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Author Topic: PFJR post op activity  (Read 2105 times)

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Offline RGB

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PFJR post op activity
« 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!

Offline Dave33

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Re: PFJR post op activity
« Reply #1 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?

Offline RGB

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Re: PFJR post op activity
« Reply #2 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.
 

Offline Dave33

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Re: PFJR post op activity
« Reply #3 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?

Offline Dave33

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Re: PFJR post op activity
« Reply #4 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.

Offline RGB

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Re: PFJR post op activity
« Reply #5 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!

Offline cooperd70

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Re: PFJR post op activity
« Reply #6 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?

Offline RGB

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Re: PFJR post op activity
« Reply #7 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.

Offline Dave33

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Re: PFJR post op activity
« Reply #8 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.
« Last Edit: July 07, 2018, 08:05:23 PM by Dave33 »

Offline Dave33

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Re: PFJR post op activity
« Reply #9 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" ;) ).

Offline RGB

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Re: PFJR post op activity
« Reply #10 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.

Offline MasterForte

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Re: PFJR post op activity
« Reply #11 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?

Offline cooperd70

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Re: PFJR post op activity
« Reply #12 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

Offline cooperd70

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Re: PFJR post op activity
« Reply #13 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
« Last Edit: July 16, 2018, 10:54:39 AM by cooperd70 »

Offline cooperd70

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Re: PFJR post op activity
« Reply #14 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. 
« Last Edit: July 11, 2018, 09:29:17 PM by cooperd70 »

Offline Dave33

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Re: PFJR post op activity
« Reply #15 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.

Offline Dave33

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Re: PFJR post op activity
« Reply #16 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.

Offline RGB

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Re: PFJR post op activity
« Reply #17 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!

Offline cooperd70

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Re: PFJR post op activity
« Reply #18 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

Offline Vickster

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Re: PFJR post op activity
« Reply #19 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)


« Last Edit: July 16, 2018, 01:21:11 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
More tears and wear, scope planned in Jan 2019 to tidy up

Offline Dave33

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Re: PFJR post op activity
« Reply #20 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."

Offline Dave33

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Re: PFJR post op activity
« Reply #21 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?

Offline RGB

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Re: PFJR post op activity
« Reply #22 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?

Offline Dave33

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Re: PFJR post op activity
« Reply #23 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.

Offline RGB

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Re: PFJR post op activity
« Reply #24 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.

Offline Dave33

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Re: PFJR post op activity
« Reply #25 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.

Offline RGB

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Re: PFJR post op activity
« Reply #26 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.

Offline Dave33

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Re: PFJR post op activity
« Reply #27 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.


Offline RGB

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Re: PFJR post op activity
« Reply #28 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.

Offline Dave33

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Re: PFJR post op activity
« Reply #29 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.















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