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TKR Suggestions needed for “tight band” feeling

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@Pumpkin: Thanks SO much! I have read the first 25 pages of your thread but have to get ready for PT on my shoulder. It’s like reading a book…with a (THANKFULLY) happy ending!!

Where is the list of revision specialists that someone mentioned? I’d need one in NC.

Two OS have said that my knee needs resurfaced but that everything else looks ok. Really my case seems to mirror Carol’s (patient99) w/the “tight band” syndrome. As I recall she did not have a revision but hers got better by the 18 month mark. I’m at 2 yrs and unchanged. Sure wish I could correspond w/her but I’ve been told she hadn’t been in the site in years…
 

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@Jamie may be able to help you locate an os who does revisions.
if you are looking for an arthrofibrosis specialist here is a list.
 
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Jamie

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@Stiff knee NC I went back and took a look at some of your posts from the past year. I hadn't realized that you didn't get a patellar button with your TKR. That is frequently a problem later when it's not done with the original replacement. Especially since you've had two surgeons recommend that, I think it's something you should consider.
 
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@Jamie: I’ve wondered abt that missing “button” for a long time! I was told my kneecap looked fine so he didn’t think I needed it. I’m VERY scared of another difficult recovery/uncontrolled pain/infection, etc. if my new OS were to put one in. Could not having that “button” be causing my tight band feeling? Tks in advance!
 

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It is possible that your discomfort is coming from arthritis under your kneecap. I can appreciate that your original surgeon saw no arthritis there and elected to leave your kneecap in place. But arthritis is a nasty little devil and it has a way of moving into all your knee compartments eventually. (This is part of why partial knee replacements don't have the longevity of a full TKR)

Of course no one can say for sure unless they go in and view your kneecap. But the smooth movement of the patella is critical to good knee functioning and it certainly could be all or part of your problem. That's why I say the opinion of two good surgeons should carry some weight. These guys HAVE seen a lot of knees and often can recognize subtle things like this that may be causing the problem.

The surgery to place a patellar button is not as involved as your original knee replacement. The patella is smoothed to accept the button, but it's not like the drilling and hammering when a knee prosthesis is placed. Also, surgical techniques have changed since 2019. These days most surgeons use a multi-modal approach to pain management where they inject pain meds into the knee before they close. Ask about it and make sure they use it. It can make a huge difference in the first few days out from surgery.

You might also consider trying a program that BoneSmart supports called OneStep. It is a gait-based app that provides constant feedback to you about your gait along with a personalized exercise program and a therapist to guide you. We recently had a special promotion that has ended now, but the company will still give a discount to BoneSmarties. You can read more about this program and register at this link.

How are your other joints? If you have another problem knee or hips that have arthritis, your gait can be impacted and that can cause pain and stiffness in your operated knee because your body is off balance.
 
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@Jamie: Thanks for this info! I’ve had 2 meniscus surgeries on my RIGHT knee (2010 and 2015) and, so far, mostly good. I do have days it really hurts but most of the time it’s okay. I’d consider myself disabled if I had the same problems with my right knee as I have with my replaced left knee

I have a torn rotator in my rt shoulder (MRI confirmed) but it’s not too painful; left shoulder showed tendonitis in an x-Ray and I’m happy to say it is much less painful thanks to a great PT.

I will check that app you told me about!

I REALLY appreciate the ongoing support from you, the advisors/moderators and other Bonesmarties!
 

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That's what we're here for. Hopefully something will click and do the trick for you! Hang in there and never give up!
 
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@Pumpkin: I just finished reading your thread. I cannot believe what you’ve been through. I, too, have had many dark days, even now at the nearly 2 yr mark. I don’t want to go into specifics…but I could totally relate to what you expressed in your thread.

I’m so happy you are feeling better and have such impressive numbers!

In comparison, I have nothing to complain about…and yet, here I am.

I took a number of screenshots of things you tried/mentioned. Could I collect my thoughts and list them as succinctly as possible and you could give me short answers? If you’re agreeable, it will take me a day or two to get it together.

Additionally, and more importantly, can you advise me on the following: I have been walking 2 miles abt 3 x/week (takes 40 mins) for the past several months. It would hurt and be very “tight,” but when I got home and rested it, it would go back to the normal, less painful tightness. I’d also ride a stationary bike 10 mins in the morning and night. (It was a borrowed bike w/a very small and very uncomfortable bike seat.)

Just re-joined my gym…did a pedal-type machine (like a recumbent bike) for 10 mins, 20 mins on a recumbent bike and 20 mins on the treadmill. So the time on machines was typical of what I’d been doing. That night I was up til 5 am after two separate doses of 600 mg of ibuprophin that did nothing. Terrible pain in BOTH knees. Took a few days off, cut way back…didn’t do the pedal-type machine at all and 3 mins on the bike and treadmill. Did ok pain wise. Took a few days off, did 4 mins on each of the 3 machines today and am hurting so much, again.

Why can I walk 40 mins on a sidewalk but not 20 mins on treadmill??!! None of this makes sense!
(Riding the bike has always seemed to help.)

Is there a path going forward at the gym… or did I rejoin too soon? I haven’t set foot in it for 16 months and was anxious to get on a comfortable bike (w/a wide seat and back) again.

Would appreciate your thoughts re the gym. Tks!
 

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Why can I walk 40 mins on a sidewalk but not 20 mins on treadmill??!! None of this makes sense!
(Riding the bike has always seemed to help.)
The side walk is an irregular surface, each step you take is different, the forces through your body vary, means less stress on any one body part.
Treadmill, each step is identical, same stress through your body, recommend walking on outside, skip the treadmill.
Is there a path going forward at the gym… or did I rejoin too soon?
Probably, try skipping the treadmill, and cutting the gym exercises in half, for now.

if pain or discomfort lasts more than 24 to 48 hours, you did too much, cut what ever it was in half and see if that helps.
 
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@Pumpkin: Tks for your feedback. Tolerating gym workout better now that I avoid the treadmill.

Am still working on organizing my questions…

One thing that jumped out at me is that your implant was one size too big (I think you got an 11 mm)… so did I (I’m 5’ 2 “). (That’s for my, reading off the OR note, “Articular Surface Persona FB CR 11 MM Left”). Am wondering if that’s a starting point to look at why I’m still having so much tightness and pain?

And pulling this off of your thread, this is exactly my problem (where you start “I can tell you…”) that describes precisely my ongoing problem.
 

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That sounds like runa42k's thread. Dr Lightner was her surgeon in Texas. I am in Nevada.
i currently have carpal tunnel, so my response may be slow.
 
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@RunA42K: It looks like I pulled a quote of yours and thought Pumpkin had written it. My apologies.

Hope you will see this message (and your quote I pulled, which perfectly describes what I’ve been going through) and can give me your thoughts….

I am a few days shy of 2 years and have had terrible tightness around my kneecap from the get go. Pain at the top of my calf behind the kneecap, too.

Interestingly, even tho I had no known metal allergy, I showed a definite nickel reaction in that special blood test (lab in Chicago). A skin patch test at Duke Derm showed no nickel allergy testing two different concentrations (level) of nickel.

At this point my new OS and PT think it’s scar tissue. I’m at 115 and 5. A consult at Duke says they wouldn’t do a scar clean up while my OS said it’s a good idea. They both recommend getting a patella button.

Am wondering if scar clean up helps (not just temporarily but for a long time) AND if they determined you had a nickel allergy, what type of implant did they put in and what was your experience w/it?

Thanks so much in advance for your help! (Really hope you see this!!)
 

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@Stiff knee NC
Here is a quote from Bonnies thread that might inform you about how she is doing. Noting that you also have a nickel allergy.
This is the implant she received. Right Total Knee Revision 05 November 2015 - Metal Allergy- Smith & Nephew Nickel Free Revision Knee

Bonnie,
@RunA42K
I stayed up all night reading your thread! Could not put it down. Your journey easily ranks up there as one of the most inspiring of all time. Your “ tag line” says it all - you are truly an example of a “ Never give up” attitude in living your best possible life.
One thing has not been clear to me as I approached near the end of your postings: do you credit most of your difficulties previously ( repeated scar tissue , etc.) to a metal allergy and is your last revision successful because of a specialized implant that addressed your allergy ?
Or do you attribute it to the water therapy mostly?
Or maybe both of the above as well as that amazing attitude of “ not settling”.
Would you feel free to say the name of your last surgeon and if he is also in Texas? I am in Pittsburgh, but I swear st this point I am ready to go just about anywhere if I can get a revision that will help me this time.
Also : how do you personally come down on the place of physical therapy in recuperation? What is “ too much” and what is “ too little”.
Would be very interested in your answers!
And CONGRATULATIONS on a job well done!
Kathy0427
@Kathy0427 Hello Kathy, please forgive my late reply, as I have not been on Bonesmart for quite some time...but that means that I am doing well and just living life. I am sure by now that you’ve addressed any issues with a new doctor and it is too late for any help from mine but if it does help anyone else out there I thought I should answer you albeit late.

I credit most of my difficulties due to the metal allergy. The scar tissue growth was off the charts when I had nickel replacements and then of course every time I’d have another surgery that would spur more scar tissue growth. Kinda like the dog chasing it’s tail.

Water therapy helped me tremendously early on when traditional Physical Therapy left me stuck and not going any further but even with water therapy my knee eventually has settled in with only 90 degrees ROM and sometimes I have to push to get to 90, but I can do it.

My surgeons name is Dr. Robin Goytia with Texas Orthopedic Hospital here in Houston, Texas. I have met many people over time since 2015 who were having significant problems and referred them to Dr. Goytia, and they’ve had surgery performed by him with good outcomes. He fixes problems!!

I still deal with the leg length difference that I was given with my 1st revision. Hip aching, back hurting, buying shoes one size too big so I can wear a lift inside the left shoe, and if the shoe is not deep enough it hurts by big toenail. But I am doing the best that I can with what I have got and it is not in my nature to ever give up.

I will keep doing 1/2 marathons as long as I am able. Since the last revision in 2015 I’ve done about 10 1/2 marathons and one full marathon (my 25th). I have another to do on January 19, 2020. My biggest fear in life is falling down on my TKR knee because if my knee does not bend, will I break my femur or tear off my quad muscle? I try to be as careful as I can during my races.

I have an OS who I see for my real knee. He told me a year ago that no doubt I’d need it replaced in 10 years or less. He’s done snyvisc injections on that knee and PRP (Platelet Rich Plasma) and that has given me new life. It works!! I find that using a CBD balm topically on both of my knees does wonders.

I guess that if I end up with another knee replacement then you will see me on here all the time again!

@Jamie, thank you for opening up my thread again. I’ll try and do better with checking in.

Love to all my old friends on here and to the new friends that I have not met just yet! ♥
 
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@Pumpkin: Thanks! I will insist on that implant (or a similar nickel-free one) IF I have to get a revision.

Can you think of anyone on Bonesmart who had scar “clean up”? I’m debating that and would appreciate reading his/her story.

Final question: can an OS “see” signs of an allergic reaction to an implant when the knee is opened up (is there “pitting,” breaking down of the materials or anything like that)?
 

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I too have a bad nickel allergy and have been blessed with no problems with my knees. You can see the make below in my signature block. While they do contain nickel, my OS explained that their process includes super heating them, effectively cerametizing them so there is no contact with any nickel.
 

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@Stiff knee NC .... you can do a search in the forum for "lysis" and get a whole bunch of posts about people who have either had or considered lysis of adhesions. That's the medical term for dealing with adhesions (what many people call scar tissue) that's in places it shouldn't be.

This is actually a pretty rare problem but it seems to come up a lot as something people fear they will get. There are things to consider if you are thinking about the procedure. First, it's tricky and you want a surgeon who specializes in the procedure. There aren't a lot of them available. Second, it's possible that the scar tissue will simply return once the procedure is done. There is some disagreement among surgeons about whether a patient should have aggressive therapy immediately afterwards or not. Our viewpoint on that is "Not." Aggressive therapy usually keeps the soft tissue angry and inflamed (that's the pain you feel afterwards). Inflamed and hot tissue is dryer than normal and can more readily stick together where it should be gliding freely over other tissue.

But we have had members who had success with the procedure. So, it may be something you want to explore. In particular, I recall one of our staff members, @skigirl, went back to skiing after her surgery.
 
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Just a few quick questions on the eve of my two-year anniversary…

1. where can I find the Bonesmart article on getting an MRI AFTER a TKR? I’ve been told by multiple doctors that getting one is useless because of the metal in there (even a MARS one). True?

2. Would an implant w/metal (like mine) look different (pitting, discoloration, etc) in a person, like me, who showed a nickel allergy in the blood test?

3. in my signature, could you please add that I had a LEFT TKR Aug. 2, 2019 and, before that, an arthroscopic surgery in my left knee in Oct. 2017.

Thanks!
 
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Oops, also, could you please add:

Arthroscopic surgery on right knee Sept. 2010 and June 2015

Tks!
 

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Here’s an article from the Bonesmart library about having an MRI:


Here’s a link to the whole list of articles in the Bonesmart Library. Lots of topics there!
https://bonesmart.org/forum/threads/library-index.14830/
 

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