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Revision TKR TKR Total Revision slated for Oct. 14, 2020

Jamie

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I have more of the stuffy stiff knee sensations that just doesn’t want to bend.
This is a feeling that is consistent with the swelling that I'm sure you still have. It's normal and indicates you need to be icing and elevating your knee (toes above the nose) 4-5 times a day for at least 45 minutes.

yesterday she performed hand stretches on my leg/knee. This really was difficult to tolerate & has caused swelling last night & extreme pain in knee cap area when I attempt to get out of chair this morning.
I agree with Pumpkln's comments that this is an issue to discuss with your therapist. It's obviously too soon to do something like this. Give it at least a couple of weeks. Make sure any new activity or exercise introduced is done very, very gradually so you can see the impact before proceeding.

I feeling a sense of control over this looming doctor visit on Monday.
This is what we LOVE to hear! :thumb: You are a partner in this process along with your medical team, and the knowledge you're gaining will help you feel more empowered to assume that role. It's your knee and your life. All this is just temporary and things will improve. You're listening to the signals your body is giving you and you're going to do recovery in a way that's right for you. Bravo!
 

Roy Gardiner

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pre-op ROM is the best indicator of post-op ROM and post-op ROM progress
True but misleading. Pre-op ROM will be limited by (for example) bone spurs, which spurs are removed during surgery. Spurs will mean that soft tissue will have shortened over the years, and that improving ROM will mean that tissue extending again. This takes time, but can and will happen. Stretching exercises can help.
 

judgar

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Jamie can you explain what a stuffy knee feels like. Just wondering if it’s the same as my knee
 
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jmoward

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Today my knee continued to swell & feel warm to the touch. I am not able to bend it either. A lot of pressure pain. Have elevated & iced throughout the day & will continue throughout the night. Discussed all of this with PT on phone today. Have decided to not attend PT tomorrow, Friday. Just rest, elevate, & ice - taking 2 extra strength Tylenols (not exceeding 8 per day).
 

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Have decided to not attend PT tomorrow, Friday. Just rest, elevate, & ice - taking 2 extra strength Tylenols (not exceeding 8 per day).
This is a good plan. Things will improve in time. :console2:
 

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I too was at 55 in week 4 following my revision this June. As my leg was at 60 bend/30 extension for the previous 4 years after the original implant, I know it will take longer to stretch everything out than for some people. It is now 4 months and I am 75/0, which I am happy with as it is improving, just slowly. I go to PT every 2 or 3 weeks where they check my gait and maybe suggest new exercises. I have seen my OS twice for follow ups - he does not mention any numbers and is realistic, saying that I might not get back to a 'normal' ROM. We agree that if I can reach a stage where there is no pain, and I can walk reasonable distances, then that will be a good outcome.
 

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@jmoward tomorrow is 5 weeks for me. I am still using the walker. It helps me walk normally. Pre-op, my ROM was terrible, today it FEELS different, I walk easier. I don't care about my numbers, I care if I can walk without lurching, limping, etc.

I am also a medication lightweight. I've been using Tylenol and tramadol and ice. Oxy at 5 mg makes me pass out, so I have only used it when I am in bed. :heehee:

Keep talking with your doc until the meds are right for you.

Hang in there, grab some patience, ice and elevate!
 
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jmoward

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Update - It was decided to have MUA on Friday 10/18. Due to the previously disclosed issues, my ROM had gone from 55 to 30. Today is Sunday & my knee & thigh is extremely swollen. Everything I’ve read says this is normal after MUA. I am trying to reset my psychological clock & counting my new recovery from Friday. I am handling all with Extra Strength Tylenol & periodic Tramadol. I am making a very concerted effort to exercise throughout the day. I performed 4 sessions of heel
Slides yesterday & 4 sessions of leg extension stretch. My thigh muscle is not firing so today I will add that to my program. My knee is very sore & swollen. I was told to elevate with moist heat after MUA which I am doing. I am trying to take it hour by hour. I am so disappointed, as I thought at 1 month out from surgery I would be without walker & going better, but here I am. I know my care giver is frustrated as there are so many things I still cannot do or participate in, and all the domestic & ranch workload has & continues to fall on him. I know there are better days ahead, I just hope they get here soon!!!
 

Jaycey

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@jmoward So sorry you had to go through MUA. Yes you are correct in assuming your recovery starts on 10/18.

Please don't worry about chores or activities you can't do just now. The important thing is to get that knee working again.

Did they tell you moist heat only? That's not really going to address the swelling.
 

kneeper

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Moist heat may help any muscles that were made angry by the MUA, but I'd think cold for the knee itself.
 
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jmoward

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Thank you. I’ve added icing to my program. Any other advice would be appreciated. Headed to first full PT session this morning.
 

sistersinhim

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I suggest you take it easy at PT. Don't let them hurt you at all. Your knee is re-injured with your MUA. Just gentle movements will help you the most.
 
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jmoward

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My last post here was seeking advice with regard to MUAs. Well since that post, I’ve been through a lot & I’m at my wits end & know that this is the best place to come for sound compassionate advice.

My first MUA was 5 weeks after my TKR. The surgeon photographed my knee bent to 130 as proof the surgery was a success - that my lack of range of motion was me & my mind’s command of my thigh muscle.

Three weeks later I had my 2nd MUA as my ROM was around 70. My PT therapist could help me get to 85 ROM but within an hour of working to this ROM, my knee would withdraw & shrink back to around 50 ROM.

Surgeon photographed my knee bend during MUA showed 125 ROM. Unfortunately, immediately following this MUA, my entire quad & hamstring experienced severe spasms. I could not sit after the MUA. I went directly to PT after the MUA. Therapist was shocked at the severity of the spasms. My quad was as hard as a brick & very swollen. The PT session was over with before it began.

The next day was PT again. My therapist decided to apply heat & TENS to my thigh followed by massaging. I did not utilize any machines. This same program has been what we’ve done for the past 3 weeks - 3 times a week.

My ROM has begun to improve.


However, every time we achieve an increase in ROM my knee swells & aches. The swelling prevents me from bending. The swelling feels just like the pressure swelling I experienced with my pre-op CPPD (Pseudo-gout).

This past Saturday I worked really hard at gaining more range of motion & in fact was able to not use my cane that day. Sunday my husband helped me with ROM exercises & my mobility was very encouraging , but unfortunately when I awoke Monday morning my knee had swollen by 1” & by today, Tuesday I can’t put any weight on it & the knee is extremely painful.

My therapist is not sure what to do. I have doc appointment Monday & I hope I can endure this pain until then. I believe I need to have it drained.
Please let me know if anyone is aware of draining a knee after TKR.

My surgery was 12 weeks ago. Any advice would be greatly appreciated. Thanks for listening.
 

Celle

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Hello again, @jmoward .

You'll notice that I have merged your two threads together as we prefer that members in recovery only have one thread. Please don't keep starting new threads.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads.
Did you ever come back and read all the good advice you were given?
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. Bookmark the thread, so you don't lose it.

If you would like a new thread title just post what you would like it to be and we'll change it for you
 

Celle

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The surgeon photographed my knee bent to 130 as proof the surgery was a success - that my lack of range of motion was me & my mind’s command of my thigh muscle.
That was nice of him - not!
It sounds as if he was blaming you, when it's not your fault. It's more the fault of impatient surgeons who insist on a fixed schedule of ROM progression, without making any allowance for prior conditions, such as your CPPD.

There's no need to rush to get ROM because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Three weeks later I had my 2nd MUA as my ROM was around 70. My PT therapist could help me get to 85 ROM but within an hour of working to this ROM, my knee would withdraw & shrink back to around 50 ROM.
Please tell us the date of your second MUA, so we can add it to your signature.

You worked on your poor knee for an hour? That's too much.
Your knee didn't withdraw. it was swollen, from the MUA and from the PT. A swollen knee can't bend.

Surgeon photographed my knee bend during MUA showed 125 ROM. Unfortunately, immediately following this MUA, my entire quad & hamstring experienced severe spasms. I could not sit after the MUA. I went directly to PT after the MUA. Therapist was shocked at the severity of the spasms. My quad was as hard as a brick & very swollen. The PT session was over with before it began.
That just says to me that your surgeon brutalized your poor knee yet again and doing PT on top of that was just too much for it.
This same program has been what we’ve done for the past 3 weeks - 3 times a week.
You don't need PT 3 times a week. Once a week is enough. In your case, you've been trying too hard to increase ROM by doing PT. Your poor knee needs a rest, not more exercises.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start. ROM will gradually increase as the swelling goes down, as long as you don't overwork it and increase that swelling.

However, every time we achieve an increase in ROM my knee swells & aches. The swelling prevents me from bending. The swelling feels just like the pressure swelling I experienced with my pre-op CPPD (Pseudo-gout).
This past Saturday I worked really hard at gaining more range of motion & in fact was able to not use my cane that day. Sunday my husband helped me with ROM exercises & my mobility was very encouraging , but unfortunately when I awoke Monday morning my knee had swollen by 1” & by today, Tuesday I can’t put any weight on it & the knee is extremely painful.
You're all working too hard at trying to get ROM and it's having the opposite effect. Can you see how the exercise sessions are actually inhibiting your flexion? You work hard and your knee swells up. Cause and effect.

Give your poor knee a complete break from all this exercising. Just use it in the normal course of your daily living. Instead of exercising, spend that time resting, icing and elevating your knee, to try to help it calm down and to reduce the swelling. Do this for a month and see what happens.
You have nothing to lose, because what you've been doing hasn't worked, has it?
Ice to control pain and swelling
Elevation: the do's and dont's

My therapist is not sure what to do. I have doc appointment Monday & I hope I can endure this pain until then. I believe I need to have it drained.
Please let me know if anyone is aware of draining a knee after TKR.
No, draining your knee wouldn't work, because the swelling isn't in one particular place. It's spread over all of your knee tissues

I suggest you tell your therapist that you're going to take a break from therapy for a while. In case you feel concerned about doing that, know that it's your knee and you have the right to decide what happens to it.
Also, whatever you do, don't allow your surgeon to do another MUA.
Saying no to therapy - am I allowed to?

Here are a few more articles that may help you:
Knee recovery - Lose the Work Ethic!!
TKR: work “smarter” and not “harder”
TKR: Evidence shows that less really is more when it comes to exercising!
TKRs and our fast food society
Life in the slow lane
Post-operative exercise – the BoneSmart view
 

Tykey

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Unfortunately, you are trying to abuse your knee into submission. If only it could talk, it would be saying "please let me heal!!!"
The current strategy isn't working is it!
If you've read through the recovery blogs, you will notice that most of the excellent recoveries are achieved by those who leave the knee alone, and just get on with life, just pottering about doing what we can do, then doing more as healing progresses. Rarely does any one of us worry about ROM, that will come if you are patient.
You do seem to have got involved with a surgeon and PT who seem to be remarkably ignorant.
Remember the tortoise and the hare? Be a tortoise.
Good luck, and adopt the Bonesmart philosophy, it really does work
 

Hoppy Nanny

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Gosh.... what an awful time you’ve had & Im so sorry they have put you through this.
Can I respectfully urge you to ignore them from now on and take up the BoneSmart Mantra.... healing first... ROM later!
I had TKR 7 weeks ago... my ROM was 81 last week & Im very happy with that... it’s getting more every week & no pain. I only go to PT every 3 weeks & do exercises at home.
Please give that poor knee time to recover from the op & two MUA’s & it will serve you well.... I imagine an injured, swollen finger joint that can’t bend until the swelling goes down.... that’s how your knee is... waiting... begging for you to let it heal first.
Thinking of you.... let us know how you get on...xxxx
 

Jockette

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I agree with the others, you have been told that working hard will fix this, but it’s not true, as you have seen.
Give your poor knee a complete break from all this exercising. Just use it in the normal course of your daily living. Instead of exercising, spend that time resting, icing and elevating your knee, to try to help it calm down and to reduce the swelling. Do this for a month and see what happens.
You have nothing to lose, because what you've been doing hasn't worked, has it?
I agree with Celle.

Your knee has been repeatedly traumatized in the last 12 weeks because of someone else’s opinion. Your opinion counts, also, so take charge of your recovery and protect your knee from all this abuse. Not all surgeons agree with your surgeon’s protocol.
 

sistersinhim

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I feel so sorry for your poor knee. All that abuse has been so unnecessary and has slowed down its healing. Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals, with no replacements, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around taking care of my daily needs. As I healed I was able to do more. Icing and elevation was a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happens, I found that resting, icing and elevating helped.

You need to stay away from that doctor and therapist. They both need to be trained on how to rehab a joint replacement. They have done you much more harm than good. If you decide to go back to PT, find one that is not aggressive and believes in the gentle recovery.
 
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jmoward

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Update... the 11th of March, 2020, will mark 6 months since TKR. My Passive ROM is approximately 90 degress and Assisted ROM is barely 70. I am not able to obtain greater ROM. All along I have stated that I feel an obstruction inside my knee. When PT pushes my knee for greater ROM, at about 90, therapist hits a block and I feel great pain. I cannot complete a complete bicycle revolution. My quad muscles are very lazy and have atrophied and since they are not that strong, my gait is very "gimpy".

Just as a recap I had 2 MUAs, one at 5 weeks and another at 8 weeks. No greater ROM was achieved after either MUA. In fact, 2nd MUA created a spasmodic thigh muscle that was so sore and swollen that I could not sit down for days. It took 2-l/2 weeks of special therapy - heat treatments, tens, & massaging, before I could return to my normal ROM exercises. It was decided by my surgeon, that the next plan was to have me visit a pain doctor, as he believed I was having a psychological/mental block in obtaining greater ROM. The pain doctor prescribed lyrica and lidocaine knee patches. Neither of these helped.

After 3 weeks, it was decided to perform a Knee Genicular nerve block. It was thought that if we blocked the knee nerves, then I should be able to obtain greater ROM. If the nerve block was successful, then radio frequency ablation of the knee nerves was going to be the next step. The nerve block did not improve ROM, in fact, the ROM was less than it as prior to the nerve block.

At this point in time - January 7, 2020 my surgeon basically, said he didn't know what else he could do, "it is up to me" (grin and bear it) I continued PT for 2 more weeks, and finally decided that after 57 PT sessions (4+ months) (January 24, 2020) was ample PT time to obtain greater ROM, so I discontinued all PT at the clinic and began doing PT exercises at my home.

I am very unhappy with my knee. I walk with a very obvious limp. The stiffness in my knee gets greater and greater throughout the day. Within 30 minutes of performing ROM exercises & bike riding, my knee is stiff once again. I have returned to about 80% of my daily ranch chores, but it takes me a lot longer to do them. Just a note: I am unable to make a complete revolution on my stationary bike - so I just rock the pedals back and forth to feel the stretch in my knee. I am unable to ascend or descend stairs. I cannot walk immediately after standing. I experience significant pain and stiffness after standing from seated position.

I am seeking a second and third opinion. It is difficult to find an orthopedic surgeon that will review another surgeon's work, but I have finally successfully found one that has come highly recommended. My pursuit of a third surgeon continues.

I am hopeful that the chosen surgeon will be able to provide a fresh set of eyes, knowledge and experience to analyze and offer help for my predicament.

My plan is to continue the stretches, quad strengthening exercises, ROM exercises and bike exercises - doing them all without much aggression.

Any thoughts, ideas, etc. would be greatly appreciated.
 

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