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Author Topic: PFR-Knee pain-Who has had this?  (Read 126887 times)

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Offline RGB

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Re: PFR-Knee pain-Who has had this?
« Reply #615 on: April 10, 2018, 04:45:25 AM »
Hi Dave. I note your 'manifesto' on how to deal with patellofemoral cartilage loss which you posted in another thread. I agree wholeheartedly, having followed a similar journey myself. That includes various treatments, including treatment with Dr Saw in Malaysia for kissing patellofemoral lesions. It didn't work for me and, like you, I find it hard to imagine anyone trying harder or sticking to the rehab protocol more closely. I have taken the next step and had a PFJR so there may be something from my experience that you find useful. I am at the 1 year post-op point. Overall, I am very happy with the result so far and I think it's going to get better yet. To put it all in perspective, I'm 55 years old and have been very active. Here are my thoughts/experiences:
1.  There's safety in numbers. Find a surgeon who's done lots of these with the new generation 'onlay' prostheses and has a low revision rate. The surgeon I used in Australia does 15 or so per annum (in addition to his 300 TKRs pa) and hasn't had a revision in the 5 years or so since he switched prostheses (to the Zimmer GS).
2. I found the initial recovery very easy. I was walking (slowly) without crutches the day after the op. Just be methodical and don't do anything stupid.
3.  It will not be a new and natural knee. There are limitations and I'm still finding mine. They are reducing over time. For instance, I cannot do a full one-legged squat. At least, I can but it's very clear that it's not good for the knee. The contact area is less and the loads are much higher than with a natural knee. You can feel them! So I stop at about 50 degrees. I can comfortably do full two legged squats though and I have full extension/flexion (to the point I can touch my heel to my bottom).
4. There's still a volume limitation which I'm trying to balance. I can cycle on the road - so a 50km ride at about 35km per hour, with a 10 minute out of the seat steep hill finish is OK. I can hike - so a 5 hour fast and reasonably steep single trail walk (without a pack) is OK. I can mountain bike - so 4 hours of steep mixed uphill/downhill single trail riding is OK. And I can rock climb - not quite back at my former grade but not far off. However, I cannot do all of these in a short space of time. Probably one strenuous activity per week is my limit and if I exceed it the knee swells and puts me out of action for a few weeks. I think that if I do this too often I will cause myself long term problems so I try very hard to avoid it. I can do less strenuous stuff during the week though - flat road cycling, rowing on a machine etc all count here.
5. I'm hoping to add skiing to the list of activities - we'll see what the (Southern Hemisphere) winter brings. I used to ski a lot so this is a big thing for me.
6.  I am very, very happy I had it done. Just being able to walk up and down stairs without pain and very loud noises is fantastic. I'm hoping to last another 10 years before needing a TKR. However, even if I get to another 5 years before needing the TKR I'll regard it as a good outcome. This is my last 5 years of a very active lifestyle and being able to do stuff with my kids (currently aged 12) which I did growing up is priceless.

Finally, a slight disclaimer. I've had what I regard as a really good outcome and I'm happy to share it. But I'm not a doctor. So no medical advice is given and no responsibility is accepted! Good luck.

Offline Dave33

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Re: PFR-Knee pain-Who has had this?
« Reply #616 on: April 22, 2018, 09:23:30 PM »
RGB - thanks a ton for this - exactly the info I was looking for - someone close to my age, with similar athletic interests. My road and mountain bike have been sitting in the basement for 10 years, with me dreaming of the day I could ride them... it's great to hear that you're back in the saddle.

Couple questions if you don't mind (I considered sending them to PM/email, but I figure the original thread creator might chime in on our discussion, and it might be beneficial to all - however if he or a moderator wants to move, no problem)

1. Can you feel the implant? Does it feel weird/take time to get  used to? Can I ask you weight and height?

2. Did your surgeon give you an idea of the lifespan of the implant based upon your age and activity level? I've heard and read the answer is anywhere from 12 years to "indefinite", but I'm thinking your surgeon with his experience might have a more valuable opinion. For the most part from what I read, it seems that the majority of failures are due to arthritis in other parts of the knee joint - and loosening is rare.

3. If it was an emergency, would you be able to run on it? Is a slow jog once a week (6 mph on a flat treadmill for 20 mins) out of the question?

4. I'm a touch troubled by your 'volume limitatation' description. What part of the knee swells? the front, like where the pain was before? Is this getting better with time/do you or your doctor expect you will be able to do more with time, or are you at your long term limit? Are there certain activities that tend to promote this type of response more than others?

5. Can I ask how long it was post surgery until you were able to ride a bike to workout levels?

Thanks very much again - you offer a rare insight.

Offline RGB

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Re: PFR-Knee pain-Who has had this?
« Reply #617 on: April 23, 2018, 06:34:00 AM »
Hi Dave. Yes - I feel a bit guilty for taking over this thread. Hopefully Mr F doesn't mind too much. As it happens, I broke my ankle last week - same leg as my bad knee. I was zip-lining with my son and hit a tree. So my answers to some of your questions will become a bit more theoretical until normal activity is resumed. Anyway, in answer to those questions:
1.  Yes I can feel the implant but not at rest. It's very slightly stiffer than a natural knee and noticeably less able to absorb shocks when it's bent. There's a slight muscle hesitation on things like stairs which I am starting to overcome and I have a very small level of crepitus. I'm still down on power from that leg when cycling although not because it feels different. The main time I notice it is deep flexion under load. Because the contact area is less, the pressures in the knee are significantly higher. It's not pain but I am aware that it's not such a great idea. The thing I hadn't initially appreciated is that the plastic patellar button leaves the prosthesis and moves onto the natural cartilage for angles over something like 110 degrees. There's a lot of pressure at that point and the areas of cartilage that are being stressed are weight bearing when the knee is straight. So there's a need for some care. That said, my surgeon seems completely relaxed about cycling although I'm not sure he appreciates the steepness of the uphills that I'm doing. Oh - and I'm 5 foot 10 and about 165 pounds.
2.  The lifespan of the prosthesis is not such an issue for me because I only have part of my medial meniscus. So my need for a revision will be driven by tibio-femoral arthritis rather than the PFJ wearing out. The surgeon expects a TKR in 10-15 years if I'm active but sensible. My own reading suggests that wear and loosening of a well positioned PFJ is now rare.
3. If it weren't for my meniscus issues I'd be quite confident running, especially on the flat. My understanding is that the prosthesis doesn't take much load running unless there are hills involved. I haven't tested this with the surgeon though and I haven't run more than a few hundred metres since the op.
4.  It's general swelling in the joint rather than anywhere specific. There's no pain but it does bulge a bit when bent - so you know you've done it. My physio is pretty confident that this will improve over time but I can't say for sure. The surgeon was pretty clear - when it swells, stop. As I said, my current limitation is for one intense bout of activity per week but for more or less unrestricted other stuff. That's not to say that I'm coasting - I row on a machine pretty hard, and cycle on the flat hard as well. It's just that I can't do too many high load activities at this point.
5.  Flat road cycling at a rate that gets the heart really pumping was at 6-8 months.

Hope this helps. It's good to be talking about it to be honest. I've had so many interventions on the knee, none of which have really worked until the PFJ and it would be good if my experience benefits someone. I see various threads talking about the success of various cartilage restoration techniques and I'm now a bit cynical. Dr Saw's process in Malaysia was my best shot and it didn't work - at least not for me.

Offline Dave33

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Re: PFR-Knee pain-Who has had this?
« Reply #618 on: April 25, 2018, 11:41:00 PM »


Great info. Thanks a ton. I'm going to print off your replies and bring to my surgeon for the consult next month - I think you've officially pushed me over the edge to commit to getting this done.

It's funny, I've had 7ish surgeries on my knees, including nasty osteotomies, and I haven't been bothered or nervous about any of them, but I'm very much anxious about this. I think the idea of an actual implant, and actually "burning bridges" at a relatively young age on an uncommon procedure is making me very cautious.... however, the possibility of getting more active with my kids is very hard to turn down.

Sorry, two more questions that come to mind... how would you rate the first few days of pain vs other knee procedures you've had, and how long was it until you could drive?

cheers

Offline RGB

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Re: PFR-Knee pain-Who has had this?
« Reply #619 on: April 26, 2018, 01:29:30 AM »
Yes - I was very nervous before this op and not before other surgeries. In the anaesthetic bay I seriously contemplated not proceeding - which is unusual for me. It's the optional nature of it and the risk that all you do is make things worse. It's small but it's there. There was also a nagging doubt (for me) that all I was doing was demonstrating an inability to adapt to a new situation.  I could get through a normal work day easily avoiding activities which led to pain so it was all about expanding the leisure time functional envelope to something approaching that which I had previously enjoyed. The surgeon was careful to explain that there is a material chance of ending up with pain that that wasn't there before, or of the tibio-femoral arthritis advancing at such a rate that the PFJR was a wasted operation. The way he explained it, he was confident of restoring the mechanics of the joint but some people just react badly to the prosthesis and end up with pain. I just had my one year follow up and he asked how I was. I said fantastic and he wiped a mock hand over his brow and said 'Phew'. So I think he was also a little nervous.

Regarding pain, there wasn't much at all really although I guess it depends on the medication regime. The main thing is that it goes on for longer than an arthroscopy. I was on a form of oxycodone for a couple of weeks, then just paracetamol. I tried to stop the paracetamol at the 3 week post-op point but my physio made me start again. He said that all I'd do was inhibit my activity. So I was on slow-release paracetamol 24 hours a day until about the 8 week point.

On driving, I wasn't at home when I had the op so there wasn't the opportunity to drive for the first 6 weeks. However, I was able to drive immediately after that.

Offline RGB

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Re: PFR-Knee pain-Who has had this?
« Reply #620 on: June 03, 2018, 12:30:19 AM »
Hi Dave33. What did you decide on the PFJR?