Total Knee Replacement Week 27

Today marks off the end of 27 weeks since surgery, the 6 month anniversary has officially passed by now.   Last week found me with my 4th round of issues since week 15 wanting to go to ER or anywhere they would help me.   My GP did tell me Thursday to go to the ER!



After Monday's PT I had increased pain which escalated into an odd tight, painful sensation of being numb and wrapped around my entire leg from mid-thigh down my leg.   I got a work-in appt at my GP's office but they only prescribed more meds for the increased pain hoping that would get me through to my Neuro visit that was to occur the following week.   They also did a follow up on a pain management referral because they would not see me until they had neurological report.  I wanted to get the ball rolling on that since neuro was finally happening.   Crazy to have to wait so long for some sort of pain relief.  Also a referral was made to a Physical Management and Therapy.   Sounds like someone to take charge of looking at what tests should be run etc? 

Wednesday I called and cancelled the remaining few PT appointments I had left on the revision specialists order for more PT back in August.  They are causing me more pain than improvement.   I feel like if 26 weeks of PT hasn't gotten me well, what would 4 or 5 more visits do.   Nothing,is what I believe at this point in time but constant pain and swelling from PT.   I researched some knee specialists online and was excited about a couple with info on their website, but none take my insurance.   The 2nd OS that I went to only ordered the PT... did not deal with pain or recommend a follow up.  He said everything looks good on xray. These surgeons.... if implant looks OK, and incision is healed - they are done with you.  And Xray - how often are problems diagnosed after scans or MRIs were performed?   I have no confidence in an xray.  My shoulder surgery even took an MRI with contrast to find the problem... and 1.5 years later.

Oddly, on Monday, I noticed my big toe looked purple.  Bob was still here and he touched it,  it went white and proper color started coming back immediately.  I forgot about it and it was not even mentioned at Tuesday's doctor work in appointment.

Thursday, still increased pain even with extra medication. At one point that afternoon I looked down and my foot was purple!  Only on surgical leg.   You quilters can see a sketch there of a design on my acrylic sketch board there by my feet.  Excuse the bad polish, I have not been to a nail salon since pre- surgery.
  

Elevating my leg in my recliner brought the color back to normal.   If I put my leg down for a short while, it turns purple again.   I called my GP's office, it was about 2:30pm and my doctor advised that I should go to the ER, either the one near my home in Spring or the one near his office in The Woodlands.  About that same time my son called to see if I needed anything and I said yes!  He picked me up and we were off to the ER that is very near my home.  Bob was/is in Memphis for drill.

My blood pressure had been elevated on Tuesday, which they marked as due to increased pain.   It was 138/89.   Upon arrival at ER Thursday ... my blood pressure was 216!!!    They also noted the foot turning purple when seated and leg bent.  They admitted me, inserted an IV and started running tests.   I was there 5.5 hours.  My blood pressure was down to 168 after being in bed that long which is still way too high but not stroke level. 

They ran a Venus Doppler ultrasound on that leg, it came back with normal results.  Then they ordered a cat scan,  CT, CTA and AAA with runoff.  The CT looks at blood vessels, the CTA looks at coronary vessels around the heart, the AAA (Abdominal Aortic Aneurysms) looks at the main blood vessel that runs from your heart through your tummy.   I have a detailed report of everything.  All arteries are widely patent.  Organs are described as normal or unremarkable or no acute findings.  So great news there.

I was hoping for detail at my knee but it only says:  post surgical changes of a right total knee arthroplasty.

ER sent me home saying to follow up with my doctors.  No advise about what to do, should I be on bed rest?  Should I continue trying to work and live life with a purple numb foot and ignore it?  What the heck???

My doctor had already advised he was not in the office on Friday but to message advising what happened at ER.  I am about at the end of my rope with this.  I did get a call back from Pain Management group!   They will see me Tuesday as a consult awaiting the neuro testing to be done on Thursday.   This group does not prescribe pills.   They look at issues and try to come up with a treatment.   No call back yet from the Physical Management Therapy doc.  Meanwhile pain is through the roof, mobility worse, foot turns purple.  I spent much of the day just crying over anything and everything, you just gotta break down every now and again.

I am hoping for no nerve damage.  Doesn't seem to be a cure for that.  Tests finally on Thursday to determine muscle and nerve responses.   A part of me doesn't believe it can be totally all nerve damage.  I hurt too badly at my knee area, not just burning or sensitive to touch.   Nerve damage can be caused by the nerve block used in surgery or the tourniquets used in the surgery or what they call trauma of surgery.

Meanwhile, at the support forums, they all say it takes an MRI or a bone scan to determine if there is a loosening of the implant, a fracture etc.  Only major failures show on an xray where you can see the implant has obviously fallen on one side.  I have now been in contact by 2 people that nothing could ever be found on testing, they underwent exploratory arthroscopic surgery and both those cases found particles of the bone cement in areas where they should not be in the knee area.  One was pressing on a nerve.  Another recent one, the implant was only off 10 degrees of whatever the center should have been.  Revision corrected her problems too.   It is just so frustrating that the orthopedic surgeons have never ordered any tests.   I have had one xray since surgery.  That's it.   26 + weeks of physical therapy and I still can't walk or stand properly and I am in constant pain.  PT, when it is not weight bearing, I can do whatever is asked of me.  Recumbent bike, Leg Press (total gym type thing) lying on my back, I can do 80 pounds.  It hurts at my knee and of course I can do more weight on my non surgical leg so some strength is lacking, but my leg is strong.   I told current physical therapist on 1st visit in August, he is watching me walk and asks am I in pain.  I said yes... and I don't think any amount of PT will ever have me walking until we can find source of pain and correct that.   This past Monday he agrees, there is something wrong, it is not something PT alone can correct.

It has taken so long and still no answers. I have known from Day 1 things are not normal but guidelines gives you a few months leeway. That has come and gone.   Hopefully Monday I can get advise from my GP on current new condition and finally neuro and pain management doctor appointments are now happening!  Meanwhile living like this is really taking a toll on me, my family and my business.  Your prayers and support have been greatly appreciated.

Comments

It is all awful to read Valerie. I cannot imagine having major surgery to fix something only to have it be the opposite.

Would you consider a consultation appt with a completely different ortho doc (even if not in your insurance)? Something clearly went wrong and another opinion is definitely needed.
Becky Collis said…
My heart just breaks for you! There is something wrong. You are strong and intelligent, talented and motivated to get back to your life. As difficult as it is, you have to keep looking for answers, knocking on doors and seeking new opinions. You will get through this, I just pray that it won't take much longer.
Elle said…
10 degrees variance is HUGE! Average these days with computer assist is under 3%.
Nancy said…
Valerie, this is a most discouraging process for you! Very frustrating for you and no one offers any answers. Keep knocking on those doors- you've been proactive and aware throughout, so hoping your input will count and you'll be heard... and treated. Best to you.