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[PARTIAL KR] Revision to bilateral TKR?<^

Discussion in 'Knee Replacement Recovery Area' started by Momma-me, Jun 8, 2017.

  1. Momma-me

    Momma-me junior member
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    Hello I am exactly 5 weeks today of a patello-femoral replacement, an OATS procedure and a MPFL tightening. I have been in a locked brace at full extension (no weight bearing) and on crutches. I have been in PT since one week post op.

    My knee is still very swollen and painful. I try to stand on both legs, distributing weight evenly, but cannot. My knee won't straighten while standing and there is tremendous pressure. My leg and foot turn dark red when I stand up. (And no it's not a blood clot.. I've had it checked). I have not even tried to walk because of the OATS procedure. (because I have not been allowed) I have not been able to. Even my quad exercises cause pain under the knee cap.

    I have 100 deg flexion (painful but can get there) and 0 extension.

    In PT I do straight leg raises, (which cause pain under my knee cap) and hamstring "curls" (lying on belly and bending knee) and short arc lifts. (Lie on back.. ball under knee and raise leg). My quads are very weak.. as are the rest of my leg muscles, obviously. Dr did say a 6-9 month recovery but I should be walking by 4 months. I'm seeing my surgeon tomorrow for my first follow up.

    I see other people, even with full replacements have been walking for some time and there is NO WAY I would be able to even if I was allowed. I just feel like this is abnormal. I'm feeling so so bummed and worried. I can't even imagine all of you are walking by now and I'm no where near that.

    Please advise!
    Thanks so much!!
     
  2. Pheebs52

    Pheebs52 big-cheese

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    Hello @Momma-me! I wish I had the knowledge to provide some answers for you, but I do not. The good news is, someone who does will come along shortly and will no doubt ease your mind a bit. At any rate, welcome, you've come to the best site on the Internet for all things knee-related.
     
    Last edited by a moderator: Jun 9, 2017
  3. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    I agree. This is the best knee replacement site for good, healthful information! One more knowledgeable that I am will soon be here to help. @Josephine
     
  4. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @Momma-me,
    Welcome to BoneSmart, glad you joined us!
    It is normal for your quads to be weak this early in your recovery, muscle inhibition, and inactivity. Your quads will wake up as you heal. Flexion and extension is great for this early in recovery, suggest you need to cut back your PT, they should be working on getting your swelling down, all the working on ROM and leg exercises are causing increased swelling and pain.
    It is your body you know it best, Saying no to therapy - am I allowed to?
    The multiple procedures you had will slow your recovery, you will have to heal from each one, your knee was very traumatized and injured during surgery. Recommend you slow down and let your knee heal.

    With all that your knee has been through, I would say your recovery is "normal". Let us know what your OS says tomorrow.
    Just curious, how come you did not have a TKR, sounds like more than one compartment was compromised.

    Please post your surgery date, a moderator will add it to your signature. Having the exact date will help us advise you. Thanks!

    Here is the reading, the articles are short and will not take long to read.

    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. Here is a week-by-week guide for Activity progression for TKRs


    The Recovery articles:

    There are also some cautionary articles here

    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.
     
    Last edited by a moderator: Jun 9, 2017
  5. PegGar16

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    Hi! I really don't know too much about your surgeries but 100 flexion and 0 extension sounds good to me at 5 weeks. I also had to go non weight bearing for the 6 weeks after my last surgery...you mentioned trying to stand and distribute weight between your legs??? Don't do that yet, wait for the doctor. That just discourages you. I went to PT with the brace also. The doctor told me to focus on the quads. Things will work eventually and you don't want to jeopardise the repairs you have done by rushing things :) Welcome to BoneSmart!
     
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  6. JennyLynne

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    I had patello femoral arthroplasty 2 yrs ago, and a revision to TKR 3 weeks ago.
    I can say that at this point in the patella recovery, I was having much more kneecap pain and quad issues. I could barely lift my leg until further along.

    I am not sure about the other procedures, but you had a major surgery! It takes a long time to recover! Patience is the most challenging part of recovery.

    I hope your appt goes well and you get the reassurance you are looking for.


    Sent from my iPhone using BoneSmart Forum
     
  7. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Hi there - see you found your way around then?

    This is why I don't care for these 'salvage' procedures - they sound really spiffing in theory but in reality they are extremely painful with a protracted recovery and their success is rarely very good. I wish I could be more encouraging but that's the truth of it. You know, there are surgeons out there who are 'enthusiasts' for certain procedures and will do them regardless because they want to and believe they are 'better than' a TKR regardless of the fact that no matter what the eventual outcome is, you've still lost several months of your quality of life when a TKR would have been a mere 3-4 months.

    In the meantime, I concur with the others on here - stop the exercising and rest more and as soon as you can, set about arranging for a TKR. However, it's unlikely you'll find a surgeon willing to treat you before 12 months have elapsed. Sorry, but that's the reality. And stop thinking of your muscles as weak. They are not weak, they are injured and require rest to heal.And you need to be icing and elevating which both manages pain and swelling. Read the articles Pumpkln left you.
     
  8. Jamie

    Jamie ADMINISTRATOR Administrator

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    @Momma-me ... I'm so sorry to hear that you're having such a tough time of it.

    Tell me, did you have your surgery at University Medical Center there in Rochester? If so, can you tell me the surgeon? I do have a couple of suggestions for someone to see there just in case you would like to try and get another opinion on your knee. Honestly, I think you should have just had a TKR instead of all these other procedures. Your recovery most certainly would have been easier if for no other reason than you wouldn't be enduring all this non-weight-bearing time. It's a shame the surgeon wasn't more up front with you about all that.
     
  9. Momma-me

    Momma-me junior member
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    Thank you everyone for your comments.

    The U of R in Rochester performed my first surgery last year (arthroscopic) which made my arthritis worse. No one in Rochester area knew what was wrong or why I was in so much pain and they would not do a replacement because I was "too young".

    I spent a year of my life in PT, lost my job and never walked again. After numerous second opinions and a new diagnosis with "CRPS", I saw a surgeon in NYC who told me I had grade 4 arthritis under the knee cap only, a loose MPFL, and a large pothole in the lateral femoral condyle. My arthritis was limited to the patella only that is why she said I was not a candidate for the full. I was just relieved that someone would help me.. but the recovery is long, frustrating and very painful.

    I saw the OS last weekend and she assured me that all is well and it's just going to take time. You're right though .. I would have recovered quicker from a TKR but because my arthritis was limited that was not an option. It's been 14 months since I have walked and I'm just feeling down about all of this and some days wonder, if this is ever going to end..?

    My knee is still swollen and tender and my quad has pooped out. They say I can unlock my brace in a week and wean off of it. But there's no way...?

    I guess I will be patient but it's hard. (But.. what's the other option??)
     
  10. Jamie

    Jamie ADMINISTRATOR Administrator

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    I'll be honest with you. You most certainly could have had a TKR if you had all these problems. The idea that you were "too young" is not correct. It's not your calendar age, it's the "age" of your knee. But that's ancient history now and I tell you this only because I want you to know that it was possible for you to have a full TKR. You just needed the right surgeon who is used to working with younger patients.

    Sooo....as you say, at this point your only option is to be patient with your recovery. We'll try to help with that if you have questions or concerns. And, let me know if at some point you want to see a different surgeon for another opinion. There are doctors at the University Hospital who will know how to handle your knee.
     
  11. Momma-me

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    Btw.. my surgery was on May 4, 2017.

    I have not been able to find hardly ANY resources on a patello-femoral replacement, let alone, a PFR ALONG WITH a cartilage graft AND an MPFL! The PT I saw in NYC said, "dang girl, you had the whole kitchen sink!!"

    Are we allowed to mention hospitals on the forums?

    I wasn't given the option of a TKR but was told that I will probably need a revision TO a TKR at some point. My left knee (the non operative one) is barely hanging on too. It has the same problem with the arthritis under the patella. I'll be getting my second monovisc injection in that knee next week to try to salvage it as long as I can. If I only have the arthritis under my knee cap and don't need the other procedures. I wonder how different (or easier) the recovery might be??

    Gosh darn I wish I had found you guys a long time ago!!!
     
  12. alexthecat

    alexthecat MODERATOR Administrator

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    You are definitely welcome to mention hospitals (and even surgeons) on the forum. It's up to you, whatever you feel comfortable with disclosing about yourself.
     
  13. Momma-me

    Momma-me junior member
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    Ok I just wanted to double check first.

    The OS I went to at the UofR made it worse and supp he was the "knee guru". Saw another surgeon for second opinion and he laughed at me and told me to get out of his office and that I was "too young". Third opinion, OS said it was too difficult for him. (??).

    So I spent all last year in PT trying to "fix" what was wrong with me, and well as hard as I tried, it was getting worse. I was so depressed. I went to a surgeon at HSS in NYC. I trust them a lot. She knew exactly what was wrong with me. I just wish now I would have had the option of a TKR but... hey hindsights 20/20. Gotta move forward!!

    Thank you for your thoughts and replies! I don't feel so crazy and alone!
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Yes it will and that's because surgeons (who often don't know any better) have a tendency to scrape and trim the rough areas in the assumption they are making the joint better. But they're not. They're just making it worse, in fact, doing the arthritis's job of destroying the joint.
    Actually there is almost no difference between a total or a partial KR.
    Those are very good signs of inexperienced surgeons.
    And I'm afraid you won't. In 55 years of ortho experience, I've never known this to be done.
    Oh nice!
     
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  15. Jamie

    Jamie ADMINISTRATOR Administrator

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    Wow, I'm surprised by the treatment you received from multiple surgeons at the University of Rochester. It certainly makes me rethink any recommendations there, although some of our members have had good experiences. In your case, it sounds as though you'll be better off to go back to HHS.

    Incidentally, long before I discovered BoneSmart I had the same experience as you with my knee. A person I thought knew what he was doing way over debrided my knee. He was so proud of himself in our after-surgery meeting. But 3 months later what little cartilage he left was totally gone and I was in horrific pain and crippled. New surgeon and a TKR followed. Lesson learned for me! So you're definitely not alone in having this happen.
     
  16. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    I was also worse off after my last scope. Scope was the end of November, the tkr was the 2nd. of June. Just a little over 6 months. I needed the time to go to a different OS.
     
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  17. Momma-me

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    Hi everyone! I am now 10½ weeks out from patella-femoral replacement, OATS on femoral lateral condyle, and MPFL tightening.

    I'm trying to do some weight bearing (it's as tolerated) but the area where I had my oats is in pain. Feels like a wicked deep bruise in there. It's even sore to touch it, and also swollen.

    I'm still on crutches.. no way I could try to walk without them. Knee still tight. I feel like I should be able to do some walking by now but I can't. Too much pain with weight bearing and quad not strong enough.

    I'm in PT two times a week and faithful with my home exercises. I just started "step ups" at PT... could the increased pain at OATS location be from that??

    How do you know if an OATS failed?

    Does this sound like a normal phase in recovery? Oh btw.. my knee started feeling really hot to the touch again the last couple days...

    Can anyone tell me how long after an OATS (femoral condyle) could you walk? I'm 10½ weeks (11 on Thursday) and I'm still on crutches and it hurts to bear weight. I also had a patella-femoral replacement and an MPFL tightening. (Surgeon said she put a couple stitches in to tighten.) I see other people are walking by 10-11 weeks.

    I see the surgeon tomorrow. I feel like I'm behind schedule.

    My daughter is getting married in 2½ weeks and before I had the surgery the surgeon said I would be walking by then and definitely in less pain by that point than I was in before the surgery. Definitely NOT the case! I'm trying to be patient with this process.. I have not walked without pain or normally in 15 months now, so this has been a very long road. Sometimes I think I can't take it any more.

    My surgeon says I should not need pain pills any more. I take one, 5mg tab of oxycodone per day and Advil and Tylenol. She said if the Tylenol isn't enough I should see the pain specialist!! I mean... I feel like 10-11 weeks out from all these procedures .. it shouldn't be SO strange that I'm still in pain?? Idk...

    I tried step ups last week at PT and was doing them at home. I think that may have aggravated things.

    I hear stories of failed OATS and don't know how you would know if it failed or not?

    Any input/encouragement would be great.

    Arthroscopic surgery July 2016
    Patello-femoral KR, OATS, MPFL repair May 4, 2017
     
  18. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Momma-me you will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

    This is for three reasons:
    1. if you keep starting new threads, you miss the posts others have left you in the old threads
    2. it often ends up that information is unnecessarily repeated
    3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

    Please keep all your questions and updates on this thread. If you would like a new thread title just give a shout.
     
  19. Celle

    Celle FORUM ADVISOR Forum Advisor

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    First, I'm going to ask @Josephine to advise you about your questoins in Post #19.
    Josephine knows more than I do about OATS procedures, but I have read that their recovery can take a long time.
    Keep using the crutches until you can bear weight more easily.
    I don't think there is a schedule for this, so don't feel that you're behind. Your knee will take as long as it needs to.
    I wonder if your own doctor (PCP) would be more understanding and willing to prescribe Tramadol for you? It's still an opioid, but it is milder than Oxycodone, so it's a useful step-down drug. You can take it in combination with Tylenol, to achieve a good effect.
    Since you are still finding it difficult to walk on the flat, I think it's too early to be doing step-ups. Tell your PT you'll do them later, when your knee has healed a bit more.
     
  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's not entirely true!
    Aggravated? You'd better believe it!
    The question is more like "How do you know if an OATS succeeded?" Answer: hardly ever!
    Easy for him to say!

    I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     

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