Success with revision surgery 4 yrs after my awful TKR
I am not a doctor, just a male patient whose 2022 TKR went horribly wrong. These comments are based on my own experience. I learned from my mistakes & those of others. I am sharing what DID work with the revision surgery I had 2 months ago to correct the 2022 TKR.
First, it's imperative that all members of the team work together. Typically, the surgeon is the chief and he (she) should oversee & be involved before, during, and after surgery. He should work with an anethesiologist he is familiar with. If u have to fight with your insurance company to get the best, do so BEFORE surgery.
Second, a qualified PT person should be identified IN ADVANCE and instructed what's needed. Meet and interview him/her. He should communicate with the surgeon and report on your progress. Retain the experienced PT person throughout. Don't allow them to push a trainee on you. If you are a large person, make sure the PT person is strong enough to handle/manipulate you. They will offer ICE packs at the end of each session & I always took the max time which was 15 minutes to reduce the inflammation PT will cause. PT WILL BE UNCOMFORTABLE. I communicated with my PT guy using a pain scale of 1 to 10. We pushed for pain level 8. The goal is to increase your ROM (range of motion) and that means effort.
Third, asking a patient who has NEVER exercised to suddenly begin exercising after painful TKR surgery is a recipe for failure, IMHO. People MUST build muscle in the other leg and both arms to assist the TKR knee. If the patient is NOT willing to put in the effort, the outcome is likely to be unsatisfactory. I didn't have that problem. I exercised before and was back at the gym 3 days after revision surgery. My PT person educated me which exercises were OK vs TOO much. Don't make things worse.
Fourth, I have a high propensity to build scar tissue which impedes ROM. The surgeon read my history and wisely started me on an anti-inflammatory BEFORE surgery and an even stronger med after surgery. The result, I took NO Oxy or Tramadol after surgery. I took NO pain med stronger than Tylenol. Two months after revision, my peak ROM was 131 degrees. Before revision, it was 92 degrees.
Fifth, I go to a local gym 6-7 days a week. You will NOT succeed unless you move the joint so either have the equipment at home, schedule lots of PT, or join a gym. There is no easy way around this.
Sixth, prepare your home environment BEFORE surgery. If you need to walk stairs, practice how you will manage stairs with a partially disabled knee BEFORE surgery. I installed solid staircase rails. Ditto for the toilet seat, the car, and mobility around your house. Buy/rent the equipment you need. Plan ahead.
Seventh, if you don't have a friend or mate whose willing to help, find one BEFORE surgery. You will need help and encouragement to continue.
Eighth, follow dosage instructions. They can be complicated so I created an excel spreadsheet to help me manage time between meds and quantity. Other people use APPS but be ready BEFORE surgery. I placarded the walls of my kitchen with my charts.
Ninth, for me, losing weight BEFORE surgery was very helpful. Having less girth to move around definitely helped.
Tenth, discuss the Saphenous nerve with your surgeon. I did NOT become aware of that nerve until after my TKR and that was my biggest mistake. I first become aware of that nerve on the Mayo website AFTER my TKR.
Bottom line? My wife and I went SWING dancing on Sat for the first time in many years. Please remember, I am not a doc. This was my experience and what I learned (the hard way). I hope you can learn from my mistakes.
Comments welcome.
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Start conditioning exercises before surgery.
Absolutely. Totally agree.
I just had my second TKR revision and the jury is out. Only 3.5 weeks. Hopefully this works.
I checked every 'box' from mrnomad's list pre TKR and first revision and still had a poor result. I have consulted with two of the best knee clinics in the country (Stanford and UCSF) and they cannot provide an answer as 'everything looks good'. Unfortunately a small percentage of people, for whatever reason, do not have a good result. Glad to hear that mrnomad is dancing again.
Regarding the saphenous nerve. The infrapatellar saphenous nerve is typically damaged or cut during TKR as it runs horizontal to the incision. It is a sensory nerve; not a motor nerve unlike the peroneal nerve on the lateral side which can result in more serious issues if damaged.
The saphenous nerve and its infrapatellar branch contain zero motor fibers, injuring or severing them during a Total Knee Replacement (TKR) will have the following clinical impacts:
Zero Impact on Mobility: It will never cause weakness in your leg or stop your knee from bending and straightening.
No Effect on Rehab: It will not interfere with your ability to participate in physical therapy, build quad strength, or regain your walking stride.
Purely Surface Symptoms: Any damage is limited exclusively to surface-level skin sensations, such as numbness, tingling, or localized burning.
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1 Reaction@dbduffer Thx for the detailed, saphenous nerve explanation. Wish I knew about it BEFORE my disastrous 2022 TKR. I first learned of the nerve's existence on the Mayo website where they discuss "tuck the saphenous nerve". I assume that means "avoid it or get it out of the way". During recovery, my TKR leg would suddenly jerk straight out causing extraordinary pain. It was NOT limited to "surface-level skin sensations, numbness, tingling, or localized burning" so maybe the surgeon hit the peroneal nerve. All I know it felt like the high side of an ignition coil. Having wired airplanes, cars and houses, I have suffered the occasional electric shock but nothing like this. When I asked the surgeon if he "tucked the nerve", he said NO. We then explored "ablation" to mitigate the shocks but the shocks died down after many weeks of drugs and nerve deadening shots. Unfortunately, the extraordinary pain and OXY precluded rehab. Scar tissue built up which limited ROM, and the downhill slide into depression followed.
It's impossible for the lay person to fully understand this procedure which is why I added it to the list of items to discuss with the doc. Perhaps a "tuck" would have helped me avoid excruciating pain.
Swing dancing was not without pain but it was emotionally gratifying. I will never be 17 again, but the marine corps expression "pain is good" is relevant here. Recovery took 4 years, a great wife, and the refusal to become a couch potato.
Best of luck on your journey. Happy to discuss anytime.
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