Problem - 1 year out

[exjock]

Had RTKR a little over a year ago. ROM (105 - 110 ) according to Dr. was good but I think I expected more. Still had some minor discomfort in knee cap area when walking down steps. I was told that this would eventually go away.

My problem started a week ago when I enthusiastically decided to start exercising knee more. I rode exercise bike for about 20 minutes with seat lower than usual enough that I would feel good stretch each time I came around and did a couple sets of leg lifts. Next morning I almost fell on floor when I got up. Extreme pain and tightness in knee cap. I have not felt this bad in awhile. I am so mad at myself for not leaving well enough alone.

It has been about a week and hasn't gotten much better. Anyone have any experience like this or idea what problem might be? I hate to run to Dr. right away. Plan on waiting another week or so.

Thanks

 

[Josephine]

Hi ex-jock. Nice to see you back but sad for the reason you came back.

I take it you didn't have a patellar button fitted? Otherwise, I'd be very skeptical about his 'eventually go away' placebo. And your recent experience tells me that you have probably have arthritis on the articular surface of your patella. Can't think what other reason there would be.

You need to get this checked out by him but also get a second opinion, preferably from someone who has absolutely no connection with him whatsoever.

 

[exjock]

Josephine thanks for reply. I assumed that a patelar button would be part of a TKR. Last time that I was there I asked that question and was told that it was replaced. Why wouldn't they unless they forgot. Should this show up on an xray. I may ask for a copy of post op xrays.

 

[ship4]

Exjock,
Did you have a lateral release of the patella tendon to allow the button to move smoothly along the groove when you had your TKR. I had BTKR well over a year ago and had lateral releases done on both knees. I was and athlete and a PE teacher and am a family child care provider, both professions are tough on the knees. Check to see if this is your issue.....

 

[skigirl]

EXjock,

Prior to surgery I had a lot of pain like you have described and it was from a tight IT band. The it band runs along the outside of thigh--it connects the hip and the knee--(ilieo-tibial band)--that is what is released in a "lateral release".

My it band was tight after surgery, but it resolving as my quads are strengthened. Weak quads are common after TKR---have you been keeping them strong? If not, a better approach might be a slower program--start with 10 minutes of bikeing and then build up each time. I think that a call to your pt might be in order--he/she can measure your quad strength and then suggest some exercises to you.

I think that a lifelong regular program of exercise is necessary to get the most out of these knees---otherwise, the ligaments take over for weak muscles and you get the tightness that you are describing. Kelly

 

[exjock]

Not sure about the lateral release. My daughter had this done on both knees when she was younger. I just made an appointment with my Dr. Can't get in for 2 weeks. I am getting a copy of my last xrays. I should be able to tell if button was installed. If not I am going to be very upset at Dr. I am also going to check around with some people I know and get a second opinion. If button was not installed I don't think I will waste my time current Dr.

 

[Texas]

Hey Exjock Im glad you made the appt. I think you need to get in asap.......I wish the best for you. Hope he can get it straight.................)

 

[exjock]

Does anyone have a link for a leteral view xray showing pattela button?

 

[Josephine]

It will be pretty obvious if you have a button or not. I did a search but couldn't find one, sorry. And please note,my comments were under the assumption that you didn't have a button. If you do then I'd agree with skigirl and I apologise for missing out that alternative. The ITB inflammation can make you feel like you have a clamp on your knee across your knee cap and makes walking very difficult. I suppose it can happen any time and then not necessarily associated with the TKR.

 

[Josephine]

Found one!

 

[exjock]

Great thanks. When I get a copy of my xrays I should definitely be able to tell if I have a new button.

 

[exjock]

Just found out that my knee cap was resurfaced not replaced of fitted with a button. I am so mad right now I don't know whether to call a lawyer, load a shotgun or jump off a bridge.

Is this a common practice not to replace patella when in there? It just seems absurd to not deal with it when already in there. I have an appointmenton Tuesday to see my Dr. I can't wait to here his bulls**t explanation. It is not like I jumped into this with no research. Dr. has done surgeries on me in past. He trained at Hospital for Special Surgery in NY. Every piece of literature that I have read or video that I have seen the knee cap is addressed.

Sorry for venting. Anyone else with a TKR still have original patella?

Thanks

 

[Josephine]

How do you mean, resurfaced, jock? A button is a resurfacing. Or do you mean he just smoothed the surface with a tool?

It is actually quite common not to put in a patellar button. It's a judgement call made by the surgeon when he eyeballs the patella during the op. I think more don't have than have them, me included!

But, if he did debride the articular surface it showed he saw some wear and damage on it and that doesn't look good and I don't blame you for being angry. Do tell us what he said.

 

[loggon]

I thought they put the button behind the original patella after they clean it up (resurfaced it)

I am 5 months out and still have some pain around the patella.
Esp. if I sit for a while and it gets stiff. But not a big problem.

 

[exjock]

Josephine I spoke with Drs. assistant. No button. Resurfaced my pattella. Made the comment that you are always "better with original parts". I would strongly disagree with that if after a year my original is causing me problems. I will have to wait till Tuesday to find out what Dr. says. It seems that I was wrong assuming that you automatically got the button.

 

[Josephine]

Well, I'd really like to know exactly what they mean by 'resurfaced'. It's confusing the heck out of me!

And don't worry about getting it wrong - I often get things wrong!

 

[edk]

It wasn't until I realized something that happened to me when I was rehabbing. I did a lot of stationary bicycling to rehab and (thank you Doug wherever you may be) I would crank the seat down as low as possible to exercise my range of motion to the max. We'll what I would do is because my knee wouldn't bend quite enough, I would rotate the hip outward so it could take a bit of the bend. This meant that rather than the knee bending I would bend it to the outside which stressed the outside of the knee. This caused some post exercise pain just below and to the outside of the kneecap. It
went away with some icing, time, raising the seat to a more reasonable level, and
concentrating on bringing my knees towards my chest.

 

[exjock]

EDK - That is probably what made my knee flare up. I lowered the seat more than usual to get a good stretch at each turn. It has been a week now and not getting any better. I even got the cane out last night. Can't wait to find out what the problem is. By the way do you know what was done to your kneecap?

Jo - I am a bit confused myself. Will Let you know as soon as I find out. Do you think I should strt another thread to try and find out how many people have had patella button installed. I really thought it was a complete system but apparently not.

 

[edk]

I don't know exactly but I assume I have a patellea button (knee is a stryker)

 

[cindy88fan]

Ex-Jock...if you were riding the bike like you described, edk is right. I was doing the same one day and the next day,right below the petella, it hurt like crazy! My PT showed me that I was working the outside of my knees. So he told me to put the seat back up where it was and told me to make sure as my feet were coming around to have my toes pointing up and to pull my knees up towards my chest instead of to the side. My pain lasted for about 5 days.

Good Luck! Hope you get rid of the pain soon.