PKR Recovery same for PKR & TKR?

[Misspoo56]

I had a left medial PKR on Feb 26, 2020. I am about 10 weeks post op now.

My first visit to OS was 8 days post op and he wasn't pleased that I was a few degrees shy of 90 flexion. He thought I needed PT to help me along. I went along with his suggestion, was evaluated by PT on my 2nd post op week and started PT the next day. I was scheduled 3 times a week and received the same care most people on this site talk about. Not gentle kind.

I too had swelling and extreme tightness above my knee. Not so much pain, just this vice-like tightness. While stretching (PT calls it that, I call if forced flexion), I felt a big pop that hurt and made me cry (which I rarely do).

The next few days my knee was swollen, painful and unable to flex. I made an appointment with OS and, thank goodness, xrays showed no damage.

It took me a week to kinda get over that, but I went back to PT, thinking I needed to regain what I lost in that week. I finally stopped PT after 6 weeks ,when the PT said she had to get "more aggressive with my knee" and that "my pain was not going to dictate what she was able to get out of my knee". I never went back.

I was getting about 120 degrees flexion at that time. I continued at home with the same exercises, but felt I was getting worse, not better. That is when I found Bone Smart. I read and read and read some more. I stopped all exercise except my recumbent bike (10 min 2-3 times day, no resistance).

I have elevated, iced and rested. I am much better. The tightness above my knee cap is much better. It comes back when I overdo.
I still have a tight band across my knee cap side to side. I'm concerned about this, because it seems to be getting worse and I have lost some of my flexion.

I forgot to say I also have an intramedullary rod in my left femur from a car accident 30 years ago. I had two ORIFs, three sets of traction and a frozen left knee from that.

I have been on NSAIDs for three weeks, stopped a week then started back. I stopped those yesterday and am trying ES Tylenol and tumeric. I don't have pain per say, just the tightness and occasional discomfort and zingers.

I see a lot of info on TKR and recovery. My question is: Is there any difference in how a PKR recovers from a TKR? It makes sense to me that there might be, as in a TKR all joint is new. In PKR the new part has to learn to work with the natural part of the joint.

I never received the "patience gene" ,so I can get anxious about my recovery. Sorry this is so rambling, would just appreciate some feedback if possible. Thanks.

 

[Sara61]

@Misspoo56
to BoneSmart.
I will tag @Jockette as she can explain this to you better, as she had a pkr although I think the recovery is almost the same for the both.

Meanwhile I will leave you the BoneSmart recovery guidelines for you x

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 Care In Hospital


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.

 

[Celle]

I finally stopped PT after 6 weeks ,when the PT said she had to get "more aggressive with my knee" and that "my pain was not going to dictate what she was able to get out of my knee". I never went back.

Thank goodness you finally stopped going to PT!
It's great shame your surgeon and your PT were so impatient. Most surgeons don't expect 90 degrees of flexion until about 6 weeks post-op.

I still have a tight band across my knee cap side to side. I'm concerned about this, because it seems to be getting worse and I have lost some of my flexion.

The tight band is normal at this stage of recovery. Unfortunately, it can linger for several more months, although it should decrease gradually.

Don't worry about a slight loss of flexion. It seems to come and go, but you won't lose it permanently.

You might try cutting back the recumbent bike to once a day. That's all your knee needs. Don't forget that your knee will be getting exercise all day, just from your normal activities of daily living.
In any case, in spite of what you've been told, it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal.

Also. probably contrary to what your surgeon and PT told you, there's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet: Just relax about ROM and let it happen.
Myth busting: the "window of opportunity" in TKR

I forgot to say I also have an intramedullary rod in my left femur from a car accident 30 years ago. I had two ORIFs, three sets of traction and a frozen left knee from that.

That's all the more reason why your knee should have been treated gently and allowed to progress at its own pace.

Can you remember any of the dates around your accident and its treatment? I'd like to add that information to your signature.

I have been on NSAIDs for three weeks, stopped a week then started back. I stopped those yesterday and am trying ES Tylenol and tumeric. I don't have pain per say, just the tightness and occasional discomfort and zingers.

The most effective way to take Tylenol is 2 x 500 mg tablets (Tylenol Extra Strength) 6-hourly, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.

My question is: Is there any difference in how a PKR recovers from a TKR?

Although advocates of PKRs often stress a faster recovery as one of their advantages, we've found that this is rarely true.

A PKR is still major surgery and, in our experience, it takes just as long to recover from a PKR as from a TKR. That is, a full year for complete recovery of all your tissues. You should be able to do most things before the year is up, but healing will still be taking place beneath the surface. Some people even need 18 months to 2 years.

 

[Qdogpa]

I was under the misconception that a PKR was a quick recovery..It was my misconception, I don’t blame the OS. Now nearly 3 1/2 months later, I realize that I was very mistaken... PT is ok, but your best friend in this recovery process is simply time..Time includes our daily activities and such..not knee bending, twisting etc...

 

[Misspoo56]

Thanks Celle for the answers and support. It helps to have someone who knows tell you your on the right track. My car accident was March 1987 with a comminuted left femur fx. First ORIF was also March 1987. Developed osteomyelitis from that surgery. Second ORIFs was September 1987 when the rod placed.
I'm so grateful to have found this site. Thank you for all you and everyone here does.

 

[Misspoo56]

Thanks Qdogpa. I know now that is not the case also. It's such a relief to "talk" to others that have gone through and still going through this.

 

[Jockette]

My question is: Is there any difference in how a PKR recovers from a TKR?

I believed all I read about the quicker recovery of a PKR vs a TKR, but it definitely wasn’t true in my case, in fact, many TKRs have recovered faster than I have.

I’m glad you stopped going to that PT, it’s not necessary to rehab a new knee like that!

 

[Wolvesfan]

@Misspoo56...I had a PKR about two weeks after you did, so I’ve read your thread with great interest. Even though my OS was very candid about the full recovery time for this surgery (a year), I thought that because it was a partial, I would heal much more quickly. I was wrong. I’ve never had a TKR for comparison, but this site has taught me that everyone’s recovery is different. During the first couple of weeks after my surgery, I was often overwhelmed with anxiety and worried that I wasn’t progressing as I should be. The fact that the quarantine came so closely after my surgery probably made it more difficult, as might have been the case for you, too. Extra worries on top of post surgery blues! Like you, I then found this site, and the reassurance offered by others (and the excellent moderators) has really helped me overcome or cope with my fears. I still worry about the tight band feeling, stiffness, and ROM...but then I try to give myself a pep talk or I read this site’s welcome to new members/guidelines again, and it helps me relax. As @Qdogpa often says, “time is our friend.” Sometimes it seems like that time is agonizingly slow, but we’re all recovering together, on our own timelines, and that’s a good thing!

 

[Celle]

My first knee replacement was a PKR. It lasted for 11 years, before it had to be revised to a TKR.
I have since had a TKR on my other knee. For me, the recovery from my PKR was just as hard and just as long as my recoveries from the TKRs.

 

[Misspoo56]

@Wolvesfan you are so right! The pandemic has added another level of anxiety while recovering. I really was social distancing before it was ordered . You are also correct that this site makes all the difference in the world. SO glad we both found it. @Celle @Jockette @Sara61

 

[Misspoo56]

@Jockette I wish I had found this site before my surgery. I still would have had it, but my decisions would have been very different. My OS and hospital is 2 1/2 hours from my home. I was a same day surgery, so had to ride all that way back home after surgery. I had a reaction to something my first day post op and dropped BP into 70-80s. I probably should have stayed a day or two in the hospital, but hind site is always 20/20. Just glad to be on the right track now @Celle

 

[sistersinhim]

I was so blessed to have found Bonesmart 6 months before my surgery. I learned so much beforehand that I was pretty sure I was ready to face the after-effects of this traumatic surgery. It helped me so much that I'm still here trying to help those others coming up behind me!

I think the best thing I learned that I can pass on to others is to listen to the knee. If it hurts during or after doing a certain thing, then the knee isn't ready for that yet. I would wait a couple of weeks and try it again. If I was OK afterward, then I knew my knee had healed enough to do that. I wouldn't try anything new for a few more days. Then I'd see how it reacted. I think I had a good recovery!

 

[Jockette]

I stayed one night n the hospital and I’m glad did. My blood pressure also went low, enough that the PT ended my walk in the hall early, due to his concern that I might pass out, though I didn’t. I walked back to my room, but his assistant had a rolling recliner right behind me, just in case. (he was the best PT I had!)

I also needed a one time catheter at 4 am. I don’t know what I would have done at that point if I’d been home already.

I wish I had found this site before my surgery.

I didn’t find Bonesmart until I was 4 weeks post op and “damage” had already been done.

But you’re here now, and your recovery will go much better with the guidance and support Bonesmart provides.