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Revision TKR Revision #7

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NFenske

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Slow but progress!! One more day of at home PT signed the discharge papers today. Outpatient starts Jan.31 9am. Looking forward to break in therapy. Therapist took it easy on me today since I over did earlier. Yesterday I sold all the fish in my 75 gallon and I hate an empty tank!!. Today starting this morning took everything off the tank filters heaters rocks gravel etc. Siphoned out approx 45 gallons of water then cleaned all of it and put it back together including adding water the easy way used a hose from outside to partially fill it then added known good water for the rest. All said and done finished by 130 therapist came at 2. Did a short walk and took some measurements finished paperwork. Fexion 132 Extension with a lot of effort meaning I am straining therapist pushing I got to -2 other wise -5. Lots of ice today ( wonder why?? ) Yes I complain and yes it gets old as in real old but I have noticed the days where I am really taking it easy ( no going to store not working on any stupid projects ) just a normal day I can on occasion get to a 5 to 5.5 but its not an everyday thing once in awhile. Hopefully fingers crossed no more surgeries on the knee anytime soon I really want to beat the average for me its a revision every 2 to 3 years my goal is to make it to 4 or 5 before I need another??
 

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I just don’t know how you put yourself through so much pain getting those ROM numbers, but I’m glad things seem to be improving.
 
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NFenske

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Flexion has never been an issue, extension on the other hand is. Sure it's great it was measured at -2 but to me it's unrealistic. The -5 is a better representation of how it really is. I think of it like this for some flexion is a nightmare look at how many are struggling to get past 85 or 90? During the surgery you know the surgeons are going to make sure the new prosthetic will work so they bend it. Now of course after surgery everything is traumatized hurts like neck but the point being just because the surgeons tested it and it works perfect does not mean you can do either. There is no way I am going to strain that frickin hard to get my extension to -2 for normal day to day activities!. So what if extension is -2 or flexion is 130 I personally can understand the importance of certain ROM measurements but really in the real world after 120 or -4,5 what does it really matter?
 

sarahd62

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Hi there , my Doctor said extending beyond 3-5 for a TKR was not good for the knee and could advance joint loosening. No idea if that is correct as I am at a 0 in my other TKR. Still at about 11 after 7 weeks in the latest revision. Worried about it a little.
 
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NFenske

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Not sure why your doctor would say that?? Every doctor I have had along with all the therapists agree that ideally 0 is the goal for extension. Supposedly if it isn't your walk will be affected ?? With me what currently is holding me back pain, swelling as well as a weak quad. As far as loosening the new joint too much weight, kneeling, improper placement ( in my case the plastic component on the tibia was the wrong size which caused knee to dislocate or as I called it locking up.)
Granted your surgery was before mine and you had a full TKR being at 11 is not of grave concern. We all heal differently my last full revision #6 it took a little over a year before it really started feeling better and even then I was still in some degree of pain along with not getting full extension. Yes I overdo it frequently but living alone well you have no choice. While some disagree with PT I on the other hand push to do better. My way is painful but at the same time my results as far as ROM speak for themselves. Extension is going to take time how long who knows??? just have to keep working at it. I still feel up to a point does it really make a difference once you get to a certain point.
 
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@Jamie Pain management in theory is really great reality well its different. You and others suggest taking meds as prescribed round the clock ideally yes I agree but try explaining to surgeon why you ran out of meds in less then a 14 day time frame. Knee pain is absolutely no fun period!!! Yes I can overdo and pay for it if I am lucky it may only hurt pretty bad for a day or two, but only if I am lucky. There are days when I do nothing out of the ordinary no driving no walking no exercise just little things around the house and it still drives me nuts. The only way I can keep pain level in the 5's is to do absolutely nothing. By nothing I mean it then okay pain wise I get a break if I do anything other then nothing well its only a matter of time as in 30minutes or more when the pain takes over. By just going by this last surgery if this was just the first or second one after a month I would be starting to feel a little better in my case if there is a difference its very slight and the sad thing I knew it was going to take awhile for this to feel better. I am sorry dealing with pain gets to me.
 

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Is there a pain specialist in your area? Maybe this pain needs to be addressed differently?
 

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Every doctor I have had along with all the therapists agree that ideally 0 is the goal for extension. Supposedly if it isn't your walk will be affected ?? With me what currently is holding me back pain, swelling as well as a weak quad.
There's still plenty of time to gain further extension, without pain or forcing. It's not at all unusual for extension to take longer to achieve than flexion does. Pain and swelling will decrease as you heal, and your quads will regain much of their strength. Don't let anyone tell you that you only have a limited amount of time to achieve full extension, because that isn't true.

This article explains how extension is measured, and gives some suggestions for improving it:
Extension: how to estimate it and ways to improve it
 
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@Celle There is no need for me to tell therapists about rushing extension I knew from day one getting full extension is going to take time. Time meaning months and months etc. Its one thing if your not in pain and they muscle your knee straight that stinks but if your already in lots of pain really what difference does it make?? I know of plenty of things to work on to get improved extension but considering how the knee has been doing I am taking it easy as in bare minimum as in mostly doing things around the house very short walks that is it. Monday morning I am going to see my surgeon the pain is bugging me!! The bad part unless I am proven wrong there is nothing wrong, color looks okay, yes its warm but not hot, still lots of swelling, none of the typical signs of infection. The biggest complaint is pain and my guess the surgeon is going to tell me considering the amount of surgeries the knee has been thru its going to take time as in lots of time before it starts feeling better. Not interested in taking stronger pain meds sure it may help but this knee is not going to heal anytime soon he could suggest different ways to manage pain but not all suggestions work for everyone. Tylenol Extra 4000mg plus pain meds helps lots Tylenol does nothing for me. Hate to say really frustrated since there is no real solution other then suck it up pain wise.
 
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@Helizabug Good idea but not worth the effort as the saying goes " Been there done that " Yes pain Dr's can help but the crack down on narcotics puts a damper on things. If you go by books yes following surgery pain meds are allowed but its only a short term solution in most cases ( ask any super genius Dumb--- resident and they will say after a week your pain will be better?? Yeah Right!! ) I had a very good pain Dr. prior to last surgery but having been thru 2 nerve blocks one which I cannot even begin to describe how bad it hurt I will not go that route again, then there is time some Dr's understand some don't if you have severe pain for over a month now its chronic not surgery related. Bottom line why waste my time and money for nothing? Not expecting any miracle but my surgeon was trained under the one I had that just retired we met day of surgery decent man so we shall see. My best guess will have to deal with it and let time resolve it FUN FUN
 

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I hear you have tried addressing the pain with a doctor who specializes in it. I’m sorry that hasn’t helped. I remember my dad coping with pain after lung surgery, and it was tough to find what would work.
 
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@Helizabug Saw my surgeon this morning no miracles was not expecting any. He did suggest I see a pain Dr. ( same one I saw before this latest surgery. ) Really do not think any real good will come of that either but its worth a shot?? My knee is very sensitive to touch ( does not take much for me to jump ) the surgeon suggested I take a dry wash cloth and rub it over the knee 10 minutes several times a day he says by doing that it should desensitize the knee. Just to make sure had to get some labs done just to make sure nothing else going on. So as I thought considering my unique situation what is not normal for most is the new normal for me.
 

lionsm13

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Saw my surgeon this morning no miracles was not expecting any. He did suggest I see a pain Dr. ( same one I saw before this latest surgery. ) Really do not think any real good will come of that either but its worth a shot?? My knee is very sensitive to touch ( does not take much for me to jump ) the surgeon suggested I take a dry wash cloth and rub it over the knee 10 minutes several times a day he says by doing that it should desensitize the knee. Just to make sure had to get some labs done just to make sure nothing else going on. So as I thought considering my unique situation what is not normal for most is the new normal for me.
Wowow. How frustrating it must be to go and see your OS and he says to wipe down your knee w/a " dry wash cloth and rub it over the knee 10 minutes several times a day"

I can relate though.
I saw my OS after 7 + months for my TKR as I was still in pain from it too and he flat out told me
"I have no idea what is causing your knee pain still"
That's basically when I just quit going and tried to accept it how it was going to be and little by little it started to come around but it took quite a while.

"They" (the experts say) that it takes 12-18 months but I say it can take much longer than that as each of us are different. At least is was in my case.


There is a procedure called "Radio Frequency" I beleive it was called that I had to have done two or three times when I had an apendectomy that was not well thought out by the attending Surgeon.

THe "R F" procedure burns/singes the nerve endings as they are growing back together which is what causes one to have pain. The burning of the nerve endings smoothes them over as opposed to communicating to the brain that one is in pain. Not sure if it would work for TKR stuff but it did for my abdomen from the not so good of an appendectomy procedure.
 
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@lionsm13 Whether it sounds absurd or not I have been told that by other therapists as well. The idea behind the dry wash rag and rubbing it on the knee is supposed to help with getting the knee less sensitive. So yeah is sounds far fetched but there is truth to the method. I have had several nerve blocks on the knee but once again I am unique!! My knee has been completely replaced 6 times this last time was a revision just replaced the plastic on the tibia side so I cannot call it a true revision / replacement. The problem that I have unlike others due to the amount of surgeries I have had the nerves surrounding the knee are not in what would be considered normal areas. Its almost like finding a needle in a haystack. The last nerve block was called something like a water oblation?? It was a new procedure that went for the nerves right next to the bone, it took 5 people to hold me down the pain was unbearable and after it was all said and done did not work. I am sure at somepoint the pain will settle down the question is when? I will not heal like those that have only had 1 or 2 surgeries the fact is its going to take awhile, last full revision took 14 months + or -. This whole thing is beyond frustrating even more frustrating everyone has their own opinion of how to proceed with therapy and its okay but very few have had the number of surgeries I have had all on 1 knee. How many times do you think I have been to therapy over the course of 19 surgeries bet its quite a few. Sorry just upset.
 

Helizabug

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My knee is very sensitive to the touch too. I’ve heard the washcloth thing helps, but I haven’t tried it yet. I remember the sensitivity from most of my surgeries, not as many nor as severe as you but seven in all on my poor left knee. I think the human knee was designed on a dare after a raucous drinking game.
 

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Only trying to empathize and perhaps offer a suggestion.

Didn't mean to offend.
 
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@lionsm13 Not offended by you by no means I am offended by how what started out as a torn meniscus snowballed into my current situation. Everytime I think about the knee dealing with 24 / 7 pain yes I get upset but I am only upset with my situation. You and everyone else is fine really my apologies if you read it wrong
 
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I do not think anyone in their right mind would want to have gone thru what I have!! Having 1 TKR is a big deal lots of pain sleepless nights wondering when things are going to get better dealing with PT etc now think about having 6 complete revisions and 1 partial revision and the average time between surgeries is 2.5 years, there is a good chance you would be upset as well. It stinks!!!
 

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