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TKR Wrong Sized Implant?

Week 17:

It’s been 17 weeks since my LTKR, and 7 weeks since my MUA.

I wish I could post a more positive update, but unfortunately I am still struggling. I think my flex is around 80 degrees, so better than it was prior to the MUA. However, my knee simply will not straighten, despite the very helpful exercise suggestions recommended to me on here. I am able to walk, still using my crutches, and am averaging 5000-6000 steps a day.

My knee is still swollen. It gets very hot at times, usually during the evening. I spend a good deal of time icing and elevating. The pain is all on the inside of my knee, where it is most swollen.

I am seeing my surgeon this week, and am not sure what he will suggest next.
 
Hi- I am reading this early this morning. I’m so sorry you’re having such a rough time, and I’ll certainly be keeping you in my prayers. You’ve had so much to deal with, in addition to “ just” the TKR. Could some of this just be that your body has had to deal with so much, & just needs more time than other people do? When I had my cleanout surgery from the infected incision, it really wiped me out......and I’d say you have been through a lot more than I have. And I know you must be frustrated; hopefully your Dr will have some good insight for you. Your body may just need serious rest, along with what you can do on exercises. It sounds like you have good and reasonable therapists who don’t push you to pain. My local one has been very understanding, & never hurt me ( as my home PT had warned me they would). Interestingly enough, both expressed concern that my flex was not “ there” yet. It still isn’t, although I work on it. My surgeon told me at my last visit that “ it will come”, & didn’t seem concerned that it’s not “ there” yet. I still struggle some with balance, & still can get pretty tired if I get too ambitious

Our initial TKRs were one day apart. And you have had the second procedure ( I’d consider an MUA a 2nd surgery!), And a UTI, And an abscessed tooth! ( not to mention the problem with medications taking a toll on your body.). I’m thinking your body has a right to complain & possibly be reluctant to cooperate. Mention this to your Dr, maybe get his insight. When I was so sick from my infection & frustrated at my slow progress, one of the nurses in the hospital said, “ of Course you are feeling tired & having pain...you’re fighting infection, you’ve had 2 surgeries in a little over a month, and, you’re on antibiotics!”. After I got home, I slept. A lot. And I think it helped. ( btw could the antibiotics you’ve had to take for your infections be some of the cause of your stomach problems?). Do be patient with yourself. And allow your body to rest, doing what you can as to exercises. And do remember, Many of us are thinking of you & supporting you. I’ll be watching for those two cute little dogs & your posts. Take care
 
It seems to me that you are doing too much. Swelling and heat are caused by doing stuff when the tissues are not properly healed - and you've just had MUA.

I suggest you stop doing so much walking - cut right down, it's not helping - and do mobility exercises that are not weight bearing, then lots of ice & elevation.

In the example below, I am pulling my legs towards me. The leg muscles aren't working at all.

1643730684896.png


Do you have an exercise bike?
 
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You are basically at 7 weeks, since you had the MUA, which is another procedure and your knee is complaining. You're still needing crutches, which also tells me you're in the early stages of recovery. My suggestion is to back off the daily steps, spend more time icing and elevating, and just do basic daily activities for a while. As your knee responds to the new TLC, you can add more activities, but listen to your knee. If it's hot and swollen, especially at night, that tells me you did too much that day and need to back off the walking.

This recovery takes, on average, a full year, and you're functionally at 7 weeks, which is early days. Give your knee the break it's begging for, and let it recover at it's own pace. Don't stress over flex numbers; as your swelling dissipates, your flex will naturally increase. I never allow anyone to measure my ROM as random numbers don't matter to me. What matters to me is that I can function daily in a pain free manner, that I can walk and do other activities without causing more pain and swelling, and that I can return to a full life. Take some time to go back to the basics, and allow your knee to recover. Then, at some point in the not too distant future, look at where you are, then look back at where you were today, and see how far you've come.
 
Thanks, @Catalien45. You always manage to cheer me up with your kind words :)
I just worry that I am doing too little, not too much!

I’m not holding out much hope from the surgeon as he is usually very curt and I’m in and out of all the appointments in minutes.

Take care of yourself :)
 
Thanks, @Roy Gardiner. I worry that I’m doing too little, not too much!

Yes, I have an exercise bike, and I have been using it for a couple of minutes at a time, just rocking the pedals back and forth, can’t manage a full rotation yet.

I have a mini skateboard that I also use, as you demonstrate above. Your exercise examples that I’ve seen in other posts have been very helpful, thank you.
 
Hi @DogTiredKnees, I know you must be truly dog tired by now. I'm glad you got your return to work date extended, that gives you a chance to focus on your recovery without the worry.

DogTiredKnees said:
I am able to walk, still using my crutches, and am averaging 5000-6000 steps a day.
Click to expand...
The forum OGs gave some great advice above. When I read your post, my eyes popped. That's almost 3 miles a day on a baby knee and it's letting you know that's too much by being all hot and bothered. I noticed you mentioned that you are seeing 2 physios, what do they say about your gait? I found that walking improved my range of motion only when my balance was good and I was focused on my gait - concentrating on heel to toe contact and stride length with each step. At just under 5 months post-op, I hit 6000 steps only a few times a week (but I'm not very focused on the count). With that said, my stationary bike is my go-to method for stretching, improving my ROM and getting some exercise (different settings for different durations).
 
DogTiredKnees said:
I worry that I’m doing too little, not too much!
Click to expand...
Please, DO NOT WORRY ABOUT DOING TOO LITTLE

Please excuse me shouting. As long as you do gentle stretching exercises, you will not have a problem. If you did not walk one step, it wouldn't be an issue. You may get weak, but that is easily fixed when healing is complete. Concentrate on eliminating swelling and pain by Rest Ice Elevatation.
DogTiredKnees said:
Yes, I have an exercise bike, and I have been using it for a couple of minutes at a time
Click to expand...
:thumb: :thumb:
DogTiredKnees said:
just rocking the pedals back and forth
Click to expand...
:thumb::thumb:

If you can't make a single rotation:
  • Set the bike to zero resistance
  • Set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
It's almost the same when you can:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 
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Wow. Some real wisdom here, and I’m trying to take note also.
@ Roy Gardiner, I’m going to have to try that one! My ROM is still lacking, I notice it most when I unexpectedly find it bending too much...ouch.
I’m taking heed of your posts & experiences, too. And I like that photo that show exactly what to do...
I also agree with @love to cook&sew...( and, I love your “post name! I also love to cook& sew, anxious to get back into both). I deter.... I agree that you are really early on in your recovery, @ DogTiredKnees. 7 weeks is not very long. It’s just been within the past few weeks, after my cleanout surgery, that I’ve really felt that good, & doing more. And that was after finally recognizing that my body needed the rest. It’s going well now, although there are still regular challenges. I’m Learning to slow down some, & rest when I get tired. And that’s not always easy. Patience is probably the most difficult exercise of them all. By the way, dumb as this may sound, I really didn’t think of a TKR as major surgery until I read it on here. So I’ve come a long way.... and still have more ground to cover! So be patient with yourself... and let your body rest.
@hawk2go....once again, I’m learning from you. I believe you were the first to educate me on the ODIC. I’m still occasionally figuring that one out. . And just now, on the gait & walking. I’m getting pretty good at the “ heel & toe” method, my PT stressed that, early on, as my walk improved. Still working on the extension... but, my balance is not always there. I need to get after those exercises again. I still can get off balance if I’m not careful. Maybe that’s why my ROM seems to be “stuck” lately. Thanks once again.
I hope you are finding encouragement from these posts. What you’re going through has to be tough. I’m hoping to hear a better report from your Dr visit this week. Just remember there are plenty of us behind you. Take care, & sending a big virtual hug of encouragement your way.
 
It is true that when you have reduced ROM and receive an MUA, you need to just "forget" your original TKR date when considering how far you are in your recovery. The manipulation done in this procedure is very traumatic on your knee as the surgeon forcibly bends and extends it. Your soft tissues are assaulted and unhappy when you come home. You must give them time to heal before you exercise at the level you are doing now. Granted, you may hear of people who didn't do that and did just fine. But everyone heals differently. The fact that your knee is swollen and painful still indicates that are pushing too hard for this point in your recovery. Please, please try backing way off the number of steps you're doing each day until things start improving. Instead do more gentle movements on your bicycle for 5-10 minutes every couple of hours followed by resting, icing and elevating. If you are in pain, take Tylenol on a 6-hour schedule to that you can begin to reduce that inflammation.

By allowing your knee to remain inflamed, you are keeping the tissues hot. Hot tissues are going to be less lubricated and tend not to move as smoothly over each other when you are moving your leg. It's not a given, but this situation can lay the groundwork for formation of adhesions as those dry tissues can stick together instead of sliding over one another. It definitely is possible to overdo things in recovery from either a TKR or a MUA.
 
Thanks, @hawk2go. I’m seeing an NHS physio and also paying to see a private physio as it can be difficult to get an appointment with the NHS at the moment.

They have both helped me with my gait, and stopped me from hitching my hip. I’m walking much better now, I think. I will definitely cut back on my daily steps though and see how it goes.
 
Thanks, @Roy Gardiner. I have seen your posts about using an exercise bike and am following your advice. I am looking forward to the day when I can ride my bike again :)
 
You should know within a week or two if this was the problem. Hopefully you'll see some improvements in that time. I'll be watching for your updates! Hang in there.....
 
Week 21:

It’s been 21 weeks since my LTKR and 11 weeks since my MUA.

Thanks for asking, @benne68 :)

Not much progress, I’m afraid. My appointment in February was not actually with the surgeon, it was with one of his associates. She told me to concentrate on straightening my knee and referred me back to the surgeon in 6 weeks, which is fast approaching.

I saw my physio today and he wants me to carry on with the leg straightening exercises, which are pretty much the same as recommended up the thread by @Roy Gardiner. I’m doing these multiple times a day, and continuing icing and elevating in the evening. I cut back on walking and now concentrate on exercises and stretches instead.

My knee is still bent, and is uncomfortable in most positions, for any length of time. I feel that I should be further along this journey by now and can’t help feeling despondent at my lack of progress. I am still signed off work, but need to go back soon, or will be reduced to half pay.

I’m not sure what my surgeon will suggest at the appointment in a couple of weeks, but I think it may be another MUA, which seems rather futile.

Apologies if my posts always seem very negative!
 
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