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Revision TKR Revision again

patsortho

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im 34 years old and 10 weeks po TKR. I have flexion of only 48. Recovery has been very tough. At 3 days po I got cellulitis and was in the hospital for some time. Orthopedic kept saying continue PT when therapist told him knee isn't moving. He scheduled me for a MUA 5 weeks from now. My concern is having an MUA at 15 weeks. I read that it isn't safe. Also would like to hear others thoughts on my situation. :dubious:
 

newlybionic

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Welcome to Bonesmart. I'm glad you found us. Let me give you a copy of our guidelines.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this Activity progression for TKRs

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

newlybionic

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Please post your exact TKR date so that we can put it in your signature so that we can advise you. Please tell us about your cellulitis and where it was located and what treated you had for it.
 

Pumpkln

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patsortho,
Welcome to BoneSmart, glad you joined us!
Sorry to hear how rough your recovery has been, cellulitis is no fun.
We have members that have MUA's after 15 weeks, some more than a year.
The skill of your surgeon is most important, if you do not have confidence in your surgeon, you will need to seek a second opinion from a surgeon specializing in revisions or complex knee reconstruction.

Surgeons that specialize in revisions have the education and experience to determine what is going on with your knee. You can call offices, or check the web sites of surgeons who do TKR's and ask if they specialize in revisions. Be sure your second opinion has no relationship with your present surgeon not even golf buddies.

MUA (Manipulation under Anaesthetic) and Adhesions
MUA for Stiffness Following TKR

If you have been doing too much for your knee, such as exercise, walking, or activity, your knee will continue to have inflammation and swelling that will block your ROM. Have you given your knee time to heal with Rest, Ice, Elevation, and pain medication on schedule as prescribed?

Keep us posted on how you are doing.
 

Jamie

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As Pumpkln says, it is possible to have a successful MUA after 15 weeks, so please don't worry about that. But I would like to know a bit more about what led to your TKR at such a young age and what has happened in these weeks of recovery. Please tell us more if you don't mind. Also, does your surgeon believe it is adhesions holding you back with your ROM? Is your knee swollen? Painful (if so, when)? When you try to bend it, does it feel tight or does it feel like you just hit a bit of a brick wall that stops the movement?
 
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patsortho

patsortho

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Hi there, my TKR was on 3/21/2017.

A little background on me. I had a wedge osteotomy in 2012 for valgus. It failed because my knee rejected the surgery. After that I keep having problems with my meniscus - if just kept tearing by itself. I went through a few scopes of the knee to fix it.

Last year my knee got real bad so the did an MRI. This revealed severe osteoarthritis along with X-rays. On the MRI my articular cartilage was affected as well. After a few opinions I went to a orthopedic in Florida that specializes in knee problems for young patients. Fast forward to my TKR I went in hoping everything will be fine. I was excited. Surgery went well, I felt. Surgery was on a Tuesday and I was released that Friday.

Friday night my knee started to get very red. Saturday morning I was in extreme pain not even meds would touch it. I checked my temp and it was 102.2. My family brought me to the emergency room promptly. I arrived in screaming pain and in tears. They gave me pain meds and took blood STAT. Doctor came in 20 minutes later saying you are being immediately admitted your blood count is 23,000.

IV team came in and put a PICC line in me. Once upstairs I was greeted by infectious disease team. They had me on several antibiotics. At that point my scar was extremely red and skin around it. I felt very sick and helpless. I was in hospital for 2 weeks and they sent me home with home health care, Vanco by IV every 6 hours.

3 days later I stopped responding to the antibiotics and ended up being readmitted. Blood count was again elevated. They tried different medications. Another 2 week stay in the hospital they finally found the one that worked. I was again sent home with IV antibiotics until May 6, 2017.

I did have a little pt in hospital but they weren't pushing it. Once home I had PT outpatient 3 times a week. Therapist had a lot of trouble because knee literally wouldn't bend. It started to get frustrating. I flew up to Boston to get a second opinion from my previous orthopedic. He said without a doubt I have a mountain of scar tissue in my knee. he knows my knee and how it heals.

I'm now 10 weeks po and can't do much of anything. knee isn't bending and I can't walk because it isn't straight either. Recovery has been very tough. I'm still swollen I elevate knee constantly and ice. Orthopedic in Florida said right now I have no choice but to have a MUA. He also stated that if it gets tough he may scope knee as well.
 

skigirl

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I am encouraged that he did not rush in to a MUA right away. Really, he would not do it if it was unsafe. Many docs use 12 weeks as a cut off for MUA, but plenty of docs are willing to extend that time.

With cellulitis, you have been delayed in your healing. I hope that no one has been pushing on your knee. Since you obviously have a lot of swelling, I hope you are spending time on the couch or in bed with your knee elevated. My doc told me to rest two hours for every one hour that I was up at your stage---make sure you are getting a lot of rest and elevation
 

Celle

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I'm also going to ask @Josephine , our Nurse Director, to advise you. She's away at the moment, recovering from shoulder surgery but, all being well, she should be back in a week or so.
 

sistersinhim

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You have certainly been through a terrible time of it. You have come to the right place online to find helpful and caring people. We will do our best to be supportive.
 

Jamie

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A couple more questions for you.....

Has your current surgeon advised that you are clear of infection? Have your blood levels been good for a test or two? That was one nasty infection you got and you want to be sure that is completely gone before doing anything. Was there an infectious disease doctor involved while you were in the hospital?

Good thinking to get a second opinion and especially from a surgeon who knows you and your body. What was his advice regarding the possibility of an MUA and/or scope to take care of the scar tissue? Would you consider having him do the procedure instead of the doctor you're seeing now?
 
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patsortho

patsortho

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Jamie, I have had my levels checked about 5 times all is clear finally! I have a ID doctor the whole time. He came in every day while I was in the hospital. He also set me up with an ID doctor in Boston while I was getting my second opinion. The second opinion didn't want to step on my orthopedics toes, which is understandable. He sent over his opinion per my request and now I have the MUA scheduled. I'm just a little worried about the MUA because my ROM is so bad. Knee still isn't straight either. It's stuck in a bent position.
 

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I had a MUA at almost six months that was successful. My Rom was about 90 when they decided it would be best to have it done. 3 months later I'm holding at about 120. Good luck, let me know how you make out. I'm from florida as well
 
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patsortho

patsortho

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Another thing is that I'm now 11 weeks still on a walker because my knee won't go straight. I have tried everything. It's stuck at a 45 degrees. Knee also doesn't bend. How can I get it straight? Does MUA help with that? Kind of nervous on MUA because I have osteopenia.
 
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patsortho

patsortho

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Karrie,

I have tried all those and nothing budges. Extention is around -13 right now . I have tried everything . I'm still pretty swollen at 11 weeks.
 

Celle

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Extension can take much longer to achieve than flexion. The muscles and tendons at the back of your leg have grown used to your knee being bent and they have probably shortened a bit. It takes time and very gentle exercise to help them lengthen again. You can't do it suddenly, in case you tear them.
At 11 weeks, an extension of 13 isn't good, but it also isn't too bad.

Both your flexion and extension will improve if you can get rid of your swelling. Try concentrating on doing lots of rest, ice and elevation, and less exercise.

How much exercise are you doing each day? I hope you're not doing lots, in the expectation that working hared at exercise will improve your ROM numbers? It doesn't work that way. If you do too much exercise, it keeps all you soft tissues inflamed and swollen. They need to calm down, so the swelling goes away.

Don't give up hope. Remember that ROM can continue to improve for a year or more after a knee replacement.
 

KarriB

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As Celle says, extention often takes longer. Those exercises should be done over a matter of months. Walking with a natural longer stride helps extention also. If your knee is swollen spend as much time as possible elevating toes above nose to get the swelling down. I wonder if your other issues with cartilage and meniscus could be part of the problem.
 
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patsortho

patsortho

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He removed my acl and meniscus during surgery . I can't walk at all not bend knee at all. Think bend is 45. I Ice and elevate a lot . I do heel sides but knee is just so stuck. I use cpm as well. I get 57 on it .
 

KarriB

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As soon as our nurse administrator, @Josephine is back from shoulder surgery we'll send her your way. The most important thing you can do is to do nothing. Rest, ice and elevate the knee to get rid of swelling. A swollen knee cannot bend, it's like trying to bend a hose full of water. Aggressive PT adds to swelling as well as anytime your knee is down and not elevated. Ideally the first month of recovery is spent just icing, elevating and resting that knee.
 

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