New Member Needs Advice on PKR

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bigdog21

new member
Joined
Oct 19, 2008
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Location
United States
Had a PKR 5 weeks ago. About 2 weeks ago, the front and inside of my knee started hurting..painful when I walk, some pains are sharp-some not. My doc was a little surprised as he hadn't seen this before. The x-rays showed that the device was fine. He said it was probably scar tissue causing the issues. He said to massage it and it should go away.

Anyone else face this? Any other suggestions to reduce scar tissue?

Thanks.
 
When you say doc do you mean your primary care physician or your surgeon? If the first, then see your surgeon. This is not at all uncommon and could be one or both of two things which are a) inflammation of the ligaments around the joint or b) adhesions between the ligaments.

a) needs rest, icing and pain killers and anti-inflammatories will help as well - ease up a little on the physiotherapy but don't quit it completely. Talk to your PT about it as well.

b)
adhesions - all the structures in the body, muscles, tendons, ligaments, even gut and lungs, need to be able to glide over one another smoothly to let our bodies work. To do this, the body produces a special viscous fluid that acts like the oil in your car engine and lubricates everything with great efficiency.

Now when the surgeon opens up any part of our body, the internal stuff gets exposed to the air which is, by comparison to the body, cool and dry. The natural reaction is that the fluids evaporate and the tissues cool. This can make the organs and structures dry so when the wound is closed, part of the healing process is for the body to go into overdrive, producing extra fluid to replace what is lost. This is one reason why you need IV fluids during and after an operation.

Now as a general rule, 95% of people manage to make up this fluid loss and normality is restored quite quickly. But in the other 5%, for a variety of reasons some known, a lot unknown, their bodies are deficient in making up this loss and lacking the necessary lubrication, the ligaments and muscles lose their 'glide-ability' and beging to stick to one another. This is what we call adhesions. (Adhesions are often mistakenly referred to as scar tissue even by doctors.
) If this happens and the function of the joint is affected, the answer is to work the joint with some force, thereby freeing the structures from their locked-in state. Much as you would if you got a sticky or rusty lock and put some oil in it, you'd work it back and forth to free it up. That's what a manipulation is.
 
Thanks very helpful information. The doc I referred to is my surgeon. I will stay at it and hope that it gets better.
 
Hey BigDog, welcome to the small group of us PKRs on the board - I think there are only two or three of us now who try and visit. I had my PKR on 8/12 and I have had much the same thing you are describing off and on. I understand that this is just the body's natural way of saying "howdy" to the new guy in town. Some days are much better than others - usually due to weather changes, sitting in one position too long, or just plain because some stranger sliced you open down to the bone, took a walk through your knee with a hammer and drill and replaced some parts. Gee, why would that hurt? Although I still take pain meds about 4 times a day, they are drastically reduced from what they were, say, about two weeks ago. I can sit on the floor cross-legged, put my knee down on a floor briefly if it's padded, and I have almost all of my ROM back. I still hurts, but it's a different kind of pain - one that I'm going to wake up one day and realize I've forgotten to think about because it'll be gone. I have not noticed massage doing a lot of good but I was not sent to PT either. They felt I could do the same stuff at home and I have my OWN therapy of 22 stairs up to my apartment and down every day to work. I'm sure Beach will be along (one of the other PKRs) to tell you that 5 weeks isn't that long - you will have major improvements in your condition over the course of the next month or so. They will be almost unnoticeable until you realize where you were NOW. Things you can't do now that in a few weeks you'll realize you're actually doing! I thought this time would NEVER get here but it has. I had my doubts about my decision, wondering if it would be worth it. I can now say that it was. I am "protective" of my knee still, but I know that it's getting better every day. My only issue is the sleeplessness that I don't understand because I still have exhaustion issues. But you just have to keep working at it and be patient. (I'm a fine one to talk - I am the most impatient person in the world.) Glad to see ya here - Feel free to message me if you want to ask anything. I'm glad to help and our recovery is a little different (but no less traumatic) than the TKRs.
 
Hi BigDog21, are you doing physical therapy? The way I understand it is that scar tissue can form more easily when your knee isn't being exercised. Don't quote me--I'm not a doctor, but by daughter is an Occupational Therapist Asst. and that's what she said. Maybe someone else out there can verify this? I'm assuming you had only a partial knee replacement. How did the ex-rays look to you? I saw mine yesterday for a total knee and they looked pretty good to me. I am 6 weeks out on my surgery. Take care and God bless, LindaZ
 
I am at 6 weeks now after surgery, and it is getting better, I just left physical therapy and it was painful, I am kind of stuck at 108. I try to work my knee at home but it just gets stuck. I also have started riding a stationary bike now for about 30 minutes. Now it is the time for me to work hard and I do understand how you feel. I still cannot walk without pain or a crutch, using only one, but it does hurt. I did have some discharge but it was because I have a couple of stitches that were stuck, surgeon pulled them out yesterday and now it is better, but still pain when I walk. Good luck and will keep everyone in here in my prayers.
 
You are correct, Linda!
[Bonesmart.org] New Member Needs Advice on PKR

 
Thanks for the advice and words of encouragement...they help. I have been going to PT twice a week. Getting (just a little) better but not where I want to be. Massaging the heck out of my knee trying to work the scar tissue (if that's truly the problem). I think I read too much propaganda on the Oxford Knee website and figured I'd be kicking field goals for the Cowboys by now. As long as I make small improvements, I'm fine. However, it appears I've leveled off for about 2 weeks. Going back to my doc in 2 weeks and am anxious to see what he says. I didn't sign up for the same level of pain as I had before.
 
I'm now 9 weeks out and just had a follow up appt. I still have pain right below the incision and it hurts when I walk as much as before the operation. My doc took xrays again and he said everything looks perfect. He drained 26 cc's of fluid and gave me a cortizone shot. It feels much better now...but I think it's probably short term. The only explanation he has now is that something from the stiches might be irritating it. Last resort is exploratory surgery.

Oh boy. Does any of this sound familar to anyone?????
 
If your insurance allows it you may wish to get a second opinion. My partial failed and my surgeon flat out lied to me about some issues and I finally had to have a total done as a result, by a different surgeon!
I PRAY that you make out better than I did!!!
gloucesterman
 
BigDog-- I totally agree with you on the propaganda on the websites--- it is unrealistic and sets you up for disappointment. My medial PKR is not pain-free at almost 11 months, but certainly is better than it was before. I have a job that requires me to be on my feet moving around on concrete floors all day and I know that takes a toll.

I hope yours does settle down and brings you the relief they promise on those websites. Best of luck to you.
 
not yet...I go back to my original doctor next week. I plan to discuss the situation in detail and then decide on next steps.
 
Word of advice - do NOT get him to recommenda surgeon for a second opinion. He may send you to a pal or ex-colleague of his and the opinion would not be truly independent.
 
Thanks Josephine, I plan to speak with my PCP and get his thoughts. I'll ask him for a recommendation as they do not know each other.
 
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