PKR When is Click or Clunk Not Normal?

Edu

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Good morning and thanks for all the great pre- and post-op info this site provides. I've been reading for months and finally have a question I can't fully answer with the search function.

First, my particulars:
56 y/o Male
Both knees medial PKR
Right: 2 November 2022
Left: 18 January 2023

Both of my surgeries were outpatient with no complications. For the most part, I've been following my OS' direction re at-home PT. I'm going to the gym now, focusing on the right leg until released to do strengthening on the left. I'm at 0 degrees or better extension on both knees. Flexion is 130+ on the right and 120+ on the left. I feel generally that I'm making good progress.

Finally, to my question....I understand some clicking or clunking is normal from when the polymer on the tibia makes contact with the metal on the femur. I'm getting a clunk with my left knee that doesn't feel or sound like that contact. It is not painful and I don't really directly feel it, but feel the vibration, if that makes sense. The clunk can be heard by others.

The clunking is loudest when walking and my knee makes the noise at the point my leg is straightened but before my foot makes contact with the ground. I can also make it clunk by standing on my right and bending my left between 0 and 30 degrees without putting my left foot on the ground. The sound is heard at both the flex and the extension when i do this. I do not get the sound while squatting down to about 30 degrees flexion and straightening. For comparison, this did not happen with my right knee.

Have others experienced this? And more importantly, did it go away?
 
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Layla

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Hello and Welcome to BoneSmart and recovery, I will leave our recovery Guidelines and type more in a post below.

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

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.
 

Layla

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Thanks for joining us! You seem to be doing very well.
Some members complain about clicking, clunking and popping sounds. It is natural to be concerned and wonder if something is wrong. It seems more often than not that noises aren’t indication of a problem. It takes time for the soft tissue surrounding the implant to heal and settle in with the implant and begin working smoothly. If it continues occurring it’s worth discussion with your surgeon, especially if accompanied with swelling or pain, but if not over time it will most likely stop.

I wish you well as you continue healing. Stop back often, we'd love to follow your progress!
@Edu
 
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Edu

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Thank you. Unless the clunking gets painful, I won't worry. If it's still there at my 3 month follow-up, I'll discuss with my OS.

In the meantime, March 15 (8 weeks post) can't get here soon enough. That's the day I'm allowed to add higher loads to the left knee. At 8 weeks post on the right, I did a hilly 20 mile bike ride. Although tired, the knee felt almost "normal" after that. I know each knee is different, but I'm expecting equal progress.
 

Layla

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I know each knee is different, but I'm expecting equal progress.
Fingers crossed, but at least you're aware they may look like twins, but act totally different. :wink:
A belated Happy One Month Anniversary, Lefty!
Have a wonderful week!
 
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Edu

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Some more info about my surgery experience and first few weeks for those who might be interested:

I used the same surgeon and outpatient center for both knees. Anesthesia was combination of Propofol, Spinal and a nerve block in my leg. Having experienced both general anesthesia and Propofol in the past, I highly recommend the Propofol, if it's an option for you. I was in surgery by 6, wide awake by 8:30 and ready to go home by 11.

With the nerve block on the right, my leg was completely "dead" for 24 hours. No feeling, pain or muscle control from mid-thigh to mid-calf. With the left, I had feeling and muscle control, but no pain for 24 hours. In both cases, when the pain came, it was significant, but controllable. The worst was over by day 3.

I used a cooling/compression machine for both knees for 2 weeks. With my first knee, i used it religiously and continued to use ice packs after returning the rental machine. With my second knee, I used it less as I felt that the cooling was causing more, not less pain. After the worst of the swelling went down, I think the ice was transferring too much cooling to the bone/metal connection, making it ache.

I used a walker for about 4 days and a cane thereafter. The cane was ditched in about 2 weeks, the right a couple days earlier than the left.

Its now close to 5 weeks post surgery for the second knee. I've been on a few walks, the longest being 2 miles. I've been also using an exercise bike to work on right leg strength and left leg ROM. I'm really loading up the right knee at this point and everything seems to be going well.

Even though my OS thought at-home PT was adequate, I've been utilizing the services available through work. The therapist emphasized the importance of balance exercises which I've incorporated into my home and gym work. If you can tolerate them, I highly recommend it.

I know I have a long way to go, but so far, I'm pleased, despite the clunking. For those who have struggled with their recovery, you have my empathy and prayers. I realize how lucky I am to be where I am at this point.
 

Layla

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Hi there Edu,
Thanks for the update. You're doing well and have a healthy attitude toward recovery.
Happy Four Month Anniversary, Righty.
I hope you have a nice day and weekend! :SUNsmile:
@Edu
 
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Edu

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Thanks. Righty is almost an afterthought now. Just left the gym after a good full body workout (pushing the right hard while protecting the left). Trying hard to be a good patient. OS wants no heavy loading for another 9 days on the left. He knows I'm a cyclist. We tend to be a little nuts.

Clunking in the left is still there. No change other than I don't worry about it as much.
 

Layla

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Happy Two Month Anniversary, Edu!
I hope your weekend is all you want it to be. :SUNsmile:
@Edu
 

shr

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It's been a dozen years since my right knee was replaced and it's still clunky. The left knee was replace eight months ago and hasn't had any clicks or clunks until the last few weeks. I suspect that the ammount of fluid on the joint may have something to do with this but haven't seen any data that confirms this. I think you're doing fine though I know that such oddities make us wonder.
 

beachy

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I remember clunking of and on later in recovery. Maybe 6 months or so. It happens. Then it just stopped.
 
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Edu

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Last Wednesday was 8 weeks post left PKR, so I'm cleared to add more load. No issues other than it's weak. I did my first group bike ride since January. 26 miles at 16.2mph pace. I'll take it!

The clunk is still there, but I'm getting used to it so I don't notice it as much.
 

Layla

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26 miles at 16.2mph pace. I'll take it!
Awesome!! :bicycle1: :yay:
Happy Three Months Anniversary, Lefty!
Keep up the good work and don't be shy around here. We love updates.
 
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Edu

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I missed my 3 month check-in on my left knee.

Things are going well. There's still a little residual inflammation as the remaining natural parts of the joints get used to a new dynamic. I try to limit the NSAIDs because they cause edema if I overuse them. I take them just a couple times a week.

I'm also not taking it easy on the knees. I'm pushing my bike training pretty hard to prep for a metric century in a few weeks. I'm riding 2-3 times a week and did 57miles this morning.

Bottom line, despite a little achiness and inflammation, I'm happy I got them done.
 

Layla

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Fifty Seven miles?!! That is pretty ambitious for three month old, Lefty, and not quite five month old, Righty!
Do you still ice and elevate for the swelling? Consider doing so, if you've stopped.
Be nice to those knees, Edu, so you have them for a good long time.
A great week to you!
@Edu
 

Peter Mac

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Fifty Seven miles?!! That is pretty ambitious for three month old, Lefty, and not quite five month old, Righty!
Do you still ice and elevate for the swelling? Consider doing so, if you've stopped.
Be nice to those knees, Edu, so you have them for a good long time.
A great week to you!
@Edu

Sounds completely impossible to me, not simply ambitious.
 

sistersinhim

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I'm riding 2-3 times a week and did 57miles this morning.
Do you have an electric bike? I see no way anyone could pedal 57 miles in one morning. If you did, you have to give us your hint on how to do that!
 
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Edu

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No e-bike. How do you ride 57 miles in a morning? Start early! ; )

Seriously, when I first started regularly riding as an adult (about 10 years ago), I thought 20 miles was long. Now, a ride less than 25 is almost not worth getting the bike off the rack. You just build up to the distance and after a while, 50-60 is a "medium" distance. I'm far from special, but am satisfied with what i can do at 56y/o. For the last 3 weeks, I've averaged 100+ mile/wk on a T/Th/S schedule. My endurance about 80% of pre-PKRs and getting stronger every ride. Hill climbing is still my kryptonite, but that is more a function of carrying 35 extra lbs.

Yesterday was my 6-month anniversary for my right knee. It's doing great. Left, as expected, is a little behind, but doing well. It still clunking when I extend it, but it doesn't hurt.
 

zdclimber

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I did a 60-mile ride on a flat trail 3 months after my PKR. It's not impossible.
 

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