PKR Long Story of my Battle with a Bad Knee

[beesknee]

Slow going for me but today at PT they measured me at 85 ROM. I'm gonna work hard tomorrow with extra knee drags and other exercises they gave me so I can hit my goal of 90 ROM on Friday.

It definitely is a battle and painful rehab but I am happy I am making slow and steady progress. Today is 21 days post surgery. I feel the botched epidural set me back four or five days.

Plus, as a wimpy male, I am probably more delicate natured than irongirl56 and patriciad who had the same procedure!

 

[patriciad]

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.

All will go well for you defintely and you will improve your ROM. Try to be patient though. I get the need to regain independence. I pushed too hard for exactly that reason with my RTKR so have learnt that lesson at least. I am not overdoing it but I have always done the knee slides and raising my knee throughout the day, lots of short walks, standing and working on balance then ice and elevation when sitting - my Physio was excellent too.
Keep posting and I expect to hear a lot more improvement from you over the coming week as you have made progress already and it’s still very early on,
try to focus on the gains you have made - you are doing something right that’s for sure and a day will come soon when like me you are “wow big difference today“

 

[beesknee]

All will go well for you defintely and you will improve your ROM. Try to be patient though. I get the need to regain independence. I pushed too hard for exactly that reason with my RTKR so have learnt that lesson at least. I am not overdoing it but I have always done the knee slides and raising my knee throughout the day, lots of short walks, standing and working on balance then ice and elevation when sitting - my Physio was excellent too.
Keep posting and I expect to hear a lot more improvement from you over the coming week as you have made progress already and it’s still very early on,
try to focus on the gains you have made - you are doing something right that’s for sure and a day will come soon when like me you are “wow big difference today“

I sure hope so. The last few days I have been able to walk around a bit without a walker. I feel much better after each PT session and ice/elevation after.

Basically at home they have me doing all the same exercises/bending that I do during supervised PT.

Today they said I should do two or three of these hour sessions a day. I am putting my Bonesmart foot down on that. If I had no swelling, maybe, but I have swelling plus limited ROM so once a day is fine with walking around outside a little more each day. Once I can bend my knee and sit in a chair properly without pain I will be very happy.

I miss the simple things one does not appreciate until you can't do them. Like walking to the mailbox or putting on socks.

 

[patriciad]

Today they said I should do two or three of these hour sessions a day. I am putting my Bonesmart foot down on that. If I had no swelling, maybe, but I have swelling plus limited ROM so once a day is fine with walking around outside a little more each day. Once I can bend my knee and sit in a chair properly without pain I will be very happy.

I am glad you are ignoring this ridiculous advice. What are they thinking?? Common sense tells you if your joint is swollen you are not going to be able to bend or straighten it more. Ice, Ice, Baby. I’ve had success by not doing “sessions” but by spacing out the exercises all throughout the day. 10 heel slides when sitting at the dining table. 10 leg raises when reclined , etc etc and watching for inflammation. Just try to take it slow. I know you’ll get there.
I start outpatient PT tomorrow and wondering how I’ll feel afterwards. It’s only a 15 min drive so my goal is to drive myself there next Tuesday which will be 4 weeks post op. Good luck carry on with the good work.

 

[Irongirl56]

@beesknee, I do still have some swelling especially after working out, PT stuff and longer walks. cant quite see my knee cap fully. I was swollen for over 18 mos from my 2 previous surgeries going into this one so not expecting that to go away for quite awhile.
I may be walking more than I should, dont really know. Just have to get outside and take my dog (who is rehabbing from a broken ankle) out as well. I am so used to training daily it is hard not too.
I am trying to keep my longer walks to every other day as I still do have quite a bit of calf pain and quad pain. I had quite a case of Quad tendinosis going into surgery and it is still there. On non walking days I do more upper body strength work and a focus on the PT stuff as well.
As you are only a few weeks out swelling like that would be pretty normal. Some say they can be swollen well into a year post op especially after activity. Constant icing and elevation as needed

 

[Celle]

Today they said I should do two or three of these hour sessions a day. I am putting my Bonesmart foot down on that. If I had no swelling, maybe, but I have swelling plus limited ROM so once a day is fine with walking around outside a little more each day. Once I can bend my knee and sit in a chair properly without pain I will be very happy.

I'm also glad you're ignoring that advice. If you did that, your knee would get more swollen, which would be counter-productive.

In any case, it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will increase spontaneously, whether you do formal PT or just let your normal Activities of Daily Living (ADLs) be your exercise.

My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise and we increase it a little each week.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

 

[beesknee]

@beesknee, I do still have some swelling especially after working out, PT stuff and longer walks. cant quite see my knee cap fully. I was swollen for over 18 mos from my 2 previous surgeries going into this one so not expecting that to go away for quite awhile.
I may be walking more than I should, dont really know. Just have to get outside and take my dog (who is rehabbing from a broken ankle) out as well. I am so used to training daily it is hard not too.
I am trying to keep my longer walks to every other day as I still do have quite a bit of calf pain and quad pain. I had quite a case of Quad tendinosis going into surgery and it is still there. On non walking days I do more upper body strength work and a focus on the PT stuff as well.
As you are only a few weeks out swelling like that would be pretty normal. Some say they can be swollen well into a year post op especially after activity. Constant icing and elevation as needed

I did about a 250 yard walk with walking sticks outside yesterday. Knee was very achy while icing it last night during Big Brother. Slept fine. And the good news is swelling is about 20% less than normal today even after finishing home PT.

So I will keep up the the walking.

 

[beesknee]

Today they said I should do two or three of these hour sessions a day. I am putting my Bonesmart foot down on that. If I had no swelling, maybe, but I have swelling plus limited ROM so once a day is fine with walking around outside a little more each day. Once I can bend my knee and sit in a chair properly without pain I will be very happy.

I'm also glad you're ignoring that advice. If you did that, your knee would get more swollen, which would be counter-productive.

In any case, it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will increase spontaneously, whether you do formal PT or just let your normal Activities of Daily Living (ADLs) be your exercise.

My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise and we increase it a little each week.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

My surgeon who has done 10,000 plus knee replacements with great success highly recommends PT for fast and successful recovery. My problem with PT is I live a long way from the doctor so I don't go to his recommended PTs.

I plan on asking him to give me a list of exercises that he recommends as guidance for my local PTs since all the PT's seem to have different philosophies.

 

[Celle]

There are lot of different opinions amongst surgeons. A lot depends on where they trained and the philosophy there at the time. Then there's the personal experience of each surgeon treating their own patients.

Just as no two recoveries are exactly the same, the experience of surgeons is going to differ as well.

 

[Irongirl56]

Oops a repeat….

 

[Irongirl56]

Plus, as a wimpy male, I am probably more delicate natured than irongirl56 and patriciad who had the same procedure!

you are stronger than you think! This is my 4th knee surgery in the last 3 years so I am pretty proficient at recovey.
Great job on the increased walking and glad to hear your swelling is less. I use my hike poles a lot when I go out too. Just be sure to really watch your form ie try to walk normal and not limp. If it starts to hurt while walking come home, elevate and ice.

 

[beesknee]

Knee felt so good yesterday I did my normal home rehab exercises and then did 1/4 mile with the walking sticks. I felt I finally turned the corner!

Woke up today with very sore knee, almost canceled going to rehab appointment. Gathered myself and went anyway, it was a tough hour plus. I barely made it to my 90 ROM goal shedding a single tear along the way from pain not happiness.

The knee is angry today my friends. Lots of elevation and icing on the menu for the rest of today.

 

[Wolvesfan]

@beesknee...Ah, yes. I remember feeling like I’d turned a corner, and then the next day my knee would remind me that it was still the boss. I’d get frustrated and discouraged and be very, very crabby (and sometimes I’d have a meltdown which involved lots of tears!), but it all worked out in the end. Hang in there!

 

[Celle]

The knee is angry today my friends. Lots of elevation and icing on the menu for the rest of today.

I'm sure your knee is angry, after all that pushing to get to 90 degree flexion. It's only just over 3 weeks since you had your knee replacement. There's absolutely no need to rush so much.
Most surgeons don't expect 90 degrees until about 6 weeks post-op.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

You might find this article interesting:
Knee recovery - Lose the Work Ethic!!
.

 

[beesknee]

The knee is angry today my friends. Lots of elevation and icing on the menu for the rest of today.

I'm sure your knee is angry, after all that pushing to get to 90 degree flexion. It's only just over 3 weeks since you had your knee replacement. There's absolutely no need to rush so much.
Most surgeons don't expect 90 degrees until about 6 weeks post-op.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

You might find this article interesting:
Knee recovery - Lose the Work Ethic!!
.

My knee was not replaced. I had a PKR affecting only a small part of my knee.

Yes, I have seen those forum posts.

I would prefer to follow my OS's opinion on PT as he has been doing these surgeries for ~25 years and after 10,000+ *KRs has seen what works and what doesn't. My OS only does knee surgery and is an expert in the field of TKRs and PKRs.

I had a rough day yesterday, but am reaping the rewards today as my knee is feeling much better and real ROM (non pushed ROM) is almost to a point where I can drive.

Here is an excellent YouTube on the top 5 mistakes people make that have knee replacement surgery.

 

[Celle]

My knee was not replaced. I had a PKR affecting only a small part of my knee.

Half of your knee was replaced and we have found, from the personal experience of many people over the years (including my own), that a PKR takes just as long to recover from as a TKR, in spite of what the advertising says.

This is a picture of a PKR:

and this is a TKR:

 

[beesknee]

One month update. Slow going recovery that I can only measure in weeks and not days. I am recently off the walker and probably would use a cane if I had one but I'm fine getting around the house so far. Outside I use walking sticks but can't go far. ROM is now at only 100 so a long way to go. Right knee so I can't drive which severely limits my independence.

I found a very small study about PT vs self managed PT for PKRs after 3 months that some here will find interesting.

What is the effect of supervised rehabilitation regime vs. self-management instruction following unicompartmental knee arthroplasty? – a pilot study in two cohorts - Journal of Experimental Orthopaedics

Purpose The optimal rehabilitation strategy after a unicompartmental knee arthroplasty (UKA) is unclear. This study aims to compare the effect of transitioning from a supervised to a self-management rehabilitation regime by pilot study of patient outcomes subsequent to UKA surgery. Methods Fifty...

jeo-esska.springeropen.com

I am finding my self managed PT is more rewarding and beneficial. All and all I am getting sick of thinking about my knee 24/7.

 

[beesknee]

I just ordered a Goniometer to measure my ROM when I stop going to in person PT. Only $7 and I can make sure I am going in right direction.

 

[beesknee]

I think I am icing too much. Recent studies have shown it is best to ice 10 to 15 minutes max for pain at a time as too much icing leads to slower healing.

I have iced and hour+ at a time after a strenuous PT session. I think moving forward I will elevate, ice for 10 minutes then remain elevated for 30 to 40 minutes without ice to let my knee heal faster.

 

[beesknee]

FYI:

My rehab exercises from start to finish in order as prescribed by OS and PT Those with the * are the ones I only do at rehab and do not do on off days at home. Nothing too crazy. When doing PT at home I do 2 sets of 10 instead of 3. I seem to be doing very well with these. I can be tough to push through but when I am done I feel good. Evenings are still rough no matter what I do during the day.



* Recumbent bike back and forth for 10 minutes as a warm up. I can’t do a full revolutions yet which is a bit disappointing.

Three 30 second calf stretches

Standing knee bends – I go down as far as possible than up. 3 sets of 10

* Walking hurtles over 4 raised bars on floor while keeping my form and balance – 5 minutes back and forth.

* Leg step. I step on a stair and push myself up than back down with no arm help with bad leg like climbing a stair. 3 sets of 10

* Leg wall slide. Leg against wall in gym and let it slide and bend it down as far as possible, then push it back up with good leg. 3 sets of 10

Hanging leg pull back. I sit on edge of bench with leg hanging. Then pull back leg with good leg as far as possible, then straighten and push leg straight out with good leg. 3 sets of 10

Leg lift with 2-pound weight. I lay on back, good leg bent bad leg straight and keep leg straight while lifting leg about 2 feet up. 3 sets of 10

Sitting kneel slides. Sitting on bench I have strap on foot and pull leg back as far as pain allows. 3 sets of 10.

10 minutes ice

The leg step was just added two PT sessions ago and my knee has been barking afterword. I am going to ask them to eliminate that exercise for now until I have more ROM and healing.

Got off the walker a week ago. At first, I seemed unsteady but now don’t need it and moving well with only slight peg leg toward end of day. I have a cane on order for when I need to walk through a store once I can move my right leg around enough to drive.

At first, I’ll probably use the right foot for gas and the left for brake to be safe.