Revision TKR Tibia break after knee revision

[BridgetJ]

Today is 6 weeks post knee revision. Only at 70 degrees flexion. MUA scheduled for Friday and I am hopeful and nervous at the same time. Had 2 MUA on this same knee last year and they were very painful - the second one was worse than the initial surgery.

I ended up having a “floating” fibula as the result of all the tendons and whatever else attaches there detaching. Hoping for a better outcome That last knee did not fit right and I’m sure contributed to part of the problem. This knee feels “right” and I have a different doctor. I trust my doctor but still anxious. Can I hear some good MUA success stories?

 

[Jockette]

I’m sorry to read you are scheduled for an MUA. Your poor leg has been through a lot of procedures in its lifetime, especially the original TKR only a year before this current revision.
I’m going to tag @Josephine for you.

. If I don’t get to 90 in 2 weeks (6 weeks post-op) then MAU. I had 2 MUA on this leg when the first knee was put in in May 2018 - I am NOT doing it again! They were more painful recoveries than the actual surgery.

If it was my leg I would not have this MUA and I’d rest my leg as much as possible so the poor thing can heal.

Is your revision surgeon the same one who did your TKR last year?

One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

“I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):

1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.”

 

[Jockette]

6 weeks is a drop in the bucket in this 52 week (one year, on average) recovery. You have barely begun to heal. Where you are now is not where you will end up.

 

[BridgetJ]

This is a different doctor than the first time and he is amazing! I hear what you are saying but am conflicted.....no wonder they call it the “practice of medicine!”

 

[Josephine]

I'd refuse. After all, you are only 6 weeks out. Much to soon for this. Remember, it's YOUR choice, not his. Be brave, just cancel it ans say you'll wait and see how it goes in the next 2-3 months.

Read this
If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Celle]

Today is 6 weeks post knee revision. Only at 70 degrees flexion. MUA scheduled for Friday

Your poor knee has had so much done to it that I think it's entirely normal for its ROM to be slower to develop than your surgeon wants.
It should be allowed more time, not be further traumatized by yet another MUA.

A MUA now will cause further swelling, which will slow down its bend even more. Please don't have it. Tell your surgeon you want to wait for at least another month.

 

[Josephine]

6 weeks is still very early. Stop worrying about it.

 

[lovetocookandsew]

This is just my opinion, but I think many surgeons want your numbers where they think they should be regardless of any individuality, IMHO, either because they are "old-school" and haven't kept up with new and better ways of recovering; while some others do it for their egos. I think, if I were you, I'd be patient and wait a couple of months, or even longer, and see where you are. You mentioned how much worse the MUAs were than the TKR, and how painful they were, etc. My question is, if they were that bad and didn't help, why go down that road again? The definition of insanity is doing the same thing over and over and expecting a different result...... I'm not saying you're insane, but having an MUA again at this early stage is, to me, bordering on insanity.

Think about this, if you had broken your leg, would the doctor want to basically re-break it to make it heal faster? No, you'd be in a cast for a time to allow the bone to heal fully, then gradually begin to use it again. During a TKR, your skin and surrounding tissue is sliced open, your knee is sawed apart, drilled, hammered, screwed, cemented and so on; to expect it to be recovered, or at some artificial number representing healing, in 6 weeks is insane! Remember, it's YOUR knee and YOUR recovery, and only you can decide how you want it to recover. Being patient for a while to see how it comes along is the better path. You tried the other way, and it not only didn't help, it made things worse, so now why not try another way? Good luck and keep us posted!

 

[BridgetJ]

Quick background:
TKR May 2018 (Result of an accident in my 20’s causing deformity and ultimately arthritis)
Revision April 2019 (2018 knee did not work due to severe deformity and past trauma)

FINALLY turned a corner October 2019. Feeling optimistic and getting stronger with improving ROM, extension and strength. Short walk with dog December 1, 2019 and I slip on a patch of ice and hear the most horrific sounds and experience excruciating drop to the ground pain. Now in the hospital after surgery to repair broken tibia at base of rod (large plate and 14 screws). Fibia also broke but that should heal on its own. I will be non weight bearing for at least 8 weeks.

Why I am posting.....today was surgery #8 on this leg (4 in the last 19 months). I’m scared, frustrated and in pain. Has anyone had a similar break post revision who can help me understand what to expect? I know we are all different but wondering how to keep some of the progress I have made with ROM, extension and strength. The bone is so weak which is the reason for the non weight bearing requirement. The photo is from December 1 and surgery was December 2. I feel so alone and need to connect with someone who has been on a similar journey.

 

[Sara61]

Oh you poor thing - I'm absolutely no help at all to you the best I can offer is a virtual hug.
Hope you find the answers you need xxx

 

[Jockette]

I’m so sorry this has happened to you.
I’ll tag @Jamie to come talk with you.

 

[Cjackso21]

Just when I start feeling sorry for myself waiting for my like 6th revision I see your post. You are in good hands with these folks. I have no experience with broken bones but I have had many surgeries (11 total, with 1 TKR and 4 revisions) and know you have to keep a positive attitude and know you will heal eventually. Keep us posted on your condition and will pray for you!

 

[TheSloth]

Oh no!! While I haven't been down your road, I want to say I'm so sorry this has happened to you and encourage you by saying I hope this all turns around for you soon.

 

[Celle]

@BridgetJ - I'm sorry to read about your fall and the resulting break in your tibia and fibula.

Non weight-bearing is a nuisance, but it will give your bones a better chance of healing.

You'll notice that I have merged your two threads together as we prefer that members in recovery only have one thread. Really, your latest update is still a continuation of your knee's story. Which knee is it, by the way?

We prefer members to only have one recovery thread for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed, if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just post what you would like it to be and we'll change it for you

 

[Jamie]

I'm so sorry this has happened to you. I can certainly understand your concerns about how this leg will be going forward. Your leg will heal and your surgeon is taking the right approach by having you be non weight bearing to allow that to happen. Once that period of time is over, you may have a partial weight bearing period to allow you to transition back to normal walking slowly and carefully. Then once you are full weight bearing, you'll want to increase your activity gradually.

A break like this is not a common occurrence. From the x-ray, it appears your implant is solid, so this is one thing to be very thankful for. Even though you are non weight bearing for a couple of months, you can still do bends and stretches with your knee while seated or lying down to ensure that you retain your range of motion. If there are any setbacks there, it is likely to be from swelling you may have in your leg from the trauma and not something that will be long-lasting.

Have you previously had a bone density scan to rule out osteopenia or osteoporosis? If not, it would seem one might be in order after your leg has had an opportunity to heal. Since you mentioned that your bones were "weak," I wonder if you already do have this diagnosis. And, if you do, it would be helpful to know what treatment your doctor has suggested for it.

Here is an article from our Nutritional Library that will give you some dietary guidelines to improve the healing process. It's a bit long, but there is tremendous value in the information there.

Healing Phases & Nutrition

Healing Phases and Nutrition No matter what part of the body is undergoing surgery, the internal process for healing is pretty much the same! Surgically "traumatized tissue" (skin, muscle, bones, cartilage, tendons, etc.) does not just magically heal; rather, the body has to rebuild and repair...

bonesmart.org

Please remember that you have all of your BoneSmart family behind you as you're healing. Reach out to us when you're feeling low and also when you have some of those good moments to celebrate. We'll be right there with you.

 

[Motherbone]

My patella fractured and my patello-femoral tendon ruptured three weeks after my right TKR, requiring a second urgent surgery to repair. The surgeon could not completely pull the kneecap fragments together. I had limited weight bearing and was prohibited from bending my right knee for 8 weeks. Interestingly, during that time, the actual replacement in that knee healed nicely (note I was prohibited from doing any PT, the exact opposite of what seems to be pushed after our TKR's). I was gradually able to recover a 90 degree bend in the right knee once I was authorized to start moving it again - the trauma surgeon who did the repair did not think I would be able to bend it any further, but 90 degrees has been sufficient to allow me to do my activities of daily living. Just as I was finally recovering some function this past summer, I suffered stress fractures of my tibia and fibula in the opposite ankle, probably because the left leg was doing double duty while the right leg was incapacitated. I was casted and non-weight bearing for 8 weeks. I can empathize with what has happened to you. Take it one day at a time. Read my recovery thread for ideas about how to cope with such a long and inconvenient recovery. Above all, wear comfy clothing - I deliberately bought shorts and underwear one size larger so that I could wiggle in and out of my clothes without too much difficulty! And by the way, my screening bone density at the hip was read as normal, but, judging by the many fractures I've suffered, the condition of my peripheral bones is more brittle, so my PCP has started me on medication for osteoporosis anyway. Just another example of "numbers" not always correlating with real life.