TKR Terry's knee story

[TerryKnee]

Thanks, @Celle. I feel I'm making good progress, but I'm not in a rush and know it's a long road to recovery and expect to have some setbacks along the way. One thing that's a big improvement for me is my quads. They just didn't want to fire right, and for the first two weeks or so, I felt very unstable and couldn't lift my leg on its own at all. But in the past couple of days, my quads are doing a lot better. They're a bit achy, but also feeling reasonably strong and stable. I'll tell my heart story after I see the cardiologist.

 

[Jajakio]

Good for you, Terry. I'm one of the people who liked PT and believe it helped me. There is a need to find a balance between overdoing and making progress and it keeps changing. Plus it took me a while to realize that sometimes overdoing doesnt show up as pain or swelling until a few hours later or even the next day. Nonetheless, I think some physical activity in or out of PT was an important component in my recovery.

I'm a bit ahead of you, just passing the 4 month mark and I think riding my recumbent bike has been a great help. For some reason, it came easy for me. I was a regular biker presurgery and in less than 2 weeks I could pedal the recumbent bike in PT. In the beginning it was stiff and uncomfortable for the first minute or so but loosened up pretty quickly. After a few more weeks there was no discomfort at all. Be patient, progress will come. I noticed the biggest improvement between 6 and 8 weeks after I'd already been dismissed from PT and was just doing recumbent bike, walking and a few stretches. I'm not sure if it was that or just healing on its own.

 

[TerryKnee]

Thanks, @Jajakio, very encouraging and it sounds like we're on the same path. It's only been a couple of days since I've been able to pedal a circle, but I think the bike is helping the most right now.

 

[SusieShoes]

I also believe self-directed, gentle PT can be helpful. Knees appreciate moving during recovery, but only the person whose knee it is should be doing the moving or in charge of any handling. I pretty much rehabbed my knees by walking, rather than a bike. My Mom (two knees replaced) swears by her bike. She has the best ROM of anyone I know.

You’re doing great, Terry! I’m glad to hear your quads have joined the recovery party.

 

[kmak81230]

I also find the bike really helpful. I could not make a revolution until my 6 week kneeversary but since then I pedal regularly, continuing to lower the seat to stretch my flexion. I was fortunate to have great, helpful PT's. We really only focused on correct gait, functional movement with good form, balance, and now, strengthening surrounding muscle groups. My quad has been slow to come back so I have appreciated the work I've been doing in PT - which I can follow up with at home. I only have two more visits and will miss it. But I am motivated to continue the work on my own.

 

[TerryKnee]

So it's been a long time since I posted, and I'm now I'm coming up on 17 months post op. My recovery and outcome has not been as good as hoped for. I'm not letting it stop me from doing anything - I've biked up to 100 miles in a day, but there's still some discomfort and I haven't had the day yet where I haven't thought about my knee. I'm still doing daily stretches and have seen a few PTs looking for the silver bullet, but my extension is still about 8 degrees short of 180. This might, at least in part, be caused by persistent swelling...hopefully you can see in the picture - the swelling is localized laterally and is more pronounced when I engage my quads. The tightness and pain is mostly in the upper calf, but still some on the lateral quad too. My surgeon has not been much help "well, it looks good on x-ray and it's not impeding activity, so what are you complaining about" (OK, I added the last part). Any thoughts from the forum?

 

[sistersinhim]

For 17 months out it looks quite swollen to me. Biking a hundred miles a day is unreal. No wonder you are swollen. You know my suggestion will be to cut back and let that knee settle down. The tightness is your swelling. Get rid of that and the swelling and pain should go away.

 

[TerryKnee]

That 100 miles was back in Nov. Because of a recent afib event awaiting further diagnosis, my cycling is way down. The swelling has been persistent since the surgery.

 

[sistersinhim]

I'm so sorry to hear about your afib. Have you gotten that under control?

For some reason your knee is still inflamed and swelling. Are you icing and elevating? Slowing down your activities should help that swelling and pain.

 

[Loriannie]

I am at 14 months and like you I do everything, swim, hike , bike etc and deal with the swelling .. your swelling looks like mine.. I honestly think this is a very long journey and was told 2 years. We've got to have a life right? Is your knee still warm? The Dr said when the knee isn't warm anymore then it's healed.. I think do whatever you want to do, and if it hurts rest it for a couple of days.. hopefully there will be a rainbow at the end [emoji16]

Sent from my SM-T550 using Tapatalk

 

[TerryKnee]

Thanks @sistersinhim. I don't believe I've had another afib episode, but my cardiologist wants me keeping my HR below 120 until I see him in a couple of weeks. I'm in the middle of moving so I don't have as much time for the bike right now anyway, so it's a forced rest of the knee. As for having a life, @Loriannie, I've been taking your approach, it'd just be nice if my knee still wasn't demanding so much attention - and yes, it's still warm. I am going to ask for an ortho consult with somebody other than my surgeon to get a 2nd opinion.

 

[sistersinhim]

I think a second opinion is definitely a smart thing to do, especially with your symptoms. It just doesn't sound right.

 

[TerryKnee]

So today is the second anniversary of my TKR - yesterday I had it scoped. Quick summary - Despite time, PT, ADL and exercise (mostly cycling), after 18 months I was functional, but still had some chronic swelling and pain and marginal ROM (10-120). It always felt like there was a physical restriction in the joint line. Dr. Google has numerous articles on impingement, but my joint replacement technician (surgeon) had little interest and was not of much help ("your x-ray looks fine, come back in 5 years"). Second opinion surgeon said "we can do a revision if you want" - No f-ing way!

The head of orthopedics was more interested and agreed I shouldn't still have the swelling, but he wanted to do further research. He drained it and sent samples to lab for cultures. No infection. Yay! Meanwhile, I had a RF ablation, which helped the pain, but not the feeling of something in there, nor did it improve ROM. He came up with a possibility of impingement (duh) and/or tight ITB, and finally concluded an exploratory scope was in order (and worth the infection risk).

So yesterday he went in. I won't get the full report until my follow-up appointment on 10/28, but he did clean out a lot of "scar tissue" from the joint space and did a partial ITB release through the scope. He has me weight-bearing with crutches for a few days, and I'm back to quad sets and heal slides, but so far, so good. It might be because of the ablation, but I haven't needed any pain meds, and while it's still wrapped and I'm sure swollen from the surgery, the feeling of something in the joint is gone, so I'm quite optimistic at this point.

 

[marieltha]

Glad you’re feeling some improvement.

I’m convinced the soft tissues are as important as the joints in recovery.

PS I’ve had 2 successful lateral PKRs and some tissue problems ( I have a thread). I have learned, however, that neither leg/knee enjoys biking anymore, in any shape, form, or setting (including in water, half motions, stretches vs training). Just an FYI for when you reach the return to active state.

 

[amiller7x7]

TerryKnee - I am most interested in what you learn about your knee. I have been on a similar journey although I am just 16 months post-op with a still somewhat swollen and hot joint and a limited ROM (although I can get zero degrees on extension). I have done lots of cycling over the years but after the TKR I have had to abandon (at least temporarily) clipless pedals, and have resorted to using an electric-assist bike for the bigger hills near where we live. i have had two arthroscopic joint clean-outs post-TKR to remove excess scar tissue but that appears to be a losing game at least until now for me. I don’t know anything about the RF ablation - what did they do? Here’s hoping things start to go right for you! And I look forward to hearing what information you can share.

 

[TerryKnee]

amiller7x7 - I've been able to ride clipless, even completing a century last year, but the pain and swelling was constant (I grew up running in the days of "no pain, no gain", so I just toughed it out). Although I could only unclip by rotating my heel in, not out. I won't get the surgical report until I go for my post-op on 10/28, but so far things are going great. I went to PT yesterday, and even with some post-op swelling and not a lot of force, my ROM was 5-113. I haven't had my extension below 10 since the TKR, so that's great. I've also had virtually no pain and have not used any pain meds since the surgery. That could be a result of the ablation. Radio Frequency (RF) Ablation is a process to treat the symptom of pain, but not the underlying cause. They insert a needle under x-ray guidance and use the RF to ablate or damage the nerves. It takes about 6 weeks to take full effect, and is supposed to last 6-12 months. They did it on me to get me some relief and buy time while they decided what else to do. It did a good (but not perfect) job on the pain - without any feeling of numbness, but I still had the swelling and the feeling that something was in my joint space. Then they finally decided to move forward with the scope. Since they debrided the scar tissue, that feeling is now gone - hopefully it lasts. I'll let you know how it goes.

 

[amiller7x7]

TerryKnee - just checking back to see if you had any results worth sharing after your follow-up after the arthroscopy “clean-up”? TIA

 

[TerryKnee]

TerryKnee - just checking back to see if you had any results worth sharing after your follow-up after the arthroscopy “clean-up”? TIA

Tomorrow is 3 weeks post-op, and I'm still progressing. ROM is 1.5-123, which is a significant improvement. I still have some swelling, but I'm also on anti-coagulants (Lovenox for 30 days) because of a history of DVT. Plus, I was on my feet probably more than I should've been last Fri and Sat at a conference.

Strength is good, but I'm still working on flexibility/ROM. The key will be if, once the swelling goes down, the ROM improvement holds.

I saw the surgical images, and there was a fair amount of scar tissue he removed from the joint space.

Glad I got it done!

 

[newlybionic]

That’s great that your ROM has grown. As the swelling continues to go down your ROM will continue to improve.

 

[amiller7x7]

Great news!