TKR crepitus in my knee

[NHKneeLady]

What a long thread! I have not logged on in so long, I see the user interface is new and different (and even better). I am posting on this thread because I have a new issue, have tried to read in library and threads to learn about it - and found similar issues in this thread. Now, about 8 months after my second TKR (and starting to feel well), I got "crepitus" (I learned the term from threads) in my knee. I can walk (3-4 miles), exercise at the gym (20-25 minutes 3 times a week), go up and down stairs (without holding on) without this issue bothering me. However, now when I stand from a sitting position, my knee makes a loud noise - seems to be located front center - and hurts. I have good flexion and extension. I have been able to stand with no issue until now (3 sets of 15 sitting to standing). I starting putting ice on my knee again after walking again - no help. What could this be? I should be getting better, not worse, right? What should I do? - more exercise? less? I am getting very worried that something in my new knee has gone wrong. Is it scar tissue? If so, what do I do about it?

 

[Pumpkin]

Hi Elizabeth,
Sounds like you may be doing too much, we do plenty of sit to stand during the day. No need to have it as an exercise.
Was your knee cap resurfaced?
Try counting how many times you sit to stand in a day, no one I have asked to do this has every been able to answer this question, they lose track. And that includes me.

I am going to tag Josephine and Jamie to put your above post in your own thread (it has been closed). They may be able to answer your questions about crepitus.

Keep us posted on how you are doing,

 

[Josephine]

Elizabeth, hello! So sorry to hear you are having a problem. I've moved your post into a new thread for obvious reasons!

However, now when I stand from a sitting position, my knee makes a loud noise - seems to be located front center - and hurts.

Given that everything else is so good and you are able to do so much, I really don't think there is anything wrong with your knee really. It's far too late to be worrying about adhesions but I do agree with Chris that you are doing too much. Why are you doing so much? Do you feel you have to still? After about 6-8 months at the most, and probably sooner, I would think that anyone was ready to just forget about the replacement and get on with their normal life. I further think that if you stop doing all those exercises, you may find the crepitus abates and things get better. And if it hurts, try taking some Tylenol (1,000mg up to 4 times per 24hrs) to help.

 

[NHKneeLady]

Josephine - Thanks for your expertise and advice. (took me some days of searching to find your response) I may be doing "too much" but am not sure what I should/can do and be safe. Before surgery (and before really bad knee issues - which does not seem so long ago), I did the same - walked about 4 miles most days and worked out at the gym 3 times a week for 20-25 minutes. I am not doing the "standing 45 times" exercise anymore and am avoiding anything that makes my knee sound bad and hurt. The things I am avoiding are a direct "sit to stand" with full pressure on that leg and also cycling. Should I lay off the walking? Leg exercise at the gym to strengthen my muscles? Am I making it worse? (it sure seems worse). You may not have an answer to these questions as my issues may be unique (but I hope you do). Coincidently, I have a check-up with my OD this week and he also will have an X-Ray taken. I am losing my trust in him - but what should I ask to get on the right track here? Thanks - I feel this forum is my only place to turn - Elizabeth

 

[speccybecky]

I was going leg curls, leg press, stepper machine and I know others do. But then my surgeon said no exercise with weights just walking, cycling and swimming. Honestly don't know what to do for the best

 

[NHKneeLady]

Nancy, Thanks for the feedback! It sounds like you were doing just what I am doing - leg curls, press, stepping machine. Am happy to give these up if is causing the issue, and love to walk so can settle for that if that fixes the problem. Were you having crepitus that was fixed by laying off the weights? (I thought the weights were OK since I did limited ROM and did not experience crepitus, now am thinking I made a big mistake)
-Elizabeth

 

[PhoenixS]

Hi NH Knee,
I had a lot of crepitus in my TKR knee, and continue to have it in my "normal" knee.
I stopped the weights for several weeks (have not restarted them) and the crepitus/swelling in my TKR knee has diminished. (It isn't gone though)
I still have a band of tissue that snaps over the base of my femur. That is painful. I have it when descending stairs, so I went back to one step at a time.
Maybe you could try stopping the weights and rest your knee a bit to see if that improves it?
My OS has heard the crepitus and attributes it to arthritis (I have RA).
I'm sure that the x-ray will identify a bone problem if there is one. But crepitus is mostly caused by fluid moving within the joint so make sure you don't do things that cause your knee to swell.
Hope that helps.
I just love NH and I have hiked all over the whites! So jealous that you get to live in such a glorious state!
Best,
Sandy

 

[NHKneeLady]

Sandy, thanks - this really helps and am convinced I need to lay off the weights (but not the walking if I can help it). I hope it works. I look forward to the XRay and hoping it is fluid. I can deal with that. Yes- I had crepitus in both knees pre-TKR and a little clicking in both afterwards, but was not concerned. Other than this, am feeling great, mostly recovered from "other leg" peroneal nerve damage (a little numbness left) and energy has returned to FL

We love NH, but am done hiking the mountains! Riding in a boat or kayak on the lake works better for now
thanks again, Elizabeth

 

[skigirl]

Elizabeth, I started hearing a sound like velcro ripping in my knees at about one year. It got worse and worse and I finally had to have a surgery to remove scar tissue (adhesions). I hope your situation clears up with a little rest. But, I am doing pretty much what your are doing--except I go to the gym every day. Kelly

 

[clovergirl59]

Just my 2 cents worth.....When I had my first knee done in 1995 my os sent me back to therapy 6 months later to see if I could get a little more ROM. On my 3rd or 4th visit the therapist put me on the stairmaster, after that my knee cap began to slide back and forth and make a popping sound. I think "does not track properly" is the correct term. It does not hurt, but os was not happy about it. He attended a conference and presented my case to his peers, the general opinion was to leave it alone until if and when it needed a revision. He did a lateral release before the conference and it did not change anything. Having said that, be careful on the stepping machine, I'm not sure if that is like a stairmaster. Cannot positivley blame it on the stairmaster but it was not doing that before I got on the stairmaster. This was 17 years ago and I was trying to be the cooperative patient and do as I was instructed....now I know better! I will not let anyone overwork my next knee.

 

[Dulcimer Diva]

When I fractured my tibial plateau in 1996, one side effect of the open reduction/internal fixation surgery was "patellar drift." (My TKR seems to have cured that). My PT showed me how to tape my knee to keep my patella in its proper place. (Reguires a base of paper tape first because the cloth physio tape is extremely adhesive). Maybe your PT or a trainer in your gym (some are moonlighting PTs) can confirm that and show you how to tape for proper tracking.

 

[Jamie]

NHKneeLady....sorry you had to hunt to find your new thread! But I'm glad to hear that you are willing to slow down on the weight bearing exercises. I think you will find that helps. If you still find you have a problem, I suggest you cut back on walking as well. Cycling (with little or no resistance) is easier on your knee and you could substitute that exercise.

 

[Roy Gardiner]

Elizabeth, your symptoms sound exactly like mine http://bonesmart.org/forum/threads/fibro-synovial-thickening.16327/ 'front and centre' particularly meaning in my case 'behind the kneecap'. It can't be bone-on-bone (there isn't any ). It's odd to occur in just one knee isn't it?

As to what to do about it - sorry, I don't know.

 

[NHKneeLady]

Thank you all - good thoughts and advice. Am feeling better (mentally) about this now. I have decided to take this one step at a time. I see OD on Friday and will see what he says. Meanwhile, will stop weight bearing. Funny that it only hurts when (1) putting pressure on it from sitting to standing and (2) a little when on stationary bike. Otherwise (weight-bearing exercise, walking, standing, elliptical walker, up and down stairs etc), do not even feel it. If I straighten leg from 90 degrees with no weight, still crunches but with no pain. Am treating knee gently and am feeling that, if my OD says I need any kind of procedure, might get a second opinion. Thanks for your help - Elizabeth

 

[maryo52]

Hi Elizabeth, Well I'm not in the camp that thinks you're doing too much. It sounds so much like what Roy has. I have a similar issue but I have a history of arthrofibrosis. Like you, the pressure on my knee cap makes me favor it. It is not a severe problem but it's not a minor problem either. It impairs my knee life, and I'm not quitting until I get it addressesd.

 

[vicki c]

I also have crepitus, which started at about 8 months. I will celebrate one year in November. I did a google search and learned that about 20% of TKRs will develop this condition. It is not really of much concern and may resolve during year two. I am three weeks out from my second TKR and had my OS check the older knee when I was in hospital. He wasn't concerned about the crepitus and said that TKRs are not perfect, that noises or small amounts of pain are too be expected. Good luck.

 

[Josephine]

You may not have an answer to these questions as my issues may be unique (but I hope you do).

In no way is your issue unique!

Before surgery (and before really bad knee issues - which does not seem so long ago)

Irrelevant - you've had surgery since then and a knee replacement. What went before is .... irrelevant!

I may be doing "too much" but am not sure what I should/can do and be safe.

What you can and should be doing is forgetting about that knee and living a normal life. Normal such as what it was before you ever had a warning that your knee was becoming arthritic. That's the objective of this surgery - to give you back your life. Surgeons refer to this as "the forgotten knee"! And there is only one word appropriate for that

Josephine - Thanks for your expertise and advice. (took me some days of searching to find your response)

If you ever need help using the forum, go to Office (top right hand corner on the grey bar) and the "How to use this forum" link.
The thread you needed here is this one How can I find my threads and posts?

 

[NHKneeLady]

Had X-Rays of both knees and saw OD yesterday. I know X-Rays can only address the bone and not soft tissue, but good news is that everything (bone-wise) is in the right place. Asked PA and OD about knee crepitus - he said he "knows exactly what it is. It is scar tissue." He offered arthroscopic surgery if it is bothering me and then told me he is retiring and new doctors will be coming in. hmmm. I told him I choose not to have the surgery and will live with it for now (am thinking one more incision in my body right now will put me over the top as well as the reality of potential complications). The PA and OD declared me "normal" and said to come back in 2 years. I decided I will likely get a second opinion if it continues (and definitely if it gets worse). Anyway, I am thankful for all your posts and will continue to read your experiences and opinions about this "crepitus.". Returning to my "normal" life as it was before I had severe knee issues (always had "some" knee issues) means --> walking 4 miles a day and regular visits to the gym to keep my upper body and my legs strong. I think I will go back to that and do everything that does not hurt my knee and make me favor it. I hope I am making the right decision (?) I feel like it is time to move on.....
-Elizabeth

 

[NHKneeLady]

Am now a year post-op and my knee issue that developed suddenly at 8 months persists. I can do most active things - walk, zumba etc.... BUT my biggest issue is sitting! I cannot sit for long, such as at a concert or play (with my knee bent at 90 degrees) for very long, and when I straighten my leg, get the crunching sound (have called it crepitus but am not sure...) - have pain when straighten leg I also have trouble straightening my leg in bed - same crunching and discomfort. This is not getting better - am lost again --- should I go to another surgeon and get a second opinion? MY OD said he definitely knows it is scar tissue and he could snip it with minor surgery, but I have lost faith in him and will not go back.

 

[maryo52]

A second opinion can be very useful.

There is "open" and "closed" removal of scar tissue. The closed removal is arthroscopically, but it's hard with this method to get behind the knee where it sounds like you are having an issue.

TKR recovery can be bumpy for some, and the time it takes involves sorting out the issues. Keep searching until you find a solution that feels right for you.