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TKR Severe Patellar Tendinitis - Week 20

Daneez

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Left TKR on Nov. 5, 2019

For over 20 weeks, I have not been able to walk any real distance. From the beginning, I’ve felt that something was wrong, particularly around my patella area. I have always had the extremely ‘tight vise’ feeling around the whole knee, but I’ve also had real problems with my patella tendon. Currently the patella tendon is inflamed to 5x its normal size – the Radiologist doing the ultrasound said it’s the worst case she’s ever seen. My surgeon has no idea what is causing it, and he has never seen this in his 30 years. He had me consult with another doctor, whose only thought was that maybe the spacer was slightly too small and the tendons were all working overtime to stabilize the joint, but my surgeon disagreed. I am supposed to see a revision specialist in April, but that may get cancelled again (due to coronavirus).

I have had to use a cane or walker the whole time, and the longest distance I could ever walk was to the end of our block. It keeps getting worse, and my muscles now are atrophying on that leg. I can no longer bend past 90 degrees due to the patella tendon, and am at risk for rupturing it. I have a lot of pain. Before the surgery, my arthritis was primarily in the patella area (“severe”) while the other two areas were mild/moderate. In 2001, I had a lateral release on both knees due to mal-tracking issues. It was bone on bone under my kneecap. My surgeon said the patella was definitely thinner, but he had enough to save it and attach the button underneath. My pre-surgical pain was nothing compared to this level of disability; I really wish I had never done the TKR. I hope that eventually I will be able to walk again.

General background: 1) Blood tests were negative for infection, 2) ROM was 125/-2 in January (but it was always hard to get flexion without feeling like I was going to tear something over my patella – I realize now it was because of the inflammation), 3) The patella was always very sensitive around the edges, and it has felt like something underneath is ‘scratchy,’ 4) The x-rays all look ‘picture perfect’ in terms of hardware & patella looks like it's in the correct position.

Things I’ve tried:

1) 11-day course of Prednisone, 2) NSAIDs (none make much difference), 3) daily icing and elevation (reduces pain a bit, but as soon as I stand it hurts), 4) wearing an ACL-type hard full leg brace for 3 weeks, which actually made it feel worse.

I didn't do any aggressive PT – my surgeon just wanted me to do the flexion/extension chair exercises, and that got me good ROM initially. He said scar tissue was not the issue. He had not anticipated that I'd have any issues (I'm healthy, 64, in good shape); he's consulted with a few colleagues, and is completely stumped. He made the referral to the specialist, and now all I can do is wait and hope it doesn't get significantly worse.

It seems that something that happened in the surgery continues to aggravate and inflame my patella tendon, or other areas of the knee. Has anybody experienced anything close to this? Do any of the Moderators have ideas that I might look into?
 

sistersinhim

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I think you should just do your minimum daily activities to see if you can get that inflammation out of that patella tendon. Ice is an inflammation reducer. Try icing all the time you are sitting and laying down. As long as you have a thin cloth between you and the pack, you can ice 24 hours a day.

During my recovery I had an ice water circulating machine that I kept on my knee the whole time I was down. I'd get up and go to the restroom or the kitchen, or to just walk a little, and then go right back to icing and elevating. This kept my inflammation, swelling and pain down. It can't hurt for you to try it.
 

Cjackso21

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Hello, I also have some sort of tendinitis after a revision on 2/7 where all but the knee cap components were replaced. It is either quad or patellar. He said it is likely due to the weak quad muscles and the tendons are being overworked trying to stabilize due to this. He suggested heat then ice, alternating. Seemed to help last night. But I agree on being so frustrated. If I work the muscles, then it inflames the tendons but I need to get them strong. He said it will just take time for the muscles to get stronger. Good luck!
 

Pumpkln

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@Daneez
Sorry to hear of your patellar inflammation, swelling, pain, and immobility.
As others have suggested cold pack and/or heat, elevation, and rest.
With cold packs and heat you will have to see what works best for you.

Maybe a softer support would help stabilize your knee.

Hope your appointment with the OS who specializes in revisions has some answers for you.

Keep us posted on how you are doing.
 
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Rockgirl4

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I am so sorry to hear of your pain and frustration following your TKR. It does sound very strange that your range of motion has decreased, and I hope your next appointment doesn't get cancelled because of the COVID 19 situation.

As for experiences, I did have patellar tendonitis after a major knee surgery in 2016, but nowhere as severe as your's. I DO remember being told I needed to slow down my recovery (less physical activity and more icing/elevation) so the inflammation could go down. However, mine had an obvious cause---over-aggressive PT. I know there are numerous causes for it though.

Regardless, I hope you get it figured out and can find relief soon. I know ice is usually my best friend.
 

Jamie

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Can you tell me the name of your current surgeon and the one you've been sent to for an additional opinion. I can take a look around and see if there might be someone else you can consult with once the virus restrictions are lifted.
 

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