Revision TKR Two Year Post Recovery - New Swelling and pain

[Celle]

HI @cammot
I'm sorry to hear that you are still having problems with pain and swelling.

I, too would have expected this to decrease by now, not get worse.

Have you contacted your surgeon about it? If not, I think it would be a good idea to do so.

By the way, I've merged your two recovery threads.

We do like people to have just one thread, so that we can see a continuous story about your recovery.

 

[Jamie]

I agree you should check with your surgeon. My guess is that when you were moving those heavy suitcases, you had some twisting motion in the process. That is tough on new knees. Even though your knees are almost a year old, twisting like that can really injure the soft tissue. It can take months to heal. But since you are having weight bearing pain, that's the thing to discuss with your doctor. He will likely take an x-ray to ensure that your implant is stable and that should reassure you a bit.

 

[cammot]

I checked with my surgeon with regards to the new swelling and pain that has emerged 10 months out since my op. They took x-rays and did not find anything broken. The surgeon said it could 1 to 2 years for full recovery !, I am just wondering if this is consistent with most recoveries ?

Secondly, he made another one year follow appointment (i.e. two year post ), suggesting that what is happening is more or less normal !. He did suggest that if the swelling persisted and pain continued, I could come back and he would drain the swelling fluid and also possibility give me a corticosteroid shot to relieve the pain.

Admittedly, I have been much more active with my affected knee. I do a lot of gardening and had to plant a small tree and had to dig out a hole for it, and also dug another small hole to plant a rose bush. These activities were done carefully, but naturally cause some stress to the affected knee. So I do understand why the swelling occurred, but now trying to assess what I should do moving forward.

Any thoughts or suggestions would be most welcome, with regards to the persistent swelling mostly.

Thanks

 

[cammot]

I am just coming on one year post TKR on my right. I have persistent knee swelling, that usually is exacerbated by simple activity as taking a 30 minute walk with my cane. I signed up by for PT with the sole purpose of getting knee massages snd support from my ortho who agreed said that I need two years for full recovery !!, My issue is with my physiotherapist who is knowledgable with advising on exercising education, but is somewhat reluctant to do a lymphatic massage on every weekly visit. My PT sessions are just a repetition of the same exercises, short session on the bike (which I already do at home) - but no lymphatic massage. I tried to hint that I need a knee massage on every visit, but its just ignored and the forty five minute session is up before I know it !!. I do the RICE procedure at home often and wear a knee sock.

Question: I understand its a tough sell to get anyone to do an intense lymphatic massage, I am not seeing any additional value with my PT sessions without the massage - any suggestions how I might address this situation ?, should I change my PT therapist ?

 

[Flutter1]

@cammot Is it possible to visit a certified massage therapist? There is an American Massage Therapy Association. Perhaps they could provide information. I am sorry you are still having problems with swelling.

 

[VolFan0927]

@cammot
Do they have other PT within the group. Within the practice my wife goes too she found out 2 of the PTA were certified in Graston massage. She now asks for those team members when scheduling visits, although she still has to remind them she want a massage at the end of the session. We may end up changing PT though, as my wife beleives it is important in her recovery.

 

[Sisterpat]

You absolutely have the right to change therapists if they are not doing what the doctor advised and you want!

 

[Jockette]

Maybe this particular PT is not trained in this type of massage. Ask for another PT or find another practice. Maybe ask your doctor to write lymphatic massage on the script for PT, to be sure you get it.

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one 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.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you. You can always bookmark this thread so you can find it easily.

Best wishes on your continuing recovery!

 

[kneeper]

@cammot
Do they have other PT within the group. Within the practice my wife goes too she found out 2 of the PTA were certified in Graston massage. She now asks for those team members when scheduling visits, although she still has to remind them she want a massage at the end of the session. We may end up changing PT though, as my wife beleives it is important in her recovery.

I'm not a fan of the Graston but I'm with Flutter1's suggestion of a certified massage therapist. Your health system may have a complementary medicine program with CMTs on staff. They would be used to working with people after joint replacements.

 

[cammot]

I am just completing my 13 months since surgery of my right TKR. In the past three to four months it seems that my recovery has worsen ! I am not sure what might be going on with my knee and trying to identify the issue, so we can proceed with proper treatment. The symptoms include constant swelling that flares up with activity, some tightness or stiffness, the pain is moderate and I have general weakness in the affected knee and overall thigh. The only pain med I was taking was Celebrex, but stopped this about three week ago as I started taking Turmeric 1000mg twice a day which initially reduced the swelling and helped with the pain.
What is unique, my first six months of my recovery seemed to be progressing well because I could walk longer distances and was feeling that recovery was progressing. But now, I just can’t make sense of what might have gone wrong!. Why would my recovery worsen?

Two thoughts that cross my mind is (i) possible loosening of the knee replacement or parts, or (ii) arthrofibrosis or abnormal scar tissue.

Are there any thoughts or suggestions what might be going on ?

Many Thanks

 

[Jockette]

Have you been checked for an infection?

If your current surgeon is not addressing this issue to your satisfaction then maybe it’s time for a second opinion, preferably by a revision surgeon who has no association with your current one. Seeing a revision surgeon does not guarantee that you will need a revision, but they may be more likely to see a problem that the original surgeon does not.

If you live in a small area I suggest going to a bigger city where they see many more cases with symptoms like yours.

Best wishes and let us know how it goes.

 

[Jockette]

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one 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.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you. You can always bookmark this thread so you can find it easily.

Best wishes on your continuing recovery!

 

[eaglemom]

I am wondering if your not doing more than you realize on a day to day basis. Swelling is an issue I personally struggle with - always have with each surgery. I know 13 months seems like a long time, but in reality with a TKR it is not. We all want to feel better and be able to do whatever we want - that's just our human nature I think. After a TKR it simply takes time, then some more time followed by, your guessed it, time.

If your wanting to get another opinion, make certain that you go to a clinic / facility that isn't associated with the surgeon whom did your TKR. Let us know what you decide to do.

 

[cammot]

Have you been checked for an infection?

If your current surgeon is not addressing this issue to your satisfaction then maybe it’s time for a second opinion, preferably by a revision surgeon who has no association with your current one. Seeing a revision surgeon does not guarantee that you will need a revision, but they may be more likely to see a problem that the original surgeon does not.

If you live in a small area I suggest going to a bigger city where they see many more cases with symptoms like yours.

Best wishes and let us know how it goes.

Thanks for your suggestion - very much appreciated

Regarding the possibility of infection, I had an interesting experience these past four weeks. In the face of my knee swelling, I had to take a course of antibiotics for an unrelated condition (prostate), soon after taking the a/b my swelling went down!, I thought I had uncovered a knee infection. I went immediately to my knee surgeon and told him what I had uncovered !. He brushed me off, suggesting that I would have been in hospital if an infection was present and the signs and symptoms would be very evident!, he said that he has seen other patient's get an improvement of their knee even if there was no infection. He said he could not take an blood draw to test for infection until two weeks after I complete my current course of a/b to get an accurate reading. I am schedule to meet with him after this point.

Regarding getting a second opinion - easier said, than done!, I am afraid that I might upset my current surgeon!, he may then tell me that if I don’t trust him I should go to the other surgeon. Since he did the original op and knows my situation, wouldn't he be a better doctor to do the revision? Just thinking and asking!, not cut in stone, I understand! - any thoughts how to approach this option ?

 

[cammot]

I had my first revision to my RTKR on December 3rd. The issue with my original TKR was a combination loosening and too smaller a size to the center plastic spacer, which caused persistent swelling. The doctor said he replaced all the parts and now I am in a recovery phase expecting some normalcy. My question relates to the immediate recovery phase, i.e. The first two to three weeks. In this first week, I am abiding with all the home PT instructions and doing due diligence with the exercises and daily frequency. All seems like normal progress for recovery. I am taking Tramadol 50mg and Tylenol 650mg every six hour, which is giving reasonable pain relief. I am using the walker, but can stand without it and even take a few steps with just a cane. It looks like I should be able to transition from the walker frame to just the cane by next week.

I am experiencing stiffness, and keeping my leg straight while lying down is working with some moderate difficulty. I notice my R leg wants to lean more to the right and the therapist has asked me to keep it straight with a pillow or other support and not allow it to lean to the right - is this normal ?. Secondly, as I exercise I am putting a little more pressure to muscles and tendons to keep the leg straight, its almost like I am attempting to go against the alignment - is this the proper way to achieve straightening ?, or should I allow and support the gravitational tendency to occur. This a subtle nuance that probably will make all the difference to achieve the intended goal of full leg straightening. Could someone kindly comment on exercising that goes against the gravitation tendency, in an effort to achieve a straight alignment?.

It also seems, that after day four there is a slight increase in my pain level, despite the swelling being reduced !. Is this normal ?. I also just switched from Tramadol to Oxycodone, as it was prescribed as an alternate to the Tramadol. Is this a good strategy to improve my pain level.

I take the compression sock off at night while asleep as it is too tight to have on 24 hours, I hope this won’t be an issue. Any thoughts ?, I did not use a compression sleeve sock the first time I had my TKR and had no problems not having them on.

Ay particular suggestions, for this early phase (first two to three weeks) after surgery ?

Thanks

 

[Indigo_Bunting]

I had my first revision to my RTKR on December 3rd. The issue with my original TKR was a combination loosening and too smaller a size to the center plastic spacer, which caused persistent swelling. The doctor said he replaced all the parts and now I am in a recovery phase expecting some normalcy. My question relates to the immediate recovery phase, i.e. The first two to three weeks. In this first week, I am abiding with all the home PT instructions and doing due diligence with the exercises and daily frequency. All seems like normal progress for recovery. I am taking Tramadol 50mg and Tylenol 650mg every six hour, which is giving reasonable pain relief. I am using the walker, but can stand without it and even take a few steps with just a cane. It looks like I should be able to transition from the walker frame to just the cane by next week.

I am experiencing stiffness, and keeping my leg straight while lying down is working with some moderate difficulty. I notice my R leg wants to lean more to the right and the therapist has asked me to keep it straight with a pillow or other support and not allow it to lean to the right - is this normal ?.

My left leg likes to lean out to the left. I asked my PT whether it’s important for my new mechanics to counter this tendency. She said no, don’t worry about it. It seems there are as many answers as there are PTs, but there’s one data point.

 

[Jockette]

Hi and to recovery!

It also seems, that after day four there is a slight increase in my pain level, despite the swelling being reduced !. Is this normal ?

It is very normal for your pain to fluctuate.

If your doctor insists on the compression hose, ask for a different size. It‘s not good if they are excessively tight. You could also ask if you can stop them, since you did fine without them the last time. Is it the same doctor?

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[cammot]

I am day six since my revision done on Dec 3rd. I am following all instruction closely, mostly the bed exercises and icing. The Therapist said we would start the chair exercises next week. It seems like I am making normal progress, but have a a couple of concerns and questions. First, as expected my swelling from the surgery has gone down appreciably - but the quality to the pain that I am now experience is a little more sharper and intense. Secondly, the pain meds, which is a combination of Tylenol 650mg and Tramadol 50mg every six hours is providing less relief than a few days earlier. Is this normal ?, that along with swelling reduction comes a different type of pain ?. Can someone please tell me what I can expect in the next week to two.
Thanks

 

[Jockette]

Can someone please tell me what I can expect in the next week to two.

You can pretty much expect things to be a lot the same for the next week or two, as this recovery is very slow. You will have ups and downs and pain will ebb and flow, especially depending on your activity, especially what exercises you do. Say no to any that cause immediate pain, and/or increase your pain and swelling within 24-48 hours. That kind of pain indicates that you are not quite ready for that exercise.

Tramadol can be a good step-down pain reliever. You can also take 1000mg of Tylenol every 6 hours as long as you count in all the meds you are taking that have Tylenol in them. If your doctor will prescribe the Tramadol here's a chart on how you can take it at the same time with Tylenol. Paracetamol is Tylenol.

The first is for 4-hourly doses and the second for 6-hourly:

 

[Jockette]

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one 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.

So, please keep all your posts in this thread. 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!