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TKR TRKR 10/13/23 - Moving Forward with Many Detours

dubloosh

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Hi from New York in the US. I've been reading posts on this website for a while and have learned much; I joined to participate and continue learning from others' experience. After years of bone-on-bone knee pain and cortisone injections that masked the pain until it returned (each time sooner than the last), I had RTKR October 13, 2023. Due to an infection at the top of my scar, my surgeon told me to hold off PT until the scar healed. PT then came to my home twice a week for three weeks to show me gentle exercises, all the while telling me I had a window within which to get a certain ROM. After reading information on this website I learned that was not true. Additionally, my lack of formal PT for the first two months post op probably helped me: by the time I started outpatient PT my ROM was 100. I didn't like the facility and chose another; two weeks later - and without exercising - my ROM was 115 at evaluation. From mid-December to nearly end of December my op knee was beginning to feel good, like a real knee. In the morning I had about 15 minutes before the swelling set in; I didn't mind as I was nearly pain free save for the two bones or ligaments on either side of my knee that made bending painful unless I took ibuprofen. The next time I went to PT I was doing half squats, three sets of 10 each. He told me he heard my knee pop. That night I saw a tendon(?) move on the side of my op knee while bending it. The knee was so painful I went back to the facility the next day and told them. The owner gave me 10 minutes of compression ice, which helped, and said she'd speak with the person who told me to do the sqats and that they'd be more gentle next time. I continued to feel pain on the outside of my op knee, pain that felt exactly like my meniscus tear a few years ago. Because I no longer have a meniscus in that knee I emailed my surgeon and asked for an MRI, which I had last week (January 25). The results said:

No evidence of fibrous membrane formation or periprosthetic bone resorption. Marrow edema is present beneath the lateral tibial tray posteriorly which may be stress related. No evidence of fracture. The liner appears appropriately positioned.

LIGAMENTS: The medial and lateral collateral ligaments are intact.

TENDONS: Mild patellar tendon thickening with slight increase in signal is present consistent with tendinosis. No evidence of tear. The distal quadriceps tendon and the patellar retinaculum are maintained. The other tendinous structures appear intact.

JOINT SPACE: Small to moderate effusion.

SOFT TISSUES: Unremarkable.

I apologize for the long post and am so relieved for the information I learned here and stopped PT. Because I was doing well on my own and letting my knee heal, I'm angry at myself for going at all. My surgeon said bicycling is good; I'm leery to do anything now that I had a setback. Thank you for reading.
 
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Hello and Welcome to BoneSmart!

Please identify which knee you had replaced for the signature we create for you.

I am sorry for the overly aggressive PT session you experienced. Try not to be angry with yourself, you were trusting the professional you met with. Thankfully you stopped the PT and you're allowing yourself time to heal.

Continue icing and elevating for the swelling, which can last for months.
I will leave our Recovery Guidelines even though you're over three months post op.

Wishing you the best as you continue healing and hope you'll update us with further progress. Thanks for joining us!

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Good morning Layla, and thank you for your kind and encouraging welcome.

My right knee was replaced. I was so focused on healing the infection as I also had my left hip replaced mid-March 2018 that I did no exercise. While I'm relieved to know nothing was torn, my surgeon did not explain the sharp pain and told me it can take one year to heal. This I know from reading here. I keep looking at images of the knee online to figure out why the pain is sometimes sharp and sometimes isn't there. I learned here I was doing heel slides incorrectly by keeping my foot flat instead of flexing my ankle. My knee is in charge. Thank you again. I shall update on this tread.
 
Hi and Welcome! I’m so sorry you were doing well and then got hurt at PT. I’ve read way too many stories like this. Best wishes as you re-recover. :flwrysmile:
 
You're welcome!
Thanks for the information.
It's understandable you were focused on clearing up the infection.

Healing can take a full year and some even notice improvement into their second and third years post op....so brighter days are on the way! :SUNsmile:
@dubloosh
 
Thank you @Jockette and for welcoming me. Seems reaching a certain ROM is paramount in PT, and not all PTs are trained for specific body parts. I look forward to being pain free again.
 
Hi @Layla, this is certainly not like my hip recovery. I'll take this as a speed bump and go slowly. Next appointment with surgeon is in April.
 
Welcome to BoneSmart! I'm so glad you've joined us and hope you will keep us posted on your progress going forward.
Seems reaching a certain ROM is paramount in PT, and not all PTs are trained for specific body parts.
This is sooooo true. Very few PTs ever take specific training in working with joint replacement patients and so they use the same techniques they would employ for someone with a sports injury. Apples and oranges!

You are wise to take things slowly. Listen to that knee; it will tell you what to do.
 
Hello @dubloosh and welcome to Bonesmart. I had added you to the October Knee Recovery Team Thread. You can go there and see the names of those who had their replacement in October, like you. You will probably find this helpful. I sure did. Here's the link: October Knee Recovery Thread There are no discussions on this thread, just the names of those who had surgery in the same month as you did.
 
This is sooooo true. Very few PTs ever take specific training in working with joint replacement patients and so they use the same techniques they would employ for someone with a sports injury. Apples and oranges!
I've learned my lesson. It also seems - and perhaps other members have experienced this, although I hope not - that PT facilities employ students who are studying PT to work as assistants. That is what happened to me. Glad I joined here.
 
Hello @dubloosh and welcome to Bonesmart. I had added you to the October Knee Recovery Team Thread. You can go there and see the names of those who had their replacement in October, like you. You will probably find this helpful. I sure did. Here's the link: October Knee Recovery Thread There are no discussions on this thread, just the names of those who had surgery in the same month as you did.
Thank you @sistersinhim for welcoming me and for adding me to the October thread. You're right, it is helpful to know when someone posts his or her surgery date. October seems so long ago. Today I began an experiment of eliminating gluten products in hopes of lessening the new inflammation caused by the PT stress on my knee. As well, I'm trying not to rely on Advil and Tylenol.

May I ask, then, where I can post updates. Can I post to this thread? Thank you.
 
May I ask, then, where I can post updates. Can I post to this thread? Thank you.
Yes, please post your updates here. We prefer that members in recovery have only one recovery thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Best wishes on your continuing recovery! :flwrysmile:
 
Hi @Jockette, and thank you for this information. I'll keep to one thread. Funny thing is last week is after I walked out of the MRI my knee was painless. I wonder if its magnetic field did some magic. On a more serious note, since the PT episode I keep eyeing the tendon - or whatever it is - that moves from the center of op my knee outward. I also feel pieces of something moving around inside. Could that be scar tissue breaking up? It's not painful; curious about it. I'm waiting to hear from another surgeon in a different practice about a second opinion and ordered copies of the MRI images.
 
Can you describe the feeling of something moving inside and where it is? I think a second opinion can’t hurt.

Any ideas @Jamie ?
 
Hi, and thank you. It feels like the gravel like at the bottom of a fish tank. When I hold my op leg at a right angle and lower it with my hand on the knee, then I feel it. No pain, just tiny somethings moving around.
 
I don’t have any ideas about what you are feeling and will be curious to know what your surgeon says. I’m glad it’s not causing you any pain.

Your body has to do a lot of adjustment to the new hard metal parts of your implant (versus the softer bone), so it’s not unusual to have odd feelings and even sounds until things settle out. Remember, that “full” recovery can take a year or more, so there is a lot of time left for these things to take place. I would continue to keep things fairly gentle in terms of activity or exercise for a while. Add any increases slowly so you can measure any impact on what you’re experiencing.

As long as it’s not hurting you, I’d say not to worry about it. But, should that change and you experience pain or swelling in your knee, you might want to get it checked out sooner than your scheduled appointment.
 
Your body has to do a lot of adjustment to the new hard metal parts of your implant (versus the softer bone), so it’s not unusual to have odd feelings and even sounds until things settle out. Remember, that “full” recovery can take a year or more, so there is a lot of time left for these things to take place. I would continue to keep things fairly gentle in terms of activity or exercise for a while. Add any increases slowly so you can measure any impact on what you’re experiencing.
Hi @Jamie and thank you. I appreciate what you said. Maybe since the swelling has gone down quite a bit I feel what was underneath. I wish surgeons offered more information to their patients. Mine feels my knee, and while his medically educated hands know everything is OK, my inquisitive mind - I was a journalist/reporter for many years - needs to know every detail. I'm glad I persisted and asked for an MRI and shall take notice of changes. I'm also interested in reading about others' experiences on the October thread.
 
Today I went to a job seminar and had to climb three flights of shallow steps to get there as it was on the top floor of a building that had no elevator. My knee was not happy this afternoon so I kept icing it and putting my leg on a heating pad. Thinking back to the past month and the day before I stopped PT, I remember I was on a recumbent bike and pedaling pretty fast. I wonder if that's why the outside of my knee has been painful since that time. Also heard from the medical records department; it's sending me a copy of my MRI images and written report. Waiting to hear from the second surgeon's office about when his scheduler can offer me an appointment. Now that the knee is less swollen I see what I think is a tendon moving when I bend the knee. That might have been the 'pop' PT heard when I was doing half squats last months. Not sure if that's good or bad as I've heard scar tissue makes a popping sound when it breaks. Which brings me to ask, please: what happens to scar tissue during MUA or when it breaks up on its own? Does it dissolve? Thank you for being patient with me.
 
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Good morning, I hope everyone's doing well. This is a positive update based upon the past few days. At Thursday's seminar I brought lunch - peanut butter on whole wheat - which I eat when I'm proctoring exams because it's quiet food. That night my knee was painful, and this is the second time it reacted (I think) to gluten. Yesterday I eliminated gluten (bread to me) the entire day and felt the results this morning. There is no patella pain, and I feel no pain in my quad, either. I've been sitting and then standing, walking around, and no pain at the bottom of my knee. I'm going to try gluten-free bread or sourdough bread. Today I'm 16 weeks and one day post op and am happy that one area of my pain is gone, at least for now.
 
If you’re gluten sensitive it can cause joint pain but so can walking up 3 flights of stairs. I guess to really know what caused your pain you would have to do only one of those at a time…
 

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