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Revision TKR Wberry knee is up<

Yes, but I think it is tied in with my atrophy of my quads. Remember this is self inflicted due to my unloaded brace I wore for almost a year.

The exercises the PT has me on a all strait leg or seriousness low impact on the knee. But they really work my quads and upper thighs. As always, they want no pain from the knee joint. I always get ice and tens for 20 min now also. I do the same each day at home with my portable tens unit.


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I was wondering if @Jamie or @Josephine could comment on the study from this link: https://www.regenexx.com/2011/02/knee-cap-pain-after-total-knee-replacement/
It looks like it is a quote out of a book, with other links.
Even though I am currently on a follow up PT regiment. I still feel signs that the sharp knee pain on the right and underside of the patella is still there. In addition the 3 -4 audible and physical clunks I feel as the vibrate up my leg are still there. I am so much hoping the PT will alleviate this, but the feeling when the knee catches and the clunks in three successions is worrisome.


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I purchased one of the large pads that would cover my entire knee above and below and most of the way around.
Icing more often and using the tens unit as I was directed. No change in the knee so far. Continuing the strengthening PT routines. I can defiantly feel the quads getting a work out. I tested the knee on one stair , but I still get that same sharp pain, so I didn't push it. Been doing this for a week and a half. Guess I need to be patient.
 
Lets just hope that at the end of 6 weeks something had improved. Now I know
how other feels when they are dreading a MUA, but my end state will be worst.
I asked the other guy in my church that had his TKR 4 weeks prior to mine, He told me he had no such issue with his. I have asked at least 9 people and none have the problem I have. Guess i may be falling in a percentage group. I just don't know if the problem is related to the tendons or what. I need to go ahead and make an appointment with someone for a second opinion.

Been researching anyhow, @Jamie I have found several possible solutions including what I am doing now. I ran across and abstract here: https://www.ncbi.nlm.nih.gov/pubmed/10546619
They commented on the patella clunk after TKR and a method for correcting it. one quoate from it said: "A common complication relating to patellofemoral articulation is patellar clunk syndrome. Patellar clunk syndrome occurs when a fibrous nodule develops just proximal to the patellar button. At approximately 30 degrees to 45 degrees from full extension, the nodule catches the anterior flange of the femoral prosthesis, resulting in the clunk and a painful range of motion." That caught my attention so further into the abstract it spoke about the correction and results: "All patients had a hypertrophic nodule at the junction of the proximal pole of the patella and quadriceps tendon and underwent arthroscopic debridement through a superolateral portal. All patients were free of patellar clunk postoperatively" If this is my problem, at least I have some doctor speak as they say to discuss with my OS if the PT is unsuccessful. Another reference article and a review of two cases was found here: https://www.healio.com/orthopedics/...uciate-retaining-design-a-report-of-two-cases

I remember that @referee54 commented on his knee noises and mayby @vinny also, but never in such a way that it seem to bother him to much. I just hope I am not wearing everyone out with this issue. I am down to walking slower because walking faster exasperates the problem for me, thus the catch and clunk is more dramatic. I ask everyone's forgiveness if I am sniveling to much, but this hurts and has put a damper on my recovery. Thus a certain level of apprehension and depression over it.
 
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wberry said:
I was wondering if @Jamie or @Josephine could comment on the study from this link: https://www.regenexx.com/2011/02/knee-cap-pain-after-total-knee-replacement/
Click to expand...
I had not seen this information before, but I suppose it sounds like a plausible reason for having kneecap pain after a TKR. In the US, most people get a patellar button unless there is absolutely no arthritis there.

I do think you're going to need to take things really easy for quite a while and let the inflammation settle. Your six-week plan is good. But quit trying to push to see if things are better. Just a few little "tests" like you have done can set things back slightly. Do that every couple of days and you may not see any improvement. ''

:rotfl:Do we need to duct tape you to your chair???:rotfl: (a little humor)

But seriously, you want to really give this a chance to settle down. It is possible the problems started with that second therapist. Maybe not. You'll never really know. The important thing is this is where you are now and you need to do whatever you can to improve the knee.

The study that included the nodule is probably best addressed by @Josephine.

Please don't feel like you're whimpering too much about the pain. It hurts and you are wise to deal with it and search for something to help rather than just letting it go or trying to power through it. That said, you do need to pick a plan and then own it. Do what you need to do to stick with the plan and then allow yourself not to worry until the 6 week trial period is over. I know this is easier said than done. But worrying about it isn't going to help. Putting your mind in a positive place will improve your outlook about any pain you have right now.
 
Thanks @Jamie, your comments make me feel better. I will stick with my 6 week PT, no more testing. I have only done one test, so no more until the 6 week's is up. The more I think about it, the more that second PT was about when this started. Well I refused to go back to them when the OS wanted to put me on PT for 6 weeks, and insisted I go back to my original PT. Thanks for your supportive words and for looking over the link. Trying to get in a positive place.
 
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I know....it's difficult sometimes to keep positive when you are worried about something. Just know that most recoveries come with unexpected challenges along the way. Very few are textbook perfect. But your approach of pulling back on the activity and treating the inflammation for weeks is an excellent one and it will offer the best opportunity to let your body recovery from any "overdoing it" that happened in therapy. Hang in there, guy!!!
 
My only comment regarding the nodule is that these issues usually occur as a result of friction. So one has to ask what was causing the friction - it would be interesting to do a study of these people that have them and see what exercises they were doing. I would bet my nurse's frilly cap most of them were doing squats, lunges and such!
 
Update on how PT is going. So I have been getting some benefits from the PT, quads are getting stronger. Okay so we had two primary issues:
1. sharp pain on right side of knee that stabs through knee cap.
2. The heavy clunking and grind of the knee cap as it catches and rides.

So far the first item has shown improvement. I am wearing a neo cloth brace that holds the knee cap in place, thus reliving the sharp pains. Basically it has given that problem some relief so it can calm down. Given time maybe it will heal and I can check that one off.

The second item has made no improvement at all. Disappointing I guess, patience , I must be patient.

So folks I am on week 3 of PT and if we don't get some production on solving problem two, I am going to have to face the OS with his options of going back in..

Keep routing for me folks.




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Rooting for you to get relief and see the progress you're working for.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005
 
Update on knee pain and clunk issue. So I have been put in a stabilizing brace to try to hold the knee cap so the area on the side of the knee cap can heal. What we have discovered is it is actually the clunking and catching of the knee cap which is causing the area on the side to stay flared up. So every step i take irritates that area :-(.
Strengthening the quads so fare is only providing minimal benefit. I am starting to get worried again, I have 2 more weeks to go. My quads are significantly stronger, but I am still hurting on the right side of my knee next to and below the knee cap and still have that catching triple clunk of the knee cap. I have stepped up icing and tens unit. Thinking of rescheduling my OS appointment to give my PT some extra time to improve things. Anyone have any suggestions for me?
 
So very sorry you are going through all this.

Except that the knee depends on all the muscle groups in the whole lower body to work properly I haven't any suggestions. I know that doing heel raises which exercise the calf muscles did wonders for knee pain back before surgery, quite an interesting discovery for me. Could your PT assess muscle strength and how they are working together?
 
Who ordered the brace then? Not your surgeon?? I wouldn't cancel the appointment with your doctor. I think you need to discuss all this with him if you're still having problems.
 
[Bonesmart.org] Wberry knee is up< @Jamie the PT ask me to look into a specific Mueller brace that would hold the knee cap.
[Bonesmart.org] Wberry knee is up<

She hoped it would help in calming down the sore area on the right side of the knee cap.
Since it was one area that generated significant pain on stairs. When they had me try stairs with it, the pain level seemed less or at least less intense. We went 4 weeks with no stair work and she had me start with 4 inch steps and only a few reps. My comments today are what i have noticed at the end of 4 weeks. I had not made the connection that the knee cap catching and riding up and down as i moved my leg forward was actually irritating the area below and on the right side of the knee. I thought they might be separate issues. I came to this conclusion because simply walking has started to hurt in that same area, and I can fee the pain as the knee cap rises up when it catches and then clunks down. This does not happen as i put weight on the leg, but when I bring it forward. unfortunately, if i try stairs and put weight on the knee, the already irritated area below and to the side of the knee caps kicks in and the sharp pain results because that area is already irritated. I am thinking the reason I didn't notice this early on, was the swelling keep the knee cap away from the prosthetic, now that my swelling has dropped so much, it is obviously presenting itself with a vengeance. if I walk a lot, the knee swells up and the issue decreases some, but not much. So I am caught in between a rock and a hard place. My quads are a lot stronger, and the exercise I do don't stress the knee or the knee cap areas because they are mostly straight leg exercises.

Biggest problem is when this started and he put me bacon PT he talked about releases of things in the knee. That translated to me as more surgery, so the PT was supposed to avoid that.
 
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