TKR Second TKR, struggling<

[Harli B]

it has been a while since my last post, but not voluntarily.

On the weekend at 2:30 in the morning I fell out of bed on to my new knee. The pain was incredible, it felt like I'd just had the surgery without anaesthesia. It was a very long hour before the ambulance arrived and took me to the ER. The only thing that kept me from totally losing it was the several doses of Fentanyl on the way!

At the hospital they took xrays and examined the incision to see if I'd torn anything. By this time I had a swelling on the inside of my leg near the knee the size of a grapefruit and a spectacular bruise forming. I was so relieved when they told me the xrays looked fine and it was only deep tissue bruising so I was allowed to go home. It has not been a happy week.

I am icing and elevating almost continuously but if I stand for even 5 minutes my whole leg and foot swell up like a sausage. I have gone from a ROM of 100 when I bend the knee with heel slides to almost nothing and am so discouraged.

I am worse now in terms of pain and mobility than before the surgery. It has set me back so far mentally and physically I am really having a hard time dealing with it all.

Has anyone else had this kind of experience?

 

[Mom2Lucy]

@Harli B , yes although not as severe as your fall. My tkr was Oct 04, and on Nov 07 I fell out of bed. My X-ray showed my kneecap has moved slightly over, other than that more bruising and swelling. I also lost some flexion as a result of the increased swelling and pain. I guess this journey we’re on is a lesson in patience.
Like you, I felt lower mentally and physically, but now I feel it’s just another step I had to go through. I tell myself to be grateful it happened at home, and I landed on carpet rather than cement.

Hope you’re soon on the mend

 

[Josephine]

I am worse now in terms of pain and mobility than before the surgery.

@Harli B That sounds like a doozy of a fall! You answered my questions earlier but that was before the fall so perhaps you'd like to answer then all again now, update them, so to speak?

 

[SusieShoes]

Oh Harli B! So sorry this happened! I haven't had a fall on my knees, but @SherrieT had one. Maybe she will stop by. She recovered from hers but was quite stiff and sore for a while. And Mom2Lucy has already stopped in.

Most falls don't damage the implant at all, but the soft tissues take a beating and get set back in recovery. If I could, I would send you a care package with extra patience, because time really is what it will take for your knee to settle down and feel better. You're doing all the right things. Keep up your spirits and look forward to getting past this!

 

[SherrieT]

@Harli B - I am sorry this has happened to you. @SusieShoes was right. I did have a nasty fall.

I had my BTKR on Feb 1, 2018. Was having an incredible recovery. Then 2 weeks later I lost my balance on our mudroom steps and fell on my knees onto concrete floor. Ended up sitting on my heels. I basically did a manipulation without anesthesia. The pain was horrible. My kids were able to get me up and I could tell nothing was broken. I started icing and elevating toes over nose. Surgeon suggested coming into ER the next morning.
Xrays taken and verified that it was all soft tissue damage.

I lost those wonderful 2 weeks and went right back to the beginning. It seemed to me that it was more difficult recovering from the fall then from the surgery itself. It really did a job on me mentally also.

But there is the light at the end of the tunnel. I'm typing this from London. Almost at the end of my 3 week vacation. I have walked this town from one end to the other. Just some muscle soreness.
PLUS I was knocked down by a bicyclist in an intersection. I have a few colorful bruises and, again, muscle soreness but the knees themselves are doing great.

It is so hard to have patience but with this surgery, especially if you have an additional injury, you have to.
Good luck and let us know how you are doing.

 

[Harli B]

Thanks for all the encouragement fellow bonesmarties

 

[CAB]

Yep @Harli B me too...a bit different tho at 4.5 weeks post BTKR I was feeling awesome so good in fact that i forgot i was disabled and stepped into the car just like an abled person instead of bottom first. Wow that hurt...but just a little muscle strain. That was thursday. On the following Sunday I thought I could step up a higher than usual step only to have my Right knee totally collapse. I thought it had dislocated, the pain was unbelievable, you know when people say they saw stars...well I saw a red hot fiery ball....weird huh? Bruising started to appear around my knee and on my knee cap and more strain to quad muscle and soft tissue damage...not to be the end but my 3rd accident was the following Tuesday when i got my shoe stuck on my mat. I was quick enough to get my self turned over to protect my precious left leg that was doing all the work now. I was and am still feeling the setback from those disasterous 6 days.
I still have a mental block stepping up with my R leg. Ive been teaching it and practicing...the muscle and surrounding tissue seems to swell at each chance it gets. Frustrating...very.
To say im happy isnt the correct word, but it makes me feel somewhat better to read about your accident and others on your thread.
Let our recoveries all be good ones.

 

[sistersinhim]

I stepped in a hole, broke my foot and ankle and went down right on my new knee. It was just shy of a year old. The pain from it was like I was back to about 2 months out of surgery. I swelled, too, but not nearly as bad as you are. I didn't really snap all the way back for a few weeks. Ice and elevate your knee as much as possible. I pray that your swelling and pain goes down quickly.

 

[Harli B]

Hi Josephine, here are my revised details:
Pain meds:

Tramadol 50mg every 4 hours except from 10pm to 8am
Targin 10/5 morning and evening
Paracetamol 1000mg every 6 hours except from 10pm to 8am
Lyrica 75mg morning and evening.​

I'm not sure which but one of them seems to be causing severe insomnia.

Since my fall the pain and swelling are almost constant. The pain drops off to about a 3 when I am icing and elevating but when I stand even for 5 minutes or sit with my foot on the floor it is about a 7.
Exercises:
Pressing back of knee into the bed and holding for 5 seconds, x5 a day.
Heel slides, x10 five a day.
Horizontal leg raises with other leg bent, holding for 10 seconds x3 a day.

Apart from that they have all been too painful or downright impossible since the fall because of the swelling.

 

[Harli B]

I am using an Iceman ice machine for at least an hour at a time several times during the day and a strap on ice pack a couple of times during the night and elevating most of the time. After the physiotherapist visits and massages my leg for half an hour I can now almost get a ROM of 80 sitting down but not much from other positions.

 

[Josephine]

@Harli B I just noticed that you failed to tell me the answer to Q4

4. what is your ROM - that's flexion (bend) and extension (straightness)

Without that, I am unable to comment on the rest

 

[Harli B]

Hi Josephine, I won't know the exact ROM measurements until I see my physio on Tuesday.

 

[Josephine]

I can help with that:
Flexion - post a photo of your leg in one of these positions

Extension -
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

 

[Harli B]

I think I have 90 Rom, +10 extension but that's about it because of the degree of swelling in the calf and foot from the contusion. I have been told to gently massage the calf contusion to prevent a build up of scar tissue but my goodness it's painful! I'm afraid I have no idea how to post photos

 

[Josephine]

1. Pain levels vary from about a 3 when I am sitting or lying down icing at about a 7 or 8 when I get up or sit with my leg not elevated, especially pain through the patella and down the left side of the knee.

Okay

2. Pain meds:
Tramadol 50mg every 4 hours except from 10pm to 8am
Targin 10/5 morning and evening
Paracetamol 1000mg every 6 hours except from 10pm to 8am
Lyrica 75mg morning and evening. I'm not sure which but one of them seems to be causing severe insomnia.

Tramadol: Your cover is not very good. Considering that any pain med is only in the system for about 4-5 hours, if you go from 10pm to 8am, you are going at least 6 hours with no pain med in your system at all! Not good!
Targin: Is this slow release? You never said as much.
Paracetamol: You're obviously taking this along with the Tramadol which is excellent
Lyrica: is my best bet for your insomnia

3. My leg is moderately swollen most of the time and severe if I have been standing or resting it on the floor for a while.

Okay. And you did include this when calculating your pain score, didn't you?

4. I have an Iceman machine which I am using almost continuously, even during the night, with breaks for meals.

Good

5. I elevate except for when I need to eat or walk around.

Good

I think I have 90 Rom, +10 extension but that's about it because of the degree of swelling in the calf and foot from the contusion. I have been told to gently massage the calf contusion to prevent a build up of scar tissue but my goodness it's painful!

That's to be expected. Most cases of poor ROM are due to swelling. That's why it's important to always manage the swelling. But forget the thing about massage to "prevent build-up of scar tissue" because that's a myth PT come out with on a world-wide basis. And there's not a bit of truth in it!

6. My husband and daughters are doing the cooking and housework so I only do the minimum like making my tea and sandwiches.

Excellent

Since my fall the pain and swelling are almost constant. The pain drops off to about a 3 when I am icing and elevating but when I stand even for 5 minutes or sit with my foot on the floor it is about a 7.

Even more necessary that you up the Tramadol to 100mg am and pm.

Exercises:
Pressing back of knee into the bed and holding for 5 seconds, x5 a day.
Heel slides, x10 five a day.
Horizontal leg raises with other leg bent, holding for 10 seconds x3 a day.
Don't do these - they ALL contribute to swelling and pain. And heel slides do not improve flexion any more than the pressing on the knee improves extension. They just don't!

Apart from that they have all been too painful or downright impossible since the fall because of the swelling.

Exactly! So stop doing them! I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

I'm afraid I have no idea how to post photos

You see in the box you wrote your post in, at the bottom, to the right hand side, is a black button with "Upload a File" though it should more properly be "Upload an Image"! Read this anyway, and it will explain all Uploading a Picture in a Post

 

[Harli B]

Thanks for all the advice. I was starting to worry about the Lyrica as sometimes my speech would start to slur and I would mix words up and was feeling very spaced out. I will decrease it slowly over the next week or so. I saw my GP about the Tramadol and he said it was a very mild painkiller and suggested I increase the Targin to 20/10 twice daily instead, keeping up with the paracetamol. He also suggested celecoxib for the inflammation so I will try all this and see how I go.

 

[Josephine]

Actually, most pharmacopeia rate it as equal with morphine!

 

[Harli B]

Maybe it is because of my Ehlers Danlos but my reactions to medications are often very different to other people's. I find morphine does very little for pain but gives me dreadful headaches. Tramadol seemed to control the pain quite well but being hyper-awake at 1 am didn't seem a great trade-off. I am sleeping better since I have come off it. Codeine even in high doses doesn't give me any issues with constipation.

At the moment the actual replacement seems to be progressing very well but the pain and knee to toe swelling from the fall contusion is depressing. I thought it would have improved more after 11 days. My biggest worry is that without being able to elevate my leg I won't be able to tolerate a 2½ hour flight plus 1½hrs in the car to visit my daughter and granddaughter in January. Maybe the setback from the fall is making me pessimistic but I am concerned because booking the flights and accommodation will have to be done quite soon. Thoughts, anyone?

 

[sistersinhim]

My biggest worry is that without being able to elevate my leg I won't be able to tolerate a 2 and a half hour flight plus an hour and a half in the car to visit my daughter and granddaughter in January.

I think you need to wait at least a couple or more months before considering a trip like that.

 

[Josephine]

I agree with that