TKR Arthroscopic Surgery after TKR to Release Popliteus.

[EllieDimples]

@Jockette if it were not for BoneSmart, I don’t know where I would be. Not only has it given me comfort through this process, but I’m sure I would have had an MUA. I’m sure because a few PT’s mentioned it, and not knowing any better I would have probably agreed, especially when I was stuck at 90 degrees for so long. Fortunately, I am blessed to have such a wonderful ortho (I have had 3 surgeries done by him so he knows the type of patient that I am, and I fully trust him, which definitely goes a long long way), so when he said, “No MUA for you”, I was so SO relieved.
Thanks Jockette, for what you and the rest of the amazing moderators do for all of us on this forum!

 

[Rain Dancer]

Thank you for your very thoughtful, helpful post @EllieDimples! I am so glad that your recovery is progressing nicely, even if slowly. There is so much wisdom in what you posted. I know that I have to stand firm in the face of opposition to a slower recovery. I am going to be my surgeon’s first ever patient to refuse an MUA. Hopefully, he will see that there is another approach to success. As with you, I see functional improvements every day that keep me motivated. My knee is strong, and my ROM will improve.

 

[Rain Dancer]

Five more degrees of flexion today at PT! I am now at 89. But what is more important than a number is that functionality continues to improve. It is easier to get in and of my car, I can sit in a chair with my feet on the floor for longer periods of time, I can walk in my very uneven yard with a cane.

 

[FCBayern]

As your swelling continues to go down your ROM will continue to increase @Rain Dancer. Glad to see you making progress!

 

[kneeper]

 

[BBCG]

Yippee! For me, also, there seemed to be points at which suddenly, I could bend more, do more, too… it’s like a proverbial turning of a corner! Hooray for you and your knee!!

 

[Rain Dancer]

Four Month Update

I am doing really well and still haven’t gotten an MUA. The pain is minimal, I take no medication, and in the last week I have stopped icing. Extension is zero. I don’t know what flexion is because we stopped measuring a month ago, at my request. It continues to improve at its own slow pace and is somewhere north of 90. The knee is strong and stable, and I am happy that I had the surgery. I go to PT once a week, where we do gentle stretching, massage gun, recumbent bike (still can’t get around, but so close!), tens treatment, gait training, and some strengthening. I can go grocery shopping, lift heavier items, and just generally take care of myself and my household. I still can’t tie my shoes or put on socks without assistance because of flexion. But, I can now lead with my surgical leg while going up the one step in my house. And there has been some dancing in the kitchen! Thanks to Bonesmart’s encouragement, I know that I just need to continue to be patient.

 

[Jockette]

Awesome report!

 

[Rain Dancer]

I’m excited/scared. I’m having arthroscopic surgery February 9th to release the popliteus. The surgeon will look for other issues while she is in there and will remove any scar tissue. I hope that this resolves my ongoing pain on the lateral side of the knee.

 

[EalingGran]

Good luck!
I hope it works out and solves your pain.

 

[sistersinhim]

Good luck!

 

[Rain Dancer]

I am home from arthroscopic surgery today. My surgeon discovered an inflamed, frayed popliteus and she released (cut) it. She said that there was very little scar tissue from the TKR, which makes me so glad that I refused an MUA in the first 12 weeks. My issues are inflammation and the former popliteus. As with @DMcM, I felt instant relief. The pain from the procedure is minor compared to a TKR, and I have started my regimen of Tylenol and Advil. I am so grateful that we found the cause of my lingering pain and gait issues.

 

[EalingGran]

Sounds really positive- good luck!

 

[Jockette]

She said that there was very little scar tissue from the TKR, which makes me so glad that I refused an MUA in the first 12 weeks.

This is why we suggest that members give their knees more time to heal before getting an MUA. Swelling at 12 weeks is still very common and healing is slow.

My issues are inflammation and the former popliteus. As with @DMcM, I felt instant relief.

I’m very happy for you that you found the source of your problem and it was addressed!

Who was the doctor and where is she located?

 

[Jockette]

Please tell me, again if you already have, what made your doctor even consider that this was your problem?

 

[Rain Dancer]

Please tell me, again if you already have, what made your doctor even consider that this was your problem?

@Jockette, my surgeon is Dr. Stephanie Grilli in Altoona, PA. I diagnosed myself by reading an article that @Gardenplotter posted about a new test for popliteal tendinitis.

The above clinical photographs demonstrate the clinical exam maneuver for diagnosing popliteal tendonitis. (A) The patient is placed in a lateral decubitus position with the operative extremity up. The patient then abducts their hip against gravity resistance with their knee in full extension. (B) With their hip abducted the patient flexion their knee from 0 to 90 degrees.
https://www.researchgate.net/public...al_Tendinopathy_After_Total_Knee_Arthroplasty

…and i found this which totally describes my problem I had from the very beginning.
Guess I will try to get in to see the surgeon sooner.

My TKR surgeon did more X-rays and an MRI, which showed nothing amiss. I went in three months later with this article, and he was very receptive, particularly since he knows and respects one of the authors. He doesn’t do arthroscopic surgeries after a TKR, so he referred me to Dr. Grilli, a sports medicine doctor in their practice who agreed to do the surgery. She had never done this type of surgery after a TKR, but said it would be fairly simple, and I was confident about her ability to do it. We did not do a ultrasound to confirm the diagnosis before the procedure because I had the symptoms, and I was tired of waiting around!

Dr. Grilli said that I am the guinea pig for this surgery, meaning that if it works for me, they will want to try this procedure for other TKR patients who have similar symptoms. I, frankly, was amazed that I found a surgeon in my small area who was willing to do the procedure.

 

[Jockette]

Thanks for repeating that information. I just tried that test, and I had no pain in the back or side of my knee. I did have some slight pain on the front of my knee, but I fell on December 26 and landed on the front of my PKR, and it’s still a bit sore, so I’m pretty sure the minor pain I felt was from that, it only hurt a little, when I got to the 90 degree point.

My pain is, and always has been, in the lower, lateral front side of my knee. Xrays never show any issues. No one will do any specific tests on my knee at this point. I was really hoping the fall would have done some damage which would lead me to a procedure to fix my knee but that is not happening.

 

[EalingGran]

My pain is, and always has been, in the lower, lateral front side of my knee. Xrays never show any isissues

Sorry you still have pain so long after surgery. I still have some medial twinges 14 weeks after my lateral PKR. I do believe my surgeon's explanation that this is due to my MCL having been overstretched due to my lateral arthritis and knock knee. My pain is in the right location and occurs with any slight twisting force when weight bearing. I hope this will improve but it seems ligaments can be very slow indeed. Could it be your lateral collateral ligament causing pain? I found that having an explanation that made sense was helpful even if it didn't remove the pain.
Not sure how easy ligaments are to repair- hoping mine will gradually settle now my leg is straight.

 

[Rain Dancer]

@Jockette, I’m sorry that the popliteus doesn’t seem to be your issue because it is easy to fix once it’s diagnosed.

 

[Rain Dancer]

I am recovering nicely from arthroscopic surgery. It is nothing compared to a TKR. Took Tylenol and Advil for two days and then stopped taking anything. As expected, other body parts are reporting in because my gait has changed for the better. I’m grateful that we found my issue but also am struggling with anger that it took so long to fix, and I am angry for others who are suffering with undiagnosed postoperative issues.

Surgeons who do replacements need to look outside the box and not think that x-rays and the occasional MRI can diagnose all postoperative issues. They need to be doing dynamic ultrasounds, CT scans, and other tests to see what is happening functionally with the knee. And, although this may be controversial, they should do arthroscopic surgery if they can’t figure it out. Based on my experience, I recommend that patients also consult sports medicine doctors when a joint replacement surgeon can’t diagnose the issue.