Revised PKR to TKR Almost 3 months after partial knee replacement

[ORpatella]

So here's a quick update: revision surgery was a week ago, implants got both changed to the Arthrex PFJ system. The patella button was really worn, about half of it gone! Not surprising the knee looked like a melon. Doc did a MPFL as well, as the patella wasn't running smooth.
Flexion is at about 80*, crutches for a few more weeks to keep the swelling down

 

[Clipless]

Hopefully this revision resolves all of your knee problems for many years to come. Did you have a different (better) surgeon this time?

 

[ORpatella]

Yes, different surgeon this time! Would be good if it holds up for the next couple of years

 

[Celle]

Welcome to recovery again!
I sincerely hope that this latest operation will be good for more than a couple of years!

Please will you add your revision surgery and its date to you signature now, so that we're reminded that you had it in 2015? Thank you.

Since it's a while since your first surgery, I'm going to give you the recovery reading list.
First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lie down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

Best wishes.

 

[ORpatella]

Thanks @Celle @Clipless
Stitches are out, but should have them removed earlier. They began itching two days prior, now I have some small blisters which should be gone soon.
Flexion on the CPM is at 105*, patella is running smooth. We'll see how it all works out once the swelling is gone.

Happy New Year everyone!

 

[Squashmad]

I'm a little uncomfortable with the " don't bother with a PKR" opinion which is frequently repeated on this site. PKR's certainly come in and out of favour but technology moves on, did you have a smart phone 10 yr ago!!!!
My OS does very few PKR's for the good reason that not everyone is suitable. What would be the rational for any surgeon recommending a procedure that is flawed!!!
As I understand it revision rates are no worse than for TKR's and that is based on review rather than anicdotal evidence.
I would attempt to advise Ferrari how to improve their cars on the strength that i've watched a few GP's

 

[Celle]

There is nothing wrong at all with the hardware for PKRs. However, it does take a surgeon with the right sort of skill and experience to do one successfully. It also takes a knee that has osteo-arthritis in only one compartment of the knee.

We have had some people here whose surgeons were not sufficiently skilled and who have had to have their PKRs revised in less than a year. Others have needed a revision because arthritis progressed to the other compartments of their knee.

Although I had a PKR that was successful and lasted for 11 years, I always advise people when there is any doubt about the condition of their knee to go straight for a TKR.

I will ask @Josephine about the statistics.

 

[Josephine]

PKR's certainly come in and out of favour but technology moves on, did you have a smart phone 10 yr ago!!!!

You really cannot compare this with the cell phone technology! PKRs were actually being done before totals came into being. I know, I was there - back in 1975!
And Celle is right - there's nothing inherently wrong woth the devices. It's th surgical skill that is found wanting.

As I understand it revision rates are no worse than for TKR's and that is based on review rather than anecdotal evidence.

I would not agree with that at all. Percentage-wise, there are far more PKRs converted to TKRs than TKR revisions. I've been keeping a record of all our members who have had to have a PKR-TKR conversion. It started in November 2011 and so far I've logged 30 names. Now considering the very, very small number that are represented on this forum, that's a staggering number. And while there are still PKR 'enthusiasts', they are very few and far between. The numbers of seasoned knee surgeons who have elected to stop doing PKRs because of the high conversion rate remain high and that's only those who admit it!

 

[ORpatella]

I agree with @Josephine and @Celle in order to have a successful partial you need a skilled surgeon who does partials on a regular basis. In addition the system used has to be the right for the patient, if the indication is wrong, the risk of revision surgery is higher.

 

[Raffs]

How're you doing?

 

[ORpatella]

Hi @Raffs
Doing ok so far, swelling is going down, CPM at 115*, on my own the ROM is 0/100. Haven't taken a pain pill since I got out of hospital. Started to walk without crutches around the house the beginning of the week, PT is gentle at the moment, lymphatic drainage and thigh/calf massages. Have the 6 week follow up with my OS in 2 weeks, looking forward to hear what he says!

 

[Raffs]

Excellent. ROM very good for this point. All sounds good, hope the OS does some X-rays so you can be reassured that the implant is doing what it should be doing.

 

[ORpatella]

Little update, cpm Ist at 120*, knee is looking the best as I have seen it over the last year. Hope I'm able to try driving again next week sitting around the house the whole day is so boring.
The only problem I have since the third week after surgery, that I can't fall asleep. Even when I'm feeling really tired it takes me hours to fall asleep (if I do, I sleep for 6 hrs without waking up...first time I've ever experienced this)

 

[Raffs]

Excellent ROM. When do you see your OS? I was very lucky in that I didn't have sleep issues after surgery (I think this is because I don't sleep brilliantly anyway) but you'll have seen from reading posts on here that lots of people do have sleep problems afterwards. It will improve in time. Like everything with knee surgery, patience is key!

 

[shrdlu]

Is there an over the counter medicine that makes you sleepy? Benedryl usually knocks me out, so I take one when I am ready to go to sleep. It works. Tylenol PM also contains the same ingredient as Benedryl, but if you take it, remember to add the Tylenol dose into your total daily dose, so that you don't take too much.

 

[ORpatella]

Had the 6 week post op follow up with my OS today. X rays look fine, patella is running smooth, doc is happy! Was walking around the city for two hrs today before and after my appointment, was exhausted when I got home this afternoon! Will stay at home for two more weeks, doc said I have to tell him when I'm ready to go back to work. As long as I'm not feeling ready, I should keep my butt out of the operating room

@iamshrdlu I might give the sleeping pill a try if I still have troubles falling asleep the next two weeks

 

[ORpatella]

Picture 6 weeks post op

 

[ORpatella]

@Celle @Josephine would you please change the title to revision partial KR? I didn't have a total, thanks!

 

[Celle]

@ORpatella
I'm afraid that, so far, we don't have a "Revision PKR" prefix, because it's so rare for that to happen. If a revision is done, most people have their PKR revised to a TKR.
Since it's more important to know that you had a revision, and since the recoveries from a PKR and TKR are so similar, I'll leave the prefix as it is for now.
I've asked the rest of the staff what they think, though.

 

[Josephine]

Yes, we did once have such a prefix but we recently had an upgrade of the forum and it seems to have been removed at that time. It only took me a couple of minutes to put it back again!