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TKR The Journey on the Other Side Begins

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@Jane B., I read the operation report and indeed, there's mention of "a side specific ortho align computer assisted resection guide was secured to the tibia...." May be what you suggested. However, no pain was felt in the area until yesterday, and only when I started walking with a cane and putting more weight on the leg. I sure hope it heals.
 
It will heal...although the IT Band issue can take a while to resolve. So you'll need to be patient. Glad you saw the surgeon and he confirmed what you and we thought....a bit too much activity too soon.
 
Whiny time. What a tough three days it's been. A week ago today, I was so pumped and excited about my progress at day5. I was walking a few times daily around my cul de sac, and I had virtually no pain. Fast forward to day 12, and I'm lying here afraid to get up and use the restroom because the pain when I put weight on my operated leg is unbearable. I'm so discouraged, because I feel all my progress and ROM accomplishment (got to 96 on my own and 108 on CPM with no pain during or afterward) is lost and all my ground gained is now well behind where I was. I knew that there would be good days and bad. But the lows have sure overtaken the highs and am looking for a little glimmer of hope. I just hope this shin pain is what they say it is and that PT can help resolve, because my symptoms don't seem anything like IT band--for instance, I have no thigh pain. Starts at Gerdy's turbucle and travels directly down and also calf that's been there since day 1. I've followed directions to the letter. And the mantras.
 
I'm sorry you are suffering, Lu. I hope they get to the bottom of it this week.

Maybe ask Josephine?
 
Good idea, @Jane B.

@Josephine, would you be able to review my thread starting at post #53 on 10/30 (Thursday )forward and provide insight please? I've included proactive notes in those posts that I believe address your regular slate of questions. I've also updated medication and activity schedules in post #67 which has been in effect since this happened. Thanks.
 
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I've read through your history and what strikes me is that you are still doing far too much at too early a stage in recovery. You're expecting too much of your knee, after a very major operation. Do look at what Jamie told you in Post #56.

Can I suggest a vacation from all formal exercise, and lots of rest, ice , elevation and medication by the clock. Also, it's too soon to be cutting down on medication.

This is a long recovery and there are no prizes for trying to recover fast.
 
@Celle, I have done all those things, no formal exercise ,except to walk < 100 feet only to and from restroom and back. Leg elevated fully iced with cryocuff and gel packs most of the day.
Meds are adequately controlling chronic and breakthrough pain.
1 x Norco 10/325 every four hours during sleeping hours,
1 x Norco 5/325 every four hours during waking hours. Total 6 per day.
No marked pain while lying and elevating.
1 15mg meloxicam each afternoon
1 5mg flexeril 3 x per day
 
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@Lusknewknees Im sorry for your pain, but if I were a betting woman, I'd bet it disappears just as mysteriously as it came. We go through all kinds of phases in the recovery process. By the way, what is Gerdys turbucle? I have had soreness and numbness on my shin below my knee that I don't remember having with the first knee, and I've wondered what may have caused it. But they did a lot of work on my knee cap and just assumed it stemmed from that. I hope you have a better day tomorrow!
 
@ConnieJOS , thanks, I hope you are right! This setback took me by surprise since I was so compliant with a very gentle PT, drs orders and bonesmart mantras. I'm concerned there is something more sinister happening but I want to be wrong! Gerdys turbucle is then place where the IT band is connected to the tibia. My dr felt there and diagnosed the IT band syndrome based on that and my pain below. I have zero pain in the thigh, which I'm reading is the normal location of IT band syndrome pain. My pain is a tenderness in the gerdys turbucle inky when pressing into the spot, and then radiating pain up and down to left of the tibia but only when walking (heel to toe) or putting full weight on the shin. Pain in the calf has been there since day one and sis sides with rest and icing. I hope PT can help me tomorrow, OS wrote Rx for treating IT band. He's the expert so I will rely on his advice at least until proven otherwise.
 
I have a question on your pain meds. You're taking different doses of the Norco during the night than you are during the day. Is there a reason for that? You have twice the medication when you're sleeping than when you are awake and more active.

Also, what to the labels on the prescriptions say is the dosage? I'm guessing it's 1-2 tablets every 4-6 hours....
 
Please be patient. If the date in your signature is correct, it isn't yet 2 weeks since your operation.

This recovery takes time - lots of time.

All you should be doing at this stage is resting, icing, elevating, medicating, and very little, gentle exercise.
 
@Jamie my PCP gave me the double dosage of the hydrocodone portion of the Norco to prevent me from over medicating with back up tylenol and overdosing that I was doing when I couldn't get adequate prescriptions. -sheprefers total acetaminophen dosage closer to 2000 mg than the published 4000 mg per 24 hours. I take the stronger dose at night to prevent being awakened by pain. The 5/325 say 1-2 tabs every 4-6 hours, and the 10/325 say 1 every 4 hours. Note: I have problem taking 2 of the 5/325 Norco if needed, I just haven't needed it.

My pain while resting is pretty well under control with this schedule. No pain until I put weight on my leg. Shin pain started Thursday and calf pain/tightness has been there since day of surgery. When I was walking last week prior to the setback I had zero pain during or after walking. The shin pain feels like a shooting pain up/down the bone. There's a tender spot at the gerdys turbucle which responds to pressure by fingers. My greatest fear is that I have stress fracture in my tibia
 
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Okay.....have you tried taking the lower dosage at night with 1 pill every 4 hours on schedule? If not, you might try that and flip-flop to take the stronger dose during the day to see if it's a pain management problem. You are so recently out of surgery, I'm thinking that you are undermedicated for your pain during the day with only 5mg of Norco every 4 hours.

Is there a medical reason for you why your doctor wants to stay at the 2000mg level of acetaminophen? That's kind of odd...
 
@Jamie @Lusknewknees

I've been through four of these surgeries, and I can tell you without a doubt that a 5/325 Norco every four hours would do nothing for me.
 
I have started to flip flop the dosage and see if it works with the shin pain. Will start today. , @Jamie primary care Dr is of the school of thought that max acetaminophen dosage should be well below 4000 mg per day due to risk of liver damage. I also take atorvastatin under her watch so maybe that's part of it. My revised dosage starting today will keep me at 50 mg hydrocodone and 2600 mg acetaminophen daily. I believe max recommended for adults is 60 and 4000, respectively.

So am I to understand that the shin pain is normal, and if I pump up the meds dosage it will heal, but meanwhile, I won't know it's there?

Re: exercise I've cut wayyyyy back on any kind of movement since the onset of this pain. Keeping it to minimum only, 1-3 very short walks around my living room to kitchen, and gentle stretch and ankle slides a few times a day. That's about all I'm doing.m really scared I'm going to lose my ROM 96 on my own, 104-106 on cpm I've stopped cpm altogether per OS direction.
 
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Weird shin pains seem fairly common. I know I had them with the first knee and was reassured here that it was all part of the healing process. Sure enough it went away.
 
My, how things changed. Started Outpatient PT today.
She used a rolling pin-like thing and helped the IT band related pain immensely. Was able to walk on shin with less pain. Still not recovered but much better
Then we tried recumbent bike next. Expected I wouldn't be able to turn a full revolution of the pedal on the first try. No pain! I got in 10 minutes. I almost wanted to cry because I was so happy.
Ended session with muscle stim and compression cold pack. Felt good. Tired afterward but she was super easy on me and very happy with my ROM at 103 extension at 2-4. Pain med dosage switch up seems to be managing too.
 
This is great news. Keep going with what works. Kneeper is right that sometimes we get odd pains here and there during recovery....hence the need for proper pain management. Sometimes it's just pain and you won't be able to attach a direct cause to it. The pains usually resolve with time. But in your case it does sound as though you may have had some IT Band issues, so I'm thankful that the therapist's rolling has helped you.
 
Thanks, @Jamie and @Jane B. Today was a welcome breakthrough after almost 4 days of agonizing pain anytime I tried to put weight on my operated leg. I'm not out of the woods yet by any means, but there is a noticeable difference and I shan't take this lesson for granted. The PT was super pleases at my limberness (?) as she was able to raise both legs perpendicular to my body without pain or pulling. I was shocked when I climbed onto the recumbent bike, expecting to get maybe a partial revolution, and got all around without effort, then she tightened a little more, still moving, then a little more, still moving! She said to try and do no more than two sessions of 5 minutes per day on my home recumbent.
PT Exercises seem doable and only assigned when I'm not at the clinic. We will see how tomorrow goes. My ROM was 103 and my extension was 2-4. So some work to do, but not in a rush. Appreciate the support and advice of the team here at bonesmart. Thanks again!
 
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