TKR TKR after tibial plateau fracture

clumsyknee

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hello I'm brand new here. Your post caught my eye because I also had an injury very similar to yours. I just got a tkr nearly 2wks ago. I hope you will get answers and some pain relief soon. Any updates?
 
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Ayse

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hello I'm brand new here. Your post caught my eye because I also had an injury very similar to yours. I just got a tkr nearly 2wks ago. I hope you will get answers and some pain relief soon. Any updates?
Hi @clumsyknee so sorry you had a similar accident! Was that the reason for your TKR? How are you doing? I just posted an update on the previous page. It's going to be a long recovery road for me and still not sure what I'll end up with due to some problems unable to be fixed.
 
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Ayse

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Having a massive pity party at the moment as I'm 7 weeks in and no furrher along than I was a few weeks ago. Still got lots of swelling that doesn't want to shift. Knee is always hot except when icing. I spend most of my day icing and elevating. Can only stand for 5 mins and walk for 5-10 mins a few times a day. The swelling is really interfering with flexion when walking and my knee cap movement. All I need to do is look at my knee and it swells more during the day! And still lots of soft tissue pain. At the moment it feels like some problems were fixed with the surgery, some weren't, and i have some new problems. I know it's still early days but feeling so down that things will never improve and I'll be stuck in the couch for another year like I've been for the last 15 months not being able to do anything except limp round the house.
 
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EalingGran

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Sorry to hear your troubles.
Do you think you could still be recovering from your recent flight?
I hope the swelling improves soon.
Some heat and swelling seems to be normal for months with even partial surgery like mine- so perhaps it is not totally surprising given the extent of your previous issues.
 
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Ayse

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Thank you @ealing. It could be. My surgeon did mention housemaids knee which I understand is bursitis so that may be some of the problem. I suspect I had it before the TKR although this is now worse. Icing isn't alleviating the pain unfortunately. Fingers crossed it calms down.
 

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When was your flight from the UK to Cyprus? In looking at your past posts, it appears you made that trip within the last few days. EalingGran‘s mention of that as a possible trigger for what you’re currently feeling is right on target. The flight was about 5 hours, plus you had a lot of stress on your knee with the packing, trip to the airport, getting through security and boarding your flight….plus all the same at the the other end of the flight. That’s a tremendous amount of activity for you, so I‘m not surprised that you would experience additional inflammation and swelling. Try not to get discouraged. You’re so early in your recovery and you’ve just endured a major setback with such a big trip. You’ll bounce back. Just listen and obey when your body says it needs more rest. Although you do need to be up and around each day, it’s okay for you to increase your activity levels very, very gradually.
 
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Ayse

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When was your flight from the UK to Cyprus? In looking at your past posts, it appears you made that trip within the last few days. EalingGran‘s mention of that as a possible trigger for what you’re currently feeling is right on target. The flight was about 5 hours, plus you had a lot of stress on your knee with the packing, trip to the airport, getting through security and boarding your flight….plus all the same at the the other end of the flight. That’s a tremendous amount of activity for you, so I‘m not surprised that you would experience additional inflammation and swelling. Try not to get discouraged. You’re so early in your recovery and you’ve just endured a major setback with such a big trip. You’ll bounce back. Just listen and obey when your body says it needs more rest. Although you do need to be up and around each day, it’s okay for you to increase your activity levels very, very gradually.
Thanks so much @Jamie I'm sure there was additional stress although I did have wheelchair assistance at the airport. It's worrying because when I try and increase the activity it just gets worse and I have to back off. Maybe this bursitis is holding me back and from what I've read that can take a long time to subside. I'm not doing any exercises anymore, just trying to walk a bit round the house. And of course icing and elevating most of the day.
 
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Ayse

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@Susie2023 I am a case in point. My surgeon wisely wrote a few exercises to do, the same as BoneSmart recommends. He said that the first two weeks were strictly for rest and healing. Just imagine if you crushed your leg in an accident. Would PT be trying to force that leg to do things? No. The leg has to heal before it can do much of anything.

My home PT kept trying to add more exercises and I took out my surgeon's instructions. NO other exercises. My surgeon had me at 0 extension on the or table and with my leg held straight in the hospital he said I did not have to put a towel under my ankles or work on extension. I told the home PT who came to evaluate and set up and he said, "Well, you may have been at 0 in the hospital, but I am sure that it is not now." He picked my leg up and bent it backwards and it HURT. I told him and the female PT he sent to never touch me again They fought the whole time to add exercises. I didn't let them.

It turned out unfortunately, that my incision got infected and bending would make it bleed, so I rested. For some reason, outpatient PT never called and I stayed home and took my antibiotics for three weeks. The infection went away and I did not need to go into the hospital for an IV drip.

When I went to my surgeon at three weeks, my bend was 90 degrees. At 7 weeks, it was 114 degrees. I barely did the exercises prescribed, just walked and did my daily life activities. I did not go to outpatient PT. Like BoneSmart says, your ROM is just there waiting for you. It does not need to be worked at, fought for. Those things make the injured leg more injured, and less likely to bend or stretch. Pushing yourself is counterproductive.

I have another complication, an inflammed bursa (bursitis) because I was so knock kneed and so much work needed to be done to straighten my leg that the muscles are different and irritating the bursa sack where three tendons join. I can't have a cortisone injection yet, but I am to rest it. I'm using a walker again to relieve weight. I'm not worried about losing my ROM. I am going to go to PT just to see about some exercises to help the muscles that are tight stretch a bit. If they hurt me, I am out of there. My surgeon and even the PT that I saw to set up the exercises for my muscles to help the bursa were amazed. No PT and you're at 114 and 0. As far as my doctor was concerned, I don't need PT for my replacement.

So, relax a little. Let your knee heal. Your bones were sawed, and a metal thing was hammered into your tibia bone. Plus everything was moved, cut and pushed around. How can it bend when so much trauma has happened. Forcing it with PT will slow your recovery. I see it every time. I had to wait three years for my TKR due to Covid and other family situations. The people hurting the most and with the worst bends are those that beat themselves up over the need to push themselves more. Let your husband know that the more you push, the longer it will take to get there. You will get there, but it will take more time, and more pain. And when you get there, PT will say it was all the hard work. You would get there anyway with less trouble.
@Softsong can I ask how long it took your bursitis to get better and did you do anything ither than rest ice and elevate? I'm suffering from the same and it's causing me a lot of pain and problem walking.
 

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Hello Ayse, stopping by at your two month post op point to say Hi and see how you're doing.
Are things improving at all for you? I certainly hope so. :fingersx: Please let us know as tine allows.
Wishing you all the best.
@Ayse
 
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Ayse

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Hello Ayse, stopping by at your two month post op point to say Hi and see how you're doing.
Are things improving at all for you? I certainly hope so. :fingersx: Please let us know as tine allows.
Wishing you all the best.
@Ayse
Hi @Layla thanks so much for checking in on me! I'm not doing too well.
Now that some of the swelling has gone down, the lateral side of my tibia does feel more stable, which is great, but it’s now apparent that the big problems with my patella being in the wrong place and the instability, pain, and difficulty walking that’s causing at the front hasn’t been improved by the TKR.

As before the TKR, my patella is still sitting too high (on the photos I’ve put my finger at the top and bottom of my patella on each knee as a comparison and it’s a good inch higher). It is very painful and unstable when standing and trying to walk on it and also sitting with knee bent. During weightbearing, my knee doesn’t bend properly or bend forwards and back in a straightish line, but instead bends inwards. It feels like my patella is rubbing/catching on my femur which is painfully restricting the bend, and I can feel/hear it clicking on something. It also gives way at the front a lot when walking and I can only walk around for 5 mins on a flat surface because of the pain and instability. It’s still very hard to even stand on my leg and often have to contract my quads to make it more stable and use a knee sleeve for a bit of support (a brace would be too painful at the moment). My patella also doesn’t move up and down properly when I walk and just stays high. Although this existed before the op, I didn’t have pain in my kneecap area but now I have increasing pain in front and behind my kneecap, along the medial and lateral side of it, and in the patella and quad tendon. It’s very hard to put weight on my knee while trying to bend it. You might remember the lump I was worried about that ran along the medial side of the incision and up over the quad tendon, that is still really painful at the quad tendon and next to it is now an indentation. My knee is still permanently hot except when I’m icing and elevating ten times a day. I can bend/straighten my knee well when sitting and lying, although it is painful and still doesn’t bend/straighten in a straight line, but when standing I or lying on my stomach doing a hamstring curl I can only bend it about 40 degrees because of the restriction in movement at my patella. When I stand and contract and relax my quads I can feel/hear my kneecap clicking on something. When I sit with bent knee my patella is pressing painfully on my femur.

When lying down and I do a patella mobilisation my patella is floating and hypermobile. When weightbearing, below my patella in the centre there is a painful thick ridge of the fatty pad of soft tissue that feels like it is sticking underneath my patella. Below the lateral side, the big deformed part of the tibia that sticks out pushes up soft tissue into the lateral bottom edge of my patella. On the medial side the enlarged tibia also feels like it’s making something painful stick into the joint. It seems like where the tibia is enlarged from the trauma it sticks out further and wider than my other leg, pushing the soft tissue up and out. Although my knee is still swollen, there is no fluid/soft tissue swelling at the top of the tibia now from the op so on the photos and video the enlargement in that area you can see is hard bone.

If it wasn’t for this problem I think I would be walking reasonably well by now, considering, but even though it’s only been two months since the op I’m concerned that because these issues were there since the accident and isn’t a normal part of the healing from a TKR that the problem isn’t going to improve on its own with time. Also that I still won’t be able to rehab my knee properly with swimming, cycling, etc, because as before the op, anything that repeatedly bends my knee is very difficult and very painful, which will only increase the pain and swelling and may cause more damage to the ligaments and tendons around my knee. When I try and do some rotations on the recumbent bike for example I can feel my patella catching painfully. I don’t see how there can be any improvement in my problems with my patella in the wrong place like this, so I really want to know if there is anything I can do to fix the maltracking, high riding patella, and instability because I don’t want to give up hope. I understand that there are methods for this, such as repair of MFPL lateral release, and moving patella tendon on the tibia but if my patella is restricted by the deformity below it I don’t know if this would be a future option given the anatomy of my tibia with increased bone size.

I'm going to try and speak to OS to see if there's anything that can be done, but he said before the op they couldn't do anything about the enlarged bone area because it's where tendons and ligaments attach. Feeling very broken right now.
 

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Jaycey

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I would definitely have a long discussion with your surgeon. If he doesn't want to do anything for you please ask him for a recommendation for someone who can help you. So sorry you are dealing with all this!
 
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Ayse

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I would definitely have a long discussion with your surgeon. If he doesn't want to do anything for you please ask him for a recommendation for someone who can help you. So sorry you are dealing with all this!
Thanks so much Jaycey. I will do.
 

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I am so sorry that your patella is not properly in position and it is causing you so much pain. You definitely need a long chat with your surgeon and possibly a second opinion before deciding what to do next.
Do keep us posted on how things go.
Hope things get sorted and you get a more positive outcome.
 

sistersinhim

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If it was my knee, I'd seek out a second opinion. Your surgeon already had a chance and it looks and sounds like he has messed up. I would not want to give him a chance to mess up a second time. In the meantime, I'd try to not do anything to upset your knee any more than it already is.
 
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Ayse

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I am so sorry that your patella is not properly in position and it is causing you so much pain. You definitely need a long chat with your surgeon and possibly a second opinion before deciding what to do next.
Do keep us posted on how things go.
Hope things get sorted and you get a more positive outcome.
Thanks so much @EalingGran . I will indeed.
 
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Ayse

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If it was my knee, I'd seek out a second opinion. Your surgeon already had a chance and it looks and sounds like he has messed up. I would not want to give him a chance to mess up a second time. In the meantime, I'd try to not do anything to upset your knee any more than it already is.
Thank you @sistersinhim Yes, I reslly don't know what can be done due to the deformity I have now but I will have to get a second opinion if I don't have a hopeful answer when I speak with him.
 
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Ayse

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@sistersinhim I'm wondering if I may have to have something drastic like a patellaectomy to solve some of my problem due to the deformity around my knee. I know you had this a long time ago and was wondering if you could share your experience of recovery and impacts it's had. Do you have limitations in movement and function and is your knee more unstable etc? Any advice much appreciated xx
 

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If you end up having to come to London for a second opinion then I would strongly recommend my surgeon- Alex Liddle.
He is a senior lecturer at Imperial College and has done a lot of research on implants and the causes of failure/ need for revision.
He also did an amazing job of straightening my very crooked ( over 20 degrees valgus) knee and matching it with my good leg. He has a great manner and explains things well. Also he has seen a couple of my friends and doesn't always rush to surgery.
He is NHS at Charing X and private at Charing X and King Edward VII.
 

sistersinhim

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I had my patellactomies in 1991 and 1993. I'm sure things have improved tremendously since then and I know that now doctors don't like to do them now, but if your doctor suggests that, you will be fine without your kneecap. The main drawback is that your leg will be weaker than a normal knee, but with what you are going through now, yours is already weaker.

Back then one of my doctors cut and shortened the patella tendon, and the other doctor wired the second knee's tendon up so it would grow together shorter. I was put into an immobilizer on each leg for about 6 weeks to allow the tendons to heal. The recovery was very similar to a TKR pain-wise, though not nearly as long.

My TKR was actually simpler because my doctor didn't have to bother with tracking the kneecap, but he did have to do a medial release so my leg would bend correctly. This created pain in that area for many months, which is normal after a release.

I still suggest you see another doctor, one that has no contact with your current doctor and will look at your knee with new eyes!

If you have any other questions please feel free to ask them. I will be on and off this site all day and will get back to you.
 

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Hello Ayse,
I am so sorry you’re having such a difficult time. Regretfully I have no advice, but will follow your thread with interest in support of you. I hope you know we’re always available to lend an ear and offer encouragement along the way. With any luck some of your questions will be answered through the collective opinions / advice received here.
Hugs and best wishes for your comfort and healing. :prayer::console2:
@Ayse
 

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