PKR PKR 9 weeks post-op

[Lefty0329]

Hi,
As of yesterday I am 9 weeks post-op PKR and still in a lot of pain. I was diagnosed with bilateral patella malalignment syndrome when I was a kid and have had knee issues my whole life. This lead to developing arthritis under my kneecaps and all of the other fun things that go with knee issues.

I'm 49 and hurt my left knee back in December and dislocated my kneecap....this led to me making the decision to go ahead with surgery because I knew that no amount of PT was going to correct the issue. I had the surgery on March 24th and the doctor said it went very well but I have been in so much pain since. I went back to work 9 days post op, which was a huge mistake because I was no where near ready, which I think contributed to the blood pressure issues....it's been really rough.

I had a lot of issues early on with pain management because I couldn't tolerate the narcotic pain meds and the Tylenol and Advil (as well as pain and stress of the surgery) ended up causing my blood pressure to get extreme and I ended up going to the ER for it. My GP put me on a beta blocker for a short period and the blood pressure got under control but I wasn't able to take anything for the inflammation, which I have had quite a bit of.

My progress has been slow and painful. At this point I am at about 115 degrees flexion and 0 extension but can't walk more than 10 minutes at a time without a log of pain. Recently, the GP said I was ok to take Advil intermittently so I have been but it doesn't always help. I reached out to my surgeon the other day with my concerns (I have been in his office twice because I have been concerned with the pain, etc. both times he took xrays and said that everything looked good) and he said it could take 6 months for me to feel better...this is NOT what I expected at all, he recommended that I reach out to my GP and see if there is a prescription anti-inflammatory that he would be comfortable giving me so I started Meloxicam this morning.

I went to PT yesterday and talked to my PT about the fact that I have pain with the exercises because my quads aren't working right and are very weak at this point so she started using a NMES machine and I noticed a brief improvement after using the machine, so that gave me a little hope. Anyway, I guess I am just really concerned at this point that something in wrong. I would love to thoughts on my situation and see if anyone else has experienced a recovery like this. Thank you!

 

[Jockette]

As of yesterday I am 9 weeks post-op PKR and still in a lot of pain.

I went back to work 9 days post op, which was a huge mistake because I was no where near ready,

I had a lot of issues early on with pain management

Hi and Welcome!

I‘m sorry you’ve had such a rough start. How many days do you work, and how many hours a day? 9 weeks is still early in this 52 week/one year recovery, even for a partial. I also had a partial, and from what my surgeon‘s office did and did not say, I expected to be recovered in 2-3 months. That SO didn’t happen!

The best advice I can give you is, don’t do any more activity in your day than you absolutely have to. One of the best pain management efforts is, cut out as much of painful activity as you can. Since you are back to work, you can cut out formal PT and formal exercises. Your knee will get all the movement it needs, just going about your day.

Regaining our ROM (and also strength, and general healing) does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[Jockette]

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.​

​

If you want to use something to help heal the incision, ​

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.​

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.

 

[Layla]

Hello and Welcome to BoneSmart, Lefty. Thanks for joining us!
I am sorry you've struggled for the majority of you life with knee issues. I can only imagine the discomfort and difficulty it's caused. Dislocating your kneecap sounds so painful!

Thankfully your x-rays look as they should. I hope you're able to find relief through dialing it all back getting adequate rest with the use of ice, meds for pain and more time to heal. Gradually you'll be feeling stronger and steadier on your feet. Stay in touch so we can follow your progress to brighter days....they're coming!
@Lefty0329

 

[Lefty0329]

Hi,
Thank you for all of your words of encouragement! This Friday will be 12 weeks post-op and the pain and swelling have improved but it still doesn't feel "right". I can't walk for more than 10-12 minutes at a time and I get super exhaused from it and it hurts. I'm worried that there is something wrong. My blood pressure is still high so I am going to a cardiologist next week and having blood work done and I am going in for a follow up with the surgeon next week. I'm so worried that there is something wrong and that scares me to death. I am struggling with gaining quad strength and PT says that's why I feel unstable but then I read that instability could be a sign that there is something wrong. I'd love to hear what others have to say about this process. I know that everyone is different but I thought that I would at least be able to walk by now. Please share your thoughts and experiences!

 

[EalingGran]

I'm worried that there is something wrong. My

Everyone recovers differently and this is such complex surgery that it is really common to worry that something is wrong.
I have felt this several times in the last seven months with my pkr.
PKRs are also less common than TKRs and the results can be a bit less predictable I think- particularly if you have one of the less common types like lateral or patellofemoral. What type of pkr did you have?
You also mentioned that you had longstanding misalignment of your patellae pre-surgery and I wonder if adjusting to the new alignment might be a cause of some pain?
I had to have my leg straightened due to severe valgus deformity and it took months of quad work afterwards to improve the residual pain from my overstretched MCL.

 

[Jockette]

pain and swelling have improved but it still doesn't feel "right". I can't walk for more than 10-12 minutes at a time and I get super exhaused from it and it hurts. I'm worried that there is something wrong.

I doubt that anything is wrong, many of us, including me, felt just like this at 12 weeks and longer. This is a long recovery, an average of a full year, even for a partial.

 

[Lefty0329]

I am so appreciative for this community! Thank you for the words of encouragement! The procedure I had was a patellafemoral to address my kneecap tracking issues along with medial replacement. It makes sense that my muscles are struggling with the new alignment. I was talking with my PT yesterday and she also said that I have a different anatomy now so maybe that's why it's so hard. I just want to be able to walk. I start a new school counseling job in August and I nervous that I am still going to be struggling. Did anyone else experience the feeling of wobbly or unstable knee from quad muscle weakness? I think what I keep doing is over exercising my quads and then they turn to jello for a couple of days. Anyone else experience this?

 

[Jockette]

The procedure I had was a patellafemoral to address my kneecap tracking issues along with medial replacement.

So you had two sections of your knee replaced?

Did anyone else experience the feeling of wobbly or unstable knee from quad muscle weakness?

Yes, many of us had this. The surgery causes a lot of trauma to the inside of our knee that takes a long time to heal.

I think what I keep doing is over exercising my quads and then they turn to jello for a couple of days.

Many of our members have found that a more gentle rehab has worked just fine, and prevents that need for the “couple of days to recover from the exercise session.”

 

[Jockette]

I also have a Patellofemoral replacement. My recovery was very long!

 

[EalingGran]

think what I keep doing is over exercising my quads and then they turn to jello for a couple of days.

It's tough because you need to strengthen your quads but without overdoing it and causing swelling and pain. It is also really. important to strengthen the other leg muscles like glutes/ hamstrings etc.
So hard to get the balance right.
My knee is definitely getting stronger at 7 months but I can still overdo things and get sore by evening.
I haven't heard of anyone having a 2/3 knee replacement although I have read that all 3 compartments can be done separately. So may give yourself more leeway as you have had a bit more complex surgery.

 

[Lefty0329]

Thank you. I have a follow up appointment with my surgeon next week so I'll be asking more questions.

 

[Layla]

Thanks for joining us! We’re happy you’re partaking in the forum.

I think what I keep doing is over exercising my quads and then they turn to jello for a couple of days. Anyone else experience this?

Consider going with your gut instinct and maybe step away from exercising your quads for a bit and see if you notice a difference. Can’t hurt, right?
Try not to worry about how you’ll feel in August so you don’t have to deal with the added stress. I’ll bet you’ll be doing a lot better and feeling ready to begin your new counseling position. Stay in touch!

 

[Lefty0329]

Thank you! I've been taking it easy today and just focusing on walking. I am going to do my best to not get caught up in the "what ifs"

 

[Layla]

I am going to do my best to not get caught up in the "what ifs"

I've had a lot of worries in my life, most of which never happened.” Mark Twain​

Love that quote above by Mark Twain. It came to mind when I read your words above.

I hope you have a wonderful weekend!

 

[Layla]

It's your Three Month Anniversary!
I hope it's been a good day and you're enjoying a beautiful Summer weekend!
Happy Three Month Anniversary!
@Lefty0329

 

[Lefty0329]

Thank you! I have been enjoying the weather but ,sadly, not improving. I have a CT scan tomorrow so hopefully that looks good. Thank you so much for thinking of me!

 

[Layla]

You’re welcome!
I’m sorry you’re not pleased with your progress. I wish you luck tomorrow with the CT scan and hope all looks as it should. Let us know what you hear, if you feel like sharing. We do care.
@Lefty0329

 

[Sonfanatic118]

Thank you! I have been enjoying the weather but ,sadly, not improving. I have a CT scan tomorrow so hopefully that looks good. Thank you so much for thinking of me!

Hi Op, how did your CT scan go? I hope you’re starting to feel more relief and like your knee is more normal. I’ve recently had the same surgery (three weeks post op) and am struggling with some of the same issues. I’m still in a lot of pain and the swelling is persistent which really limits my ROM. I’m also really sensitive to narcotics and apparently prescription NSAIDs. Everything I read said recovery from PKR would be quicker the TKR and less painful but I’m starting to regret my decision…I start a new job next week and don’t know how I'm going to cope.

 

[EalingGran]

Everything I read said recovery from PKR would be quicker the TKR and less painful but I’m starting to regret my decision…I start a new job next week

I think PKRs can be oversold in terms of recovery time- and BoneSmart members suggest the recovery time is similar to TKR. This fits with my experience. It is only now at post 6 months that my knee feels mostly OK.
PKR can also be more complex surgery and it is important to get a surgeon who does plenty.
There are some papers that show that patients who have both a PKR and a TKR prefer their PKR knee and say it feels more natural and moves better than the TKR one. Having said that presumably the PKR knee was less damaged originally.
Hang on in there. It does usually get better.