Revision TKR Would like advice please, I think knee has moved

[busylizzie]

@Shortie, I will ring in the morning. ESR etc wasn't down to be done, only standard diabetic blood test. Full blood count should show if anything is wrong. The swelling and heat have subsided after stopping the foot exercises. I am going to leave it a few days then start chasing the new appointment with foot specialist if I haven't heard anything.

Last night was a bad night for sleep for some reason. It was 4am adjusted time before I got to sleep. I'm shattered now and will try an early night tonight.

 

[Nana moon 27]

Hi @busylizzie

I hope you get a better nights sleep tonight. Good luck chasing up everything. It's a nuisance but worth it to get results.

I'm glad your pains gone down a touch x

I'm thinking of you ....

Take care love Nana moon 27 xox

 

[Dabber]

Just sending thoughts and hugs. What a difficult time you're having, I empathize. xx

 

[busylizzie]

Thanks everyone. I rang GPs reception just now to book appointment and get blood tests results. Receptionist cagey as usual, they don't like giving out results over the phone. All I could get was all my tests were in range bar one. I asked which one and was told HbA1c and eventually got a value. Yes it has gone up, but I'm not that worried as it is 6.5% in old units. I have an appointment to see specialist nurse this Thursday.

 

[busylizzie]

My patience got the better of me. I have rung the hospital appointments line enquiring about the foot/ankle specialist consultant appointment. My referral hasn't reached there yet. It is still with this consultant. However, they are now booking into December! So much for an urgent referral to him from my knee consultant. I was told by him 2 to 3 weeks to see him. From past experience you have to at least double this. It is 3 weeks this Wednesday.

The way it is going it may well be after Christmas before before I get an appointment! Mean while I suffer with pain 24/7, getting worse when I weight bear? Family wanted to go away this week as it is half term but I said I didn't want to. I can't even use my exercise bike any more, even without using the left stirrup. Just hope I don't loose my ROM.

I have an appointment next week that I was supposed to cancel. It was a backup appointment made by my hospital physio when the so called gait analysis appointment at Salford University was taking so long to come through. It is with the hospital podiatry department. I AM going to it hoping that they can help and feed some more information back and into the hospital system to speed things up.

 

[Pumpkin]

Busylizzie,
I am just curious, with your leg going out to the side, looks like the tibia is rotating and your foot pronating. I just wonder what is happening elsewhere to counteract this, or feed into this position? Is your trunk rotated, are your arm (s) held in a way to compensate, is your head rotated, tilted, flexed and/or extended? What muscles are in spasm to maintain this position? What muscles are not working? The physio should be able to help you with a full body postural assessment, palpation for muscle tone or lack of muscle tone and note anything else that may be compensating, or feeding into the painful position of your leg.
Just my random thoughts of other questions to ask, and other things to look for that may be making this worse.

Glad you have the appointment next week, what a long wait for the gait assessment, I am puzzled why they have let this referral sit for so long?

Sending positive thoughts and prayers,

 

[busylizzie]

@Pumpkln, I believe that my left tibia is rotatated badly to the lateral side. My foot is about 45 degrees to the horizontal position at rest in a natural no load position with my big toe pointing upwards. Hence my little toe points down and is lower than my ankle. It is like a twisted foot drop. It has been like this since 2 June this year. It is hard to describe. I can rotate it round so that it looks normal but is very painful to do so especially if I weight bear at the same time. If I do this I have to bow my right hip out to compensate and get knee and back pain. This is what they made me do my last Xray. The consultant looking at this Xray said my knee alignment looked OK. I told him the Xray was very painful to do. He only examined my leg when sitting on the consultation couch and got me to correct the alignment of my foot and swing my leg round to vertical. It was then that he said he was referring me to the foot/ankle consultant. I then stood up and bent my knee to show him what was happening. Boy was I sore afterwards.

The gait analysis that I wanted to go to was at Salford University and was the full works. I was told that I needed to have a GP referral and be at least 3 months out from this surgery. I was told I needed to attend an assessment first. That is the appointment I went to recently only to find out it wasn't for the full gait analysis but an appointment anybody could book for a podiatry assessment and that I didn't have to have a GP referral and didn't have to be 3 months out. It was a private appointment that I had to pay for not like the full gait analysis which was to be on the NHS. I was very disappointed and have repeatedly tried to get to the bottom of it but have had no luck on the telephone. I just kept being told to do the exercises and try the orthotics I had to buy and wait until I go back for the next appointment which is still over 2 weeks off.

The orthotics aren't right and the exercises have made the pain so much worse until I stopped them. The exercise is to pull with my muscles my foot round by rotating my foot outwards and upwards. This hurts my knee, leg and back even when gently done. It makes the alignment worse.

My foot is painful to touch underneath on the lateral side from my little toe to my ankle and on top on the fleshy parts. I have got a pain under my heel which feels like a stirrup pulling which I have been told is plantar fasciitis. My ankle feels like it is badly sprained. All this new from the 2 June. Looking down my left leg it doesn't look straight, it bends outwards from my knee and my foot does not lay flat. It looks like the bone was cut at the wrong angle at the top of my tibia/fib and the bottom half of my leg rotated. As I have a fixed hinge knee with a pin I am unable to rotate the bottom half of my leg round relative to the top.

I have mentioned the foot problem to EVERY medical person I have talked to since the op. At first they ignored it and said give it time to settle. I am 5 months out at the weekend and it is getting worse not better. The more ROM I get the worse it becomes. I have now limited everything that makes it more painful but I don't have much of the life I was hoping for. Without this problem my new knee would be wonderful!

 

[busylizzie]

Just changed to my laptop so I can post some images. Here are the orthotics I was told to try. They are not custom made but off the peg. They have a lateral post.

I was supposed to start with the left one, slowly building up the time I wore them and then introduce the right one whilst maintaining a 2cm heel raise in my right shoe. It doesn't work, I can't get a height differential as the orthotic is so high, no way can I get my right shoe 2 cm higher. I even have my trainers that are oversize to fit orthotics in but it is still impossible. The tilting of my foot inwards is like doing the exercises, it puts a tremendous strain on my leg, knee, back and the alignment pain is so much worse.

The podiatrist wasn't happy with the heel raise I was using. I prefer for comfort a long length one not just at the heel as it makes the back of my heel painful. i have never been able to wear high heels as they too make my heels painful. Short heel raises do the same.

Prior to the appointment I'd been using a tubigrip compression bandage on my foot, not a very strong one, and leaving it on overnight. I got told off and told not to wear it at night even though it was helping.

The link to the clinical gait analysis I was referred to is here broken link removed: https://www.salford.ac.uk/chsc/facilities/gait-analysis-clinic

The Podiatry Assessment and Management that I actually got link is here broken link removed: https://www.salford.ac.uk/chsc/facilities/podiatry-clinic

 

[Dabber]

It looks as though it will be very good if you actually get there. I've had plantar fasciitis, it's very painful. I had shoe heel inserts and saw a podiatrist who took a pattern from my shoe so the orthotics were custom made. This was in Crewe so no great posh place, all NHS.
It tends to be like this sometimes in the NHS @pumpkin, we wait and wait.

 

[Josephine]

I am appalled that you are no further forward with this issue after all this time.

Forgive me if I have asked this before, but which hospital are you attending?

I would also suggest - never ever phone the appointments office/manager about an appointment. They know nowt! Phone the surgeon's secretary instead. They can get things done.

 

[busylizzie]

I phoned foot/ankle consultant's secretary this morning. I got to know that paper work had been passed to appointment dept with 'soon' as the timespan for the appointment. I rang appointments and now have a date of 10 November. Just under 2 weeks to wait. @Josephine I am at Wrightington hospital.

 

[Pumpkin]

I am happy to read you finally have an appointment and it is only 2 weeks away. It will be interesting to hear about your experience at the gait lab.

Prior to the appointment I'd been using a tubigrip compression bandage on my foot, not a very strong one, and leaving it on overnight. I got told off and told not to wear it at night even though it was helping.

Unless they had a good reason for you not wearing the tubigrip, I would wear it, if nothing else for comfort.

Looking at the photo of your legs, have you tried a medial wedge?
2 cm lift inside a shoe is a lot, has anyone suggested adding a lift to the sole of your shoe?
Like you I prefer full length insoles, the shorter ones seem to drop off to much and are uncomfortable.

I looked at the website for the place you are going for a gait analysis, looks like you will get a good assessment. I was sorry to read that you cannot consult directly with the gait experts. It would seem they would be best to steer you in the right direction.

Hope you can get the pain undercontrol, don't forget you are the expert on you, and know what is best,

 

[Jane B.]

I was awake in the middle of the night doing some research on knee pain. I wonder why?

I have no idea if this pertains to you, but it made me think of you in a heart beat.

Article title is at bottom of post:

"Physical Examination...
Excessive internal or external rotation of the foot may be indicative of suboptimal rotational positioning of the tibial component. However, as discussed in subsequent sections, the rotational position of both the femoral and tibial components is best evaluated with computed tomography (CT) scanning."

Review Article

The Painful Total Knee Arthroplasty: Diagnosis and Management
Edward C. Brown III, MD; Henry D. Clarke, MD; Giles R. Scuderi, MD

• Orthopedics
• February 2006 - Volume 29 · Issue 2

 

[Pumpkin]

@Jane B. ,
Thanks for finding the article, it contains a lot of information about painful TKR, great find.

 

[busylizzie]

@Jane B. Thank you I have being some research and it agrees with your article.The podiatrist I saw a while ago suggested I got a scan. Its making it happen that is the hard part, getting somebody to agree to it.

@Pumpkln, the reason that they told me not to wear the bandage at night was it could constrict my circulation. Being diabetic apparently increases the risk. The bandage is not tight and did help.

Next week I have a new appointment with Wrightington hospital podiatry etc dept on Wednesday 5 November. I was told to cancel it if the Salford appointment came through first. In the light of what happened at Salford I am going to go for it. This one is on the NHS and the Salford one private so I don't envisage a clash.

Then the following Monday 10 November I now have the foot/ankle consultant appointment.This will either be at Wigan or Wrightington (part of the same trust) On the web site it states he also does TKRs

Tuesday 11th I have a routine Rheumy appointment. They have been my rock through this ordeal.

Wednesday 12th I should go back to Salford Uni to a follow up podiatry appointment from the orthotics and exercises. I will wait until the 10 th before I decide what to do.

Thursday this week 30 October I have my annual diabetic review.

In the midst of this hubby has to go to hospital to have 2 teeth extracted, one is an impacted wisdom and the one next to it has a crater underneath it that is causing problems.

We are going to be busy. Hubby also looks after grandkids on an ad hoc basis if DIL gets casual work. I help by reading to them and playing board games to entertain them.

We went to Yorkshire today to see my Mum in the dementia care home. We haven't been for a while, I haven't been up to it. She is deteriorating but today was one of her better days so I came away not too sad. There is nothing we can do except keep her comfortable. I wish this final stage does not drag on. She doesn't have much quality of life. She hasn't known who we are for a long, long time now. She gets violent at times, but today was OK. I usually have to keep my leg well away from her.

 

[kneeper]

 

[Josephine]

Try asking your rheumatologist to order it. Worth a punt!

 

[busylizzie]

Josephine, I'm glad the rheumy appointment is after the foot/ankle specialist. Then if I don't get much joy plan 'b' can come into action. I am seeing the rheumy advanced practitioner (specialist nurse) not the prof this time. She is very good at her job and very knowledgeable. I will get to see the prof if she thinks it is necessary. It was this team that organised the Leuka scan (white blood cell) not the orthopaedic team and kept pushing for action. I spoke to one of their other advanced practitioners on the phone in July as a follow up after the op. They wanted to keep a close eye on me. He is more physio based and when I described what was going on he thought the gait analysis was the way forward. It is a pity it hasn't turned out that way.

 

[busylizzie]

I am not giving up yet, I am fighting the system all I can. But, if nothing fruitful is in place by the New Year I am going for the amputation, this has been going on long enough. It is a lovely day today after yesterday's rain. Hubby is in the garden working, oh I so wish I could go and join in. I could go outside and sit on a seat but it isn't the same. I've always been a very active person, not one to sit and watch TV when I got home from work.

 

[Nana moon 27]

Hi @busylizzie

Let's cross everything that something will turn up for you xx tbh could you not insist on seeing the prof instead because of how you are feeling about the whole situation. AP's are ok but I've seen two that I didn't rate.

I empathise the feeling about all this immobility. I too used to be a live wire when I came in from work. So I understand your frustration. The garden used to be my domain. It kills me to see how it's going.

btw was it you that said they'd dealt with pip? I applied in June they coming to my house 10th nov 9am!!! Worst time for me x

It's raining here today really miserable and I ache all over. My hip and knee. Just spoke to doc on phone he's prescribed me antibiotics and steroids, I have a chest infection again!

Love Ann xxxx