PKR PKR Success - 1 yr out.

[NavyGunns]

@SusieShoes, thanks for the well wishes. My transition next week is currently planned for me to work Monday, Wednesday, Friday in my office and from home Tuesday and Thursday. I’ve already made arrangements to have gel packs in our coffee break room freezer (which is right next to my office ). I’ve just to make sure I schedule reminders to elevate my leg. My drive is another issue. My office is 60 miles from home. Morning drive is usually an hour. Going home can be almost 2 hours.

We’ll see.

 

[kneeper]

@SusieShoes I’ve already made arrangements to have gel packs in our coffee break room freezer (which is right next to my office ). I’ve just to make sure I schedule reminders to elevate my leg. My drive is another issue. My office is 60 miles from home. Morning drive is usually an hour. Going home can be almost 2 hours.

We’ll see.

Very true about scheduling ice/elevation breaks. It's very easy to get involved in something and you forget until your knee starts screaming at you.
That sounds like a very long drive at this stage. Will you be able to go back to working at home for a while if it winds up being too difficult at this point? I'm thinking of the knee as well as the energy drain.

 

[NavyGunns]

@kneeper, your concern is exactly why next week will be a transition week. Working from home on Tuesday and Thursday gives me a break if it turns out being in the office is a bit draining. Additionally, if the day proves to be challenging, I have the option of heading home and finishing the day there. My manager and employer are very supportive. In fact, my manager had concerns about me coming back too soon. But, he was willing to give it a try if my OS agreed and as long as I don’t over do it.

It will definitely be a challenge. I just have to be smart and back off when it gets to be too much. I can say, even working from home was much better than just sitting around doing nothing.

 

[NavyGunns]

@Josephine, after reading several posts from other members regarding infection post surgery, I’m wondering if you could provide some information on how to distinguish early onset of infection from normal warmth and swelling that is part of the healing process. I’m also curious as to whether TKR is more prone to infection than PKR. I don’t have any immediate concerns in my own case but want to gain insight so as to know what to look for.

Thanks.

 

[Josephine]

how to distinguish early onset of infection from normal warmth and swelling that is part of the healing process

Actually you can't. The only additional symptom would be excessive pain but even that could be due to doing too much!

whether TKR is more prone to infection than PKR

Absolutely not!

 

[NavyGunns]

Second week back to work, but first day in the office. My 1 hour drive in the morning was uneventful. I was a bit stiff getting out of the Jeep, but not sore. Overall, the day was tolerable. I was able to elevate my leg and get an ice pack on my knee 3 or 4 times during the day. I did leave about an hour or two earlier than normal and finished the day from home. I work from home tomorrow with PT at the end of the day. Wednesday will be back to the office.

I’m looking forward to my PT session tomorrow to see whether I’ve continued to make progress or slipped due to over doing it. I don’t feel like I’ve over done it, but I’m not the boss right now, my knee is.

Still haven’t been able to sleep in my own bed. Wondering if my mattress might be part of my problem not being able to get comfortable and causing me to constantly toss and turn. The spare bed I’ve been using is much firmer. Might have to look at getting a new one. Ours is over 10 years so probably time.

Still have swelling (slight most of the time, just under moderate when on my feet too much) and associated pain. Elevating and ice help a lot. Swelling makes my knee joint feel stiff and tight, but I know that will get better over time. Just have to be patient.

I’ll post another update at weeks end unless something significant happens.

 

[sistersinhim]

You've got this! What a good post!

 

[NavyGunns]

Interesting experience this morning. I had a standard dental appointment this morning for routine cleaning. When my reminder popped up late yesterday, I got this thought that I ought to check with my OS to see if I needed to be on antibiotics as a precaution (nothing had been mentioned previously). His office said yes and they would call in a prescription but apparently failed to do so (never got a call from pharmacy confirming it was ready). As a precaution, my dentist gave me a “mega-dose” of amoxicillin (2000 mg) indicating this was the standard dose other doctors start with. She also insisted I follow back up with my OS in case I needed to continue over some period of time. I also have to go back in a week to get an old filling / cavity addressed. When I checked with my OS, they confirmed I needed an additional scrip for more antibiotics. They also informed me that my OS prefers that dental work be held off for 3 months post surgery to minimize infection risk. (I’m at 5 weeks post-op). No one said anything before about this so I didn’t know. Since I already had a mega-dose if antibiotics just before my cleaning this morning, they felt the risk was minimal but do want me to wait on the new filling unless my dentist feels there may be additional risk for infection in the tooth.

Has anyone else ever experienced this or heard of this before? I really hope this doesn’t cause an issue with onset of infection in my knee

 

[SusieShoes]

To pre-medicate for dental work, or to not pre-medicate... that is a question that pops up a lot. And the answer is: That depends. It depends on who you choose to believe. There are very good authorities like the American Dental Association who say you don't have to pre-medicate for joint replacements; it's not necessary and it doesn't help. And there are surgeons who are absolutely convinced that you should. And then there's the ultimate decider of these things... you. It's your body.

So you'll hear that you should. And you'll hear that you don't have to. And you'll even hear that over-medication with antibiotics is a serious problem for us all and you shouldn't do it.

All of these viewpoints are valid.

I personally did what my OS said to do: I pre-medicated for a year after surgery. I no longer need to. According to my OS. Who may or may not be correct, but I figure he's a good surgeon, so I did it. That said, I forgot to take the antibiotics (same as yours) for one cleaning. Completely slipped my mind. That was four months ago and I'm doing fine.

 

[Jockette]

I am very opposed to me premedicating so I looked around and found a dentist who does not require it. I did not ask my surgeon for his opinion.

I have had some weird reactions to this surgery and I didn’t want to invite another weird reaction to such a huge dose of antibiotics, since the American Dental Association says I don’t have to.
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis

As always, differing opinions.

 

[NavyGunns]

The fact there is NO consistency in opinion in this area really bothers me. If my OS says premedication is strongly recommended (in fact he recommends avoiding dental procedures for 3 months post op) and I choose to ignore and an infection happens, I can just imagine the back and forth that will then happen. If premedication offers some level of protection, I guess I’m inclined to go with it, especially since I don’t have any allergies or other issues with the antibiotics normally prescribed. I just find it interesting that my OS recommends delaying dental work for 3 months. I’m going to point out to my OS that none of that information was provided either pre-surgery or post-op as it should have been. I think it should be part of their up front discussion with patients during surgical planning so that patients have plenty of time to make alternate arrangements as needed.

 

[sistersinhim]

Mine never mentioned anything about it either. I will forgo taking them.

 

[Jockette]

The fact there is NO consistency in opinion in this area really bothers me

You’re “preaching to the choir” here!
There is very little consistency regarding many aspects of knee replacement. PT is another area.

 

[nuttybrunette]

My current OS says premedicate forever. Says it’s my knee, why take chances. My previous OS (first knee-10 years ago) said premeditate for 2 years only. I’m in the same quandary....

 

[Celle]

Dental antibiotics: Evidence insufficient to recommend prophylactic antibiotics for dental procedures

 

[NavyGunns]

I have a question regarding an area of pain that is persistent and bothersome when going down stairs. My PKR was on the lateral side, but I’ve got an area just to the lower right (medial) side of my knee cap where I get a sharp pain, especially when going down steps. If I put my finger on this spot when bending my knee, I can feel something that could be described as a “rope” rubbing back and forth across the front bone area (not the knee cap).

See attached picture. Area circled is the area in question. My PT says it’s probably some inflamed ligaments and should go away in time. I don’t feel the same “ropy” sensation in my right knee. Is this something is should have my OS look at right away or wait till my next visit in mid-July?

 

[sistersinhim]

Do you know if you had a medial release? I kept having pain in your same area. When I received my surgical report, it stated that the OS had done a medial release. That explained my pain and it might yours, too.

 

[NavyGunns]

@sistersinhim, great question for which I don’t have an answer. I don’t have a copy of my surgical report, am planning to ask for one at my next visit which isn’t until mid-July.

That said, I have no clue what a medial release is or whether that is a procedure typically associated with a PKR versus TKR. Maybe @Josephine can provide an explanation? I’ve been unable to find anything in layman’s terms that helps me understand what it is and whether it might explain my source of pain.

 

[Jockette]

If you don’t want to wait until July for the report just call and ask for it.

I had a lateral release with my Patellofemoral replacement and now I have all sorts of discomfort on that side. I googled the procedure and didn’t really understand much either. I wonder if my surgeon was a little over zealous with the procedure. My report said during surgery my patella didn’t track properly so he did the lateral release. As far as I know I never had tracking issues before surgery. But even so, surely mine should have healed by now, it’s been 14 months.

 

[sistersinhim]

You have tendon that run on each side of the kneecap. The one on the outside is called the lateral and the one on the inside is called the medial. Somehow, these help to keep the knee bending straight. When it pulls to one side or the other, that means that, that side's tendon is stronger than the other side. The OS will cut part of it cross ways. This makes it weaker, allowing a better bend. This was explained to me way back in the 80s when I had my first lateral release. The explanation might be different than that now. Hopefully, @Josephine will correct me if I stated it wrong.