Knee Pain return months post TKR

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   61 yo female, not overweight. TKR in May, manipulation in June, PT 3/wk X 2mo led to excellent flexion and extension. Almost normal gait returned, felt great.
 Returned to work in Oct.(outside sales - not a lot of walking, mainly in and out of car 10-15 times/day, drive between 40-150 miles/day) Pain has returned,seems to be progressively getting worse, mobility has decreased, limping noticeably, stairs which previously posed no problem have become problematic. Have problems "getting going" when I go from sitting to standing. 
Returned to Ortho who gave me a brace to wear and Rxed e-stim for "lazy quad" muscle. 

Looking for an explanation as to what is going on as I am 7 mo out from surgery - and any suggestions for additional exercises I could be doing. Currently walk on treadmill 1 mile/20 min each day, 15 min on floor pedals. Thanks for any help/suggestions!

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hurting Members Profile Send Private Message Find Members Posts Add to Buddy List Newbie Joined: Jan 04 2009 Status: Offline Points: 4	Post Options Post Reply Quote hurting Report Post Thanks(0) Quote Reply Topic: Knee Pain return months post TKR Posted: Jan 04 2009 at 9:41am
	61 yo female, not overweight. TKR in May, manipulation in June, PT 3/wk X 2mo led to excellent flexion and extension. Almost normal gait returned, felt great. Returned to work in Oct.(outside sales - not a lot of walking, mainly in and out of car 10-15 times/day, drive between 40-150 miles/day) Pain has returned,seems to be progressively getting worse, mobility has decreased, limping noticeably, stairs which previously posed no problem have become problematic. Have problems "getting going" when I go from sitting to standing. Returned to Ortho who gave me a brace to wear and Rxed e-stim for "lazy quad" muscle. Looking for an explanation as to what is going on as I am 7 mo out from surgery - and any suggestions for additional exercises I could be doing. Currently walk on treadmill 1 mile/20 min each day, 15 min on floor pedals. Thanks for any help/suggestions!

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PT Guy Members Profile Send Private Message Find Members Posts Add to Buddy List Newbie Joined: Jul 21 2008 Status: Offline Points: 18	Post Options Post Reply Quote PT Guy Report Post Thanks(0) Quote Reply Posted: Jan 07 2009 at 10:56am
	Hi- I was just wondering if you have had a recent x-ray performed on your knee? In a few instances a patient may be doing well until the hardware and bonding in the knee may not hold which could result in increase pain, decrease mobility and decrease function. How is the e-stim working out for you and has your condition improved since you started using it? You might also want to decrease or layoff the walking on the treadmill and increase the duration on the floor pedals to see if that helps with decreasing the pain.

Ask a PT Members Profile Send Private Message Find Members Posts Add to Buddy List Senior Member Joined: Jul 07 2008 Status: Offline Points: 954	Post Options Post Reply Quote Ask a PT Report Post Thanks(0) Quote Reply Posted: Jan 07 2009 at 2:43pm
	Ask a PT Response: "Sounds like you were doing great until you returned to work. Getting in/out of a car does put alot of stresses on a knee and can result in pain if your new knee is not accustomed to it. Has the brace been helping with managing your pain and letting you do your various day activities? Often times when this happens, surgeons will refer the patient back to PT for further rehabilitation to work on mechanics and improving strength/endurance. It might not be a bad idea to see if you could get an x-ray of the knee to make sure that the components of the artifical knee are still aligned correctly as well. In some cases the components of the knee may shift over time and result in a recurrence of pain for patients. I hope this helps and thanks for using CyberPT."

hurting Members Profile Send Private Message Find Members Posts Add to Buddy List Newbie Joined: Jan 04 2009 Status: Offline Points: 4	Post Options Post Reply Quote hurting Report Post Thanks(0) Quote Reply Posted: Jan 08 2009 at 9:07am
	Thanks so much for your response. Yes, a recent X-ray showed good bonding in the knee. I have not as yet noticed any improvement as a result of the e-stim. Also doing the dexamethasone thing on the inner area of the knee, only had one treatment to date. The PT also suggested backing off the treadmill, decreasing time NTE 15 min/1.8 mi/hr. Upon reassessment of my knee by the PT (done 1/6) it was noted that I have a lot of play in my patella, and my quad (or whatever muscle goes down the front of my thigh) is not firing at all. When walking I also hyper extend and my knee will often buckle backwards. So, as I'm sure you have determined by now, I have a lot of muscle weakness to overcome - and the PT feels that correcting this will give me more comfort and stability. So I am back to PT 3x/wk with about 6 sets of different exercises to do at home as well. Again, thank you for responding, I am so glad I found this site! If you have any other suggestions I would love to hear them. I will do everything (!) to get myself moving comfortably again.

hurting Members Profile Send Private Message Find Members Posts Add to Buddy List Newbie Joined: Jan 04 2009 Status: Offline Points: 4	Post Options Post Reply Quote hurting Report Post Thanks(0) Quote Reply Posted: Jan 08 2009 at 9:29am
	Thank you so much for your response. I am so glad that I found this site. At this point in time its clear to me that my PT should be my first point of contact, not the surgeon - he's already done his job!! I have an ever increasing respect and admiration for what you folks do!! You are right, going back to work had me doing things that I hadn't done since May, and probably uncovered weaknesses in the musculature surrounding the knee. I did all the pre- surgery exercises religiously, so this came as a surprise to me. During my post surg. PT , we concentrated so much on flexion, and rightly so, that these weaknesses just weren't ID'd or addressed (nobody's fault) The brace has helped a bit mainly in making me feel more stable, but I also find as the day goes on it binds me uncomfortably, so I take it off. I did have an X-ray done in late Dec and according to the PA, all looked as it should. They are doing the dexamethasone thing on the inner area of the knee, only had one treatment to date. The PT also suggested backing off the treadmill, decreasing time NTE 15 min/1.8mi/hr. Upon reassessment of my knee by the PT (done 1/6) it was noted that I have a lot of play in my patella, it slips to the outside aspect of my knee which apparently is irritating whatever muscle/tendon/ligament structures are there. My quad (or whatever muscle goes down the front of my thigh) is not firing at all. When walking I also hyper extend and my knee will often buckle backwards. On the positive side, my extension is "wonderful" and they were shocked at my 130 degree bend - done with ease. So, as I'm sure you have determined by now, I have a lot of muscle weakness to overcome - and the PT feels that correcting this will give me more comfort and stability. So I am back to PT 3x/wk with about 6 sets of different exercises to do at home as well. Again, thank you for responding, I am so glad I found this site! If you have any other suggestions I would love to hear them. I will do everything (!) to get myself moving comfortably again.

PT Guy Members Profile Send Private Message Find Members Posts Add to Buddy List Newbie Joined: Jul 21 2008 Status: Offline Points: 18	Post Options Post Reply Quote PT Guy Report Post Thanks(0) Quote Reply Posted: Jan 09 2009 at 1:39pm
	Hurting- glad to hear that you went back to your PT and were able to find out what may be causing your problem. If you do have trouble firing your quad that definitely would create a problem with performing functional activities. Good luck and good health to you!

hurting Members Profile Send Private Message Find Members Posts Add to Buddy List Newbie Joined: Jan 04 2009 Status: Offline Points: 4	Post Options Post Reply Quote hurting Report Post Thanks(0) Quote Reply Posted: Jan 09 2009 at 5:58pm
	I'm sure that this won't surprise you, but changes in my med insurance plan from 08 - 09 prevented me from returning to my original post surg PT group- took a while to find a group that contracted with my plan, and then more time to get an appt. for the re-eval, etc. Everthing thats been shared here is exactly what I've heard from my new PT, knowing a bit more going into the process hopefully has made me a better pt., easier to work with and hopefully I will have a better outcome. (But boy I am sore today after my session! and more exercises to do yet at home tonight!)

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