TKR secondary resurfacing of patella

[Fitzywhite]

I had a TKR of my right knee in April of 2022. It has never been pain free, but everyone says it can take up to two years. It's been a while since I posted here. The surgery was done in South Carolina and the surgeon did not resurface my patella. His rationale was that I was very active and it made a patella fracture possible if I fell off my bike, etc., and the research showed no real benefit. He did warn me that another doctor would jump on it. He never discussed it with me prior to the surgery. We have since moved to Virginia and the first doctor I saw said the knee was fine and the patella didn't matter and it takes 2 years. I saw him months after that and mentioned hip pain on the same side (I had the left hip replaced 23 years ago and it is still perfect) and his answer was I don't do hips. He mentioned that maybe I did need to have the patella resurfaced. Fast forward, Iast week I went to a new doctor at a highly regarded practice in Richmond and was told that the implant is unstable and there is a problem with the PCL and I need revision surgery because the first doctor made a mistake. We were coming to Boston (where I had the hip done at the Baptist) and I was able to get an appointment with my original orthopedists office at New England Baptist. They said there is no instability, the PCL is fine and the whole issue is the patella. It will never get any better, might get a bit worse, and although resurfacing is the answer it might not be successful. YIKES. Anyone out there had secondary resurfacing of the patella and did it help? I can walk about 4 miles at a time, but painful at the end and no twisting. Low level discomfort all the time. . . .

 

[Jockette]

Yikes is right, that’s a lot of differing opinions. I’m sure it’s hard to make a decision on what to do. Offhand I can’t think of other members who had the patella resurfaced (which means putting a patella button on it) as a later surgery after TKR, but I do remember seeing it mentioned to someone. I’m not sure she went through with it.

I can walk about 4 miles at a time, but painful at the end and no twisting.

How far can you walk before pain starts?

Low level discomfort all the time. . . .

I’m sorry to say that some of us still have low level discomfort, 2 years later, and sometimes longer. I do, and it’s been 7 years for me. My 3 second opinions didn’t find anything to fix. How bad is your discomfort?

By the way, I merged your newest thread with your original recovery thread, to keep its history all in one place.

 

[Fitzywhite]

Depends on the day. Some days it hurts the whole walk and some days I can go almost 3 miles and it seems fine. It is better. 6 months ago i couldn't go more than 1.5. However, I think maybe I am just used to it. I certainly can walk with the speed I used to have. Maybe 18.5 for the first but by the end I am at 20 minute miles and it usually hurts a lot by the end but I just walk anyway. I have to decide whether it is bad enough to want to have more surgery (that could end up making it worse). It does get swollen and it gives way sometimes but nothing too bad, it is just surprising when it happens. Thanks for merging the posts. it's been a while.

 

[Jockette]

6 months ago i couldn't go more than 1.5.

Maybe you’ve increased the distance too quickly. Have you tried taking shorter walks and maybe a slower pace, since it‘s worse after a certain time? If it was me, I wouldn’t push the knee to walk to a point it hurts and swells.

I have to decide whether it is bad enough to want to have more surgery (that could end up making it worse).

I totally understand this. In the case of my knee, my answer is no, but I’ve never been offered more surgery, anyway. I didn’t get a good outcome so my trust level is poor in anyone trying again.

 

[Fitzywhite]

Agree. I certainly don't trust the guys in Virginia. I have total trust in my Boston doctor but having it done in Boston and living in Virginia is fraught and I am just going to wait and see. . . . I was told by them yesterday that my right hip is "pregnant" so who the hell knows if that is going to just get worse. . ..

 

[NeedaThneed]

Hi - I am facing this very decision about patella resurfacing. I’m having a scope soon to free up my kneecap which has very limited mobility and has a lot of scar around it. So far I’m opting for just the scope (vs the surprise let’s open you up and resurface the patella). I’m scared to go through incision healing again. I can’t find any research that says yay or nay to patella resurfacing, other than that doing it the first time has far better results than after the fact. No idea what you should do but just curious if a knee scope is something your original surgeon does regularly? Does surgeon say your patella moves freely and normally?

Can you ride a bike still? The kneecap fracture possibility is also a concern for me being active. Though I’m no longer active due to being in so much pain :(. I can’t go up or down stairs without pain and walking down a hill can be excruciating. Can’t pedal a normal bike yet.

When I used to hike, my knees would hurt early season until I got a good up and down hill in - strengthened muscles in eccentric way. But I just can’t bounce back like I used to. I just want to wander freely in the forest again….and I keep living in this dream bubble of “I just need to find the magic spot to loosen off and all will be well again!” The deep joint pain is gone but the kneecap area so so much worse than ever.
If your patella is the problem, then maybe finding a really good manual therapy practitioner or PT might help loosen off tissues? It was a huge help for me pre-op to keep the muscles looser and balanced.