PKR Long Story of my Battle with a Bad Knee

[beesknee]

Where my actual PKR was done, medial, right leg. I get some soreness and if that was it I would be good to go.

It is the spots around my knee away from the PKR that is giving me trouble. It is under and to the side and below the knee cap that give me the trouble and sharp pain when trying to climb and especially decent chairs. I think this is from swelling that keeps kneecap out of ideal position.

I am doing a bunch of total leg exercises that limit strain on the patellar tendon. The idea is to strengthen all leg and glute muscles and thus stabilize knee so I can climb and descend stairs like normal person at some point.

I figure at month 9 if I still can't go down stair without hanging on I will visit my OP and then get second opinion from another surgeon.

I am using KS Tape to help keep my kneecap tracking properly while I build the muscles that will do the job. I stopped taking NSAIDS as my stomach is a mess after months of taking them.

I may have been overdoing it as I felt better a few months ago. 30 minutes on elliptical and exercise bike probably was irritating knee cap that was misaligned by swelling.

Last few weeks feeling better. Now, when doing my exercises and I feel the slightest twinge I stop and move to next exercise. No more pushing through to where I was a week previous. If I could do 3 sets of 10 of something last week, no shame of doing one set of 10 this week if I feel any kind of a sharp pain.

Baby steps.

 

[Ginger1210]

It s difficult to decide what to do to strengthen the leg muscles without annoying your knee. I know i am getting stronger at 10 months now but i still have pain and stiffness. If i didn't take NSAIDS i don't think i would be able to work. Just like you my kneecap causes me a lot of pain and discomfort. I have got help with my mental health due to my knee this has helped me cope with the every day challenge of managing pain.
I agree beesknee if you do not see improvement in your knee get your OP to review it. I will be 12 months in April my surgeon is concerned i am not free of pain yet we shall see.
Hang in there beesknee.

 

[beesknee]

Two more months.

Still doing daily exercises.

Very small improvement since last update. It seems I can go down stairs with taking slightly less weight off my knee by holding onto the railing. Up stairs, occasionally I can do 1 or 2 stairs unassisted if I am very careful, go slow, and make sure knee, foot, hip are all properly aligned.

Knee grinds like gravel in the knee. The grinding does not always = pain. But sure does not feel normal.

So frustrated.

I have an April 19 appointment with the doctor and will not accept a quick look and a "these things take time" excuse. Since my last follow-up just after Christmas I have not made any noticeable progress except maybe less soreness at the surgical side of my knee and very slightly better on stairs. The frustrating thing is I now have pain all around and under my kneecap with doing any type of step up or step down. Knee is still always warmer to the touch and has visible swelling and a knob/bump of scar tissue or something where he took out and replaced my healthy meniscus. I feel that this knob of whatever is pushing against my kneecap and may be the source of my issues. Last few visits to doctor he at first said it would go away then next appt said it was probably scar tissue and of no concern.

If my doctor offers no new options it will be time for a second opinion.

 

[patriciad]

I am so sorry you have not had any improvement in all this time. You are one day after me so I can only imagine your disappointment and frustration. If it were me I would be researching another surgeon not connected with your current practice and going for a 2nd opinion. You deserve better.

 

[Ginger1210]

Hi Beesknee. I am sorry you are still struggling. I hope you get the help you deserve on the 19th. You are trying to do all the right things it is frustrating i know. I am still struggling 1 year out i am improving slowly but boy its tough.

 

[partialfixFeb]

Have you had any post-op imaging done? If not, I would push very hard to get imaging of your knee and request a copy (disk and report) so you have it on hand to bring to any doctor appt. That's what I do and it makes it easier. If this doc won't agree to the imaging, I'd find another practitioner to order it. I too would push for a second opinion from a surgeon from a different practice regardless of what your current surgeon says - I don't see how it can hurt - s/he can reaffirm what your current surgeon says or may see something different. You seem to know in your heart that something just is not healing correctly and I am very sorry about that - beyond frustrating.

 

[beesknee]

I am so sorry you have not had any improvement in all this time. You are one day after me so I can only imagine your disappointment and frustration. If it were me I would be researching another surgeon not connected with your current practice and going for a 2nd opinion. You deserve better.

Do you have grinding in your PKRs ? Can you do up and down stairs no problem?

Have you had any post-op imaging done? If not, I would push very hard to get imaging of your knee and request a copy (disk and report) so you have it on hand to bring to any doctor appt. That's what I do and it makes it easier. If this doc won't agree to the imaging, I'd find another practitioner to order it. I too would push for a second opinion from a surgeon from a different practice regardless of what your current surgeon says - I don't see how it can hurt - s/he can reaffirm what your current surgeon says or may see something different. You seem to know in your heart that something just is not healing correctly and I am very sorry about that - beyond frustrating.

I have had only x-rays. What type of imaging - MRI ?

 

[partialfixFeb]

Based on what you describe, if it were me, I would want an MRI to go along with the X-Rays. I am guessing your x-rays are fairly recent also.

 

[patriciad]

@beesknee - No I don’t have nor ever had grinding in the PKR. I had a setback at 3 weeks out from my one and only aggressive PT appointment. After that I had pain on weight bearing and the sensation of my leg buckling. X-rays showed tissue inflammation and I had to go back to square one resting, icing etc. Apart from that progress has been steady and I have rehabbed the Bonesmart way myself at home. I consider my surgery a huge success in that I have already reached the point where I am not aware of the joint replacement. Indeed my original nearly 6 year old RTKR feels improved and I attribute that to walking properly, equal weight bearing on both legs. I am not the sporty type so not playing tennis, hiking, biking etc etc but I can walk distance, do flights of stairs , stand for long lengths of time and just enjoy a life without painful, non working knees.
We all heal very differently and it’s not always useful to compare - it took longer to get to this stage with my TKR as the knee was much worse prior to the surgery. Having said that I do believe a 2nd opinion with another surgeon in another practice would be appropriate for you. I think one of the moderators could help you find someone or check the tab find a surgeon on here. The 2nd opinion surgeon will want to do his/her own imaging so I wouldn’t worry about getting additional from your current OS just request the images already done on a CD and your notes from Medical Records. Good luck going forward you have been very patient.

 

[beesknee]

Had my Doctor visit yesterday. Doctor finally saying something might not be right. Looking at xrays everything looks perfect related to spacing between kneecap on "good" side of my knee. He things the grinding could be scar tissue under knee cap which is causing irritation and swelling.

Gave me a cortisone shot in knee and a 6 day course of Methylprednisolone to reduce inflammation. He wants to see if I can strengthen knee while inflammation is down over the next few weeks to start improving again. He also gave me an MRI prescription I should fill if knee shows no real improvement over the next week or two.

He said set another appointment with him in 6 weeks and bring MRI results (if I end up getting MRI). At that point he would set up a scope to look under knee cap and remove any scar tissue that formed or smooth any roughness under knee cap.

If all is good I would cancel appointment. I gave up on having a positive attitude about my knee and expect to get scoped but will go through the process. Hopefully this inflammation caused by the PKR has not permanently damaged the good part of my knee. I asked about this and he said it probably is not the case but could happen if inflammation goes unchecked long term.

I already notice I am doing stairs much better. I still need slight arm assist with railing, but better. I am going to push hard during my daily knee exercises to build quad strength while I am on the steroids - normally I can only push so hard with my knee exercises because if I overdo it I need to rest for a few days and am back where I started strength wise.

I am wondering if by some miracle I can start doing stairs normally, do I just live with grinding in knee if it is causing no pain? At this point, the grinding does not seem to cause direct pain, but it might be causing inflammation under and around kneecap which is causing my troubles.

My initial goal was to be back playing tennis by now, then when I noticed slow healing I lowered goal to Pickleball. Now my goal is to go up and down stairs slowly without hanging on.

Holding off on second opinion for now since he is no longer saying it will take more time and has and action plan moving forward.

 

[beesknee]

After the cortisone shot and taking the Methylprednisolone dose pack the past 3 days my knee is about 50 percent better. I can go up stairs slowly without arm assist. I can take 1 step down without sharp pain. Multiple steps I still hang on to take some of the weight off but much better. Worked in the yard several hours spreading mulch yesterday and ready to get back out their today to spread the rest of the 16 yards. Still have the grinding and would not be able to sneak up on anyone with the noise it makes but grinding does not cause pain. Doing my best to get leg stronger while inflammation is down.

I fear this is most likely only a temporary drug induced boost and my knee is basically Charlie Gordon of 'Flowers for Algernon'.

 

[Ginger1210]

Hi beesknee. Mixed news then but at least your surgeon is showing concern regarding your knee. The explanation you received does make sense, I hope you continue to see improvement.

 

[beesknee]

Well 2 weeks since the cortisone shot and finished the Methylprednisolone dose pack last week. These 2 things gave my knee a 50% improvement. I am still able to go up stairs slowly and downstairs while only helping myself down with my arms a little. I can take 1 or 2 steps down without arm assistance which is nice because it seems having to take a step or two down is a common daily thing that I never thought about before I had my knee "fixed".


I am doing my quad/glute strengthening exercises nearly every day but I seem to have plateaued at this level and knee is not getting any stronger. At least have not slid back to where I was stuck at 3 weeks ago. I am still getting the MRI and then a scope as my knee really makes a lot of noise and grinds while taking steps down. I think I have gravel in my knee which most likely is limiting my recovery.

Fortunately walking and standing are pretty much ok. I can walk a few miles with just a bit of soreness toward the end of the walk.

 

[beesknee]

I have been wearing a Garmin Fenix fitness watch since May of last year before surgery. I was looking at my weekly steps and it is showing my recovery path quite clearly.

I see that I made steady recovery July thru November then recovery stalled from November until April. I had one outlier week when we were on vacation the first week of March and was forced to walk more than I would have liked. It looks like after the cortisone shot my improvement started moving in a positive direction again.

At the start of November I thought I was on my way - then 5 months of stagnation. I wish I had the OS give me the cortisone shot at my December 28 appointment. If I did, maybe I would be much farther ahead of wear I am now.

Yesterday I hiked with my dog a few miles through the woods. First time I got off nice level paths. It went very well and no after effects today. It looks I may not have to cancel my Grouse hunting trip this fall. While bird hunting we normally walk through heavy woods 4 -6 miles a day over 6 to 8 hours, so on the right track but a ways to go.

Step graph below. Can you guess when I had the surgery?

 

[glidefloss]

I have been wearing a Garmin Fenix fitness watch since May of last year before surgery. I was looking at my weekly steps and it is showing my recovery path quite clearly.

Hi @beesknee , I too have a Garmin Fenix watch but never thought of looking up the cumulative statistics till you did so in your post! Super cool to see how the numbers mirror the tale!

Very nice to see you're well on the mend!

All the best!

 

[beesknee]

Knee has been doing very well with normal day to day activities. Worked on getting the boat ready for summer yesterday. Spend about 6 or 7 hours power washing, vacuuming, buffing out oxidation, waxing, polishing, and then checking motor and fixing the bilge pump. Lots of standing, bending reaching and knee is fine today.

Knee still makes noise and grinds and going down stairs is not great. Running is not an option and tennis is a distant dream, but that cortisone shot definitely moved me forward after months of stagnation. If your stuck, I would highly recommend asking your doctor about a cortisone shot in the knee.

MRI scheduled for Monday and if scar tissue is causing the grinding and inability to run or go down stairs easily I will get is scoped out.

Good news I am at least functional this summer. Still feel like and old man sidelined from athletics, but there is hope.

 

[zdclimber]

Glad that the cortisone shot worked really well for you. Just in time for the summer fun.

 

[beesknee]

Glad that the cortisone shot worked really well for you. Just in time for the summer fun.

I walked from the living room to the kitchen to get a snack. Came back, sat down and realized I did not think of my knee during this short walk. What a treat. There is still stiffness but it is to the point where my brain tunes it out. Oh happy day!

Now the goal in sight is strengthening the knee so I can be at least my pre-PKR level where I could jog across a busy street or go down a flight of stairs carrying a clothes basket without looking at my feet or hanging on.

I work each day to get leg stronger but can only push it so hard, however, feel it is very slowly getting stronger. Some of my home exercises are getting too easy - like body weight squats. A month ago I had sharp pain and it was a struggle to do 3 sets of 10 and now I need to wear my 20 lb weighted walking vest to feel I am getting a benefit with the exercise and not just maintaining strength at a low level..

 

[beesknee]

My knee is about the same going up stairs slowly is possible without hanging on, down stairs still a struggle. Had my MRI done last Sunday and from what I read I have a lateral meniscus tear which is on the opposite side of my medial PKR. Must have happened during operation.

Will be seeing my doctor on Tuesday to go over my options. Sounds like the condition of my knee went backwards which make since I am worse off the pre-PKR.

Below is the MRI analisis - anyone that understands everything that is said and what it means, please let me know. I would like to see the doctor with the right questions.

Impression

IMPRESSION:

1. Limited evaluation due to susceptibility artifact from medial

compartment unicompartmental arthroplasty, unable to evaluate medial

compartment pathology.

2. Lateral meniscus body free edge tear.

3. Osteoarthritis with cartilage abnormalities, progressed subchondral

bone marrow edema in patellofemoral joint.

Narrative

MRI of the right knee without contrast

Exam Date: 5/22/2022

History: Presence of right artificial knee joint

Comparison Studies: MRI on 5/19/2021

TECHNIQUE: Multiplanar, multisequence MR imaging was performed without

Gadolinium contrast per the standard protocol on a 1.5 Tesla magnet,

utilizing metal artifact reduction sequences.

FINDINGS:

The patient is status post medial compartment unicompartmental

arthroplasty with extensive susceptibility artifact, therefore, unable

to evaluate medial compartment pathology.

* Menisci: There is lateral meniscus body free edge tear.

* Ligaments: Limited evaluation of MCL due to above-mentioned

limitation, within the limitation, MCL appears intact. ACL, PCL, LCL,

ALL, posterolat corner: No tear

* Extensor Mechanism: No tear

* Joint: Small joint effusion. Osteoarthritis. A tiny Baker's cyst

* Articular Cartilage: There is moderate thinning, signal abnormality,

and fissuring in patellar cartilage associated with subchondral bone

marrow edema and cyst formation, progressed since last study; mild to

moderate cartilage signal abnormality and irregularity also noted in

trochlear cartilage with associated subchondral bone marrow edema;

grossly intact lateral compartment cartilage

* Miscellaneous: No acute fracture. No aberrant vessel. Shallow

trochlear groove again noted.

 

[zdclimber]

I am not in medical field but I kinda understand what's described in your MRI report.

There are two issues -
1. lateral meniscus tear.
2. (kissing) cartilage defects in PFJ. Both under-surface of the kneecap and the trochlear have moderate cartilage defects, and the bones under the cartilage have bone bruise (subchondral bone marrow edema). I think that's what causes the pain and grinding feeling you are having.

I am really sorry that it appears your PFJ is affected. From my own experience (I had a bad PFJ cartilage defect in my left knee and had to have the PFJ replaced), it's very hard to heal on its own. The lateral meniscus tear may not be a big issue if the tear is small.