PKR son of textbook perfect recovery; this time I really mean it.
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Jane B.
graduate
@jeano, this is terrific! I hadn't seen your posts, something about the alert system is just not right.
So you are done-done. You are feeling better (not 100%, but that will come), riding, off all narcotics for a crazy period of time, giving horse manicures, walking good distances, driving, tending to housework, and thinking about going back to work.
Amazing! I couldn't be happier for you.
Do you think there is a big difference between a total and a partial, in terms of recovery? I would think that with a partial you still have to heal from cutting, sawing, hammering, etc., maybe just a smaller footprint. I can't imagine there is all that much difference, but I know nothing.
So you are done-done. You are feeling better (not 100%, but that will come), riding, off all narcotics for a crazy period of time, giving horse manicures, walking good distances, driving, tending to housework, and thinking about going back to work.
Amazing! I couldn't be happier for you.
Do you think there is a big difference between a total and a partial, in terms of recovery? I would think that with a partial you still have to heal from cutting, sawing, hammering, etc., maybe just a smaller footprint. I can't imagine there is all that much difference, but I know nothing.
Thank, you ladies and germs! Thinking about going to work and actually going are 2different things. I did stick my head in at the agency and was told at present they only have some (12 HOUR) weekend shifts in the biggish city 50miles away. So, nope, not gonna bite that off. When they need someone closer to home on short notice they'll call me and unless I'm having a really terrible day I'll say yes, as the close place does 8 hour shifts and its possible for me to do some icin' and elevatin' there for at least a few minutes.
I was demonstrating the classic farrier's stance (not that I can do it and actually grapple with a horse leg at the same time) at PT last week and the consensus was that I looked like I was trying to back up to a tree trunk to pee. I get no respect there. The stance involves standing facing toward south end of north bound horse, at about a third of a squat with knees together, feet apart, toes turned in, back bent forward from the hips, back straight, and the horse's lower leg trapped above one's knees. Looks and feels even worse than it sounds.
Went to PT and did get 130, or so therapist said. I told Mr jeano I would be graduating Friday and he inquired, what were parameters for the ceremony. Told him I will bake some cookies and borrow his Master's cowl from bitter rival school to my therapist's alma mater. That'll work!
I was demonstrating the classic farrier's stance (not that I can do it and actually grapple with a horse leg at the same time) at PT last week and the consensus was that I looked like I was trying to back up to a tree trunk to pee. I get no respect there. The stance involves standing facing toward south end of north bound horse, at about a third of a squat with knees together, feet apart, toes turned in, back bent forward from the hips, back straight, and the horse's lower leg trapped above one's knees. Looks and feels even worse than it sounds.
Went to PT and did get 130, or so therapist said. I told Mr jeano I would be graduating Friday and he inquired, what were parameters for the ceremony. Told him I will bake some cookies and borrow his Master's cowl from bitter rival school to my therapist's alma mater. That'll work!
Re the difference between partial and total. Having only had partials I can't say, but the BoneSmart official line seems to be that the trauma and recovery times are similar. OSs and implant manufacturers tout 'less surgery, less trauma, speedier recovery, feels more like normal knee.'
However, if I run into someone who's had a tkr they scoff that I had the 'easy' procedure and no wonder I am doing well. If you browse through the archives of the PKR threads on BS, though, you will, I think, find the same proportion of doom, gloom, agony, and Wish I'd Never Done This threads as found for TKRs. I just dont know.
However, if I run into someone who's had a tkr they scoff that I had the 'easy' procedure and no wonder I am doing well. If you browse through the archives of the PKR threads on BS, though, you will, I think, find the same proportion of doom, gloom, agony, and Wish I'd Never Done This threads as found for TKRs. I just dont know.
amber777
member
It would seem that for most people a TKR would take longer than a PKR to recover from. There are always exceptions to every situation though. I found this blog post online. broken link removed: https://www.makoplasty.com/blog/2012/05/how-to-choose-partial-knee-resurfacing-pkr-vs-total-knee-replacement-tkr/
Sent from my iPhone using BoneSmart Forum
Sent from my iPhone using BoneSmart Forum
TexasTee
post-grad
No, my quad is intact but my understanding is virtually all KRs, full or partial, are quad sparing nowadays. But we psych nurses ain't necessarily up on orthopedic procedures. I think I read that on BoneSmart. My guess is, as Jane B said, similar surgery but smaller footprint. Probably you could draw an analogy to the comparison of strength/athleticism between men and women. The strongest man will always be stronger than the strongest woman, but there WILL be some women who are stronger than some men. With knee replacements, the fastest pkr recovery will probably always be faster than the fastest total knee recovery, but there will also be some TKRs that recover faster than some PKR's.
I suspect that if I had had TKRs, or when I need revisions to TKRs, that I will have a relatively rapid recovery then too. (We are out there, in your towns and cities, healing with astonishing rapidity.)
Thinking here also of Mr Jeano,getting up the morning after outpatient hernia repair and fixing himself breakfast. The next day he started digging a ditch 3/10s of a mile long. He felt fine. And he has a desk job, so its not like ditch digging was his daily routine. I don't think this is about surgeon's skill or 'attitude' as much as its just about the protoplasm you were born with.
It may or may not be significant that both Mr jeano and I just won't take narcotics if we can possibly avoid them. That's not a recommendation that others not take them, but perhaps our pain tolerance isn't 'normal' and we don't NEED them for very long and that is somehow related to rapid recovery. Mr Jeano had to be hogtied and forced to take a Tylenol#3 after his open heart surgery, and he'd been on IV fentanyl and God knows what for three weeks prior to the surgery. Once he was operated on and off sedation he wanted no part of pain meds.
I suspect that if I had had TKRs, or when I need revisions to TKRs, that I will have a relatively rapid recovery then too. (We are out there, in your towns and cities, healing with astonishing rapidity.)
Thinking here also of Mr Jeano,getting up the morning after outpatient hernia repair and fixing himself breakfast. The next day he started digging a ditch 3/10s of a mile long. He felt fine. And he has a desk job, so its not like ditch digging was his daily routine. I don't think this is about surgeon's skill or 'attitude' as much as its just about the protoplasm you were born with.
It may or may not be significant that both Mr jeano and I just won't take narcotics if we can possibly avoid them. That's not a recommendation that others not take them, but perhaps our pain tolerance isn't 'normal' and we don't NEED them for very long and that is somehow related to rapid recovery. Mr Jeano had to be hogtied and forced to take a Tylenol#3 after his open heart surgery, and he'd been on IV fentanyl and God knows what for three weeks prior to the surgery. Once he was operated on and off sedation he wanted no part of pain meds.
TexasTee
post-grad
Actually - I'm not sure that is the case. Looking for more current article but this is from last year.
As the number of people undergoing total knee replacements has grown, so has the number of surgical options available to patients. Approximately 70 to 80 percent of total knee replacements are performed using the traditional approach involving a larger incision that affords a surgeon a wide enough view to properly align the implant and bone. Precise alignment is key to the durability of the implant.
broken link removed: https://health.clevelandclinic.org/2013/05/thinking-of-minimally-invasive-knee-replacement/
There are still doc's that don't believe the minimally invasive approach is as good and everything I've read about minimally invasive has insissions of 4-6" and a traditional at 8-12" I've seen a LOT of scars that look like they are lots bigger than 6"!
And this...
Minimally invasive knee replacement is like repairing a car engine via the muffler rather than opening the hood — it might be possible, but it is more difficult. It requires specialized instruments and is more technically challenging because the surgeon has a smaller field of vision through which to do the operation.
It's more difficult since it requires more training and special equiptment.
From John's Hopkins - again, last year.
Surgeons continually seek ways to make joint replacements and repairs easier, safer and less arduous for the patient. A number of new techniques are currently under development.
Some surgeons have started performing knee replacement surgery through very small incisions, a procedure called minimally invasive joint replacement. However, minimally invasive procedures are more difficult to perform than standard joint replacements, and researchers don’t yet know whether the long-term results will be as good. In addition, not everyone is a candidate, including individuals who are obese.
Is minimally invasive surgery for a total knee replacement as safe and effective as conventional surgery? Studies conducted to date on minimally invasive knee replacement surgery have had conflicting results, and not many have been completed with randomization and control groups. Recently, however, surgeons in Europe conducted a randomized multicenter study to compare the safety and effectiveness of the two procedures. They enrolled 134 people, average age 70 years; 66 had a minimally invasive procedure, and the rest had conventional surgery. The minimally invasive procedure took nearly an hour longer to perform because it is a more technically demanding procedure. However, it was associated with less blood loss.
At the four- to six-week postoperative visit, people who had minimally invasive surgery were in less pain and were dealing better with their daily activities than patients who had standard surgery, but this advantage was short-lived. At one year, there were no significant differences between the two groups.
You and your doctor should carefully and realistically weigh the short- and the long-term advantages of minimally invasive surgery before making a decision on which technique will be used.
https://www.johnshopkinshealthalert...Invasive-Knee-Replacement-Surgery_6086-1.html
As the number of people undergoing total knee replacements has grown, so has the number of surgical options available to patients. Approximately 70 to 80 percent of total knee replacements are performed using the traditional approach involving a larger incision that affords a surgeon a wide enough view to properly align the implant and bone. Precise alignment is key to the durability of the implant.
broken link removed: https://health.clevelandclinic.org/2013/05/thinking-of-minimally-invasive-knee-replacement/
There are still doc's that don't believe the minimally invasive approach is as good and everything I've read about minimally invasive has insissions of 4-6" and a traditional at 8-12" I've seen a LOT of scars that look like they are lots bigger than 6"!
And this...
Minimally invasive knee replacement is like repairing a car engine via the muffler rather than opening the hood — it might be possible, but it is more difficult. It requires specialized instruments and is more technically challenging because the surgeon has a smaller field of vision through which to do the operation.
It's more difficult since it requires more training and special equiptment.
From John's Hopkins - again, last year.
Surgeons continually seek ways to make joint replacements and repairs easier, safer and less arduous for the patient. A number of new techniques are currently under development.
Some surgeons have started performing knee replacement surgery through very small incisions, a procedure called minimally invasive joint replacement. However, minimally invasive procedures are more difficult to perform than standard joint replacements, and researchers don’t yet know whether the long-term results will be as good. In addition, not everyone is a candidate, including individuals who are obese.
Is minimally invasive surgery for a total knee replacement as safe and effective as conventional surgery? Studies conducted to date on minimally invasive knee replacement surgery have had conflicting results, and not many have been completed with randomization and control groups. Recently, however, surgeons in Europe conducted a randomized multicenter study to compare the safety and effectiveness of the two procedures. They enrolled 134 people, average age 70 years; 66 had a minimally invasive procedure, and the rest had conventional surgery. The minimally invasive procedure took nearly an hour longer to perform because it is a more technically demanding procedure. However, it was associated with less blood loss.
At the four- to six-week postoperative visit, people who had minimally invasive surgery were in less pain and were dealing better with their daily activities than patients who had standard surgery, but this advantage was short-lived. At one year, there were no significant differences between the two groups.
You and your doctor should carefully and realistically weigh the short- and the long-term advantages of minimally invasive surgery before making a decision on which technique will be used.
https://www.johnshopkinshealthalert...Invasive-Knee-Replacement-Surgery_6086-1.html
TexasTee
post-grad
And to close out - here is the Bonesmart article...
Quadriceps-Sparing Total Knee Replacement
Beyond making the skin cut smaller, there are modern knee replacement procedures called “quadriceps-sparing knee replacements.” “Quadriceps” refers to four well- developed muscles in the front and sides of the thigh. These muscles combine just above the knee cap into a heavy tendon called the quadriceps tendon. The tendon controls the knee cap, and allows one to straighten out the bent knee, or do bench press exercises. This function is critical to normal walking, climbing stairs, and standing. Traditionally, knee replacement surgery involved cutting into the quadriceps tendon sufficiently to turn the kneecap over and push it out of the way to expose the arthritic joint during surgery. Most surgeons still do this, although they make the skin cut smaller in keeping up with modern times.
When surgeons refer to minimally invasive surgery of the “quadriceps sparing” type, the cut into the quadriceps tendon is much less so compared to the standard procedure. Also, the kneecap is not turned over; rather it is pushed over to the side during surgery. Special instruments allow this to happen through a smaller skin cut. Of the four quadriceps muscles, the insertion of at least three is preserved onto the knee cap this way, and only one (called the vastus medialis obliquus, or VMO) is surgically cut and later repaired. This so-called “quadriceps sparing total knee” is a legitimate minimally invasive procedure that improves recovery over the traditional approach described above, independent of the skin incision length. Discharge from the hospital in a day or two after surgery is possible in selected patients.
https://bonesmart.org/knee/minimally-invasive-knee-replacement-techniques-and-procedures/
Sorry - I'm a big old nerd and find this stuff fascinating...looks like they cut the quad in the sparing type also, just lots less.
Quadriceps-Sparing Total Knee Replacement
Beyond making the skin cut smaller, there are modern knee replacement procedures called “quadriceps-sparing knee replacements.” “Quadriceps” refers to four well- developed muscles in the front and sides of the thigh. These muscles combine just above the knee cap into a heavy tendon called the quadriceps tendon. The tendon controls the knee cap, and allows one to straighten out the bent knee, or do bench press exercises. This function is critical to normal walking, climbing stairs, and standing. Traditionally, knee replacement surgery involved cutting into the quadriceps tendon sufficiently to turn the kneecap over and push it out of the way to expose the arthritic joint during surgery. Most surgeons still do this, although they make the skin cut smaller in keeping up with modern times.
When surgeons refer to minimally invasive surgery of the “quadriceps sparing” type, the cut into the quadriceps tendon is much less so compared to the standard procedure. Also, the kneecap is not turned over; rather it is pushed over to the side during surgery. Special instruments allow this to happen through a smaller skin cut. Of the four quadriceps muscles, the insertion of at least three is preserved onto the knee cap this way, and only one (called the vastus medialis obliquus, or VMO) is surgically cut and later repaired. This so-called “quadriceps sparing total knee” is a legitimate minimally invasive procedure that improves recovery over the traditional approach described above, independent of the skin incision length. Discharge from the hospital in a day or two after surgery is possible in selected patients.
https://bonesmart.org/knee/minimally-invasive-knee-replacement-techniques-and-procedures/
Sorry - I'm a big old nerd and find this stuff fascinating...looks like they cut the quad in the sparing type also, just lots less.
TexasTee
post-grad
@tiredwife - I can imagine that must be horrid! All the studies I read say in 6 months that all the various kinds of surgery patients are in a similar place but if I can avoid that additional pain then I'm all for it!
RedRider
senior
@jeano I had the pleasure of plowing through your whole thread, start to finish. You make it look like a cakewalk, such a perfect way to ease the nerves of someone like myself on the verge of a PKR. Thanks for the enjoyable read.
A quick bit on horses: my wife and I have been riding for years and it's became increasingly painful for me while in the saddle. Even with my stirrups dropped it kills my lateral side to stand up to trot/run. Just wondering how your knee holds up on a horse nowadays. Granted you're medial, but I imagine you experience the same angles of twisting and turning that horseback riding entails.
Keep up the good work!
A quick bit on horses: my wife and I have been riding for years and it's became increasingly painful for me while in the saddle. Even with my stirrups dropped it kills my lateral side to stand up to trot/run. Just wondering how your knee holds up on a horse nowadays. Granted you're medial, but I imagine you experience the same angles of twisting and turning that horseback riding entails.
Keep up the good work!
icep707
post-grad
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Hey Jeano , sounds like another great recovery. While we are on the subject of horses, my dear beloved GF is on the verge of getting a job for the state, working for the horsing commission.. i personally wasnt aware of such a entity. In the meantime she will continue at the dentist office. Anyways it has already been over 1 month since your surgery. And already pressing 120 lbs on the machines. I dont want to scold you but ..... what the heck !! Try less weight , more reps. Theres really no point but building massive muscles. And perhaps jeopardizing your implants. Id hate to hear about future complications due to muscle building. Send my regards to the ice sherpa and ancient mother. All is well here sunny California . (With no water). Best wishes Iceman
amber777
member
I've had both a partial and (now) 2 totals.
For me, the partial was just as painful and took just as long to recover from as the totals.
In fact, my first total was a revision and my recovery was easier than from the partial.
For me, the partial was just as painful and took just as long to recover from as the totals.
In fact, my first total was a revision and my recovery was easier than from the partial.
Jozilla
supremo
I will try and post some photos today @TexasTee on my thread as well as @DogLoverx3. I know she wanted to see some knees!
Y'all been busy here! Re quad sparing vs minimally invasive. Back in the day surgeons just sliced through whatever was in the way, but nowadays they spend a little more time dissecting the muscle fibers apart, that's pretty standard, and while not minimally invasive it is certainly spares the quad and other structures a lot of unnecessary trauma. My first OS says joint replacement is like carpentry. There are carpenters and carpenters. Me, I like having a cabinet maker as opposed to a house framer!
@RedRider Re riding, it doesn't hurt my knees. I try to be careful these days not to land on my right leg when I dismount, same as I was careful with the other leg last winter. I can sit or post my gelding's big road trot. Both my horses are gaited but both can trot, the mare doesn't trot under saddle very much, probably because she's too busy dreaming up new gait to spring on me and/or propping and spinning or spooking sideways.
When I bust my ankle riding in May, going down with the ship, getting rolled on, falling off and getting back on a horse to ride a couple miles back to transport to civilization didn't hurt my KNEE.
Before this most recent surgery I could not ride the gelding comfortably, because even his running walk jostled my right knee painfully. I've ridden him just once since the right was done and not for very long, maybe half an hour, forty minutes, something like that, but no problems. Understand I don't have an arena, I trail ride. We go thru the woods, beside the paved road, on the dirt roads. So constantly dealing with deer, dogs, armadillos, turkeys, cars, ATVs and worse. This weekend i'll venture further afield on the boy. I mostly need to continue working on the right ankle because it isn't as quick to recover a dropped stirrup as it used to be. Using aussie or English leathers on my western saddle has helped a LOT with both knee and ankle issues.
@icep707 phooey on your dire warnings against the measly 120 pounds on the leg press. Let's do the math. The pressing is with both legs, so a max of 60 pounds on the fresh knee. I weigh 198 stripped. I stand up umpty ump times a day putting a LOT more weight and force thru my poor knees doing a more difficult open chain movement. The press is closed chain, my back is supported, the machine lurches and stalls a lot less than me getting up from the toilet, I can promise you. Until I figured out how to get out of bed after I broke my ankle, I was doing it one legged on the left and was convinced I was killing my left implant. So that was nearly ALL my body weight pushing on that knee, with no harm done other than some muscle pain.
BTW, to get out of bed and into a wheelchair one legged WITHOUT killing the one leg or putting any weight on your broken ankle you do this: you roll from your butt to your knees, back to the edge of the bed, and put your good leg down, and stand. For the life of me I don't know why it took me two weeks to figure this out.
@RedRider Re riding, it doesn't hurt my knees. I try to be careful these days not to land on my right leg when I dismount, same as I was careful with the other leg last winter. I can sit or post my gelding's big road trot. Both my horses are gaited but both can trot, the mare doesn't trot under saddle very much, probably because she's too busy dreaming up new gait to spring on me and/or propping and spinning or spooking sideways.
When I bust my ankle riding in May, going down with the ship, getting rolled on, falling off and getting back on a horse to ride a couple miles back to transport to civilization didn't hurt my KNEE.
Before this most recent surgery I could not ride the gelding comfortably, because even his running walk jostled my right knee painfully. I've ridden him just once since the right was done and not for very long, maybe half an hour, forty minutes, something like that, but no problems. Understand I don't have an arena, I trail ride. We go thru the woods, beside the paved road, on the dirt roads. So constantly dealing with deer, dogs, armadillos, turkeys, cars, ATVs and worse. This weekend i'll venture further afield on the boy. I mostly need to continue working on the right ankle because it isn't as quick to recover a dropped stirrup as it used to be. Using aussie or English leathers on my western saddle has helped a LOT with both knee and ankle issues.
@icep707 phooey on your dire warnings against the measly 120 pounds on the leg press. Let's do the math. The pressing is with both legs, so a max of 60 pounds on the fresh knee. I weigh 198 stripped. I stand up umpty ump times a day putting a LOT more weight and force thru my poor knees doing a more difficult open chain movement. The press is closed chain, my back is supported, the machine lurches and stalls a lot less than me getting up from the toilet, I can promise you. Until I figured out how to get out of bed after I broke my ankle, I was doing it one legged on the left and was convinced I was killing my left implant. So that was nearly ALL my body weight pushing on that knee, with no harm done other than some muscle pain.
BTW, to get out of bed and into a wheelchair one legged WITHOUT killing the one leg or putting any weight on your broken ankle you do this: you roll from your butt to your knees, back to the edge of the bed, and put your good leg down, and stand. For the life of me I don't know why it took me two weeks to figure this out.
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