Revision TKR YYZ Back To YYC!

[celynda]

Surgery went well on friday woke up after surgery in operating room feeling like I had the best sleep ever. That was the last significant stretch of sleep I've had since.

Made it back on flight here on sunday. Very tiring trip unaccompanied 4.5hrs. Significant pain typically in evening 45 mins around 11pm and then again 6am for about 45min.

Hello from HSS in NYC.

I could end up flying and was hoping for any tips you might have. My 45 minute flight is on a regional flight. Then I have a 90 minute drive home.

It’s my right leg so a bulk row seat on the left side of the plane makes the most sense. Any other suggestions?

Thanks, Christa.

 

[2chains]

For sure I can share a few tips.

Pack less than you think you need, carryon will be more than enough and will streamline your airport experience each way. My multi day stay went quickly and glad I didn't bring a laptop or books to cart around or keep track of. I did pack a favourite snack! Use a fanny pack to carry strictly essentials keys, passport, phone, chargers, wallet, meds etc.

Most airlines offer assistance to passengers with mobility issues. Arrange for a wheelchair when you book your flight. A tip is common practise for the porter. Although I initially felt guilty arranging this it was a great help. I was wheeled to the front of the security lines and boarding lineups! There was no way I would have been able to stand for any length of time in these lineups let alone walk through the airport.

Arrange for a cane as a two wheeler walker was not allowed in the cabin of my flight.

For the return flight I wished I had booked an larger seat. I'm a regular sized person 5' 2" but had not flown for many years. I didn't realize how crammed seating is in regular cabin. The standard seat booked on my return was torture as I could barely stretch out. I had picked an aisle seat on the left side to stretch my left leg but it wasn't ideal even for my short stature. Might not be an issue for shorter trip...

For the return car ride have a plastic bag ready so you can slide into the car seating. Make sure you have a full rear seat to stretch out your leg for the car ride home! Make use of your cane by using the handle end to support leg movement in and out of your vehicle.

Best wishes to you!

 

[EalingGran]

For the return flight I wished I had booked an larger seat. I'm a regular sized person 5' 2" but had not flown for many years. I didn't realize how crammed seating is in regular cabin

Absolutely agree. I think some of the airlines have even squeezed in more seats in recent years from what I have read.
I did a short flight ( 1 hour 15 minutes) at about 6 months after surgery. I am also regular size ( 5 foot 4 inches BMI 123). I managed ok but definitely resolved that for any longer flights I would pay for premium economy/ extra leg room.
I went to the theatre a month or so back and the only available seats were in the upper circle with limited leg room and my knee got sore and warm after an hour or so.

 

[celynda]

Thanks for the suggestions. They are very helpful.

I made three trips to/from NYC before surgery. The regional jet is flight is about 45 minutes long and I’ve sprung for first class to get extra room. It’s a 1-2 configuration. I don’t think it’s possible to pull up the arm rests and take full advantage of a row.

Once I land, the ride home is 90 minutes in my SUV so I can put down the back seat. Between pillows and the Lounge Doctor, I should be somewhat comfortable.

I’ll probably need wheelchair assistance to get on/off the plane. I have a cane but am only 30% WB right now (Day 6 post-op) and am wearing a brace for the next five weeks (I think). I have a hinged implant so travel home will be difficult as I cannot bend the knee.

Another option is taking the train which only 20 minutes from home at the other end. It’s a 8 - 9 hour ride but if I can get an accessible room with a private toilet, It may be more pleasant than flying.

I should hear in the morning about the timing/decision re going to sub-acute rehab vs home.

 

[2chains]

16 month update
I have a new physio and he has lots of experience with long term TKR patients. He states that TKR recovery can potentially be 2 years to 5 years in total! uugh! It definitely explains some persons experience here!

He feels that my patella is very tight and it is low on fluid underneath the top medial portion of it. It is not moving freely. I am now doing numerous jiggling/massaging of my kneecap daily. He states the implant itself is fine but issues are based on soft tissue re-alignment and healing. I am off all old exercises except daily cycling 6 mins 3x daily.

His techniques I am using are loosening/massaging the joint tissue.

One is putting my knuckles behind my bent knee and gentle rotation of upper leg side to side...kind of like trying to scrape gum off your heel. I do this 3x daily. This has really helped loosen up tightness behind my knee. He also manipulates/massages/probes behind my bent knee with his fingers trying to loosen up tissues.

Another technique is skin rolling/pulling of my lateral quad while seated...this is a faster and easier way to loosen tension as opposed to foam rolling. I do this 3x daily. I feel the surgical tourniquet has affected my upper thigh and it has never felt 'right' since surgery.

The one other exercise is a lying leg raise. Lean leg to outside and lift for total 30 reps. I did 6 sets of 5 reps first week and could not do my home stairs for three days due to inflammation! Dailed it back to 3 sets of 5!

At home continuing to put together 30 mins of small chores with 60 min rest. Watching myself walk on my security cameras at home shows i need to focus on posture and standing more 'upright' not bent over!

Going for walks 2 x weekly 15 mins with 20 min rest x3 seems comfortable, Standing limit is 20 mins...worked on fixing my gate latch the other day and tolerance was ok.

 

[Susie-Q]

Sounds like you have a good plan and are seeing positive changes. I had issues with my IT band for awhile after surgery, all the way up to my hip. I'm not sure how it resolved but I noticed I don't wake up with as much hip pain as I used to when sleeping on my side. I'm sure time is what was needed. I do agree with your physio that some people need much longer for a full recovery than just 12 months.

 

[EalingGran]

He states that TKR recovery can potentially be 2 years to 5 years in total

Interesting. I have read that knee implant area remains warmer on MRI for 2 years- suggesting healing/ inflammation still present. This would fit with what your physio says.

The one other exercise is a lying leg raise. Lean leg to outside and lift for total 30 reps

That sounds like the one I do to work vastus medialis and strengthen my MCL.
30 sounds like a lot though. I just do 5-6 a couple of times a day.

 

[celynda]

Sounds you’re making good progress. That is good news, for sure.

 

[2chains]

@EalingGran
""That sounds like the one I do to work vastus medialis and strengthen my MCL.
30 sounds like a lot though. I just do 5-6 a couple of times a day.""
Definitely found this to be too much. Had to ease off to 3 sets of 5 so I could manage my stairs through the first week although this is still on the brink of too much with significant joint line pain.

 

[2chains]

18 months post surgery update.

Small progress but still moving forward at least!

Able to leave house and not lean/grasp on doorframe sideways to step down off threshold, wow that took a while!

Able to get up from chair/stand/walk more upright and confident

Able to get in/out of vehicle more easily as long as trips are less than 30 mins or so

Able to walk/sit/stand max 30mins before tiring or seizing up but not repeatedly through the day

Able to put together four small 10 min chores and not be totally immobile ie. load/fold laundry, take out garbage, pickup litter outside, quick pruning, sweeping etc.

Finding the sweeping to be my “best’ activity as not too much of either standing still or walking.


Current issues;

Only able to walk for short periods of time. Have stopped short hill walks in neighborhood as too much pounding on knee

Finding when I do walk it’s with a ‘peg leg’ type jerky gait, throws off my symmetry and aggravating everything up the kinetic chain ie. hips/ankle foot

Locking knee on heel strike, can’t seem to go more than a few steps with a ’soft knee’ bend, this is effecting hips/foot negatively

Downhill walking is manageable but uphill is very jerky and unbalanced putting extra stress on both hips/ankles

Super stiff can barely get downstairs, upstairs is ok...even with daily cycling, if I go a day without cycling it is even worse

Kneecap itself is very stiff ...daily mobilization to try and loosen

Joint line inflammation along with the stiffness and medial side pain daily

Exercises

Sweeping daily 20 mins, yes I’m finding this helps! Kitchen, garage floor, and front porch
cycling daily 15min
Leg lift daily 30 reps
forefoot walking/backward walking 200 steps daily
kneecap mobilization every other day
2 x 25min walk with 20 min rest every other day
I have a clock in my living area and focus on standing/moving every 30 mins or so

PT every 2 weeks focusing on kneecap mobilization

Big picture I feel this is still a very sad and sorry state to still be in and was definitely expecting more at this point. With all my physical activity/efforts prior to surgery I’m definitely disappointed!

 

[Jockette]

Big picture I feel this is still a very sad and sorry state to still be in and was definitely expecting more at this point. With all my physical activity/efforts prior to surgery I’m definitely disappointed!

Yes, you definitely have a disappointing outcome, as do I. I’m sorry about that.

 

[2chains]

Is MUA something that is recommended at 18 months? PT is thinking that might be what I need to make further progress from 109 degrees flexion. Still having issues with basic walking ie .when crossing a crowned road the uphill portion is very difficult also stepping up onto curbs can be a taxing.

 

[benne68]

Is MUA something that is recommended at 18 months?

This is really something you need to discuss with a surgeon, but at your stage of recovery, it's my understanding that arthroscopic surgery is a better option for dealing with adhesions -- if, indeed, that's what's going on.

Your surgeon will likely want to do some imaging to see exactly what is going on in your knee before deciding on the best course of action. Well intentioned though he might be, I would not trust a PT to diagnose this.

I'm so sorry to read that you are still struggling and hope you get answers soon.

 

[2chains]

@benne68 Thank for the info...I specifically asked about arthroscopic surgery and he said chance of infection opening someone up. Didn’t sound right as I haven’t seen much on the forum about having MUA so far along. (This PT is very well regarded in acute knee cases so I was very surprised to hear this.)

I agree talking with DR is best bet and posted up to my fellow “smarties” as I know they have real life experience. I’m hopeful someone with arthroscopic surgery can post their experience with similar scenario in the meantime as I wait to get into the DR.

My issue with flexion is it won’t bend after 109 degrees..it is like it has hit a concrete block and won’t budge one bit further. Not sure if flexion addresses my main concern at this point anyway which is my walking peg leg style and locked knee on heel strike.

 

[skiforever]

I would expect PT to be working on walking. I can walk fine and have less flexion, maybe 105. I focus on a correct stride. It takes lots of effort. Some people need a cane or trekking poles to get rid of their limp. Try lots of things. Something may work.

 

[Jockette]

in the meantime as I wait to get into the DR.

Does this mean a trip back to the surgeon, didn’t you have to fly somewhere to get your surgery?

And, please refresh my memory, have you had a second opinion with a totally different surgeon? If not, you might want to consider that.

 

[2chains]

I would expect PT to be working on walking. I can walk fine and have less flexion, maybe 105. I focus on a correct stride. It takes lots of effort. Some people need a cane or trekking poles to get rid of their limp. Try lots of things. Something may work.

Glad to hear you can walk fine at 105! So I shouldn’t have any issues at 109.
"The Walking Code" is the youtube channel I’ve been utilizing for correct stride guidance. Daily forefoot walking and backward walking is on my PT”s exercise list. This seems to diminish the force of heel strike but still have a locked knee issue. Not sure what else to try for my peg leg jerky thing my PT has prescibed leg lifts ...have been doing those for a long time.

 

[2chains]

in the meantime as I wait to get into the DR.

Does this mean a trip back to the surgeon, didn’t you have to fly somewhere to get your surgery?

And, please refresh my memory, have you had a second opinion with a totally different surgeon? If not, you might want to consider that.

Yes I flew to a different province for surgery. My surgery was private pay as the wait list is 4 years here if you are deemed severe enough which I wasn’t. Original surgeon was contacted but was told I’m discharged.

My general practitioner was able to find a surgeon locally to consult on my case but says everything in the x rays looks “fine” and nothing else he can do. Really no other options here but I’ll maybe look into going to United States or Mexico?

 

[Jockette]

but says everything in the x rays looks “fine” and nothing else he can do.

That’s pretty much the situation I’m in, and I‘ve had 3 second opinions over 6 years, all with surgeons who do revisions.

 

[2chains]

Uugh! So sorry to hear this. I see you are in the eastern US so you’ve probably have had access to a few specialists. What are you dealing with at this stage?