Revision TKR The second time is the charm

[vjice00]

@Celle as you said I had extensive scar tissue. This is what it look like when he went in, I can't even see the knee replacement. My adhesion surgery was June 15th 2019

 

[vjice00]

@Celle tried to send imaging but I can't seem to upload it

 

[Celle]

Thank you for your surgery date. I've added it to your signature.

Some of your images loaded all right. I'm not good at reading that sort of image and Josephine, our expert, is on extended leave, recovering from having a Revision TKR herself.

I've edited out the two images that were just black boxes.

 

[vjice00]

@Celle ok thank you

 

[Jamie]

@vjice00 .... I'm so sorry to hear of your accident and sudden need for a knee replacement last spring. You've certainly had a time of it in recovery, but I'm glad you're coming to realize that any type of aggressive therapy is not for you. As Celle described, for some people pushing like that in therapy can actually promote an environment where adhesions can develop.

Treating adhesions properly is unfortunately a skill that not a lot of surgeons have. However, there are some specialists who work routinely with this problem. Would you be willing to travel to see someone like this? If that's not possible, we'll try to work within your local, driveable area to find someone for a second opinion. Are you being treated under Workman's Comp? That could make a difference in what you are allowed or not allowed to do.

In the meantime, is it important that you minimize any therapy, exercise or activity that might keep those tissues inflamed and hot.

There is a surgeon, Dr. Michael Terry, in the Chicago area who was doing some work with arthrofibrosis patients some years ago. I don't know if he's still involved with that or not, but it would be worth a call to his office.

Faculty Profile

www.feinberg.northwestern.edu

Please tag me in any post where you need my assistance so I will see it and respond faster. To tag, you type the "at" sign (@) followed by the username with no space....like this..... @Jamie

 

[vjice00]

@Jamie I feel like you are the only one that understands my case my doctor remove the adhesion and sent me back to therapy to do the exact same thing that probably caused the adhesion at first. Yes this is a workman's comp case through the United postal service so I am at a limit of things that I can do but, I did talk to my adjuster who also said it was okay for me to see a second opinion. I don't know if I can actually go out of town to see someone but I know I can do in state and get my insurance to pay if need be. I was so bewilder about finding another doctor it is not easy because I ran into no one wanted to touch another doctor's work or it was too soon they wouldn't see me before year. I will also love to see a doctor who actually understands my case so if you can point me into any direction that will be the best help for me right now I did hit the link that you sent and I don't know if he would see me about Annie he specializes in shoulders and elbow but I will give him a call and any other recommendations I will gladly check into them thank you in advance.

 

[Jamie]

Yes, I noticed that his bio says sports medicine, shoulders and elbows. But, since he is right there is Chicago, it wouldn't hurt to call his office and ask if he still works with arthrofibrosis patients. This is not technically a "knee" problem since your implant is fine. So if you can locate a surgeon who understands how this type of tissue forms and reacts following surgical trauma in some people, you may have success. There is that "one year" thing sometimes, so I'll keep my fingers crossed that we can get you to someone now without waiting. I'm thinking that would be one year from your TKR, though and not the lysis procedure. So.....even at that, January is just around the corner.

I'm going to tag one of our staff members, @skigirl, who had a successful lysis of adhesions. She is also the one who compiled the list of surgeons working with this problem as it was a discussion during a conference she attended several years back. She may be able to tell you more details about all this than I can.

 

[vjice00]

On Friday October 30, 2020 I went in for a revision total knee replacement. My first knee replacement never gave me the mobility I need it just didn't bend past 80° and it got worse over time come to find out my prosthesis wasn't in my knee correctly it wasn't aligned which never allowed me to get the range of motion I needed so needless to say I needed a revision my first knee replacement was January 29th 2017. I got to say the second experience was totally different than the first I knew what to expect I knew what to do and the doctors and facility was totally different. I'm praying for a different outcome. So the first day was pretty good I still had the nerve block so I could move and not feel much pain but after that first 24 hours all the pain came rushing in and it was a bit much to say the least. I iced and elevated and took my pain meds on schedule so I wouldn't have any breakthrough pain which has been working the swelling is pretty bad which is causing my therapy sessions to be a little bit more painful than they should be but I am pressing through not overdoing it not putting myself in too much pain but getting the leg bent I'm now at 93° range of motion and minus two straight which is better than I've ever been I'm looking for a outcome of 115 and zero finger crossed

 

[Pumpkin]

@vjice00
Welcome back to BoneSmart, and the otherside for the second time.

the swelling is pretty bad which is causing my therapy sessions to be a little bit more painful than they should be but I am pressing through not overdoing it not putting myself in too much pain but getting the leg bent I'm now at 93° range of motion and minus two straight

Your ROM is fantastic for less than a week after you revision, all your knee needs now is time to heal, time for the swelling to go down and reveal your ROM.
There is no need to work through the swelling, right now your PT should be helping to reduce the swelling with ice, elevation, electrical stimulation, and retrograde massage.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

​

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

​

Activity progression for TKRs​

6. Access these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Pumpkin]

@vjice00
You'll notice that I have merged your newest thread with your original recovery thread, as it informs your current recovery.
For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.

 

[Pumpkin]

doctor remove the adhesion and sent me back to therapy to do the exact same thing that probably caused the adhesion at first

Since you had adhesions in after your primary TKR, suggest you will want to take extra care to avoid any additional pain, inflammation, or swelling beyond what occurs after a major surgery.
Be sure you let your current PT know your history so they can avoid over working your knee and risking a second round of adhesions.

 

[vjice00]

Hello beautiful people, of the bone smart community, I just wanted to reach out and update my recovery.

I'm now at two and a half weeks and I go for removal of my staples in a couple of days.

I'm now pretty much off the meds, except at night. I don't get a full night's sleep the pain comes in at night.

I'm still seeing a in-house therapist 3 days a week but he doesn't push me at all - the best therapist I ever had.

I had one bad day because I started getting down on myself because as the knee is healing it feels like it's getting stiffer and I was worried about it not moving because I had such a bad time the first time around, but I got my attitude together and the next session went great. The knee was moving just fine. He told me it will be days where it will be tight and stiff; that's the process of it healing.

Some days he can get it or I can get it to 110°, some days it's only 95°, but I'm not worried. It's almost straight as well. It hurts to the touch and I'm in pain mostly at night.

I haven't taken any long walks but I've read some of the nurses bone smart suggestions about taking walks so I will take some small walks as tolerated but I do walk around the house and my house is pretty big, so I think that counts for something LOL ,and I also walked down the driveway to the mailbox and to the corner - I forgot about that .

Again as I said in my previous comment, this time is definitely different from the previous time and I feel like I will have a better outcome. With a little work and encouragement I can do this.

I also have to mention that through this whole process before in this time the bone smart community was a awesome tool for information and encouragement and if I know someone that was ever in the position I was in I would definitely pass along this website.

Also I forgot to add in my last PT session on Tuesday I got a charlie horse at the top of my knee and I just could not lift my leg after that the PT made me push through the pain which exacerbated it even worse after he left.

I should have stopped PT after that because I was potassium/magnesium deficient and my body was trying to tell me that, which made for a horrible night and a sore morning but I now know better and will stop the PT if this occurs again.

 

[Jaycey]

@vjice00 Great update! Sounds like you are making very good progress. Please don't hesitate to tell PT to back off if needed. Your knee will quickly tell you if you are doing too much. As you found, pushing through only makes you sore.

Thanks for your feedback on BoneSmart! So glad we could help.

 

[Jockette]

but I do walk around the house and my house is pretty big, so I think that counts for something LOL

This definitely counts, your body walks the same whether inside or outside.

 

[vjice00]

Hello good people of the bonessmart Community, I am now on week five and my incision looks pretty good the stitches are gone and I am continuing to heal. My quad is pretty sore most time which I’ve never had a problem with before but I guess because of the surgery. I feel like it’s getting stronger by the day. I’m seeing a PT three times a week and my swelling comes in after the therapy session and also when I am in the sitting position for too long with my feet hanging but other than that I’m elevating icing and resting trying to find the balance between the two (Stretching & healing). I’m still in pain at night mostly but I get a nice sleep most days because I take the meds but only at night and maybe for my PT session. My leg is moving at a range of 105 but my extension seems like it’s getting worse I got to work on it I hope as i heel it gets better because I’m walking with my leg bent a little bit and it’s uncomfortable. some days I get a little discouraged because I stretch and my leg is moving I go to bed and get back up the next day and it’s stiff and tight and not moving is discouraging I hope to see the light at the end of the tunnel when all of this is all healed up.

 

[Jockette]

Your ROM, both flex and extension, will improve as you continue to heal. Sometimes extension takes longer, so don’t worry and try to be patient. And, there’s no rush, my ROM continued to improve in my second year, and even a bit more in my third year, so don’t push, you have lots of time.

Also, your ROM will fluctuate, depending on how much swelling you have on a particular day, so don’t look at it as going backwards.