PKR Long Story of my Battle with a Bad Knee

[kneeper]

Right now my main goals are to start improving ROM and getting swelling down when I stand up.

A lot of this simply takes time. Remember that you are very early in the process and you can't "will" things to heal faster. The knee has a mind of its own.
But its fine to look forward to those improvements.

 

[Irongirl56]

@beesknee, I am hoping I never need to convert to a TKR but have read that PKRs last an average of 10 years or so, but do not know if that is because they just wear out or the other parts of the knee eventually get bad. I have osteo in both knees so I expect more surgeries at some point but like you I will be avoiding my passion for running.
Recovery definitely seems to evolve week to week. 2 weeks ago I was freaking out about my ROM but it has improved so much even just this week. I really took it easy the first two weeks and didnt push it too much. I didn’t even start PT until week 3.
Do know I felt just as you do even last week. But today I was able to drive to Lowes and that felt ok. I think you will continue to see small improvements every week just be careful not to get to impatient and push too much. I have to put the brakes on all the time and let the pain be my guide.
Keep us posted on how you are doing. as I read on many threads it does get better every week!

 

[Ginger1210]

Hi Beeksnee I am just at the end of week 12 of Right Medial P.K.R. still not quiet where i want to be i am back at work full time and average around 2 miles a day walking but i still have pain and discomfort mainly the tight band feeling around and below my knee cap. This is where the surgeon does most of his cutting to get access to the knee. I made a point of asking the surgeon who by the way is one the the top knee surgeons in the U.K. If he looks at the whole knee then makes a decision what to replace. He said of course because in the UK it is done on the NHS they do not want the risk of revised work later down the line. I know of another patient who was due to have a full T.K.R and ended up with a P.K.R for the same reason. He is very much of the mind to try and preserve as much of the good knee as possible. I do question my self over if i had had a full T.K.R would i be feeling the same pain as i am now. I guess i will never know. But reading other threads on Bonesmart the pain and swelling i experience is very similar to others weather they have had full T.K.R`s or P.K.R`s.

 

[beesknee]

PT has me doing 2 exercises to increase ROM.

The first one I sit on a high bench and bring knee down as far as I can then take my good knee and push down to stretch knee further then bring leg up as far as I can then push it up with good leg and hold it. 30 reps. Very painful.

The second one is where I sit down with a strap on my foot and pull back on my foot bending the knee as far as I possibly can 30 reps, very painful.

The rest of the exercises are isometric type exercises.

Three times a week with the PT and he wants me doing these on the off days. Does this sound like a reasonable PT program?

At 2 1/2 weeks since surgery I am nowhere near 90 ROM. PT says he wants me at 90 rom in two more weeks.

So far after the stretching and iso I feel a bit improved after I elevate and ice. It does not seem to be pushing me backwards.

 

[beesknee]

I would create a new thread for this but I don't think it is allowed.

I am looking for a leg elevation pillow so I don't have to spend 5 minutes adjusting a pouf and pillows.

The recommended Lounge Doctor is out of stock. I am looking at other ones on Amazon and they don't seem to have the elevation of the lounge doctor. Maybe hard to tell from pictures.

I am 6'4" so need something of decent size and height.

Anyone have recommendations.

 

[kneeper]

Definitely the right thing to do to ice after your exercises.

 

[beesknee]

Second PT appointment today, he doesn't push me, he makes me push myself. I do all the pushing and pulling and bending and he never puts a hand on me other than massage and move my kneecap back and forth and side to side at the end of the session. Favorite part of PT is the ice pack for 10 minutes at the end!

After PT my knee is a bit sore but a good sore and I can now move around a bit better than the middle of last week

RoM at 73 which is up from 45 on Friday . PT says he wants me at 90 by Friday, I think I can do it but I'll have to push pretty hard through the pain. I feel if I am doing the pushing and pulling it allows me to stop when it is too much. Seems like I am finally making progress since my first PT appointment Friday plus the home exercises I do on the off days. I am pleased so far.

I'm still a bit concerned that my ROM is not very good but as long is it gets better each day I am happy. It seems that PT is putting me on the right track so far.

Forget tennis until next spring, if I am able to play some old man pickleball (on my new repaired knee of a 20 year old) by fall I will jump with joy!

 

[Sisterpat]

Sorry, but pushing hard through the pain is going to set you back and goes against the BoneSmart philosophy! You are going to make that new knee very angry and you will pay the price with reduced ROM. I think you need to rethink your plan a bit. It’s your knee and you must decide what’s best for it, but if forcing a bend results in a setback, you might not be happy.

 

[Jamie]

I would create a new thread for this but I don't think it is allowed.

I am looking for a leg elevation pillow so I don't have to spend 5 minutes adjusting a pouf and pillows.

The recommended Lounge Doctor is out of stock. I am looking at other ones on Amazon and they don't seem to have the elevation of the lounge doctor. Maybe hard to tell from pictures.

I am 6'4" so need something of decent size and height.

Anyone have recommendations.

I checked the Lounge Doctor site and it does appear that the size you need (X-TALL) is not available in the 24-inch width. But it is in an 18-inch width and I suggest you give that a try. That is still wide enough for both legs if you desire or you can just elevate your surgery leg. You won't find a comparable item from other vendors. That's why we endorse the Lounge Doctor. There is real science behind it's design to safely elevate and provide maximum blood circulation for swelling reduction and better healing. The various sizes put the bends in just the right places for your body. Since you are very tall, this will be especially important.

 

[beesknee]

Sorry, but pushing hard through the pain is going to set you back and goes against the BoneSmart philosophy! You are going to make that new knee very angry and you will pay the price with reduced ROM. I think you need to rethink your plan a bit. It’s your knee and you must decide what’s best for it, but if forcing a bend results in a setback, you might not be happy.

Understood, however, I don't have a new knee, only a partially repaired knee 2/3s of it is my healthy original knee. My knee feels so much better after pushing it a little bit to increase ROM each day since July 16. I am not pushing through the pain, I am pushing to the pain (if that makes sense)

I am the one doing the pushing so I know not to go to far and hurt myself but will be extra careful. I would not let the PT push my leg.

 

[Jo Wo]

Oh, Beesknee, I'm so sorry for your knee troubles! I think there is a general tendency in the knee surgery world to under-advise and oversell the results of these surgeries, or so it sounds from everyone here.

I think you will soon hear from others here who have dealt with similar issues, and one of the Moderators will send you the list of articles, which I found very helpful when I first found Bonesmart in 2016.

It may be that, if you can wrap your brain around a longer recovery timeline, that you'll heal well and be back to normal sooner than if you push too much and are too hard on yourself. I've heard many here say that the timeline for knee recovery is nearly the same for a PKR as a TKR, so if you can modify your expectations, maybe it will be less frustrating?

Hang in there and know that there are a bunch of us here to commiserate with you and cheer you on as you recover!

I was just thinking that perhaps the first gift from this bonesmart site was setting expectations about the recovery timeline. My in home pt tried to manage my expectations at her last visit and said it takes 3 or even 6 months to feel normal then she looked like she didn't want to say it, so I said, I know, it can take a year. she looked relieved that she didn't have to blurt it out.

 

[beesknee]

It may be that, if you can wrap your brain around a longer recovery timeline, that
I was just thinking that perhaps the first gift from this bonesmart site was setting expectations about the recovery timeline. My in home pt tried to manage my expectations at her last visit and said it takes 3 or even 6 months to feel normal then she looked like she didn't want to say it, so I said, I know, it can take a year. she looked relieved that she didn't have to blurt it out.

Yeah I agree, I can see a TKR taking a year or more recovery time. That is major surgery, they actually detach balance and reattach tendons/muscles that all need to heal.

You are not just dealing with healing from the incision and trauma from inserting a metal and plastic prosthetics into your knee like PKR. You also have to heal up from a completely new knee and get those reattached tendons and muscles working properly again. Definitely a long road for all but the fastest healers.

 

[Celle]

That is major surgery, they actually detach balance and reattach tendons/muscles that all need to heal.

You are not just dealing with healing from the incision and trauma from inserting a metal and plastic prosthetics into your knee like PKR. You also have to heal up from a completely new knee and get those reattached tendons and muscles working properly again.

Usually, no detachment of muscles and tendons is done during a TKR. Nor are muscles and tendons cut. They are pulled aside, out of the way. The surgeon accesses the knee joint by going between different layers of muscle.

At one time, surgeons used to snip a small area of the quads but this is now considered unnecessary and rather old-fashioned.

 

[beesknee]

That is major surgery, they actually detach balance and reattach tendons/muscles that all need to heal.

You are not just dealing with healing from the incision and trauma from inserting a metal and plastic prosthetics into your knee like PKR. You also have to heal up from a completely new knee and get those reattached tendons and muscles working properly again.

Usually, no detachment of muscles and tendons is done during a TKR. Nor are muscles and tendons cut. They are pulled aside, out of the way. The surgeon accesses the knee joint by going between different layers of muscle.

At one time, surgeons used to snip a small area of the quads but this is now considered unnecessary and rather old-fashioned.

I guess it can depend on the knee and the damage going in as to how much the muscles need to be dealt with to balance the knee. Still TKR is some major surgery to recover from and can take a long while to recover from.

 

[Celle]

Still TKR is some major surgery to recover from and can take a long while to recover from.

That's certainly true. Complete recovery from both a PKR and a TKR can take as long as a full year.

I have had 3 knee replacements - one PKR, one Revision to TKR and one TKR.
I'm also a registered nurse and I've been on BoneSmart staff for 7 years.

My own experience is that my PKR was the hardest to recover from, as I had to wait for 9 years for that surgery and much deterioration had occurred. My muscles and tendons had distorted during that time and they had to adjust to being different lengths again. They weren't cut or re-positioned. They just had to take the time necessary for them to stretch or shrink.

We do find that most people on BoneSmart take just as long to recover from a PKR as from a TKR. In neither surgery are muscles and tendons routinely cut or re-positioned.

You might find this article interesting:
Knee replacement surgery types and suggested videos

It was written by Josephine, our original Nurse Director, who had over 30 years' experience participating in orthopaedic surgeries. She was the senior nurse in a large suite of operating theatres.

 

[beesknee]

My own experience is that my PKR was the hardest to recover from, as I had to wait for 9 years for that surgery and much deterioration had occurred. My muscles and tendons had distorted during that time and they had to adjust to being different lengths again.

Wow, 9 years is a long time to wait, making things more difficult. I had to wait 6 weeks. OS appointment, MRI prescription, get MRI, follow up visit to decide what to do. Schedule surgery a few weeks later.

 

[patriciad]

And there really ARE lots of happy, success stories here. Look for them. TKR can be a wonderful, life changing experience.

I just had to respond with my own story so far!
I had a left medial PKR on June 29th. This has been a life changer for me as could barely walk, stand or do stairs since January for the increasing pain. I couldn’t hardly push my little granddaughter in her buggy or play with her. Having had a TKR on my right leg I knew the time for surgery had come and my surgeon said that the recovery from the PKR should be easier but not to expect it. I was frankly dreading the surgery remembering how long the journey had been with my TKR. I read that it is one of the most painful surgeries you can have and I agreed based on my first op.

One thing I’ve learnt from these forums is that we are all different and recover differently no two experiences are the same but we can be encouraged by the similarities.

At just under 4 weeks I am walking unaided, use 1 extra strength Tylenol for the aching When needed (twice a day and add a Melatonin nightly to help sleep. I still take a Meloxican and baby aspirin every morning as directed for first 30 days. I do the exercises every day and walk around as much as I can and incorporate some light cooking and housework being careful to listen to my knee. My PKR knee strength is the same as my right leg. My ROM is at 125 but I started out measuring 90 at my first in home Physio. I elevate and ice every time I sit down. Only having the implant on the one side, keeping my kneecap and ACL has made a huge difference to my recovery this time around.

I am so happy I had this done! Already I am more mobile and in less pain than in over a year and am looking forward to really being able to enjoy life without the limitations of my arthritic knee joints. I would definitely recommend the PKR if you are a candidate and your surgeon routinely performs hundreds of these a year. I’m sure there are many other Bonesmarters here with positive experiences to share but I did want to add my “twopenneth” to the thread.

 

[beesknee]

I just had to respond with my own story so far!
I had a left medial PKR on June 29th. This has been a life changer for me as could barely walk, stand or do stairs since January for the increasing pain. I couldn’t hardly push my little granddaughter in her buggy or play with her. Having had a TKR on my right leg I knew the time for surgery had come and my surgeon said that the recovery from the PKR should be easier but not to expect it. I was frankly dreading the surgery remembering how long the journey had been with my TKR. I read that it is one of the most painful surgeries you can have and I agreed based on my first op.

One thing I’ve learnt from these forums is that we are all different and recover differently no two experiences are the same but we can be encouraged by the similarities.

At just under 4 weeks I am walking unaided, use 1 extra strength Tylenol for the aching When needed (twice a day and add a Melatonin nightly to help sleep. I still take a Meloxican and baby aspirin every morning as directed for first 30 days. I do the exercises every day and walk around as much as I can and incorporate some light cooking and housework being careful to listen to my knee. My PKR knee strength is the same as my right leg. My ROM is at 125 but I started out measuring 90 at my first in home Physio. I elevate and ice every time I sit down. Only having the implant on the one side, keeping my kneecap and ACL has made a huge difference to my recovery this time around.

I am so happy I had this done! Already I am more mobile and in less pain than in over a year and am looking forward to really being able to enjoy life without the limitations of my arthritic knee joints. I would definitely recommend the PKR if you are a candidate and your surgeon routinely performs hundreds of these a year. I’m sure there are many other Bonesmarters here with positive experiences to share but I did want to add my “twopenneth” to the thread.

You are my new hero! What a great outcome. I had my PKR done 3 days after you and still use the walker mostly as a security blanket. Pain is minimal and my biggest issue is lack of ROM. I started at only 30, am now in the 70s after 2 supervised PT sessions and 3 self guided PT sessions. This week's goal is to hit 90 by Friday - where you started at!

I really need to get the ROM up so I can start driving reducing some of my dependence on my wife.

Here is what the Cleveland Clinic says about PKR recovery:

What is recovery like?
You can start moving the knee the day of your surgery. Your knee function should return rapidly and with less pain than with total knee replacement. You’ll work with a physical therapist to mobilize the knee while in the hospital and for two to four weeks after discharge. You’re usually discharged no later than one or two days after surgery.

You’ll need medication to guard against formation of a blood clot while in the hospital and maybe for a period of time after you’re discharged.

If all goes well, you should be back to full activity in about six to eight weeks. Impact exercises or jogging/running may not be recommended because the replacement includes a bearing surface that can wear. However, activities like tennis, skiing, and other sports are okay. This, of course, is why partial knee replacement is even being considered — to return you to activities you enjoy.

I hope "all goes well" for me. I am doing my prescribed PT, ice, and elevating so I hoping for the best.

 

[Irongirl56]

I am 4 weeks out from my PKR, I have found that I have gained most of my ROM in the last week. The first 2 weeks it was not even at 60. I was 105 last Thursday and as of today I can actually walk down the stairs foot over foot although very slowly. So just realize it is a slow steady process and do not push yourself too hard as it will come.
One of the things I did to increase my ROM was lots of walking and a focus on the correct form. I used the cpm for 3 weeks as the lazy way to do heel slides as I absolutely hate heel slides and really dont even do them now. I am using my husbands seated elliptical to work on my ROM.
At 4 weeks I can easily walk 3 miles on a flat trail, go up hills, down is a little slow, I am driving, shopping, sleeping well, only use Tylenol for pain at nite and anticipate being able to head to our Montana cabin the first week of August. But every day is just a bit more gain to full activity.
This morning I was surprised to be able to go down the stairs as I couldn’t yesterday!

 

[beesknee]

I am 4 weeks out from my PKR, I have found that I have gained most of my ROM in the last week. The first 2 weeks it was not even at 60. I was 105 last Thursday and as of today I can actually walk down the stairs foot over foot although very slowly. So just realize it is a slow steady process and do not push yourself too hard as it will come.
One of the things I did to increase my ROM was lots of walking and a focus on the correct form. I used the cpm for 3 weeks as the lazy way to do heel slides as I absolutely hate heel slides and really dont even do them now. I am using my husbands seated elliptical to work on my ROM.
At 4 weeks I can easily walk 3 miles on a flat trail, go up hills, down is a little slow, I am driving, shopping, sleeping well, only use Tylenol for pain at nite and anticipate being able to head to our Montana cabin the first week of August. But every day is just a bit more gain to full activity.
This morning I was surprised to be able to go down the stairs as I couldn’t yesterday!

@Irongirl56 how is your swelling? That is one thing I am battling with. In the morning or after elevation and ice I have no swelling. As soon as I stand up my knee swells.

One thing you are doing that I am not doing is lots of walking, I may force myself to do a few short walks outside while keeping my walking form and see if the helps my progress.