PKR PartialFix -- Recovering...

[Freya34]

While I’m not happy with my knee’s current condition I am managing ok, I don’t limp and I don’t use a walking aid. Two second opinions found nothing to fix, so at this point I’m not interested in any more opinions. It’s been almost 5 years now. I try not to think about a future revision. I deeply regret having this partial done and I’m not in any hurry to do this recovery over again, though if I do, I’ll do many things differently!

May I ask what type of things/issues make you regret your partial? I just done my 2nd partial and my biggest fear is that I just exchanged my arthritis pain for a different pain.

 

[Jockette]

@Freya34 My surgeon also did a lateral release in the same surgery as my partial, the same partial you have. Mine has never healed well and I still have a lot of discomfort in the lateral area. I never had any trouble with my patella tracking before my surgery, but according to my surgical report, it didn’t track well during the surgery, so he did a lateral release. I have learned a lot since my surgery, thanks to Bonesmart, and I now suspect my surgeon had little experience doing a Patellofemoral, and I wonder if something went wrong with the lateral release. I’ve also learned that lots of experience of the surgeon is key to a good outcome.

 

[partialfixFeb]

An article I saw showed a strong correlation between RoM before surgery and after surgery. If I had it to do over again I would have gotten the first TKR as soon as my RoM started to decrease. Pain was not the driver for getting the TKR in my case, it was loss of RoM.

Good point. So far, my ROM hasn't seemed to decline but I will start to track it more closely. With my other knee though, I could not get to zero extension pre-op so have been monitoring that as well.

 

[Rick951]

@partialfixFeb I think I waited a bit to long for my first (RPKR) I was barely able to walk normally for more than 10 yards. I was bone on bone and living on NSAIDS. My body paid the price for that.
For my 2nd I was bone one bone, but not in as much pain. I did have some episodes when my Left knee pain would increase and the knee would swell. I still had good ROM and little swelling the day I had my LPKR. My recovery on the 2nd was MUCH easier!! The 2 reasons: 1. I gave the surgeon a knee in better shape to work with. 2. I did not push recovery. I knew what to expect, and did not overdo it.
My only regret getting the 2nd one done, I have not gotten to the point that I feel comfortable kneeling. I can if I have to, but it is NOT comfortable.
On the good side, at our beach VACA this past summer. I walked several miles each day with NO pain. I even did a bit of jogging, just short spurts. I wanted to see if I still could.
Good Luck with your decision!

 

[partialfixFeb]

@Rick951 I really needed to hear this.

That would be great if getting my right knee done sooner rather than later does help with the recovery. Certainly not looking forward to going through this again esp. since it is my driving leg this time.

I am leaning towards scheduling the surgery for February but now it seems that it may be out of my control as I live in Maryland and just read that overnight non-urgent procedures may have just been put on hold due to rising COVID hospitalization numbers.

Last time, I was outpatient but required to stay overnight so I need to ask if I could get same day surgery if that is even an option depending on whether or not COVID hospitalization rates continue to rise. I'll find out more when I talk to the scheduler this week.

I am glad you are able to resume walks, etc. with NO pain. That's great!

Thanks for sharing your thoughts.

 

[Rick951]

@partialfixFeb The other thing I did have in my favor for my 2nd PKR. I was physically and mentally MUCH better prepared. I had to quit smoking to get my first PKR done but, I had only quit 2 weeks before the surgery. For my 2nd. I was 1.5 years out from smoking, so my body was in much better shape. I was also eating better and, getting more exercise. I also spent some time stretching in the weeks leading up to surgery surgery.
After surgery I did my best to eat as healthy as possible.

 

[partialfixFeb]

Knee #2, Day 10.

Same surgery, other knee. It's done and I'm working on my recovery.

It's going okay. I needed stronger painkillers (than last time) to get through days 2-5 after the nerve block wore off. I also relied much more heavily on the walker this time - up until yesterday. I think the worst of the pain is now behind me - thank goodness. I had a very rough time.

Horrible swelling....PT's compression ice machine is helping relieve the swelling/tightness a bit. Getting around well now, feeling steady with full weight bearing yet walking fairly peg-legged as the bend gradually comes. Went in with extension of 0% and came out with extension of 0%. Bend is gonna take a while...no point in measuring/estimating yet. The swelling dictates/limits the degree of bend and I am respecting that.

First post-op was today to remove stitches from the shin and quad. Most of my pain (soreness) this time is with the inner quad muscle so I (and my PT) are being cautious to work on my bend passively so as not to strain my quad muscle. I worked very hard to have strong quads pre-op so not sure what that's about.

Time is my friend. I am glad this major surgery is behind me. Pre-op anxiety is no joke.

 

[Jockette]

Welcome to recovery again!

Here‘s a refresher course for you,

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The 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
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​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[beesknee]

Knee #2, Day 10.

Same surgery, other knee. It's done and I'm working on my recovery.

It's going okay. I needed stronger painkillers (than last time) to get through days 2-5 after the nerve block wore off. I also relied much more heavily on the walker this time - up until yesterday. I think the worst of the pain is now behind me - thank goodness. I had a very rough time.

Horrible swelling....PT's compression ice machine is helping relieve the swelling/tightness a bit. Getting around well now, feeling steady with full weight bearing yet walking fairly peg-legged as the bend gradually comes. Went in with extension of 0% and came out with extension of 0%. Bend is gonna take a while...no point in measuring/estimating yet. The swelling dictates/limits the degree of bend and I am respecting that.

First post-op was today to remove stitches from the shin and quad. Most of my pain (soreness) this time is with the inner quad muscle so I (and my PT) are being cautious to work on my bend passively so as not to strain my quad muscle. I worked very hard to have strong quads pre-op so not sure what that's about.

Time is my friend. I am glad this major surgery is behind me. Pre-op anxiety is no joke.

I was thinking how little swelling you have. I am at 9.5 months and have more swelling and a big tumor like knob on the side of my knee.

 

[partialfixFeb]

I am curious to hear how your next appointment goes. I can't picture what your knee must look like but it sounds upsetting. Every surgeon is different and every PT is different. I will say that I went in planning for a very long, slow, tedious, gradual recovery because I saw my dad go through it first hand and surgeons should not downplay what is involved with the recovery as it sounds like yours did. I wonder if you need a PT who takes a different approach and I am curious what another surgeon says should you get a second opinion. My PT said there are differences between post-op PT for PKR's vs. TKR's and many PT's don't get that. It's exhausting when you are in pain to have to fight with medical professionals to get answers, additional imaging, and advocate for yourself in general. I hope you find answers and relief soon. It is no fun to have your life revolve around your knee and I am sure it is getting old.

 

[Jockette]

My PT said there are differences between post-op PT for PKR's vs. TKR's and many PT's don't get that.

What are those differences? I also have a PKR.

 

[partialfixFeb]

I can't recall all of the differences as they were comments from 2 years ago when I got my first knee done. In a nutshell, she is careful to try to protect the unoperated parts of my knee. For instance, during my first pre-hab she said no leg presses but she said if I were going in for a TKR she'd have me do leg presses because it wouldn't matter if it hurt/wore out the rest of the knee as it would all be replaced anyway. When I see her later this week, I'll ask her to remind me what to avoid. My PT has also commented on more than a few occasions that there isn't a lot of data out there for PKR post-op therapy and she won't just treat therapy as one size fits all for PKR's and TKR's. She is very conservative but it worked for me.

 

[partialfixFeb]

Today was my six month post-op. The surgeon was pleased and said he would see me in 3 years - which will be at my 5 year post-op for the other knee -- he said he'd look at them both at the same time. My knee is still healing, of course, but I am grateful that the surgery is behind me and that I finally got a decent bend. I was stuck until I tried prolonged passive stretching which did the trick for me.

 

[WFD]

How prolonged and what kinds of stretches? Thanks.

 

[partialfixFeb]

For me, wall heel slides. Instead of holding a couple of minutes, I found research that said hang out there for 20-30 minutes each session....2-3 times a day. I was surprised by the advice but had nothing to lose and it made all the difference for me. Try googling "your ortho MD" since I can't post websites here. He is all about passive extension exercises and bending exercises...gentle (like BoneSmart) but hanging there much longer than most PT's suggest. He has several articles, videos, and Q&A's from other patients describing their struggles. Best of luck to you.

 

[campcol1]

I had my LTKR in December 2020. I waited 20 years after many operations including a total ACL reconstruction. My recovery included an arthroscope 2 months after ltkr to remove debris and the synovium. It took me a good year of painful recovery. My right knee gave out in April. Torn meniscus, severe bone on bone OA. I didnt wait. Surgery was 5/11/22. I am just shy of 3 weeks. This is a completely different recovery. No cane or walker from day 2. No oxi needed just Tylenol. Extension 0, flexion 120. I gently walked 2000 steps 2 days ago with minimal discomfort. I am very conservative with pt. This is a wonderful recovery compared to last. I can only attribute it to not waiting on surgery and a virgin knee. Pain was excruciating prior to surgery. My 2 cents. Good luck, Colleen

 

[partialfixFeb]

@campcol1 It is so good to hear your recovery is going so well. You went through a lot with your first knee! Both my knees were, as you say, "virgin" knees so it was a bit puzzling and anxiety-provoking to struggle so much with this knee's early intense pain and problems bending. I will say that I feel I really turned a corner this week. The swelling is subsiding nicely (slowly) and I am now able to easily walk 4- 5 miles (I stick to flat surfaces as much as I can). Zero meds but I still ice some daily. PT is very conservative as well and I personally think that is key. She cautions me that while my knee can handle certain activities, the ligaments, tendons, tissues are also still healing making me at increased risk of pulling/tearing something. Recovery is so gradual and slow and just cannot be rushed. So much of it is the passage of time to allow healing from the trauma from the surgery itself and I know eventually the knee will be an afterthought if I am lucky. I am glad your surgeries are behind you.

 

[campcol1]

So glad that you are progessing nicely. As they say, it takes a full year. It is amazing to see the differences in everyone's recovery. I also had bilateral hip replacement in10/2020. Both hips recovered completing differently. It took my right hip a full year before it felt like my own. It is so much more sensitive to bursitis. Who knows, maybe now that I got the right knee fixed, it will feel different. My left hip felt normal within the first 3 weeks. Same exercises different experience. Like they say, everyone's journey is unique.

 

[benne68]

PT is very conservative as well and I personally think that is key. She cautions me that while my knee can handle certain activities, the ligaments, tendons, tissues are also still healing making me at increased risk of pulling/tearing something.

Sounds like you have a great physio! If only all of them understood this surgery as well as she does, we'd have a lot fewer folks struggling from post-therapy trauma.