TKR Struggling at 1 Year

Daneez

new member
Joined
Sep 21, 2019
Messages
14
Country
United States United States
Gender
Female
Left TKR on Nov. 5, 2019

For over 20 weeks, I have not been able to walk any real distance. From the beginning, I’ve felt that something was wrong, particularly around my patella area. I have always had the extremely ‘tight vise’ feeling around the whole knee, but I’ve also had real problems with my patella tendon. Currently the patella tendon is inflamed to 5x its normal size – the Radiologist doing the ultrasound said it’s the worst case she’s ever seen. My surgeon has no idea what is causing it, and he has never seen this in his 30 years. He had me consult with another doctor, whose only thought was that maybe the spacer was slightly too small and the tendons were all working overtime to stabilize the joint, but my surgeon disagreed. I am supposed to see a revision specialist in April, but that may get cancelled again (due to coronavirus).

I have had to use a cane or walker the whole time, and the longest distance I could ever walk was to the end of our block. It keeps getting worse, and my muscles now are atrophying on that leg. I can no longer bend past 90 degrees due to the patella tendon, and am at risk for rupturing it. I have a lot of pain. Before the surgery, my arthritis was primarily in the patella area (“severe”) while the other two areas were mild/moderate. In 2001, I had a lateral release on both knees due to mal-tracking issues. It was bone on bone under my kneecap. My surgeon said the patella was definitely thinner, but he had enough to save it and attach the button underneath. My pre-surgical pain was nothing compared to this level of disability; I really wish I had never done the TKR. I hope that eventually I will be able to walk again.

General background: 1) Blood tests were negative for infection, 2) ROM was 125/-2 in January (but it was always hard to get flexion without feeling like I was going to tear something over my patella – I realize now it was because of the inflammation), 3) The patella was always very sensitive around the edges, and it has felt like something underneath is ‘scratchy,’ 4) The x-rays all look ‘picture perfect’ in terms of hardware & patella looks like it's in the correct position.

Things I’ve tried:

1) 11-day course of Prednisone, 2) NSAIDs (none make much difference), 3) daily icing and elevation (reduces pain a bit, but as soon as I stand it hurts), 4) wearing an ACL-type hard full leg brace for 3 weeks, which actually made it feel worse.

I didn't do any aggressive PT – my surgeon just wanted me to do the flexion/extension chair exercises, and that got me good ROM initially. He said scar tissue was not the issue. He had not anticipated that I'd have any issues (I'm healthy, 64, in good shape); he's consulted with a few colleagues, and is completely stumped. He made the referral to the specialist, and now all I can do is wait and hope it doesn't get significantly worse.

It seems that something that happened in the surgery continues to aggravate and inflame my patella tendon, or other areas of the knee. Has anybody experienced anything close to this? Do any of the Moderators have ideas that I might look into?
 
I think you should just do your minimum daily activities to see if you can get that inflammation out of that patella tendon. Ice is an inflammation reducer. Try icing all the time you are sitting and laying down. As long as you have a thin cloth between you and the pack, you can ice 24 hours a day.

During my recovery I had an ice water circulating machine that I kept on my knee the whole time I was down. I'd get up and go to the restroom or the kitchen, or to just walk a little, and then go right back to icing and elevating. This kept my inflammation, swelling and pain down. It can't hurt for you to try it.
 
Hello, I also have some sort of tendinitis after a revision on 2/7 where all but the knee cap components were replaced. It is either quad or patellar. He said it is likely due to the weak quad muscles and the tendons are being overworked trying to stabilize due to this. He suggested heat then ice, alternating. Seemed to help last night. But I agree on being so frustrated. If I work the muscles, then it inflames the tendons but I need to get them strong. He said it will just take time for the muscles to get stronger. Good luck!
 
@Daneez
Sorry to hear of your patellar inflammation, swelling, pain, and immobility.
As others have suggested cold pack and/or heat, elevation, and rest.
With cold packs and heat you will have to see what works best for you.

Maybe a softer support would help stabilize your knee.

Hope your appointment with the OS who specializes in revisions has some answers for you.

Keep us posted on how you are doing.
 
Last edited:
I am so sorry to hear of your pain and frustration following your TKR. It does sound very strange that your range of motion has decreased, and I hope your next appointment doesn't get cancelled because of the COVID 19 situation.

As for experiences, I did have patellar tendonitis after a major knee surgery in 2016, but nowhere as severe as your's. I DO remember being told I needed to slow down my recovery (less physical activity and more icing/elevation) so the inflammation could go down. However, mine had an obvious cause---over-aggressive PT. I know there are numerous causes for it though.

Regardless, I hope you get it figured out and can find relief soon. I know ice is usually my best friend.
 
Can you tell me the name of your current surgeon and the one you've been sent to for an additional opinion. I can take a look around and see if there might be someone else you can consult with once the virus restrictions are lifted.
 
@Daneez, @Rockgirl4: (I hope I am at Daneez’ thread) I wanted to ask if he got any additional suggestions from his recent visit to the OS (other than ice, elevation and rest) to help with tendinitis. And Rockgirl14, I, too, think I had overly aggressive PT pretty early in my recovery. Any suggestions to deal with it other than RICE? I know of 3 people (all within 5 yrs of my age) who had TKR and are doing SO much better than I am (I know everyone is different, but still). I just had blood drawn Wednesday and see my OS on Tuesday. Am hoping to get ultrasound at some point, too. And answers to why I am still in pain and have bad stiffness.
 
Last edited by a moderator:
@stiffkneenc yes you're on my thread ..& I'm a she not he :)
Unfortunately my OS had no new advice. He's at a loss. He did new set of xrays which looked fine, ordered new bloodwork and that was all fine. A new ultrasound also showed no improvement of tendinitis-- the tendon is 5 times normal size. Next Wednesday I have a televisit with a specialist so I'll update here next week. Meanwhile I'm in my recliner with ice.
 
@Daneez: I’m so sorry that you didn’t get some helpful suggestions. Does your doctor say that the tendon will “go back” to its “regular” size? Surely it can’t stay 5 times bigger forever! Did he/she have any idea on timeline for that to (hopefully) happen? And, if you’re comfortable sharing, what kind of specialist will you be seeing next? At this point I wouldn’t be surprised if my doctor referred me to someone else. Hang in there!!
 
@Daneez - we've not heard from you in a bit. How did the televisit go? Have you experienced any improvement in your knee? We are here to support you.
 
(moderators – can you please change thread title to: “Struggling at 1 Year”)

It’s been a long while since I’ve updated – I kept hoping things would turn around. Next week I have my 1-year (!) follow-up appointment with my surgeon; unfortunately I am still having lots of pain and I’m unable to walk very far.

My lateral hamstring pinches behind the knee, as if there’s not enough space in the joint. While standing, I can’t bend the knee (bringing my heel to my butt) without incredible pain – but if I press on the hamstring while bending, I can get more flexion without pain, so it seems to be a functional issue.

My patellar tendon continues to be very inflamed, and the area to left of my patella is very warm. None of this is improving. My patella ended up being very thin (it was minimum required to save during TKR), and I have a lot of pain underneath the patella.

I’ve had 3 surgeons tell me they’ve never really seen this outcome in their many years. None see a problem with the implant. I’ve gone to a University Pain Center and had the ‘test’ temporary nerve block, but I am holding off on the nerve ablation for now because it doesn’t seem that nerves are my primary issue. That’s not to say that I haven’t had terrible burning and nerve ‘shooters’ fairly constantly – I’ve been on 2700mg of gabapentin, which helps nerve pain, but it makes me sleepy. I don’t want to stay on that level of the drug, and am trying to slowly wean down, but I’m noticing my pain ramping up. For now, I’ve been given the generic ‘complex regional pain syndrome’ but don’t really fit that profile.

I did allergy testing: on the Patch Test, I was highly reactive to titanium but negative for nickel, but on the Orthopedic Analysis blood test, it was the opposite. On the blood test, I was Reactive to Nickel (4.5) and Mildly Reactive to Vanadium (3.8) and Cobalt (2.8). My implant is made out of Cobalt (Stryker).

I have continual tightness, which I suppose I could live with if I didn’t have such bad pain. It feels like I have a metal vise poking from inside my knee. I’m doing very gentle stretching, slow recumbent bike, easy PT exercises, some walking. Stairs are incredibly painful (hamstring & patella). My original issue with my knees was patellar misalignment (genetic), and my soft tissue on both knees was always vulnerable. I had a lateral release done on both 20 years ago, and I don’t know if that has made this recovery worse. I have virtually no cartilage left under both patellas.

As bad as I felt pre-surgery, it was nothing compared to this last year. Thank goodness that my husband has had to work from home! Every day, I just try to stay present to this moment, and try to focus on the positive in my life (which is a lot!).:yes:
 
@Daneez: here’s a virtual HUG! Our recuperation is remarkably similar. I have bad tightness all day, and lately, more achyness than pain. DEFINITELY worse now than before surgery. I go to a university Med center tomorrow and will ask if I should follow thru w/skin patch testing (scheduled for nov). My surgeon’s office is pushing me to get a nerve ablation...I didn’t get much relief from the block (about 24 hours without the tightness...but replaced w/a feeling of bad swelling... so unsure what to do). Hoping for clarity tomorrow! Take care... wishing you pain relief and healing!
 
I only had about 6 hours of some nerve relief from the block, and I also had a feeling of swelling. It may have been from the lidocaine fluid? The nerve block didn't resolve my tight feeling. The ablation would not involve injecting fluid. But I've heard mixed things...
Good luck tomorrow! :)
 
I wish you both some relief!! This year has been bad enough without both you @Daneez and @Stiff knee NC dealing with excessive pain and impaired mobility. Daneez, I wonder if going back to some of the hamstring stretches you were probably given right after surgery - those where you don't have to bend your knee - might be helpful. I recall my PT saying that the hammies are the first to start to atrophy. While under Covid-limited movement, I know mine are feeling a little more cantankerous now so I am back to those stretches.
Very odd about the differences in the allergy tests. Since we knew I was allergic to nickel, my surgeon found effective knees - mine do have nickel to make the titanium less fragile, but were "cerametized" (super-heated to effectively create a barrier between tissue and nickel, as he explained it). I have had no adverse response. Just wondering if that may in fact, be your issue.
 
I saw my surgeon for my 1-year follow up, and he is still baffled as to what is causing my difficulties. He referred me to a colleague who I was able to see this week, and both do not think the problem is an allergic reaction.

The new doctor said that I've had one of those rare outcomes that surgeons feel badly about because they can't always help. He thinks that one possible cause may be that I need a thicker spacer - I hyperextend in my joints, and so that may be causing constant instability and irritation to the tissue in the knee. A thicker spacer could make the knee stiffer but less painful. But he doesn't want to rush into that, and suggested I wait another 6 months to see if there's gradual improvement. At that point he'd suggest aspirating the joint (if there's still fluid), and if there's no infection, then do a spacer revision.

Another scary possibility (I've heard this from a couple of surgeons) is that I may develop avascular necrosis in my patella. Because I've had lateral releases done in both knees (20 years ago), I'm at higher risk with a TKR for causing bloodflow issues into the patella. If this turns out to be the case, there isn't anything that can be done... and I'm not going to think about that for now.

He encouraged me to do the recumbent bike, and to not do things that hurt the knee. Gentle stretching and strengthening, no PT. So no more doctor visits for now. My goal is to stay in the moment, focus on being grateful for each day, for my wonderful family, and for my health.
 
My partial was done March 2017 and I’ve had a bad outcome. My first year was very uncomfortable and I was very stressed about it. However, even though I still have a fair amount of discomfort, I am better now than I was in that first year. I saw improvement in ROM and overall healing in the second year. I hope that you will also see the same.

I’ve had 2 second opinions and no one has found anything to fix. To say I am disappointed in my outcome is an understatement, but like you, I am trying to be grateful for each day, for my wonderful family, and for my health.
 
It is certainly frustrating when the experts cannot come up with a solution. I love your positive attitude - it will help so much as you continue your recovery.
 
@Daneez: just popping by to see how you’re doing! Hope your knee is doing better…have you posted since last October, which is now nearly a year? I’m probably going to have arthroscopic surgery on my replaced left knee early in 2022 to clean up what many doctors think is scar tissue.

Have you done anything that’s helped?
 

BoneSmart #1 Best Blog

Staff online

Members online

Forum statistics

Threads
65,180
Messages
1,597,061
BoneSmarties
39,364
Latest member
All2Gd88
Recent bookmarks
0

Latest posts

Back
Top Bottom