TKR Dearjr's new knee

[Slainte]

Wonderful picture of your dog. Cockers are such sweet animals.

 

[New England Librarian]

Love your adorable cocker spaniel and so sorry to hear of your loss. I had a black cocker who passed away 2 years ago at age 11, and I still miss him every day They are so sweet! I did not get another dog because walking was so hard, so maybe this year I will be ready. They just don't live long enough.

 

[Dearjr]

The knee still is warm after using it

Still clicks and clunks all
The time

 

[newlybionic]

My knee isn't making much noise any more, but I still have pain and the lower half is warm to the touch constantly.

 

[Dearjr]

I'm on the opposite side. I have no pain but when walking constantly feel it. It's hard to describe

 

[newlybionic]

Together we make a whole!!!

 

[Dearjr]

Hopefully we will both get there
We all hear it can take a whole year

 

[skigirl]

The clicking is caused by the plastic tapping against the metal prosthesis. (when I first heard the word prosthesis, I almost fainted). Why don't you spend some time and figure out where it is tapping. Is it the patella tappiing against the groove? I have a stryker knee and it taps when there is side to side movement.

Once you know what is tapping, you will have some thoughts about what is causing it. If, for instance, it is the patella---maybe your IT band is tight and is pulling the patella slightly off center. Or maybe adhesions are pulling the patella agains the prosthesis. (that is what happened to me).

So, be Sherlock Holmes for a few days and find out what part of your knee is tapping. The fact that you feel is when walking makes me wonder if there is laxity in your knee. Have someone give you the Lachman (?) drawer test to see if your knee is moving forward slightly. Mine was about 5.5 degrees. My OS told me that 3-5 degrees is considered normal. However, the moving caused adhesions to form and so, I ended up with a Lysis of Adhesions and spacer exchange. After that, my knee was MUCH more stable---I had been barely aware of the knee shifing, but when it was gone, it was amazing.

 

[Dearjr]

@skigirl thanks for the answer. I will try to figure it out. I do believe when I do side to side I clunk more. As time goes on when I'm walking I am feeling less clunking. I have been doing a lot of walking on this vacation in Israel.
I think the os did the Lachman test. I was lying down and flexed the knee then he pulled it out. He said it was stable and not loose. Again he told me mine had to be more lax for me to get the rom I needed

How did your os know that it was the adhesions pulling your patella that was causing your clicking
My new pt thinks it might be something
Moving the patella out of the groove

We are working to strengthen the muscles

I will show her your response and see what she thinks

How long after your tkr did you have your adhesions lysed?
Was it arthroscopically?

Why did you need the space r replaced?

 

[newlybionic]

I'm sorry you're still having a problem with your knee clunking. I do feel it at times and it is more frequent side to side. I think that was the one thing that my OS said before surgery that he as absolutely truthful about. It just might be that I'm used to it so it doesn't bother me anymore. I'm interested to see what your therapist thinks.

 

[Celle]

If your surgeon has examined you knee and said it's OK, I don't think you need to keep worrying about the clunking, @Dearjr . For many people, it is a normal phenomenon.

 

[skigirl]

I could not move my knee cap and when I went on a 20 mile bike ride, I could feel the knee cap grinding against the prosthesis. My Lachman test was almost normal---my OS also thought that I needed a smaller spacer to get more rom.

I had an open Lysis--he felt that he could only get to the extensive adhesions if he opened the knee. As it turned out my patella was completely held down by adhesions. He changed the spacer as well---he told me later that if he had known how limber I am before the surgery he would have used the larger spacer at the time of the first surgery.

I have a stiff IT band after years of knee issues and I have an injury in one of my glutes from a fall down some stairs. So, my IT band on the left side is stiff. That can pull the patella sideways. ITB (ilio-tibial band) issues and treatments. I am in PT working on the IT band and the piriformis muscle.

The first question that my OS asked me after the surgery was whether it felt more stable---it did.

I found it interesting that your doc told you that the lachman test was normal and the knee is stable yet also told you that the knee had to be lax so that you could get more rom. I think he is speaking out of both sides of his mouth at this point. Let's face it---the spacer size is subjective and doctors don't like to think that they maybe just maybe made a small mistake.

 

[PolarBear60]

For me, the clunking goes away when I concentrate on lifting my foot just a little more when walking. It is a gait issue for me. Once I figured that out, I'm able to control the clunk. It could be entirely different for you, of course. As Celle says, if your doctor doesn't have any concerns, it may be just the way it is for now.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[Dearjr]

Hi all

Here is an update for everyone and for those who answered above @skigirl @Celle @newlybionic @PolarBear60

First I went to new pt and got a great thorough eval. My quads weak and hamstrings tight. Working on them "might" help clunking
However os said to get full rom I needed he had to put in bigger spacer. It does not feel loose or unstable at all just clunk

At this point I am getting used to it and it doesn't worry me anymore!

I went to Israel for 10 days and had a wonderful trip
As you know it is very hilly and it did not swell or bother me at all!
I went in 3 1/2 hour walking tour with limited sitting and it was fine!
I got stuck in an elevator on the 20th floor and had to walk down 14 flights to catch the other elevator...I beat my wife down
So all in all I'm happy....function is better. But the knee is still partly numb and funny feeling

I started hyaluranidase in my left knee. It's the 5th set over the years

Hoping to eke out 1 or 2 more years with it

Any suggestions when to do the second

Regards to all

 

[Slainte]

Love your activity level! Your second knee will tell you when it's time. I got five years with the rooster comb injections. They helped me sooo much. Until they didn't. Great to see you doing so well!

 

[newlybionic]

Wow it sounds like you had. A great trip and are doing very well. I have to have a revision on my knee due topoor placement of the original and I'm still trying to figure out when to do that. I would think that since your new knee is doing so well I would decide when would be the best timetime for you. Do you have a job, do you want it to be warm weeather and when you might have some help available. It is a hard decision.

 

[metalheart]

About the clunking, here is my experience with my January 2015 knee: My knee clunked for the first 4-5 months. After I started cycling again and did some gym work to build up my legs, then about month 6 the clunking went away. Then I had surgery in August 2015 for the other knee and had clunking in that knee that is ongoing. However, about month 3 after August surgery or month 9 for the January knee the clunking returned for the January knee. My activity level has not been as intense as I would like and there has been less muscle development in my August knee and I think that has put some strain on my January knee. I attribute the return of clunking in my January knee to a loss of muscle conditioning. I prefer to cycle outdoors, but the weather has been wet and I became lazy about gym and indoor cycling, so........... Anyway, I'm trying some more focused work on leg strength and I hope it will address the clunking in both knees. At first it bothered me significantly, but now if it clunks forever, I can live with it. I hope yours resolves so that it works for you.

 

[Clipless]

I had some clunking of both knees (TKRs done 1 year apart). The noises from my left knee had completely disappeared over time, but returned somewhat as I recovered from RTKR. This puzzled me until I realized.. ATROPHY! The muscles in my left leg shrank along with my right during my RTKR convalescence, allowing the noises to begin again. PT and limited home exercises weren't enough to completely prevent muscle wasting. Now that I'm feeling better and strengthening for real the clicking/clanking is gone. You'll have to be careful, but IMO balanced strengthening is the way to go.

 

[Celle]

It's lovely to hear that you had such a good trip to Israel and that your knee behaved so well.

If it were me, I'd live with the clunking (you know that my 4-year old right knee still clunks) as long as it doesn't hurt. I don't think a bigger spacer would let your knee bend more. If anything, it would make the joint tighter, which could take away some ROM. Usually, they only put in a larger spacer if the joint is too loose.

What's your ROM now? It's not quite 6 months since you had your TKR, so there's still time for ROM to increase. Some people have had increased ROM even after more than a year.

As for your other knee, as Slainte said, it will let you know when it's time. That time will be when you get sufficiently fed up with it to say "That's enough. Let's get this thing fixed."
I had my second knee done when it was starting to affect everything in my daily life and was beginning to hurt all day long and disturbing my sleep.
Getting it done before I had significant muscle loss and tendon distortion helped me have an easier recovery, I think.

 

[skigirl]

I went in earlier on my second knee than I did with the first---I just wanted to be finished with knee junk. It was a piece of cake and so easy to rehab. So, I would not wait as long as you did for the first---and I would do it at a time when you could take six weeks off instead of three!!!