PKR Nolander's LPKR Recovery Thread

Nolander

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Hello everyone! My name is Scott and I have been lurking and reading everything this wonderful site offers for a while now. I decided to chime in and add my thread so here I am.

My Story: About twenty years ago I ruptured my right ACL in a skiing accident. I had ACL replacement surgery not long after with considerable menisectomy as well. Shortly after the surgery, the pain became increasingly unbearable and I was pretty sick. Ten days after the ACL surgery I was back in for emergency debridement of the wound after they determined I had a massive infection in the joint. I had to have a PIC line installed and received 6 weeks of IV antibiotics (Vancomycin and something else). I lost 25 pounds and needless to say this set my recovery way back.

I did eventually recover. I am an avid cyclist who has competed on occasion. I average 5K-7K miles a year on the bike. I did return to skiing and cycling and, for the most part, did so with impunity for years. But alas, in time, I started having more and more pain in the knee. When I turned 50 I decided to train and race in the National Ultra-Endurance Series, a national MTB competition series racing 100KM courses. In 2017 I won the series in the Masters category! But as time went on I started having more and more pain as a result of activities. I gave up skiing three years ago and this year I started limiting some cycling. Meanwhile, I was taking cortisone every three months to keep going but it was really not working anymore.

My local ortho saw me again and said I was ready for a knee replacement. I was bone-on-bone in the lateral compartment. The good news was, that my medial compartment looked good in imaging. He referred me to a surgeon in Boston as my surgeon did not do LPKRs.

My Surgery: I had surgery on 8/29 in Boston. The procedure went very well I am told. The surgeon had warned me that he could not guarantee a partial was possible until he was inside my knee and able to evaluate the medial compartment as well. He reported afterward that the medial side looked great, especially considering what it had been through with the infection. I went home the same day and have been recuperating since. I am of course super paranoid of infection and they did prescribe antibiotics as a precaution. I can flex a bit past 90 with no pain now, just discomfort. I have in-home PT twice a week and they say I am doing very well. I am walking without assistance around the house.

My Recovery: I am following the recovery guidelines laid down here closely! Swelling has seemed fairly low all things considered. Today, day 7, I woke up with a fairly swollen knee. I had a rough night of sleep with background pain daily constant but not too severe. I walked a bit more yesterday but didn't do anything out of the ordinary in the past 6 days. I am hoping it's nothing much but I am super paranoid of infection!

The knee in general feels extremely tight, but again the PT feels my ROM is excellent at this stage. I am taking just Tylenol and Alleve and Gabapentin during the day. At night if I wake up with pain I am adding Tramadol and/or Hydromorphone, but they honestly don't seem to bring a ton more relief.

I hope to return to cycling and skiing full bore! I welcome any feedback and am very grateful for this wonderful resource! Cheers.
 
Very best of luck with your recovery, my recovery thread is Coddles so far so good success story

Like you I ski and cycle, I've successfully returned to cycling and golf 3 months post op, and plan on skiing in November (op was in April), so just to say that good outcomes are more common than bad outcomes, the internet can lead you down a rabbit hole of poor information and horror stories. I think the resources available on here are excellent and there is a very supportive community of people either recovering or fully recovered from knee replacement that will help you out on the journey. I think the best thing mentally I heard when I was feeling a bit down was from my surgeon who basically said "your knee is now STRONG, you have A STRONG KNEE", having lived with a weak liability of a left knee for years, this has taken some time to sink in, but really really has helped me figure out that its "just" muscles, tendons and ligaments that need reeducation, the knee is now bullet proof for all intents and purposes. Good luck and let us know how you go!
 
Good to hear! I agree, one has to be careful of what they read on the interwebs:). Humans naturally tend to report negatives more than positives. Thanks for sharing!
 
Hi Scott. I’m from Mass as well, north of Boston on the NH line. Where did you have your surgery done?
I’m actually from Maine:). I was referred to Dr. Shah at Brigham and Woman’s, Faulkner.
 
Welcome from another lateral PKR recipient.
We are a pretty rare bunch.
Laterals and patellofemoral PKRs are much less common than medials, which make up 90% of PKRs.
Good luck. Hope all goes well.
 
Welcome to BoneSmart and the other side of surgery!

I'll leave your recovery guidelines here for you:

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
@Nolander Easy does it - very early days for you. You are not in training, you are healing. Give that knee time to heal and you will be back to active living soon.
 
22 Days Update: Howdy all. Things are progressing well so far. I am in outpatient PT now. I am following my surgeon's exercise regimen through the "Force" application. It updates my program every week and progresses. I still spend most of my time sitting in bed with my legs elevated with the cryo-cuff. Edema is good when not doing too much but does blow up from exercises. My gate is almost normal unless swollen. Pain is pretty much non-existent except for the night when I inevitably wake up because I've moved to a bad position. But I am only taking OTC pain meds now.

I've been on my bike trainer for a week now, 10 minutes a day. I raised my seatpost maybe 1/2 an inch but that's it (for the cyclists: I have my road bike on a Saris smart trainer on a Saris rocker platform hooked up to Zwift. Going lowest resistance. I created some custom "riders choice" programs to use so inclines are ignored). Feels relatively good pedaling, stiff but not painful. However when swollen, both on the bike and during some exercises I am getting a bit of clicking and clunking. PT says that's pretty normal. Would love to hear your experiences.

I also have quite a bit of irritation on the top part of my incision. I think it's from the end of the suture. PT noticed it (it is red and raised a bit) but didn't think it is an infection. Monitoring.

I go for my 4-week post-op checkup and x-ray next Monday in Boston, five hours of driving for a 45-minute appointment:)
 
I go for my 4-week post-op checkup and x-ray next Monday in Boston, five hours of driving for a 45-minute appointment:)
I wouldn't be surprised that this long drive causes some complaining from your new knee. That's a long time to be bent and in a car. It doesn't mean your recovery isn't going very well, it is! We never know when we've gone too far until we do. Good luck to you!
 
Hey Scott!! Fellow cyclist, here… Riding and racing up until 2010. I can completely relate to what you went through. I too, slowly kept taking steps back from the cycling I wanted to do after injury and some joint osteoarthritis.

I’m currently at 18 months post TKR and feel as though I have got my life back. Every few weeks my knee gets a bit more stable and my muscles get stronger. Have been on three 400+km bikepacking trips this summer, usually over 2-3 day stretches. Such a renewed vigour and thankfulness for what I have.

Trust me I’m excited for you and the journey you have just begun. You will definitely have big gains and tough setbacks. Watch out for the ODIC(overdoitclub)
@Axx7 <—permanent member.

Keep the info coming! We r with u all the way! Stay positive and you’ll get there before you know it, step-by-step.

:bicycle1:
 
Awesome thanks to both of you! Axx that is inspirational. I fully intend to return to where I left off. I look forward to doing some gravel races next spring! The more immediate goal is getting back to skiing. I stopped getting my winter season pass at our local mountain a couple of seasons ago because lift-serviced skiing was just too painful. Instead, I started skinning (climbing) up the mountain and skiing the one run down. Great exercise and tolerable pain-wise. But I am really hoping I can return to skiing later this winter as my son and I hope to go out west to visit some colleges and ski Montanna and Colorado.
 
Have always loved getting into the backcountry in whatever form. I have been ski touring for about 12 years and this year will be the first winter season post TKR that I will be attempting to get back into it. My son is going to join me as well, taking up ski touring with me this year, so that will slow me down and keep me honest. Will be doing some preliminary touring in K-country and Banff National Park on some less strenuous routes.

Definitely, lateral stability was/is the last motion to come back. Quick motions like hopping both up and down and side to side seemed to irritate still by the 1 year mark. Lots of stretching and ergonomic stability exercises. You will find diminishing returns as your level of recovery gets further along. I know it's exciting and extremely difficult to be patient. If you stay the course rewards will come:yes!:
 
Good to hear! I agree, one has to be careful of what they read on the interwebs:). Humans naturally tend to report negatives more than positives. Thanks for sharing!
This is very true. I have been around here 2 plus years because I never fully recovered. During this time I have seen many people come to this site complaining about a painfulll recovery and then after 3 to 5 months they are never heard from again. I suspect these are the people that fully recover and are no longer obsessing about their knee.
 
Good to hear! I agree, one has to be careful of what they read on the interwebs:). Humans naturally tend to report negatives more than positives. Thanks for sharing!
This is very true. I have been around here 2 plus years because I never fully recovered. During this time I have seen many people come to this site complaining about a painfulll recovery and then after 3 to 5 months they are never heard from again. I suspect these are the people that fully recover and are no longer obsessing about their knee.
100%. I will endeavor to report the good, the bad, and the ugly. No matter what!

To that end, my sleeping has improved greatly over the past few days. I am no longer sleeping with my legs elevated as I now sleep on my side again - thank the recovery gods. I am using a pillow between my knees.

I am now doing 15 minutes on the bike at low resistance but a little higher than before (I started around 70-90 watts now 90-150W). The pedaling really loosens the knee up well before I do my PT exercises.

Cheers!
 
Happy One Month Anniversary, Nolander!
Thank goodness for improved sleep. It sounds like you're making nice progress. Keep up the great work.
I hope you have a wonderful weekend!
@Nolander
 

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