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TKR Two days forward, one day backwards

alija said:
Very painful to start off with but eases after a few minutes. Still have to support my lower leg when moving in bed but driving is getting a little easier. Disappointed I am not yet managing to walk upstairs alternately despite strengthening my muscles. Knee is still significantly swollen, not straightening completely and my flexion has regressed to about 106. Saw my GP who says this is not a satisfactory outcome and is trying to refer me back to Orthopaedics.
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I agree that this is not a satisfactory outcome, even though you are only about halfway through the year of recovery. I hope you can see your surgeon again, and at least get an X-ray, and maybe some other tests to see what’s going on. X-rays do not tell the whole story.
 
Have a one off PT assessment mid July. Have realised my knee is no longer straightening fully and I can now get my hand underneath it. Flexion has regressed from a few months back, guesstimate 95-100. Could this be why I still can't walk upstairs alternately and without significant pain when I try? It is getting very wearing doing the stairs one at a time for over 7 months! Can move a little easier in bed but still makes me yelp if I move without prepping. Just returned from a few days away and walked 8000-10000 steps a day for a couple of days. That's a lot for me so it's rather swollen at present and I get a little pouch of fluid appearing on the lower, lateral side of my patella. My gait is difficult especially for the first 10 minutes or so and I have to really concentrate on a good heel toe stride. Hoping that if scar tissue is the culprit it won't be too late to break it up without surgical intervention.
 
Have you managed to get a follow up appointment with your surgeon?
I know it can be difficult in the UK at the moment. I wouldn't rely on the GP alone to re- refer. You could try ringing your consultant's secretary and tell her things don't seem right.
The other thing that really works is PALS
It stands for patients liaison service. Every NHS hospital has one and you can find the phone number/ email online.
If you ring/ email them to say that you have a problem and want that information communicated to your surgeon they will definitely help you and you will get a response.
 
Hi Ealing Gran, no I haven't pushed to see the Consultant yet as I haven't decided the best way forward. My previous PKR was done by a knee specialist but this time it was an OS who specialises in complicated hips. Considering paying to get opinion from my first Consultant. Pre pandemic I did a few years as an Acute Trust Governor so know about PALS but they usually deal with specific complaints and not sure I want to go down that route. He was probably competent but I think the lack of aftercare in this country is an issue and in the long term not cost effective. Most NHS care is now being triaged for clinical priority so it will take a while. My step daughter is a Chiropractor, sadly not local, and I might try that.
 
8 month update LTKR.
Had physio triage mid July and he has prioritised hydrotherapy. May be a problem with my patella but have not heard back from Consultant. Am back on Tramadol and Paracetamol to try to break pain cycle and hopefully improve my gait. Second session in the water today and felt the therapy might be helpful. Flexion measured at 112/0, I am told 120 is considered good enough for most required movements. Still painful enough to make me squeak if I turn over in bed without supporting whole of lower leg and if it "dangles" or follows. Have changed my car to Automatic as constantly depressing clutch was too sore. Most frustrating is still having to go upstairs using just my good leg which is really starting to complain and has a 9 year PKR so overuse is a bit worrying. Lifting the knee up is painful (I find myself hitching up from the hip) and pressing down is really bad. Can just about manage slowly on shallow, wide steps. Downstairs is a complete no no. Really hoping therapy will help as I absolutely don't want any major interventions. Pre op arthritic pain was bad but so is this and I am definitely more incapacitated now. Just off to massage my knee with Arnica Oil.
 
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alija said:
Still painful enough to make me squeak if I turn over in bed without supporting whole of lower leg and if it "dangles" or follows. Have changed my car to Automatic as constantly depressing clutch was too sore
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This doesn't sound right somehow. I think I would be pushing to get a consultant opinion and ? X rays/ scans. Sorry you are still in pain.
 
I agree that I could justify plain xrays for loosening but my GP felt that it would be a quicker pathway to pursue the physio triage. I am a retired radiographer mostly in MRI and CT and although I know MR technology has moved on there is always significant image degradation and artefact with implants. CT would not be helpful. My post op xray looked "messy" and I think may account for the slow soft tissue recovery. I will press more if the hydrotherapy doesn't help.
 
9 months update: Have had 6 hydrotherapy sessions now which has helped strengthen the muscles and eased the pain slightly. My other knee was getting really painful and starting to give way so a couple of weeks ago I was having to go upstairs on all fours. Have seen a physio twice and he won't start a more vigorous regime until the pain is more controlled so he advised taking Tramadol and Paracetamol to maximum dose and this has helped. Last few days I have been able to go upstairs alternately and it's slow but bearable. GP wrote to my surgeon mid June but not heard anything back so I have booked a self pay privately with a knee specialist, first available appointment mid September! My gait has improved with the increase in pain relief, turning sideways in bed is also easier. I also have less tingling under my foot so am feeling a little more optimistic. Just hoping that these small improvements are not all down to the extra pain relief and that I am starting to heal properly.
 
It sounds like you are improving nicely.
 
10 1/2 month update.

Have had 10 hydrotherapy sessions and 3 physio since August, which has helped a little. ROM = 115 / 0. Seem to think it is IT band syndrome and hamstring wasting. Saw private surgeon who agreed but said I should be pushing more forcefully to see NHS Consultant as self pay for whole gambit of tests, scans etc would cost a fortune. My OS has left but I contacted his Secretary who apologised for delay and said she'd send an urgent appointment with his replacement. That was 10 days ago and I've again heard nothing. Still too painful to lie on unaffected side, even with pillow and have to support lower leg when turning. Prickling and numbness under sole of foot after any slight activity that involves knee. Have been concentrating on muscle strengthening exercises as advice is not to walk for IT band syndrome. Have joined Health Club with warm, quiet pools to practise my own hydrotherapy.
Trying to do upstairs alternately is very painful and the more I do it the worse it gets but I want to try as my older knee replacement is really complaining now. Today I caught my foot against the stair riser and jolted my knee which was extremely painful and I haven't been able to weight bear at all since. Been getting about the house in my Dad's old wheelchair and don't think I'll be able to go upstairs to bed tonight.
Am so fed up with this new knee which has never been pain free.
 
I’m so sorry, especially with this new injury/setback. Please be very careful with it, give it lots of rest so it can heal.

Keep making those phone calls and now you can mention a new injury. Hopefully that will get you an appointment faster. :console2:
 
Thank you. Have made it up the stairs backwards on my bottom but my partner had to haul me off the floor. Good job he was a fireman! Hope tomorrow brings some relief.
 
11 1/2 month update.
Knee still painful after walking and swollen. Still can't walk upstairs properly and often have to go up on all fours as my other knee is so bad now. A couple of weeks ago walked just under two miles slowly with stick and just about managed but pain was quite significant for few days after. Knee seems to have to click painfully through a certain point, between about 30 and 90 degrees, with each step. Have finished hydrotherapy sessions (12) which has strengthened muscles but lead physio examined me last week and said they can't do any more as my knee is "catching" and I needed to ring OS secretary every day to get urgent appointment. Saw my GP again last Friday and she said she'd write again, but as they ignored her June letter was not very optimistic. She has changed pain meds from Tramadol to Gabapentin which seems to have helped slightly. Saturday evening I emailed the Patient Advice and Liason Service and complained and lo and behold I got a reply this morning with an appointment to see the new OS! (Ealing Gran, you were right!). It's not till 5th Jan 2024 but at least I know something is happening which is a massive relief. I'm afraid at this point I still regret having the op as I have had constant pain like before surgery but I was never this incapacitated then.
 
Hello alija,
I am sorry for your struggles with pain and the difficulty you've faced trying to schedule an appointment.
Thankfully the switch in meds is helping somewhat and you finally have an appointment with a new OS to look forward to.
Wishing you lots of comfort. We're here for you always. :console2: Please keep is posted.
@alija
 
Hello @alija
I am wondering how your appointment went. I read your posts and feel for you. I had my surgery around the same time you had yours. I have not been happy with my surgery either. I am starting the new year with a new ortho doctor and had an MRI on my back, then saw a neurologist and a pain management doctor. You gotta do what you gotta do to get better. You're right, this can't be your life. Not acceptable.
 
I'm afraid my appointment got postponed till the end of the month due to the doctors strikes. I have been trying to exercise without using my legs too much but my knee swells every time I use it. Both knees are now starting to give way. The new painkillers are helping but I don't want to take them forever. I have had a private consultation but he said I should be more forceful in seeing my NHS Consultant, easier said than done and believe me I've tried. There are too many people waiting in the system. I simply can't afford to do the whole thing self pay, it costs a fortune!
 
I'm so sorry to read that your appointment has been postponed. I pray you can find out what is causing all this swelling and discomfort.
 
Oh no! I hope you can get some help soon and find out what is going on. Please let us know. I am so frustrated on your behalf that it’s been so difficult to even get this evaluated, when there is clearly a problem that should have been addressed so much sooner.
 
14 month post op. Saw new Consultant last week and he agreed it's significantly swollen. Ordered MRI and I am on theatre waiting list to have fluid drawn off to test for low grade infection. The MRI showed lots of fluid but is awaiting a specialist radiologist report as image degradation from metalwork makes it difficult to interpret. I have progressed with pool exercises and can now do quite a few "doggy paddle legs". It used to be too painful to do one! Still can't lie on unaffected side, even with pillow support , which seems weird. Starting to cut down my Gabapentin to see if I can manage without. Stairs are improving slowly but have started to mind my 1 year old grandson and carrying him around has set my knee throbbing again. Feeling more optimistic that there may be an end to this long saga of constant pain.
 
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