PKR Left knee patellofemoral arthroplasty

[zdclimber]

I think I am fortunate to live in Seattle area where there are plenty of flat bike trails, either paved or gravel. That is where I rode early during my recovery. These days I am mostly riding on streets for my weekly "long" rides, but most of the streets have dedicated bike lanes or very wide shoulders.

Regarding PT - I stopping seeing physical therapist at the end of month 2. I wasn't sure if these early PTs helped me or set me back. During the last 3-4 months, on a few occasions I thought I could benefit from some strengthening exercises. So I started the exercise and kept doing it everyday. But every time I had to stop a few days later because my knee didn't feel so good. So no PT for me, at least for a while.

By the way, a few things I forget to mention - 1. the feeling of a tight band around me knee is now completely gone. I stopped feeling it probably a month or 2 ago. 2. I can kneel normally on my knees, with both knees taking equal amount of body weight, on bed and on carpeted floor, but not on hardwood floor. 3. My left knee is not hot/warm to touch anymore. It's usually cool. My right knee is however usually cold to touch. 4. My left knee is still visibly a little bit bigger than my right knee, it does not look swollen. It is just bigger.

 

[FCBayern]

Sounds like you are doing great @zdclimber! At just 6 months in I think you'll find most of the niggling issues will fade with more time. My TKR knee is still visibly bigger than my other knee but it's closer than it has been in 20 years so I don't know how much of that is due to so many years limping around.

 

[Sara61]

@zdclimber How is your 8 month old knee doing ? We love to hear follow ups from past BoneSmarties, it's also good for our newer members xx
Wishing you Happy Holidays xx

 

[zdclimber]

9-month update:

There is steady but very slow improvement of my left knee from 3 months ago. No significant change, either good or bad.

ROM: no improvement during the last 3 months. Active ROM is already at its max (i.e., same active ROM for both knees). Passive ROM is about a few degrees off its max, with a couple of inches of gap between heel and butt when pulling my left foot up doing quad stretching. I guess that's what it is for the rest of my life but this limitation is hardly an issue.

Strength/stability: noticeable improvement when doing the heel dip (i.e., standing on a step and touching the heel of the non-surgical side to the step below). Also, when hiking downhill, I can go as fast as other younger hikers, and oftentimes, I feel my surgical knee is my stronger knee during the descent.

Activities: around 3 miles of walking (at about 3.5 mph pace) 4-5 times a week. No cycling nowadays as the weather is really not favorable this time of the year in PNW. (I do indoor cycling on my trainer occasionally but I can't do that for more than 10 mins every time because it's extremely boring.) Hiking or inbound ski touring once a week. I really like the inbound ski touring where I could skin up and ski down on a groomed run in a local ski resort. It's very knee friendly. My knee can handle groomed black run without an issue. Last ski season, I felt knee pain for every turn even on green runs. So this is a huge improvement. As for PT, I don't do regular PT, either for strength or flexibility. Maybe it's about time to start one.

Current issues/limitations:
1. Still unable to exert much force when knee is deeply flexed.
2. Left quad muscle, in particular the VMO, is quite a bit smaller than the other side. Even though the strength is improved, the muscle size does not appear to have changed much.
3. Occasionally, I feel the pain around my left knee, especially after walking for 4-5 mins (but stops after walking for 10-15 mins). What used to be painful, the kneecap, is completely pain-free. But what used to be fine, now can become painful. If taking my left knee in a axial view where the kneecap is at 12 o'clock and medial side is at 3 o'clock. The pain is at 2 o'clock or 9 o'clock, but usually not in both places at the same time. I also tried running once. I only ran 1/10 of a mile on a gravel road with a slight incline. Quite a bit of pain at 2 o'clock near the end of the run but the pain did not last long after I stopped running. I will try running again in a few months to see if it improves.

 

[zdclimber]

One year update -

Not much change during the last a few months. Whatever limitations I had 3 months ago are still there.

We had a family ski trip for a week last week. I managed to ski 5 out of 6 days (skipped on day 3 due to mild cold), about 3 hours of non-stop skiing every day. My left (surgical) knee held up well but I did feel my left leg quite weak. At the end of each skiing day, the tendons (in particular patella tendon) around my left knee were sour, but they mostly recovered the next morning.

Early in March I got a bad flu (COVID-19 negative however) and stayed in bed for a couple days and stayed inside for the whole week. No exercise at all during this period. To my surprise, when I resumed daily walking, during the walk my knee was quite painful for a much longer duration for the first 2-3 days. Before this, it was just mildly painful for only for 5-10 mins and the pain only happened occasionally. Fortunately, after the initial 2-3 days, it's back to what it used to be. So it appears to me regular exercise, ideally daily, is important.

I just had my one-year check up. Everything looked great. My surgeon was very happy.

 

[FCBayern]

Fortunately, after the initial 2-3 days, it's back to what it used to be. So it appears to me regular exercise, ideally daily, is important.

Motion is lotion, all of my replacement joints let me know if I'm too sedentary, on the other hand staying active is easy when you don't have the grinding pain of a bad joint.

 

[beesknee]

What an amazing outcome! I could not imagine skiing. I still can't go up or down stairs without holding onto the rails. I exercise my knee about an hour a day. I can only push so hard because after a point, knee pain holds me back.

Can you detail the daily exercises you do?

I do 8 - 10 quad and glute strengthening exercises, 10 - 15 minutes on the elliptical, and a 1 mile walk with my dog each day. Then ice at night while watching TV or reading.

I often wonder if I should drop or cut down on the strengthening exercises and go on longer walks, elliptical, and cycling.

One year update -

Not much change during the last a few months. Whatever limitations I had 3 months ago are still there.

We had a family ski trip for a week last week. I managed to ski 5 out of 6 days (skipped on day 3 due to mild cold), about 3 hours of non-stop skiing every day. My left (surgical) knee held up well but I did feel my left leg quite weak. At the end of each skiing day, the tendons (in particular patella tendon) around my left knee were sour, but they mostly recovered the next morning.

Early in March I got a bad flu (COVID-19 negative however) and stayed in bed for a couple days and stayed inside for the whole week. No exercise at all during this period. To my surprise, when I resumed daily walking, during the walk my knee was quite painful for a much longer duration for the first 2-3 days. Before this, it was just mildly painful for only for 5-10 mins and the pain only happened occasionally. Fortunately, after the initial 2-3 days, it's back to what it used to be. So it appears to me regular exercise, ideally daily, is important.

I just had my one-year check up. Everything looked great. My surgeon was very happy.

 

[zdclimber]

Can you detail the daily exercises you do?

Mine is quite simple:
1. Either walk around 3 miles (at 3mph pace) or bike 20 miles (at 15 mph pace), depending on weather, 4-5 days a week.
2. Once a week, a moderate hike (2000 to 3000 ft elevation gain) either on dirt trails, in which case I also hike down, or on uphill routes of a local ski area, in which case I ski down. As the weather improves here in PNW, I will switch to long bike rides soon.
3. On the average every 2-3 days, but quite irregularly, I do some light leg strengthening exercises, like 3x20 body weight squat, lunge, single leg standing with eyes close, etc. The whole thing lasts no more than 10 mins.

I often wonder if I should drop or cut down on the strengthening exercises and go on longer walks, elliptical, and cycling.

If I were you, I would reduce the strengthening exercises for a while and keep walking or cycling (but not increasing the distance yet) to see it can make some positive change. If you still need to ice your knee daily at this stage of your recovery, you might have done too much.

Hope you will find what works well for you soon.

 

[beesknee]

I have only gone one day without icing since the operation maybe 5 months ago. I thought I was turning a corner.

I also have gone very few days without any type of stretching or exercising of knee. First was 3 or 4 months of ROM increasing stretches. ROM is fine now, then I shifted to building back strength. I think I will cut back on exercises and increase walking distance (the dog will love), elliptical, and cycling and see what happens.

I can walk a long way without pain if surface is flat. I can feel the up and down of minor hills though.

 

[zdclimber]

15 months update -

Really not much to report. The surgical knee is functioning really well. There are only a couple of minor issues. One is that at the spot where my surgeon did lateral lengthening, there is some discomfort when I do strengthening exercises, usually for the first a few reps. The other is I can exert some force, but not a lot, when the knee is deeply flexed (>120 degree). These are the issues that I always had after the surgery. Now they are getting better but still not gone.

Over the last weekend, I just did a 3-day bike tour around Seattle, riding my fully loaded touring bike (bike and camping gear weight about 70 lbs) for close to 200 miles over moderately hilly back roads. My surgical knee held up extremely well, no pain or discomfort whatsoever. The kneecap of the other knee however feels a bit painful at times. I am planning to ride 1000 miles from Seattle to Glacier national park at the end of July.

 

[campcol1]

Congrats on your knee

 

[zdclimber]

Congrats on your knee

Thank you @campcol1

 

[sistersinhim]

Sounds like you're having a very good outcome!

 

[zdclimber]

Quick update -

I rode my fully loaded touring bike from Seattle to Glacier national park over the last 2 weeks. In the park, I rode the entire Going-to-the-Sun road from Apgar to St Mary. My surgical knee had absolutely no issues during the trip.

 

[bdiddy18]

Thats amazing well done @zdclimber !! I’m 40 years old my kneecap is no good due to forceful impact. I’ve been seriously considering the PFJ replacement however I wasn’t sure how much running I could do if I had it done. Can you run?

 

[zdclimber]

Thats amazing well done @zdclimber !! I’m 40 years old my kneecap is no good due to forceful impact. I’ve been seriously considering the PFJ replacement however I wasn’t sure how much running I could do if I had it done. Can you run?

I have not seriously tried running yet after the surgery. I am planning to give it a try this fall, which is against my surgeon's advice. But even if I can run again, I will not do so more than twice a week and more than 2-3 miles (at very casual pace of 9:00 per mile) every time. No more races, 5k or marathon - the days of racing and running high mileage is over for me.

 

[bdiddy18]

Thats amazing well done @zdclimber !! I’m 40 years old my kneecap is no good due to forceful impact. I’ve been seriously considering the PFJ replacement however I wasn’t sure how much running I could do if I had it done. Can you run?

I have not seriously tried running yet after the surgery. I am planning to give it a try this fall, which is against my surgeon's advice. But even if I can run again, I will not do so more than twice a week and more than 2-3 miles (at very casual pace of 9:00 per mile) every time. No more races, 5k or marathon - the days of racing and running high mileage is over for me.

Hi ZD climber, just checking in have you started running?

 

[zdclimber]

Hi ZD climber, just checking in have you started running?

I tried to run a few times, only 400m each time. Every time I did, my knee was a bit uncomfortable during the run after the initial 100m or so. Even though it was just a bit uncomfortable, and my knee was fine after I stopped, I still felt it's a risk not worth taking. I will keep trying every month or two.

 

[bdiddy18]

Hi ZD climber, just checking in have you started running?

I tried to run a few times, only 400m each time. Every time I did, my knee was a bit uncomfortable during the run after the initial 100m or so. Even though it was just a bit uncomfortable, and my knee was fine after I stopped, I still felt it's a risk not worth taking. I will keep trying every month or two.

Thanks ZD. Does it feel better running than it did prior to your operation or still average? I am really up in the air as to what I should do!!

 

[zdclimber]

Thanks ZD. Does it feel better running than it did prior to your operation or still average? I am really up in the air as to what I should do!!

It feels different. I felt kneecap pain prior to surgery but now it's discomfort well below tibia plateau on the medial side.

Note that with my surgery, I am able to go back to skiing, climbing and bike touring. Running unfortunately isn't one of them, at least not at present.