TKR Lateral tilt of patella after tkr

Tgcmoore

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I had my right knee replacement on July 12, 2022. Initially I did very well with physical therapy and got normal range of motion back pretty quick. The biggest issue I’ve had is pain and stiffness when sitting and then standing, especially when getting up from a low seat. I dread going sit in a restraunt, sitting on bleachers at grandkids games and using a toilet other than my raised seat at home. I have seen my ortho doctor several times and he says strengthening exercises will help and recovery takes a full year. I’m also having the arthritis in my left knee start to hurt so I got a cortisone injection today. He did X-rays today and in the notes he said that the transplant looks well aligned but there is a lateral tilt of patella on the sunrise view. He did say there is nothing surgical that he could do to help this. Is this tilt something that I should be concerned with? I just want the pain to go away.
 
He did X-rays today and in the notes he said that the transplant looks well aligned but there is a lateral tilt of patella on the sunrise view. He did say there is nothing surgical that he could do to help this.
Sorry to hear that you still have pain after so many months.
Not sure if it is related but I still have some medial pain due to my medial collateral ligament being weak and stretched pre- op due to valgus forces ( knock- knee). It is getting better gradually ( my PKR was October 22).
My pilates teacher and a physio recently stressed the importance of the medial quads, especially vastus medialis in supporting the MCL and in patellar tracking.
Apparently it is often weaker than the other quads because it only fires in full extension. Weakness can then result in the patellar being pulled to one side and cause pain. It was explained to me as being like the tracking on a car being out and it pulling to one side!
I do special exercises now for the medial quads.
 
Hi and Welcome!

I’m sorry you still have quite a bit of pain at this point in recovery, but yes, healing can take a long time, as long as a year or even more. However, the circumstances in which you feel pain do sound like it might be because of the tilt of your patella.

When my surgeon did my Patellofemoral PKR, he also did a Lateral Release because my patella did not track properly during the surgery. (Interesting, I never had patella tracking problems before my surgery.) If time doesn’t improve it you might want to consider getting a second opinion, as this might be an option for you. @sistersinhim has also this procedure.

I know it’s been quite a while since your surgery but I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​
If you want to use something to help heal the incision,
BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
Even though I had no kneecaps and no worries about the kneecap's tracking, I still had a medial release to make my knee bend correctly during my TKR. Through the years before my patellectomies, I had 2 lateral releases on each knee. If I am reading this correctly, the lateral tilt sounds like your kneecap is pulling in that direction. This can definitely be corrected with a release of that tendon. I think you need a second opinion. This problem should not have arisen from your TKR and if it was already there, it should have been corrected during your TKR.
 

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