Revision TKR Revision knee surgery - post op 7 months<

2. 1,000 mg Tylenol 3-4x daily concerns me. For seniors it is recommended to use less than 3,000 mg Tylenol/day and not to take longer than 10 days in a row for pain. Please further explain what you suggested.
The US decision to recommend 3k Tylenol as a max per 24hrs is based upon the fear that people might not take into account any acetaminophen (Tylenol) they might be consuming in other medications such as Vicodin, Percocet or even simple cold remedies. I do mention this if the person I am posting to has stated they are taking these pain meds but if they are not, I trust their common sense and say it's 4,000mg.
3. Is slight swelling at the end of day WNL?
What's WNL?

On one of your posts I saw a video of a male showing what helped him if knee pain woke him up at night. He spread a "cream" on the knee, then wrapped it with a plastic wrap such as "Saran" wrap. Last night, when I woke up at 2:30 am with pain,, I did this procedure. I went back to sleep not having to take any medication.
I've used that many times after my two TKRs but never used any cream, just the Gladwrap which a member of this forum was kind enough to send to me, it not being available in the UK. I found it most effective and I'm delighted you did too!
 
MARY,
Glad to hear that it was a "goodfall" as I remember my OS telling me not to fall in those early stages. I thought that after 6 months, I could do "anything" . My PT always warned me that I overdo exercising. OS told me that SILVER SNEAKERS exercise was ok but not to walk on those days. I really think I am overdoing and going to cut back on those classes and also my walking. I'm going to elevate and ice more and listen to my knee and not the age of the revision.
Thanks
 
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Josephine, Thanks for your reply.
2. Tylenol. What about the limit of not more than 10 days?
3. WNL- sorry term used for Within Normal Limits.
 
What about the limit of not more than 10 days?
No comment. I've never heard of it before. And I think it's unreasonable but then a lot of what your FDA puts out seems unreasonable to me. No offence intended.
 
Just look what our FDA has done to our pain meds availability. Completely blown out of proportion.
 
Agree to both your comments
 
I'm now almost 10 months post op revision rt knee surgery done 7/17/18. I still have stiffness/pain on the medial side of the knee extending to upper calf and also lateral side of knee.

Often knee is numb due to Gabapentin and I've tried to titrate down on Gabapentin but can't get below 600mg twice daily. Even at that dose, my pain level is about 3 during the day and sometimes about 5 which was last night.

I take Tylenol 1000mg PRN pain. I have asked my OS if I could possibly be allergic to implant but he said that I have no symptoms of this such as swelling, rash, heat to the area.

Even after my right TKR done 6/30/16, I had stiffness/pain. Gabapentin 600 mg twice daily helped until implants became loose. Reason for revision (osteoporosis found in tibia).

I thought the revision would help, however I have more pain at times than before the revision.
 
Hey there. Sorry you have not experienced any appreciable improvement. Let me ask you some questions.

Did you cut down on activity and ice & elevate more as you mentioned you would? I'm also wondering who you've had for surgeons. Did you have a different surgeon for the revision, or the same as the original TKR? Have you tried NSAIDs (either ibuprofen or naproxen)?

If your pain is neurological in nature, then perhaps you would benefit from a neurology referral.

If I were in your shoes, I would want a different pair of eyes on my problem (maybe a neurologist, or a pain management specialist). My Plan B would be a second opinion. Surgeons generally will not see you unless you have passed the one year mark. But you can line up some names now. When I did that I went for top docs. They are just as accessible as the others.

I hope this helps. Thanks for PM-ing me. I had meant to respond to your post and dropped the ball.
 
Thanks, Mary
Since my last posting, I've cut down on exercises and no SILVER SNEAKERS CLASSES. If I hurt, I stop doing something that causes it. I'm elevating/icing every afternoon 3-4 hrs after doing errands. I go to warm water pool at my gym twice weekly and take a chair yoga class weekly which I love.
I had a different OS for the revision.
I've been to a neurologist who did an EMG after TKR but saw him after revision and did exam and didn't think I needed another EMG. Thinks it is nerve and suggested the GABA and exercise. I asked him about NERVE DECOMPRESSION. I saw an article on line from BaltimorePeripheralNervePain.com and asked neurologist he knew anyone in San Diego area that did this. He didn't but said he knows the neurologist in this practice and he questions this procedure.
He suggested that I see a Pain Specialist which I'm in the process of doing.
After my RTKR, I had the same type of pain in different area of my knee. I saw 8 top OS in the area, who suggested no revision. However, after implant became loose, there was a reason for revision.
@ Josephine. Have you heard of nerve entrapment after surgery and NERVE DECOMPRESSION?
Thank you.
 
@Josephine. I saw my OS yesterday for my one year post op revision surgery visit. I feel tightness on the medial side just above knee extending down to mid-calf .

My chiropractor who has been working on my knee recently feels that contractions (combination of psoas and rectus femoris) decreased combined ROM hip tension and leg flexion.

I have a vacation home in the mountains, where I go every other weekend which has 18 steps going to entrance. While I'm there I go up and down at least 2-3 times a day. My knee will ache after doing this so I elevate/ice.

My knee tires after walking. I've been going to chair yoga weekly since May and it feels good..

On appearance, my knee looks "normal" i.e. no swelling. Xrays look good, signs of maturation of the bone around the implant. I told him my knee feels stiff but he said it doesn't look stiff. He told me that it is a little unusual to have the sensation of scar tissue when I have fantastic ROM which is at least 120. He worries when scar tissue is blocking motion so the sensation of scar tissue is not something he could go surgically and find. But he said that I feel tightness, but it moves well, that is not something that is visible.

If knee doesn't bend, then he would go in and out a camera in in there and remove the scar tissue. My problem is invisible. He cannot objectively find what I feel on my knee. Where I feel tightness, in his opinion it could be a nerve where I'm attributing it to be a scar. It could be nerve pain because it has responded to Gabapentin in the past. I'm presently on Gabapentin 300mg in a.m. and 600mg at bedtime but in order to sleep without pain I also take either 1000 mg Tylenol or 25 mg Tramadol.

What I feel and what he can find on my knee are very different things. What I'm doing i.e manual manipulations, massage, ice are what he would recommend also. He examined my knee and to him it looks like a pretty good knee.

In your experience, Josephine, have you seen this at one year post op, and is there a possibility of sensation of tightness, perhaps due to nerve, ease up?
 
@Calgirl, I am 9½ months post revision and saw my OS that did the revision this past July 16th. The PA examined me first and he said my IT band and quads were very tight. He suggested massaging it (I see you are already doing this). Everything looked good on xrays, although the PA was concerned my original patella button might be loose. When the OS came in, he said my patella button was not loose. That was not revised. My OS said, "you are expecting too much out of the revision". I didn't ask him to clarify but hope he meant for 9½ months?

I still have some internal swelling in the knee and sometimes my upper thigh and below the knee feel sore (on the lateral side). The PA said it is the "soft tissue still healing". I have a good bend 120-130 and my OS was very pleased the way I walk!
 
Hi Cementless, Thanks for your reply. Interesting that your OS said "you are expecting too much out of your revision". That's kind of how I felt , like he did a good job and I'm not satisfied. I've been hurting since my TKR 6/30/16, then my revision 7/17/18 which I was hoping for more. Because I have scar tissue/ nerve issues is not because of his surgery which I told him. I have made scar tissue with other surgeries.
 
I might be way off but I saw your question about RF Coolief. I had that procedure in October. I hesitate to say it, but it did nothing for me but run up medical expenses. You can't have a local so the procedure is in a hospital and your knocked out.

I had high hopes but as I said it did absolutely nothing for me. I've read its helped some - but each one of us is very different. My surgeon wanted me to do it to see if that wouldn't hold me from but yet another big knee surgery.
 
My other knee is bone on bone and I went in this past Thurs to have the diagnostic for the cooler RF. I get more relief from wearing QUELL (wearable TENS unit) than from the diagnostic so I will not be going for the procedure where they cauterize the genicular nerves around the knee. My OS knows that I'm very fearful to have a TKR on My left knee because of the history I've had with my rt one.
 
I told him my knee feels stiff but he said it doesn't look stiff. He told me that it is a little unusual to have the sensation of scar tissue when I have fantastic ROM which is at least 120.
In my opinion, people get unnecessarily paranoid about that old gremlin, 'scar tissue'. Not only is it pretty uncommon but it's rarely responsible for any stiff knee feeling. What IS common is swelling and that can be internal or external. Internal swelling is very often the culprit when it comes to stiffness.

I should ask you if you are still doing exercises of any kind? Because that can very effectively result in stiffness. And with your level of ROM, it's highly unlikely that isn't what it is!
 
@Josephine. Thank you for your reply. The area that is tight on my knee is on the medial side where my scar is and I felt that tightness when I woke up from the revision surgery. OS told me that was normal and as incision will heal, pain/stiffness will decrease. I went to ASTYM THERAPY for 1st 5 months post op because of scar tissue built up with past surgeries. I had bilateral subcutaneous mastectomy (prevention surgery) and had 13 surgeries to remove scar tissue on left side.
I discovered BoneSmart this past February and have followed advice of no PT, ice/elevate.
Recently I went to my chiropractor who could feel tightness and areas that is restricting my ROM. Even though my ROM is over 120°, I cannot bend my knee back to 90°. Upon rising in the morning, I have to hold on to table next to bed to be able to walk. Once I get my ROM, I'm able to walk.
I presently go to Chair Yoga once weekly, dangle my leg off the side of my bed, manual manipulation of thigh and calf, massage, elevate/ice, walk 3000 to 6000 steps daily, ride stationary bike 5 minutes 4-5x weekly.
My OS feels that healing is done on my knee, no noted swelling, and on examination knee looks good and he feels that it is "a pretty darn good knee". Do you think it may be a nerve issue? Thank you.
 
My knee still wasn’t great at my one year check up, but now at 2+ years it has relaxed a lot more and my ROM still seems to be improving.

When I’m laying in bed, even still, and do a “heel slide” my bend is very poor in that position. (Note, I’m not doing heel slides, I just bend that way one time, on occasion, for the stretch.) However, sitting on a chair my bend is much better.

So, you may continue to see an improvement in ROM as time goes by.
 
@ Jockette . My ROM is over 120, however, when I lie on my stomach which is not too often, just to get this stretch, it is not even 90°. OS doesn't measure it, only PT and chiropractor. My quads are very tight and were before my TKR & revision. I thought when referring to ROM, it is referring to sitting and sliding heal toward me.
 
ROM stands for Range Of Motion and it encompasses both bending and straightening. It has nothing to do with the position you are in when it is measured.

For some reason, that I don’t understand, it can vary depending on the position we are in.

By my second anniversary the tightness in my leg was much more relaxed than it had been at one year. I think you may find that, also.
 
Even though my ROM is over 120°
Calgirl, you do know that ROM is both flexion AND extension, don't you? So you're told us the flexion but what is your extension?

You can check this yourself and a good way to check it is like this:

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee
a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's 0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved
knee-rom-small-jpg.50489

My OS feels that healing is done on my knee
Oh clever him! Even at 13 months post-op, there's still a lot of healing to be done. Your symptoms show that. Just stick with the 'take it slow and easy' that we preach on here, you'll get there in the end.
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
 

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