PFJR post op activity

[Dave33]

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

[RGB]

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!

[Dave33]

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

[RGB]

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.....

[Dave33]

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

[RGB]

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......

[Dave33]

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

[RGB]

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.

[Dave33]

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

[RGB]

Knee is improving again. I don't think is was ever as bad I'd thought to tell you the truth. There was a bit of tenderness in the medial tibiofemoral area and some more swelling than usual - which I took to be a sign that my tibiofemoral arthritis was progressing faster than I'd like. I responded by reducing the uphill mountain biking load (higher seat, lower gear and just less time) and swimming a bit more, all of which were helpful but didn't fix it completely.

However I saw my physio again a few days ago. He's very good - all he does is knees and he keeps right up to date with all the current research. In many ways, he's more helpful than many orthopaedic surgeons. Anyway, he looked at the knee and said that, although arthritis progression was possible, he thought I'd just tweaked a bit of the remaining medial meniscus, caused some swelling and never really gotten on top of it. He recommended 2-3 weeks of Celebrex to get rid of the swelling completely, along with more rehab exercises to strengthen the quads. He pointed out (and he's right) that when the knee swells, the quads switch off and start to weaken. That all needs to be undone once the swelling is back under control.

He also suggested an X-ray, mostly because he was certain it would show no tibiofemoral arthritis progression and that would make me a bit more confident that I had a few more years of good activity left! I got the X-ray and he was right. So all good.

I've seen a few recent threads concerning the difficulties of quad strengthening with patellofemoral issues. I sympathise because pre-pfjr I had exactly the same problem. However, now the patellofemoral joint is artificial, I can rehab the quads without irritating the joint and quad strength is absolutely essential for my knee. So - I have no solution for those struggling with that quad vs patellofemoral balance but I think both are important in the long term i.e. once you've got your patellofemoral problems under control, you're going to have to find a way to build back your quad strength. Otherwise, many sporting activities will remain out of reach. Sorry for the rant - I'm aware my evidence base is only one person but it may help somebody.....

Dave33 - are you booked in for that second pfjr yet?

[Dave33]

Sorry for the rant - I'm aware my evidence base is only one person but it may help somebody.....

Heh, make that two people!

Great to hear that there's still some life in the meniscus....wonderful news, as I'm sure your pfjr is still in great shape. That said, I'll be extremely interested to hear what wear presents itself on the implant when you finally have to have it done.. but the longer you do sport on it, the even more interesting the outcome will be!

So are you back to your previous activity level on the mtb? Hopefully the celebrex can knock out the inflammation... I read somewhere (I'll try to find the link) that a bone scan is gaining popularity in terms of determining whether pain is coming from cartilage compromised bone surfaces, indicating whether to resurface, or revise a resurfacing. Might be of interest.

Yes, 2nd pfjr is "booked" - I have to see surgeon in a month, but I've emailed my intentions and timelines prior, so I expect I'll just fill out the paperwork and come back home. He's already been in that knee for an hto, and seen the damage (he described it as "crab meat") so I doubt he'll have any objections, especially considering the success of the other pfjr.

I'll be thrilled after this one is done and I'm finally back on my road bike. It sits there in the basement, taunting me with possibilities. How I've missed riding.

cheers

[Dave33]

Well, tomorrow was the day I was "supposed" to have the 2nd pfjr done, but obviously with the COVID situation, all elective surgeries have been cancelled for the foreseeable future. Obviously the right call for the health care system. I don't imagine I'll be getting this done in 2020.

In the meantime, I'm getting out with the dog, doing more walking, and working on partial squat/strength exercises for the "good" (pfjr'ed) knee.

RGB, Brandon, all - hope you're staying healthy and managing ok.

[RGB]

Hi Dave. I was wondering if you'd managed to squeeze in your next PFJR before COVID hit. Probably best you didn't - hospitals are a place to stay away from, both because of the risk of infection but because their attention will be elsewhere. You're in Canada aren't you? I haven't heard much about Canada and COVID but I imagine one of your biggest issues will be having the US as a neighbour. It's going to get a lot worse there. Here in NZ, we're in complete lock down with the borders closed. Cases at about 1,000 and deaths of 1, with the daily number of new cases starting to drop. So a good place health-wise but huge and unknown economic damage. I generally travel to Australia to work (about a 3 hour flight) but that's not possible now. So I'm working remotely (and furiously) - trying to keep income coming in and staff employed.

As far as the knee goes, we're supposed to be able to leave home once a day for exercise, keeping to the local area. Mountain biking is highly discouraged - unsurprisingly - too much risk. So I've been road biking every second day. I go out for an hour with a steep 10 minutes of hill climbing to finish. It's fine. Not so exciting but, in the circumstances, that's a first world problem. On the 'off-day' I do glute activation exercises, plus some squats with a beach ball against the wall, shallow one legged squats holding 20kg of weight, then some flights of stairs with the 20kg and finish with some push-ups, sit-ups and pull-ups.

That's it. Another 3 weeks (at least) of lock down then hopefully a resumption of mountain biking. But many months of travel restrictions and years of repairing the economic damage - both for me personally and for the country. Sigh. Best wishes to all.