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[TKR] Trailspud Recovery thread

Discussion in 'Knee Replacement Recovery Area' started by trailspud, Aug 31, 2012.

  1. trailspud

    trailspud graduate
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    I have a bit of a story to tell. I'm out of the hospital and in my hotel room as of an hour ago. I'm looking forward to walking (w/walker) a bit more and lifting some light weights while seated...then I get to shower!

    The good news is I am well and as far as I know, the surgery finished well. Pain is okay. More at times, less at others. I'm more swollen now on day 3 than before, but I have better range than before my RTKR. I am close to full extension and maxed the 110 flexion my CPM goes to, but flexion is getting tougher with the additional swelling. I'll go slow.

    The bad news is that my trip to Orem, Utah for a Confomis iTotal custom shaped/sized implant was not a success in that my surgeon had to, interoperatively, choose a different implant. He visited me on the following morning and said, "we had quite a rodeo with you." I told him I was glad it wasn't his first rodeo. I will post more details later, but the basic problem was that my right knee was too messed up for the iTtotal to work. My extension was about 20-25 and I had less than 90 of flexion. My surgeon's first cut was measured as too constrained and the 2nd cut appeared to provide enough space, but it was then revealed my PCL was compromised (very loose). The iTotal is a PCL retaining implant so another device was implanted.

    I'm disappointed, but also I'm hopeful for a good recovery and return to a higher activity level soon.
     
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  2. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Trailspud,
    Welcome to the other side. Disappointed for you that your custom implant did not work out. Sounds like you are doing well, All the best for a smooth recovery,
     
  3. Nyland

    Nyland post-grad

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    Hi Trailspud,
    CONGRATULATIONS! I understand that you are disappointed. You researched everything before your decision. I'm glad, though, that your OS had the wisdom to implant the device that will work best for you. WOW 110 ROM? That is FANTASTIC!!!!!!!!!!! Someday I can only hope. Take it easy. Keep posting. Best wishes!
     
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  4. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Welcome to the other side! Sorry your other implant didn't work out. But the important part is your surgeon knew exactly what to do and you are now on your way to a better life. Happy healing!
     
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  5. trailspud

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    Early morning day four and feeling pretty good. Pain has been very manageable. Last night my whole leg tightened quite a bit, but thankfully it's a bit less so now. My ankle is actually the location of my worst pain and I hope to make progress on it today. My flexion is probably less now due to more swelling, but I think I still have 100. I"m pretty close to full extension if not already there. My big task is going to rehab my strength and while retaining full flexion as it has been a quite a few years since I had a straight right knee.

    I see my doc on Wedneday a.m. then hope to ride home afterwards (350 miles of interstate highway w/lots of walking breaks). I only saw him on the morning after then his PA visited on the 2nd and 3rd mornings. I have some additional questions to clarify what happened, but I think I have a basic handle on it. Life does not always work out as planned and this is one of those cases. I certainly would not have traveled out of town for my RTKR had I known the custom implant would not function. I will say there was something in the back of my mind that troubled me about how little range of motion I had going into surgery. My doc did tell my sister immediately following, and myself the following day, that he made a judgement error in thinking he could make the iTotal work. He said he has done about 140 iTotals and this was only the 2nd case in which this has happened. I wish I had a little more insight about the my PCL functioning (lack thereof) before surgery.

    Best wishes to all the August patients. I will try to reply to other threads soon.
     
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  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Spud, you are doing very well but I am left wondering why you want to compromise that progress by using weights and stuff so soon after surgery. Were you given the TKR recovery articles? If not you really need to read these two
    Energy drain for TKRs
    Swollen and stiff knee: what causes it?
    So What Is It Going to Take? The Five “P’s” of Knee Recovery

    You've already sussed that the swelling causes a reduction in the ROM. The same thing applies to general activities and the energy drain. This also has an effect on your overall progress. Please remember, this is a marathon, not a sprint. You don't have to do it all in a couple of weeks and you will be much better in yourself if you rest a lot more for now and leave the weights and stuff till week 3 at the earliest. It will profit you nothing bu good, I promise you.

    As for the unexpected change of implant - seen that happen a g'zillion times in the course of my career!
    As the Scots say "the best laid plans of mice and men gang oft aglay"!
     
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  7. trailspud

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    Josephine,

    Thanks. Don't worry I am taking things easy. When I mention light weights, I mean light...and for just a few minutes...easier than a walk since I'm seated. Once a day...mental health benefits.

    I have had one stubborn problem that is bugging me. My right ankle is pretty swollen. I didn't think to ice it before this morning and so have added that to my polar machine regimine for the knee. No help so far. I can still walk and put some weight on it, but it's become quite a pain.

    Oh, and as for the wisdom of the Scots, damn those Scots. They do make some fine single malts so I'll let them off the hook. Now, I really want a short glass half filled (but too many meds).

    Seriously, I'm disappointed, but not devastated. I made a lot of effort towards making the trip for surgery. I could have stayed home for this surgery and be in my own bed now. I knew I had no ACL, but I'm also thinking I should have thought more about the possibility of my knee lacking a functioning PCL and also being so constrained that it would impact surgery. I hope to be more lucid when I speak to my doc in a few days and get a bit more clarity.

    Cheers.
     
  8. Nyland

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    Sorry about your ankle swelling. I was a swollen mess, too, 1 week out. Ankle, foot, calf, knee....My OS was pretty horrified when he saw me. I was ordered 5 days of NOTHING but Rest, Ice, Elevation, and to wear my TED at all times and only take it off for bed. Try a compression stocking and elevate. Are you all by yourself? I hope that you have someone with you. Take care!
     
  9. trailspud

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    Thanks, Nyland. My sister is a nurse. She is taking good care of me...getting me ice, food, drink, and even a blood thinner shot each day. He is also enjoying riding her bike and walking on the Provo River Canyon path each day. It's beautiful country. My surgeon did not order me to use TED, but I may try them. My upper leg and calf are both less stiff than yesterday so they have made some progress. I'm using a CPM and I think it helps loosen me a bit. Hopefully, it will carry over to the ankle soon. In any case, I can still walk using the walker.
     
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  10. maryo52

    maryo52 Sr Bonesmartie

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    Trailspud, I don't think there are many here who didn't encounter some disappointment in the course of TKR. Often our knees are worse than we thought. The recovery is slower than we want it. We on this forum tend to be quite active and we're not really patient about the down time. But mother hen, Josephine, did caution about the weights. It doesn't matter if they're light or even lifted for a short time, your muscles are injured from surgery and they need a rest hon!! You have great ROM early on so that's a big plus. And even though you made a lot of plans to travel for a special implant, it sounds like your knee kind of needed the level of expertise this guy had. Good luck on the ankle swelling. If you keep it up above your knee (the knee being above your heart) enough of the day, that will help a lot -- though, again, for we active types, not terribly fun.
     
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  11. 1ELISEA

    1ELISEA Sr Bonesmartie

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    Awwww Trailspud that is too bad. All that time, study and travel and you wound up with something else. But it is probably a very fine implant. You might ask if it is a deep flexion type of implant if he replaced both the ACL and PCL; that would get you quite a range of motion. Wonder why he didn't tell you before the surgery he had his doubts and why he couldn't make it work.

    I am pretty happy with my implant after needing a nickel free one. It doesn't seem to be making any noise that people complain about with new implants so thankful for that. And I was commenting the other day to my OS how straight and flat my leg was and made him smile. It has been a long time since it was at a zero extension.

    Take care!
     
  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Folks, it's not necessary to use the "Reply" icon in someone's post to reply, specially when that post is going to be the one right before yours.
    Just scoot on down to the bottom of the page and start writing in the window, okay?

    aflagsforworship.co.uk_jo_pic_images_quickrcfc.jpg
     
  13. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Glad you're okay and you've got a good sister to see after you! Nothing like having your own in-house nurse!

    As for the ankle, they do sometimes swell, for what reason we don't know but it might be referred swelling from the knee.
     
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  14. TheHistorian

    TheHistorian post-grad

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    Hang in there, it only gets better!
     
  15. Nyland

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    Hi Trailspud,
    So glad that you have your sister there with you. Good luck on your one drive home. I'll look forward to your posts once you are home safe and sound.
     
  16. trailspud

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    Labor Day weekend was not much fun this year. My right foot/ankle worsened...pretty darn painful. My surgeon was off to Lake Powell, but supposedly his PA would be available through the on call doc. I called the on call doc on Sunday and he was not able to connect with the PA (a good guy whom I have trust in). The on call doc suspected a gout attack based on symptoms described and my history w/a few previous attacks. Things were no better on Monday so I spent a few hours in the ER where it seemed some of the workers were also celebrating Labor Day...they moved so slow.

    ER test results were good. No infection. No clots. Some anemia,but no internal bleeding. Uric acid level okay, but the ER doc thought gout in my right foot was probable. The dilemma is that gout meds can clash w/the blood thinners. I am awaiting a call from the PA today to discuss options.
     
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  17. Nyland

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    Awwwwwww, Trailspud,
    I'm so sorry that you had such a tough weekend! Do you like cherries? Snack on them all day today. My dad has gout and cherries seem to help him. Keep us posted. We care!!!
     
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  18. trailspud

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    Thanks, 1ELISEA. I see my surgeon early on Wednesday. I will get some clarifications, but the device implanted is one from a major company and has a long track record. It is a fixed-bearing implant and a PCL substituting tibial insert was chosen. I know the tibial poly is a bit more concave...PCL substituting feature fro more stability.

    I knew that I did not have an ACL, but in hindsight I should have been more concerned about the possibility of my PCL being as trashed as it was. My surgeon said his mistake (possibly) was in thinking he could make it work despite the constraints of my knee prior to surgery (he could not get 90 flexion in the OR during pre-op, and I think extension was around 20-25). degrees). My surgeon thinks I may not know what pain is (I do)...he said I should have been in significant pain prior to surgery. He knew I was working hard in the gym and traveled for a specific reason. He also said he has put in roughly 140 iTotals and this was only the 2nd case where he had to switch implants inter-operatively.

    If I had known my right knee was too far gone for the iTotal, I would have stayed home for surgery. I am disappointed. But, my surgeon is really a top notch guy (17 years a team surgeon for a major college athletic program among other accolades). He had to expand the amount of bone resected as compared to the iTotal, but his maximum cut was still at 10mm. So, I have a new knee put in by an expert surgeon and there is plenty of bone left if a revision is ever needed. I'm alive and mostly healthy...can't complain about that.

    Good luck on your progress. I hope to follow yours and others recovery stories more closely as the days move on.
     
  19. trailspud

    trailspud graduate
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    Tart organic cherry juice is on board! However, my uric acid level is okay so I guess the cherry juice is more for pleasure than function now.
     
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  20. trailspud

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    I got home to SW Idaho last evening...doing some short walks and light stuff around the house when I'm not napping. I saw my doc yesterday morning...X-Rays looked great, knee looks like it should, but I probably do have a gout attack going on. My foot and ankle are still more painful than my knee. Oh, well. It's great to be home to perfect late summer weather. Time will improve things.

    Thanks, to anyone on BoneSmart who sent me good wishes...I tried to send some replies, but I don't think I got everyone. Thanks to my sister, Marilyn, who took great care of me. I think she also got a bit of vacation. Each day she was able to ride her bike and/or walk along the Provo Canyon River Trail. Below is picture of Bridal Veil Falls...just a few miles up the trail Orem/Provo.
    at1_gstatic_com_images_cf3888e872cd6f8b3672f351cfc27a09._.jpg
     

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