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Author Topic: 4 mos. post op -- pain when extending, crunching when flexing  (Read 2204 times)

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Offline judychaps

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4 mos. post op -- pain when extending, crunching when flexing
« on: November 10, 2007, 04:17:31 PM »
I am new to this board.  I hope someone can offer me some suggestions.

My TKR and PT went just fine but then at about two months post op I started having a twanging feeling in the back of my knee towards the outside when I try to stand up.  It feels like there are two bands fighting for room in the same space.   Once I'm up and get the bands in the right place I can walk totally pain free and there is no twang.  I can be in a sitting position with no pain. It's the getting up that hurts.

I get the same feeling if I'm in a sitting position and try to stretch my leg out straight in front of me, such as when I'm driving.  I also go through the same thing in bed if my leg happened to be bent and I try to straighten it out so basically it's any time my knee is going from being bent to going straight. 

It is so disappointing because even though my knee hurt before the replacement it was nothing like this.   I didn't have this problem for the first two months after my replacement.  I could sit for any period of time and just get up and take off walking.   Not now.  It's been like this for two months and is very disheartening to sit down for five minutes and know that if I have to go to the restroom or someone rings the doorbell I will not be able to get there right away.   I have to stand up and  move my leg in all kinds of positions until I can feel those bands work their way back into place.  When that happens it hurts.  Then once everything is in place I'm all set to walk and all is fine.  If I try to hurry and walk before the "big twang" it's like walking with a knife twisting in the back of my knee.

At the same time I'm also experiencing a lot of clicking and popping in the front of my knee when I bend it.  It hurts a lot but not as bad as when I'm trying to stand up. 

Oh yes, I'm 59 and physically active.  I've been doing both physical therapy since my release from the hospital and just recently also added water therapy.


Offline costumer

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Re: 4 mos. post op -- pain when extending, crunching when flexing
« Reply #1 on: November 10, 2007, 08:51:23 PM »
Hi Judy-

        hmm.. almost sounds like me. I don't get a twanging in the back of my knee, but more laterally (which makes me really scared that ti's subluxating), pretty much the same times you get yours. I wonder though, apparently when Donna had her TKR done they kept the PCL (my OS said he never does because it's all scarred and trash and shouldn't be kept). I wonder if your OS left your OCL as well and that's what's twanging??? And I know for me this twanging (and that's what I call it, too) is NOT the same as the very common click - for one thing it's in a different place than the click and it leaves the area a little sore. I've mentioned it to my PTs, but until I can replicate it with them, they can't tell - and of course the car never makes noise when you bring it in to the garage  ::)

Dx: bi-lat subluxating patellae w/chondromalacia 4/1977
6/78 LR - LK
1/80 TTT-Hauser LK; 12/80 Proximal Realignment Mystery- RK
1/82 Maquet TTT- LK
11/06 Meniscectomy; Mild OA- RK, 12/06 Meniscectomy; Mod OA- LK
3/07 Bi-lat severe arthritis
9/18/07 bi-lat TKR

Offline Janet

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Re: 4 mos. post op -- pain when extending, crunching when flexing
« Reply #2 on: November 11, 2007, 03:28:48 AM »

I had that pain, too. It started after a MUA. My OS said there is an area on lateral side and the back of the knee there where several "things" have to pass through a small space. Mine were inflamed and unhappy. I also had pain where the IT Band attaches beside the knee. The pain was so bad when weightbearing that I was still using a cane at five months post-op. When it didn't clear up on its own, I was sent back to PT, where I had lots of ultrasound, stretching ice, heat, and some limited strengthening. Within a couple of months, the pain was much better. I had given up the cane and was no longer limping. I still get some discomfort in that area, but it continues to improve over time and as I get stronger.

Are you still in PT? If not, you might ask to go back for "modalities" (ultrasound, etc). I don't think I would have gotten through this without going back to PT.

Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline judychaps

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Re: 4 mos. post op -- pain when extending, crunching when flexing
« Reply #3 on: November 11, 2007, 12:16:27 PM »
Sorry this message got a little long.

Judy(costumer) mentioned that my doctor might have left my OCL.  I have to admit that I really didn't know enough about anatomy before I had this surgery.  I've been reading up on it as I have time and still can't figure out everyone's conversations when they use initials.  I remember reading on some web site how someone mentioned their doctor said a lot of "stuff" had to pass through the same area I get my thwangy pain.  And like Janet said her doctor said all the "things" in her leg were not happy in that area.  With so little knowledge of exactly where everything is I keep looking at the anatomy pictures.  Could it have something to do with the cruciates?  But then I look at the pictures of the muscles and the bicep femoris looks like it's in that same area I have the pain.  If I look at pictures of the posterolateral corner I see where the popliteous tendon and the popliteo fibular tendon are in there too.  I don't have a clue as to what all of those things are so I'm back to using the same term ....."there's a lot of "stuff" in there."

Judy mentioned that she needed to duplicate these same things for her doctor.  That's where I don't have any problems.  All I have to do is sit on the examining table for a few minutes and then get  up.  I'm hanging all over the table trying to get my leg straight so there is no problem demonstrating to the doctor.    Also, while sitting on the table the doctor can wrap his hands around my knee and have me bend and partially straighten it and he can easily feel the popping and clicking towards the front.    Still nothing concrete in a diagnosis. 

As Janet mentioned, she had pain in the IT band area. I do too.  I even got a cortisone shot there but it did nothing to help.  Back when I first got out of the hospital after the replacement I use to push hard on all of my home exercises because I wanted to meet the criteria the therapists had on measurements of the flexing and extensions.  It hurt so bad in the IT area when I pushed myself at home but I did this so they would not push on it during physical therapy.  One time they pushed so hard it shoved me off the table.  Every time they bent my knee in a jamming effect I got blinding pain.   I hated that so I pushed and pushed at home so I could meet the goals of measurements they wanted for me.  I often wonder if some of the shoving they did or the over doing I did caused some of this. 

Janet, you asked if I was still in PT.  Yes, I've been in PT continually since my surgery four months ago.  I had originally started out going three times a week for an hour.  Then when all of this started they had me go five times a week. Now they have me back at three times a week but have also added water therapy three times a week too.  My land therapy takes about two hours but my water therapy only lasts about 45 minutes.  I'm sure glad my business slows down this time of year or I'd never have time for all of this. 

Also, I did have weeks  of ultrasound but they have discontinued that for now.  They said after so long it doesn't do as good as the first week or so and too much ultrasound can eventually do some damage. 

Right now the doctor has me doing closed chain, short arc exercises.  I have no problem with strength or stability.  I bet by the time I'm done with all of this my legs are going to look like they belong to some football player.  <G>

Thanks for the input so far.  Suggestions anyone?

Judy L