Revision TKR Third and final surgery all done

[Polkadot]

I love how you are thinking all of this through. Share as much as you want! You appear to be coming to some helpful conclusions that took me a lot longer to get to. Hang in there. Things do get better.

 

[kayow11]

Does anyone have any opinions or medical knowledge out there about when might be OK to do regular massage or lymphatic massage on my new knee which is now 17 days old.? Also, is it a go with my three-month-old knee? It seems to me that the old knee could handle it but, The new knee is still very tender and the whole leg is actually. But if it could have a benefit in decreasing some of this crazy swelling, it might be worth it.

And as far as thinking all this through, I have had lots of time so believe me, I have thought and re-thought many things these past several weeks. I am still a little fearful thinking that if I am not going the correct route, what will the consequences be of that? But then the reasonable part of me reminds me that I tried the traditional way the first time and it didn't go that well for me. I am learning earlier this time and I just hope and pray that it shows me that it was the right decision. If so, I will have a great testimonial for others that may find themselves in my shoes. Believe me, I have been very skeptical and still am. I am waiting for the proof of no exercise as the best choice, to make me get better.

 

[kayow11]

Another thought, normally movement which makes the muscles contract, can help with swelling too, at least that's what I have always believed and known. Walking seems to be the best for this all around leg muscle contraction activity, but it is too soon I guess for my new knee since it gets aggravated and extra swollen more than five minutes out on the pavement. So some of this laying around seems contrary to that method. But on the other hand, there is a major wound to heal toO. Did any of you feel like you got weak and de conditioned from so much laying around?

 

[kayow11]

I really am trying to be patient and take it real easy on my legs now,. Despite all of my concerns, this is the chance I am taking. I am being encouraged and convinced by Celle and KarriB, and many others to that have put in their two cents worth which is valuable opinion and information for me. Thanks to all of you and you will definitely be hearing from me frequently to update you on my anticipanted progress.

 

[Celle]

Sweetheart, I really think you are over-thinking all this. Your brain must be whirring at breakneck speed.

Your knees are in charge, no matter how much you want to take control. Sit back and let them "do their thing".
Stop looking for ways to hasten or improve recovery. Recovery isn't something you have to work at. It happens, given the right conditions.
All it takes is time.

Massage may help - but not yet. Be patient.

Why not just leave your poor knees alone and let Nature do its job of healing? She's been doing it successfully for thousands of years and really doesn't need a lot of intervention. All you have to do is supply the right conditions for healing, and do nothing that retards healing, and the miracle will happen.

 

[kayow11]

Thanks CELLE, your words truly are comforting and restful for my soul. Our personalities and ways of handling life are very different from each other but it is good for me to balance things out, so people like you with your words, really do help with this.

 

[skigirl]

My first knee I did what u did, my second knee I took it easy for 4weeks. No exercise except pt. Healed faster and better. Have better rom in second knee

 

[RadioGal]

@kayow11 I have the same issue, where it's almost as if my knee is now turning in. Wasn't like that before. Doc is not worried whatsoever about it stating as the muscles strengthen the knee will sort of "right" itself. Do I believe that? Not entirely. But I could be wrong. I hope I'm wrong.

I half suspect that there is a misalignment to some degree. I will seek another opinion on that eventually, but honestly I have no extra pain from it, it does prohibit me from walking or daily activities. I do get a laugh out my doc telling me "you're not walking valgus." Whatever that means. He also says that it's normal for women to be 7 to 8 degrees valgus. Once again, I'm a layperson, what do I know? All I can do is take his word for it. I'll let the experts here address that one for you. But as for me, I'm not overly worried about it, at least at this point anyway.

 

[kayow11]

Ski girl, what do you mean when you state you did what I did on the first knee and on the second knee you get no exercise except PT? PT usually is exercise. Do you mean just two times per week you did the exercises at your appointment? And nothing at home? Please clarify.

On my first knee, I did regular PT two times a week, did all of my exercises that they gave me to do at home two times a day, did my walking a couple three times a day, and really worked on trying to gain flexion. Stayed pretty active too and didn't rest, ice or elevate very much. It's still healing and isn't very painful now and I am still swollen but I think that is me no matter what. I am now almost 14 weeks out from my first knee and it feels not too bad except it is weaker again because of my second surgery. And also, it is still swollen and only around 95° consistently.

I don't like how my knee looks now but it is very swollen. Only day 18 my knee looks but my surgeon thinks it is from the excessive swelling. He did say that if it is only about 5° in the end. That is usually just fine and functionally still really good. But if it is 20°, then they would need to look at possibly a revision, but in his 21 years he has never had to do one and has seen this before he sad.

My surgeon said that four or 5° of rotation is OK and usually causes no function problems. But if it is 20°, then they need to look at fixing that. Wonder how that happened? My surgeon is well known for being excellent and that is why I chose him. I know there are mistakes and human error involved, but there is plenty of fancy equipment used to take these calculations and measurements so that things can turn out perfect.

My first knee had a little bit of this and it did straighten out before two months. We'll see what happens with this other newest knee, where it is much more pronounced, along with the swelling.

 

[KarriB]

If the first knee is still swollen, that's the reason it's stuck at 95 and an MUA would most likely bring on more swelling. As Celle said, (and I think I did a few posts back) give your knees 4-6 weeks to recover from the trauma of surgery. Surgical trauma = swelling, surgical trauma + exercises = masssive swelling. Nearly everyone's knee is very swollen the first 4-6 weeks after surgery.

 

[kayow11]

KArriB, My first knee is still swollen and it may not look that bad, but when I try to straighten or bend it it is very round and shiny and feels like a lot of pressure in there. I can't see any bony prominences either so I know it is still swollen. I am just waiting for it to diminish on its own as the internal parts heal. I do not plan to have a. Manipulation because I know it leads to more swelling and sets everything back. I have read that people really don't gain that much over all, at least most of them.
You would think that almost everyones knees would be very swollen the first 4 to 6 weeks, but it is amazing how people can still bend even if they're swollen. I don't understand it, 100 degrees, 110° out two weeks, seems crazy to me when I have never seen that yet and it is 3 1/2 months now.
I am trying to be patient and do what I am supposed to do. Have not been exercising, minimal walking, lots of laying down resting and icing and elevating, and sure hope this all pays off.
My other big concern though is that the that the new knee looks crooked and twisted. I sure hope it really is just the excessive swelling that makes it appear that way and causes some rotation. I sure hope the surgeon is right and we will know that in a few weeks as the swelling Diminishes. Thanks for the reminder though on the 4 to 6 weeks and about MUAs.

 

[RadioGal]

@kayow11 I've made no secret that I thought my MUA was indeed very successful. I was scared to have it, more so than the TKR, but I need not be worried. Pain did not increase, swelling as far as I could tell was about the same, and I instantly got more bend, 87 to now 110. I delight every time I move that knee and it actually bends instead of coming to a dead stop where it was frozen. And I'm not the only one on here who said their's was successful. But I realize that is not always the case. So, you're right to look deep into that option. You can filter to see MUA threads only here. Might want to check that out to read about the different experiences.

 

[kayow11]

Is there a good spot on this forum to read about revisions? I hate to even think about this, but as I mentioned earlier, it looks to me like my knee was over corrected. The swelling is starting to go down a little bit but that deformity or exaggerated angle remains.
I will see the surgeon on October 26 to review this issue. I am very concerned and worried about it. Even if it feels OK, if the angle is really off by unacceptable degrees, do I get a revision? Can't this cause problems in the future with a parent misalignment?
I guess I will try not to worry at this point, and just get a little information about revisions while I am waiting. I don't think they typically go that well from what I have read in the past.

 

[Celle]

Don't start worrying about a revision yet. Wait until after your appointment with your surgeon and even after that give your knee more time..

I guess I will try not to worry at this point, and just get a little information about revisions while I am waiting. I don't think they typically go that well from what I have read in the past.

If you look down the list of threads, you'll see several with a yellow prefix, "Revision TKR". Click on that prefix and a list of threads will come up, all of them by people who have had revisions.
By and large, all of them have had good results. I think that, typically, they go very well.

The important thing with a revision is to choose a surgeon who specializes in doing revisions. It's usually best to have a different surgeon from your original surgeon, one who has no connection with him, either professional or social, so he/she will look at your knee with new eyes, uninfluenced by the findings of your current surgeon.

I had a revision, back in 2011. My revised knee is now 6 years old and it's doing just fine. My recovery from the revision was no harder than the recovery from the original surgery.

 

[kayow11]

Thanks Celle for your response. I like your input. I didn't even think that I would have to be looking for a different surgeon that would specialize in revisions. And yes, I will give things much more time, but I sure don't like how it looks now. I guess I have been the false assumption that revisions don't frequently have good results and that they are harder to recover from.
The reason I was asking for information on this procedure is because I am a person that doesn't like to be surprised with serious matters. I like to think ahead, and plan ahead, and educate myself so that I can mentally prepare for things like this. That way I have already done a lot of thinking about it and can usually handle those negative situations better.
I do feel a bit angry thinking that this was possibly just an error that could have been avoided. I will ask the surgeon about that when I see him later in October. There is all kinds of fancy equipment with the calculations and measurements that are used to make things as excellent as they can be when remaking parts and joints. And my surgeon is known all around here as being great. It baffles me how this can even happen.
So I guess my job is to quit presuming things and wait to see what the end result is. I suspected something right away when I saw how exaggerated the correction was. But I guess that things can still continue to look more normal as the swelling keeps going down. Thank goodness that is starting some. Bending is still pretty bad but at least some of the excessiveness of swelling is just starting to decrease some.

 

[Celle]

I guess I have been the false assumption that revisions don't frequently have good results and that they are harder to recover from.

Usually, a revision has a good result, because it corrects something that was not right, or that has gone wrong with the original replacement.

Whether or not they're harder to recover from than the original surgery usually depends on how much work had to be done during the revision. Just replacing the plastic spacer is an easy surgical job, while removing the entire prosthesis is obviously more complicated. And then, fine-tuning and adjusting ligaments can be technically more fiddly.

My first knee replacement was a medial compartment PKR. I wore out the spacer and it broke suddenly (without warning) one day. One broken piece shot out the front of the joint and one went to the back of my knee. They caused some soft tissue damage and left me with two metal components rubbing on each other. By the time I could have the revision, the metal parts were a bit damaged and I had some metal filings in my knee.
All the hardware had to be removed and my femur and tibia were re-shaped, to fit a TKR.

In spite of all that, I think my recovery was no harder than my initial recovery and the end result is great.

Now, let's think positively, and assume that you won't need a revision!

 

[kayow11]

Hello all, it is four weeks today on my second knee. The swelling definitely has decreased some but I am really really concerned about the angle of my leg. It definitely looks over corrected and when I walk I can tell it is not a normal heel to toe strike.

I am striking on the left outer heel and then heading to the big toe on that left foot. A diagonal line, not the heel to toe straight line as in the other leg. You can also see that the angle is off. I feel as if my left hip was slightly internally rotated, and then the lower leg was attached at an angle outward to the side. This makes me pronate more on that foot.

When I saw my surgeon two weeks ago he said he thought it was from excess swelling and wanted me to see him again in four weeks which is now in two weeks. I have had lots of moments of crying about this since I had such bowed legs before surgery, and really was hoping for straight legs as the first one is.

How does this happen?!?! All kinds of measurements are taken with fancy equipment to make things so called right. My surgeon is known to be very good also which is even more disappointing.

I wonder if this will affect my feet and hip angle enough to cause troubles even more than there already has been. Sometimes you don't know these things until years later because of not walking correctly due to misalignment.

I went to PT yesterday and didn't do much there but talk to him about this and he said not to even think about a revision until many months or years down the road. He said that our bodies are very good at compensating and ignoring problems and can make things work out OK. That may be so but I still can hardly get over my big disappointment and anger about this apparent misalignment that likely happened during the surgery process.

Has anyone else had this problem and did you do anything about it? Does any one out there have any advice for me or can share your personal experience or if this happened to you too?

 

[kayow11]

Celle, I know that a couple weeks ago you addressed this problem and I just read that again. It was somewhat comforting for me but still have it on my mind and just wondering if anybody else has some thoughts on it. Thanks for that post though. It was informative and helpful.

 

[kayow11]

I have another question for you all. What is the approximate amount of time that you guys kept taking your narcotic pain medication? I have been taking oxycodone, 5 mg, every four hours during the day and a missed dose during the night. It has been helpful, but now I am at four weeks today and I am hoping to try to start cutting down on it. I did half a pill every four hours today but it hasn't felt very good. Do any of you think it's probably too soon? I don't like the idea of staying on this for two or three more weeks.

 

[sistersinhim]

The time to cut back is when you start forgetting to take a pill. Some people do it at 2 weeks, so at 8 weeks. Each person is different. Listen to your knee. It'll tell you when to stop.