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TKR Robert Johnson's hybrid recovery'

I know what you mean. I've been walking with a came for 4 years so I pretty much forgot how to walk. If I had to walk a straight line I don't think I could do it, but little by little I'm starting to look normal to other people when walking. I'm still aware that I'm weaving a little though.
 
@Josephine I read your article "THR: Cemented and uncemented". Thank you for providing that information. I found it to be very informative and educational. I was looking for this information on Google, but then I remembered a thread where you suggested someone read your article so I found that link instead.

My interest lies in the fact that my OS used a cementless femoral component. He mentioned it the morning after surgery when he came in to visit and tell me I could go home. If I remember correctly he cited a couple of reasons you mention in your article: less bone is removed, the bond is better, and less occurrence of failure since cement failure isn't possible without cement.

I wasn't thinking clearly at the time, so I never really asked any questions, but instead read about it later. One thing I still don't know and haven't been able to find is sort of a two part question: How long does it take to form a rock solid bond? ...and... What might cause "movement of the implant" before that bond is secure? (How big a blow? etc)

In your article you mention "movement of the implants before bony ingrowth is established" as a reason why "bony ingrowth can be interrupted". I'm curious how fragile this period is before bony growth is established and how long a period it is. Can it be the full "6 to 12 weeks" it supposedly takes for broken bones to heal?
 
They talked about cementless in the JRAD video conference on Saturday. When it is up for viewing you will want to take a look.
They did say 8 to 12 weeks for ingrowth into the prosthesis.
 
robert johnson said:
How long does it take to form a rock solid bond?
Click to expand...
8-12 weeks
robert johnson said:
What might cause "movement of the implant" before that bond is secure?
Click to expand...
That is addressed in the article also. It could depend upon how well the surgeon prepares the site for the implants - that removal of blood, fat and bone debris.
robert johnson said:
I'm curious how fragile this period is before bony growth is established and how long a period it is. Can it be the full "6 to 12 weeks" it supposedly takes for broken bones to heal?
Click to expand...
If the site is well prepared, then this micro-movement shouldn't be a problem.
 
Thanks Josephine. I'm pretty confident in the quality of the site preparation. He even used the word "spectacularly" when talking to my wife about the fit.

I guess I misread your article on this:

Josephine said:
That is addressed in the article also. It could depend upon how well the surgeon prepares the site for the implants - that removal of blood, fat and bone debris.
Click to expand...

I took it to mean that "movement" was a separate reason, aside from site preparation, why ingrowth might be interrupted.

I was thinking about something along the lines of me tripping over a banana peel at 8 weeks and slamming my knee into something, and was wondering if I would be any better or worse off than if a person with a cemtented femoral component did the same thing.

Based on the fact that I got no warnings about being careful during the initial 8 to 12 weeks, I guess I have to assume I'm worrying about nothing.
 
After going 10 days taking nothing but Tylenol, I decided to go see my PCP. The OS cuts you off at 6 weeks, so my last prescription for oxy ran out on Apr 29.

Without any real pain relief, I was starting to doubt the soundness of my recovery. When I was out for my 20+ minute walk Wednesday I started noticing pains on the medial side of my femoral component while I was still about 1/4 mile from home. I even thought I felt a quick painful pop. I was losing my perspective.

My PCP took one look at my chart, and commented that I was still in the early days of my recovery. I thought I detected a small amount of annoyance with the system they find themselves in.

After checking out my knee and listening to my complaints, he wrote me 4 prescriptions: Norco, Tramadol, Zanaflex and Diclofenac Sodium 1% Gel. That should last at least one month, possibly six weeks. He said to come back if I still think I'm having a problem.

It's good to know the system hasn't been totally upended. :)
 
Glad to hear you were able to get more pain meds, the system is certainly screwed up right now.
 
It may even be worse than I thought. Luckily I had read that the PCP can take over after the OS shuts it down. I think a couple of the forum advisers also mentioned it.
 
I just found out recently that I have some self dissolving stitches under the fat layer on the medial side of my knee, about 2 inches above the knee.

I noticed a 3/4 inch bump under the surface while still in the hospital. I finally remembered to ask the doctor about it at my 8 week post op exams and he told me it could take another 4 months to dissolve.

Has anyone else experienced this? Did it go away completely so you don't feel anything any more?
 
In the middle of my 11th week post op and I had something unusual happen to me Sunday night. I was awakened by knee pain about an hour after falling asleep. It was a deep aching pain on the outside of my right knee. It was enough to shock me wide awake, even though I had taken a zanaflex just prior to going to sleep. I can't remember the last time something like this happened. Probably not since the first few weeks post op.

At first I thought I must have gotten myself into some kind of strained sleep position that aggravated my knee, but then I remembered something that happened Sunday around 6:30 that evening.

We had just gotten home and I had to put the organics bin out to the street for pickup the next morning. It still had plenty of room so I thought I'd go around the yard with a five gallon pail and a weeding tool and pull out any weeds prior to taking the bin to the street. When I was done, I carried the full five gallon pail out to where the bin was. While I was walking, I stumbled a bit on the uneven ground under the grass and my leg bent outward a bit. Not much, but I remember thinking that can't be good because it was more of a lateral movement of the leg where the foot rotates outward stretching something like the lateral collateral ligament (or something?). It bothered me, but I remember thinking well it's too late now. I probably should have iced but I forgot about it right away.

It didn't swell excessively or anything like that. I still have the same slight swelling I've had since week 3, but I do feel a little pain I didn't have before. I have to believe at this point it's not much different than if a person without a recent TKR did the same thing, and since it doesn't seem like anything major happened, it shouldn't be a big deal. (I mean, at what point does a recent TKR knee become pretty much the same as a regular knee with regard to injuries?)

At least I hope that's all it is.
 
I am sure someone will come along to address your concerns with more experience than I have. But I would think that maybe you strained some soft tissue when you stumbled. Maybe just take it a bit easy till things settle down in there.
I also had suture issues and it did take several months for that area on my incision to completely flatten. When I saw my OS, he said I could massage the area which did seem to help.
 
Thanks @gia2cats . I think you're right. I went for a walk tonight and I didn't notice any issues. Earlier in the day though I got that pain again where it just sort of wells up out of nowhere like it did when I was sleeping. Hopefully it just a temporary distraction.

Was your suture issue something that was beneath the surface? Mine appears to be under the fat layer and is a couple of inches away from the main incision.
 
I actually had a tiny suture abscess on the suture line. It healed but I could still feel the bump for a few months. But I also had an area away from the suture line that was a bit lumpy so that was probably a dissolving suture also. Eventually flattened out.
Happy to hear you’re feeling better. I think as we recover and forget about our knees, we will tweak them with our normal activities and cause a little discomfort.
 
@Celle I have a question for you, if you don't mind. I need an opinion about something that seems a little odd to me.

For the most part, I'm doing quite well. I have little to no pain or anything outwardly to complain about. I walk a mile or so most days and ride my bike occasionally. I have no swelling to speak of and for all intents and purposes my leg looks pretty normal. Once in a while my knee might bother me enough to remember I hadn't iced it in a few days, so I will ice in those situations.

I take one 100mg tramadol in the morning with 1 500mg Tylenol, and then the rest of the day I just take Tylenol. 1000mg twice at 6 hour intervals. A total of 2500mg Tylenol a day usually.

Here's the problem. Ever since six weeks ago when I stopped taking oxycodone 5mg (that's as far as my OS would go with it) I haven't slept more than 2 hours in a row on any night. I literally wake up every two hours, usually to go to the bathroom, but still I didn't do that when I was taking oxy. Maybe I fall asleep around 11 or so and up by 5 or 6 am. Compared to my old life before this TKR, it's almost like not sleeping at all. I always slept 8 hours or so (in a row) most of my adult life.

As a result of that, I seem to have gotten into the habit of taking a 1 and 1/2 to 2 hour nap every mid-day.

I'm at 13 weeks post op. I know everyone says you should take a nap while you're recovering if your body tells you you need it, but I'm starting to feel like this is getting a little ridiculous.

I would be very interested in hearing any opinions on this subject. Are there any suggestions for breaking this cycle, or should I just ride it out.

TIA,

Robert
 
As you know, sleep disturbance is common with this recovery.
Sleep deprivation is pretty much inevitable - but what causes it?

I guess you could try cutting out the daytime naps now, but often that doesn't work well and you still end up with insufficient sleep at night.

I think it's just a matter of time, and trial and error. It was about 4 months before I started getting more than a few hours of sleep at night, but by about 6 months I was getting 6 hours or more.

However, now I'm a bit older, I sleep poorly at night again and I find I need to have a "nana-nap" most afternoons. I get about 8 hours in total, but it's definitely not all at night time.
 
Thanks for the link @Celle . That pretty much says it all, doesn't it? I'll have to get my wife to read that. While she's been very good about me taking naps, she thinks the problem might be I'm staying awake too late reading and playing computer chess. This should convince her it's more of a "chicken or the egg" thing. I'm reading and playing computer chess because I'm awake, and not the other way around.
 
Robert, if full recovery takes at least a year, at 13 weeks you're only about a quarter of the way (25%) through the process. While your progress may be fairly quick in the early months, some things can take longer - like normal sleep patterns. It's different for everyone and that's why we don't like people to try and compare or figure out what is "normal." Normal is what is working for you. There is nothing wrong with taking naps during the day unless you're doing it in the middle of a job. You're not. So don't worry and just go with the flow.
 
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