PFJR post op activity

[Dave33]

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?

[RGB]

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.

[Brandon123]

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.

[Dave33]

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

[Dave33]

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.

[Brandon123]

Thanks for the update, great that things are going so well!

[RGB]

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.

[RGB]

PS - static squats against the wall with an exercise ball behind your back.

[Dave33]

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

[RGB]

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.

[Dave33]

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

[RGB]

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.

[Dave33]

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

[RGB]

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.

[Brandon123]

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.