PKR 6 Week Post PFJR

[Layla]

Hi PFJR,
Thankfully the preliminary results came back negative for infection. I am happy it brings you some relief.
I can imagine that this feels frustrating and challenging. I am sorry. It's not just a physical struggle, but an emotional one too as you're trying to heal and make the best decisions for your long term mobility and comfort. It's good you sought multiple opinions and you're weighing the risks and benefits of suggested treatments. This is a journey and I know you will do the best with the information and options in front of you. No matter the uncertainty now, there is hope for improvement.
Please keep us posted and have a pleasant weekend.
@PFJR or Bust

 

[PFJR or Bust]

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.

Thanks! No one recommend a TKA and frankly I wouldn't have done one at my age and activity level. The flawed logic I had was that a PFJ would be a simpler surgery with quicker recovery. My medial compartment wasn't pristine as I had small osteophytes but pretty well maintained cartilage. The MRI I had last week didn't show any fissuring or cartilage defects only bone stress reaction/edema on the outside of the medial condyle and medial tibial plateau. Likely this is caused by the intense pressure in the joint and soft tissue inflammation around it. I'm using one crutch to get around to offload the knee to allow the stress reaction to heal itself. I really have no choice as I can't afford to allow that situation to become chronic and the body will heal stress reactions with reduced loading. I have noticed the effusion in the knee hasn't completely returned since the aspiration. I'm able to do get my quad to fire the best it has since surgery. Hopefully the effusion will stay out as I baby this thing along. I think some people are more prone to effusions and swelling and despite the risk of infection contamination it may be worthwhile to aspirate when the body isn't resorbing the fluid for whatever reason. An effused joint is impossible to get right from my experience.

 

[PFJR or Bust]

Hi PFJR,
Thankfully the preliminary results came back negative for infection. I am happy it brings you some relief.
I can imagine that this feels frustrating and challenging. I am sorry. It's not just a physical struggle, but an emotional one too as you're trying to heal and make the best decisions for your long term mobility and comfort. It's good you sought multiple opinions and you're weighing the risks and benefits of suggested treatments. This is a journey and I know you will do the best with the information and options in front of you. No matter the uncertainty now, there is hope for improvement.
Please keep us posted and have a pleasant weekend.
@PFJR or Bust

You aren't wrong about the emotional toll this can take. It took three consults to find a surgeon willing to aspirate to check for infection. The removal of the fluid seems to have kickstarted an improvement in knee function but time will tell if I can progress. Sometimes changing the environment in the knee can allow it to get back to closer to normalcy. I'll keep my fingers crossed.

 

[Jockette]

The flawed logic I had was that a PFJ would be a simpler surgery with quicker recovery.

You are not the first of our members to believe a PKR has a quicker recovery than a TKR. From all I read before my surgery I certainly believed it. To be honest, recovery takes as long as it takes, for each individual. There are some TKRs that recover “quicker” than a PKR, and vice versa.

I have noticed the effusion in the knee hasn't completely returned since the aspiration.

This is good news, as well as knowing there’s no infection, so I hope you feel encouraged that this will be a success.

 

[Layla]

Hello and Happy Saturday,
Thankfully you're feeling some improvement. I'll cross my fingers for you also, with the hope things continue to move in the right direction. A great weekend to you. Stay in touch!
@PFJR or Bust

 

[Nekocarlo]

PFJR, I’m sorry you now have pain on weightbearing. have they given you you any medications to help relieve the inflammation? I’ve tried Celebrex and it doesn’t help.
I need to research patella Alta, though I don’t believe the patella is part of my problem. Did they send the fluid off to lab for culture testing or do they believe the tests you’ve had are definitive?
My MRI is late next week, and will hopefully have some answers from that report. If not I’ll go ahead with the metal/cement testing from Orthopedics Analytics in Chicago, but I know I’m very allergic to nickel and he used a hypoallergenic prosthesis so I’m not sure what type of allergy would cause all this fluid retention. I’ve had no reaction to cement used in dental crowns, which is the same type used in joint replacement . I wonder if a ct scan would show prosthesis loosening or placement problems?

 

[PFJR or Bust]

PFJR, I’m sorry you now have pain on weightbearing. have they given you you any medications to help relieve the inflammation? I’ve tried Celebrex and it doesn’t help.
I need to research patella Alta, though I don’t believe the patella is part of my problem. Did they send the fluid off to lab for culture testing or do they believe the tests you’ve had are definitive?
My MRI is late next week, and will hopefully have some answers from that report. If not I’ll go ahead with the metal/cement testing from Orthopedics Analytics in Chicago, but I know I’m very allergic to nickel and he used a hypoallergenic prosthesis so I’m not sure what type of allergy would cause all this fluid retention. I’ve had no reaction to cement used in dental crowns, which is the same type used in joint replacement . I wonder if a ct scan would show prosthesis loosening or placement problems?

I take an Aleve a day which definitely helps with inflammation. The weightbearing pain started a few weeks ago and corresponds with the bone marrow edema in the medial side bone. They did a synovasure which tests a variety of inflammatory markers. I've already heard back those were all negative for infection. Still have to wait on the culture but it likely won't grow anything given the preliminary results. I was mildly sensitive for nickel on the LTT allergy test. That's likely not the cause of the effusion. But who really knows? It sounds like your problem is fairly significant, so don't stop searching until you find an answer.

 

[PFJR or Bust]

4 Month Update--
The last month has definitely brought improvement from what I describe a challenging recovery from PFA in December. Walking is much easier as my glutes and quads have gotten much stronger. Walking on flat ground is effortless at this point. I'll do an occasional hill or stairs if need be. I'm going to take it easy on them until my quad is stronger and more of the swelling has subsided. I developed a stress reaction on my medial joint bones at around 3 months from ongoing effusion and weak muscles. That fortunately has mostly resolved. I still have a moderate joint effusion, which is definitely not optimal. As mentioned previously the going theory is that it's being caused my patella baja and abnormal stresses on my new implants. My patella clunks over the implant around 90 degrees going from flexion to extension. That used to be a grind when I had cartilage. I visit the MD next week to talk about patella tendon lengthening if that hasn't resolved by 12 months. Patella baja can also be accounted for with joint line adjustment in TKA. Obviously I'm in zero hurry to go that route as I'm not prepared to go down that rabbit hole anytime soon. Although the industry is becoming more accepting of total joint replacements in sub-50's patients, the satisfaction data is inferior for more active patients who have their ACL removed. You only get so much natural bone stock in the event of infection or revision scenarios. I'll probably post every couple months for posterity's sake. Good luck everyone!

 

[Layla]

Thanks for stopping by to give us a progress update at four months post op, PFJR. Here's to continued healing and strength as you recover from your surgery over the next months. Take care and best wishes for the visit with your physician next week!
@PFJR or Bust

 

[Wallace walla]

4 Month Update--
The last month has definitely brought improvement from what I describe a challenging recovery from PFA in December. Walking is much easier as my glutes and quads have gotten much stronger. Walking on flat ground is effortless at this point. I'll do an occasional hill or stairs if need be. I'm going to take it easy on them until my quad is stronger and more of the swelling has subsided. I developed a stress reaction on my medial joint bones at around 3 months from ongoing effusion and weak muscles. That fortunately has mostly resolved. I still have a moderate joint effusion, which is definitely not optimal. As mentioned previously the going theory is that it's being caused my patella baja and abnormal stresses on my new implants. My patella clunks over the implant around 90 degrees going from flexion to extension. That used to be a grind when I had cartilage. I visit the MD next week to talk about patella tendon lengthening if that hasn't resolved by 12 months. Patella baja can also be accounted for with joint line adjustment in TKA. Obviously I'm in zero hurry to go that route as I'm not prepared to go down that rabbit hole anytime soon. Although the industry is becoming more accepting of total joint replacements in sub-50's patients, the satisfaction data is inferior for more active patients who have their ACL removed. You only get so much natural bone stock in the event of infection or revision scenarios. I'll probably post every couple months for posterity's sake. Good luck everyone!

Hi PFJR,
any updates regarding your recovery? How are u doing?

 

[Layla]

Hi there Wallace walla
Thoughtful of your to check in on PFJR. He hasn't been on the forum since August, so you may not hear back from him.

I am wondering if you've experienced joint replacement? If so, consider sharing the date and type of surgery you had so we're able to create a signature for you. If you are post op, we'd love for you to take part in our community so were able to follow your progress and encourage you along the way. Please join us!
Here is our membership information -> https://bonesmart.org/forum/pages/membership/
@Wallace walla