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Revision TKR Revision to TKR <

Josephine

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ligamentum patella
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


her response is "well, you DID have a very complicated revision" I guess I don't know exactly what that means.
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.
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"
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 plicae (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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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.....
 

Jockette

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:console2::console2:

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

Celle

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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.
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.
 

Irish471

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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. :)
 

sistersinhim

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She said "most people" are at 90 degrees flexion by now, and some have 90 degrees right out of surgery. ???
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.
 

Softtail

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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.
 

sistersinhim

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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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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 patient 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. (??)
 

Celle

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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. (??)
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.
 

KarriB

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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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Momma-me

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Hi all, I was wondering if it is appropriate at 3 weeks post op (or any time, really), at PT... to lie on your stomach and try to pull your foot up (or have someone push it or use a strap) to gain flexion.

My home PT did this to me last week, and it was excruciating. I couldn't bend it at all. It also hurt like the dickens on my incision!!!! I told him to stop and that I cannot do this. This makes no sense to me. My home PT assured me that this will be done to me in outpatient PT. My first outpatient PT appointment is tomorrow. I am assuming this is not something anyone should be doing, but I wanted to ask.

Also... I still can hardly bend my knee when I am walking. I walk with a stiff leg and it's hard to get heel/toe and good extension. It's still so swollen that I can't really get it into extension after the swing through. I am hoping this is all normal at 3 weeks.
 

Jockette

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No, that is not appropriate. Do not let anyone do that to you again.

When you go to PT tomorrow, take charge right away. Tell them no pushing, no force bending, no touching you, unless it’s a gentle massage. If they argue, do not stay, walk out.

Seriously, it’s only their misguided opinion that they think this is appropriate.

If I have to have another knee replacement in the future, I won’t go to PT. Too many of them do things that are harmful.

PT is not necessary. You will get plenty of movement for your knee doing everyday things.
 

Celle

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I was wondering if it is appropriate at 3 weeks post op (or any time, really), at PT... to lie on your stomach and try to pull your foot up (or have someone push it or use a strap) to gain flexion.
My home PT did this to me last week, and it was EXCRUCIATING. I couldn't bend it at all. It also hurt like THE DICKENS on my incision!!!! I told him to stop and that I cannot do this. This makes NO sense to me.
My home PT assured me that this will be done to me in outpatient PT. My first outpatient PT appt is tomorrow. I
No, it's definitely not OK and it's not normal.
Don't let anybody do that again. You can already feel that it has done harm to your knee.

When it comes to PT, you are the boss. You don't have to do anything you don't want to. You can set the limits and the PT has to respect your wishes, or else he/she is committing assault on you.
You don't have to please the therapist. He/she has to -lease you.

It's your body and your knee and you are the only one who is allowed to choose what happens to it.
If a therapist can't respect your wishes, remove your knee and yourself from their presence. Tell the home PT not to come again. You don't need that torture and it's bad for your knee.
Saying no to therapy - am I allowed to?
 

KarriB

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I didn’t know about BoneSmart or their philosophy on aggressive PT, but I didn’t permit anyone to touch my leg until months after the surgery. I was petrified someone would drop my leg so no one touched it. But having someone push/pull your traumatized knee/leg will only make the swelling and pain worse. It will not help with ROM.
 

Cynof4

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@Momma-me,
What a journey you are having! I’m so sorry the PT hurt you.
I’m with KarriB-
I don’t like anyone to touch my leg. If I’m going to do something with my leg it will be with my muscle power, not with anything or anyone’s assistance:thud:.

Hang in there and let us know how your PT goes today.
~Cynthia
 

sistersinhim

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is appropriate at 3 weeks post op (or any time, really), at PT... to lie on your stomach and try to pull your foot up (or have someone push it or use a strap) to gain flexion.
My home PT did this to me last week, and it was EXCRUCIATING. I couldn't bend it at all. It also hurt like THE DICKENS on my incision!!!! I told him to stop and that I cannot do this. This makes NO sense to me.
This is absolutely NOT alright. It's is the opposite of what your knee should be experiencing. You need to take complete control of what your knee has done to it. Don't ever let anyone, even you, hurt it. Treatment like this keeps your knee inflamed, pulls apart those inner tissues that are healing and causes much more swelling. If I were you I would not go to PT. You do not need it. You know how to walk. That's what our knees were created for. As time goes on you will increase your activities as your knee heals. You can not speed that up. But, what this therapist did to you slows it down.

It's still so swollen that I can't really get it into extension after the swing through. I am hoping this is all normal at 3 weeks.
After the treatment you just had your knee is bound to be swelling. That inhibits ROM, bend and extension. As Celle says, if someone does something to you that you have said not to, then it's assault. Tell them and also tell them that you will have them arrested.
 

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