My popping knee

[1jt@atime]

I went to the OS for my 3 month and 12 month post op appt for my two knees today. I hadn't been to the office since I had my staples out. My newest knee is doing great, only a little soreness remaining which I expect to clear up in the next month or two.

My almost 12 month old knee has been a little bit of a problem all along. Any time I straighten the knee or stand up, I will hear about 10-20 fast pops. I also experience pain anytime I go up/down stairs, stand up/sit down or walk up/down a hill. Because my OS had previously said my knee was in such horrible shape, I thought this was it and I was going to have to live with this forever.

Today, he said he knew exactly what was wrong and that it had to do with the capsule, sort of like a bag around the joint. Josephine, help me with the correct name for this because I did not write it down and it was one of those names no one but a doctor would remember......When my knee was replaced last October, this bag/capsule was badly inflamed and injured and he cleaned it up but its never fully recovered. We are going to go conservative and work our way up with treatment and the first being a stronger anti-inflamatory. If that doesn't work, he will give me a cortisone shot (He does NOT like cortisone shots and is very conservative with dishing them out). If this doesn't work, then he will go in and do arthroscopic surgery. I am SO happy that he may be able to get rid of the pain. The pain is nowhere near as bad as it was pre-replacement but I hate to have gone through all this to still have pain like this. I am REALLY happy he may be able to get rid of it!

He also gave me some doctor names that concentrate on ankles and feet so that'll be my next thing to concentrate on. Karen

 

[Linda2]

I'm glad that your problem is not the new joint itself. Good luck with the treatment for your condition.

 

[Jamie]

Karen, you are so brave to have such a positive attitude with all you are experiencing and all you've been through. I admire you so much! Hang in there. It sounds like you have just the right doctor working on your side. ((((HUG))))) for you!!!

 

[Josephine]

Assuming the pain is above the knee cap, the term he probably used was "suprapatellar ( above the knee cap) fat pad impingement". There's also a fat pad below (infrapatellar)

They can be seen in this MRI scan. If they start getting caught or nipped by the edge of the prosthesis, then they get swollen and nipped more. Bit like when you bite your tongue or cheek - it swells and you bite it again!

If he can get the swelling to quiet down then all might be well but frequently they need an arthroscopic trim.

Hope it settles down for you.

 

[Jamie]

Wow, Josephine....what a GREAT explanation. We are so lucky to have you with us on this forum!!!

Karen.....hope the next few weeks bring you some relief!

 

[1jt@atime]

Jo, This might be it but I'm not so sure. Would this cause all the popping also? He said the popping was air pockets. He described it more like sort of a bag around the knee that was already inflamed when he first did the replacement so I guess it was a problem even before I had kr. He cleaned it up at that time. The pain is more behind and under the knee cap, not just in one specific spot and it's bothered me since having the joint replaced. After the initial recovery period, I just kept thinking it was still healing and the pain would go away but after a few months, felt it was a little more then that. Thanks Jo for your advise. You are always great! Karen

 

[Josephine]

Popping can occur anyway to some degree and yes, the general consensus is that it is air pockets, much like when kids crack their fingers!

The bag he mentioned which was inflamed would be the synovial membrane which is a kind of lining on the joint capsule and is often inflamed as a result of the arthritic changes.

Can't give an explanation if it's under the knee cap other than it might be some debris there. Did you have a plastic button on the knee cap, by the way?

 

[1jt@atime]

I think you got it this time and yes, I do have a plastic button on the knee cap. Seems odd this lining would still be inflamed, especially since I've been taking anti-inflams the entire year except when I had the second knee replaced. Hopefully we can get it all under control since obviously, the arthritis is gone from this joint. Thanks Jo....Karen

 

[Josephine]

Then the pain won't be UNDER your knee cap as there's nothing there to feel pain. I think the pain you are getting IS from the fat pad as it's so close it's not very easy for you to tell the difference. It's only about ½ an inch, maybe less.

 

[1jt@atime]

It's an area much larger then 1/2 inch. I think your second description of the synovial membrane fits more closely to what he said. Maybe I described the pain wrong. It's not necessarily behind the knee cap. I might even say it's in the joint and down below the knee cap. Much easier to point then to describe it on the internet. It's like I still have an achy joint though nowhere near as bad as pre-tkr.

I'll keep you posted after I see my OS again.

 

[Josephine]

Ah - I see.

Actually, I just meant the distance between the patella and the fat pad is about ½ an inch!

 

[Josephine]

Karen, you should watch this short video - I know it's on hips but he does touch on popping and clicking which explanation does carry for knees as well.

Video: Dr. Raj K. Sinha, M.D., Ph.D. on Squeaky Hip

 

[1jt@atime]

I had a cortisone shot in my 12 month old knee today. It actually hurt less then the hyalgan and cortisone shots! Actually it didn't hurt at all. I was kind of surprised the OS brought in the RN that I don't often see and the PA that had assisted with my second tkr. Seemed like quite a few people for a cortisone shot at 5:20 in the afternoon. I would have thought everyone was ready to go home! It's still too early to tell if the shot is going to help the knee but I sure hope it does. I'm in no hurry to have a scope on the knee which will be the next step if this doesn't cut the pain. He basically said to give it a couple of weeks so that's what I'll do.

Sometimes, it's hard to tell which knee is hurting; #1(1 yr old) or #2(4 months old). Do others experience that? Hess and others that had knee replacements in June....Do your 4 month old knees still hurt like mine, mainly up and down - steps/seats? Mine does and I keep telling myself it shouldn't be hurting so much at this point and I'm kind of paranoid it will continue to hurt like knee #1. I'd like to hear how much pain some of you are experiencing at 4 months. Both knees feel stong when walking and don't hurt when walking on level ground.

I also saw a foot and ankle specialist today. Not sure I will stick with this guy but it was a good start. We are starting with orthotics which I should have gotten a long tme ago but I guess I was busy taking care of knees and a back.... You know Hilary Clinton's saying about putting cracks in the glass ceiling? That's kind of how I feel about my feet. Whenever I stand/walk, my feet feel like they are cracking in a thousand places. Hopefully the orthotics will help....I also showed him an MRI of my ankle from three years ago and he went ugh..... not the way you want a surgeon to react when seeing a test result, and an old test at that. He mentioned fusion or ankle replacement options down the road. My knee surgeon has said the same thing so I'm batting 2-0 on that one or maybe I should say 0-2. Ankle replacements are not as advanced as hips and knees and don't always have good results. You also have to stay off your feet for a long, long time.

I'm actually okay with all of the above. (No new surprises) This stuff can really get to you so you have to keep a sunny disposition.....something I'm good at. Beach, maybe I should try the Cymbalta again! Karen

 

[JudyS]

Karen

I have been on the Cymbalta for almost 3 weeks and I have not got any mood effects from it yet!!

This morning I was feeling bummed that both knees really hurt this weekend adn my back really hurt.
Then I told myself that there are so many people out there without legs that would give anything to have painful knees. And many paralized that would love to feel their backs.
I got over myself pretty fast!!!

Judy

 

[1jt@atime]

I'm more interested in the pain relief from the Cymbalta. Luckily, depression is not a problem for me.

I know what you mean Judy. I work in the Pentagon and once a month they bring in the Wounded Warriors from Bethesda and Walter Reed Hospitals. They walk or wheelchair down the halls with their loved ones and you realize how young these service members are. Male and Female, some without legs and some with obvious brain injuries. It is quite sad. All the building employees stand along the sides and clap or shake their hands as they go by. It makes us all realize why we are there doing our jobs, to support these Soldiers/Marines and other service members. I've missed the procession the last couple of months as our office has moved to the other side of the building and we don't always get advanced notice of their arrival.

 

[beachcomber]

Karen,
I am sorry your knees are still problematic. You are still pretty "new" with #2 and to have had both replaced like that PLUS your back and ankle issues is a great strain on both your body and spirit. My new left PKR knee still flares up when I spend too much time on my feet. It swells right above my knee cap and feels like it is pinching that fat pad. I think it just needs more time and a "break" now and then so I try to sit down for a few minutes when I can and bring out the ice packs. I will see my OS next month when he returns from his leave of absence.

I don't know if the Cymbalta would help with your knee pain. It is more effective against neuropathic pain and fibromyalgia and doesn't help my knees.
But it has helped with my back pain and improved my attitude. I guess I didn't know I was that depressed, but I sure feel better now!

Take care of yourself. You are an inspiration!

Beach

 

[1jt@atime]

Beach, I find you to be an inspiration also! I really do! It's hard enough going through a joint replacement but when you throw in so many other problems, it's a lot to deal with for many of us, isn't it?

I know knee #2 is still pretty new....I'm just getting impatient for something to stop hurting. I've considered going to a pain management doctor but I'm not sure I want to add another doctor to the mix. I mean, how many doctors does one person need? I tried the Cymbalta last year and I couldn't live with the side effects but even some relief would be good, ie: the back, and I also have myofascial flare-ups once in awhile.

I hope both of your knees, back and feet learn to cooperate and get you through the school year. Karen

 

[beachcomber]

thanks Karen--- I am glad we all have each other to support us in the tough times.

How long did you take the Cymbalta? The side effects were not too problematic for me and are pretty much all gone now. Unfortunately that includes the anorexia side effect. My appetite is back, darn it! But I am also sleeping fine now and just have a better attitude and more energy along with less pain. It is a relief to find something that is actually helping! My goal now is to reduce/get off of the prednisone. I know it is bad for my bones but every time I tried to taper off of it I had very painful flare-ups and had to start taking it again. Wish me luck!

Scott has a bum ankle from being run over by a log truck 25 years ago. They have offered him fusion and he has refused it and doesn't think ankle replacement is successful enough to try yet. The NSAIDs they put him on helped a lot, but also elevated his blood pressure so he had to stop them and is now limping again. We are quite a pair on some days! LOL. Let me know if you learn anything encouraging from your foot/ankle doc.

 

[1jt@atime]

Beach, I was only on the Cymbalta for two days. It made me real jittery and I mean like crazy. I couldn't deal with it. I wanted to climb out of my skin..... I can't imagine having to be on prednisone all the time. I've only had to go on it for about 10 days at a time off and on when having bad asthma attacks. I used to get hospitalized quite often, and even intubated once, during the late 90s until they came out with better asthma meds. Luckily, my daily meds are better now and so only have to take the oral steroids inhalers which are not as bad as prednisone. Prednisone always made me gain weight and caused headaches so I have full sympathy for you having to take it all the time.

I've had a great day today. I was almost walking normal with little pain. It felt so good! I felt like I could run a marathon! Well....not really :D I found out this evening that we have a high pressure front coming through and I think that is why I felt so good. I might keep a log for days like this to just see if it's the high pressure thing. I think it really is, especially after last winter.

I belong to another forum for ankle replacements that I highly recommend for your husband. I've not participated as I feel I don't have enough information about my ankle as of yet but I've learned a lot from it. It is very informative and he can get information about specialists. They are much fewer and further between.

Here's the forum website: broken link removed: https://health.groups.yahoo.com/group/Ankle_Joint_Replacement/

I have messages go to my email and it's not overpowering; maybe 2-5 messages a day. I know some of the people on this site talk about a surgeon in the Northeast, possibly Seattle. I can't remember his name off the top of my head. You often have to travel to find a surgeon that's done enough replacements.