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Josephine is under the weather and will be away for a while.
Revision TKR Tabbykit's recovery from TKR revision
- Thread starter tabbykit
- Start date
I don't know if this is related,
given that it's been a couple of months since your surgery, but I found early on that I would get pain doing a straight leg raise or sometimes just lifting the leg to change position if I didn't tighten the muscles around the knee first. What my PT called a "quad set." It takes some pressure off the joint.
given that it's been a couple of months since your surgery, but I found early on that I would get pain doing a straight leg raise or sometimes just lifting the leg to change position if I didn't tighten the muscles around the knee first. What my PT called a "quad set." It takes some pressure off the joint.tabbykit
member
Thanks, @kneeper, funnily enough I just realised this very same thing today! If I make sure to engage the quads first it hurts less. Still having the weird thing when bending (still only around 60 bend) my leg just sticks out as if made of concrete, and I have to press down on the quads and tell them to let go. Every single time. I guess it is 'guarding' but is this usual at 8 weeks?
I know sometimes people have had this issue with straightening their legs and it just takes time for the quad to
get itself in gear. I'm not sure, but I think quad sets were one of the things PTs had people do for that. But I'm really just guessing here.
get itself in gear. I'm not sure, but I think quad sets were one of the things PTs had people do for that. But I'm really just guessing here.
Gel-girl
member
Just read both your threads. Very interesting. I reckon that 4 years of tendons muscles etc being used ‘wrongly’ or not used at all will have an effect on your recovery.
I wondered if you found out if you had adhesions, if so what has been done about them or is being done about them.
I wondered if you found out if you had adhesions, if so what has been done about them or is being done about them.
tabbykit
member
@Gel-girl , yes that's what I have thought, but surely many others having TKR will have had poor gait, problems with tendons, muscles etc, but most have a trouble free recovery. I also realise that a revision op is more complex than a first TKR, so not expecting miracles, but am plodding away with ice, elevating, doing all the right things as far as I can. On my first meeting with this revision surgeon, I said I had been told I had adhesions (as detailed in my preop thread), but he seemed to poo-poo this. I asked why then it had not been successful and he said it was 'an unhappy knee'. I asked if something had been done wrong but he just repeated that it was unhappy, and the implant was unstable. Of course I realise that no surgeon will say if they think a fellow surgeon has done something wrong.
After the op he said he had removed a mass of scar tissue, and that he had balanced things up (which implies it was not done correctly the first time). My leg is indeed straighter than it was. I had an x-ray after the revision and he said it looked good. When I saw him at 4.5weeks with a bend of around 55 he said it was ok and I needed to keep exercising etc. Of course I am worried about adhesions again as my bend is still very poor, but here on BS it is said that adhesions are rare and cannot develop in so short a time. I will see the OS again on 19 September, and to be honest I'm not expecting my bend to be much better than it is now as it seems pretty stuck.. There is no way I would have a MUA though, read a lot about it and not good. I would go for arthroscopic removal of adhesions/scar tissue if necessary, but will have to wait and see. Going to PT on Monday, then to a sports massage PT on Thursday, so will report back on what they say.
Sorry to hear you had your arthroscopy cancelled, hope you will get another appointment soon.
After the op he said he had removed a mass of scar tissue, and that he had balanced things up (which implies it was not done correctly the first time). My leg is indeed straighter than it was. I had an x-ray after the revision and he said it looked good. When I saw him at 4.5weeks with a bend of around 55 he said it was ok and I needed to keep exercising etc. Of course I am worried about adhesions again as my bend is still very poor, but here on BS it is said that adhesions are rare and cannot develop in so short a time. I will see the OS again on 19 September, and to be honest I'm not expecting my bend to be much better than it is now as it seems pretty stuck.. There is no way I would have a MUA though, read a lot about it and not good. I would go for arthroscopic removal of adhesions/scar tissue if necessary, but will have to wait and see. Going to PT on Monday, then to a sports massage PT on Thursday, so will report back on what they say.
Sorry to hear you had your arthroscopy cancelled, hope you will get another appointment soon.
You could still have some swelling which is making the knee unhappy. As I learned from Josephine, we can't always visually detect how much swelling there still is inside the knee. It doesn't have to be the size of a cantaloupe 
to still have swelling.
Sounds like the OS is recommending you just keep going slowly but surely. It's always a challenge to figure out how much is too much or too little.
I have read that "balancing" is part of any tkr. It may or may not indicate that your first was done wrong.
to still have swelling.Sounds like the OS is recommending you just keep going slowly but surely. It's always a challenge to figure out how much is too much or too little.
I have read that "balancing" is part of any tkr. It may or may not indicate that your first was done wrong.
Gel-girl
member
Thanks for info. You sound worse off than me having to go through revision. Only know what I know by reading and re-reading info on bonesmart and one of the biggest things to avoid adhesions is to not let the knee get hot or warm. I used gels the first time but I have invested in a Cyro cuff which if I remember right is what you have. It’s a bit more of a pain to set up but I can keep it on for longer. The gels at the beginning seem to warm up so quickly as my knee was so hot. I’ve never stopped using gels as the knee is nearly always warm even after nearly 2 years! Now I use the cyrocuff everyday usually in the evening. All the best for your recovery - you are still early days especially what you’ve gone through.
tabbykit
member
Thaks @Gel-girl. Yes i i have a Cryocuff this time, having done a lot more research and reading up here on BS. I remember using frozen peas only original TKR so must have been vaguely aware that I should ice. I don't remember being told just how important it was to regularly ice and elevate, a pity the hospitals don't stress this enough. Also have gel packs, and by far the best ones are Thera Flex, which stay cold much longer although they feel wet. I made some little cotton cases to slip them into! Just lying here with some after a walk round the garden. PT tomorrow, will see what she has to say.
for PT. Thanks for the info on gels always useful.tabbykit
member
Hi @Gel-girl, it was good, a little reminder on gait, some massage, and I was able to ask the questions I'd been writing down. She measured bend at 70, which is again an improvement. Even if it is slow, as long as it's increasing I'm happy with that. Before the revision I was about 60/30 so am better than that now, but of course it will take time to stretch out this leg as it has been so poor for the last few years. I dream of reaching 90 bend!
tabbykit
member
Thanks, @Gel-girl, yes 90 would be great, and I hope you will get your appointment soon. I'm going to a sports massage PT on Thursday, will be interesting to see if he can help. I went to the same guy 4 years ago after TKR, and after moving my leg for a few minutes said there was nothing he could do as there was a 'hard end'.
tabbykit
member
Well that was odd! Went to the sports massage therapist today. Gave him all the background and about the pain I have in the knee on raising my leg when bent. He did a few things to test the bend etc then said he would use Muscle Activation Techniques to see if it would help. This consisted of massaging particular points on my stomach, was painful and felt like trigger point massage, then the base of my skull. He gave me an illustrated sheet about this and said I could do them at home. Then he massaged the scar, mobilising the kneecap. He then charged me half of his advertised rate, so I wondered if I was being used as a guinea pig ! Have googled Muscle Activation technique but am a bit mystified. Anyone else come across this in TKR recovery?
There was no need for him to mobilize your kneecap. My PTs did that the first weeks but I learned here on Bonesmart it’s not necessary. I won’t allow that in the future.
Jockette is correct. Mobilizing the kneecap and massaging the scar are not necessary. It's best to leave them alone and let Nature do its job of healing, without interference.
It's normal for the kneecap and scar to feel fixed at first, but they will gradually mobilise naturally, as healing progresses.
I've had three knee replacements and my policy has always been "Keep your hands off my knee." I had no problems at all with adhesions or bad scar tissue and my kneecaps are now completely mobile.
I also never let anyone touch my knee but me! Even my OS didn't touch my knee after the tkr, why should a PT?
