PKR Left knee patellofemoral arthroplasty

I am amazed that you can work at two weeks out. My brain fog was so bad I couldn't even concentrate on a book, much less work! You will find that having your leg down will increase your swelling so taking lots of ice and elevation breaks makes sense.
 
I never felt my ability to concentrate was compromised after my surgery. Maybe it is due to the fact that I stopped taking narcotics on day 5 post-op. Luckily for me, pain was not a issue during my recovery (neither is poor quality of sleep).
 
I have partials, but not in the kneecap. Sometimes looking back, I think my early joint recoveries were better than I expected, but then perhaps because of that, I misjudged/ underestimated the trauma to all the soft tissues. Sigh. And the painful experience of bending too low too soon--without anaesthesia as @sistersinhim so humorously noted. Time really does heal.
I couldn't tolerate narcotics either, so got off those very quickly.
My joints loved icing and elevating, but didn't like compression at all. My md had me remove the stockings 24 hrs after the surgery. I used manual gravity feed cryo cuffs and adjusted the cuffs to avoid compressing too much. I didn't get the electric icing cuff because it auto compressed. No doubt there are others now that you can auto ice and turn off the compression.
Your mention of your post-surgical nausea brought back some uncomfortable memories. One anaesthesiologist finally advised me to never ever get gas anaesthesia again, and never ever allow anyone to give me versed again. The latter is quite common, it turns out, allegedly to "relax" you. But both trigger nausea.
So my anaesthesia is now simply propofol (sp?), very lightly administered. This method requires very close monitoring of my breathing, but I wake up quickly and clear-headed, and without any nausea!!!
Someone on here said he uses a marker and writes NO VERSED! prominently on his body before surgery.
Good luck!
 
Week 6 update -

Overall good progress over past 2 weeks. ROM improved to about 0 - 130. Now I can ride my road bike, which makes me quite happy. I can walk upstairs with normal gait, but walking downstairs is still a little jerky when the surgical leg is the trailing leg. Leg extension, which I had difficulty with 2 weeks ago, is no longer a problem. Now everyday, I either walk 2.5 miles or bike 20 miles.

The only issue I have now is swelling. It does not seem to have much improvement over the last 3-4 weeks. I spend much more time lying in bed with my leg elevated (that's how I work now with a laptop computer) than sitting or standing during the day, but still the swelling persisted.
 
Swelling can persist for many months, even a year! Sounds like things are going great for you!
 
You are doing amazing! I can’t do any of those things and I’m 4 years since my Patellofemoral, as I did not get a good outcome.

Yes, swelling can last a long time. Maybe you should consider cutting back on the walks and bike rides until you heal a bit more. Sometimes just because we can, doesn’t mean we should, at least for now.
 
You ride your bike 20 miles per day? Wow!
I know everybody is different, but if I go over 8 miles, my knee swells. And, I am 12 weeks post op.
Some days ( like today) both knees hurt, and my motivation goes way down...hope I see some progress soon!
 
@Jockette, I am considering the same thing. I will see my surgeon in a few days. If he thinks the amount of swelling I have is concerning, I will cut the distance I walk/bike and reps of PT exercises.

@MARYCOOL, if it's not raining, I am alternating between walking (2.5 miles) and biking (20 miles) everyday, and walk only if it is raining. As you said, everyone is different. My knee swells and stiffens quite a bit after PT or walking, but not much after biking. On the other hand, I feel pretty tired (and want to take a nap) after biking, but not at all after PT or walking.
 
Hi ~ glad you're doing so well in your recovery. I was wondering what your initial symptoms were and what the diagnosis was? My husband has had relapses of a high school football knee injury, most recently, but also in the past. He did work out and eventually he participated and completed around 3 half triathlons; not sure how long ago, 10 years ago maybe, but he has kept up his fitness, either on his own or for a few years with a personal trainer and a fitness class (he's a avid golfer).

Recently, just before Christmas and just before my accident, he had to go to e.r. for excruciating pain in his knee (couldn't make it home walking the dog); had blood drained from his knee; surgeon said it was hemorrhaging. It happened a couple weeks before that and then again a couple times after, all while out walking our dog. He went to surgeon for a follow-up and has also been going to physio and both said that it was unlikely they would do arthroscopic surgery at his age (68). Anyways, he's been committed to doing the home exercises and going to physio and has not had a relapse since sometime in February. Ambulance wouldn't come for last relapse; (lucky we had some hydromorphone). His MRI for May 3 was cancelled due to pandemic, re-scheduled for June 16, so he can find out exactly what is going on.

Just wondering what your experience was. Thanks in advance.
 
Thanks @liam2015. My pre-op symptom was anterior knee pain when running, jumping, skiing, hiking downhill, and biking steep uphill. Walking and biking on flat, even for many hours, did not bother me. (I did bike touring with an unloaded bike for almost 1500 flat miles, averaging 70 miles a day with my "bad" knee). Initial diagnosis based on X-ray and MRI was a small full-thickness cartilage defect behind knee cap. It turned out the size of the defect was much larger, as shown in the attached picture, when my knee was opened up.

Note that I did a partial knee replacement. I think that's probably part of the reason my recovery to this point appears to be faster than a lot of people here. That I am relatively young at 52 and relatively fit may have also helped.

Hope whatever procedure your husband decides to do with his knee, if it ever comes down to that, the outcome will be great.
 

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@zdclimber ~ thank you so much for your reply; I will tell my husband. at this point they have no idea what the problem is. thankfully, he's a lot better and walking the dog again. p.t. wants him to ride his bike outside ~ yikes ~ one of us has to stay healthy.
 
Month 2 update - Again steady improvement over the last 2 weeks.

ROM is now at 0-140, increased from 0-130 at week 6. My pre-op ROM was 0-145 (active) or 0-160 (passive), so there is still some room for improvement.

Swelling comes down quite a bit during the past 2 weeks. Compared with the non-surgical side, it is still visibly swollen, although not by too much. Swelling would increase after PT or walking, but quickly subsides to pre-activity level after elevating my knee for just 10-15 mins.

Main activity these days is either walking for 2.5 miles or biking for 25-30 miles. It's interesting that unlike walking, which would cause more swelling as I mentioned, biking does not increase the swelling of my knee at all. Going forward, I am planning to increase my biking distance for one day every week, so I will have a long ride once a week, eventually reaching 100 miles.

Going upstairs or downstairs is no longer an issue. I can do it easily with normal gait. I can even run a few steps going upstairs. It seems I will be able to start hiking soon.

Before surgery, my expectation was that my knee would be back at its pre-op level at month 6, which means I can bike 100 miles at moderate pace or do easy hikes (no more than 6 miles round trip and 2000 ft elevation gain) with a light pack. By 1 year, I would be able to climb or ski with multiple consecutive days. I think so far, my recovery met and even slightly exceeded my expectation.
 
Great update @zdclimber ! Sounds like you are doing very well. And you will continue to see improvement as this process can take one year or longer. Enjoy your bike rides!
 
Wow zdclimber your doing great i had a medial right PKR on April 19 so far so good i am not at your level of activities but today i washed my car and yesterday cut my grass i still get swelling but i no longer have bone on bone grinding in my knee on wards and up wards.
 
3-month update:

Overall, continued progress but the rate of progress slowed down. The surgical knee is still not at its pre-op level but close.

Very little change in ROM during the last month. Maximum flexion is about 140 to 145. I cannot squat all the way down, and when I squat to the point that I exhaust the ROM of my surgical knee, I cannot put much weight on it.

I stopped formal PT. It seems to me that the PT sessions neither help or hinder my recovery.

Swelling comes down significantly but is still not completely gone. I stopped icing/elevating but am still wearing a relatively tight elastic knee brace around my surgical knee. The knee is no longer hot, and is just slightly warmer than the other knee most of the times.

As I mentioned in my last update, I am increasing the distance of my bike ride every week. I did a 60-mile ride at moderate pace (~15mph) last weekend. My knee held up just fine. A few weeks earlier, I rode with a friend of mine for 50 miles. It's hard for me to keep my pace down with I ride with others and I picked up my pace a bit to about 17-18 mph. After that ride, my knee felt quite stiff, ROM also declined, and for the first time since the surgery, I felt a bit pain at night. Luckily, the symptom only lasted 2-3 days. I learned a lesson. Now I am either riding alone, or adamant about keeping the pace down in a group ride.

I also started hiking and doing so once a week with increasing distance and elevation gain. This past weekend I did a hike with 1000 ft elevation gain. Again, my knee held up just fine. I am hoping to climb Mt Rainier again late spring next year (when the whole mountain is snow covered so it's easier on my knees), it seems to be achievable at this point.
 
6 months update -

Continued progress in my recovery. Nowadays I don't really think about my knee that much anymore. There are still limitations however.

ROM: Same active ROM between my left (surgical) knee and right knee, at about 140-145 degree. Active ROM of my left knee is a bit less. When I hold my ankle and lift it to my butt in an attempt to stretch my quads, with my right leg, the heel can touch the butt, but with my left leg, there is about 2 inches of gap.

Limitations: When I squat all the way down, I cannot put equal weight on my legs/feet. Now I can put about 20% of my body weight on the left side. This is a progress from 2-3 months ago when I cannot put any weight on the left side at all. Additionally, I cannot exert much downward force on my left leg when it is bent beyond 90 degree. The more it bends, the less force I can exert. This severely limits my (rock) climbing. But again, it's getting better during the last 2-3 months.

Annoyance: my left knee makes squeaking noise when it's bent beyond 90 degree. No pain or discomfort, just the noise.

Other than the limitations (and the the annoyance), my left knee is functioning very well. In addition to my daily 3-mile walk or 20-mile bike ride, every week I have one more "strenuous" activity. It's either a hike of 6-mile round trip with 2000 ft elevation gain, or a 50-60 miles, moderately hilly bike ride. My knee handles them quite well.
 
Great report!

I can’t do any of that with my Patellofemoral. Mine is such a mess. I wish I had known more before surgery, but, I didn’t, so it is what it is.
 
6 months update -

Other than the limitations (and the the annoyance), my left knee is functioning very well. In addition to my daily 3-mile walk or 20-mile bike ride, every week I have one more "strenuous" activity. It's either a hike of 6-mile round trip with 2000 ft elevation gain, or a 50-60 miles, moderately hilly bike ride. My knee handles them quite well.
Great report!

I can’t do any of that with my Patellofemoral. Mine is such a mess. I wish I had known more before surgery, but, I didn’t, so it is what it is.

I don't think most healthy people can or want to do the extreme biking and hiking zdclimber does with two good knees.

I have a high end bike and the longest ride has been 8 miles on a safe bike path around a lake. I think I could do more but I am way too afraid of riding on a road with cars. We have some 55 mph 2 lane curvy two lanes around me that are popular with road bikers. When I dodging them with my car I think I would not bike a half mile down those roads even if someone paid me $1000 cash!

Jokette, what would you have done differently if you knew more? I know you had aggressive early PT. Do you think they did permanent damage to your knee? I had some overly aggressive PT where I was not happy with them and limping around after, but always recover back to my mean after a good night sleep (or two) and some ice.
 

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