Revision TKR Revision RTKR due to laxity in ligament 3rd March 2015

[chereb]

Monitoring my knee it is hot all of the time. I am worried it may be an infection. :-( Fingers crossed its not!

 

[Jamie]

Hang in there....I know you're worried....you hopefully will have some answers on Monday. If xrays are taken, see if you can get a copy to post here on the forum. It would help to see them.

 

[Josephine]

Could my kneecap have dislocated here?

If it was, you wouldn't be sitting there wondering - you'd know!

I was thinking of a&e in my local hospital as i travel 25 miles to this one.

I know you've got action from your surgeon already but this is never a possibility. It's doesn't make a short cut through the system and A&E folk don't know a TKR from a hang nail!

However I agree it doesn't look quite right. I thought it might be just swelling. Be interesting to here what the surgeon has to say about it. I do hope he at least does an xray ....

 

[Josephine]

My pain level is probably 5/6 but this burning/nipping pain is a shock pain if that makes any sense as it is only as i bend. The area on top is also very painful to light touch.

Can you indicate the exact locations of this pain using this chart, please?
Each square needs a double reference like so BR1 and please say if it's front or back.

Taking tramadol x8 50mg paracetamol 8 500mg brufen 400mg x3

That's a per 24hrs amount. I need to know what doses you are taking during the day and when. And what is actually prescribed on the box.

Hoovering, cleaning kitchen up, beds, online shopping so putting away only. Walk my daughter to school and back daily.

That's quite a lot for when you wrote it which was about 5 weeks out. Far too much, actually. Unless your daughter's school was just across the road! If you'd read this article Activity progression for TKRs, you would have seen that at 5 weeks you should have only just been starting to "increase walks around, out in the garden or street, to 20mins, longer if you feel up to it". No wonder you were in pain.

- leg raises x5
- heel slides x10
- wall sliding
- holding leg in air and letting gravity help
- all twice a day

Bit late in the day now, but that's a little too much as well. But you neve said how many wall slides you did or how many leg lift. Plus once a day would have been better with 5 heel slides about 5 every couple of hours.

Can swelling cause that kind of pain at the incision site? It feels almost like its stretching apart.

Yes it can. That sensation is typical of internal swelling and some people get that even without having had a knee replacement.

Are you still doing that much activity or even more? Because you need to do LESS!
And are you still taking pain meds?
I would also like to know what doses and times you take them as I believe you are under medicating yourself.
That's probably your biggest problem.

 

[chereb]

Ok pain is. DR4 CR4 BR4 DR2 CR1 DR1 FRONT
R1A R1B R1C R1D BACK

Pain meds 2x50mg tramadol 4 times a day, 2x500mg Paracetamol 4 times a day and Ibrufen 400mg 3. Times a day.

My daughters school is a 3 min walk so not very far.

Leg raises 10 reps twice a day
Wall slides twice a day about 5 bends with 2-3 min hold on discomfort.
Heel slides 10 reps twice daily
Periodic holding leg in air for a few minutes for gravity.
Chair sitting and using good foot to push back 5 reps twice daily

Rom is currently 73-85 11 weeks 2days post op

Knee is hotter than the other consistently.
Swelling does not go less despite rest
Have spent last 3 days doing nothing except bathroom and odd coffee making and no change.
Elevating and icing every 2 hours minimum for at least 45 mins.

Obviously the pictures i posted in the prominence thread show what i mean by swelling.

My scar goes very angry and raised and knee is at its hottest then as well. During rest as well as movement.

I have rehabbed from 2 osteotomies and various scopes and metal removal. My side leg osteotomy scar has been opened 4 times. I know TKR is a different surgery but since the week 5 mark my knee feels as if its got at times worse and no improvement.

For Rom i have tried using a towel to pull the leg in also
Sitting on the dining room table letting my leg dangle and trying to push it back. I gain around 10degrees at the time and within 30 mins its gone

 

[chereb]

@Josephine i take my pain meds in morning, lunchtime, dinner and before bed.

 

[Josephine]

This is your pain pattern yes?

Pain meds 2x50mg tramadol 4 times a day, 2x500mg Paracetamol 4 times a day and Ibrufen 400mg 3. Times a day.

That's a lot of meds but you are only taking the Tramadol every 6 hours. I suggest you try taking 50mgs occasionally but every 4 hours instead. Perhaps 4 times you can do that with the paracetamol and take the 100mgs on it's own the 2 other times.

Like this - but there would be three times* you could take an extra Tramadol if you needed to. Froget the ibuprofen - it doesn't really contribute much anyway.
I think you would find this regimen much more effective
[TABLE="class: brtb_item_table"][TBODY][TR][TD]time[/TD][TD]Tramadol[/TD][TD]paracetamol[/TD][/TR]
[TR][TD]8am[/TD][TD]50mg*[/TD][TD]2 tabs[/TD][/TR]
[TR][TD]12md[/TD][TD]100mg[/TD][TD]1 tab[/TD][/TR]
[TR][TD]4pm[/TD][TD]100mg[/TD][TD]1 tab[/TD][/TR]
[TR][TD]8pm[/TD][TD]50mg*[/TD][TD]2 tabs[/TD][/TR]
[TR][TD]12mn[/TD][TD]100mg[/TD][/TR]
[TR][TD]4am[/TD][TD]50mg*[/TD][TD]2 tabs[/TD][/TR]
[TR][TD]450mg[/TD][TD] 8 tabs[/TD][/TR][/TBODY][/TABLE]
As for your exercises - see notes
- leg raises 10 reps twice a day and periodic holding leg in air for a few minutes - do 5 night and morning only and hold for maximum of 45secs
- wall slides twice a day about 5 bends with 2-3 min hold on discomfort - do these once a day only and hold for 2 mins only
- heel slides 10 reps twice daily - do 5 every three hours and never to more than mild discomfort
- chair sitting and using good foot to push back 5 reps twice daily - the other heel slides are sufficient
- tried using a towel to pull the leg in also - the other heel slides are sufficient
- Sitting on the dining room table letting my leg dangle and trying to push it back. - no

I gain around 10 degrees at the time and within 30 mins it's gone - of course it does - that's what happens when you're doing too much

Swelling does not go less despite rest

Rest is only effective to a point. It's doing less that stops the swelling developing in the first place that matters.

Have spent last 3 days doing nothing except bathroom and odd coffee making and no change.

Wow! A whole three days? Nothing happens in 3 days, my dear. You must have read on here "this isn't a sprint, it's a marathon"!

Elevating and icing every 2 hours minimum for at least 45 min

Not enough. Try doing it for 2 hours minimum as often as you can. Every time you are sitting, elevate and ice. Doesn't matter how briefly or long - get the leg up and slap the ice on and leave it until the ice is no longer cold! THAT'S the way to do it!

 

[chereb]

Yes Josephine pain is in those areas.

I cant see the meds? Just bold table mixed in.

Ok i will try the exercise out and the extra icing and elevating.

Thank you for all the advice. Im going to go and read in the library now for a bit.

 

[chereb]

Ok so went to see the surgeon today. No X-ray taken. Had a blood test and he flexed around my knee movement. He doesn't think its infected. He said the bottom and inside are packed with scar tissue and as my wound is keloid then its likely inside will be as well.
I have to have formal physio and return in 6 weeks. If things have not improved then its MUA.

 

[Jamie]

I'm going to tag @Josephine so she can comment. I'm sorry he didn't take an xray, though.....

 

[chereb]

Oh and also he said the lateral ligament is a bit looser than he expected but hopes it will get tighter with time.

 

[Josephine]

He said the bottom and inside are packed with scar tissue and as my wound is keloid then its likely inside will be as well.

Oh well, perhaps he's right. 12 weeks out isn't a bad time for an MUA

 

[chereb]

Well it will be 18 weeks by time the physio is done so hopefully that will fix it. Im worried though that physio will push it too far and i will be worse off. It will balloon and then i will be chasing swelling again. Fingers crossed it turns out ok. He did say he would be happy with 90 though as i could do most things which annoyed me. I am not content to live with 90 rom at 42.

 

[Josephine]

Is this better?

Like this - but there would be three times* you could take an extra Tramadol if you needed to. Froget the ibuprofen - it doesn't really contribute much anyway.
I think you would find this regimen much more effective

 

[chereb]

Yes thank you i will try that from tomorrow

 

[Josephine]

I also merged your threads as per this request One thread for your recovery please?

 

[chereb]

Apologies Josephine.

 

[maryo52]

Oh and also he said the lateral ligament is a bit looser than he expected but hopes it will get tighter with time.

I have not heard that this happens. I cannot imagine how it could. I wish it could because I have loose medial ligaments.

But I agree with 90 not being good enough. It was by no stretch enough for me. I have no regrets about the interventions that allowed me to be at 130 today. I can even do a bit of a squat to pee in the woods!

 

[chereb]

Omg Mary pee in the woods made me lol

 

[chereb]

Going for my first round of formal PT today. Still no change in flexion yet. Fingers crossed i can get some progress. 12 weeks post op tomorrow!