BoneSmart® Hip / Knee Replacement Forum
Joint Replacement Patient Advocacy
and Online Community

[REVISION TKR] TKR in 2014 and now fractured femur

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

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    77
    Messages:
    80,891
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Quite so, Celle. Well said.
     
  2. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    Those arrows are the start. It continues down and left of the arrows (when looking at the picture).

    We’ve been icing since the day of surgery almost constantly. It’s hard and doesn’t move. It impedes ROM. It has stayed about the same size for the last 6-8 weeks. It will not get smaller.

    I was immobilized for over 2 months after the femur surgery. I was limited weight bearing for most of that as well.

    This isn’t a recovery for a TKR. Waiting any longer at this point to try to gain some flexion is not recommended. The knee was done back in 2014.

    This is also a workers comp case so there is not much control I have in the treatment. It has been 13 weeks already. PT has been non-weight-bearing and gentle this entire time.

    PT is concerned since I have PVNS that wasn’t ever addressed properly. Before this fall, I was looking for a specialist to see what should’ve been done to address that issue. The spiral fracture of the femur was the injury this time...not the knee.

    I know there was some shock and trauma to the knee but it has been over 3 months at this point and I have 70 degrees of ROM (and I’ve been stuck at this ROM for almost a month).
     
  3. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    77
    Messages:
    80,891
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Well I still think it's a chronically inflamed bursa.
    You say "ROM" but you've only mentioned flexion. ROM (range of movement) is both flexion AND extension. So would you be kind enough to tell me what your extension is?

    Just asking this, not being antsy!
    I know all this - why are you telling me it all again?
     
  4. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    The last quote you replied to was for Celle, not you. I have 0 extension as I’ve had for almost the whole time (positive I guess to being immobilized for so long). I struggle to get full extension during PT when I bend (even 45 degrees to 0 becomes incredibly stiff and difficult). What would they do for chronic inflamed bursa? How would it be diagnosed?
     
  5. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    I cannot have cortisone shots due to a bad reaction both pre and post tkr. My knee became inflamed and swollen and extremely painful for months after the injection. I also had a poor reaction to Synvisc before the tkr as well. It was so bad that the dr said no more ever.
     
  6. Celle

    Celle FORUM ADVISOR Forum Advisor

    Member Since:
    Nov 19, 2011
    Age:
    77
    Messages:
    29,488
    Gender:
    Female
    Location:
    New Zealand
    Country:
    New Zealand New Zealand
    All the staff read posts and respond to them.
    What I said about mobilising the kneecap still applies - it isn't necessary.
    A spiral fracture of the femur is major trauma and it will take a long time for complete recovery - just like recovering from a knee replacement.

    It's a fact of life that almost nothing in orthopaedics happens fast. You need to take the long-term view ( and a bucket-load of patience :heehee: ) and wait for nature to do its job of healing.

    I'm not surprised that, at this stage, ROM is still difficult. I guess that your knee was also impacted by the accident and then by the surgery. What happens in one place in your leg is going to have an impact on the rest of your leg as well.

    There's not a lot you can do for an inflamed bursa, except wait for it to settle down again. Certainly, having injections wouldn't be the right thing to do, and I don't think that massage and manipulation will help either. Ask your therapist to leave it alone. Just treat the pain.
     
  7. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    77
    Messages:
    80,891
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Oh - sorry!
    It's diagnosed mostly by the surgeon using his intimate knowledge of anatomy, just like I did! And the treatment would usually be a cortisone shot which you can't have, or just a regimen of Tylenol 1,000mg 4 times a day and ibuprofen 200mgs three times a day. And rest, of course.

    In extreme cases, the surgeon might consider excising it if it's got very hard but that's unusual.
     
  8. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    @Josephine So I’m now 6 mos post op from my femur repair.

    Dr suggested a manipulation because my ROM is 90 on my own and 95/100 with some pushing. The amount of swelling and hard spots is frustrating. That lump next to the knee is bigger. I also have nerve damage/entrapment between the popliteal and peroneal nerve as evidenced by an EMG. Foot drop, inverted food, and no dorsi-flexion is present. The nerve symptoms have gotten worse, not better (started with foot drop, then toe dors-iflexion, then inversion and now foot dorsi-flexion).

    The nerve pain is just horrible. I don’t sleep much. Because of the increasing symptoms of nerve issues, surgeon is sending me to UPenn to see a trauma ortho. I have an appointment on the 24th of this month. I’m assuming the trauma Dr will do an MRI.

    The other surgeon didn’t want to because he said it wouldn’t show much. Of course you can see part of the shadowing of the large lump on the X-rays. The lump does improve a little with massage therapy, so the Dr has labeled the knee as a case of fibrosis. Of course he said he’d never seen anything like this lump (and checked labs for infection just in case he missed something). Between the nerve issues and the lumps of adhesions (that’s not the only spot of scar tissue) the flexion is definitely impacted.

    I did refuse manipulation unless I was given an MRI to see where the nerves are hung up (I am afraid he could do more damage to them) and he agreed manipulation isn’t a good choice for now.

    There’s also a possibility of femur fracture. I told him I’m not starting this again. LOL.
     
    Last edited: Jul 12, 2018
  9. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

    Member Since:
    Oct 31, 2016
    Age:
    65
    Messages:
    6,176
    Gender:
    Female
    Location:
    Philadelphia
    Country:
    United States United States
    When you mentioned a MUA I too thought about the possibility of femur fracture, given your history (and it's a risk of MUA in any person). You're wise to seek out a specialist in joint injuries. The University of Pennsylvania is first-rate. I'm sorry you're having so much nerve pain along with the bad consequences that go with the damage! I wish there was something doctors could do to give you relief.
     
    • Agree Agree x 1
  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    77
    Messages:
    80,891
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    It's actually a REMOTE risk. In my entire career, while I've helped out at scores of MUAs, I have never seen even ONE fracture resulting. I also never knew a surgeon who would do an MUA on a knee that was already at 90 degrees of flexion. 85 hmmm, well maybe but never 90.
     
  11. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

    Member Since:
    Oct 31, 2016
    Age:
    65
    Messages:
    6,176
    Gender:
    Female
    Location:
    Philadelphia
    Country:
    United States United States
    My OS mentioned it as a risk, but it was probably in the same context as death being a risk of aspirin. Very rare but mentioned just in case. We were just talking about MUA in general, because I brought it up, not because I needed one. He too said he would not do an MUA on someone with a flexion of 90.
     
  12. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    The reason it was considered is due to all the scar tissue in there. It has been 6 months and I cannot sit in a chair without being uncomfortable. I am exploring my options. I anted to go to Cincinnati but I was sent closer to home first. It’s arthofibrosis. It needs to be removed for any more range to be experienced. The ortho is sending me to UPenn because he thinks the nerves are stuck in the fibrosis and it needs to be evaluated carefully. I’m barely at 90 degrees on my own and I’ve beem there for two months now. Something needs to be done since I am in so much pain. I cannot work, and because this happened at work, there’s no short term disability benefits. workers comp provides some relief but not my full amount I made after taxes. And I now pay benefits out of pocket.
     
    • Friendly Friendly x 1
  13. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    Saw a trauma surgeon at UPenn. My TKR is loose from the fall. How two drs missed this, I have no idea. Surgery to decompress the peroneal nerve and then revision in 6-9 mos. so frustrated right now.
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    77
    Messages:
    80,891
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Oh what a shame! I really, really feel for you!

    However, I have to say this - it would be the first time I've ever known a knee made loose because of a fall or it would have had to have been a mighty calamitous fall to do it!

    It makes me think of all the times years ago when elderly folk would 'fall and break their hip' requiring a hip pinning. But the truth of it was that they had osteoporosis and so because the bone gave way between one step and the next, what actually happened was that they broke their hip and fell ! It would be much the same with your knee. I strongly suspect that your knee replacement was already loose and that's what made you be unsteady and fall! Ring any bells?

    Not that it makes much difference now but I thought you'd like to know this.
     
  15. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    I hit the knee replacement on a metal step/old tile floor after flying across the lobby, landing on the third step with me leg stuck on the landing (the floor was wet without any notice and it wasn’t an exterior door where one would think it would be wet and it was nice outside). I heard it clink as I landed. I felt the vibration through my thigh. It was a horrible fall. It wasnt a normal little fall. It’s on video and it’s still painful to watch. Haha. I was steady before this fall. I was doing cross fit and plyometrics without any pain. This was a total freak accident. My fault was not going to a trauma specialist from the start and having a regular ortho perform the ORIF surgery (not that one thinks so well when in such a painful emergent situation. Haha
     
  16. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

    Member Since:
    Oct 31, 2016
    Age:
    65
    Messages:
    6,176
    Gender:
    Female
    Location:
    Philadelphia
    Country:
    United States United States
    How awful that your implant was damaged. That’s really rare. It explains a lot about why you’re in so much pain, though. I hope your nerve decompression goes well and you can go on to an uncomplicated revision.

    We all can think of things we could have/should have/would have done in retrospect, but there’s no way to really know how that would have gone. Forward. You are doing the best possible treatment for where you are now.
     
  17. jenng2003

    jenng2003 member
    Thread Starter

    Member Since:
    Oct 4, 2014
    Age:
    34
    Messages:
    160
    Gender:
    Female
    Location:
    Pennsylvania
    Country:
    United States United States
    Anyone have experience with a peroneal nerve decompression? What’s the recovery like? I tried searching, but didn’t find anything. I’ve tried researching online, but didn’t see much. I was told I’ll be nonweightbearing for two weeks and in a brace, but that’s all I know.
     
  18. Jockette

    Jockette FORUM ADVISOR Forum Advisor

    Member Since:
    Aug 29, 2017
    Messages:
    7,484
    Gender:
    Female
    Location:
    Delaware
    Country:
    United States United States
    I’m sure @Josephine will be able to explain this to you.
     
  19. kneeper

    kneeper FORUM ADVISOR Forum Advisor

    Member Since:
    Dec 11, 2010
    Age:
    54
    Messages:
    11,577
    Gender:
    Female
    Country:
    United States United States
  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    77
    Messages:
    80,891
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Yikes!
    "Plyometrics, also known as jump training or plyos, are exercises in which muscles exert maximum force in short intervals of time, with the goal of increasing power (speed-strength)."
    I don't see the logic of that. Orthopaedic surgeons have equal experience in trauma as in their chosen speciality. Otherwise they couldn't really call themselves an orthopod!
    It rather depends upon the size of the incision the surgeon needs to make. Usually they are about 2-3" in length and look something similar to this. As for the nonweightbearing and the brace, never heard of that being required before.

    peroneal-nerve-leg-pain-jpg.jpg

    Common-Peroneal-Nerve-Release.jpg
     

Share This Page

Sponsors
Close X