PKR 6 Week Post PFJR

[beralc]

@PFJR or Bust presuming you mean post surgery symptoms. My symptoms have been slightly coloured by my pre existing conditions. Having RA Fibromyalgia and Raynauds it was a good 10 days until I was able to really do any exercises/walks of any note, because the surgery caused flares. I wasn’t able to ice because of the Raynauds and I also developed anaemia. But apart from all that I’d say getting beyond those initial two weeks of pain, specifically in the calf and thigh, was my biggest challenge.

I found once I was able to lift my leg off the bed etc independently, (which happened about day 10) as opposed to literally having to lift it with a belt things got easier and once pain reduced,I was able to move more albeit within the boundaries of the anaemia.

I notice that swelling was a big issue for you initially so I thought you might find it interesting to know that I wasn’t able to use ice so elevation was key for me. As I slept well from the get go, my knee was elevated all night and when I wasn’t walking and pottering about my leg was also elevated. I’d say almost half of the day my leg was toes above nose and the swelling reduced down to within a centimetre circumference of my other knee.
Don’t know if any of that answers your question?

 

[PFJR or Bust]

@PFJR or Bust presuming you mean post surgery symptoms. My symptoms have been slightly coloured by my pre existing conditions. Having RA Fibromyalgia and Raynauds it was a good 10 days until I was able to really do any exercises/walks of any note, because the surgery caused flares. I wasn’t able to ice because of the Raynauds and I also developed anaemia. But apart from all that I’d say getting beyond those initial two weeks of pain, specifically in the calf and thigh, was my biggest challenge.

I found once I was able to lift my leg off the bed etc independently, (which happened about day 10) as opposed to literally having to lift it with a belt things got easier and once pain reduced,I was able to move more albeit within the boundaries of the anaemia.

I notice that swelling was a big issue for you initially so I thought you might find it interesting to know that I wasn’t able to use ice so elevation was key for me. As I slept well from the get go, my knee was elevated all night and when I wasn’t walking and pottering about my leg was also elevated. I’d say almost half of the day my leg was toes above nose and the swelling reduced down to within a centimetre circumference of my other knee.
Don’t know if any of that answers your question?

Thanks for the update @beralc. My operated knee is still a cm bigger in circumference than the non-operated knee but definitely fluctuates with activity. Taking it easy today with lots of ice and elevation as I think I did too much yesterday. No pain just a puffy knee.

 

[beralc]

@PFJR or Bust well sounds like it’s all heading in the right direction for you. I actually woke up naturally for this first time this morning and not because I was in pain, that was a great feeling. I definitely take that as a good sign. Had a fall today which has made things very sore again, but I think once that settles, I’ll be moving forward again.

 

[PFJR or Bust]

I received my long awaited compression sleeve (German made) from Amazon today. I won’t mention the name as I’m sure we aren’t supposed to promote products on here. It’s a game-changer. It has a donut for the patella. The difference weight-bearing with it vs. my previous ace bandage set-up is night and day for compression and stability. I walked a total of 3.5 miles today. I’m hoping wearing this will unload the knee joint and help the lymphatic system drain more fluid over time. It’s nice to see a patella the same size as the contralateral side when I remove the sleeve I’m struggling mentally with the concept of being confined to my house all day icing and elevating to rid my knee of the dreaded swelling. Maybe wearing the sleeve will be a nice compromise along with icing and elevating? I’ve also cracked the code of my previous lateral IT band discomfort/pinch with walking by foam rolling the IT band. Just sharing notes along this rocky road to recovery…..

 

[Jockette]

I’m struggling mentally with the concept of being confined to my house all day icing and elevating to rid my knee of the dreaded swelling.

Try to remember that this recovery is temporary.

You can post the name of the product, so others can look it up, just not a link.

 

[PFJR or Bust]

I’m struggling mentally with the concept of being confined to my house all day icing and elevating to rid my knee of the dreaded swelling.

Try to remember that this recovery is temporary.

You can post the name of the product, so others can look it up, just not a link.

Good perspective! Bauerfiend Genutrain is the brand.

 

[Jockette]

@PFJR or Bust Thanks for the brand name. I looked for it on Amazon but there were many different styles. Can you give more of the product name of the one you have? It sounds like it would be good for others to know about.

 

[Jamie]

We like to know the names of good products that work. As part of our new Membership Program Bone Smart will soon be rolling out a Recovery Store where members can purchase items. Once we get it going, we will hopefully be able to add some of these items that members report helped them.

 

[Layla]

Just sharing notes along this rocky road to recovery…..

Thanks for joining us and sharing! These updates are helpful to other members healing right along with you, as well as those still facing surgery, or in early recovery.

I’m hoping wearing this will unload the knee joint and help the lymphatic system drain more fluid over time.

You'll have to let us know how you feel this product is beneficial after using it for awhile.

I’m struggling mentally with the concept of being confined to my house all day icing and elevating to rid my knee of the dreaded swelling.

I will quote my fellow staffer, Roy Gardiner from the UK -

"When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme".

Interesting way of looking at it, right PF?
I hope you have a great Thursday!

 

[PFJR or Bust]

I'm approaching 10 weeks post-op and my persistent knee effusion continues to be a major hurdle to recovery. Due to the ongoing fluid in my knee I've had to ratchet back activity to basically nothing. My surgical knee is consistently a cm greater in circumference in the suprapatellar area than my other knee. I can see the synovial fluid circulate around my patella when I tension my quad. To say I'm concerned is an under-statement. I've never had this level of effusion after any of my previous surgeries. Nor did I have effusion pre-op. Walking is difficult now. Not due to pain but the inability to fully straighten the knee due to fluid and the large baker's cyst in the back of the knee.

Patella mobility is good and I get full extension and around 125 degrees of flexion but I don't push flexion as it causes more effusion. This doesn't appear to be a scar tissue issue. I tried doing some isometric exercises to help fire my non-existent quad muscles and they did nothing but irritate the knee. I'm icing and elevating for long periods and that does slightly bring the effusion down temporarily.

I had a normal blood test at 6 weeks post-op but have been pushing the OS to draw fluid and test it for infection. They of course don't seem to want to deal with it. Sometimes indolent infections don't show up on inflammatory serum markers initially. I had an open incision for a week after surgery due to extreme bleeding so I'm suspicious that a low-virulent infection could be a cause.

I ordered the metal allergy test from orthopaedic analysis today. My symptoms due mirror others who've had allergies to metals or bone cements. I'm better knowing sooner rather than later. My job entails travel so I'll likely be going on disability soon as that isn't feasible. I really need to rule out something insidious causing the inflammation in my knee before I can accept this is just normal post-op effusion.

I've consulted with a few other surgeons who agree the effusion is abnormal for this stage but none have been willing to pull fluid out to test at this stage due to contamination risk. They want to give it time. I'm skeptical that it will improve as the effusion hasn't come down since week 2.

Pain isn't my issue which I guess is one reason to be somewhat optimistic but honestly I haven't done enough activity and this is a partial. If I had a TKR in this situation then I suspect I would be having more pain issues. It goes without saying that this surgery was a mistake at this point and potentially could be a life-altering event. Nonetheless no one is going to advocate for my care and I need to keep looking for answers even if that leads down the path to more intervention. I was hesitant to do this surgery for that very reason but it's water on the bridge at this point.

 

[Jockette]

Pain isn't my issue which I guess is one reason to be somewhat optimistic but honestly I haven't done enough activity and this is a partial. If I had a TKR in this situation then I suspect I would be having more pain issues.

Over the years I have been on Bonesmart I have seen little difference in the recoveries between partials and totals. It seems some, if not many, who get partials expect the recovery to be quicker and easier, than totals. I certainly expected to see that, but I didn’t.

Walking is difficult now. Not due to pain but the inability to fully straighten the knee due to fluid and the large baker's cyst in the back of the knee.

You can do a search for other members who had a Baker’s cyst and how that specific recovery went. It’s an added thing to heal from.

It goes without saying that this surgery was a mistake at this point and potentially could be a life-altering event

I’m sorry that your complications lead you to this conclusion at this point. I do know the feeling. But, even for a partial, 10 weeks is early in this year long, on average, recovery. You have lots of time to improve. Even with my issues, I saw a lot of improvement all the way through my second year. That may actually sound discouraging to hear at 10 weeks, but it’s true, that healing can continue for a long time.

You’re doing the best you can, with the knowledge you have, which is more than most of us have, and I hope your healing will take care of these current complications.

 

[PFJR or Bust]

Pain isn't my issue which I guess is one reason to be somewhat optimistic but honestly I haven't done enough activity and this is a partial. If I had a TKR in this situation then I suspect I would be having more pain issues.

Over the years I have been on Bonesmart I have seen little difference in the recoveries between partials and totals. It seems some, if not many, who get partials expect the recovery to be quicker and easier, than totals. I certainly expected to see that, but I didn’t.

Walking is difficult now. Not due to pain but the inability to fully straighten the knee due to fluid and the large baker's cyst in the back of the knee.

You can do a search for other members who had a Baker’s cyst and how that specific recovery went. It’s an added thing to heal from.

It goes without saying that this surgery was a mistake at this point and potentially could be a life-altering event

I’m sorry that your complications lead you to this conclusion at this point. I do know the feeling. But, even for a partial, 10 weeks is early in this year long, on average, recovery. You have lots of time to improve. Even with my issues, I saw a lot of improvement all the way through my second year. That may actually sound discouraging to hear at 10 weeks, but it’s true, that healing can continue for a long time.

You’re doing the best you can, with the knowledge you have, which is more than most of us have, and I hope your healing will take care of these current complications.

Thanks as always for the comment @Jockette. I would be more optimistic if I was experiencing a gradual improvement of the effusion. I had a full patella without cartilage after one of my failed cartilage graft surgeries which had almost zero joint effusion. This level of effusion is usually a big red flag that something is seriously awry in the joint whether mechanical, infection or allergy. The only recourse I have is to exclude those options via tests and to lay low in the interim.

 

[Layla]

I'm approaching 10 weeks post-op and my persistent knee effusion continues to be a major hurdle to recovery

This sounds normal at only nine weeks post op. Swelling can fluctuate and improve with rest, elevation / icing.
Assuming there's no heat, redness or sharp pains.

I'm icing and elevating for long periods and that does slightly bring the effusion down temporarily.

Good!
It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

Stay adequately hydrated and eat an anti-inflammatory diet, if you're aren't already.

It goes without saying that this surgery was a mistake at this point and potentially could be a life-altering event.

Recovery can be frustrating for certain, especially when the timeline you're experiencing isn't meeting your expectations. Swelling doesn't automatically mean something is wrong. Especially so early on. Many have swelling for months and your OS may even tell you this can go on for a full year, slowing easing over time. Your knee is still healing and swelling is part of the process and doesn't mean your PKR was a mistake. It sounds like you are no longer experiencing the pre-surgery pain, so that's a positive! Many who doubted their
surgery / recovery initially, eventually feel relief and normalcy once again. I hope this is the way you feel soon.
Wishing you a good week!

 

[Jockette]

and to lay low in the interim.

I had to cut back on the PT I was getting, as it was too aggressive and keeping/increasing my swelling. I thought my PTs knew best until I learned different after finding Bonesmart.

 

[PFJR or Bust]

I'm approaching 10 weeks post-op and my persistent knee effusion continues to be a major hurdle to recovery

This sounds normal at only nine weeks post op. Swelling can fluctuate and improve with rest, elevation / icing.
Assuming there's no heat, redness or sharp pains.

I'm icing and elevating for long periods and that does slightly bring the effusion down temporarily.

Good!
It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

Stay adequately hydrated and eat an anti-inflammatory diet, if you're aren't already.

It goes without saying that this surgery was a mistake at this point and potentially could be a life-altering event.

Recovery can be frustrating for certain, especially when the timeline you're experiencing isn't meeting your expectations. Swelling doesn't automatically mean something is wrong. Especially so early on. Many have swelling for months and your OS may even tell you this can go on for a full year, slowing easing over time. Your knee is still healing and swelling is part of the process and doesn't mean your PKR was a mistake. It sounds like you are no longer experiencing the pre-surgery pain, so that's a positive! Many who doubted their
surgery / recovery initially, eventually feel relief and normalcy once again. I hope this is the way you feel soon.
Wishing you a good week!

Thanks for the feedback @Layla. To be fair every clinical situation is different. There is definitely heat with the effusions. Swelling (edema) is a different phenomenon than recurrent joint effusion. The other reality is that if effusion persists and hasn't diminished over the first three months, especially with limited activity then that is a pretty big red flag. At this stage most prudent surgeons are going to draw fluid and check for WBC and other markers. Indolent deep knee infections don't always have the telltale signs of acute infections. Probably worth ruling out a metal allergy as well if there are no apparent mechanical causes of effusion. There also could be issues with the deep arthrotomy. Leaving a knee effused for a long period without resolution can be devastating long-term for the function of a knee. This is a LARGE joint effusion not the typical post-operative effusion that ebbs and flows with activity which you may expect given the tissue trauma.

 

[Layla]

Hello PFJR,
You're right everyone's recovery and experience is different. We can all learn from one another here.
I wish you well on your journey and the best possible outcome given your situation.
Take good care.
@PFJR

 

[Nekocarlo]

Hello PFJR, I was wondering if you have resolved your effusion issue. I had a right tkr (with hypoallergenic implant as I’m allergic to nickel) one year ago this month and I still have a very swollen knee apparently due to excess synovial fluid. It is about one inch larger than my left knee. I had a mua 9 months ago and after months of additional pt I’ve reached 120-125 range of motion. I can live with that but not the chronic swelling. I’ve had it the entire time and my crp tests are normal. He has mentioned synovitis and Arthrofibrosis but I don’t have the pain usually associated with Arthrofibrosis, nor the very limited rom so now he’s not sure about arthrofibrosis (though I do have ‘gummy’ scar tissue).
No heat or redness so Dr doesn’t think it’s an infection. I’m having a mars mri this month so hopefully that will provide enough info for a diagnosis, but this effusion ( if that’s the correct word for my condition) seems to be permanent. I’m interested in your progress.
Thank you
@PFJR or Bust

 

[PFJR or Bust]

Hello PFJR, I was wondering if you have resolved your effusion issue. I had a right tkr (with hypoallergenic implant as I’m allergic to nickel) one year ago this month and I still have a very swollen knee apparently due to excess synovial fluid. It is about one inch larger than my left knee. I had a mua 9 months ago and after months of additional pt I’ve reached 120-125 range of motion. I can live with that but not the chronic swelling. I’ve had it the entire time and my crp tests are normal. He has mentioned synovitis and Arthrofibrosis but I don’t have the pain usually associated with Arthrofibrosis, nor the very limited rom so now he’s not sure about arthrofibrosis (though I do have ‘gummy’ scar tissue).
No heat or redness so Dr doesn’t think it’s an infection. I’m having a mars mri this month so hopefully that will provide enough info for a diagnosis, but this effusion ( if that’s the correct word for my condition) seems to be permanent. I’m interested in your progress.
Thank you
@PFJR or Bust

Hello Nekocarlo- Unfortunately my effusion is still ongoing. I received the results of my LTT blood metal allergy test and indicated only "slightly reactive" to Nickel and no reaction to any other metals. I have an appointment this week with a highly respected fellowship trained expert on both infection and metal sensitivity. I got a self-referred MRI this week and it showed bone marrow edema in my medial joint bones and tibial tuberosity. They had become painful a week ago. I'm on crutches now as weightbearing will only make that condition worse. This could be a result of poor walking mechanics due to the swelling or possibly the early manifestation of an indolent infection. My blood test came back normal. I also have persistent swelling in the subcutaneous tissues anterior to the patella and patellar tendon. I haven't had a synovial fluid test yet which likely happen this week. For some reason all three of the surgeons I've consulted with prior have refused it. I believe my knee is around a half-inch larger than the non-operative side over the patella. This is combination of the effusion and swelling. Your lack of heat is encouraging for not having an infection. I have heat, swelling but no redness. Certainly something is awry in my situation. My quad won't fire due to the fluid in and around the knee and I had a very pronounced limp due to poor joint mechanics. I would recommend you push for a synovial fluid test. Many people struggle with effusions early on and get no resolution and only discover they an indolent infection after many months and making no progress. I'll keep you posted.

 

[PFJR or Bust]

14 week update-
Given the struggles with recovery due to pressure/effusion/swelling and now pain in other areas my knee, I got a few second opinions. I'm slightly sensitive to nickel per Orthopaedics Analysis LTT Test. I had 20ml of red/clear fluid aspirated this week and the preliminary results came back negative for infection (WBC, Alphadefense, Neutrophils). What a relief that I'm not staring down the barrel of a two-stage total knee revision. The second opinions both thought some of my issues may be a result of patella baja and scarring in the extensor mechanism from previous surgeries. I know that patella alta (opposite of baja) is contraindicated for PFJs. I think most surgeons opt for TKA in my pre-op situation. There's not much else for me to do at this stage other than try to create the best possible environment in and around the knee for it to heal. If that's even possible. My original surgeon discussed the option of a patella lengthening surgery or proximalizing the tubercle to get my patella higher to improve joint mechanics. Something for me to consider but certainly something that could make a bad situation worse as well.

 

[Jockette]

I’m sorry things haven’t improved more, but glad there doesn’t seem to be any infection.

Was a TKR suggested pre op? What made you decide on the PJF? I know you knew the general outcomes for them.

I hope your knee will settle down and heal to some extent, before the possibility of considering any further surgery.