PKR 6 months post op Patella Femoral Arthroplasty with severe pain

[dkaitz]

HI

I am now 6 months post op a partial knee replacement where my only arthritis was behind my kneecap due to a fall over 15 years ago. So I had my femur resurfaced and metal implanted and a plastic button put in for my cartilage behind my kneecap. This was done on 8/11/2023. As this is not a common surgery I cannot find much information about recovery on this but I know have a stabbing pain behind my kneecap when I walk. I didn't have this pre surgery. The pain I went in for pre surgery like unable to walk up and down stairs is better. My kneecap is no longer grinding on my femur. But now I just can't walk without severe pain. and a popping sensation for whatever is in there. I found an article the other day about scar tissue formed around the cement left behind the implant. Anyone else have anything like this? I meet with the surgeon last month had a CT scan(they say they didn't see anything) it may be scar tissue and I was told I need to strengthen my muscles more. For some context. I am 55 years old work out 4 days a week. But am now making sure to do the 'PRESCRIBED" exercisers daily. This is super frustrating as I feel like everyday my knee hurts more than it did before. It is not infected I have been worked up for that.

 

[EalingGran]

I am sorry you are still in so much pain.
Do you still use ice? I know I found it helpful for many months.
As someone who had one of the rarer partial knee replacements ( in my case a lateral pkr) - I know it can be frustrating at how little information there is on these rarer variants.
Put patellofemoral into the search bar and you will find other BoneSmart people who have had your surgery.
One good thread to read is @JusticeRider
She is like you in that she had a patellofemoral, is young and active.
Her recovery was slow but ultimately very successful.
I have tagged her @JusticeRider to see if she can offer any support and advice.
She doesn't come by so often now as she is busy riding her horses!

 

[Jockette]

Hi and Welcome!

I also have a Patellofemoral PKR so I understand what you’re going through. Recovery does take an average of a year, so you still have more healing to do.

As this is not a common surgery

I have also learned, from a surgeon, that PKRs are controversial and that not all surgeons will even do a PKR. It seems Medial PKRs are the most common.

but I know have a stabbing pain behind my kneecap when I walk. I didn't have this pre surgery.

This pain is due to the trauma of the surgery and is what still needs to heal.

But am now making sure to do the 'PRESCRIBED" exercisers daily.

Don’t do these to extreme, your knee is still healing. More exercise does not equal healing, or even faster healing. This all takes time.

 

[EalingGran]

am 55 years old work out 4 days a week. But am now making sure to do the 'PRESCRIBED" exercisers daily

Just another thing. Is it possible you have been doing too much for a healing knee?
What do you mean by "working out"?
It can be that if you overdo things- especially using weights or resistance bands too early that it can slow down recovery. Also PTs sometimes push people- especially possibly younger recipients- too much.

 

[EalingGran]

have also learned, from a surgeon, that PKRs are controversial and that not all surgeons will even do a PKR. It seems Medial PKRs are the most common.

Agree with @Jockette that medial PKRs are the commonest and it is important to get a surgeon who is an expert in partials.
They can be very successful though, if done by a surgeon who specialises in them.

 

[lrj]

I also had patella femural PKR. I don't have the pain you are talking about. I do have some popping too. When I talked with my surgeon, he said it's common with this type of partial and typically improves with decreased swelling and increasing quad strength. I can definitely tell mine is directly correlated to swelling. When I over do things, it gets worse. I've now learned to gauge my activity based on how it's feeling and stop to rest. As someone told me the other day, "Don't go 15 minutes past stupid."
However, as I said, I don't have the pain. But I'm not a good person to compare pain with. I snapped 2 bones in my leg in 2 as a teen, and just said something didn't feel right. I would definitely recommend talking with your doctor. Also try just having a day or two of rest and see if it improves.
I almost forgot, at 1-3 months past the first surgery, I would have pain with my first step. After that, I was fine, once I worked on proper walking mechanics. I still had that the morning of my second surgery, but never had it afterwards. Didn't have that problem with the 2nd knee.

 

[dkaitz]

So interestingly the pain behind my kneecap just keeps getting worse. It truly feels like something is there. Like I said the simple act of walking is severely painful. My surgeon told me to work on certain muscle groups. He also told me maybe scar tissue is behind the kneecap causing this. All I know is every day it seems to get a little worse not better. If I keep my knee bent I have minimal pain. If I try and walk normal whatever is behind my kneecap is causing severe pain. I am barely walking most days at 7 months post op 6,000 steps so I don't think I am over doing it. I was told I would have been able to ski by now. But I can't even walk at this point. Golf season in New England is coming up and I am fearful I can't walk 7 months to me I would think I could.

 

[lrj]

Maybe there is something soft tissue going on that can't be seen in x-ray or CT. With the replacement, that would effect the image quality of an MRI.
My sister had a loose piece of cartilage floating around her knee for years. When it moved to the wrong place, she couldn't walk until it moved again. I'm curious if there is something like this and how would they determine that.

 

[EalingGran]

So interestingly the pain behind my kneecap just keeps getting worse. It truly feels like something is there.

He also told me maybe scar tissue is behind the kneecap causing this. All I know is every day it seems to get a little worse not better

That doesn't sound right to me. I wonder if you should be considering a second opinion. Recovery can be slow and take up to a year but you should be seeing some signs of progress by now I reckon- not worsening pain.