Too Soon ????

[patfinch]

Hi all,

I saw my consultants UNDERSTUDY last friday, 6 week post op, and he was very please with my ROM and overall progress.

He told me that I was able to resume light /normal duties....

I queried with him that my physio had insisted that I should be on crutches for 12 weeks, and due to my occupation as a prison nurse, no way would they let me through the front gate with lethal weapons...

He said, oh no no no, 6 weeks is adequate, you should not be on crutches now, discard them and go back to work..
He NEVER even checked in my notes which were sat on the desk in front of him.

As you can imagine I was a bit took back by this, by collected my sick note to send me back to work, and walked out, ( with my crutches) feeling rather disheartened, as I could not believe that I was fit for my job just yet ( you know your own body dont you ?)

Now , very very confused I wondered if my conversation with the physio was a figment of my imagination through the post op morphia......but still I was convinced that I was right...

I have tried to do without my crutches for the last few days, and my leg has become increasingly stiff and sore....
Am I being a wuss or should it really be like this?

So, today, just to satisfy my confusion spinning around in my head, I telephoned my consultants secretary.....
She pulled my notes, and guess what.????
12 WEEKS ON CRUTCHES....NO LESS.........

Just shows some of these guys are NOT the gods we think they are.......

I could have done irrepairable damage thanks to him, but now I know that I WAS right, my sticks are going to stay with me to the bitter end......
We will face this journey together

I am soooooooo annoyed with that guy, but the secretary is going to have words with my OS on my belhalf about his understudy........so no doubt he will be told ......NOT all patients are the same....CHECK THE NOTES.....

WE ARE REAL PEOPLE....NOT JUST A CONDITION THAT REQUIRES SURGERY
He needs to listen to his patients instead of playing at being a false god sat there issuing his false orders.....

Great .............got that lot off my chest now have to wait for phone call back with further instructions.......just glad that my fears were real, and I WAS NOT BEING A WUSS AFTER ALL !!!!!!!!!

Have a nice day y'all I feel much better now, and as a bonus......the sun is shining !!!!! Thanks for listening....

Take care
Love and hugs Pat xx

 

[JenniferG]

Morning, Can't speak to your specifics obviously, but my experience was 6 weeks was plenty of time to be walking solo. Maybe a cane. There is bound to be some stiffness and sore ness as you ask the new knee to do its calling. The muscles, and such need time to strngthen and build up stamina. They were assaulted by the surgery and will protest for a good few months or more.

 

[Doug]

Pat, that seems an awfully long time to be on crutches for a TKR..I used a walker for 7-8 days, and went to a cane.
Granted, at six weeks, I couldn't break any speed records, had lots of stiffness and swelling but by three months I didn't use anything.
However, you need to do what's best for you!!
Just keep working it hard because all the effort pays off in the long run.

 

[Coppernob]

Hi Pat
I was never on crutches for either UKRs or TKR. Just used a zimmer for a couple of days in hospital, then went to two sticks. I used two sticks for a bit at home and just seemed to know when to go down to one. I still use one outside if I'm walking far, or on uneven ground, but that's mostly due to the knee being dodgy again. I was off work for 10 weeks with both UKRs and TKR - and I only work part-time in an office, nothing as demanding as your work! Take care
Lin

 

[patfinch]

Thanks all
I had a cementless component put in.......would that make a difference to the recovery time? Would it take the extra few weeks to become more part of me as I believe the bone grows around the component to eventually both fuse as one.
Either that or its just my consultants way of doing stuff......and he is THE BEST at least in the northwest surgeon for knee surgery

Love and hugs Pat xx

 

[ship4]

With a cement-less implant, it will take you longer to recover as you are waiting for bone growth. The cemented ones have a much quicker recovery period as I understand it.
Good luck to you and keep using the sticks for as long as necessary.
Best,
Crystal

 

[patfinch]

Thanks Crystal.
I thought that must be it, ......it certainly feels better to know that someone is on the same wavelength....
Have you had a KR yourself?
Love and hugs Pat xx

 

[exjock]

Must be because of the cementless style. I was discharged from hospital with as much weight bearing as I could tolerate. I was told that glue connection is as good as it is going to get in just a few moments. Kind of scary if you ask me. In 2 weeks I was using just a cane and nothing shortly after.
Was there a reason that they used that style of Joint?

 

[Josephine]

(I feel a mini-lecture coming on!

)

Bone cement simply acts as a kind of filler between the smooth surface of the implant and the honeycomb of the bone. It doesn't actually stick to anything. It's important that the cement is forced into place whilst soft so that it extrudes into and around the matrix of the honeycomb, thereby supporting and preserving it. If this is not done efficiently, the bone can die back from the loading on it (resorption) and thus cause the implant to become loose. Around 90% of all loosening occurs at the cement/bone interface rather then the implant/cement interface.

..............CEMENTED ............................................ UNCEMENTED

However, the cementless prosthesis, instead of a smooth surface, has a unique porous coating which not only enables but encourages the bone to grow into it making a strong and fairly reliable bond. The downside of this is that during the regrowth period, whilst the immature bone is growing into the metal, undue pressure or loading can break the microscopic bone and even bring the growth process to a halt. Thus the need for a period of non-weight bearing. Length of which is, as per usual, down to surgeon's preferences.

Now an uncemented hip has a better evironment for this process as the weightbearing component, i.e. the femoral implant, is more secure but in an uncemented knee, the weight bearing component, the tibial implant, has less purchase within the bone and therefore needs more care during the growth period.

 

[patfinch]

Oooooooooh Jo......
I knew that you would come up trumps
What an excellent answer..thank you so much.
I could even send this to my manager and solicitor, as it explains everything perfectly.
What a plonker that doc was as I would most likely have done irrepairable damage and set myself up for further surgery if I had listened to him...
Thank god I trusted my instinct
Hope he got a right earful from Mr Mohammed

Again, this site has come up trumps....IT'S JUST THE BEST !!!!!!!!!

Thanks to all
Love and hugs Pat xx

 

[patfinch]

Bye the way Jo....
You never answered my question the other day.....Is that your pic top right of we page?
E mail me [email protected] if you dont want any one to know
It will be our little secret..I'm intrigued..

Love and hugs Pat xx

 

[Josephine]

sorry, Pat - must have missed it - but which page?

 

[ship4]

Thanks Crystal.
I thought that must be it, ......it certainly feels better to know that someone is on the same wavelength....
Have you had a KR yourself?
Love and hugs Pat xx

Pat,
Yes, I had BTKR on June 18, 2008. I am currently 3 months post op. I am doing pretty well! I still need medication at night (Dilaudid, Celebrex, & Visteral) and I take the Celebrex and Visteral in the AM. I sometime supplement with 2 Arthritis Strength Tylenol in the middle of the day, and the middle of the night.
I have excellent ROM. I am looking forward to my OS appt. in the middle of October to see exactly what it is. I know it is high....... I want to know how high! After 9 home PT visits I was at 125 and 0 with both legs. I know I have more ROM now.
I have used my stationary bike, my Brazilizn Futebol, and my Total Gym in my recovery. I plan to hike, ski, and get back to a normal life. I also followed the exercises as outlined in the broken link removed: https://www.pricegrabber.com/search_getprod.php/isbn=9780897934398/
My goal indicator to know I am truly healed is my balance. If that is good, I will attempt to ski in February.
I just love the fact that I am continueing to get better daily.
You will too, once your bone grows in.....
A local woman I met had a cementless on her left and was going back to her her right done. She said she would opt for the cemented version. So, it is one day at a time!
Best,
Crystal

 

[Rowdy66]

Thank God my OS did whatever he did because there is no way I would have tolerated that long on crutches. I used a walker for a week and a cane twice. Been up and running since the fourth week and relatively pain free since the third week.

This is a question for Jo, what if any is the benefit of not using the 'glue'? I am sorry but it sounds to me like it makes the recovery harder and what if the bone doesn't grow like it is supposed to? I ask because I have a friend who is having this surgery in a couple of months and I want her to know the difference and if one is preferential to the other. Thanks Jo.

And, Pat, sorry you have to stay on crutches so long, I would be crazy if I were you. Also, my husband works at a maximum security prison here in Arizona and from what he has told me about what it is like to be a nurse in a prison you have my sympathy there too. You certainly have no business going back to work until you a 110% and even if you were not on crutches I think six weeks is too short a time for the kind of job you have. I am constantly amazed at how quickly the people on this forum go back to work teaching school and even in law enforcement. My husband works with a man who had both knees done and it took him a full six months before he was back to work and that made perfect sense to me. Prisons are tough places full of unstable, dangerous people, you need to be in top form. Good luck. Rowdy

 

[Josephine]

Oh it's worth it, Rowdy. Specially if you're on the younger side, say 40s or early 50s. The incidence of loosening in cemented JRs is somewhat more than in uncemented and that is because of the cement security issue. This is where the cement - as I said - is forced into the honeycomb of the bone. (Getting techincal) if the cement is allowed to sit atop the bony spicules, they will break and die back which is what causes the loosening. But in the uncemented variety, the metal/bone interface is much, much stronger and more reliable.

It has to be said, there are occasions when the bone doesn't 'bond' like it's supposed to as I described in post 9 and we have a member whose uncemented knee has failed for that very reason Still in pain 1 yr post surgery but thankfully they are quite rare. This thread does demonstrate the importance for the non-weight bearing period to be committed to with veracity, particularly in TKR.

Another consideration is that revision after an uncemented is a lot less complicated than with cement as the surgeon has to remove as much of the old cement as he can and that's a bit like when archaeologists have to free an artefact from the stone it has merged with - it ain't easy. Although it is becoming increasingly common for the cement to simply be reamed like the bone was and new cement put on top of the old.

Hope this gives some answers.

 

[patfinch]

thanks all,
Jo, you have helped ease my mind...I went back to my GP to get a valid sick note today, and he reckons that the understudy is a total pillock..his words not mine.
He gave me a note for six more weeks then for review again.
the picure I refer to which looks like you is at the top right of each web page...the lady to the right of the couple......
Crystal, my my you have BIG plans ...good for you..I was never over active and sporty before but hope to be able to get more done with my new knee, more walking and cycling perhaps as I've taken quite a liking t

 

[patfinch]

cont'd

to my exercise bike.
Rowdy, like you my husband was a Prison Officer for 20 years, and life as an officers wife is not always a happy lot....
Rest assured I will be going NOWHERE until I am well fit, I had my accident at work when I was ok so I am being over cautious..
Which Prison does your hubby work in? we watch all the documentaries on TV about the USA jails, and ours are pussy compared to yours.....Give em bread and water thats what I say lolol

Love and hugs pat xx

 

[jessie]

OK, now I have an issue. I have a cementless hip. They said my mobility was limited by pain. I frequently now walk without a cane. Only walked with a walker for about two to three weeks. Not only that, but once I was released to work, my PT stopped. AHHHHHHH!!! Yes I'm having pain that I thought would be gone from what my MD said. I saw him at 3 weeks and he said to lose the cane. Didn't do that. I'm now having to request PT from my Nurse Practitioner. Won't see my OS until Nov 9. God love the Veterans' Administration. I was once a dept. head in a VA hospital. And I left Why????

 

[jessie]

Oh, 'scuse me, Department of Veterans' Affairs.

 

[patfinch]

JESSIE
dont know about cementless hips, as cementless knees are totally new to me, despite being a nurse since 1979.
However I have recently come across an excellent forum wher you can get help..........you are here chick......
also on here is an excellent orthopaedic nurse who has some VERY good answers and advice for all of us........GO JO !!!!!!!!!!
Best wishes

Love and hugs Pat xx