TKR Getting back to hiking and climbing.

[marieltha]

Thanks for the bursitis (pesanserine) link (in @rustic thread)
@sistersinhim
Let us know which US device you buy if you do.
Also interesting that the medial pain and/or stiffness seems to occur in both partials and fulls, and in people of different levels of activity.
@76Dawg @WendyEL

 

[marieltha]

Fyi. Mine was not bursitis, but sinovitis. Got the medial area treated (details in my thread) and am doing much better. Still working on the gait. Stretching and strengthening glutes. Did you improve? Did you identify the cause? Hope so.

 

[rustic]

Yes, I had the very same thing. It was a pes-anserine inflammation. I went to PT for ultrasound treatment on it. It worked great! If it flares up again I plan on buying an ultrasound machine from Amazon an do it myself! https://bonesmart.org/forum/threads/pes-anserine-and-mpfl-pain.8723/

Not quite the same as what I was talking about in post #93, with the picture . My "mystery" pain is on the lateral side, radiating inwards. The top part of the upper leg in the photo. There are multiple possibilities that can cause pain at that "posterior lateral corner." LCL doesn't hurt much though, and it doesn't seem to be IT band either. #1 suspect is the popliteus. Either the ligament, or the muscle-tendon group that crosses behind your knee.

 

[rustic]

I had my 13 month followup with the OS. Same old stuff. I'm in the top 10 percent for function and "fluidity of movement," but one of the problem people as far as lingering pains. I gave him an article about popliteus pain diagnosis (that is where the photo was from), and he read it with interest. He agrees with it, as the most likely cause of my "mystery pain." I've been doing a very specific stretch that is quite painful, but is helping the situation. As long as that keeps improving, I won't be getting my popliteus "released" surgically.
I have two other trouble spots that are more superficial and tend to come and go. That lump in my quad at the top of my incision hurts and swells up sometimes. It feels cramp-like sometimes, and massaging with heavy local pressure seems to help. So I bought a very expensive pulsating massager, with amazing results in a few days.
The third spot is a "spike like" pain on the inside corner of my kneecap. The surgeon is recommending nerve ablation for that one. I had MCL pain in the first few months, and this is not the same. This spot seems more like what @sistersinhim was talking about above (pes anserine bursitis). Or it might just be a grumpy nerve, like the OS thinks.
On a more positive note, my "functionality" is continuing to improve. My endurance is starting to come back. Rock climbing is great and usually painless. My hiking distances are still lagging, but my leg strength and stability muscles are coming back due to exercises, and a local hill climb that I'm doing frequently.

 

[sistersinhim]

It sounds like your function is great! Even after 3 years I still have some aches and pains. Being better than before the TKR is what it's all about. Arthritis would just be getting worse. We don't have that anymore!

 

[WendyEL]

Thanks for your continued updates, I don't check this site frequently but I find it reassuring when I do. Your thread always gives me hope that I'll get back to my activities eventually! Congrats on hiking and climbing as much as you do, I can't wait to be there!

I'm 4.5 months out from my TKR and still 'limping' along. I'm at 115 flexion and 0 extension, but I still feel very disabled. I'm finding that biking is throwing my hip out of alignment and causing hip and back problems, did you struggle with any issues when you returned to the bike? I'm hoping to talk to my PT this week about hip strengthening exercises, as that is something I haven't worked on yet. I switched from aggressive and sport-rehab PT to massage and ultrasound about 6 weeks ago, and I do feel like that has helped calm things down.

Unfortunately the hip problems are preventing me from getting back to climbing. We were just in Joshua Tree for the few days before Thanksgiving, and I could hike a short distance to hang out with my kids and friends, but I didn't try climbing. I've climbed just a couple of times at the gym, doing laps on a 5.7 just to prove to myself it was possible, but I don't feel ready yet to push it. My hip is on a hair trigger and I'm reluctant to test it out too much.

Anyway, thank you for continuing to post your updates. I'm sorry your pain hasn't gone away completely, but I do appreciate your describing it, and also your descriptions of the activities you are now doing. This recovery feels so hopeless at times, particularly if you're an active person in your pre-TKR life.

 

[rustic]

Thanks for checking in with me @WendyEL.
Like you (wendy), I've had some problems with my hip and sometimes biking made it hurt. But, I haven't been biking enough for a real test of that. Once in a while climbing, I'd get a sharp pain in my hip, but it could be nerve pain referred to my hip from my knee. It (the sharp hip pain) only happens when my knee is bent at a certain angle. Generally, both hips have been a bit grumpy since my knee surgery, especially at the end of my longer walks when I have to step over a barbed wire fence.
My big news this month is that I tried cross country skiing, just yesterday, and it was much more successful than my attempt at the end of last ski season. I went about two miles, and it hurt some, and felt weird. But, it didn't swell up or hurt after. It didn't wake me during the night. And, it felt fine this morning. If anything, a little less stiff than an average morning. Yay! I'll go out again today if I get a chance. Maybe a little longer.
Interestingly, I had a similar type of scenario going during my first post surgery climbing experiments. Some scary pangs of pain that didn't last, followed by feeling more mobile the rest of the week.

 

[Recovering Andy]

Hello rustic and everyone.
I am 3.5 months SP right TKA.
I had a horrific first 3 weeks.
Bedridden with 9/10 pain for 17 days due to a hemarthrosis (bleeding in the joint). My rehab since then has gone well. I'm at 1 - 130 degrees. My strength has been incredibly slow. I was unable to perform a straight-leg-raise without lag for the first 2.5 months! HOWEVER, I skied for the first time today. 4 super mellow runs at Ski Cooper in Leadville Colorado. I am a ski coach and have been skiing since 2 years old (I'm 54 now). So I'm better at skiing than walking! Otherwise there is no way I would have been able to ski with my current level of severe weakness. The first run was quite weird. A really uncoordinated R leg! The next 3 were better. Someone in the lift line told me not to overdo it, so I went home. I might pay for it tomorrow, we'll see (probably will). But it was super nice to get out. I hope you all continue to progress. I'll let you know to what extent I pay tomorrow!
Andy.

 

[WendyEL]

Wow Andy, good for you! Did you end up thinking skiing was a good idea?

My family is headed to Colorado after xmas for a ski trip. I was intending to read a book by the fire and hit the climbing gym when everyone got home, but between Andy and Rustic's posts above, I'm talking myself into trying cross country skiing. I'm normally a skate skier, but that seems farther away than just tootling along on a flatish trail. Thanks for the motivation!

 

[Recovering Andy]

Hi Wendy!
Thank you for the reply!
I was a little sore but I not terrible. I skied again yesterday (sat). Skied 7 runs. Again a little sore today but not terrible. Remember, the prosthesis is as strong as it will ever be, on day one. It's only the trauma that has to heal.
I hope to Nordic ski soon. That is way more foreign to me than downhill. But it is very low impact. I wish you the best luck and please let me know if you tried classic skiing!
Andy

 

[rustic]

Glad to hear from you guys, @Recovering Andy and @WendyEL. Interesting to see you guys getting back into skiing.
Not much new on my "home front." We had a big snow storm, which required leaving the vehicles in a non-drifting area for a week, and walking or snowshoeing back and forth to them. I'll attach a picture of what was my "daily commute" for a while.

So, I'm in my 15th month. I really didn't predict the knee would still be holding me back but it is. I've got three lingering problems. They mostly affect my more "athletic" endeavors, and especially become a real "pain" when trying to do floor exercises. The length of my hikes is still limited by my knee, rather than overall fatigue. But I'm improving on that. My climbing is going great, and I often don't think about my knee for the whole session (my climbing limit is based on finger strength, and core strength, as it should be).

 

[rustic]

A new year! I started it off (yesterday) with cross country skiing. Six miles made it my longest ski jaunt since TKR. More pain than I hoped for, and it ached last night. But, I'm still headed in the right direction, ..I think.

I hope everyone is on the mend, and has a good year.

 

[WendyEL]

Happy new year to you guys too! Using you both for motivation, I went on my first classic ski last week and had such a good time I decided to do it almost every day on our vacation to Aspen! There was a nice mellow trail and good snow, so it was low risk and I was pleasantly surprised my knee and hip were just fine for an hour of movement. The one day I went 90 min I was more sore, but not awful, and the whole experience gave me so much hope!

And also following Andy's post above, I bit the bullet and tried downhill skiing one morning. Again it felt amazing, I couldn't believe it when I could keep up with my daughter on blue groomers! All was well until we went in for lunch after 7 runs, I felt like a star but my knee started to get stiff while sitting in the lodge. I didn't realize it and we went out for more runs after lunch, at which point I was in total agony getting off the lifts! I've never realized how scrunched up you get when your skis first touch down to get off the lift. One lift in particular bent my knee way more than it wanted, and suddenly I was done for the day. We had to ski a run called Sheer Bliss back to our rental house, and it was sheer torture. I ended up taking the next day off just to let my knee relax, and then I classic skied the rest of the trip.

Advice for people returning to downhill skiing...keep it short at first (if I had stopped at 2.5 hours I would have felt great), and think about what lifts you ride (if I had stayed on a gondola I would have been fine). I was really really excited to find I could return to skiing in both forms, I had pretty much written off skiing for the next few years but now I realize it doesn't have to be that long afterall. I'm considering investing in some new randonee gear so I can skin up our local mountain and take one run down to the car. I used to do that all the time when I lived in Jackson Hole, but once we moved to Oregon the skate skiing took over. I can't envision skate skiing right now, pushing off seems like it would be bad for my hip, but a single downhill run after skinning up now seems like a great way to work out.

THANK YOU THANK YOU Andy and Rustic for the motivation to try skiing again, the hope you've given me is immeasurable!

 

[Recovering Andy]

Wendy! Super awesome! I am so happy for you. And I'm psyched to be part of that motivation. There's a push from some here to expect very little from TKR's. With proper PT, the sky's the limit!
Don't over do it. I'd say half day ski max.
Great luck!

 

[rustic]

Shoot. I had a setback of sorts. Tuesday (Jan 7), I hadn't done any sort of workout or anything new. Things had been going pretty well kneewise. I was in the gym locker room, before going to physical therapy (for my neck, not my knee). When getting up and stepping away from a bench, I heard a "snap," along with a quick/small jab of pain in my knee. Standing at the sink, it started to ache. By the time I walked to the PT's office, it was hurting with each step. I tried shaking it out some while I was in the waiting room, but nothing seemed to help. I guessed that a tendon or nerve or strand of fascia popped over something else, which is the kind of thing where the pain usually abates quickly. But laying on the table for an hour (while the PT worked on my back and neck) didn't help. When I left, I had trouble walking across the parking lot. I couldn't straighten my leg and had to walk on tip toe. I cancelled plans for that day. Went home to ice and elevate. Did a round of Diclophenac gel.

The knee hurt generally everywhere, but the pain was worst in two places: Around the lower medial edge of the femur and at the medial corner of the kneecap (which has been one of my long term remaining pain spots). I had some mild generalized swelling.

Wednesday, I rested it completely, and did some compression that night (which helped the swelling). Thursday, the pain was getting less all day, even though I was standing much of the day. Last Friday, I was almost back to normal, but achy enough since then that I have avoided walking long distances.
It has been 9 days now. The lower pain (just above the joint line, at the most medial place) is about 10% of what it was last week (hurts to the touch, not when I walk). The upper, "corner of the kneecap" pain is still there but comes and goes unpredictably (doesn't hurt to the touch, but hurts with each step sometimes).

Any ideas from the medical folk here?
I don't think anything major happened, or it would still be getting worse. I've got a couple thoughts:
1) Since the swelling was at its lowest ever in the week before this happened, things may be starting to rub together or catch on each other. I can envision a bigger than usual "twang" that might hurt for a week or more.
2) The two sore spots might be the ends of fascia that goes crossways between the corner of the kneecap and the femur. The lengthwise fibers that connect quad to kneecap to tibia don't hurt at all.
3) A strand of scar tissue might have torn or shifted. In the early months, I had a few big pangs of pain that were followed (within 30 minutes) by a bit more mobility in twisting movements. Maybe something similar happened this time (wishful thinking? lol).

PS before I got my TKR, I thought one of my pains was from an inflamed medial plica. I wanted to get that removed, but they wouldn't do "small stuff" because I was headed for TKR anyway. I hoped that it would get removed in the process, but maybe it didn't. The exact same spot has often hurt on the other, non-surgical knee, for years.

 

[rustic]

Well, my "wishful thinking" (see previous post) seems to have come true. After I recovered from the mysterious "snap," everything got a lot better. I feel like I'm on a recovery path that should have started happening in the early months. Every week feels better. I'm cranking out some big hills. The picture is from the Grand Canyon. My wife and I hiked to the bottom and back up to the top in 8 hours. 17 miles. 4600 foot elevation gain coming back up. Thousands of these "stairs" that you can see in the picture.

 

[Lindylee]

Wow! That's amazing. You're doing so well. That's fantastic news. I'm so pleased for you. Makes my 1.6 miles yesterday look pitiful, but I was happy with it. Not such inspiring views though.

 

[sistersinhim]

17 miles. Wow!

 

[rustic]

Hey guys,
It has been another two months since I last posted. I'm lucky that I can hike and mountain bike from home, without being around people, or even going to the highway. So, my plan for getting back into shape and undoing the atrophy in my leg is still on track. My last big challenge was to hike (snowshoe) up Humphreys Peak, 12,663 ft, the highest peak in AZ. Mt DW and I put up with high winds, snowstorm up high, and even some rain near the end of the day. The picture is taken from about half way up the mountain. We didn't see a single person all day, because we climbed the remote north side of the mountain, and the ski resort on the other side is closed. Even the road to the ski resort is closed.
I guess I'm a slow healer, because I really made big improvements after the one year mark. I still get random pains. Sometimes they limit what I do. The most persistent one is associated with my kneecap (just under the medial corner), but "cupping" therapy usually helps for several days (I bought a set of cups on Amazon). I also still use Diclophenac topical gel once a week or so. No need for icing or elevation any more, but when I sit I keep my leg straight out, or shove my foot under the chair to maintain my flex (135º, but I lose some if I don't maintain it). Sitting with my knee at 90º becomes uncomfortable quickly.

 

[pamsknees]

Nice photos! Congrats on your hike- that’s awesome & gives me hope that I’ll be able to hike one day ( I don’t want to do mountain climbing but a long hike would be nice)