TKR Widget1's recovery thread

[Widget1]

@kneeper
I'm glad I told the OS about the experience, because he had recommended this particular home health agency. The only way I knew that he had called their director is because I called the agency to speak to the director and ask that a note be put in the personnel file of the female therapist (I had two therapists) about how amazing and encouraging and skilled she was with my therapy. The director told me that my OS had called about the nurse, and that the nurse had told the director that she hadn't done any of those things. The nurse that was assigned to me was a temp covering for the regular nurse who was out on leave.

 

[Kssii]

"The CEO personally wrote me a letter in response and detailed the steps that were being taken and who was leading an investigation (the COO, the CNO and the Director of Patient Relations). One of the follow-up letters I received stated that employee training was being evaluated, that old equipment was being replaced (like the corroded commode), and that patient bathrooms would be undergoing deep cleaning (no one did any cleaning of the patient bathroom during the 4 days I was there)."

Can You say fear of a "LAW SUIT?" That is why the CEO is sending you letters and promising improvements--although they might actually follow through.

 

[Widget1]

I'm having a slight issue and am reaching out to this community for ideas/assistance.

Today is the three month "anniversary" of my left TKR. Everything has been pretty great in my recovery journey. However, three weeks ago it started feeling like an auger was grinding inside my knee (medial side adjacent to my patella and by the lower end of femur), and the knee was "hot" again like it was the first 4-5 weeks post-op. I went to the OS office (but saw a Fellow, not my OS) and was told that it was tendinopathy and I should just take it easy for a week (the x-rays taken that day looked fine). I hadn't been doing anything strenuous prior to that either. He told me to take Aleve or Advil to relieve the pain and if I had any other problems before next May I should just see my primary MD. The issue resolved last week (without any action on my part).

However, last night the stabbing/grinding pain started again and that area is swollen again and hot. I'm not running a fever, but it hurts to sit or walk or even lie down, and the pain is constant. I don't know if "tendinopathy" is a recurring condition or if I've done something to make this happen, or really how to make it go away. Do you have any suggestions for me? Thank you in advance for your help!

 

[Widget1]

Can You say fear of a "LAW SUIT?" That is why the CEO is sending you letters and promising improvements--although they might actually follow through.

@Kssii - You're probably correct about the fear of a lawsuit. They only addressed the issues with the commode, lack of paper towels and the patient bathroom filth, and that's probably because I sent them the photos I'd taken in the room. There was no mention of why I wasn't in the Joint Replacement Center or even on the Ortho floor, why no one responded when I asked for assistance multiple times, why I was left on a bedpan for over three hours and then had to sleep in a urine-soaked gown because they said there weren't any clean ones available until morning, why I didn't get the therapy that I was supposed to receive while an inpatient, why I was sent home with both syringes of a blood thinner drug to inject in my stomach twice a day and coumadin (when my OS ordered only coumadin and my INR/PT was so out of range that I couldn't have therapy for the first week at home), etc.

 

[mytrose43]

Wow that is like a nightmare story I don't understand how a hospital can be so callus when it comes to patients health I was not happy with my stay in the hospital but nothing like what you endured mine was a cleaning thing also I was not offered a sponge bath or a shower or a clean gown or sheets the whole 5 days I was there .like you I did write a letter and verbally complained but it seemed to fall on sorry but we were short staffed and were very busy this is a small hospital the only one in the entire county so I don't expect much in response as I am 11 weeks out and luckily no infection at least I was able to get up and wash daily.

Sent from my XT1080 using Tapatalk

 

[Widget1]

@mytrose43 I didn't have clean sheets either the entire time I was there. The only saving grace for me was that I was instructed to bring street clothes to wear in the joint replacement center, as there was a physical therapy unit within the center, etc. The morning after sleeping in the urine soaked gown (which was my 1st night there), I used some baby wipes and then changed (on the bed) into my own clothes. There was never anyone around to help me to the bathroom and I wasn't provided a walker until later that day. They had the yellow wrist band and yellow sheet for the bed to indicate I was a fall risk, but those two things were thrown into the trash by someone during the first night.

 

[PolarBear60]

If your nurse had patients dancing, they were slow dancing clinging to someone else.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[skigirl]

It just gets worse and worse, doesn't it!!! If you are going to have another tkr, I went to the hospital a week before my surgery and spoke to the Head Nurse about my experience. I told her that I wanted a proper private room, etc. In your case there should have been a gaurantee of the joint center since you were scheduled so far in advance. Ugh, getting the brush off is the worst---that is pretty much what I got too---they even had the nerve to say to me---You were heavily medicated!! I pointed out that my husband, who was with me and verified my story was not medicated!!!

It was amazing to me that they would use my medications to excuse the horrible nursing care that I got.

But, back to your question, it is interesting, he said tendon---but which tendon???? I have had some issues with my IT band--it is a fibrous band which connects your hip to your knee. It can become shortened when you have knee problems and then cause problems after the tkr. I will give you the library articles on it

ITB (ilio-tibial band) issues and treatments

If this does not seem right to you, it is okay to call the doc's office and tell them that the pain has returned and that you want a pt referral. The pt will receive the notes from the office and should be able to help you work on the injured tendon.

 

[Widget1]

@skigirl - Thanks so much for the library article! I don't think it's the IT band, because the pain and a bit of swelling is only on the inside of my leg from the middle of patella and up. I'll call the doc's office on Monday and tell them the pain has returned and that I'd like a pt referral. One of their ortho offices w/pt section is only about a mile from me and I'll go there. I haven't had any pt since week 4 post-op, as the therapist and OS office said I didn't need further pt because I was already at a month 6 level and perfect gait, etc.

I'm so grateful that this forum exists, because I've never known anyone who has had a TKR and don't know the proper terminology or questions that I should be asking. When it comes time for my right TKR I'll have a wealth of knowledge from this time around. The sister of a friend had both hips replaced a year ago and had glowing recommendations for the joint replacement center and the private room and personalized pt and ot care from recovery through discharge.

 

[skigirl]

good idea. Then, when you see the PT have him/her describe exactly what tendon is inflamed. If it is your patella tendon, it could be making the patella tilt which then hurts when you step on the knee. At any rate, you need a good diagnosis of the problem, then you can work on how to fix it.

 

[Widget1]

I left a message requesting a PT referral because the tendinopathy I was diagnosed with on August 11th had returned. The office said someone would call me back within 48 hours. BTW this is standard for this office, as I saw the OS for 2 min. when the surgery was scheduled, for 30 seconds prior to being wheeled into the OR, and less than 5 min. at my 7-1/2 week checkup. All the other times I was seen by one Fellow or another working with him.

Hopefully I will receive a PT referral, and will go to the local PT center for this ortho practice. However, I want to be better informed than I've been through this journey thus far. What should I ask when I see the PT (other than asking about what tendon is involved, how to reduce the pain)?

I went from walker to cane the first day after hospital discharge, and stopped using the cane the following week. After 10 days I was walking a mile a day with no limp and no pain while walking - but during those days I was taking 2 Norco every 4 hours because of the pain. After my home PT discharge at 4 weeks, the therapist said I would not need any further PT and that I wouldn't need to be icing any more either. I did ice and elevate and rest after that time, and still take 1 Norco and 1 melatonin at bedtime because I'm still having pain, especially at night. I was walking at least 3 miles a day until we had the deluge of rain and flooding.

I cannot take aspirin (other than one 81mg per week) because of my GERD. I'm not able to take NSAIDS because of the red & yellow box warning on my pharmacogenomics test (CYP2C9 Phenotype), and have a very low sensitivity to opiates (yellow box warning that my dosage would have to be double). The Fellow who diagnosed the tendinopathy said I should just take some aspirin for pain and take it easy and the problem would resolve itself. My ROM at that visit was down to 0/120.

The pain is on the medial side of my upper knee (adjacent to my incision), and the area has swelling and is hot to the touch, and the upper 5" of my incision is dark purple, with the purple area at the top 2" of the incision extending about an inch in either direction. The lower part of my incision is just red and is healing okay. It's the left side of my knee that's completely numb. For the last 2+ years I've had an issue with bone marrow edema in that area of that knee. I don't know if this has anything to do with it, but the only similarity is the swelling on that side.

I wasn't overdoing anything prior to this swelling and pain, and am not overdoing anything now. Two days after hospital discharge I started working on 18 orders I had (I have an online store). Working on the orders and subsequent orders put no strain on me, and I paced myself and also had my mailman pick up my outgoing packages (because I was unable to drive for 7-1/2 weeks). Prior to surgery I reworked my studio so that I wouldn't have to go down to the floor or twist around, etc. and it's a comfortable place for me to work. I was asked to participate in Fashion Week again next month but declined because I didn't know if I'd be ready to do that and didn't want to be stressed if I accepted and then would have to pull out.

Thank you in advance for any guidance you can provide, and I appreciate it so much!

 

[SarahJane]

Widget, I'm going to tag our nurse adviser, @Josephine, since your situation has me scratching my head, while she's a long-time orthopedic nurse and might have some insight.

 

[Widget1]

@SarahJane - thank you!

The OS office hasn't called me back, and my knee is so angry today (and I was up most of the night). It even hurts to walk, and I haven't had pain like this since June, and haven't limped when I walked since then either. The medial side of my knee is still swollen, very hot and the purple area along my incision has not lightened in color any. At the end of July the entire incision area was a pale red and looked like it was healing so nicely.

I am unable to just walk into the PT clinic at the OS practice and be seen. If I go to the local ER it will be pointless as well because they don't have any Ortho Doctors on staff - when I went there last fall after my left leg became completely stiff & couldn't bend it after the SynVisc One injection, they just had me stay there for 8 hours, then discharged me with prescriptions for Tramadol and Naproxen, and said I should see the OS who gave me the injection. I had already tried that earlier that day and the earliest appointment was 3 weeks away.

 

[Josephine]

I went from walker to cane the first day after hospital discharge, and stopped using the cane the following week. After 10 days I was walking a mile a day with no limp and no pain while walking - but during those days I was taking 2 Norco every 4 hours because of the pain.

Those two statements are contradictory!

The pain is on the medial side of my upper knee (adjacent to my incision), and the area has swelling and is hot to the touch

Can you tell me the exact site of your pain using this chart?

Please note the instructions in the smaller image

the upper 5" of my incision is dark purple, with the purple area at the top 2" of the incision extending about an inch in either direction

How about a photo?

It's the left side of my knee that's completely numb.

Perfectly normal and I don't know why surgeons don't tell their patients that!
Numb area after TKR: how long will it last?

I wasn't overdoing anything prior to this swelling and pain, and am not overdoing anything now

Well, forgive me but I'm going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT exercises and exercises at home are you doing? How much and how often?

Can you detail it like this

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Strait leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[Widget1]

those two statements are contradictory!

I meant that while using Norco I was able to walk without limping, and always followed up my 1-3 mile walks with elevating my leg and icing. Other activities, especially heel slides, had level of 5-7 even while on Norco.

C LF4 and D LF4

I'll take a photo later and post it.

Perfectly normal and I don't know why surgeons don't tell their patients that! Numb area after TKR: how long will it last?

I realize that's normal, just wanted to be clear that the pain and swelling I have now is on the other side, not the numb side.

1. Pain currently at about 3, with spikes to 6-7 when the pain feels like a knife turning inside the C LF4 and D LF4 areas. The C LF4 and D LF4 area is where a Fellow in the OS office diagnosed tendinopathy on August 11th.

2. I take one Norco 5/325 at bedtime (the pain still persists during the night). The OS office said I should stop the Norco at week 7 and just take aspirin or NSAID, but I'm unable to do that because of reactions to both. My primary MD told me to continue to take one Norco right before bedtime.

3. I'm icing my knee 2-3 times a day, for about an hour each time. I use the device prescribed by my OS - it's large and the ice insert is large and covers my entire knee area front - back. It closes with straps, and there's a bulb part of it that I squeeze to have compression. The PT told me at end of week 4 I shouldn't have to ice any longer, but I keep icing now at almost 14 weeks.

4. I'm elevating my leg 2-3 times a day (during the time I'm icing) and I also elevate it (but not as high) when I'm sleeping.

5. My ROM is 128-139 and 0. At week 4 it was 132/0, and fluctuates now. When I was seen 3 weeks ago for the tendinopathy it was 128/0.

6. I live alone and have been doing all my housework, cooking, cleaning, shopping (with a ride for first 7 weeks) since week 1. I also have an online store (with home studio) and only slowed down in week 1.

7. The OS stopped my at-home PT after 4 weeks and said I didn't need any further PT. I left a message Monday with OS asking for PT referral because the tendinopathy is now worse than it was on August 11, and I'd like the therapist to evaluate and provide exercises, etc. to aid in getting rid of this tendinopathy (no return call yet). When I can (because of storms/flooding we've had) I still walk at least a mile a day outside (switching from grass to sidewalk, etc. to vary the terrain), and also go to a mall where I can walk indoors as well. I go swimming (in lap pool) three times a week for about 1-1/2 hours. When I'm sitting for awhile (like when on computer) I routinely move my left heel back under the chair to keep my flexion. Tomorrow it will be 14 weeks since surgery, and my in-home PT had me stop the leg raises and the other easy exercises after week 1 (I was 119/0 and walking without a cane at that point). I'm still doing the wall slides and exercising on a step every day or so, but have stopped the squats because the right side of my left knee feels like fire when I attempt to do them.

 

[Josephine]

1. Pain currently at about 3, with spikes to 6-7 when the pain feels like a knife turning inside the C LF4 and D LF4 areas. The C LF4 and D LF4 area is where a Fellow in the OS office diagnosed tendinopathy on August 11th.

Well he's correct! But the structure that is inflamed is most likely the ITB (ilio-tibial band) and that's not too bad to manage as you will see from the article.

I realize that's normal, just wanted to be clear that the pain and swelling I have now is on the other side, not the numb side.

Really?That's not what you've indicated from the chart. Can you clarify some more?

Other activities, especially heel slides, had level of 5-7 even while on Norco.

You're probably doing them to harshly. Read this Heel slides and how to do them.

2. I take one Norco 5/325 at bedtime (the pain still persists during the night). The OS office said I should stop the Norco at week 7 and just take aspirin or NSAID, but I'm unable to do that because of reactions to both. My primary MD told me to continue to take one Norco right before bedtime.

Is that the pain in your knee, the one indicated above?
Aspirin is an NSAID and an extremely mild pain killer. You'd be much better off taking Tylenol 1,000mg 3-4 times a day. Or better yet, see a chiropractor. They're very good at treating tendinitis.

3. I'm icing my knee 2-3 times a day, for about an hour each time. I use the device prescribed by my OS - it's large and the ice insert is large and covers my entire knee area front - back. It closes with straps, and there's a bulb part of it that I squeeze to have compression. The PT told me at end of week 4 I shouldn't have to ice any longer, but I keep icing now at almost 14 weeks.
4. I'm elevating my leg 2-3 times a day (during the time I'm icing) and I also elevate it (but not as high) when I'm sleeping.

All excellent.

5. My ROM is 128-139 and 0. At week 4 it was 132/0, and fluctuates now. When I was seen 3 weeks ago for the tendinopathy it was 128/0.

Well, you do know you're not actually losing ROM, don't you? it's just being hampered by the pain but it's still there and will be available when that's cleared up.

6. I live alone and have been doing all my housework, cooking, cleaning, shopping (with a ride for first 7 weeks) since week 1. I also have an online store (with home studio) and only slowed down in week 1.

I live alone too and prioritise my cleaning: first is the kitchen and sitting room as they are most used and open to public view but I might do them about once a week if that! Second is my bathroom, third my bedroom which gets done - er - less often and the rest - study, spare room and such - might see the backside of a duster about 3-4 times a year! In other words, don't over do things. Nobody knows but you!

Tomorrow it will be 14 weeks since surgery, and my in-home PT had me stop the leg raises and the other easy exercises after week 1 (I was 119/0 and walking without a cane at that point).

Well your PT was very wise!

7. The OS stopped my at-home PT after 4 weeks and said I didn't need any further PT.

And so was your OS! Remember that - you don't need any further PT!

I left a message Monday with OS asking for PT referral because the tendinopathy is now worse than it was on August 11, and I'd like the therapist to evaluate and provide exercises, etc. to aid in getting rid of this tendinopathy (no return call yet).

Want me to repeat your surgeon's comment? It's overdoing it is causing your ITB issues so the very last thing you need is another exercise!

When I can (because of storms/flooding we've had) I still walk at least a mile a day outside (switching from grass to sidewalk, etc. to vary the terrain), and also go to a mall where I can walk indoors as well.

I would strongly suggest you stop doing this because you're making your ITB pain worse!

I go swimming (in lap pool) three times a week for about 1½ hours.

Same here. Give this a rest for a few weeks. It's not doing you any good.

When I'm sitting for awhile (like when on computer) I routinely move my left heel back under the chair to keep my flexion.

I'm betting to be like a cracked record here - please don't do this. Your ROM is fine. Let your knee rest.

I'm still doing the wall slides and exercising on a step every day or so, but have stopped the squats because the right side of my left knee feels like fire when I attempt to do them.

Well at least you've recognised the squats were injurious but do you not see that so are wall slides and steps. Your OS said you don't need any more PT and he's right. You certainly don't need all this at 14 weeks!

So in summary, please stop
walking at least a mile a day
swimming three times a week
move my left heel back under the chair
wall slides
step exercises

If you want this IT band tendinitis to settle down and go away, stop it all. I'm not kidding.
And you will eventually find your ROM gets better too.

 

[Widget1]

Thank you, Josephine!

I really messed up on the chart (maybe I should get my eyes checked) because the pain is on C LF3 and D LF4. That's the same area that the OS said I had extensive damage in, and that he'd had to remove more of my femur than normal and there were some bone growths that thankfully came back from pathology as benign. But I shouldn't have pain due to that, because the OS removed the damage prior to cementing the knee in.

As of right now I'm stopping the things I was doing (the Fellow told me to take it easy for a week or two and it should resolve), and I should have listened to him and not considered that swimming and walking that much might be contributing to the issues with the pain.

I will check into seeing a chiropractor, as there is one in the OS ortho institute, and perhaps he can help me resolve this. The only "company" I've had this summer consisted of the two PT and the home health nurse, and they've all been gone since first week in July. When they came I was worried that they'd see some dust I'd missed, etc. Now it doesn't matter because it's really not dirty, and I'm fine with it. This surgery has stopped my scrubbing my floors on hands and knees, and I've switched to a Swiffer.

Thank you for the reassurance that my ROM has not gone away, and that I'll be able to recover it. I was worried that I'd messed it up somehow.

 

[Pescara]

@Widget1 I keep forgetting to ask where in Florida do you live? Manatee Memorial and Blake Memorial both have a separate OS floor. I hear Blake is better but Manatee was good for me. Look on the internet and check them both out. I went to Manatee first then Blake and recommend either one. The PT at both were great and both have private rooms so no sharing!

 

[Widget1]

@Pescara - I'm one county north of you (waving to my southern neighbor!).

When I had my surgery at Tampa General I was supposed to be in their joint replacement center (which was named tops in FL last 3 years by US Business & World Report), and was told at pre-op that I'd have a private room and that I should bring street clothes to wear starting day after surgery, and that I'd have PT right there in the center (I even had a brochure detailing the layout of the center, etc.).

Obviously that didn't happen, and after waiting in recovery for something like 7 hours I was finally taken to a room in the vascular unit on another floor (and I have no vascular issues). I distinctly remember asking twice in the elevator when it passed by the 7th floor why we weren't going to the joint replacement center, and receiving no answer. From that point on it was like I'd been forgotten about, because I had to beg on day 2 for a walker and to be shown how to use it so that I could use the bathroom. I copied my OS and Internist on the letter I sent to the TGH CEO, because when my OS was chief of staff he started the joint replacement center, and he brings an awful lot of money to that hospital each year with the ortho patients admitted. I knew the morning of the surgery (I was the first case of the day) that a surgeon would open me, then my OS would put in the new knee and make sure everything was fine, and then yet another surgeon would close. I also knew that my OS would not be visiting me in the hospital, but that one of the Fellows or other surgeons working with him would. No one visited me, and my discharge was delayed until they could find an OS resident to do the discharge. I guess I ceased to be an ortho patient once I was put on the vascular floor. None of the staff on the vascular floor had any experience with ortho.

 

[Pescara]

@Widget1 If you go to either one of the hospital in Bradenton we can finally meet and share our misery lol. You have been a wonderful friend and I will make sure you get great care. I have been to both so I think I have a little pull lol xx