KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: RGB on June 26, 2018, 06:25:23 AM

Title: PFJR post op activity
Post by: RGB on June 26, 2018, 06:25:23 AM
Dave33 and I will probably continue our discussion on patellofemoral arthritis and PFJRs in this thread to avoid taking over Mr F's!
Title: Re: PFJR post op activity
Post by: Dave33 on June 26, 2018, 02:10:18 PM
Thanks RGB.

For those who may be following in the future- RGB has had a PFJR and I am scheduled to have one in a few months. Perhaps due to the relatively rare incidence of this type of resurfacing, there is not a lot of information available to those considering it in regards to sporting activities post, particularly in the younger subset of arthritis sufferers in the patellafemoral joint. - and RGB's experience has been invaluable.

My intention is to return to hockey and semi competitive cycling post implant.

I've been somewhat outspoken of my failures to address the arthritis with biologics, which I don't think is uncommon. I'd be happy to answer any questions pre and post op, and I'm sure RGB will do the same.

RGB - glad you're back in the saddle! A 2 hour ride is a very decent workout. Yes, i understand the new dual suspension bikes are the way to go now.. the advantages outweigh the extra weight in a lot of cases..

Could you do a 2 hr ride on consecutive days without pain?
Title: Re: PFJR post op activity
Post by: RGB on June 26, 2018, 11:37:55 PM
The 2 hour mountain bike was after a 1 hour hardish road ride session the previous day, with a 10 minute out of the seat hill at the end. I had no symptoms of pushing it too hard. I probably wouldn't have done a second mountain bike session the next day though. So that gives you some idea. Post the PFJR there's not really any pain - the signs that I've overdone it are general swelling and a mild feeling of pressure in the medial tibiofemoral area. The latter is probably more a consequence of my missing meniscus than the PFJR. Bear in mind that I've only just started to increase activity after the ankle break so I expect to ramp up slowly rather than hit it hard straightaway. I'm currently on a program of mini one legged squats with 20kg weight plus a Swiss ball against the wall 'phantom chair' - 90 degrees without weights and about 50 degrees with 20 kilos. That happens 3-4 times a week and the idea is to strengthen the knee before skiing but I haven't left myself much time. I tried something similar at about the 6 month post-op point but it was too soon and didn't go well. However, it's all good this time.


I'll search back through my emails and try to document my rehab program from just after the op to the present - in case it's useful. However you really need a good physio who specialises in knees, immediately after the op and, ideally, beforehand. Once the prosthesis is in, strong muscles are going to have some value.
 
Title: Re: PFJR post op activity
Post by: Dave33 on June 28, 2018, 01:59:33 PM
Thanks rgb- your physical therapy regimen would be helpful to know. I'm especially curious about the days immediately post surgery. My surgeon said he'll have me up walking as soon as I'm out of recovery, but I'm curious how that will translate to day to day living. Were you using crutches or a walker up front? Is it better to move as much as pain will bear, or elevate/ice/rest?
Title: Re: PFJR post op activity
Post by: Dave33 on June 28, 2018, 02:03:02 PM
In a way, I'm trying to compare the expected rehab and pain to that of the tibial osteotomies I've had, which were largely "wait out bone healing" endeavours.
Title: Re: PFJR post op activity
Post by: RGB on June 29, 2018, 12:15:17 AM
I haven't yet gone back and consulted my physio's rehab program but here's what I remember:
1.  Immediately after the op I felt remarkably good. No swelling. I could bend my knee a little and bear weight. So I walked down the corridor a couple of times (very slowly) and was able to go to the bathroom without crutches or a walking frame. I did leglifts and some mild bending on a set of 'portable bicycle pedals' which I could position near my chair. It sounds like I was very active but it was only for short bursts. Ice and elevation were important. The swelling kicked in sometime on the second day.

2.  I probably could have gone home after a couple of days but I didn't. Australian private healthcare has a system where you can be referred to an inpatient rehab program at a specialist unit and that's where I went (at no cost to me!). I probably could have done just as well at home but it was nice to have someone take care of the medication and enforce the 2 physio sessions per day. The other big plus was a 'cryocuff' automatic icing wrap. This was on most of the time that I was lying down, including overnight. In addition to the 2 supervised physio sessions per day I did more leglifts and some mild heel slides. I did a daily gentle walk around the block - maybe 500m - 1km. Medication was endone, paracetamol, anti-inflammatory and a blood thinning injection. Pain was minimal and I had no trouble sleeping. The only pain was trying to walk up and down steps. Towards the end of my stay I did a few of these just to be sure I could but I didn't push too hard. I was there 10 days.


3.  After the rehab unit I went to my Airbnb accommodation for the next 4 weeks (I was away from home and couldn't easily fly back). That was pretty tedious. Lots of lying around, icing, physio exercises (I'll provide more detail of these in another post), low/no resistence cycling and walking. I used a step counter and aimed for about 4,000 steps a day. I did a bit of work on my PC but I wouldn't have wanted to travel far or have my leg lowered for too long. Medication was just slow release paracetamol and maybe an anti-inflammatory. The swelling gradually decreased and so the flexion increased. I would have been well past a 90 degree flex by the end of that time.


That's enough for now - more later. I now wish I'd kept some notes as my memory is a bit hazy. Let me know if this is too much detail or generally not useful!
Title: Re: PFJR post op activity
Post by: cooperd70 on July 02, 2018, 01:09:43 PM
Going to keep my eye on this thread, so keep up supplying all the fantastic info RGB/Dave33  :D

Male/48/5'10"/101kg
I was knocked from my cycle by a car two years ago.  The patellar must have been bashed against the femur during the collision.  At the time it only caused swelling and heavy bruising that was gone within 3 weeks or so and then I was pain free.  I had no medical intervention.  I then started getting pain at approx. the 1 1/4 year mark after the accident, but only when climbing stairs.  The pain got a lot worse very quickly over a two week period.  I stopped climbing stairs with the knee (just used the good one to get up stairs) and also stopped commuting to work by cycle (10% hill on the way into the office).  I iced the knee each evening to reduce swelling and just did non-weight bearing exercises on the bad knee until I was given an MRI (6 weeks later - UK NHS).  This showed two full thinkness and two half thickness fissures on both the medial/lateral condyles of the femur as well as one each side retro-patellar, plus some early quadriceps tendinopathy.  I started a lower limb physio class to strengthen muscle groups.  At the same time as starting physio I started to commute to work via cycle again - I'd had a 3 month rest-up at this point).  This was when I actually noticed muscle loss in my quads on the bad side.  I can get up most of the hill, but I get off and walk when it kicks up to the 10% part of the climb (which thankfully isn't a long distance).  I no longer have swelling in the joint and at the end of the 6 week physio class do seem to have less pain.  I now only get it when climbing stairs and I 'skip' up the step on the bad knee to ensure that I don't get any pain.

I assume that I will need to re-address this as/when my situation gets worse.

Will I have to accept the loss of muscle in my left leg or are there any good exercises that you guys can recommend?
Title: Re: PFJR post op activity
Post by: RGB on July 03, 2018, 06:10:22 AM
I hesitate to offer advice because I'm not a medical professional but more so because I think what seems OK for one knee will not be so for another. However.... for my knee pre-PFJR, the best compromise of strengthening and non-pain/irritation was a range of static squats at different angles. Usually I would do this with a Swiss ball behind me against a wall at a range of angles from 30-90 degrees. Something like a 2 minute hold, one minute rest, 2 minute hold, then move onto the next angle. The reason was that I found anything that involved movement and load was no good. That included cycling. However, I could row on a machine and that's what I used for a good cardio workout. Hope this helps but don't do anything that hurts or causes more swelling. Another tip - I always found my knee reacted slowly. If I pushed it too hard, I couldn't tell straightaway. It took me a while to figure that out. I kept thinking that because the knee reacted well initially to exercise then I was all good. However, I'd pay in pain and swelling two days later.
Title: Re: PFJR post op activity
Post by: Dave33 on July 07, 2018, 07:52:21 PM
Another tip - I always found my knee reacted slowly. If I pushed it too hard, I couldn't tell straightaway. It took me a while to figure that out. I kept thinking that because the knee reacted well initially to exercise then I was all good. However, I'd pay in pain and swelling two days later.

I can second this many, many times over. I've countless left a short workout thinking "wow, my knee is not nearly as bad as I thought" and then two days later, I'm on the couch with ice bags for the rest of the week. My understanding is that the inflammation in the synovium is a delayed response to pain receptors.

Regarding my pending PFJR - I've been formally given a surgery date of end of Aug, so I'm starting to feel the reality of this setting in. The one thing that is a bit troublesome is that the other left patella has been even worse than the one they plan to resurface first... so much so that I've considered going back and begging for them to do a bilateral procedure.

After thinking it through, however, I've had so many surgeries that didn't end up the way I'd hoped - so it makes more sense to do this one side only, and confirm that it is the magic bullet I'm hoping for, before going "all in" on a 2 for 1 deal ;).

How goes the skiing prep, RGB? I see the tour de france started the other day (froome took a spill early), and was wondering how you were doing.
Title: Re: PFJR post op activity
Post by: Dave33 on July 07, 2018, 08:03:53 PM
Going to keep my eye on this thread, so keep up supplying all the fantastic info RGB/Dave33  :D

Male/48/5'10"/101kg
This showed two full thinkness and two half thickness fissures on both the medial/lateral condyles of the femur as well as one each side retro-patellar, plus some early quadriceps tendinopathy.  I started a lower limb physio class to strengthen muscle groups.  At the same time as starting physio I started to commute to work via cycle again - I'd had a 3 month rest-up at this point).  This was when I actually noticed muscle loss in my quads on the bad side.  I can get up most of the hill, but I get off and walk when it kicks up to the 10% part of the climb (which thankfully isn't a long distance).  I no longer have swelling in the joint and at the end of the 6 week physio class do seem to have less pain.  I now only get it when climbing stairs and I 'skip' up the step on the bad knee to ensure that I don't get any pain.

I assume that I will need to re-address this as/when my situation gets worse.

Will I have to accept the loss of muscle in my left leg or are there any good exercises that you guys can recommend?

There's lots of good quadricep excercises out there, and RGB mentions a good one with the swiss ball, and of course the disclaimer of not being a medical professional (applies to my ramblings as well) . One thing I'd caution you on is that you need to be hyper sensitive about "good pain" vs "bad pain" when it comes to cartilage damage. You need to establish what your envelope of function is, and stay within it and very, very gradually increase - and you may very well get to a point where you can't increase any further, and have to live with what you have. At 48 (we're close to the same age) - we simply don't regenerate articular cartilage any more to offset full thickness damage. It's about protecting what's left.

The problem with many people, especially those from athletic backgrounds, is that they're mentally conditioned to see results by "pushing past" thresholds - and even get mental satisfaction from it. This is not how recovering from cartilage damage works -and you can seriously damage your lifestyle further by pursuing it in this fashion (I'm exhibit "A" ;) ).
Title: Re: PFJR post op activity
Post by: RGB on July 10, 2018, 10:56:16 PM
Hi Dave. Brief response from the ski slopes. We are only here for 6 days and the field was closed for the first 3 due to bad weather. So the first opportunity was yesterday. I ended up skiing about half a day spread over the whole day. It was great fun obviously but I assume that's not of much interest  :). From a knee point of view, here's what's relevant:
1.  I was a pretty good skier years ago. Double blacks etc were no problem. Yesterday I was skiing intermediate and advanced runs but nothing more than that. My turns were OK but I would have struggled off piste or on the steep. It's hard to know if that's just time away (I've only skied a couple of times in the last 20 years) or the knee.
2.  There was no real pain but the knee was working pretty hard so took it easy, with a few rests, and finished early. I took a couple of Voltaren overnight as a precaution. There was some minor swelling but nothing more than I would get after a 2-3 hour mountain biking session.
3.  The interesting thing from my point of view is that my hip flexors on the bad leg were sore both during skiing and afterwards. They were clearly working much harder than they have for a long time. I do rehab exercises aimed at strengthening them (mostly the crab walk with a black Theraband) but I must be cheating in some way because those muscles are not strong! I'll need to address this in some way and when I do so it might improve my functionality in other areas.
4.  I've elected to have the day off today, to give my knee a chance to recover and also to see if there's more swelling to come - I've learned previously to my cost that waiting one day is not enough to understand the effect of new or hard exercise on the knee (both before and after the PFJR). So I'll start gradually and build up - there will be more opportunities later in the season.

I see Froome is on his way back. I feel conflicted about him and cycling generally. It would be nice to assume that it's all completely clean but I suspect most, if not all, of them push the medical boundaries. Is he an outlier and deserving of the negative publicity he's getting? I'm not sure - the case is not so clear as for others in the past.
Title: Re: PFJR post op activity
Post by: MasterForte on July 11, 2018, 04:35:32 PM
Hi RGB,

How long did your swelling last post-op? Do you still get any with activities or has that pretty much cleared up?
Title: Re: PFJR post op activity
Post by: cooperd70 on July 11, 2018, 08:56:28 PM
I hesitate to offer advice because I'm not a medical professional but more so because I think what seems OK for one knee will not be so for another.

No worries on that.  The situation is often unique for each individual.  However I only ever use information that is relevant to my situation (pick and choose).  Just trying to manage what damage I have and minimize it from worsening.  I, like most want to maximize the time up unto the point where I will require surgery.  I won't be having an op anytime soon and will hold back on that until I have no further options.

DC
Title: Re: PFJR post op activity
Post by: cooperd70 on July 11, 2018, 09:11:58 PM
I can second this many, many times over. I've countless left a short workout thinking "wow, my knee is not nearly as bad as I thought" and then two days later, I'm on the couch with ice bags for the rest of the week. My understanding is that the inflammation in the synovium is a delayed response to pain receptors.

Regarding my pending PFJR - I've been formally given a surgery date of end of Aug, so I'm starting to feel the reality of this setting in. The one thing that is a bit troublesome is that the other left patella has been even worse than the one they plan to resurface first... so much so that I've considered going back and begging for them to do a bilateral procedure.

After thinking it through, however, I've had so many surgeries that didn't end up the way I'd hoped - so it makes more sense to do this one side only, and confirm that it is the magic bullet I'm hoping for, before going "all in" on a 2 for 1 deal ;).

How goes the skiing prep, RGB? I see the tour de france started the other day (froome took a spill early), and was wondering how you were doing.
I'm by no means athletic, but I have been commuting in/out of London ([amended, sorry] 15 miles each way, 5 days week) for the past 9 years or so.  I love cycling and I'd hate to have to jack it in.  I have been learning where my threshold is and as its mostly uphill to work (low % though except for a short sharp 10%) I've learnt to keep on the inner chainring and spin, rather than mash on the outer.  Then as a reward the outer on the way home)  ;D
I too agree with both of you in that pushing it too far is a no go that just sets you back a few days.  If my situ were to change and I have to have an op, then here in the UK I have heard of a surgeon by the name of Jonathan Eldridge, Bristol or Bath way who specializes in knees.

I manage to get home in time for the TdF highlights at 7pm for an hour...its been put pack until 10pm this eve due to the Word Cup {not a fan}...boo  ;D
Title: Re: PFJR post op activity
Post by: cooperd70 on July 11, 2018, 09:24:11 PM
I see Froome is on his way back. I feel conflicted about him and cycling generally. It would be nice to assume that it's all completely clean but I suspect most, if not all, of them push the medical boundaries. Is he an outlier and deserving of the negative publicity he's getting? I'm not sure - the case is not so clear as for others in the past.
I read an excellent book by Tony Hewson some years ago called 'In pursuit of stardom' and think along the same lines as TH (rode pro in Europe in his day).  Its a grueling 3 week cycle race with 2 days rest...they've been taking anything that may give them the edge or dull the pain that their body is going through since its inception.  In the early days it was whatever they could get their hands on (sometimes having a negative impact on their performance).  As the years have gone by they've {the sport} got smart as to what does/doesn't work.  I'd like to think that present day guys race clean, but how much further can an athlete push their body for even more impressive wins, year on year. 
Title: Re: PFJR post op activity
Post by: Dave33 on July 11, 2018, 10:41:45 PM
...

Hi RGB - interesting update. First off, I'm hoping you're at least skiing well enough such that it's enjoyable... I'm guessing that you've been overcompensating for the patella for quite some time, probably unconciously, and some supporting muscle structures have suffered as you mention. I woulnd't be suprised if you came back stronger than when you left, and capable of doing more next ski trip! - assuming of course, that the knee is limited to minor swelling only, as opposed to outright pain. Smart to take it easy, especially since you haven't been to the slopes much.

I played a game of ice hockey on the weekend as a sub player (one of the regulars was out), and let me tell you, any second thoughts I might have had about scheduling the replacement were gone by about 5 minutes after the game started. I was awful, slow, in terrible pain, and still am 3 days later. I'm actually relieved that it hurt so much, because it justifies the decision. Sounds odd, doesn't it!

Let us know how the rest of your trip goes.
Title: Re: PFJR post op activity
Post by: Dave33 on July 11, 2018, 10:45:53 PM
I see Froome is on his way back. I feel conflicted about him and cycling generally. It would be nice to assume that it's all completely clean but I suspect most, if not all, of them push the medical boundaries. Is he an outlier and deserving of the negative publicity he's getting? I'm not sure - the case is not so clear as for others in the past.

I agree with you 100%. I started as a fan during the Greg lemonde/ Laurent Fignon battles, and watched the sport deteriorate into the soap opera of doping - and the Lance Armstrong revelations were pretty much the last straw. When I tune it, it's usually to get a taste of the scenery, equipment and spectacle of it, particularly the mountain stages. But I could really care less who wins at this point.
Title: Re: PFJR post op activity
Post by: RGB on July 12, 2018, 10:13:18 AM
Hi Masterforte. See my posts (starting April 10) in the following thread for the start of a description of my post-op activity levels

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55386.msg681372#new

I've then continued in this thread. Still swelling when I do too much and I've been told by the surgeon in no uncertain terms that I should not be pushing it to that point. So I'm trying to stay the right side of the line but made a deliberate decision I was going to ski with my kids this year, come what may. I'm hopeful the current swelling will subside in a week or so.

Cooperd70 - 500km cycling per week sounds pretty athletic to me!
Title: Re: PFJR post op activity
Post by: cooperd70 on July 16, 2018, 11:22:23 AM
Cooperd70 - 500km cycling per week sounds pretty athletic to me!
Whoops...was going to type 30 miles daily...its actually 15miles each way  ;D
Title: Re: PFJR post op activity
Post by: Vickster on July 16, 2018, 12:31:38 PM
I seem to recall he saw Ian McDermott

If your issues are patella, there’s a list of surgeons in the primer area of the learning portfolio

http://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery

If you’re looking for a Consultant Physio rather than a surgeon, Clare Robertson at Wimbledon Parkside is recognised as a knee expert, especially when it comes to patellofemoral issues

If Cycling is your primary concern, and in London, check out Nicole Oh (Peloton physiotherapy)


Title: Re: PFJR post op activity
Post by: Dave33 on July 20, 2018, 11:28:48 PM
https://www.amjorthopedics.com/article/return-activities-after-patellofemoral-arthroplasty

Thought this was an encouraging journal/publication.

"Our findings show that patients who undergo PFA have a high rate of return to their preferred activities. These findings can be used to inform patients who want to remain active after PFA."
Title: Re: PFJR post op activity
Post by: Dave33 on August 19, 2018, 07:32:37 PM
Well, unfortunately procedure is delayed until October, which is good in the sense that I can enjoy the weather a bit more, but on the other hand was hoping to get this done while I still had my nerve to do it.

 This would be so much easier to mentally commit to if it was more than a lifestyle decision, if that makes sense.

RGB - has the effects/swelling of the skiing trip abated? Back to riding? Any insights post?
Title: Re: PFJR post op activity
Post by: RGB on October 24, 2018, 01:22:08 AM
Just in case anyone is still interested. My knee continues to strengthen - I can feel my glutes being a bit more active and bulk is still returning to my quads. So all good. It's amazing how long it takes to unwind 8 years of muscle hesitation and protecting the knee.

I'm not hiking at present but will as the Southern Hemisphere summer arrives. I am mountain biking though and the knee holds up pretty well to a solid one hour uphill at maximum effort, average 12-14 degrees with plenty of steeper pinches. That's something I couldn't have dreamed of pre-PFJR. Downhill it's pretty good too. It copes with lots of roots/rocks and the odd drop although I don't jump the bike - more to do with my advancing age and lack of courage rather than the knee. I did try skiing for a couple of days over the winter and that wasn't so good. One day skiing, a rest day then another day skiing was enough to give pain walking for a couple of weeks. Better luck next year when I have more strength.

Dave33 - are you still having the PFJR?
Title: Re: PFJR post op activity
Post by: Dave33 on November 04, 2018, 02:30:31 PM
Hi RGB - yes, indeed - in fact, I'm now one week post-op. I sent you a note, but it bounced back - could have been the hospital wifi, which was a bit spotty.

So far, this has been an absolute piece of cake compared to the osteotomies. One week in, i'm walking without support, completely off pain meds, and the low-moderate swelling is coming down. I'll be happy to get the staples out in a couple days.

The physio is a touch rough, which basically consists of bending the knee as far as it will go (I'm at approx 95 degrees so far, not sure if that is acceptable or not)

It's funny to your point about overcoming muscle hesitation - since the two major surgeries I had prior involved bone resets, and the need to protect them post surgery, the hospital physiotherapist told me my biggest issue would be to forget those experiences, and get active and moving immediately, and he was correct. I'm heavily favoring the leg partially due to pain, but also subconsciously due to the idea that it needs to be protected. Some of the exercises involving leg extensions which caused massive pain for the last 10 years prior to surgery my brain tells me is a no go, rather than my new joint, simply due to usage patterns. This is indeed a psychological exercise for those who've lived with cartilage damage for some time!

I had some good conversations with the surgeon and some of the senior PT folks regarding limitations post-op, and their opinion was very encouraging. Ultimately, they said they'd they wouldn't consider this implant to have any sport or activity-related limitations with the exception of jumping down from heights. Apparently the cross-linked polyethelene in the patellar button is dramatically better wearing and higher technology than just 10 years ago, and could literally last 40 years, and regardless, it isn't a huge endevour to replace it regardless should it wear out.

So I'm feeling very positive so far (although a bit bummed out that I still have to do it on the other knee, so I won't have my life back yet), but so far very pleased overall.
Title: Re: PFJR post op activity
Post by: RGB on November 04, 2018, 08:13:45 PM
Hi Dave33. That's good news. It sounds like your early recovery is even better than mine. 95 degrees one week post-op sounds pretty good to me. It'll keep improving as the swelling comes down. A word of warning. Mine felt so good that at about 6 weeks post-op I was walking down a slippery grass slope and my good leg slipped out from under me and I put instant full weight on a very bent operated leg. Not great. More swelling. No permanent damage but it set me back a few weeks. So activity is good but stupidity isn't!

In a similar vein, I came off my bike going uphill a few weeks back - a nasty single-track tight rocky corner but something I'd usually make without trouble. Anyway, because it was uphill I didn't have my knee pads on and I took impact from a rock directly on the prosthesis. A bruise but no damage - yay. However, I will be more careful with my knee pads from now on.

It's early days for you but the signs are promising. I did read about your doubts pre-op and the whole lifestyle vs risk dilemma. I felt exactly the same way - right up to receiving the anaesthetic. It's easy to find bad stories about PFJRs on the net - so it's good to be putting up a couple of stories on the other side of the ledger. Best regards. Not sure what happened about the note - I didn't get it.
Title: Re: PFJR post op activity
Post by: Dave33 on November 05, 2018, 02:17:30 PM
Hi RGB - good to hear from you. Heh, yup, that's the downside of single track.... you'll take a spill now and again. Glad everything held up. I didn't know they actually sold knee pads for cycling, I'll have to look into that, because certainly intend to get back on the trails one day.

Yes, unfortunately in 6 weeks here, we'll be covered in snow and ice.. slipping hazards abounds. I'll try not to replicate your setback!

What's the update on your swelling issues post-activity? I know the skiiing was a touch disappointing, but has anything improved on your cycling/hiking freqency and output of effort in that regard? You mention you're getting stronger - was hoping to see that correlation in less swelling for you post workout in back to back days, etc.
Title: Re: PFJR post op activity
Post by: RGB on November 05, 2018, 09:21:53 PM
The answer to the swelling question is a bit imprecise. When I flex my knee to the max - heel touching bottom - there's definitely a small fluid bulge at the front/outside which is not there on the other knee. The other test is to sit flat on the floor with the leg outstretched and flat. Brush your hand down the inside of the knee, then the outside, just towards the floor from the kneecap. If the outside brush causes the inside of the knee to bulge outwards with fluid then that's also a sign of excess fluid. My physio says that if the latter test is positive then the quads are starting to shut down. My knee always fails that test. The surgeon told me to avoid activities that resulted in swelling so if I used that test as a guide I'd do nothing. The swelling gets mildly worse with intense mountain biking and it also got more materially worse with my unsuccessful skiing attempt. Interestingly, road biking doesn't seem to have the same effect but I'm pretty sure I'm favouring the bad leg a little when I road bike. That's harder to do on a mountain bike on a steep hill. The only things that resulted in actual pain are the skiing and the lifting of heavy weights (due to fence building!) but that was a couple of days afterwards and in the weight bearing area of the knee rather than the patellofemoral joint so it could well have been due to the missing part of my medial meniscus. So at the moment, I'm increasing my mountain biking gradually but making sure I don't go on successive days - which would result in more swelling. Also, I still do physio exercises 2-3 days a week. I notice a deterioration in muscle activation if I don't. I've got good quad muscle bulk on the bad leg now but there's still a bit of mass missing from the upper outside of the thigh. The mountain biking seems to be addressing that over time. Sorry - that's probably not overly helpful. Regards.
Title: Re: PFJR post op activity
Post by: Dave33 on November 06, 2018, 04:55:01 PM
The surgeon told me to avoid activities that resulted in swelling so if I used that test as a guide I'd do nothing.

Yeah, my surgeon specifically mentioned that there's likely be an element of permanent swelling that woudn't fully go away, but wouldn't be harmful. He attributed it to the body's natural response to the implant.

As you mention, if the exercise level you're doing isn't making it change dramatically, then I guess you'd just consider it the base level, and go from there. I'm still very impressed with the level you've taking the implant to, specifically on the bike. That duration of pitch and duration of uphill riding is a serious workout, natural knee or no.

Had a good physio session today, a week and half after surgery.. got on the stationary bike with no resistance, and got the joint to bend to 115% degrees. Very encouraging.

Title: Re: PFJR post op activity
Post by: RGB on November 06, 2018, 08:44:31 PM
Excellent news on the ongoing recovery. Please keep me posted. I think I'm close to doing as much mountain biking as I have time for. The downhill difficulty will go up but the duration and difficulty of the uphill probably won't. Some hiking to come though and hopefully skiing eventually. I've recently cut down to 2 days work a week. The idea is to spend more time with my children rather than exercise like a maniac but I've gotten them interested in mountain biking so maybe I can do both at the same time. Regards.
Title: Re: PFJR post op activity
Post by: Dave33 on November 14, 2018, 10:04:02 PM
Well, I'm just coming up on 3 weeks as of tomorrow AM, and so far, nothing but positives to report so far.

I'm walking with minimal limp, ditched the cane, physio has me at 130 degrees of bend, and I'm starting to do more advanced exercises, like step ups. The real win for me there, is that I couldn't have done those step ups without pain prior to the resurfacing. So I'm wary of getting too ahead of myself at this early stage, but all indications are good. A fair bit of swelling still exists, and there's clearly still a lot going on around the knee joint, but every day everything gets a bit better.

I'm considering taking my old Cervelo off the wall on the weekend, where it's hung for almost 10 years, and putting it on the fluid trainer. Now that, would be a big moment for me, with a fair bit of emotion involved if I was able to do even a light ride, with no resistance.

RGB/all - hope everything is going well.
Title: Re: PFJR post op activity
Post by: Dave33 on December 21, 2018, 08:35:39 PM
Well, I'm pretty much closing in on the 2 month mark.... again, nothing but positives for the most part.. actually got out on the ice and did a bit of skating the other day. It might have been a touch early, and I'm definitely feeling it today, but it also resulted in a good workout for the stabilizing muscles around the knee.

So definitely going well. The only "troubling" (and I use that extremely loosely) thing is the swelling that persists.. it generally starts a bit swollen in the morning, and by the evening, is nice and hot with more fluid around the joint. I generally ice it down in the evening, and the process starts over again.

My understanding is that this is fairly normal, but I was hoping this would begin to resolve at the 8 week point. I'll keep an eye on it, and continue to ice/move/add activity. RGB - could you relate to this during your early recovery, and at what point in your rehab timing could you say that the joint looks fairly optically similar to the non-operated side?
Title: Re: PFJR post op activity
Post by: RGB on December 22, 2018, 10:02:34 AM
Hi Dave33. I was just about to post and ask for an update. 2 months is about the stage I fell on the knee - unplanned full weight in a flexed position. That reactivated the swelling in a big way. But it was still quite swollen before that as I recall. I would have had close to full flexion but still a noticeable bulge when it was flexed. As for looking the same as the non-operated side - if I tense my muscles it looks close but if I'm relaxed then my operated knee is still noticeably larger than my other knee, even after 18 months! My party trick is to stand up straight and relax so that the patella hangs loose from the femur then tap the patella against the femur for a loud metal against plastic noise. I doubt I could do that if there wasn't excess fluid. So I'm sure the swelling will reduce from the 2 month point but, if you follow a similar trajectory to me it will never go away completely. If I recall correctly, at the 2 month point I was walking about 5,000 steps a day, practicing  some up/down/sideways steps off a single step, some clam exercises, heel slides, standing on one leg with my eyes closed for a few minutes and cycling 20 minutes or so on low resistance. Also, I would still have been icing 2x a day.

As for me - strength still improving which surprises me. I thought I'd be there by now. Don't get me wrong - it's great and I can cycle pretty much as hard as I want. But the uphill is still getting easier and it's not just fitness - I can feel the operated knee getting better. So good news. And I'm having great fun doing harder and harder downhill trails. Summer is here so I'll try hiking again shortly. Maybe skiiing will better next winter....

Regards to all.
Title: Re: PFJR post op activity
Post by: Brandon123 on December 22, 2018, 12:48:38 PM
My party trick is to stand up straight and relax so that the patella hangs loose from the femur then tap the patella against the femur for a loud metal against plastic noise.
;D ;D ;D
Title: Re: PFJR post op activity
Post by: Dave33 on December 24, 2018, 07:02:58 PM
Thanks RGB,

That helps a lot. I think I should be increasing the icing to two sessions, and maybe lowering the resistance on the bike.. probably overloading the joint. That said, after a couple achy days after the skating, it actually feels better than before without as much effusion. Feeling good!

I have to admit, I just tried your party trick. And lol, I can do the exact same thing! Aaaaa! It's both neat and a bit stomach churning at the same time, as most of the time, the joint feels perfectly natural
. I forget there's plastics and metal in there. And after I tried the trick, the thing was clicking by itself on every step for the next ten minutes. Ugh. Heheheheh.

Hey, all the best for the holidays to RGB, Brandon, and everyone else with or without annoying knees. Cheers
Title: Re: PFJR post op activity
Post by: Dave33 on February 10, 2019, 03:35:34 PM
Hi PFJR fans,

Thought I'd give a brief update since I just got back from the 3.5ish month appointment from surgeon.

Things are going just about as well as I could have hoped. I started playing hockey once a week since the 2 month mark, a few aches and pains, but everything just keeps getting better and better. The only thing that holds me back is the other knee, which isn't quite so bothersome knowing that I have a proven treatment option.

 I've decided to just enjoy life for the next 6 months instead of immediately booking the second knee - which coincides with my next checkup appointment.

Only "issues" are: 1)  - man, this thing is noisy, which can vary based on the amount of swelling or what ive been doing on the day.. click, pop, ping, clunk. Sometimes, completely silent for 2 days, sometimes, I feel like a one man band. Heh. Doesn't bother me much, and surgeon laughed (I relayed RGB's "party trick" comment) - but he said totally normal, and being so early, not surprising at all, and will likely settle down a bit by the 1 year point.

2) Trying to rehab the quadricep. It's extremely tough to do when you can only use one leg. Cycling really bothers the other knee, and that would have been ideal as my go-to exercise, same with elliptical. I do step ups, and short range one leg squats, and the like, but it is taking a long time to see any mass start to form in the quad. I think likely the remaining swelling is playing a part in getting it to activate, but I'd like to see a lot more muscle in there in the hope that it will help protect the implant long term. Any ideas there RGB or others, would be good. I was considering trying a rowing machine, and just use the one leg in the motion...?

Anyway, I can safely say that at 3.5 months, if it never got any better past this point, which I'm sure it will, I'd still be thrilled with the outcome. And truth of the matter, if I hadn't got RGB's insights early in the process, I very likely may have not have gone ahead with the procedure. So put one up on the board for shared experiences and decent, helpful people.
Title: Re: PFJR post op activity
Post by: Brandon123 on February 10, 2019, 05:24:45 PM
Thanks for the update, great that things are going so well! :)
Title: Re: PFJR post op activity
Post by: RGB on February 10, 2019, 11:00:18 PM
Great news Dave33 and happy I could play a small part in you making the right decision. I was expecting an update about now and it seems it couldn't be going any better. Playing hockey at 2 months - puts my recovery in the the shade. I know everything is individual but there's no way I could have done that. My ideas for one legged quad rehab are a rowing machine and static squats against the wall.

I used a rowing machine pre-op because my bad knee didn't like cycling but it was fine for about 30 minutes a day of pretty hard rowing. As well as general strength, it helped with the timing of the quad firing and in getting the hip/glute muscles going properly. My bad knee was fine with it so maybe yours will be too. Didn't use it post-op because cycling was fine and more fun. Rowing on a machine is great for cardio but so, so boring.... I ended up on a 'hire to buy' deal on a Concept Ergo rowing machine then purchased it and it's served me well. I'm currently having to go back to it because we've got a wildfire blazing nearby which is set to keep going for a few weeks. There have been evacuations etc all around and all the tracks/roads I cycle on are closed.

Static squats also helped me. Not so good as real squats but I found deep, dynamic squats too tough and this was the next best thing. Once you're in position you can adjust the load between legs to suit. Apparently, squats only work for +/- 10 degrees of the angle you squat to, so it's best to do them at a range of angles. I do mine for 2 minutes, 1 minute off and then another 2 minutes, then move to the next angle, all the way down to 90 degrees. For those down to about 50 degrees I put a 10 kilo weight in each hand but I had to work up to that. Not for the deeper ones though.

Hope this helps. Keep up the good work. Regards. Richard.
Title: Re: PFJR post op activity
Post by: RGB on February 10, 2019, 11:04:32 PM
PS - static squats against the wall with an exercise ball behind your back.
Title: Re: PFJR post op activity
Post by: Dave33 on April 06, 2019, 02:30:32 AM
PS - static squats against the wall with an exercise ball behind your back.

Hi RGB  -I've done these now for about a month, and am definitely seeing a difference. More bulk in the vmo/quad is sloooooowly becoming noticeable!

Well, for all you PF replacement fans out there, I'll give you my 5 monthish update. I'm playing hockey once a week, as I have been since approximately month 2.5, and am skating as well as I was prior to surgery, but with a 95% less pain during and after. I still take an advil prior to getting on the ice, but it's more for my other kneecap which is also arthritic.  I see my surgeon for a followup in August, and I expect I will book the replacement on the other knee at that time - in only a 5 month period, it is clear that the replacement was a great success, and I only expect it to improve further.

Downsides? A few. One, it makes a ton of noise. Pinging, clacking, and occasionally, a solid clunking noise and sensation, which is a bit stomach churning, and can result in a bit of swelling. It seems to be related to IT band and hamstring flexibility, so I'm putting more efforts in to stretching the muscles and tendons around the knee, and this helped greatly.  99% of the time, its unperceptable, but the metal and plastic makes itself known on occasion. It isn't a natural joint.

Looking forward to the other one getting done so I can do other things, like cycle and elliptical, and possibly get back to cross country skiing as well.

RGB, anything new to report?

cheers


Title: Re: PFJR post op activity
Post by: RGB on April 09, 2019, 11:48:21 AM
Only thing to report is that I'm just back from my first multi-day outdoor trip in years. Mountain biking 85km of grade 4 single track with lots of elevation. Fantastic and no complaint whatsoever from the knee. I'm stiff in most other parts of my body though - which is very much a good thing. Hello to all and especially Dave33 - your recovery seems very, very good but now we both know what we mean when we say it's not a natural knee. It's very good functionally and I often forget that it's metal and plastic - then some happens to make me notice it again. I haven't really done a good job of describing it but I think it's hard to communicate to someone who can't feel it for him(her)self. Hands down a good outcome for me though and I'm very happy I persevered through many doubts and poor outcomes with other procedures to get it done.
Title: Re: PFJR post op activity
Post by: Dave33 on June 09, 2019, 11:01:22 PM
Just about at the 3/4 of a year mark -booked my 1 year follow up. I'll probably make this the last update, as most likely get the picture that I'm happy with the outcome after so many failed attempts prior.

Basically, I can do anything at this point. I play hockey now twice a week (non contact), and have seen my speed increase and post game discomfort decrease as the leg has gotten stronger and stronger. I can jog very slowly on the treadmill (mostly limited by the other knee, which is also a PFR candidate) I can bike and elliptical, but am also limited by the other knee (the PFR one is pain free). I do the static squats outlined by RGB on a 4x a week basis, and that's helped greatly with the rehab.

The knee is not normal- lots of crunching, cracking and pinging noises, none of which bother the surgeon, and none of which are painful. It can be stiff first thing in the morning, and I'm still working on priopception and balance... it's really due to the years of lack of use. It's a perfectly acceptable tradeoff in all respects.

Anyway, any questions to anyone considering this surgery, and have questions they'd like to ask, feel free to reach out, and I'll shut the updates down at this point regarding my personal  healing process.

RGB - you'll be going into your "winter" season now.. anything new activitywise? cheers
Title: Re: PFJR post op activity
Post by: RGB on June 16, 2019, 02:07:39 PM
Hi Dave33 (and anyone else interested). Well done on your recovery to date. Hopefully there's still some improvement to come yet. Are you going to get the other knee done?

Not much to report from me. Mountain biking still improving. I've abandoned my previous rule of keeping at least one wheel on the ground at all times. Too limiting. I've moved onto tracks that require good 'drop' technique. Otherwise it's a face plant at speed. That means a lot more load on the knee although the suspension soaks up most of the landing. Anyway, the main message is that my patellofemoral joint is not the limiting factor.

 I haven't been hiking this summer. Too much else to do although I suspect I might have been limited by my missing medical meniscus. Hard to tell without trying. I'm due a few days skiing in three weeks. That wasn't very successful last winter so I'm hoping for better. Again though, I don't think it's the PFJR that's the issue with skiing - its weight bearing through the missing meniscus.

All in all, I'm very happy with my knee. The PFJR has given me back a wide range if activity and a cardiovascular exercise which I enjoy. I don't notice it on a day to day basis except in stairs where there's a very slight hesitation before I get going.

Happy to answer questions - either about the success of my PFJR or the failure of various stem cell, prp and microfracture procedures.

Regards to all.
Title: Re: PFJR post op activity
Post by: Dave33 on June 23, 2019, 12:50:58 AM
Hi Dave33 (and anyone else interested). Well done on your recovery to date. Hopefully there's still some improvement to come yet. Are you going to get the other knee done?

Not much to report from me. Mountain biking still improving. I've abandoned my previous rule of keeping at least one wheel on the ground at all times. Too limiting. I've moved onto tracks that require good 'drop' technique. Otherwise it's a face plant at speed. That means a lot more load on the knee although the suspension soaks up most of the landing. Anyway, the main message is that my patellofemoral joint is not the limiting factor.

 I haven't been hiking this summer. Too much else to do although I suspect I might have been limited by my missing medical meniscus. Hard to tell without trying. I'm due a few days skiing in three weeks. That wasn't very successful last winter so I'm hoping for better. Again though, I don't think it's the PFJR that's the issue with skiing - its weight bearing through the missing meniscus.


Sounds like you're doing great! Full on singletrack MTBing! I'll be interested to hear how your ski trip goes; especially if you see improvement vs your last trip, which if I remember correctly, caused a bit of swelling and required some rest days.

Yeah, I'm waffling on the other knee. I'm definitely limited by the exposed bone there; the osteotomy helped a bit, but it's not unloaded enough to really put any kind of regular sport related pressure on it, like cycling or elliptical/running. I can get through a hockey game, which is wonderful, but I'm struggling with regular exercise apart from that. Not to mention it's summer here, so all I see is country roads full of cyclists/triathletes getting rides in, and I certain miss taking part (11 years and counting!) I think what is holding me back is the idea of having both done and being "on the clock" twice in terms of future repairs/revisions. But on the other hand, the idea of getting one done was to get more active and happier psychologically, so.... although I must say, playing regular hockey has been such a godsend in terms of stress relief. I guess now that I've had a taste, I want the entire 4 course meal.

 I have an appointment with the surgeon in early October to assess my implant at the 1 year mark; I guess I'll make the decision then. What are your thoughts? All your damage is on the one knee, correct, and no need for any work on the other?

cheers
Title: Re: PFJR post op activity
Post by: RGB on June 26, 2019, 11:20:52 AM
Will report on the skiing in 2-3 weeks.

Dave33 - I completely understand the uncertainty about the other knee. On the plus side, proceeding likely means another leap in general functionality and sustainable activity levels. On the minus side are the risks - both short term and long term.

The short term risk is that something goes wrong and the op makes things worse. It's easy to write this off as unlikely but it's significant enough to worry about and gave me a lot of stress right up until I was in the anaesthetic bay. It worked out well for both of us but there are plenty of bad luck stories on this forum regarding PFJRs.

Then there's the longer term risk. We'll both probably need TKRs at some stage but the questions are will the PFJR delay that or bring it forward, and does the PFJR affect the success and longevity of the TKR? I don't really know about the first question but, as regards the second, there is some recent evidence that the TKR revision rate after a PFJR is higher than for a 'fresh' TKR although lower than for a revision TKR. I can't recall the exact reference but my vague recollection is that paper was based on the UK and Aust joint registry data and seemed pretty solid. I'm not too concerned about this - the revision rate is low anyway so we'd need to be unlucky to need a revision TKR before we were very old. I guess that's easy to say when it's far off in the future but the deciding factor for me at the time was that I was prepared to trade some 'possible' activity restriction in my later years for increased functionality now in what I see as my last remaining active years.

However, in hindsight it was about even more than that. Pre-PFJR I was obsessed and depressed. So the PFJR has done a lot more than giving me functionality - it's enabled me to haul myself out of a mental pit that I couldn't otherwise deal with. That was worth all the short and long term risks. But maybe if you're not in such a pit, it's not worth the risk?

Sorry - I think I'm probably just expressing stuff you've already thought through. Anyway, that's the extent of my current insight on the subject. Happy to converse further if it's of any value. Regards.

Title: Re: PFJR post op activity
Post by: Brandon123 on June 28, 2019, 10:36:21 AM
Thanks for your reflections on the topic, RGB. I think your thoughts are very valuable for anyone who comes to this forum to seek out information about PFJRs.
Title: Re: PFJR post op activity
Post by: Dave33 on July 11, 2019, 06:04:30 PM
Will report on the skiing in 2-3 weeks.

Hi RGB - how did it go? Any improvement over the last trip?

I had a "bit" of a setback at 8 months... I played a hockey game about two weeks ago, and a day or two later, the knee responded with a fair bit of delayed pain and swelling that took a full week to get back under control. I had been pushing it more and more over the last few months, and perhaps I went past the envelope of function.

 I was initially worried that perhaps I'd damaged the implant, but there was no fall or impact of any kind during the game, and no pain during or even in the hours post-game, so I've chalked this up to simply overload.....

My quad/vmo is still drastically underdeveloped vs the non replaced side; I've started a regimen of 1 leg cycling on the ergo (the other knee can't tolerate the cycling motion) to try and get the supporting muscles stronger. Hopefully this provides better results.

I remember that you mentioned in the first year of your recovery that you were limited to one "hard" sporting effort a week; is what I mentioned above similar to your experiences when you overdid it? You were mentioning that your results and tolerance had improved past the 1 year mark, so I'm hoping I'm following in your kneesteps, as it were.

cheers
Title: Re: PFJR post op activity
Post by: RGB on July 12, 2019, 01:34:32 AM
Hi Dave33. Just finished 4 days skiing and no ill effects. Yes! I'm back. The season is pretty poor here and it's early so there was only man-made snow on intermediate piste. However, I skiiied reasonably quickly for the 4 full days and my knee felt very close to normal. So much so that I invested in a pair of ski boots so as to make all the days I intend to ski in the future a bit more fun. I don't mind renting skis - if you pay enough they're pretty good and you can pick models to suit the conditions. However, I hate renting boots.

As regards your temporary set back, it doesn't sound anything more than that to me. I've had a few and I may get a few more although it's been a while since the last. You're right, for the first year or so, I couldn't do any more than one hard session per week - by hard session I mean something like a one hour continuous uphill ride. Also, I couldn't really do any 'normal' squats or similar. Any of this would lead to some mild discomfort and swelling so I knew to back off. The most notable set back was my previous attempt to ski last season which was a full 15 months post-op. The knee swelled and was quite sore. It took at least 2 weeks to get it back under control. As part of that episode, I noticed that my glutes were still not firing properly to support the knee and that led to a minor change in my rehab exercises. So I wouldn't worry too much although I accept that's hard to do - I'm still hyper-vigilant wrt the knee and any small pain has me contemplating the worst. Anyway, my main message is that my knee is still improving noticeably even now and so you are only part-way through the rehab process. So keep listening to the knee and changing your rehab activities to suit. It's finding the balance between expanding the envelope of function and not irritating the knee which is the trick (lecture over!).

Over the last year, my improvements have been significant. I can now do normal squats and the occasional one-legged full squat. My muscles are firing close to normally. When I'm doing vigorous exercise I really don't notice the knee at all. My muscles are not quite as large as those on my normal knee but that's quite a common consequence of ACL repairs (which I had 25 years ago) - even for athletes. When I'm walking, there's still a slight hesitation when I climb the first few steps on a flight of stairs. My main restrictions are that I don't run or do jumping activities (although I jump the mountain bike - the suspension takes care of the jarring), I haven't been on a full-on hike with a heavy pack (and I'm not sure I would) and I try not to bend the knee under high loads at more than 90 degrees. That last restriction is not from my surgeon but I'm certain that the plastic kneecap moves onto native cartilage just beyond that angle and I'm not crazy about the thought of plastic on cartilage.

Best wishes and keep those updates coming. I'm slightly invested in your recovery!
Title: Re: PFJR post op activity
Post by: Dave33 on July 29, 2019, 04:23:35 PM
Hi Dave33. Just finished 4 days skiing and no ill effects. Yes! I'm back.

Terrific news! I'm really pleased to hear that; I remember you were a little down after your last trip, and the fact that you're still improving years later is great to hear, and makes me think that my "setback" is merely an issue of time and rebuilding strength/tolerance in the joint.

To that point, the PFJR knee is back to normal, and I've got it on a regular more intense regimen of one leg cycling/static squats, and I'm seeing benefits already; hockey no longer causes post-game pain, and it feels more solid doing regular activites, like descending stairs, etc.

I went on a vacation recently to some mountains (summer here), and looked enviously as a constant stream of happy mud-caked mountain bikers came in and out of trails around the hotel. So, of course, I'm back to considering having my other knee done, which would get me back out on the bike... the problem with doing a little, is that you want a little more.

I have my 1yr appointment with the surgeon in October, so I'm making this deal with myself - i'm going to gently spin on my road bike 2x a week outside for 25km until October; I know my pfjr knee will love it, and if the other knee can tolerate it, I'll delay the other other knee for a year; if it causes significant discomfort, then I'll commit to getting it done asap, and get on with life. Sound reasonable?

Heh, I know what you mean about the 90degree loads - you're right, it doesn't feel... "safe" if it makes sense. It's a weird sensation that feels damage prone. I can certainly live without that range of motion regardless.

cheers
Title: Re: PFJR post op activity
Post by: RGB on August 02, 2019, 10:46:37 AM
Sounds like a good plan. If you can do enough activity to remain fit and happy then it doesn't seem worth the risk of it going wrong in either the short or long term. If you can't though.....
Title: Re: PFJR post op activity
Post by: Dave33 on September 14, 2019, 03:37:19 PM
Sounds like a good plan. If you can do enough activity to remain fit and happy then it doesn't seem worth the risk of it going wrong in either the short or long term. If you can't though.....

Hehe, I had a couple short (<20K) gorgeous summer evening rides on the smooth roads in the fields near my home, and unfortunately after the third one, the other knee started the old familiar distal catch and ache. I'll give the surgeon the go-ahead in my next appt. Once more into the breech!

You're getting into your summer season, I trust your mileage going up and your knee strong as ever?

cheers
Title: Re: PFJR post op activity
Post by: RGB on September 15, 2019, 02:33:05 AM
Yes - not sure I would live with 2x20km on the flat per week being uncomfortable if there's a high probability solution. Good luck. Let me know when the op is and how you recover.

I've been slowed up a bit over the last month by a cracked rib. Built two mtb features in one of our paddocks: a drop with adjustable height and a 'cannon log' jump. The drop was fine - started low and gradually raised it to about 1.2m. The cannon log not so much. I observed my son and his friends on it, jumping 4-5m (horizontal) which sounds small but is actually pretty confronting when you see it. I was too scared so built a wooden landing ramp, started with it near to the jump and then moved it further away as I got more confidence. After a few jumps I ended up clearing the ramp quite easily and got a bit over-confident. Gave it a lot more speed, got a little offline on the entry and lost the pedals in the air. No way back from that. Landed heavily, smashed glasses, bruised a shoulder and cracked a rib, jumped 3 more times to make sure I wasn't too scared and then retreated to the house. It hurt badly to move and especially sneeze until about now. I should know better at age 57. Good news on skiing though - I just took my kids for 3 days skiing (taking care not to fall and further damage my rib) and the knee was absolutely fine. A few black runs, skied fast so it got a decent workout. Yay.

Best wishes to you Dave33 and anyone else still reading although the information content in this thread is now quite low - sorry......
Title: Re: PFJR post op activity
Post by: Dave33 on September 23, 2019, 02:45:18 AM

Heh, I laughed at your "I should know better at 57" quote. Ah, you're as young as you feel - but I imagine a few cracked ribs will certainly move the clock forward a bit, my friend! In a way, the fact that you didn't land on the implant in any angle is probably a relief, and the fact that you're trying out these sorts of jumps is a testament to how comfortable you are with the joint.

Still, skiing with the bones still knitting, and a partial knee, and you're getting a workout? There's a lot to like in there. Good stuff.

I'm getting my 1 yr xray next week; one thing that I offered my surgeon was for him to feel free to have any prospective PJFR reciepients get ahold of me if they wanted my perspectives - apparently there's a few that indeed want to chat, so I'm going to meet them with the surgeon during my appointment. I figure since there was a certain fellow in Aus that was such a huge help in this for me, the least I can do is pay it forward locally. I won't show them the "party trick" patella tap/clang, though. ;)

cheers
Title: Re: PFJR post op activity
Post by: RGB on November 07, 2019, 09:03:31 PM
Hi Dave33. Any news on your intentions with your remaining bad knee? I had a reminder of my fragile mental state the other day. I'd done a few days of heavy lifting of logs over broken ground - not something I should really be doing. Then noticed my knee was swollen after mountain biking. That immediately triggered the whole "I can't do anything on the knee - I'm condemned to a life of misery" spiral. It took me a few days to realise that it was probably the lifting that was the problem and that I just need to find my find my envelope of function again which will almost certainly include lots of mountain biking. I'm temperamentally inclined to push and push, which doesn't work so well in later years, irrespective of my PFJR! So all good again and I've been out for a ride which went well, so will gradually ramp up.

Sigh. There's an over-representation of people like me on this forum. No coincidence. Regards to all.
Title: Re: PFJR post op activity
Post by: Dave33 on November 19, 2019, 02:40:45 AM
Hi Dave33. Any news on your intentions with your remaining bad knee? I had a reminder of my fragile mental state the other day. I'd done a few days of heavy lifting of logs over broken ground - not something I should really be doing. Then noticed my knee was swollen after mountain biking. That immediately triggered the whole "I can't do anything on the knee - I'm condemned to a life of misery" spiral. It took me a few days to realise that it was probably the lifting that was the problem and that I just need to find my find my envelope of function again which will almost certainly include lots of mountain biking. I'm temperamentally inclined to push and push, which doesn't work so well in later years, irrespective of my PFJR! So all good again and I've been out for a ride which went well, so will gradually ramp up.

Sigh. There's an over-representation of people like me on this forum. No coincidence. Regards to all.

Hey, RGB! Definitely the lifting was the problem. I did the same thing at 6 months with my implant... I was moving car wheels and tires, and wondered why the knee was swollen the next day.. took about 4 days to settle.

So true about the need to push limits. If not for the love of cycling and hard exercise/athletics I'm sure I wouldn't have put myself through even 5% of the nonsense I've been through; the depression of setbacks, etc etc. We're two of a kind, and as you say, not an anomaly here or in the PF section of the board.

Speaking of which, I saw the surgeon last month, who xrayed the implant again, and told me it was in pristine shape, and asked about my other knee. I told him I'd wait a bit, since it was holding up ok for walking and 2x a week hockey, which was such a huge improvement in life pre-replacement, so I figured I could put it off and still stay sane. So we shook hands and that was that.

Feeling a fair bit pleased, I decided to get on the elliptical and do a decent 20 minutes.. normally the knee my natural knee that is) can take me to about 12 minutes before it starts to complain, but I was feeling good, loud music was on, and I had a good sweat going, and of course, despite ten years of evidence to the contrary, I figured I could push it a bit.

So predictably the next day the patella was swollen and very painful, and it took a full 4 weeks to be able to walk comfortably for short distances. So I was very much regretting not going ahead with the 2nd replacement when I had a easy opportunity to do so.

So I've decided to make another appointment in January, no matter how the knee feels at the time, and commit to doing it. I badly want to ride my road and mountain bike as well as play hockey, and it would seem, based upon the replacement on the other knee, that this is a very realistic goal, so best to go ahead with it.

cheers