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[TKR] TKR in 2014 and now fractured femur

Discussion in 'Knee Replacement Recovery Area' started by jenng2003, Jan 28, 2018.

  1. jenng2003

    jenng2003 member
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    I broke my femur above my knee replacement in a fall two weeks ago. I go back to the surgeon tomorrow to determine the healing. I had emergency surgery where they put a rod in my femur through the tkr implant with screws. What’s the rehab like? I had a horrible time with the tkr. I have been immobilized for the last two weeks. Thanks.
     
  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @jenng2003 So sorry to hear about your fall! Please update us after you seen your surgeon. Meanwhile I'm going to tag our medical expert @Josephine to give you input on healing your broken femur.
     
  3. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    As with any broken bone, I assume you'll do nothing until that bone is healed, which is at least 6-8 weeks. Are you non-weight bearing?
     
  4. jenng2003

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    No. I am weight bearing as tolerated with a walker or crutches (I choose walker to be more steady). I have a rod in there to hold it together. I am not weight-bearing unless the step is with the walker. I am walking to the bathroom and back and to the kitchen and back.

    There’s nothing crazy going on. Today’s grocery shopping adventure involved a wheelchair. I cannot walk more than 20-30 feet with the walker.

    Surgeon said it’s aligned and healing, but it still is very fresh. No hard PT or walking without the immobilizer for 6 more weeks. I will work on bending without weight bearing as tolerated. No pain allowed he said.

    The x-rays before surgery on the 12th showed a break but I was in too much pain for better X-rays. It wasn’t even controlled by Fentanyl. The dr discovered it was a spiral fracture. It does explain the location of discomfort I have on my thigh.
     
  5. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Was your femur break on Jan. 12th? It needs to be added to your signature.
    What an awful thing to have happen to you, especially so soon after your tkr!
     
  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    The doctor should have known that when he operated on it! Spiral fractures are actually much easier to fix than straght across ones. Did he put in any transverse screws, similar to one of these?

    1 IMF-horz.jpg
     
  7. jenng2003

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    Yes! He knew it was a spiral fracture. I did not know it was. I was taken to the ER. Dr Cranky Pants came in and said I broke my femur and showed me the X-ray. He said his partner would do the surgery the next morning since he was tired and only the “C team” was working that night. Now, I understand he was tired and had a long day, but the snarky comments weren’t well received by someone who is writhing in pain for 6 hours at this point without relief. Now, OS came in around 7 am the next morning and explained everything and said he was confident the TKR has a hole for the rod. He did the surgery around 8 am. I was walking to the bathroom by 11:30 am (with a walker and nurse). I have two screws like 4 up top and one above the replacement like 1. It’s a big screw on the bottom. I do have some concerns about a bone scan I had on this knee in Aug due to pain. A different surgeon told me everything was fine. I just saw the report today and found out otherwise. There appeared to be some sort of inflammation on the femoral condyles. I have a call into my current surgeon who just did this surgery to see his thoughts since the other surgeon who did the actual tkr in 2014 doesn’t seem to care to figure it out. I was wondering if the PVNS or even if undiagnosed lupus could be the cause of that inflammation, but I haven’t heard back yet from the new OS. I just discovered this so I know he would need time to look it over.
     
  8. jenng2003

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    OS said he saw the bone scans, but did not see any signs of loosening even after that hard fall. I’m wondering if the bone scan images from
    aug were reflecting some autoimmune issue (left over PVNS since my knee cap is still all bone or maybe lupus—I’m almost 100% certain I have some form of it, but I cannot get a rheum to take me seriously). One would think the fall I had, would have really loosened the implant. Unfortunately, he did not see a bone scan until after surgery, so now we wait and see how this recovery goes. I am so frustrated right now. I am up most of the night in pain and nothing seems to help it. My hip flexors are screaming. The immobilizer makes it all worse. I will not be going back to my original OS who did the tkr. I am so angry he lied to me about the bone scan. This is the second lie I’ve caught him in. Done.
     
  9. Gel-girl

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    Oh boy you’ve been through the wars. Puts my pain into perspective when I read your last two comments. I had a lovely OS but the one I had for keyhole 5 years ago was arrogant- could have swiped him one! Hope your sorted soon pain wise. Really feeling for you.
     
  10. GingerP

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    @jenng2003 I am so sorry for your pain and situation with your leg. How horrible to have fallen. That is still one thing I always will worry about.
    Bless you in your recovery. Hoping you do get some answers on your leg. Plus, I think there are more than enough of us with a surgeon we really don't want to remember in our life, me included.
     
  11. jenng2003

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    @GingerP I really loved my OS until recently. He had a death in his family and his demeanor has changed.

    As for the femur fracture, it has started to heal, but it’ll be awhile until it heals completely. I also have a flexion of about 55 degrees for the last month. There’s hard tissue/fluid build up. Manipulation will not be performed due to femur fracture. If it doesn’t settle, he will go in and clean it up and then do intensive PT for awhile. I’m in PT now and we are seeing if it will help, but I know my body and I know it will be very difficult to get maximum range at this point without a clean out.
     
  12. GingerP

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    @jenng2003 , if there is one thing I have learned, we know our body best and even though we have an idea that there are people out there that should know how to help us best, advocate for yourself! Keep asking questions, be persistent. Eventually someone will HEAR you! There came a time in my wound vac process that the dr sent me to a plastic surgeon to "fix" the hole they didn't think was going to heal. It had come a long way from the process and here they were going to take a part of my calf muscle and sew it to my knee....not only did it 'sound' silly to me, I was not about to undergo another surgery that seemed like it would make my situation worse. At that point I was instructed to have an intense test to be certain I didn't have infection in my tkr which proved I was clean. I could have told them so without it. I think the wound dr was frustrated with the hole healing and started grasping at straws.
    It was at about that time I started meeting with my new OS. He said to be patient, it will heal, and stop prodding and it did heal up. Took a few more months, but sometimes less is more.
    You are in a different situation here, but I would suggest to keep asking. Sometimes I ask my general internal medicine dr questions and get better results for anow answer and have been referred to people who know better what tests I need. There has to be someone who can help eleviate your concerns.
    I pray you get some relief and understanding. You are young and need some answers so you can heal, both physically and emotionally. Sending you my love!
     
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  13. jenng2003

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    So I saw the OS again. This is WC, so I don’t have a choice yet as to my own provider. I think I have arthrofibrosis of the knee. Dr offered manipulation to which I asked if he was nuts since I broke my femur. He said it wouldn’t be ideal but our only option down the road if the stiffness continues. I’ve researched. It’s not my only option. I am not sure what to do at this point though.

    He told me I was crazy to suggest arthroscopic procedure to clear out the scar tissue. I also have the PVNS diagnosis from my TKR in 2014. He said if I get to 100-110 degrees flexion that’s fine. I was like heck no! I was doing so well before the femur fracture. I had over 120 degrees and doing cross fit stuff and other workouts daily.
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Good for you! I also think it highly unlikely that you have this. It's much more likely to just be plain ol' stiffness since the accident.
    We have an article on that PVNS: Pigmented villonodular synovitis
     
  15. jenng2003

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    @Josephine there’s a hard lump/area on the lateral/front side of my left knee. It isn’t swelling. It doesn’t really move. The shoulder surgeon who did the femur surgery says it’s hard scar tissue. It is impeding movement (not to mention it is so ugly to look at).

    With the PVNS (which wasn’t ever addressed) being found after my TKR in a bone biopsy, I couldn’t get my knee OS to take it seriously. Now I have this lump of hard tissue that won’t move (and I’ve tried massage and PT does mods as well).

    It just seems like no one knows anything. I flipped when he suggested a manipulation. Seriously! I have one of the worst femoral breaks he’s ever seen and he wants to force my leg to bend under anesthesia!?! I asked him if he was crazy.

    I just feel like that won’t solve the problem. The problem is there’s something hard in there that’s not breaking apart. I have some sort of auto-immune disease as well. They have me diagnosed as fibromyalgia, but I firmly believe it’s something more. I feel with my symptoms and test results, it points towards lupus. I am so tired of fighting the drs to get quality care.
     
  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    It could be genuine scar tissue, meaning NOT adhesions which is a different animal altogether.
    How about posting a picture of it for me?
    If it's real, genuine scar tissue that could very well be the case. But don't confuse that with adhesions which are what MUAs are performed for.
    I believe PVNS is an auto-immune disease.
    What does this mean?
     
  17. jenng2003

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    PT does patella modalities. They move my knee cap up and down and side to side. I am thankful to have a very gentle PT. They both believe in giving time to allow healing. They didn’t necessarily agree with the dr leaving me immobilized for so long with my history (I was immobilized up to March 29th). Especially with my history of scarring issues and the PVNS. PT has been massaging the area.

    The lead PT isn’t so sure it’s only scar tissue since it hasn’t changed at all. I will take a photo later tonight after the TROM brace is off for the night. I definitely have scar tissue issues with the incision on the front of my thigh. It’s still indented in when my quad contracts (although it has gotten less attached in the last two months).
     
  18. jenng2003

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    It’s hard to see and I couldn’t send the one I marked up because the file was too large.

    On the left side of the photo there’s a small white scar (that’s a very old one from about 15 years ago). You can see the lump the best right around that little white scar. It extends up towards my thigh but at a diagonal (out towards the lateral side). It is hard. It doesn’t move at all.

    It’s right next to my knee cap at one spot (but not attached to it). That area hurts when they slide my knee cap laterally to keep it moving. It’s a breath taking pain.

    jenng.jpeg
     
  19. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Have I marked it correctly? Because in that case, it's very possibly a simple bursa that is inflamed and so full of fluid it feels solid. I know the bursa I've pointed to is not in the exact same position but the human body is not exact and structures do vary, sometimes quite considerably.

    I think you should stop her massaging it and moving it because it will be irritating the bursa and making it worse.

    knee bursae 2.JPG
     
  20. Celle

    Celle FORUM ADVISOR Forum Advisor

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    That's the place where I had the greatest, and most persistent swelling when I had both of my knees replaced. It did settle down, eventually. I did nothing to it, except to elevate and ice.

    Since moving your kneecap seems to increase your pain there, I think you should ask your therapist not to do that.
    Moving the kneecap to mobilise it isn't necessary anyway. As your knee heals, your kneecap should automatically become more mobile, without any external help.
     

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