PKR Ligament Sprain in GoodLeg

[marieltha]

Continuing to make steady progress—as long as I don’t get onto the ODIC bus.
The hip adjustments seem to be holding. I am slowly able to do more pool walking and more normal walking on the alternate days. Doing peddling also, in several short increments each day.
The ligament sprain, now healed, and the resultant period of lessened activity, seems to have accelerated the arthritis in the medial compartment of the first PKR leg. So I think more surgery on that knee is in my future.
For now, I’m increasing overall strength and stamina, and at least am beginning to experience periods of normal walking. It truly scared me to have lost that feeling—first time for me.

 

[luvcats]

I'm glad the ligament strain is finally healed, but sorry that all the excitement has caused your knees to want their own prime time show.

I envy your pool walking. The Universe has been conspiring against me. We came home from our travels sick, and a drippy nose just does not go with the pool. I feel so stiff. I hope the stars align to get me in the pool next week. Which is what I said last week. lol

 

[marieltha]

Nice to hear from you @ luvcats !
I hope you are able to be in the pool soon. I’m going every other day for 30 minutes. Not increasing. Staying in the deep water. It is keeping me sane—or at least, close to.
Peddling a bit on most days. Some walking. Strength building, especially quads (@FitGal thought of you) and core.
I read your post on “joy” @Macknit and was anything but joyful that day. But I think you planted a seed, as I am focusing again on the improvements I am seeing.
@luvcats you mentioned the Universe. Four men LOL !!!have confirmed this week that my hips are level and I’m walking better (OS, Chiro, FootMD, & my Beloved) and the bizarreness of even thinking about such a thing so appeals to my quirky sense of humor that I both laughed out loud and had to read some DaLai Lama to accept this message from the Universe.
So, forging ahead, in the pursuit of progress,
(@Izabel and @Sara61 ) I sat in our beloved sports car today and was able to get out of it unassisted!!!! I love the elevation and bigness of our SUV, but every now and then, ....
So a ride will be next.

 

[Macknit]

Oh @marieltha, how funny...we just might have similar senses of humor...Four men...and DaLai Lama (I think that makes 5) LOL!!! I really had to laugh too! All checking out your hips! Well, maybe not DaLai!? I'm glad to hear seeds are being planted...the Universe is constantly speaking to us..eh?

 

[marieltha]

LOL it is Dalai Lama, not DaLai (un peu trop francais peut etre?).
Will see chiro tomorrow and see what he says about the latest change to my custom orthotics that the foot md made, and his request that I wear them again. He has asked me to wear them 1 hr every day (in the house, just ADL) for 2 weeks. Then return for a check.
The chiro had asked me to not wear them again yet, or change shoes, while he’s getting me balanced. The foot dr (who knows my chiro) wants the chiro to do another gait analysis on me tomorrow, with the altered orthotics and without.
This sounds like my foot thread, but the hips, knees, and feet all have to be aligned for me to walk normally.

 

[Macknit]

"un peu trop francais peut etre?" Oui, juste un peu trop français

Ha...of course I cheated....I don't know French...but I did live in Germany for 2 years and of course, I took Spanish in my middle school years. Haven't used either language for many years...

It is definitely a hips/knees/feet thread, I have had issues in all of them. I'd add spine too of course, because our alignment from the top down is critical.

At least now I'm out of the pain from the back. Thank goodness. Some days when I try to walk at work the TKR side just tightens up and pulls on my lumbar region. I believe it really is the IT band. I'll be working on it more starting next week again!

 

[marieltha]

1-17 Chiro did the gait analysis as the foot dr requested. Without the orthotics, I swing the right leg out to the right side a bit, and the hip goes to the side. With them, the legs bend at the knee and the hips move front and back, as they should. So he agreed that I should wear them as directed by the foot md for 1 hr a day, at home, ADL, for 2 weeks.
He tweaked the whole spine and hips. Feels heavenly: Both fluid and balanced.
@Macknit , ooh, German & Spanish! @Izabel is teaching us/me Portuguese. I found a church that still says the mass in Latin, but it is a bit of a drive, so that is on the list of things to come as the knees enable me to expand our range.
Let us know if your work w your IT band helps. The core work is giving me the best improvement at the moment. The chiro suggested combining the pelvic tilts (I do lying down) with Kegels and with a buttocks squeeze. My body likes that—even the hamstrings and the glutes seem to benefit (reminds me a bit of @luvcat ‘s seated squeeze).
Just got the Anderson Stretching books out of the library. Recommended by @Roy Gardiner in @FitGal ‘s thread recently. I got the standard classic and the one for people seated at a desk/computer. I will share feedback.
And I find these chiro tips for standing helpful. Published during the holidays for standing in lines, but improving and extending my standing time (post PKRs) is another of my goals:

Start with your toes and work your way up:​ Spread your toes out as wide as you can and hold for a few seconds and then bring them back to neutral. Stand on one foot while you rotate the opposite ankle and then switch legs. To stretch your calves, lean forward on your toes keeping your legs straight. Bend your knees a little bit, just 5 to 10 degrees, and then straighten them. Tighten the muscles in your thighs and bottom and hold for 5 seconds and then release. Tuck your butt underneath while sticking your bellybutton out then switch and stick your butt out. This pelvic tilt can be a very small movement, but it is great for taking the pressure off your lower back. Roll your shoulders backwards several times and then push your shoulder blades together to stretch out your chest. Open your hands as wide as you can and then gently close them. In addition to stretching, shift your weight and alter your stance every 3 to 5 minutes to give your body a postural break. Source: American Chiropractic Association. November 03, 2010. @Jamie: Okay for me to add the standing tips as I did? If not, just delete them and my last paragraph. Thanks

 

[Izabel]

Marie

Well, I know how you are and your report above sounds good.

for the Chiro tips which I will incorporate into my regime today. Balance is still my bugbear/annoyance/apprehension or whatever and that is what I must overcome. However, having this issue for some 8 years now is going to take some extra time and effort to conquer, especially since having all my ops (5 of them) in the interim. My sister (bless her now not with us) had asked back in 2012 if I had suffered a stroke to suddenly become so unbalanced ... of course Hubby says I have always been unbalanced!!! Just wish the knees would ease up whilst walking and they really ache by the evening.

Hubby is going to the Osteo/Physio on Friday for dry needling so I will have him ask Berry (my guy also) if he has any more thoughts/tips for me.

The chiro suggested combining the pelvic tilts (I do lying down) with Kegels and with a buttocks squeeze.

I do this also along with leg lifts and side kicks before I get up in the morning.
It is drizzling here today but warm so a day indoors crocheting.

Take care and have a peaceful weekend.

Izzy xx

PS I started off some Calla Lily corms yesterday. I have had a white/purple one for years ... don't know what colour these two will be.

 

[marieltha]

FitGal, Steelergal, Poctdb, Luvcats, Macknit, Izabel, Sara61, Jockette
Following everyone’s talk of stretching and strengthening made me think of my very first OS (AirForce superstar at NASA/Langley who did my torn meniscus removal—I always felt like an astronaut going there, hahaha) who gave me 2 quad tips: 1)When you do the classic leg lift, keep your hand on your quad, fingers on the top of the knee, to make sure it is the quad that you tighten and does the work; 2) Always do both legs, to stay balanced.
PS @Roy Gardiner I just started using the stretching guide you recommended and like it and the easy to use format—very clear pictures—very much. thanks again!

 

[Macknit]

Hi there,

I missed a few of your posts in January...I'm not here on BS as often as I was. So, Air Force???You, Hubby, other government work at Langley ???? Interesting....We were Army (DH is retired, I did 4 years) and then 2 active duty Navy sons.

Also, Latin Mass we've hit a few times in our travels, but our go-to is a local Evangelical Catholic Church that is very outreach-oriented and welcoming. It has been a big blessing in our lives we connect with so many from our local community that want to help others... yet still, very catholic!

I'm in here searching for your hyaluronic acid injections experiences....I'm glad to hear such a positive experience for you! I still can't find them, but I'll keep searching!

 

[Jockette]

I have 2 laterals and probably will have a medial in a year or so.

I didn’t realize a surgeon would consider adding another partial component to a knee with a different partial already in place.

 

[Celle]

I have 2 laterals and probably will have a medial in a year or so.

I didn’t realize a surgeon would consider adding another partial component to a knee with a different partial already in place.

@marieltha - The usual procedure if osteoarthritis has spread to a second knee compartment is to revise the PKR to a TKR, not to do an additional PKR.
Revising a PKR to a TKR is much less "tricky" than adding a second PKR, and it's more likely to be successful.

If the internal ligaments of your knee are in good condition, it is possible to preserve them during a TKR, using a cruciate-preserving prosthesis, like this:.
The implants have a notch to accommodate the cruciate ligaments.

 

[marieltha]

@Celle Thank you very much! This information is very helpful! I would like to read more about what you said here:

Revising a PKR to a TKR is much less "tricky" than adding a second PKR, and it's more likely to be successful.

Source(s)? Please give me a link(s) to read more about this research.

@Jockette My OS has done quite a few 2nd PKRs although the percentage of people with his single pkr who need/get a second in the same knee is comparatively small. When I search online, I have read of doctors saying they do each compartment one at a time but now cannot find that; recently, one NY dr said he often does the kneecap and one compartment (?). He didn’t explain why, but it isn’t it very rare to replace the kneecap? I haven’t read anything about lateral & medial together or even about adding a second, which is why I am interested in @Celle sharing her sources.

Like you, I am not in any rush to do another surgery. My OS is very conservative, not only about removing healthy ligaments, but also, about the amount of trauma to a knee/foot/other at once. He isn’t pushing for additional surgery.
I’m a big believer in doing research before making such a decision. So while I am rebuilding my overall and my leg stamina, I am researching.
Thanks!

 

[marieltha]

@Macknit

I had my meniscus surgery at Langley NASA as a dependent in 2010. Started Euflexxa there in 2011. Continued every 6 months until first PKR in 2018. AF surgeon said probably 5 years 2015-16? to knee replacement. I should have done it then, but was okay. Then very late in 2017, the Euflexxa only helped for 3 months, and that winter, literally one day, at the opera, in the parking garage stairwell, I couldn’t go down the stairs. So I replaced the lateral (then damaged) part shortly thereafter.
In fall of 2018, I felt the left knee (okay prior) suddenly deteriorate, felt bone on bone, and had that lateral in March of 2019. Had to wait a few months because the left foot was recovering from PTT (foot thread PTT) and would have liked a full year after the first knee. The left leg knee was not as damaged as the right and the recovery has been easier. Except for following it with the RCR shoulder repair!

When I go to the OS this week I will ask for the name of the one that he wants to use the next time. All natural like Euflexxa (Gel something?).

 

[Macknit]

@marieltha thanks for the timeline....it is interesting how these knee surgeries go. My R knee had the meniscus surgery in '96. Then my knees were great for a long time...my R knee deteriorated on me very quickly Christmas 2018. It just swelled up and was very hard to move, they gave me Zilretta the long lasting cortisone, which helped, and they recommended that I also wear a brace. I was originally scheduled for TKR in July, 2019. However, I herniated a disk which was an acute situation so spine surgery came first... then 2 months later for the TKR.

I suppose that once OA decides to set in, it just happens everywhere!? It started with my thumbs...the L surgery was in Dec 2017, (I'm holding out on the R thumb because of all the issues I mentioned in the Other Joints Forum), then the back surgery took care of some OA issues too.

I'm have been wondering if my L knee will also deteriorate like that? Maybe these hyaluronic injections will buy me a bit more time??? I'm hoping. I'll find out which brand they use, when I head in in early March!

 

[Celle]

@Celle Thank you very much! This information is very helpful! I would like to read more about what you said here:

Revising a PKR to a TKR is much less "tricky" than adding a second PKR, and it's more likely to be successful.

Source(s)? Please give me a link(s) to read more about this research.

I don't have any sources or studies, but it seems like common sense to me. If doing a PKR correctly demands a certain skill set (which it does) and some surgeons make a hash of it, it would be so much easier to make a mess of a second PKR in the same knee. Not only would he/she have to cut and shape the bone to fit the prosthesis and give the correct alignment, it would also be necessary to align it correctly with the first PKR, to keep all the angles correct and the spacers the same size.

If it was easy to add a second PKR to an initial PKR, most surgeons would be doing it. But they don't. They opt to revise the whole thing to a TKR. Less chance of making a hash of it and more chance of success.

All I can tell you is this:
I've been on BoneSmart for 8 years and in that time I've read of far too many PKRs that didn't last the expected time and had to be revised early - some of them even within the first year post-op.
Some PKRs fail because arthritis has invaded another knee compartment, but many fail for no obvious reason.

That makes me not a fan of PKRs. Why go through two or more surgeries when one will do the trick?
Not all surgeons have the skill set necessary to do a PKR.

Even though my surgeon was meticulous and my own PKR lasted for 11 years, it gave out on me suddenly, when the spacer broke without any prior warning. One minute I was walking briskly. The next minute I was on the floor, in extreme pain, not able to get up, and unable to walk at all.
Counting the post-op recovery time, I was on crutches for four months after that. I could have done without all that.

When my other knee needed replacing, I opted to go straight to a TKR, which now has a projected life span of 30+ years. "Do it once,do it right" is what I think now.

The other thing is that I've seen far too many people choose to have a PKR, believing that it will give them a quicker recovery - it doesn't - or that "a partial will feel more natural" - again, it doesn't.

For the vast majority of people who have come to BoneSmart, recovery from a PKR takes just as long as recovery from a TKR and expecting a faster recovery leads to worry and disappointment.

As for a PKR feeling more natural, I've had both, and they felt the same. My revision TKR feels so natural that I usually forget I have it, and I can do just as much with it as I could with my PKR.

 

[Jamie]

Sadly, @marieltha, Celle is right. There isn't a lot of research done on partials vs total knee replacements. However, we do have the benefit of years of BoneSmarties here on the forum and their experiences to draw upon. As Celle mentioned, she has 8 years here and I have 12. Here are some observations I've made both from the forum and from talking with surgeons directly over the years.

PKRs fell out of favor for a while because they tended to need conversion to a full TKR relatively quick...many times within a year after the original surgery. That has changed a bit in the last couple of years with more PKRs being done now. Technology changes and it's possible that they can be more successful now than in the past and have more longevity.

But, most surgeons don't do multiple PKRs on the same knee for a couple of reasons:

(1) if you get a PKR, then shortly (like within a couple of years) afterwards develop arthritis in another knee compartment, the chances of you getting it in the third compartment of your knee are very good and at that point you would need yet another surgery to have a full TKR. When a knee starts to deteriorate (versus damage resulting from trauma), that arthritic degeneration generally continues in the cartilage in areas not replaced. Sometimes new damage can come on rather quickly.

(2) Like a TKR, a PKR is major surgery. Every time you open up a knee, you cause trauma to the knee itself and surrounding tissues. In addition to cutting the bone, nerves and soft tissues are moved around. You expose the patient to the risk of infection with each surgery. The patient has to go through anesthesia and recovery every time. Multiple surgeries in a short period of time is not advisable for anyone unless absolutely necessary and knee replacements are not "necessary." They are considered "elective surgery."

I don't know that it's any more difficult to balance a knee that's having a second PKR than it is to do a knee with just one PKR or a TKR. But I suppose it could be. The thing to me would be the succession of surgeries and what that does to your body. And the potential for increased problems because of the normal risk with any surgery. At your age, I don't see the value of all this when a full TKR would get your knee fixed and most likely carry you at least 20 years down the road - possible much more. Longevity of current implants simply is not known yet.

Of course, it's always your option as to what road to take. But for most people and a majority of the surgeons out there, multiple surgeries on a knee is not the way to go.

 

[Helizabug]

I am a sample size of one, here, but I would just get that TKR, if you could and there’s no medical contraindications. I’ve had several surgeries on my knee, over the course of a few decades, and each one was another long recovery, with possibilities for infection, lots of exhaustion and down time, stress on my support system, time away from work and fun, and so on. Maybe I’m over optimistic, but, as long as this TKR progresses as expected, I think it will be a good way to get lots of quality of life with fewer stretches of debilitation.

 

[marieltha]

@Celle @Jamie @Helizabug
Thank you all very much for sharing your opinions and personal experiences.

Your feedback and all the years of info you have access to argues strongly for a TKR, but even more, for the fewer surgeries the better. Moreover, my soft tissue experiences have made me especially wary of anything invasive in the joint. I do not like the idea of even a second surgery on that knee, let alone a third. Nor do I like the idea of removing the PKR implant that is already there, as it is fine and has settled in.

The lack of research data is discouraging, of course. But such is life.

The certainties in my personal experience are these: I had 4 surgeries (includes one non-joint) in 18 months from which I am still recovering; I underestimated my leg strength/stamina going into the two surgeries; the shoulder surgery (most recent) recovery is continuing; I inherited osteoarthritis.

So I am focusing on regaining my overall stamina and strengthening my legs and core.

All of your feedback has underscored the need for patience and acceptance of the pace of recovery that the body is experiencing, not that the mind desires.

Thanks again.

 

[Helizabug]

I want to make sure I was being clear: I was saying that I would move from the PKR to the TKR when that becomes necessary, as opposed to adding a second PKR to the first. And please understand that I am talking as a patient and a consumer, not with any more expertise than how I feel about my own experiences. (Sometimes I forget to make that clear.)