PFJR post op activity

[Dave33]

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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.

[Dave33]

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.

[RGB]

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!

[cooperd70]

Cooperd70 - 500km cycling per week sounds pretty athletic to me!

Whoops...was going to type 30 miles daily...its actually 15miles each way 

[vickster]

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)

[Dave33]

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."

[Dave33]

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?

[RGB]

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?

[Dave33]

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.

[RGB]

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.

[Dave33]

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.

[RGB]

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.

[Dave33]

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.

[RGB]

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.

[Dave33]

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.