Knee Replacement Failure, Revision Surgery, Recovery
By Robert Douglas
Seven or eight years ago I decided to start working out, so I started running. Through the time I was running I had multiple meniscus tears. I would go in and have them scoped to have them cleaned out. Little did I know what was ahead.
The real trouble started in September of 2016. I was playing flag football, and I ended up tearing my meniscus again, but I also tore the articular cartilage that lined the surface of my femur bone. I had a scope in January of 2017 to clean that out. It really wasn’t doing well: I had a lot of pain still. I talked to my surgeon about it and he basically said “You’re just gonna have to live with it.” I went to another orthopedic surgeon to get a second opinion and he said, “Well, I agree with him, but we could give you a steroid injection if you want.” That was in February. I said, “Sure, why not? It couldn’t hurt.”
Well, exactly 24 hours after I got the steroid injection, my knee just got swollen and stiff, and I really didn’t know what was going on. I thought it might have been a reaction to the steroid shot at first, so I thought, “Well, I’ll give it a couple of days and see what happens.” It was a Friday when it swelled up, and so I just waited throughout the weekend: it never got better. I went into the emergency room on Monday, this was the 20th of February, 2017, and told them, “Look, something’s going on with my knee.” I told him I had steroid injection, 24 hours later it got stiff. What’s interesting is when I went in I really didn’t even present with any outward symptoms that you could tell. However, I had developed a septic knee.
They were actually going to turn me away. My temperature was normal. My knee was not obviously swollen, maybe a little bit. It wasn’t red. It wasn’t hot to the touch. I said, “Something is wrong, just please get some testing going.” They did a CBC and an x-ray and they did a CRP, and it was just a little bit elevated. They came back to me and said, “You know, it’s a little bit elevated, your white blood count. Not really a lot, but the only way we’re going to be able to tell is tap your knee.” So they did that procedure, and you could tell right away. They had a hard time pulling it out, actually.
I spent a week in the hospital. I had two surgeries back-to-back to clean out my knee. Then, out of the hospital, I was at home on IV medications. The physical therapist that came out and told me there wasn’t anything that they could do for me, so I was without therapy for six weeks. I finally went to outpatient rehab after I got off the IV antibiotics. The other thing about my knee is that the infection actually got into my femur, so I got osteomyelitis as well. My knee was shredded. All the soft tissue was gone. I was bone-to-bone, and I was in a lot of pain. I could not walk. I had to buy a mobile wheelchair to get around. After a septic knee you have to wait so long to make sure it’s totally eradicated before you can have a knee replacement. The surgeon told me 12 months, but he said, “If you’re good in eight months we’ll try to do it then.”
In November of 2017, I had my initial TKR, a total knee replacement, and I had a tremendous amount of swelling. I actually went to a rehab hospital for the first week. From the very beginning I had a hard time really gaining any range of motion. That really continued on after I got home and went to outpatient rehab. You can tell if you’re not getting motion because of tight tissue but mine was really, really tight. There was some kind of mechanical block that was going on, so I kept talking to my surgeon about it, kept talking to my therapist about it, and really didn’t get anywhere. I just told them it won’t go past a certain point. Something was blocking it, and I could feel it whenever the therapist would press on my knee. They would muscle up on my leg pretty good. It would just be excruciating pain and it was like just bone pain, so I knew there was a mechanical block.
Finding the X10
I was looking for options on the internet to see what I could do? I saw the X10. I thought, “Well that might been helpful. I don’t know.” At the time I kind of looked into it and thought really it would be good. I needed to get something done about the mechanical block before I could do anything with the X10. I was left with at about 85º flexion. I could walk, but it was very limited. I had lot of pain still just walking, so my walking was just around the house more than anything. I just really deteriorated. Since my flexion was about 85º I’d have a hard time getting up out of a chair or anything like that. Even sitting for very long was tough.
I finally found a surgeon that was actually recommended to me by one of the therapists, and they said check him out and so I did. I got in with him and he did a workup on me and looked at me and actually put his hands on me and tested me and said, “You have a lot of instability in your knee.” He didn’t really know about the mechanical block. He couldn’t comment on that. He said, “You definitely need a revision, but we need to give it some time and let your knee calm down.”
I had the revision knee surgery, on October 3rd, 2018. Within 19 months I had five separate knee surgeries. For close to two years I had a ton of scar tissue that had built up. I was left with 85º degrees flexion and my muscles were severely, severely atrophied.
For me, my biggest focus was on getting that range of motion back. In fact I had scheduled home PT for after the surgery. The plan was to have home PT for four weeks. They came on Tuesday the following week after I got out of the hospital. They did the normal exercises and quadriceps stuff, the heel slides, the leg raises. After I had done about fifteen sets of each, so not a ton of work, but my leg just blew up. It just blew up with swelling and it set me back. I called the surgeon’s office and told him I just want to hold off on PT right now, so I held off on PT for close to two weeks. I focused on my range of motion only on the X10 machine, and that really helped me.
Using the X10 Machine
The first day when I used the X10 for range of motion, I started out at 80º. I was at around 85º going into surgery and then I was in a brace for two days, for the whole time I was in the hospital. So when I came out I was pretty stiff. I was so amazed to find that within the first week I was at 100º range of motion.
One of the things about the X10, that the coach has really reinforced on our frequent coaching calls, is to just really listen to your knee. Take it easy. Take it slow. Maybe if you could get one degree a time at each session that would be great, but listen to your body.
On the X10 you’re excited and you’re feeling good. I hit 103º and I was feeling great, so I thought, “I think I can get that extra degree,” so I did that. I worked it a little bit and I thought, “You know what? I think I can get that 105º,” and I did that. I got 2º at that one time and my knee blew up, and it really set me back. I think that’s an important thing in just making sure that you just take things really easy. You may be feeling good, but you’ve got to really listen to it. There’s such a fine line. It set me back for maybe a day, but what I found was if I just take it easy, so I backed off for the next day. I just walked off and I think I thought, “Well, if I could get back to that 103º at least,” so I did that basically for the two or three sessions that I did that day and didn’t try to push it and made sure I rested a lot.
Then the next day, okay, now I’m back at the 105º and can kind of start to move forward. You got to remember that I’m starting at 85º, so I’m starting to tear into that old scar tissue at this point. The deeper I go, the more that I’m really breaking up that old scar tissue that was there.
My surgeon told me when I got out of surgery, he said, “We did cut out some scar tissue, but you have a lot of scar tissue.” He told me he really felt like I’d get back to where I was “pretty quickly.” He said, “You could expect to get to 105º maybe, max, in three to five months. He said, “I’d like for you to be able to clear stairs easily, walk up and down stairs, but be able to walk and that sort of thing for exercise.” That’s where he was hoping I would be at three to six months.
At a little more that four weeks after my surgery (at the time of this writing) I maxed out at 123º degrees, but from 110º to 123º, it’s still pretty tight. I usually will warm it up with the bike a little bit first maybe for five minutes. I can ride a bike now. I’ll warm it up on the bike for maybe five minutes and I’ll start at 110º to 115º, kind of depending on the time of the day. Early mornings it’s going to be a little bit stiffer, but I’ll start out at 110º, 115º, something like that and just slowly work it back through the numbers. I think the thing for me that I know is that it can get there, and if I keep working at it, keep just slowly … I think it’s already broken in there. It’s already gotten to that place. I know that over time if I just keep working and keep riding that bike, keep moving the seat, I feel like that I’m going to end up at a very good place. If I end up even at, say, a comfortable115º, that’s 10º over what I thought I would achieve. I think, coming from 85º degrees to 115º degrees is tremendous progress and more than what I had anticipated, and certainly more than my surgeon anticipated.
A Two Year Knee Recovery is a Long Time!
I’ll be very honest with you. For nearly two years I lived in a very dark place. You go from playing flag football to barely being able to get around the house and you’re stuck in a mobile scooter, just enough to make it to the kitchen and get a cup of coffee.
I looked at the X10. I would encourage people out there, if you don’t know what the X10 is, look it up. Read about it, research about it because what it gave me was hope. Without that hope I couldn’t have done what I’ve done. The surgeon was a big part of that and X10 was a big part of that. I had hope. It really is what drove me.
I will say, too, even during the time for people out there that have gone through multiple surgeries and you’re wondering if things can be possible, I think it can, but I think even during the time where you’re thinking, “Okay, I’m getting a reset, I have this great machine,” there are still going to be dark days. You have to keep pressing it.
in retrospect I kind of laugh about my reaction to the therapy. I went from 103º to 105º and my knee blew up. Well, I didn’t know if that was going to be the end? Was that it?!! Was I going to make any more progress? You just have to believe in your plan.
There are still going to be dark days in between the days when you are making progress. At times it can be slow and tedious. I think it’s important that you listen to your body. Don’t push it too far and don’t, don’t, don’t give up!
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery and such subjects as how to avoid a knee Manipulation Under Anesthesia. Voted Top 10 Knee Blog of 2018.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here. Executive Editor: PJ Ewing (email@example.com)