Patellofemoral Arthroplasty in March

[tejubeha]

After almost a year of appointments, physical torture (therapy), injections, imaging and a scope, I was informed last Friday that my tentative PFJ replacement date is March 6th, 2019.

The scope showed "grade 3 degenerative arthritis fairly widespread of the lateral facet of the patella and of most of the trochlea."

When I joined bonesmart in the Fall, I thought I was ready to have the surgery but now I am getting apprehensive about the whole process. I have read mixed reviews about PFJ replacements but not sure I want to jump to a TKR if the rest of the knee is not damaged.

One of the hardest things is the realization that I will not ever be able to run again. I was a marathon runner before all of this started.

Other than knowing that I will be in the hospital for a couple of days and off work for 6-8 weeks, I am not sure what else to expect. Should I obtain a walker, scooter or other medical accessories so I can get around? I have a friend who is willing to loan me all of that stuff. I have read several threads and I know this forum will help me get through the process.

 

[SusieShoes]

We'll be here should you have any concerns or questions, before or after!

Chances are your patella-femoral partial replacement will eventually need to be revised to a total knee replacement, but... if you're not ready to undergo a total replacement, and want to give the partial a go, see what happens. Eventually can mean a long time down the road. Many people are very happy with their patella-femoral PKRs. If this is your decision, stay positive and believe you will be one of those people.

True, most surgeons will agree you should not continue to run marathons. Doing so is just not worth the wear and tear on the prosthesis. Maybe you can find another sport to fall in love with? Many KR recipients turn to biking, which can be competitive and long-distance. Swimming is great exercise. People with replacements play sports that have some running in them, like soccer and baseball/softball. So you can still be very active!

What recovery aids to have on hand is highly individual, but a walker and a cane are universally recommended. Check with your medical team; often one or both are provided by your insurance. Chances are you won't need a scooter.

Also highly recommended is a toilet seat riser. Getting down onto and up from low toilets can be difficult in the first weeks after a knee replacement. Toilet rails are another option. Also good are ice packs/machines for the lots of icing you'll be wanting to do, and an elevation wedge or a few nice firm pillows for getting your leg up. Reducing the swelling in your knee greatly helps control your post-op pain.

In case you're looking to purchase a few things, here’s a list of recovery aids BoneSmart members have used and recommended. If you click on an item to purchase, BoneSmart receives a portion of the purchase price.

https://bonesmart.org/forum/threads/recovery-aids-a-comprehensive-list-for-hospital-and-home.12499/

 

[Celle]

Hello @tejubeha - and

Here are some article to help you prepare for your PFR:

Score Chart: How bad is my arthritic knee?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:
Stories of amazing knee recoveries

 

[tejubeha]

I received a phone call from my surgeon's NP today confirming the date of the surgery for March 6th. She also stated that there was a small area 5x9 mm of grade 4 degeneration on medial femoral condyle and that he would use an OATS procedure for this small defect in conjunction with the PFJ replacement.

 

[Celle]

She also stated that there was a small area 5x9 mm of grade 4 degeneration on medial femoral condyle and that he would use an OATS procedure for this small defect in conjunction with the PFJ replacement.

Please make sure that your surgeon will be prepared to replace the medial compartment of your knee, as well as performing the PFR, if he finds that the damage to the medial femoral condyle is greater than minimal.

OATS procedures tend to work only if a very small area is damaged.

I'm going to ask @Josephine for her advice for you as well.

 

[Josephine]

One of the hardest things is the realization that I will not ever be able to run again.

I don't think that's a reality but you might consider the side strike style of running that is referred to here Running: impact of running styles on knee joints, arthritis and running

Other than knowing that I will be in the hospital for a couple of days and off work for 6-8 weeks, I am not sure what else to expect.

That's what I would call a tad optimistic! At the least! In our experience here, recovery, off work, is likely to be nearer 8-12 weeks. The longer term recovery, during which you will likely be able to return to work, would be about 4-6 months. You need to read this Phased return to work

Should I obtain a walker, scooter or other medical accessories so I can get around?

Absolutely not! You should be on your feet and fairly mobile about 2-3 days after the surgery plus doing stairs and walking about. Read this Activity progression for TKRs

he would use an OATS procedure for this small defect in conjunction with the PFJ replacement.

OATS stands for OsteoArticular Transfer System also known as Mosaicplasty. They very often do this because there is very often lesions in the bone, bone cysts or similar. Don't worry about it!

 

[tejubeha]

I received a phone call from the Nurse Coordinator yesterday and everything is set for the 6th of March early in the morning. Hard to believe that this time next week I will be walking around the hospital under the guidance of my Physical Therapist. I am still a little worried about the anesthesia, the post-op pain and the recovery process.

 

[Jaycey]

@tejubeha What is it about the anaesthesia that worries you?

Unlike pre-op pain, post op pain is manageable. Take your prescribed medication around the clock as prescribed and you should be fine. Icing and elevating will also ease the swelling that causes post op pain.

I'll leave you our recovery reading list since you are concerned. Lots of good information that you can use from day 1 post op.

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 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 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.

 

[tejubeha]

So tomorrow is the day! Received a phone call from the surgical department and I have to arrive at 0600. I was excited about the early start ("Let's Get It Started"), my wife on the other hand was not so happy! She was hoping to sleep in. In her world 6 only comes once a day! Just kidding, she is a trooper and will keep me from doing anything stupid during recovery. Hopefully my next post will be in my recovery thread!

 

[Jaycey]

All the best tomorrow @tejubeha ! First up is the best position. You are done and dusted and will be tucking into lunch while others are nervously waiting. See you on the other side soon!

 

[Jockette]

I have the same philosophy as your wife about early morning hours, in most circumstances, but agree there are exceptions.

Best wishes tomorrow!

 

[catkin69]

All the best for tomorrow

 

[gia2cats]

Best of luck tomorrow. I love being the first surgery of the day. Had to be there at 0530. But it’s not as if I was sleeping well the night before. None of it was as bad as I feared.

 

[Irish471]

Just said a prayer for you tejubeha! You, too, catkin69!