TKR TKR #2 --Left Knee -- (August 5 2015)

[PeterL]

@metalheart - much appreciated. I'm nowhere near as proactive as perhaps I should be when it comes to formal exercise but there again I have been discharged from the local hospital PT knee class as having reached the stage that they are more than happy with my progress - still waiting for a date for the second TKR and have an open invitation to return to the Knee Class. Unfortunately one of the reasons I'm less active is the need for that second one, all a bit Catch-22 and very frustrating. Still, the appointment is next Wednesday so here's hoping I do get the date I'm looking for.

The intention, of course, having had the second op, is to push myself. There are lots of good reasons: being able to walk the dogs and generally enjoy what was a fairly active life and lose a bit of weight of course, never a bad thing.

 

[analysta]

@metalheart - I hope you continue to post here and not "move on." There is a lot of recovery story left in you that I could benefit from. As you said, there are many recovery modalities and all of them could use support and would benefit from sharing.

 

[Wanttobebiking]

Metalheart, I will miss your camaraderie and positive recovery stories. But I understand. We all have to move on at some point. And it is not like this is your first rodeo.

Your comments have been very helpful to me. Perhaps you want to be active in the Cycling Club for Us thread?

Thanks and best of luck.

 

[PeterL]

Well I had the follow-up and the go ahead for the left-knee. The letter has duly arrived and whilst there is a 12 week 'guarantee' with the NHS (30th December in my case) it has been pointed out that the hospital regularly don't meet it. Should I refuse the offer whenever it comes that will put me back to the end of the queue. Pity my Insurance has lapsed. Still on the positive side at least I know it will happen and hopefully back on my feet (both legs) well before Easter next year.

Even more positive the right knee is just fine, if not yet perfect, still a bit of pain there.

 

[metalheart]

I haven't stopped in for awhile, so it seems time for an update just to keep this knee in synch with TKR#1. I had my three month doctor visit: full leg X-Ray followed by an exam by the doc's PT, then the Doc goes over everything. I came in with concerns that ROM was not as the same as the first TKR, I have experienced more swelling, and more stiffness with this second TKR. The PT measured my ROM as 0-124 for the recent knee and 135 (!!!) for my right knee (TKR#! January 2015). The Doc and PT were especially pleased with extension, but then I have worked consistently on that. I was not sure about the first flexion measurement, so I asked for a repeat and it went from 122 for the first measurement to 124 for the second, so seems close enough and I will take the higher number!

The doc said not to worry about the swelling and stiffness, just to address it when it occurs. His advice was to let swelling be the guide to cut back on type or intensity of activity causing the swelling. Then we went on to talk about our mutual cycling interests and activities.

I was pleasantly surprised by the ROM numbers since my subjective assessment has been that flexion was less than TKR1 at the same point in recovery, but I was wrong. So, at this point I go on with the activities of daily life and continue to use cycling as the path to ongoing recovery for me. It has worked well for my right knee and unless something unusual happens, it should help the left. Otherwise, I am focusing on rebuildling lost/atrophied muscles and getting on with life.

One last thought: recovery from this surgery is a long process and I have been as impatient as anyone here. It gets frustrating, depressing, infuriating, and it gets old and tiresome after months of being compromised. But, we get over it and get back to life, some faster than others, but the slog of recovery is just part of this process, or at least it has been for me.

 

[Wanttobebiking]

Hi there! Sounds like you are doing well but I understand the concern and frustration. I still cannot go downstairs normally without pain. I put myself back in PT to work on it and while I know intellectually that I am doing great, I will not feel okay emotionally until I conquer this last obstacle. I do think we lose a lot of muscle mass in the first 6 weeks or so of revovery and it takes time and commitment to build it back up.

Congrats on your ROM and your good 3-month check-up!

 

[PeterL]

@metalheart - good to see your post and in many ways to note that there was a real difference in the post-op journey between operations - more swelling and no doubt bruising? I'm hoping the same for me, but in reverse as my leg really was black and blue way back in July and indeed even now a little tender at times albeit working well. My next operation is now scheduled for the 17th December, just in time for Christmas and I'm certainly both ready and prepared for it - almost looking forward to it! It really does help to have your thoughts so clearly expressed, I never did think it would be plain sailing but like you say there is always a level of impatience to counter any realistic ambitions we might have.

 

[metalheart]

Wantotbebiking: I think we all have recovery benchmarks and going down stairs is a big one. Fortunately, I can do that most of the time, but I do get lazy and one-leg it until, but then remember that I can do it and need to do it for continuing recovery. The benchmark I have yet to achieve is being able to play chase with my dog. My left knee is not there yet. And, the loss of muscle mass has been substantial for me and it was with the first TKR. It took from January to August to get close to recovering what I lost for the first TKR and now I have to do that again, but it will happen and it is just work to get there. While I am happy with the ROM in my right knee, the 124 in the left is a variable: some days it is much less and other days it is better, so it takes ongoing work, again very different than the first knee. Keep up the good work in your recovery, you have the attitude to sail through this despite the tough times!

Peter: I have definitely had more swelling with TKR2, but I never had any bruising with either surgery. I am not sure about the explanation for that other than I had a drain installed post-surgery, but I thought that standard for these surgeries? I don't regret having the surgeries relatively close together. The advantage is knowing what to expect that reduced anxiety and helped me to form a plan for the second recovery: lessons learned type thing. I am sure you will find you can apply the experience of your first to your second to make the process easier, of course knowing that things can and no doubt will be different. However, the best thing about having the second is that you will be DONE: even though I am stiff and my knee is present everyday, I know that in the relatively near future it will fade into the background like my first and the days of thinking about my knee, for the most part, will be history. That is the thought that keeps me happy and I hope you have a similar experience. Please keep us posted about how things go.

Below is a picture of the drain inserted just after surgery (I am not sure this has any substantial affect on post-surgery bruising). There was a machine that reinfused the blood and it was on for a relatively short time. When they removed the drain it was among the most uncomfortable of hospital experiences. Are these types of drains used in the UK?

 

[KarriB]

I agree @metalheart , pulling the drain was probably the most painful experience after the surgery in the hospital. Worse than any PT. My drain was above the knee, on the lower outside of my thigh. The PA came in, said he was taking the drain out, I should take a deep a breathe, then he pulled it out. I decided he wanted me to take a deep breathe so I wouldn't scream. When I could breathe again, I told the PA he was lucky I couldn't move my leg, because I if I could I would've kicked him.

After my infection surgery, I had TWO drains and every time the nurses told me the drains would be pulled out my BP sky rocketed! This went on for several days, eventually the drains just fell out in their own with now pain at all. Whew, I was happy about that.

 

[PeterL]

Metal heart: certainly didn't see anything like that on my Ward albeit the connection was there over night. Might well be that on seeing the anaesthetist the next day I said that the pain levels were OK with me... not a good move I suspect as it certainly got a whole worse for the next week or so. I do know that he was trying a new method albeit I didn't pay as much attention to it as perhaps I should have - I probably gave him the answer he wanted to hear so that was the end of any direct pain relief. My bruising really was quite bad but its gone now for sure. Yes, the thought of having both done and dusted is indeed comforting - there's just so much more I want, and expect to do come Easter next year. Just being able to walk the dogs any distance will be a great start! As for painful, removing the plaster (Bandaid) from over the super-glued wound was fairly telling...

 

[Wanttobebiking]

I had a drain too, but it was small. I must have been very drugged up when they removed it because I barely remember it. I also had virtually no bruising.

Thanks for the vote of confidence Metalheart. I am quite worried about the stairs still and would not be happy to live with that pain.

 

[analysta]

metalheart and Wanttobebiking, I was reassured somewhat by your posts about going downstairs, as I was wondering about that this morning. It's still not easy for me although I can force myself to do it right. I've been trying going downstairs in slow motion (to make the muscles work more, as in step exercises) and it's never fun. So that makes three us from from the same time period who are at about the same place with this particular ADL. Must be normal!

 

[metalheart]

Maybe he drains do have something to do with bruising. I am always surprised when I see images here with large amounts of bruising and I am curious why that did not happen with either of my surgeries. But, the drain removal is forever in my memory, more the first one than the second. The first one, the nurse just slowly pulled it out and I swear it was 2 feet long and the more he pulled the worse the pain until I was about ready to grab the drain from him. The second I told the nurse about my first experience and maybe she should be prepared for me to jump off the bed, but she did a relatively quick withdrawal of it and although it was uncomfortable it was nothing like the first. War stories!

Analysta: I hope you are doing well and it is nice to hear from you! Going down stairs is still one of those things that I do not do without thinking about it. The outside of my knee near the knee cap stiffens and impedes a completely smooth step down, but I can do it. I have started doing stretches that seem to make the whole knee feel a bit better, especially when I go down stairs. It is the one where you stand with your back to a stool/chair etc... and place your foot atop the stool and then step forward and it is a deep hamstring stretch. It looks something the like image below only, I do it standing. Anyway, it is a process and these days my focus is on functional recovery by keeping active doing the things I need to do in life and supplementing that with some strength exercises and stretching. There is still healing to do!

 

[KarriB]

How do you get up from that position???
I had no bruising either and had a drain. My dad was totally purple and had no drain, so there must be some connection.

 

[metalheart]

How do you get up from that position???
I had no bruising either and had a drain. My dad was totally purple and had no drain, so there must be some connection.

If I used the stretch in the image and I had to get up, I would call 911 . Here is how I do the stretch:

1: place stool behind me with a counter or wall in front.
2. I face the stool then turn around and place my foot on the stool so I am facing away from it.
3. using the wall or counter for balance, I then lean forward with the non-surgery leg much like a lunge position
4. push back up with the non surgery leg after holding the stretch for a count of 10
5. I do that till I am bored or my hamstrings tell me to stop.

So you can see this is less aggressive than the stretch in the image, but I could not find an image of the stretch I am doing. At this point, I approach most exercise/stretch work in terms of what functional deficit is giving me a problem. This one helps me with going down stairs.

I hope that helps!

 

[PeterL]

I've been OK with going up and downstairs, as long as I can see where I'm going clearly. With the nights drawing in I have absolutely no confidence at all and hang on to the rail and move very carefully one step at a time. Yet to try walking on an icy pavement...

I will certainly pay attention the the 'drain' this next time and probably ask the questions on admission, it would be good not to have the bruising this time around.

 

[KarriB]

After a month or so I just stretched on the stairs. Putting my TKR on a higher step and stretching down. My pt was so non-aggressive after the 2nd surgery, sometimes I would lay on the pt table with my TKR hanging over the side. I loved it because I didn't have anything like that at home.

 

[Wanttobebiking]

I just tried your stretch on both legs and could tell that the TKR leg was substantially weaker than my other leg. I am looking forward to strengthening my surgical knee and leg through rejoining PT. I thought I could strengthen it through normal activity, biking, walking, and swimming but that isn't working for me.

 

[metalheart]

Peter: I did a quick search about drains and bruising and apparently the use of drains in general and reinfusion drains in particular is controversial. The quick search also did not find much information about the relationship between bruising and drains, but I did find some oblique comments suggesting there is less bruising with the use of drains. But, it would seem worth asking your doc about it just in case. I would guess there are various sources of bruising, for example, things such as if the surgeon has to grip the leg firmly, as well as just susceptibility to bruising that may contribute to post-surgerical bruises. Anyway, I hope you continue to make progress with going down stairs, eventually it works out, but it seems to be one of the things that takes longer in recovery.

Kerri: My PTs for the second TKR have been very gentle and attentive to any discomfort. And, I know what you mean about being able to just hang the leg over the table and let it swing back and forth: that feels soooooo good. I hope you continue to do well in your recovery.

Wanttobebiking: I am in the same boat as you about rebuilding. Cycling and other activities of daily life only do so much to recover strength. After my first TKR I went back to the gym early and started doing strength training to supplement cycling and I believe that made a big difference. I have only done a bit of that with this second surgery and I can tell I am not as strong. I have just been lazy and lots of chores have built up that need attention and I get tired and find excuses not to hit the gym. .... I like the stool stretch, it just makes my hammy feel better after I do, much more so than the other stretch I have been doing where I lay on my stomach and put a band around my ankle and pull and hold for 20 seconds. For some reason I feel I get more out of the stool stretch, but then that could just be me! On a side note, since my left leg is now a bit longer than before surgery -- I had a fair amount of varus (see before pic below) -- I have raised my seat to the point I need a new seatpost to have enough tube in the frame. One of those unexpected costs of surgery!

 

[Slainte]

I did not have drains and had no bruising with the first knee and very little with the second.