TKR Widget1's recovery thread

[Widget1]

@Pescara -
Is the LWR hospital a branch of Blake? Does your new OS use both MMH and Blake? I'm sure we'll meet at some point, even if it's for a quick lunch somewhere near you after your back is in better shape, and we can "compare" our journeys for our LTKRs that were one day apart, in hospitals that are one county apart.

 

[Pescara]

@Widget1 My new OS goes to Blake the old to Manatee. I don't know of any that go to LWR but it's supposed to be good. I know where it is and a bit further away. LWR is a nice area and more upscale than my area. It's about 1/2 hour from me and a little out in the country. It's a nice drive.

 

[Widget1]

I can't get in to see the chiropractor at the ortho practice until October, so I kept the PT eval this morning that the OS office ordered at my request, and knew I would not allow anything painful to be done to me. The therapist spent 90 minutes with me, and the exercises she had me do were so very gentle (still hurt, but as bad as other ones that I did at home).

Now I'm afraid that I've done something terribly wrong and that my knee won't recover fully (total fear of the unknown). My ROM used to be 132-9/0, and today it was 115/5. Today I'm at 15 weeks post L TKR, and it's been close to 7 weeks that I've had the pain on the inside of my left knee (B LF3, C LF3 and D LF3 from Josephine's illustration) that was diagnosed as tendinopathy by OS Fellow 5 weeks ago. The pain did not go away as the Fellow said it would, and seems to be worse than it was at the beginning of August. The therapist today said that I'm not straightening my leg when walking, and that I'm starting to get knock-kneed on the left knee with this bent knee gait. She said there is bursa swelling on the medial part of my knee, and that the part of my quads called the vastus medialis is very weak and must be strengthened. She said the lateral quads are perfectly strong, and when I move/walk the knee is going in the direction of the vastus medialis because it's so weak. I couldn't tell the strength of the lateral quads myself because the entire lateral knee area is still numb and I wouldn't know if the quads were good or bad if I had to describe feeling. The pain on the swollen medial side is almost constant, and is between 3-5, and I'm still elevating my leg and icing for at least 45 minutes several times a day.

I'm scheduled to return to outpatient PT on Monday morning, followed by a visit to my internist for a flu shot and a prescription for some type of pain medicine (I continue to take 1 Norco at bedtime, per my internist instructions in mid-July, and that OS written prescription runs out next week) and to discuss results from recent radiology tests and biopsies (not knee-related).

Please, does anyone have suggestions for me? I had to grab a pen and have the therapist spell vastus medialis for me and it's all very foreign to me. If this involved regulatory compliance I could have rattled off appropriate sections from the Code of Federal Regulations without pause, but this post-TKR world is a totally new one to me. Thank you for your assistance!!!

 

[Widget1]

My thanks to BoneSmarties are certainly heartfelt, but could I please request that this thread title be changed to Widget1's recovery thread? Thank you!

 

[Widget1]

In reference to my post a little over an hour ago...

1. Pain is constant 3-5, and has been that way for awhile on B LF3, C LF3 and D LF3 area of left knee (from the chart that Josephine posted).
2. Icing and elevating at least 3 times a day for at least 45 minutes.
3. Not doing any of the exercises that Josephine advised against doing (stopped walking, swimming, etc.)
4. ROM today was 115/5, when normally it's been 132-9/0 for last 2-1/2 months.
5. The new outpatient PT I saw this morning wants me to do the following exercises:
   1. Supine Gastroc Stretch - 4 times a set, twice a day
   2. Hamstring Stretch - 4 times a set, twice a day
   3. Quad Stretch, Left Leg EOB - 4 times a set, twice a day
   4. Trunk Stability Bridging - 10 times a set, once a day
   5. Hip / Knee Quad Set in Slight Flexion - 10 times per set, once a day
   6. Hip / Knee Strengthening: Terminal Knee Extension - 10 times per set, once a day
6. Will have ultrasound treatment starting Monday AM (I had it at least a dozen times in 2013 and 2014 and found little relief)
7. Noticed today that the Baker's cyst on back of my left knee is "full" (about 4x size of right one) and painful again. I've had problems with this cyst behind my left knee and had it drained in 2013 and 2014. Will OS office drain a Baker's cyst on a patient 3+months post-op on a TKR?

Thank you so very much for any advice, as I'm feeling quite overwhelmed and discouraged.

 

[Widget1]

@skigirl - I forgot to ask the therapist what the tendon name was that the "tendinopathy" was diagnosed on, but the therapist did mention 2 or 3 times about some tilting to the right when I walked and the knee not being able to be in locked position, the knock knee appearance when I walked, and then she gave me the vastus medialis being very weak explanation and I had to get the spelling for the vastus and asking about the name of the tendon slipped my mind.

 

[Widget1]

I finally put 2+2 together and figured out that an issue with my right foot is probably related to my not walking correctly on my left leg for the last month (due to dx tendinopathy on left knee). I've had sharp pain under my metatarsal on my right foot with every step in the last couple of weeks, and can feel pain in the same area I had a stress fracture on last fall, and I can tell the PF is trying to sneak back to hurt me. Last year when on crutches for 8 weeks after surgery on my left knee I relied on my right foot, and PF of right foot reared its ugly head, followed by a stress fracture of the foot 4 months later (the stress fracture was diagnosed as osteomyelitis by two different radiologists and I was so relieved that they were incorrect). If I have to go back to wearing the walking boot on the right foot, my gait for my still healing left knee will probably be a failure. Sorry, but this seems to be the day that I have my meltdown.

 

[Josephine]

My ROM used to be 132-9/0, and today it was 115/5.

Well, there's nothing much wrong with that. Extension could use a little help but not too bad.

Now I'm afraid that I've done something terribly wrong and that my knee won't recover fully

You've done nothing bad to the knee.

The pain did not go away as the Fellow said it would, and seems to be worse than it was at the beginning of August.

Is this the pattern of the pain?

She said there is bursa swelling on the medial part of my knee, and that the part of my quads called the vastus medialis is very weak and must be strengthened.

Vastus medialis is part of the Pes Anserine structure.

Not doing any of the exercises that Josephine advised against doing (stopped walking, swimming, etc.)

Jolly good.

The new outpatient PT I saw this morning wants me to do the following exercises:
Supine Gastroc Stretch - 4 times a set, twice a day
Hamstring Stretch - 4 times a set, twice a day
Quad Stretch, Left Leg EOB - 4 times a set, twice a day
Trunk Stability Bridging - 10 times a set, once a day
Hip / Knee Quad Set in Slight Flexion - 10 times per set, once a day
Hip / Knee Strengthening: Terminal Knee Extension - 10 times per set, once a day
Will have ultrasound treatment starting Monday AM (I had it at least a dozen times in 2013 and 2014 and found little relief)

I'd agree with pretty much all of those except the number of reps and the twice a day sessions. I'd also say that a chiropractor would deal with your issues much more quickly and effectively and not with a 'little' relief.

Noticed today that the Baker's cyst on back of my left knee is "full" (about 4x size of right one) and painful again. I've had problems with this cyst behind my left knee and had it drained in 2013 and 2014. Will OS office drain a Baker's cyst on a patient 3+months post-op on a TKR?

I would doubt it but chiropractic treatment will loosen it up for you.

I've had sharp pain under my metatarsal on my right foot with every step in the last couple of weeks, and can feel pain in the same area I had a stress fracture on last fall, and I can tell the PF is trying to sneak back to hurt me.

This could very well be the cause of your issue but you know, a chiropractor will deal with this as well!

 

[skigirl]

Here is what I think might be the issue----there is a patella tendon and if your patella is tilting to the right, that tendon could be affected.
There are two bands of tissue called the lateral and medial retinaculum which hold the patella straight. If your quad tendons are weak, there could be a pull against the medial retinaculum which causes pain under the kneecap.

Finally, the quad muscles---they need to be strong to support the joint, when they are weak, the IT bands gets shorter to help hold the knee up. The vastus medals is the small muscle on the inside of the thigh. It has to fire or contract to work properly. If you lift your straight leg with the foot pointed to the outside of the knee, you will see the vastus medals contract. I had to work hard to get that small muscle working properly.

If you have tendonitis, you will have to wait until that tendon heals before you can begin strengthening the leg again. It will take some time, you will have to be patient.

 

[skigirl]

I also have some pain on the bottom of the arch of my foot. I freeze a water bottle and then roll it around with my arch. It does help.

 

[Widget1]

@Josephine -

Yes, the red area on your chart is where my problems are. I looked at your linked article, and I really don't have the pain where the bottom blue pes in indicated. However, I have the swelling and a big knot and most of the pain in the vicinity of where the MPFL yellow marking is on the diagram.

I will cut down what the PT said I should do to 1 set a day with fewer reps.

Tomorrow I will call the OS clinic back and tell them that I need to see a chiropractor before mid-October, explain that their one chiro is fully booked, and asked that they provide a reference to someone outside the clinic that I can see. I've never seen a chiropractor and certainly didn't realize all the benefits of their treatment.

Josephine, a big hug to you across the pond, because you've certainly put my mind at ease, and now I know I can get through this glitch in my formerly steady-forward recovery. Thank you for so kindly sharing your invaluable expertise!

 

[Widget1]

@skigirl - Thank you for your helpful information! I'm going to follow Josephine's suggestion and make sure that I'm able to see a chiropractor soon.

The way the therapist stated it was that my "kneecap tilted to the right" when I walked. I don't know how experienced she was, as she was pretty young, and while I was lying down going through the reps she gave me I noticed that she kept running to the computer and looking stuff up.

I keep a frozen water bottle in my freezer, and used it lots when I had the PF last year, as the doctor said if he gave me a cortisone injection while I was relying 96% on that right foot to be ambulatory it might blow out the fascia. Instead he ordered PT (I had one therapist working on my left leg and another one working on my right foot) and had me use ice water bottle and had a pharmacy prepare a compound pain cream and I used that. After I was able to ditch the crutches after 8 weeks he gave me the cortisone injection (and some stretches and orthotic shoe inserts) and it did the trick.

I'm just relieved that now I have more knowledge than I did hours ago when I was having an unfortunate meltdown. Thank you again!

 

[skigirl]

You are more than welcome---I am also a person who needs to know what is happening to my body. I am an art major---took Anatomy with a bunch of medical students, so I do understand the muscle system in the body!!

the PT's also take anatomy---and in her defense, it is hard to remember the names of all of the muscles.

the quads and the vastus medialus are two that I have spent a lot of time working on myself!!

 

[Josephine]

@Widget1 If I were you, I'd go one step further that cut down, I'd cut it OUT! I did no exercising AT ALL for either of my knees and things turned out great. I don't think that's a fluke or - as one US PT put it - that I won the TKR lottery (twice?). I am hugely convinced that all this emphasis on exercises is over done and unnecessary and causes more problems that it solves. I got this from my surgeon in the first instance and he has one of the best records of good outcomes I have ever seen. He is also very fast and careful when operating so his patients also have a lot less post-op pain and swelling. Must be something in it!

 

[Widget1]

Thank you skigirl and Josephine!

The only difference today is that my head isn't exploding from the fear factor I had going on yesterday. I'm still waiting for a call back on the chiro referral from the OS practice. I want to make sure that I get someone that has some specialization in ortho.

I'm attaching two photos of my (ugly) knee. The first one (green background) I took immediately after the steri-strips and suture were removed on June 19th (before I could scrub away at those tape marks, etc.). I was sewn shut with one very long blue suture, and they snipped the one end and then just gently pulled out the long single suture. Whoever closed me up could easily get a job as a seamstress/tailor if the ortho field ever runs out of need for joint replacement. I still had significant swelling at the knee area three weeks post-op.

The second photo I took this morning. The arrow shows where the most pain has been (for the last 6-7 weeks), and the pain radiates up and down from that one spot on the medial side of my patella. My left knee is once again larger than my right knee (swelling).

 

[Widget1]

@Josephine - Thank you! I was just about to muster up the energy to go through those exercises for the first time today, and now that's off my to-do list because I won't be doing them!

 

[Josephine]

Widget, when did your surgeon last see your knee? Because I don't want to scare you (though I know it will and I'm really sorry for it) but I think that scar looks like it could be infected. Probably a superficial infection but it has all the markers - pain, swelling and redness. I suggest you get it looked at within the next few days. I know it's a weekend and next week will do fine, but it needs to be looked at. It might even be a bit of cellulitis. I had a patch quite close to my wound and it was okay after a few days of antibiotics, so don't panic!

 

[Widget1]

@Josephine,

If I call the OS office, I'll be given an appointment, but I will never be able to see my OS. I have only seen him three times - once 3 months before surgery after being referred to him (by my other OS surgeon who doesn't do replacements), a few seconds prior to going into the OR and for 10 minutes 7-1/2 weeks post-op. In my other 6 appointments with his office I was seen by a PA (twice), a Resident (once), and by three different Fellows (once each). Every six months a new group of Fellows rotate through his office.

Yesterday at the PT eval when I showed the therapist the area that was bothering me, the therapist told me that my nerves were probably just having problems firing, and I should take a loofah and scrub at the scar (YIKES!!!). Obviously I will never do that, and I shudder even thinking about scraping something against the top half of my scar.

The OS practice does have an ortho urgent care center (open 7 days a week), and I think the better route for me would be to go to the urgent care office. Whoever sees me at the urgent care center will be able to communicate directly with my OS (something I'm unable to do). I will go to the urgent care office tomorrow.

You're not frightening me, you're providing invaluable assistance for me! Earlier I wrote that the top area was purplish, and didn't know how to properly describe it, which is why I posted the photo I took 3 weeks after surgery and the one I took today, almost 3 months after the first photo. I can see that there is a difference, and it's not that the scar has faded with time.

Thank you again!!!

 

[Josephine]

I think the urgent care centre sounds ideal.

But as for that PT suggesting you scrub your wound with a loofah!

 

[Slainte]

Glad you have the walk-in clinic option. Going tomorrow? I will be waiting to hear.