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

[dubloosh]

Thank you @Jamie. It will take the focus off my knee. Just had a snack and Advil. Have a good night, everyone, and thank you again. This is the first time in months I'm turning in early.

 

[dubloosh]

Hi hi I hope everyone's doing well this midweek day. Checking in to say work is going really well. The people are very nice as is my manager. This is a four-month contract assignment at a funeral home and may extend longer after an evaluation in mid-May. I hope it becomes permanent. It's a two-story building; the first floor is meeting rooms for families and for services, and the second floor is offices. I have to walk up 10 steps, then a tiny landing, then 10 more steps at 9 a.m. and down again at 2:30 p.m. My knee hurt when I got home yesterday even though the car was warm so I iced then and am now. Because I forgot to ask him last week, I emailed my surgeon about an MRI if only to confirm it's inflammation and make me feel better. Medicare will approve given the November procedure (payment is a concern now that the medical group merged with a larger group). Today I sat most of the time, walking only to stretch or get coffee. It was 21 degrees Fahrenheit this morning in New York. Summer, hurry and get here!

Adding: my surgeon wrote back, "Thanks for the update," and nothing more so I wrote to my PCP. She had ordered blood work as she does a few months after surgery so I told her about my knee and said I'd like an MRI to see if there's inflammation. This would be reflected in blood work. Frustrated with my surgeon's non-answer.

 

[Layla]

Thanks for stopping by! It's good to read that you like your new place of employment and the people you associate with there. I hope the rest of the week goes well for you. Keep us posted!
@dubloosh

 

[dubloosh]

Thank you @Layla. I feel blessed to have nice coworkers who patiently answer questions and a convenient work schedule - Tuesday to Thursday. Happy Thursday!

My apologies for incorrect name.

 

[Neecey]

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.

After my complication due to too much PT I found walking and pool exercises to help the most. Of course I did gentle PT things at home too but just getting back to life seemed to help me the most. My dogs were and still are very happy because they’re my walking partners!

 

[dubloosh]

Hi @Neecey, nice to meet you. I'm glad to hear that everyday living has helped you more than PT. And you have walking partners! Many in this group feel the same, and it worked for me, too. Fast forward to now: I had scar tissue removed two months ago, went briefly to PT and am now taking it easy on my knee per suggestions here. No need to push as that causes me inflammation and stiffness. I'll read your other posts here.

 

[dubloosh]

It's Saturday, and the northeast is due for a snowstorm. Eek! When the presidential inauguration is moved indoors due to the cold, you can be sure my knee wants to stay inside, too. Work is going very well. While Tuesday and Wednesday I used a chair with an adjustable height lever, all such chairs were taken Thursday as most employees were in the office. My manager brought a regular chair from another room for me, and it was too low for the desk. Not wanting to complain, I sat as high as I could and tried not to lean on my knee. Hopefully, I can use one of the lever chairs next week though I'll only be in two days. Surprising news to me: my manager will be out of the office Tuesday, and instead of asking me to come in a different day (I offered), she assigned me some work from home. I never had a manager who assigned at-home work when she was out of the office. What a treat! I'll be here in sweatpants and sweatshirt with either ice or heat on my knee and work and get paid. About the knee: next Friday is an MR to see what is causing the pain. My surgeon wants to be sure it's nothing more than inflammation. Have a wonderful day everyone.

 

[benne68]

My manager brought a regular chair from another room for me, and it was too low for the desk. Not wanting to complain, I sat as high as I could and tried not to lean on my knee.

I feel your pain on that. Could you bring in a cushion to help elevate you a bit? I used a large memory foam cushion in my home office (like the one in the photo) during my first few months after my TKR and it helped. Look for one that is 2-1/2 to 3 inches thick.

 

[dubloosh]

Excellent idea. Thank you @benne68 I hadn't thought of this. I'm glad it helped you and shall look for one with the thickness you mentioned. Can leave it in the office to use with other chairs.

 

[dubloosh]

Good evening. I ordered a cushion from Amazon for the chair; I'll leave it at work. Today I was in the adjustable height chair. Work is going well, and I'm learning quite a bit. No one is the wiser about my knee, which doesn't like the cold. The steps are no problem - I walk up and down foot over foot and there is a landing - and without pain save for on the two areas on either side of my kneecap. Friday I have an MRI to confirm it's soft tissue and nothing more. I try to rub it with castor oil when I get home and before bed. It better hurry up and feel better as I'm hoping to have surgery on my left basal thumb joint in late spring or the summer. Little did I know my left hand would become as painful as the right was. For now, I wear a brace at night. I'm also hoping to resume walking outside once the weather warms a bit.

 

[dubloosh]

Hi, it's Friday! Hope everyone's doing well.

The MRI was this afternoon, and I received the results online prior to my surgeon seeing them (he's in surgery today). Here are the indications:

COMPARISON: Right knee x-ray 1/10/2025

FINDINGS

CRUCIATE LIGAMENTS: Absent

MENISCI: Absent.

PROSTHESIS: Total knee replacement seen. Anatomic alignment. No evidence of anabnormality.

COLLATERAL LIGAMENTS: Intact

.BONE: Artifact from the prosthesis limits the evaluation. No evidence of an abnormality, otherwise.

JOINT SPACE: Small joint effusion.

MYOTENDINOUS STRUCTURES: Patellar tendinosis with thickening. The distal popliteus tendon is not well seen, possibly torn. Otherwise, within normal imits.

OTHER SOFT TISSUES/POPLITEAL FOSSA: Within normal limits.

IMPRESSION: 1. Status post right total knee replacement in anatomic alignment, without evidence of prosthesis abnormality. Artifact partially limits evaluation.2. Small joint effusion.3. Possible tear of the popliteus tendon.4. Patellar tendinosis.

How can I have patellar tendinosis when I have no pain on the front of my knee as I did last year? That was painful and took two months to heal. The back of my knee is sometimes painful; I thought that was due to hamstring pain. Does small joint effusion mean inflammation?

Interestingly, after the MRI my knee felt like a knee, no pain at all. Maybe that's because I was lying down or maybe the radiation zapped it away.

Have a great weekend!

 

[mendogal]

Hi @dubloosh
Of course you'll need to talk with your surgeon.

It's quite possible that the patellar tendinosis is something that will be permanently visible as a non painful thickening of the tendon after healing. Remember, these scans don't have brains; they just take images of things.

An effusion is specifically a small area of fluid within a space . Often they're not large enough to "tap" or to cause problems, but yes it's often related to an inflammatory process.

The popliteus tendon is behind the knee and provides stability.

 

[dubloosh]

Thank you @mendogal. Dr. Oh called me and said it's possible to have patellar tendinosis without pain, the effusion is probably from inflammation - you were right - and the popliteus tendon, well, it hurts a bit to the back and side of my knee yet I figure time will resolve that. I should look into a knee brace as I've not gotten one and should have never gone back to PT after four weeks as I was walking down stairs foot over foot (still am), and everything else was healing. Learned my lesson.

 

[dubloosh]

Happy Caturday, as one of my friends says. Dr. Oh called again to tell me he looked at the MRI, and the tendon was not visible. The radiologist who read it was playing safe; he asks me to walk during each appointment to see knee stability. I apologized for asking so many questions. Now that I've dissected each part of the report, I'm satisfied. Hope everyone has a relaxing day.

 

[dubloosh]

I'm humbled to ask for help. For the past 24 hours my knee has been screaming at me. I thought it was improving, and I'm regretting having the scar tissue removed. While I can walk downstairs easily now, my full knee is burning and feels tight. Since yesterday the bottom of my kneecap has been painful. Might this be a delayed reaction to what happened three weeks ago? I'm not testing my knee, not walking stairs unless absolutely necessary - up the stairs to the office and down the stairs to the exit (the building is a converted house with no elevator) - and have been icing and taking ibuprofen and acetaminophen at regulated intervals and with food. The scar tissue made steps painful yet I never had burning like this. The MRI indicated the alignment was good, nothing impinged. I don't know what to do. Today I tried to cheer myself by answering a few job postings. Thank you for advice/suggestions.

 

[Jamie]

Yes, this can be a delayed reaction to the procedure and the extra stress and activity you've been putting on your knee with your new job and life in general. The burning sensation is a form of pain and should be treated the same way. The best thing to do is what we always recommend. Rest, ice, elevation, pain meds (just what you're doing), and patience to give your body the grace it needs to heal properly. Your latest procedure reset your recovery time clock. You can expect to have good and bad days/weeks. Improvements will not be linear. When the bad days hit, scale back for a while. Time is what is needed for healing.

 

[dubloosh]

Hi @Jamie thank you for this information and for explaining the burning sensation. I keep forgetting my recovery was reset. As I developed scar tissue from the original surgery I was trying to avoid that and continued as if this is 15-1/2 months post op instead of two and 1/2 months post op. Appreciate your reassurance as I worry when there's pain. Back to babying it.

 

[dubloosh]

Hi everyone. Hope everyone's having a good day. I'm doing the best I can although the steps were painful today. Earlier the clinical manager of the facility called me and explained why the therapist was aggressive despite me telling her numerous times to stop, that she was hurting me. He said she did that to prevent ossification. Would someone kindly weigh in on this? I was doing very well, able to walk down steps, and was progressing after scar tissue removal. The manager told me to wait no more than five days before going back to PT; I told him it's been more than two and one-half weeks, and my knee is very sore, that this is a setback. I'm being very gentle with it and apologize to it often. Yes, I talk to my knee.

 

[Jamie]

I’d find a new therapist. If the clinic manager believes this is a good approach, that group is obviously not for you. I cannot believe a manager would tell one of his employees to continue pushing when a patient tells them to stop because of pain.

This type of excess bone growth is more typical of a hip replacement than a knee. Even then, it is relatively uncommon. It’s the first time I’ve ever heard of it mentioned with a knee replacement, but I suppose it could happen. Please trust your own instincts in whatever decision you make about continuing therapy with this group.

You do need to be moving your knee frequently during the day and challenging the bend and extension until you feel mild discomfort. You may be getting enough exercise on the days you work at your job. Just be sure that you are doing some exercises on your own at home on the days you don’t work. If you do that, it’s probably still going to be some more time before things settle down after the pushing youl experienced.

 

[dubloosh]

Thank you @Jamie I'm with you and had some strong words for him when he said that. Dr. Oh ordered xrays and would have told me if there was ossification. Work is getting up and sitting down and steps coming and going. I'm not going back to PT with this or another group and am looking into an inexpensive under-the-desk peddler to use while typing to keep my knees moving at home. Sometimes when I walk down the hall to the compacter room I add a few rounds up and back (a healthy walk) for exercise.