TKR TKR Progress

[mendogal]

Hi. I'm just catching up on your history.

It's good you're going to see your surgeon.

I returned to my strength training regimen on the machines when my newer R knee was 10 months old. It's been invaluable to very slowly work my quads and hamstrings to exhaustion once a week. A month earlier, my surgeon pointed out that my R quads had atrophied. My R leg still lags behind my L, but is coming along.

So, yes, 10 pounds extension at 2.5 years means that since your surgery those quads have weakened. That alone puts you at high risk for the joint instability that you experience as pain and a kneecap issue.

I suggest that pending your surgeon apointment you consider stopping the sports activities and start a targeted strengthening program (if you've never done so, it's worth paying for a few sessions with a trainer at the gym).

My advice would be to use a machine that offers both hamstring curls and quad extensions. The leg press machines use other muscles as well, for a well rounded workout. But from the research I have done and my own experience, for post op targeting of atrophied quads and hamstrings, a machine (or two separate ones if necessary) that focuses on them is the place to safely and effectively start.

The other thing is nutrition: at our age we cannot build muscle without a somewhat higher than usual protein intake. Research indicates simply having a protein packed dinner won't work - we need protein spread among three meals daily.

 

[Odieodell]

@mendogal thanks for sharing your suggestions.

I thought my normal sports activities (golf, tennis and pickleball) would strengthen my quad, but apparently not. I had noticed prior to the knee pain starting would have a sore calf muscle and my Achilles would ache. I have been doing some at home quad lunges, but know I need to work with the machines like I did prior to my surgery. We have a machine for leg curls, leg extension, leg press and I also like the machines that work the hips.

I don't typically eat lunch, but love protein packed meals.

 

[Layla]

I don't typically eat lunch, but love protein packed meals

Snacks are great too, if you don't want a full meal. Some of my go to protein snacks are -
Greek Yogurt, Peanut Butter & and Apple, Edamame, Hummus and Veggies, Cottage Cheese, Cheese Slices, Protein Shakes, Nuts or Trail Mix, Hard Boiled Eggs, Chicken Salad, No Bake Energy Bites.

Best Wishes for your appointment on the 3rd, please let us know how it goes.

 

[Odieodell]

I continue to be frustrated with this new knee pain I have frequently had on and off since August after being pain free for 2.5 years.

I did visit my surgeon and the implant on the x-rays looked good. I've felt all along it is tissue pain. He suggested a bone density scan which I am getting done later this month. I highly doubt it will reveal anything.

We have been on vacation this past week and this knee pain has been problematic all week. The pain started up again from going down steps. Over the counter pain relievers don't help. Bending is the most painful, so I haven't been able to bike. Today it hurts just sitting. I'm sure I have some swelling or fluid in the knee. Painful trigger areas are around the outer sides of the kneecap (bottom, medial, top).

Has anyone had this kind of pain this late after surgery? Any suggestions as to what I should ask the surgeon for? I'm not sure that asking for PT would help. Would a CT scan or MRI reveal something? Do surgeons ever scope TKR?

I would really appreciate some advice and direction before I contact the surgeon again.

Thanks in advance for any input.

 

[mendogal]

I'm sorry it's getting worse - that definitely merits a fresh, serious look.

Scans can be done despite the metal in implants, if it's known ahead of time. Here's our article on MRI!

My suggestion is a consultation with a revision specialist totally unconnected with any facility your original surgeon uses. Don't ask your ortho for the referral.
This doesn't mean I think your ortho did anything wrong, or that you need a revision! It's just that you want someone impartial and who can be better attuned to carefully looking for issues in the knee.

A lot of orthopedists aren't very good on soft tissue issues. For this reason, at the same time it's also good to consider a referral to a non-surgeon. Specialties to look for can include physiatry (physical medicine), sports medicine, pain, or outside of physicians, a doctorate-prepared PT.

 

[Odieodell]

@mendogal so you recommend seeing any of these specialists as opposed to my surgeon? Would an ultrasound reveal more
than at CT Scan or MRI?

The implant doesn't hurt and it makes no
sense why I now have this pain 2.5 years post-op. I certainly hope I never have to consider a revision.

 

[mendogal]

I suggest it, not out of any disrespect to your surgeon, but because of
1) the value of getting fresh eyes on it by a different surgeon and
2) the non surgeon specialties tend to be better on soft tissue problems

Meanwhile you can certainly ask your existing surgeon for a scan he feels will be the appropriate next step.

There's a reason for your pain, and it won't get assessed and treated without a proper workup.

 

[Odieodell]

@mendogal your advice actually makes a lot of sense. I never considered that these specialists would look at a joint that had been replaced.

I didn’t get a strong sense of confidence that my surgeon had any idea what could possibly be wrong since the implant wasn't loose in the recent x-ray. I was a bit concerned going back to him for answers.

Thank you so much for this suggestion. Now I need to find a highly rated sports doctor in my area.

 

[mendogal]

You're very welcome, @Odieodell !

Please do keep us updated both on how your knee is doing and how your search for answers goes.

 

[Odieodell]

I am making plans to see a local sports doctor who has excellent reviews regarding the pain I have been having since August as previously posted.

I've also been doing a lot of internet searching to see if others have had similar pain late post-op following TKR. I found quite a bit regarding the saphenous nerve causing medial pain. I've felt all along that the kneecap might be pinching a nerve. Has anyone else here dealt with it?
I definitely plan to mention it to the sports doctor. I've read about some exercises on YouTube which may help too.

Saphenous nerve neuroma after total knee arthroplasty - Mayo Clinic

www.mayoclinic.org

 

[mendogal]

I did a search of our postop knee forums for mention of it. Here!
I look forward to learning how that appointment goes!

 

[Odieodell]

Good news: The pain I was having in my surgical knee for nearly 5 months after 2.5 years post-op has resolved itself. I believe it was an impinged nerve. I wonder if nerves are still reconnecting that late after surgery.

Bad news: I have started getting some pain in my other knee.

 

[Layla]

Yay for the good news! Great to hear the pain resolved. Thanks for the update.
I am sorry to hear about your other knee. Hopefully the pain isn't too intense and it is sporadic.
Have a nice weekend, Odieodell!
@Odieodell