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Author Topic: 8 weeks post op  (Read 2373 times)

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Offline cornish_girl

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8 weeks post op
« on: July 14, 2012, 07:57:27 AM »
Hello

Im new to the forum and I was just after a bit of advice and reassurance

On the 21st May I had an arthroscopy purely for exploratory reasons (or so I was told).
This was due to the fact that my left knee cap subluxes.  This all started in my early teens when the knee cap came out
and pulled everything so far round that the bottom corner of my femur was broken.
Now at 28, I had the keyhole to verify what else was wrong, I do not have a groove under my knee cap and is in fact
slightly domed.  My interior ligament is also ruptured so every now and again the cap comes out (when I say now and again it can be months or years
between it coming out)

7 (coming up to 8) weeks after surgery ( while getting DVT in the mean time) I can drive but I still have to use a crutch to walk as without it I hobble badly
and I have zero confidence walking without the crutch.  When I do walk without it between rooms I grip with my toes.  Im afraid to walk outside anywhere without the crutch as I dont have the feeling of being able to hold onto something.

Before this I was on my feet nearly every hour of my waking day every day as I am a gardener/nursery worker, to go to this has been horrendous, physically and mentally.  I was told I would be back to work within 2 weeks originally, I have only just been back to work this week on light duties and amended hours, 7 weeks after the op

Is this walking with a crutch 7 weeks after surgery normal? or is it pshycological and my confidence on my knee is shattered, I just want to be able to walk normally again and be able to my job properly (an quickly like i used too)



Offline kneepaincure

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Re: 8 weeks post op
« Reply #1 on: July 15, 2012, 12:38:26 AM »
An arthroscopy should not have such a long recovery period normally. Have you checked back with your doctor to see if anything can be done to speed up the recovery?

It's also possible that the fear of dislocation is hindering your progress, but I would be hesitant to blame everything on fear.
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline emergRN

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Re: 8 weeks post op
« Reply #2 on: July 15, 2012, 01:13:37 AM »
Are in in a physio program?  If you have been using crutches for an extended period of time, then you may have lost a lot of your quad muscle on the inside of your knee.  This could cause the feeling you are describing.  You also state that you have torn an "interior" ligament.  Do you know what ligament?  Is it ACL or PCL?  This could also cause a feeling of instability, especially in the presence of a weak VMO(quad) muscle.

Have you tried using a cane?  A cane will give you support, but it will require more weight bearing than the crutch!

I would suggest strongly, that if you are not currently in a physiotherapy program, that you do so.  They can give you appropriate exercises to help you strengthen your leg, and help you get your confidence back.  It is also highly important that if you have a torn ligament in your knee, that you get those muscles built up to help with the over all stability of the joint!

Good Luck!

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline cornish_girl

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Re: 8 weeks post op
« Reply #3 on: July 16, 2012, 07:27:08 PM »
Thank you both for your advice.

I am to be very honest, very unconfident on it and scared that it will come out,
even though, technically, nothing was done to it.  I had no confidence on it before the
op so now its even worse.

I do think I am relying on the crutch to much, trying to not use it that much in
the morning but by the afternoon it feels quite weak and the leg starts to buckle.

Im not able to do the most basic of quad strengthening exercise, i cant get the back of my knee flat to the floor,or lock the kneecap,
and then lift it straight, theres always some little bend in the knee, difficult to describe.
Will any leg lift help even if the back of the knee isnt flat to the floor?

The DVT didnt help, Im now wearing stockings to work so by the afternoon theres a lot of swelling around the knee.

Offline emergRN

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Re: 8 weeks post op
« Reply #4 on: July 16, 2012, 08:23:13 PM »
It really sounds like you have quad weakness.  I really think you should go see a physiotherapist.  You do not have full extension either.  Even though "nothing" was done, they were still in your knee joint.  If you had the muscle weakness pre op, then it isn't going to be better post op.

Before you start trying to do straight leg raises with a bend in your knee, get it assessed by a physio.  I was warned not to do them when I had a quad lag, as they can damage you knee joint.  If you can even work on just tightening your quads while sitting in a chair, it will be better than nothing.  I am sure that the fact that you were probably restricted in your movement after being diagnosed with a DVT did not help matters.

It really sounds like you need some help with this.  I would advise you to do this sooner, rather than later.  I urge you not to go by what others here have done or not done.  Every situation is different.  You need a qualified professional to assess you, and to determine the best rehab course for your particular case.

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline cornish_girl

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Re: 8 weeks post op
« Reply #5 on: July 16, 2012, 09:10:35 PM »
Sorry, I do apologise, you asked me in your last post if I was seeing a physio.

I am but not often, I dont feel I had great enough support with physio when I came out of hosp and
now I regret not kicking up a fuss about it.

The first time I saw my physio after being diagnosed with DVT, he told me to treat it as week 1 after the op.
And because I couldnt straighten and lock my knee and lift, the two exercises I were given were, sit on edge of a table or something like, with legs
dangling, lift leg, hold and release.  Also to lie on back with a pillow under thigh and lift the leg to a straight position, hold and release.

The last time I went back to physio, we couldnt actually do anything as my leg was so swollen due to DVT, so to just carry on
with those exercises and some little wall squats.
Dont go back now till august. 
Ive been working the quads today, its difficult to do with being back at work, but the muscle does now ache which im
hoping can only be a good thing

Offline emergRN

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Re: 8 weeks post op
« Reply #6 on: July 16, 2012, 10:22:37 PM »
Maybe it is time to see another one.  I am guessing by your screen name that you are in the UK.  I am not sure exactly how the system works there, but I do know that there is the NHS, and private.  If you could book even one session privately with someone that you choose, it may be money well spent!

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline cornish_girl

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Re: 8 weeks post op
« Reply #7 on: July 17, 2012, 06:27:10 AM »
I am in the UK.  I have thought about getting second opinions, everyone does.

I cant fault my physio, hes lovely.  It would just be nice to have weekly support, instead of
every so often. 
But like I say, with the DVT and the swelling there isnt much he can do.  Just waiting for the bulk of the swelling to
go down now before I go back.

Again, thank you for your advice :)

Offline LindaM

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Re: 8 weeks post op
« Reply #8 on: July 17, 2012, 11:30:52 PM »
Hi there,

Sounds like you are having a real time of it.  When you mentioned DVT I immediately thought that you are probably sitting and or lying down with your feet up.  Hopefully you are not putting a pillow under your knee as you do so.  If you are not already doing so I would encourage you to sit with your thighs and feet supported but your knee unsupported for short periods to help with passive stretching to get your knee straightened. 

When you can comfortably begin, you really need to get going on the quads.  If a straight leg lift is too challenging or you just can't begin the lift, use a towel under your foot and pull up the leg to get started.  I needed to do that after my last surgery for a couple of weeks until my quad got more cooperative. And my first PKR I was unable to straighten going in but still got assigned SLRs starting the day of surgery, so I think you are safe in beginning them asap.

By the way, how are you treating the DVT?  Usually this is pretty aggressively treated and it doesn't sound as if you have even been seen by the doctor for it.  If you have not been in to have it evaluated  by a doctor I would certainly get in and have it taken care of.

Good luck and good healing :)

Linda
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline emergRN

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Re: 8 weeks post op
« Reply #9 on: July 18, 2012, 12:41:59 AM »
How recent was the DVT.  I was under the impression that it had been dealt with.  What week post op were you diagnosed with it?  Are you still on any meds(blood thinners) for it?

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline cornish_girl

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Re: 8 weeks post op
« Reply #10 on: July 18, 2012, 08:16:14 AM »
The DVT was diagnosed approx 3 or 4 weeks ago.  I had shots of heparin into the stomach for 7 days and now I am on
warfarin for three months.  More blood tests today to check INR levels.

Last week when I went to my physio I had also started back at work that week.  On light duties and altered hours and I hadnt started
wearing flight socks at the time (getting measured today for proper compression stockings) so of course because I couldnt put my
leg up fully at work the leg swelled badly so he wasnt able to do anything apart from reassure me and tell to me carry on with
the previous exercises when the swelling goes down.

I now wear flight socks to work and they really help the swelling on the foot and calf, still bigger than the
other one when I get home but nowhere near as bad, it just looks like all the swelling had been pushed up to the knee.
So once i have iced it for a bit I can do some exercises.

Linda- that is what I did first couple of weeks after op, I slept with a pillow under my knees trying to get bend back in it.  I was told by the hospital
dont do it for the first couple of nights but after should be fine, now Im wondering maybe that was a factor in me getting it as the DVT nurses and my own GP both kept saying that I do not meet the criteria for DVT.  They put it down to immobility.  I am on the pill but I have been on it for ten years so they didnt think it was a big factor, it may not have helped but not played a big part.

I need further surgery but I am not so sure now due to the DVT.  I know they will start me off on meds again weeks before the op to stop me
getting it again, but Im really not sure I want it now.

Offline emergRN

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Re: 8 weeks post op
« Reply #11 on: July 18, 2012, 12:44:51 PM »
The DVT probably would not be caused by the pillow being underneath your knee.  It can cause problems with achieving full extension.  If you still have significant swelling, then the inability to straighten your leg could be due to that as well.   You can do passive exercises to improve your extension.  You can lay on your stomach on your bed, and let your leg hang over the edge.  You can also put your heel on a coffee table when you are sitting in a chair, and let gravity do it's thing.  These are some simple things you can do to improve your extension. 

The surgery centre where I had my surgery will not do surgery unless you stop the BCP and all hormone replacement therapy for 1 month prior to procedure.  That could very well be the cause of your DVT with the addition of joint surgery, and immobility!  There is an increased risk of DVT with birth control even when you do not have surgery.

Your best move right now is to wear the compression stockings when you get them, decrease the swelling, and get going with the physio as soon as the physiotherapist gives it the go ahead!  You are anitcoagulated, so that is good!

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline cornish_girl

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Re: 8 weeks post op
« Reply #12 on: July 18, 2012, 03:21:42 PM »
Thank you for all your advice I really do appreciate it.  When I am at home I sit with my heel up on a stool.
Its just when I am at work its difficult as I not always in the same place, but will try.

My consultant didnt even want to talk about surgery until I was off Warfarin, here they start you on shots of Heparin
weeks before the surgery I do believe, which again isnt nice as im also needle phobic but oh well, hopefully this will get me over that phobia!

Would you think I am daft then at really not wanting the next bout of surgery?  It really does worry me.  You read on here so many threads where
people are in worse pain than they were before

Offline emergRN

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Re: 8 weeks post op
« Reply #13 on: July 18, 2012, 04:20:48 PM »
Heparin is short acting.  You are always started off on Heparin, or similar anticoagulant with a DVT because it works fast.  Warfarin takes time to build up in your system over time.  When your INR gets to an acceptable state of anticoagulation with the warfarin, then the heparin is stopped.

It would not be smart for any surgeon to do surgery while you are on warfarin.  You would have to come off of it first.  The risk of bleeding is much too high.  If you needed anticoagulation after surgery, you would then be started on injectable like lovenox, heparin, or fragmin!  I am sure that they would also want to make sure that the DVT had been broken down as well!

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline LindaM

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Re: 8 weeks post op
« Reply #14 on: July 18, 2012, 04:57:42 PM »
I feel better hearing you are being treated for the DVT.  I guess I must have missed a different post somewhere that explained it.  Just take this one thing at a time, get the DVT taken care of and work on ROM and strength, and worry about the surgery when it is time to worry about that.  You want to not just get the swelling down and the knee back to normal, you would be better off giving your whole body time to build itself up again.  Surgery can take a lot out of you and back to back even more. 

Has your PT had you working on any balance exercises?  If not you might ask for some just to get your confidence and stability back a little sooner.  If you have been moving like a 90 yr. old with slow, shortened little steps your balance can be affected as well which becomes more noticeable when you start to take normal length strides again.  One easy one I was given was to balance on one foot every time I was at the kitchen sink with my hands hovering over the edge in case I needed them to catch myself.  Because it was a place i stood frequently I got a lot of practice and it really helped.

Linda :)
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012