Bilateral TKR Where to begin, did too much?

[Tmgrl3]

5 months tomorrow. Doing well. Rarely take tramadol at bedtime...occasionally at night a 25 mg or 50mg if I overdo. Eliptical several times a week. Otherwise just normal daily activities. Best in am and get tighter as day wears on. Climbing stairs more of an effort then. Still trying for two icings a day. Always one at bedtime. Still feel like fake knees, like wooden blocks in place of them, but still range of motion at max. So all in all better and not stopping me from any activities. Rarely take cane with me. Balance much better but a ways to go. So all in all, progress as expected. I can see why doctor said a full year to feel “ normal.” I’ll take this though!

 

[Tmgrl3]

Almost 6 months since my bilateral knee replacement and , in general? doing very well.I do take an occasional 25 mg of tramadol at two or three in the morning so I can go back to sleep. I take none during the day but find that I have just enough pain some nights to keep me from going back to sleep. Also I can only sleep on my right side so that me and the inside of the left take a little bit more hammering.

I do take an occasional 25 mg of tramadol at two or three in the morning so I can go back to sleep. I take none during the day but find that I have just enough pain some nights to keep me from going back to sleep. Also I can only sleep on my right side so that me and the inside of left take a little bit more hammering.

Today I developed a sharp pain in my right knee, somewhat like a nerve pain, so I’m taking it easy but had a recent UTI with a strange history. I hadn’t had a UTI in 30 years until the year before my double knee replacement. Then on July 10 I went to the urologist and left a cloudy urine sample at my yearly yearly check up. Somehow I never got the results and the report later on about eight weeks ago today I developed a sharp pain in my right knee, I had no real symptoms other than slightly cloudy urine which was the only symptom I had a year ago.

Then on August 26 two days before my hubby zero logical surgery I noticed that my urine was extremely cloudy and decided to drop off a sample at the doctors office. The first two reports said that the sample testing was canceled at the lab but I started taking Macrobid that day because the urine was so cloudy. About four days later I got a call and saw results online that I had an e,Coli UTI was significant inflammation. Fortunately by day two of taking the Macrobid my urine was clear but I did continue to finish the full seven days. I now wonder if I had had that UTI since my visit July 10 when I never got results and when the urologist assumed that I would start on Macrobid since I was symptomatic. I have no other symptoms than cloudy urine. No burning no fever. Nothing but the cloudiness.

Has anyone else had a UTI that was not treated for a while that became bacteremia and went to their joint replacement? Would I have to have a fever or some inflammation other than this pain today for there to be a joint Infection, or can I assume that because the Macrobid cleared up the cloudiness in two days that I’m probably good since everything went in the right direction and not towards fever, bacteremia, or sepsis?

Appreciate any thoughts from anyone on this in any experiences anyone has had regarding UTIs and knee replacement infections.

I think I may go back to PT which I stopped over a month ago because the physical therapist and the doctor felt I was at the point of having achieved all my goals. When I’m on my feet all day I get very tired and my balance is off and I could use some strength work even though I have done some basic leg exercises and a little work on the elliptical since I stopped PT

 

[knee#2]

@Tmgrl3 following to see what others say... I developed UTI following week after TKR and another last week.. we have to be so particular about resolving infections.. I also have newly implanted pacemaker so I’m very cautious, you have brought up some good questions.

 

[sistersinhim]

I had my first UTI shortly after having my UTI, also. I will tag @Celle, one of our nurses and see what she has to say about your concerns.

 

[Celle]

It's always best to get a UTI treated, because it's not good for you to develop a chronic infection.
In theory, a UTI could spread to your new joint, but in the 8 years I've been on BoneSmart I haven't heard of anyone this has happened to.

Macrobid is Nitrofurantoin, which is an antibiotic often effective at treating a UTI, but you should probably check with your own doctor, to make sure the infection is gone. He/she can test your urine for blood, protein and leucocytes which, if present, would indicate that you still have an infection. It is possible to still have an infection, even if your urine isn't cloudy.

If an infection is still present, a urine sample should be sent off, to be tested for which antibiotics would be most effective at curing it.

 

[Dolly Girl]

Go to sleep hygiene, and really follow it.

 

[Tmgrl3]

Thanks for the replies! I did have a UTI and I did treat it with Macrobid. So all good on that front. I am now 6 months and one week out from my double knee replacement. In general, all is good. I went to see my regular orthopedist who is now tracking me since I am long done with PT and have at home exercises mostly consisting of squats and stretches. I had gone to 2% on leg extension so encouraged to do some push downs on knee when extended to maintain that 0 %.

Overall, my sleep has been good. Generally just my usual tylenol. The ortho noticed that the day I went, some inflammation in both knees and I did have the aching, stiffness I get especially when I run around all day. Correction “walk” around. He said I should still be on an NSAID, but I said I never took NSAIDs, except for a few days at a time, in my whole life because I don’t do well with side effects. He gave me Celebrex. I took it for two days and put on 3 pounds of fluids, and my BP was elevated, but my knee swelling went down.

I was on the eliptical which I have at home, too, when I was at PT, 10 to 15 minutes. Lately I have been back on it a few times a week, never two days in a row, but yesterday I did 20 minutes, 1.4 miles, and instead of the during the night discomfort I could handle, I had pretty severe pain under both knee caps about six hours into the night. I am up icing both knees now..

Wondering what other people’s experiences are with using the eliptical. I don’t bike anymore because I got regular abscesses from that no matter what I did, so pre-surgery I had already replaced my bike with a professional eliptical.

My guess is I just did too much and maybe too fast. 30 RPM.

It seems that if I just do my normal daily living routine, I manage nicely. I am going to be 77 a few weeks. My dental hygienist was surprised I still had some pain, stiffness and discomfort, and wondered if I should still be in PT or see the OS, but I reminded her that while she had one knee done and is much younger, I am older than she and that I had a bilateral.

I was taking a 25 mg tramadol a few days a month when I woke up with pain at 2 or 3 am, till September 3. The orthopedic doctor said to stop taking it completely so I did. I do agree that pain is a symptom and at this stage I don’t want to mask anything else. Dentist and doc still want me to premedicate even before cleaning teeth, but this week, I had it with me but had forgotten to take it so we rescheduled appointment for next week.

My OS did say one full year to full recovery so I taking him at face value and assuming that these little painful setbacks linked to what is probably over exercise are “normal.”

Thanks everyone. Backing up to catch up on some newer threads.

 

[marieltha]

Great post by @Roy Gardiner (advisor) in @FitGal’s thread about stretching & exercise during recovery versus training. He even gave links to how to video. Valuable information for avoiding overdoing and chronic inflammation.
He would be a good one to ask about the elliptical.

It takes about a month for a body to adjust to Celebrex, I was told initially. I drink less coffee with mine at breakfast. I always take it soon after a full meal.

Good luck!

 

[Tmgrl3]

Thanks, Marieltha. I will check out the link. I simply can’t take NSAIDs...my fluid retention and blood pressure shoot up by day 2-3 and that’s on 200 mg of Celebrex only ONCE a day. I am not really training! LOL. However, my muscles need some building up . Took first long walk at our mall today. Maybe 4 blocks in all. My balance a bit wobbly so need to get my balance pad out and work with it, but then, with a bilateral knee, the OS said I will experience a different recovery from unilaterals. Both knees were cut into. I will be going back on Fosamax next month too. My stomach tolerates these meds even though I have controlled GERD and hiatal hernia.

Thanks again for the info to check out. I really have just begun to do more regular work. My hubby had two major operations in 11 months. Then my knees in same period. He had a triple lumbar fusion and recently a urological surgery requiring hospital stay. Will keep posting as I go.

 

[Tmgrl3]

October 31, 2019 7 months and 10 days post op. Balance much better. Sleeping mostly without pain at night and no pillow between my legs for first time, these past two nights. All in all functioning well with daily living, plus 20-25 minutes on eliptical.

I did have a THR 10 years ago right hip, and somehow my right leg is lagging a bit. Lately , I get low back pain, and hip pain in groin,mostly if I try to do the marching leg lift. Can do one or two and then get pain in groin, down leg...but not so much IN the knee. Yesterday I was on my feet all day long till about 6 pm when I did first icing. Today took it easy but still couldn’t do more than 5 of the leg marching lifts with right leg. Maybe an overdo yesterday? Or maybe the 25 minute eliptical workout earlier this week. I had been doing 10 to 15 minutes. So icing now and hoping nothing going on with hip other than overdo and having two joints replaced on right side. That leg had a little wobble in it when I did biked motion or raising leg in marching position from start, but then got stronger and it straightened out when I did the march. I have appointment November 27 to see OS but think I might see my regular Orthopedic doctor and see what he thinks. Maybe rest for few days and gradually reintroduce the marching motion to strengthen that leg overall. The surgeon said that if I had hip pain on outside of hip it was bursitis but inside groin it could be related to joint replacement. Have had NO hip pain since hip healed 10 years ago except for occasional bouts of bursitis on out part of hip. Low back pain too, a 40 year history of that so that hurts today today. Hopefully just too much eliptical and too long on my feet yesterday. My orthopedic doc said I should still be taking some antiinflammatories but they all cause fluid retention and bp elevation and affect my GERD, so icing is my only option. I have no pain sitting, or while sleeping so hope it is a muscle thing going on.

 

[Tmgrl3]

Also, been reading about arthrofibrosis and hoping this isn’t my pain in right groin and leg when I life knee to marching. I forgot to take my am meds, so no diuretic, BP meds...holding fluids which may be everywhere including knees. Hopefully, not real inflammation, since no NSAIDs for me. I still have 130 degrees of flex ion and 0 degrees extension. I push down on leg above the knee to keep extension as doc told me a month ago.

 

[Roy Gardiner]

I don’t bike anymore because I got regular abscesses from that no matter what I did

If you'd reconsider cycling if you didn't get them, I might be able to help.

 

[Tmgrl3]

Thanks, Roy. No...not going to reconsider. Got rid of my huge pro bike and have an Octane eliptical. Seeing my orthopedic doctor this week. Just hope I don’t have an infection brewing.

 

[marieltha]

Hi, I hope your OS visit goes well and you do not have an infection.

I just used a seated Octane elliptical for the first time, after reading about @luvcats and @Carole4815 using it, and I liked it. Is yours seated or upright?

Also, I have had 2 lateral PKRs and my OS gave me exercises (no PT), but never mentioned marching. So I was intrigued at your mentioning it. Has this been part of your PT/exercise plan?

 

[Carole4815]

@marieltha , and @Tmgrl3 , that is the exact same seated elliptical that I like so much, the Octane. What a great machine, and if used carefully it can be very easy on a new knee.

 

[Tmgrl3]

Hi, I hope your OS visit goes well and you do not have an infection.

I just used a seated Octane elliptical for the first time, after reading about @luvcats and @Carole4815 using it, and I liked it. Is yours seated or upright?

Also, I have had 2 lateral PKRs and my OS gave me exercises (no PT), but never mentioned marching. So I was intrigued at your mentioning it. Has this been part of your PT/exercise plan?

Hi Marieltha

I have a standing Octane. I found out recently I am supposed to have my knees slightly bent when I use it. I do that now. Last time I did 25 minutes. Maybe too much. 29 RPM. But also, I started Fosamax a week ago today and those side effects that are prominent can be joint and muscle pain. That can take up to a month to go away. My pain got better as week wore on and then I took my weekly dose yesterday again, and woke up with pain under my knee and in groin again. I am guessing Fosamax is the culprit since I assume infection would be ongoing and I would have other symptoms. I am holding off on seeing ortho unless it gets worse. I had the marching in place as soon as I got up from surgery. One leg at a time, 10 reps each leg to total 30 each leg...have standing exercises that work most of leg muscles and I can do them anywhere anytime. My PT said when he realeased me last June to do mini squats still, and stretching on stairs and pushing down on either side of knee while leg is extended between two chairs. To maintain extension and flexion. I thought that by 7 + months I would be pretty much pain free, but not so. Yesterday I ran 5 errands, some groceries (I have a chair lift at home to help) and I feel it today. Tired too. Who knows . Could be age (77) and errands and maybe side effects of Fosamax. I see OS in December.

 

[marieltha]

I have a standing Octane. I found out recently I am supposed to have my knees slightly bent when I use it.

The trainer who showed me how to use the seated Elliptical told me to make sure always that my leg was bent just a bit when fully extended, which sounds similar to what you were told.

Interesting about the marching. Thanks.

Good luck with the Fosamax. Hope the aches subside.

 

[Tmgrl3]

I have a standing Octane. I found out recently I am supposed to have my knees slightly bent when I use it.

The trainer who showed me how to use the seated Elliptical told me to make sure always that my leg was bent just a bit when fully extended, which sounds similar to what you were told.

Interesting about the marching. Thanks.

Good luck with the Fosamax. Hope the aches subside.

So we got same advice About the eliptical! I haven’t restarted Fosamax but my regular ortho ordered two MRIs, one of my 10 year old hip replacement and one of femur to make sure we got whole hip replacement. All came out great. No loosening at all, but then he said I shouldn’t start back on Fosamax so soon. Maybe second opinion so seeing another endocrinologist at NY Langone Center, docs who treat mostly unusual cases, including regular cancer treatment center. My gynecologist visit this week was also good. She isn’t a fan of bisphosphonates but prescribes for severe osteoporosis. My hip reading on DEXA she said is osteopenia and only osteoporosis was in wrist which the used to read instead of my spine since my severe scoliosis prevents clear read of my spine. Given that she said she wouldn’t rush me on them. The MRIs did show a partial tear in the hamstring which I wondered about since pain started after that 25 minute workout on my eliptical. However, it got better first week on fosamax and kicked up again after next weekly dose. Also the symptoms I had in groin and leg are sometimes the precursor to femur or hip fracture but they say the side effects like that usually (the fractures) occur after some time on the drugs. I will wait till 1/22/19 to see second endocrinologist. Mine is good, but very very young and I feel he is spouting the standing recommendation. My gynecologist said she would NEVER prescribe based on single reading and never on wrist alone. At least my hip and my knee look really really good. Just some mild edema in knee.

 

[marieltha]

So glad your hip and knee are looking great!
Your full discussion of the osteoporosis and fosamax was very informative.

 

[Tmgrl3]

So glad your hip and knee are looking great!
Your full discussion of the osteoporosis and fosamax was very informative.

Thanks! There is so much controversy about these drugs. Some studies show they help remodeling of bone after joint replacement but with three artificial joints in my body I want to be sure before I go back on those drugs. Different brands have same side effects and different kinds of drugs have , in some cases , worse ones.