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TKR Suggestions needed for “tight band” feeling

@Jamie: clarification: the results of my c-reactive test and bone scan mentioned above are the results (within the past week) of what my new OS ordered; the last time I had a bone scan was May 2020. I’ve had several blood tests in the past 2 years so I will have to check my notes from when those “previous” numbers came from.
 
Okay.....thanks! I'll be interested to hear the result of your appointment this coming Tuesday.
 
@Jamie: Had a good appointment. We talked abt scar tissue removal and putting in the “button” in the replaced LEFT l knee. Sadly the scan showed moderate to severe arthritis in the RIGHT knee :sad:

(re the bone scan, he said it showed no loosening/infection, looked unchanged compared to the one in May 2020, and didn’t show any “degradation of the bone.”) I think his nurse confused me with another patient…

He could do arthroscopic surgery for the scar clean up… if it helps, great!; if not, then he’d open me up to put in the button and I assume clean up more scar tissue. Taking a conservative approach, which I appreciate. In your opinion, can the small incisions of arthroscopic surgery provide enough “room” to see and remove scar tissue? I’m trying to avoid the big incision and the difficult recovery.

We briefly talked abt a cortisone shot in my replaced knee (is this a good idea?) and how my high C-reactive protein shows inflammation but not exactly where in my knee.
 
Arthroscopic surgery is the way this procedure is done. It can work well for some people, but isn't a guarantee that it will take care of all your tightness. I think your surgeon's approach to what he'd like to try makes sense, though. You might want to consider doing as he suggests.

I'm glad to hear there was no sign of loosening and no degradation of the bone. Boy, that's irritating that you would be given incorrect information, isn't it!
 
@Jamie: yes, I was a bit irritated (but mostly relieved!) that I was told I had “degradation” of the bone when I didnt.

Probably will do the arthroscopic in early January or February.

What about a cortisone shot in my replaced knee… good idea?

THANKS, as always!
 
Trying the cortisone shot really depends on how much pain you are in between now and the first of the year. There is no guarantee it will help or if it does, how long pain relief would last. There are some risks associated with injecting a replaced knee.

This is strictly my personal opinion, but since you are planning to have a procedure after the first of the year that does have a higher probability of helping, I would skip the injection.
 
@Jamie: Hope you are doing well. I’m sorry to bring up this same issue but here goes: I’m no better and cannot stand for any length of time. I went to my high school reunion a few weeks ago and could barely move my knee after standing (occasionally, briefly, sitting, too) for so long.

I went to my new surgeon yesterday with the SOLE objective of getting a date on the January 2022 calendar for a procedure.

He said it’s up to me…arthroscopic vs opening me up and putting the button in. A part of me wants to start with a conservative procedure first. (I am frankly terrified of going through another horrific recuperation like I did with my replacement.)

He doesn’t think he can get enough scar tissue out arthroscopically and thinks that it will not help very much. Do you/Bonesmart have any idea about how much scar removal can be done arthroscopically (20%, 50 %, etc)?

I am agonizing over this decision…but SOMETHING needs to be done. I suppose I could get a cortisone shot first (perhaps THE most conservative thing to do)… and then go the arthroscopic procedure and, if not better, the cut me open and put the button in procedure.

I’d be grateful for any thoughts you have… thanks.
 
I don't think anyone - even your surgeon who has seen you personally - could predict how much removal of scar tissue could be done via arthroscopy versus open surgery. I understand how agonizing it is to have to make this type of decision yourself, but it really is up to you to decide which route to take now that you have your surgeon's input.

Whichever procedure you opt for, it will be important to keep inflammation down in the first couple of months following surgery. This may mean taking pain medication to keep pain levels low and not overdoing the exercises or activity.

Inflammation causes heat and that tends to dry out your tissues. Then they are more likely to stick together and reform adhesions. This could happen no matter which procedure is performed. But....please know that the removal of the adhesions can improve your knee's function. Add in the change of the plastic insert and the potential is there to make your life much better.

My thought (and it's strictly my personal opinion) would be to go with your surgeon's recommendation to do the procedure that offers the greatest potential to remove all the constricting tissue from your knee and insert the plastic button. I wouldn't want to risk going through 3 procedures (shot, arthroscopic surgery, maybe followed by an open surgery) in a short period of time. That's a lot of potential recovery time. At some point a person has to trust the surgeon you've chosen and take a leap of faith.

Sure, there is a risk that your recovery could be uncomfortable. But there is an equal or greater chance that it could go very well. No two recoveries are ever the same.

I'm sorry you have to make such a difficult decision. Please don't hesitate to hash out your feelings here until you know what is going to be the right choice for you. We're here to listen and discuss any thoughts you have with you.
 
@Jamie: Thanks, again, for your thoughts! It sounds so much more reasonable when you lay it all out. Will ask husband to come to yet another appt so HE can ask questions and feel better about it all. That will help me then, too. :)
 
Sounds like a plan. All the best to you and your sweet hubby. It's so nice that you have his interest and support for all you've been through.
 
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Open surgery scheduled for April 11. Waiting for confirmation of the date. It will take every ounce of courage I have to go through this again. My prayer is that he will identify the problem causing unending tightness/pain…and be able to correct it.
 
I hope this will be the answer for you. I know this must seem as though it's been going on forever. In this time before the surgery, try to do some things every few days that bring you pleasure. Maybe get out of the house if possible for a nice lunch or just to sit in a park and realize that the world is out there and it's waiting for the time when you can enjoy it again. Good for you for having the strength to make this decision.
 
Thanks, all, for the encouragement! Right now it seems quite far away…but I know time will zoom by. Trying to stay positive and will follow your suggestion, Jamie!
 
@Jamie: Hope you are well! I'm getting close to my April 11 revision surgery (remove scar tissue and put in patellar button). Two questions: the PA said he doesn't like a recliner bc it causes the knee to bend. I slept in the recliner for the first 3 weeks post-op after my replacement....I had gobs of pillows to prop it up. He said he prefers the leg to be straight w/a towel rolled up and put under the ankle. I'm okay to do that but it REALLY hurts (now....and esp right after surgery) to bend it after it being straight for a while (does this make sense?). Any ideas on how to sleep that don't involve the recliner?

And secondly, I've met with my PT and stressed that I won't allow unnecessary pain/pushing. Last time I had extreme pain w/PT....don't want to go through that again. I've been told that I should be at 90 degrees by the time I get my staples out (10 days post-op). I'm quite nervous being told I should be at a certain degree by a certain date.

For reference, I'm at 115 degrees (good!) but 6 straightening.

Guess I need a pep talk....and some practical tips on sleeping. I REALLY want a good outcome this time!

THANKS for all your help (and the help/tips/encouragement of all the forum advisors and fellow members.
 
@Stiff knee NC I never used a Recliner on either of my replacement , nor a towel rolled up under my ankle, I simply lay with my leg straight in bed, I placed pillows either side to keep it straight, it takes a while getting used to, but eventually you'll find it's OK.
Whatever you do, don't feel you have to get a ROM at a specific time, the bend will come on its own, in its own time, by forcing it you will just make it swollen and cause yourself more grief.
Good luck for your revision xx
 
There is no need to keep your knee totally straight, a gentle bend is fine, and much more comfortable.

Many of our members are much more comfortable in their recliners.

There are many, many contradictory things we are told to do, and not do, in this recovery, by many different medical teams. Which tells me there is no right or wrong. (Well, I do personally believe there are some wrongs! :heehee: ) Anyway, it is your knee and your medical team is not going to be at your house 24/7, so do what works for you.

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.
Saying no to therapy - am I allowed to?


bonesmart.org

Elevation: Doing It the Right Way

Updated June 11, 2024 by Jockette Proper elevation is one of the best ways to help with pain and swelling following either hip, knee, or ankle surgery. Many people elevate improperly, which can dramatically lower the effectiveness. In the weeks following your surgery, make sure you elevate...
bonesmart.org bonesmart.org
 
Stiff knee NC said:
I've been told that I should be at 90 degrees by the time I get my staples out (10 days post-op). I'm quite nervous being told I should be at a certain degree by a certain date.
Click to expand...
This is one of those wrong ideas. Very few of us were at 90 at 10 days post op. I was actually told 95 by 2 weeks, and the only reason that I was, was because both my PT and my surgeon forced it that far. :blackcloud:That was before I knew better than to let them do that. It will not happen if I do this surgery again.

My ROM continued to improve well into my second year, and even more in my third year. Notice the article below talks about how it isn’t even necessary to happen by 6 weeks, let alone 10 days. Your ROM will be dependent on swelling and healing. As your swelling goes down, and as you heal, your ROM will improve, and this process is different for each of us.

bonesmart.org

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...
bonesmart.org bonesmart.org

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."
It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!) :egypdance:
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" :yes:“

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. :happydance: “
Click to expand...
 
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