PKR Long Story of my Battle with a Bad Knee

[beesknee]

End of year update.

2.5 years since PKR and 3 months since the same knee scoped to remove scar tissue and junk under my kneecap caused by the PKR. I can confidently say getting the knee scoped was the best decision I have made with this knee. While I am not playing tennis or running any more than 15 yards at a time yet (I can now run across a street if a bus is about to mow me down). I am well on my way and least 90% functionality in my knee.

The biggest change is I can now push harder each workout while exercising/rehabbing my knee without having a setback due to swelling and pain. There is still some soreness at times, but no more sharp pain in under and around my kneecap while going for a walk. My legs are no longer noodles and now have some actual muscle build up.

The best part is for the first time in a few years I have stood up and walked somewhere around the house and not thought about my knee. Also, while there is still some crackling in my knee at times it is way less than before and does not cause pain.

I plan to continue to build muscle in my legs for another 2 months before I start working on forward and lateral movements I will need to do to start playing tennis.

I feel where I am now is where I should have been 6 months out from PKR.

If you’re still suffering 1.5+ years after knee replacement and x-rays all look good. I highly recommend getting your knee scoped. It is the only way to determine why you are still having pain and not healing up properly.

Fingers crossed but so far so good.

 

[benne68]

Glad to read that you are feeling improvement, @beesknee! You've had a very long journey, and it's great to know that you are feeling optimistic about the future.
Here's to tennis in the new year!

 

[Jamie]

Although it took a long time to get to this point, hearing how well you’re doing is great news. Can you share the name of your latest surgeon who diagnosed and did the scope? I can’t recall if you had the same surgeon through this whole process or not and it’s an important point to make for others. I’d like to have this surgeon on my list for future patients.

 

[mendogal]

What a great update!!!! Onward into new 2024 milestones for you!

 

[beesknee]

2+ years since last post update. The scope made my knee about 50% better but never could get pain free.

At the end of summer I will have this partial ripped out and have it revised to a TKR. I have seen too many people get full knee replacement and 4 months later they are wake boarding, doing 100 mile hikes in the mountains of Spain or going up and down the stairs of Italy without thinking about it. Heck Lindsey Von was professional skiing on a full knee replacement and it was an ACL on her other knee that ended her run this morning.

At my doctor's appointment this week, I walked in with another guy. He had a very slight limp. Started talking to him, and ask him if he was considering a knee replacement. He said "this is my follow-up, I had my knee replaced 3 weeks ago and it is the best think I ever did, no constant pain in my knee anymore".

Will update.

 

[Jamie]

I think this is a very good move for you. Partials can be wonderful for some people, but unfortunately they are not good for others for a variety of reasons.

Are you having the revision done by the same surgeon or have you decided to use a different one?

 

[sistersinhim]

I have seen too many people get full knee replacement and 4 months later they are wake boarding, doing 100 mile hikes in the mountains of Spain or going up and down the stairs of Italy without thinking about it.

These examples are not normal recoveries of a knee replacement, they are a very small precentage of people. As we have said many times, it's a year-long recovery. Of course, it's very possible that you will have a remarkable journey and find yourself recovering just as quickly!

 

[beesknee]

I have seen too many people get full knee replacement and 4 months later they are wake boarding, doing 100 mile hikes in the mountains of Spain or going up and down the stairs of Italy without thinking about it.

These examples are not normal recoveries of a knee replacement, they are a very small precentage of people. As we have said many times, it's a year-long recovery. Of course, it's very possible that you will have a remarkable journey and find yourself recovering just as quickly!

I agree but I know 3 people that have had TKRs over the last 6 months and all three shake their head at me and say II should have had a TKR. Talking to that guy that walked in with me 3 weeks after surgery with a slight limp makes me jealous. Looking back at my journey at 3 weeks I was still using a walker.

Don't worry, I am realistic and my hopes could not be much lower, but I want to take a swing at a pain free knee. Not doing anything - constant complaining about my knee - having a TKR - at least a small chance of being able to be more active.

I think this is a very good move for you. Partials can be wonderful for some people, but unfortunately they are not good for others for a variety of reasons.

Are you having the revision done by the same surgeon or have you decided to use a different one?

I’ve decided to move forward with a different surgeon. My original doctor is 90 minutes away, and quite frankly, I’ve lost trust in him. My new practice was recommended by a neighbor who is a retired pro hockey player who had both knees replaced there.

The surgeon who did my scope a few years ago recently retired (and just had a TKR himself), so I’ve been moved to Dr. Schultz. He has great reviews and doesn't seem concerned about the complexity; he mentioned he could remove my current partial (PKR) in about 10 minutes.

The Surgical Plan: Dr. Schultz doesn't use robotics, as he feels he can achieve better results manually for now. He also mentioned he plans to "seat" the base deeper in the tibia to account for the transition from a PKR to a TKR. He said knew cap will be replaced also.

I recently messaged him regarding the ligaments, as I’ve read here that muscles and ligaments are often preserved. Here is the response I received from his assistant:

"Patient has a partial knee replacement and is getting a revision to a total. He will be getting a Posterior-stabilized (PS) knee, which is the best for this specific situation. The others posting on the forum likely do not have a revised knee."

My Concerns

• Ligament Loss: Since I’ll be losing both my ACL and PCL, am I headed for a "clunky" knee? Is that a common outcome for TKR patients, or is that a sign of a poor result?
• Robotics: How much weight should I place on robotic assistance versus a manual approach?
• Lifestyle: He says I’ll be able to play pickleball, bike, and handle stairs without pain. I currenly can't do any activity without feeling my knee except walking on a flat surface.
• I’m currently terrified of making things worse, especially since we are moving to a coastal home next year with lots of stairs.

Second Opinion? There is a Dr. Carpenter in my area who comes highly recommended. I’m considering a second opinion with him if I can get an appointment.

Both Dr's see to be excellent which is a good problem.

Questions for the Group:

1. For those who had a PS (Posterior-stabilized) knee, how does the stability feel?
2. How common is Bicruciate-Retaining surgery. I read it is very complex.
3. Is the "clunky" sensation inevitable when losing the PCL/ACL?
4. Is losing the PCL/ACL normal operating procedure with a TKR?
5. In my pre-surgery follow-up in May, what specific questions should I ask Dr. Schultz (or Dr. Carpenter) regarding a PKR-to-TKR revision?

 

[benne68]

I'm sorry you are still struggling with your knee, @beesknee, and glad you've come back to update your thread.

It's been quite a while since you've been on the forum, and you may have noticed that we've made some changes. Because we are a non-profit and depend upon donations to keep the website and forum operating, we established a two-tier membership program.

You are currently a Basic Member. Basic membership is free. It allows you to read others' threads and continue to post in your existing thread about this recovery. However, as a basic member, you will not receive advice from Forum Staff and you will not be able to start a new thread for your upcoming surgery. You also will not have access to our library of educational materials. Those are benefits reserved for our Insiders Club members.

You can learn more here: Become an Insider

 

[beesknee]

Yeah I see the pop-ups. Sad to see this site lose most of the regular person perspectives and mostly only hear from the Bonesmart staff. But I can get regular person perspective from other sources.

I'll join when things start moving forward in a few months.

BTW: I asked my Doctor about your Bonesmart guidelines and he was mostly positive:

These guidelines are safe and follow the core principles of post-operative care, particularly regarding swelling management and pain control. They are a great antidote to the "no pain, no gain" trainers who might treat a 65-year-old knee replacement like a college athlete's ACL tear.

However, the "If it hurts, don't do it" rule can be a double-edged sword. To ensure a successful result, you need to find a middle ground: Movement is medicine. You don't need to scream in pain during PT, but you do need to move consistently to prevent the "glue" (scar tissue) from setting.

 

[sistersinhim]

I'm glad your doctor agrees with Bonesmart's guidelines. Members have benefited from these guidelines for many years. Myself included!

 

[Jamie]

Thanks for providing the comments from your surgeon on BoneSmart’s recovery guidelines. We are in sync for sure, including our meaning of the “if it hurts, don’t do it.” We always tell people to expect mild discomfort with some of the movement following surgery. It’s the very painful therapy or exercise we encourage people to avoid. Early and frequent movement of a new joint is critical for a successful recovery. No lying around on the couch eating bon bons!

 

[Layla]

At the end of summer I will have this partial ripped out and have it revised to a TKR

Ripped out?!!

PKR to TKR...going for the deluxe model I see.

Sad to see this site lose most of the regular person perspectives and mostly only hear from the Bonesmart staff.

You can still benefit from members commentary by typing buzz words of concerns you mentioned in Post 208, into the SEARCH feature, top right corner. Please know that the community hasn't really changed we're just helping it stay sustainable.

I can get regular person perspective from other sources.

But we're more fun.
We do hope you'll join us in a few months, we appreciate your input.
Thanks for stopping by, beesknee. Enjoy the rest of the week!

 

[beesknee]

I recently reached out to Dr. Carpenter for a second opinion, as his name is highly recommended in my area. Unfortunately, he doesn't perform revisions on surgeries he didn't originally do himself.

Through some research, I found Dr. Carender at the University of Michigan. He is highly regarded for handling troublesome cases and revisions and utilizes robotic assistance—something I feel is a priority for me. I’ve scheduled an appointment, though the wait is significant at four months out.

It’s a major decision. I can handle most activities of daily living now, aside from some stiffness and occasional sharp pain on stairs. If I were coming from years of crippling pain, I’d likely be overjoyed with where I am. But I want to do more than just get by; I want to play pickleball, hike uneven terrain, handle the cliff stairs in Italy, and play doubles tennis without 'paying for it' for weeks afterward.

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Gemini search profile:

Dr. Carender is a Clinical Assistant Professor and the Service Chief of Adult Reconstruction at Michigan Medicine.

Elite Training: He completed his medical degree at Case Western Reserve University, followed by a residency at the University of Iowa. Crucially for your needs, he finished a prestigious fellowship in Adult Reconstruction at the Mayo Clinic, which is widely regarded as one of the best programs in the world for complex joint issues.

Academic Researcher: He is an active researcher with over 60 peer-reviewed publications. His work often focuses on improving clinical outcomes and the use of technology like robotics in surgery to ensure more predictable, long-term results.

Dr. Carender specializes in what is known as "failed or painful joint replacements." This makes him highly qualified to evaluate your current PKR and determine the best path forward.

Robotic-Assisted Surgery: He is an expert in using robotic systems (like Mako) to perform high-precision surgeries. The robot allows him to map your specific bone structure in 3D, which is especially important during a revision where the surgeon must work around existing hardware and potentially compromised bone.

Revision Specialist: His practice is specifically built for patients who are unhappy with a previous surgery. He deals with complex cases involving bone loss, ligament instability, or component failure—the exact issues that can cause a PKR to feel "off" after a few years.
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On a side note: Has anyone here looked into "Jiffy Knee"? They claim a faster recovery because they don't cut the quad muscle. It’s not an option for me since they’re based in Tennessee and honestly, the name doesn't exactly inspire surgical confidence—but I am curious if the "quad-sparing" approach is as revolutionary as they claim.

 

[Jamie]

If you search on the forum for Jiffy Knee, you will see threads from some of our members who looked into or had the “Jiffy Knee” type of surgery. It involves a particular approach that is done on the side of your leg versus down the center and does involve less trauma to soft tissue. This is where the claims for faster recovery originate.

 

[benne68]

Thanks for joining Insiders, @beesknee. We appreciate your support.

I'm sorry to read that you have to wait so long to see the surgeon, but that may well be an indication that he is well-respected and in demand.

You may want to get another opinion while you wait.

If you are willing and able to travel, there are some great revision specialists at Rush in Chicago, including: Dr. Craig Della Valle, Hip and knee revisions; and Dr. Richard Berger, Adult reconstruction hip and knee

Another option, which some of our members have used, is a remote video consult with the experts at Hospital for Special Surgery in NYC. The Complex Joint Reconstruction Center deals with diagnosing and treating the most challenging joint replacement problems. As part of the diagnosis, a committee of surgeons meets to discuss your case. There is a $500 fee for case review.

Regarding your question about jiffy knee, you might find this article informative: https://bonesmart.org/forum/threads...en-do-they-cut-the-quads-tendon-muscle.31506/

 

[beesknee]

I’ve read that PKRs are notoriously more 'finicky' than TKRs. While a total replacement offers stability for low-impact activities like golf, a partial relies heavily on the health of the remaining natural ligaments and compartments. If the patellofemoral tracking is off, the PKR can feel like a failure even if the hardware is perfect.

My X-rays show zero arthritis, and my pre-PKR MRI showed only a single defect in the medial cartilage. My non-medical theory is that the medial implant and subsequent scarring pushed my kneecap slightly out of alignment. If I didn't have a PKR, I would conclude I have a textbook patellofemoral issue; the symptoms match exactly. Consequently, I’m hyper-focusing on a strict stability program: heavy spin and elliptical sessions followed by targeted exercises to force the kneecap to track normally.

The knee feels better temporarily, but I’ve been down this road before: I rehab, the knee improves, and then—during a standard workout—I hit a wall and I'm back to square one. I can't seem to get the knee strong enough to carry a 35 lb suitcase upstairs without a re-injury or setback. At this point that is my target; if I can haul suitcases or a heavy laundry basket upstairs without thinking about the knee, I’ll feel I am finally better off than I was before the surgery.

I want my next surgeons to see the work I've put in, but also to recognize that this PKR has a functional ceiling that doesn’t reach my pre-injury activity levels. Maybe they’ll have options beyond a TKR. But I think ultimately, I have to decide if a revision is worth it. If the odds of returning to high-level activity are only slightly better, is the risk justified? The saving grace of this PKR is that it feels 100% like my own knee and when it is at a good spot I can walk forever. Maybe I should just take up golf and be happy. The downside is no matter how much I try I just can't get it strong enough for the more life I want to lead.

 

[Layla]

The downside is no matter how much I try I just can't get it strong enough for the more life I want to lead.

You deserve to be able to do the things you love now, not just someday.
Respectfully....you are as young as you will ever be and have a lot of life to live rather than sit on the sidelines. If a TKR can help you feel better and give you the ability to do more, it's worth considering sooner, rather than later.

Big decision! I wish you clarity as you contemplate options and peace of mind in any decision you make.

 

[EalingGran]

can't seem to get the knee strong enough to carry a 35 lb suitcase upstairs without a re-injury or setback. At this point that is my target; if

I can understand about wanting to hike uneven ground or climbing rock staircases but I don't see the need for lugging heavy suitcases. I am travelling lighter and lighter these days. If your knee doesn't like heavy loads on stairs is that really a problem? I couldn't do that but have hiked steep rock climbs in Sri Lanka and Germany on my PKR. I have a bit of patellofemoral arthritis and some tendinopathy in both knees and I listen to my knees and don't force things or push to reinjury level.
I think I would want to understand precisely what the issue was with the PKR, and exactly how the surgeon planned to remedy it- before I went for a revision. Have you done the Oxford knee score here?

 

[eaglemom]

I do not envy this decision your contemplating. One thing that struck me was that you want the surgeon to see the work you've put in. I'm afraid most surgeons will only be concerned with your knee and going forward. You know the work you've done to try and strengthen your knee, and that's what's important.

You will have to decide exactly which route you want to take - stay as you are or have a revision. Lots to consider in making your decision also. Such as down time with the recovery time. Factor everything in and then don't second guess yourself.