PKR Long Story of my Battle with a Bad Knee

[beesknee]

I met with the the top UofM revision specialist today and brought all my records: MRIs, previous surgical reports, and scope photos.

Given my current baseline, a major revision just doesn't make sense. I can handle 90% of my daily activities pain-free. I can walk around Costco all day and climb or descend stairs without issue. My only real limitations are carrying something like heavy suitcases up steps, playing tennis or pickleball, and trying to strengthen the knee past 50% without triggering a setback. Honestly, compared to people who are bone-on-bone and can barely walk, I know I'm in a good spot.

Because the non-PKR (partial knee replacement) side of my joint has zero arthritis, and my pain is mostly localized around and under the kneecap when walking on uneven ground, the doctor was very candid. He stated that a Total Knee Replacement (TKR) revision has a very high chance of leaving me no better off than I am right now. I’d have to endure months of grueling rehab and suffering, only to likely end up right back where I started—or worse—with a clunky artificial knee I don't actually need.

When I asked about less invasive alternatives, he advised against injections due to the infection risk which is something no one wants. Instead, he suggested a Genicular Nerve Ablation. He said 60% to 80% of patients find it successful, and it’s definitely worth a shot to manage the localized pain.

It’s funny—the doctor who took over for my retired surgeon was ready to schedule me for a full TKR revision immediately. When I told him my concerns that I may not be any better after surgery he said I would need to decide if is worth the risk. I am so glad I waited for this specialist.

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.

The suitcase is just an example. Could be a heavy load of laundry or a bag of water softener to the basement. I am a strong looking guy so when it comes to doing heavy lifting people look to me.

 

[benne68]

Hi @beesknee

I did some research to see if other members have had this procedure and found a few mentions of Genicular nerve ablation and Genicular nerve block. You might take a look through this threads to see if they are helpful:

F

TKR Post in thread 'Finally in recovery'

May 21, 2024

Good morning! The nerve block has htremendously. Gives me hope that the ablation will work for me. I'm on day six post nerve block and I have done more in the last few days than I could hope for, shopping, gardening, cleaned the house, cooked meals, all after working all day! I feel like me again.
As far as the doctor knowing that I was in pain..it was quite obvious. I was so embarrassed afterward. I screamed quite loudly and repeatedly. He kept asking if I wanted him to stop. I wasn't about to stop halfway!

• Finally

• 

TKR Post in thread 'Pain'

May 26, 2020

By a nerve burn are you meaning RFA? Radio Frequency Ablation. Yes I've had it done. Being honest here, and this is just me and my opinion, it was a total waist of time, energy and about a thousand dollars. As a last ditch effort to cross off everything prior to a third TKR Revision my surgeon pretty much insisted on me having one.

Mine was specifically on the Genicular Nerve. I was told its about 60% receiving some relief, I wasn't in that category. It did nothing for me. I know of someone else who doesn't have as bad of knee's as I do and he had relief for over 9 months, then had...

• eaglemom

• 

TKR Post in thread 'Has anyone had a nerve ablation post tkr?'

Aug 22, 2024

I think ablation might be a little different from cryoneurolysis, which involves injecting ice into nerves to freeze them, rather than using radio frequency. Killing the nerves is the goal in both cases but they usually grow back and cause the same problems. I am now starting to feel the creep. Sadly in my case the procedure didn’t get everything: the exterior part of my knee has stayed painful. But I have been able to do much more. Am also working with a physio who takes the ‘thoracic ring’ approach that targets and straightens whole body. It’s helping.

• Vida

• 
• 

S

TKR Post in thread 'Suggestions needed for “tight band” feeling'

Sep 25, 2020

@Tykey: sorry, I should have been clear. It’s a genicular nerve block with ultrasound. It is done at my doctor’s office (definitely post surgery) to see if it will help with pain. I believe they inject some kind of numbing medicine into the 3 main nerves (located by ultrasound). It can last from a few hours to a few days. IF it works, they then do a nerve ablation, which again uses ultrasound and they cauterize those same 3 or 4 nerves. This procedure can last up to a year. These procedures sound different from what you describe!

• Stiff knee NC

• 

 

[EalingGran]

https://academic.oup.com/painmedicine/article/22/Supplement_1/S20/6328220

Here's a good review of the procedure. It does seem to be beneficial in a fair number of cases with relatively low side effects.
I am not sure whether there are more long term follow up studies though.
As someone who has some residual pain from soft tissue issues ( enthesopathy and MCL issues)- my concern would be if that pain were eliminated, whether I would be at risk of overdoing things and causing myself more damage? I do workout with light weights to strengthen my glutes and hamstrings but I use pain as a message for when to be careful/ stop.
Ultimately, only you can decide whether your pain is sufficiently problematic to warrant any risks involved. Good luck!

 

[beesknee]

https://academic.oup.com/painmedicine/article/22/Supplement_1/S20/6328220

Here's a good review of the procedure. It does seem to be beneficial in a fair number of cases with relatively low side effects.
I am not sure whether there are more long term follow up studies though.
As someone who has some residual pain from soft tissue issues ( enthesopathy and MCL issues)- my concern would be if that pain were eliminated, whether I would be at risk of overdoing things and causing myself more damage? I do workout with light weights to strengthen my glutes and hamstrings but I use pain as a message for when to be careful/ stop.
Ultimately, only you can decide whether your pain is sufficiently problematic to warrant any risks involved. Good luck!

Thanks for the link. Those in the study is seem to all have full blown knee osteoarthritis so it is amazing it worked as well as it did. If you have MCL and other ligament issues this would not be for you. You don't want to numb damaged ligaments.

I had the exact same concerns as you initially, but my research shows that shutting down the constant pain signals allows my brain to finally release the guarded muscles around the joint so they can be properly exercised and strengthened.

That said, I know I can't just jump from 30 minutes on the spin bike and 20 minutes on the elliptical to an hour of spinning, a half-hour of elliptical, and doubling my leg weights overnight. Even if the pain signals are blocked, I still need to increase my workload slowly and monitor for swelling.

I’m hoping I’m in a somewhat unique position here. All my tests and three different surgeons see absolutely no structural cause for the pain, meaning there is a very good chance my issue is hypersensitized joint nerves, not a actively tearing or structurally failing ligament. My PKR looks great and isn't loose, ligaments are intact and not damaged, the unoperated side of my knee shows no arthritis, and the revision specialist gave me a very low probability of improvement if he were to rip out the PKR and replace it with a TKR. He noted that if I were limping around in severe pain because of bone on bone or a wonky PKR a TKR could get almost surely get me to where I am right now.

At least I finally have some clarity and hope on the path forward. If the ablation works, it will be amazing. If it doesn't, I'm no worse off. There’s really no risk of structurally damaging the knee even if I overdo it a bit, because there is nothing mechanically wrong in there to damage.

 

[benne68]

If the ablation works, it will be amazing. If it doesn't, I'm no worse off.

You have such a great attitude about this! I'm keeping my fingers crossed that it works for you and I hope you will keep sharing your journey. As you say, your experience is unique to us and your story will be helpful to others.

 

[beesknee]

Fingers definitely crossed. Based on my luck with this knee I give it 50/50. July 2 I first have to do the test where they temporarily numb things and I see if I have pain relief. Since I am not in pain sitting or walking on level ground I am not sure how they will test. I guess I'll try to find some stairs and go up and down them with a 30lb suitcase and then walk around very un-carefully outside on some uneven ground.

Then it is 2 weeks before the actual procedure. Then a week or two before I know if it is helping.

If it improves things for me, maybe others with long time pain after knee replacement for no apparent reason can look into it.

 

[IdaCzech]

Hallo! I have read the whole thread. What a story.
How did thé last procedure go?

 

[Layla]

Hi @IdaCzech
Thank you for your interest in, beesknees, thread. I've tagged him for you since he's not on the forum regularly.
This way, next time he visits BoneSmart he will notice right away that you posted to him.
Here is a tutorial on tagging -> Tagging Another Member
@beesknee