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[REVISION TKR] Revision to TKR <^

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

  1. Momma-me

    Momma-me member
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    @sistersinhim that is so interesting. I have never really heard of a medial release. I've only heard of lateral release. I mean, I'm sure it's the same concept. I find it interesting, because my incision is straight down the middle (for the most part) but then veers off toward the medial aspect of my knee toward the bottom. As if they were doing something over there and needed more room

    BTW.. I did ask for my surgical report so maybe that will give me some answers, or at least know that it is normal. I have mentioned it to the PA twice that something doesn't seem "Right" about it, and her response is "well, you DID have a very complicated revision" I guess I don't know exactly what that means. Maybe a lot of patients are OK with that response but I wanted more details.
     
  2. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    I dislike how general their statements are. It's a very few that will actually explain what they did during their surgery. Their bedside manner stinks. Hopefully, you'll get some answers when you read your report. I assume the medial release is the same thing as a lateral release but on the other side. @Josephine, is this true?
     
  3. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I understood my surgical report better than I thought I would. I got it right after my one year check up.

    I read it again at the 2 year mark, and understood even more, after being on Bonesmart for 2 years. I’ve learned lots since being on Bonesmart.
     
  4. Jolease

    Jolease member

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    I have just made a apt with my gp to request a copy of my surgical report. I actually am asking for all three. Maybe I’ll understand things a bit better.
     
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  5. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I only asked for mine because I thought it would be fun to read. I was very surprised to read that he’d done a lateral release during the surgery.

    The second time I read it is when I noticed that he said my other knee compartments were satisfactory. (or something like that, I can’t remember the exact word) I would feel more confident if he’d said they were better than that.
     
  6. Momma-me

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    @Jockette exactly. What does "satisfactory" mean exactly?

    As you know... I had my left knee scoped with this RTKR. On my MRI from this past Feb on the left knee, the MRI report states that I have grade 3 arthritis, close to exposed bone". When the OS went in there to scope, he said I had a plica stuck in my patella that was causing it to lock on me, but said everything else in my knee was "pristine". (his words). I don't feel like grade 3 under patella close to exposed bone is "pristine" (??)
    It's all slightly confusing.
     
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  7. Momma-me

    Momma-me member
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    @Josephine I am looking at my OP notes and it says "significant ligamentum patella and plica excised"

    I tried google searching the ligamentum patella part and didn't have much luck. Just curious if you know what that meant exactly?
     
  8. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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  9. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Doctors and especially surgeons, do tend to revert to the original Greek or Latin terminology so I'm not surprised it flummoxed you!

    Fact is,those two words are Latin for patellar tendon! This is the continuation of the muscle in the thigh that becomes the quads tendon, the patella and then the patellar tendon and finally is attached to the knobble on the tibia called the tibial tubercle.

    Though why he should have excised part of this ligament is a mystery to me.

    patellar-tendon and quads tendon.jpg

    The range of possibilities in that statement are numerous. So unless you can get the rest of the record of the surgical procedure, I cannot help.
    The soft tissue lining inside any joint is made of synovial membrane. This membrane turns into folds within the joint which are called plica. Sometimes these folds - or placae (p) - can get swollen and then nipped in between the bones in the knee. Since no other plicae seemed to be involved with this issue, he certainly would refer to it as being "pristine".
     
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  10. Momma-me

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    Thank you for your response! Much appreciated!
     
  11. Momma-me

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    First official post op visit: 2 weeks:

    I had my stitches removed from both knees. Incision looks good,.

    As of last weekend when PT measured my bend, it was approx 61. (61/+2)
    The NP I saw today told me I am "WAY BEHIND" where I should be at 2 weeks post op. She said "most people" are at 90 degrees flexion by now, and some have 90 degrees right out of surgery. ???
    She told me I had to "work harder" at PT to get my knee to bend. She acted as if I am not cooperating or doing what I am supposed to be doing. I told her I am not worried about it.

    But geez.....
     
  12. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    :console2::console2:

    Your bend will come along fine, your knee has been through a lot. Don’t worry about it.
     
  13. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I'm glad you told her you're not worried about it - because she's wrong! Most surgeons don't expect 90 degrees of flexion until about 6 weeks post-op.
    You'll get there.

    I do wish there wasn't such an emphasis on ROM. The first month should be about healing, not about how far your knee can bend or straighten.
    There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
    Myth busting: the "window of opportunity" in TKR

    It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.
     
  14. Irish471

    Irish471 senior

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    Eh...I was told I was behind at my 2 week post-op, too. My flexion was at 74. It was all the swelling, for sure! He wanted me at 90, too. Your extension number is really good! Sounds like you are doing just fine. :)
     
  15. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Good for you standing your ground and telling her you're not worried about it. PT is supposed to help people, not beat them down. Like Celle said, OSs don't expect 90* until the 6 week mark. Why is the US so obsessed with the ROM! It's infuriating.
     
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  16. Softtail

    Softtail senior

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    Momma-me, as sistersinhim says, it does seem that many US surgeons are focused on getting flex and straightness to your knee as quickly as possible. Maybe even more so ,they seem to believe PT is a necessity to get you there. I have 4 friends, who recently have had their knees replaced by 4 different doctors than my own, and all have ordered active PT for them, as has mine. That was route I followed for previous leg, and one I am following now. Obviously this is not the approach that all doctors follow, so along with experts here on bonesmart, and what your doctor directs you to do , hopefully you can find the right approach that works for you.
     
  17. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Every knee is different inside. @Momma-me, yours has been through much more than the average tkr. I believe all this has to be taken into consideration when rehabbing. How much more damage inside did your OS have to repair? How damaged are your muscles and tendons? These are just a few of the differences each knee can have. That why we say to listen to the knee. If what you are doing causes it to swell more and increase the pain, then it can't be good for healing it. Healing it is the number one thing to be concerned about at your early stage.
     
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  18. Momma-me

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    Yes I agree everyone! It's just hard when wherever you go, all they talk about is how you are "behind". The PT told me today that he just saw a pt that had 102 degree flexion right out of surgery. I had maybe 30 degrees tops. That's not something I can control or not control. (??)
     
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  19. Celle

    Celle FORUM ADVISOR Forum Advisor

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    It's not a race! Why do they act as if it is? It's demoralising for people with a new knee.

    I'm convinced that, with PTs, it's all about them being able to write down "good" numbers, so they can prove to the insurance companies that pay them how effective their treatments have been. So they say "you're behind" to try and make you work harder at exercises - which is good for the PT, but bad for a newly-wounded knee.

    I'm lucky. My surgeon never measures ROM. He looks at the knee and says "Show me what you can do." For him, function is more important than the numbers.
    He doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
    After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
    His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
     
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  20. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    After my infection surgery my OS said he’d be happy if I reached 90°. Fortunately I am well past 90° but it took over a year, not a few weeks. Your knee will heal and bend, just give it time.
     

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