less ROM than I have but who are surfboarding and skiing- something I wouldn't have the strength for. Every recovery is individual. A lot depends on our previous history/ weaknesses and strengths.