PFJR post op activity

[silver_maple]

I guess today's the day, Dave. Best wishes for a smooth recovery, fellow canuck (and same town to boot). When you can, please let us know how you are doing. Your right PFJR had some swelling initially and emitted lots of sounds, would be good to compare with the left now. Did you go to the same surgeon, exact same procedure and implant (Zimmer I think you had on the right)? Or have things moved on a bit in the intervening 3 years? At some point you showed interest in HemiCap Wave, not sure if this is offered in Toronto.

Anyway, all the best. Hope you are back in the saddle of your Cervelo soon!

[Dave33]

Hi Dave - I may not have caught you before you go to hospital. Good luck. Let's hope you have as good a result as the other one. Regards.

All good, RGB. Went pretty smooth. They had me stay overnight, but released me pretty early yesterday, so I was back home by noon. Got behind on the pain meds (2nd time I've made this mistake) so was a bit rough last night.. not a lot of sleeping. Seems under control now. I think it's because they lecture so hard on the dangers of opioids (quite rightly) so one tries to get by with less than they truly need. At any rate, it's done, I'm hobbling around ok, and can't wait to get back on the bike!

How are things going for you these days? Knee still holding up?

[Dave33]

Hope you are back in the saddle of your Cervelo soon!

Thanks silver, appreciate it. Yup, same surgeon, same implant, even got the same hospital room and bed post-op. If I have the same result, I'll be pleased! Cheers

[RGB]

Good news. Yes - I know what you mean about opioids. I was on them for a couple of weeks I think. Panadol for much longer - maybe 6 weeks. I also stopped Panadol earlier but the physio told me that was counterproductive - I'd stop using the knee as much as I should. So I went back onto it. He was right.

The knee is still fantastic in comparison to pre-op. Of course, I focus on what I can't do rather than what I can. That list is pretty short and is getting more dominated by increasing age than knee specific limitations. So I mountain bike around 2x per week, 2-3 hours per session. Lots of steep up hill and Grade 5/6 downhills with a few drops. I avoid the gap jumps for reasons related to age and fear rather than the knee specifically. I'm currently fighting the temptation to buy an e-mountain bike. Beautiful machine but the price of a car and all so I keep less fit. Maybe once I'm 60 - less than a year away! Will also require partner consent, which I'm unlikely to get.
Also, lots of general walking around because I have a rural property to maintain. I can ski pretty well although not for an extended period. If I ski hard all day I need to take the next day or two off.

Generally, I just need to be careful about long or repeated activity. If I cross the threshold the knee swells a bit. If that happens, there's very little pain - I just lose strength and it takes a couple of weeks on Celebrex to bring it all back under control.

Please keep us updated and I look forward to your reports of increased activity once you can get back on the bike. Best regards.

[Brandon123]

Well, tomorrow I'm booked for my 2nd PJFR, after a year of false starts and stops and covid interruptions.

In a way, I'm less stressed about it, as I know what to expect in terms of both the procedure and the result, but on the other hand, the enthusiasm for going through it all isn't quite as high.

Anyway, hoping for 3-4 month recovery, like my last one. If anyone is considering the procedure, and has any questions, fire away.
cheers

Great to read (in a later post) that your surgery went well Looking forward to your updates on the recovery and everything down the road. Take care!

[Dave33]

Please keep us updated and I look forward to your reports of increased activity once you can get back on the bike. Best regards.

Great stuff, RGB. Sounds like the implant is functioning at the same level as before, despite the miles you've put on it. Terrific. I spoke to a tech at the hospital before I left, and he mentioned he's never seen a pfjr worn out. I told him I'd be doing my utmost to try, and he told me he'd still make the bet that I wouldn't succeed. Here's hoping he's right.
Regarding the E-bike, go for it. Life is too damn short.

Let see, I'm at 7 days, off all drugs, bending to 90 degrees, walking around the house slowly, but with no cane/crutches- took the dog for a short walk outside today. Swelling when upright is still the bugbear, but overall, feeling good. I'm going to introduce some no to low resistance stationary cycling starting tomorrow. Insomnia bothersome, but I chalk that up to the anesthesia still working it's way out, and all the sitting.

So all signs point to a pretty quick recovery. My goal is to get back on the ice by February.

[Brandon123]

I spoke to a tech at the hospital before I left, and he mentioned he's never seen a pfjr worn out.

This statement is in line with what I've read in several studies on PFJRs, i.e. that it is typically not component failure/wear that is the problem in the end, but rather progression of arthritis in the tibiofemoral compartments, which is the reason for why revision into TKRs is needed eventually.

Let see, I'm at 7 days, off all drugs, bending to 90 degrees, walking around the house slowly, but with no cane/crutches- took the dog for a short walk outside today. Swelling when upright is still the bugbear, but overall, feeling good.

I'm impressed, sounds like you will have a quite quick recovery after all, awesome

[RGB]

Hi Dave33. Just checking in - how is the recovery going? Nothing new from here although it's worth reporting that I hit "peak mountain biking difficulty" the other day. There's mtb park about 30km from home built by Ken Dart - a US billionaire who spent lots of money on it and then donated the land back to the public with the tracks/infrastructure to be maintained by the local club. It has a fearsome reputation so I've stayed away until now but spent a couple of days there over the last month. You get a 4WD shuttle up and then ride for about 30 minutes down - fast. 5 runs a day after which I was exhausted. My knee held up surprisingly well although I wouldn't have wanted to ride again for a few days afterwards. The whole park seems to be graded about one grade easier than it actually is and on my penultimate run I did a full grade 5/6 run. I've ridden those grades before but this was harder and much longer. No full drops but terrifying nonetheless. A few "foot downs" but no walks or falls. 30 minutes of high concentration and fear. I'll never do a harder/longer run although I may repeat that one again when I rebuild the courage.

I hope all is well. I note there's a bit of renewed hope in the forum on the efficacy of stem cell treatments. All I can report is - they didn't work for me and I don't think there's been a material improvement in technology since then. Anyway, not relevant to us anymore with our metal and plastic! Regards.

[Dave33]

Hi Dave33. Just checking in - how is the recovery going? Nothing new from here although it's worth reporting that I hit "peak mountain biking difficulty" the other day. There's mtb park about 30km from home built by Ken Dart - a US billionaire who spent lots of money on it and then donated the land back to the public with the tracks/infrastructure to be maintained by the local club. It has a fearsome reputation so I've stayed away until now but spent a couple of days there over the last month. You get a 4WD shuttle up and then ride for about 30 minutes down - fast. 5 runs a day after which I was exhausted. My knee held up surprisingly well although I wouldn't have wanted to ride again for a few days afterwards. The whole park seems to be graded about one grade easier than it actually is and on my penultimate run I did a full grade 5/6 run. I've ridden those grades before but this was harder and much longer. No full drops but terrifying nonetheless. A few "foot downs" but no walks or falls. 30 minutes of high concentration and fear. I'll never do a harder/longer run although I may repeat that one again when I rebuild the courage.

I hope all is well. I note there's a bit of renewed hope in the forum on the efficacy of stem cell treatments. All I can report is - they didn't work for me and I don't think there's been a material improvement in technology since then. Anyway, not relevant to us anymore with our metal and plastic! Regards.

Hi RGB! Good to hear from you. That MTB track sounds terrific. Full suspension bike, I hope! That's amazing that your knee is handling it so well. These are the things we'd miss out on in life if we hadn't taken the plunge. Do you plan to ski again?

Yup, I hit the 3 month mark last week, and went out to the rink to test it out - was weak, but managed to play a couple shifts of hockey. Went out yesterday for the 2nd time, and felt even better. I figure I'll be skating at full power in 1-2 months - just need to be careful and add a little bit every week. It's hard sometimes when the competitive juices start to flow, one tends to overdo it, and try to win a race to the puck, etc. But I've been good so far, and i'm very much looking forward to getting back on the road bike in spring (there's 2 feet of snow on the ground right now, so just spinning on the trainer)

I'm interested in what advice you've had regarding "day to day" type of exercise. I went for a short jog on the treadmill a few days ago, and it felt terrific. But after, I was wondering whether I'm contributing to wear, and perhaps I should stay on the bike or elliptical. Did your doc ever make references to "good" and "bad" type of activities? Mine basically is just saying go for it, do anything you want apart from jumping down from heights, which really isn't part of anything I do from a sporting perspective. - but obviously i'd like to get as many years as possible from the little fellas.

Yeah, the PRP/biologics etc are attractive, from both a marketing/moneymaking point of view, as well as more accommodating regarding invasiveness- so the placebo effect is strong. The results are poor, and even viscosupplementation has a very patchy success rate, and that's considered mainstream medicine. It's really, really easy to get papers published with encouraging data on limited scope, which don't stand up to real world efficacy. I guess at long as no bridges are burned, there's no point in raining on anyone's parade. You and I went through a ton of useless treatments and procedures, and it's really hard not to pin hope on them, just part of the process.

cheers

cheers

[RGB]

Good to hear the recovery is going well. Yes - I will ski again this year if COVID etc allows. I find I can ski reasonably hard for 2 days in a row, then I have to take a day off. As far as regular exercise is concerned - the surgeon gave me the safe and standard "no squats and no lunges" advice which I've clearly ignored. The specialist knee physio was a bit more realistic and said just don't make it hurt or swell. I avoid repeated deep  (i.e. >100 degrees) flexion under heavy load. I probably would run if it weren't for my mostly missing medial meniscus. I can walk, including reasonably steep hiking trails, but I don't do that with any significant pack on my back. Again, I think that limitation is mostly meniscus related. So I stick to what I can do and luckily that still allows me to get my adrenalin and endorphin fixes.....

[Dave33]

Good to hear the recovery is going well. Yes - I will ski again this year if COVID etc allows. I find I can ski reasonably hard for 2 days in a row, then I have to take a day off. As far as regular exercise is concerned - the surgeon gave me the safe and standard "no squats and no lunges" advice which I've clearly ignored.

Heh, you've definitely got your "money's worth" out of that op, that's for sure. Terrific. Yeah, i've decided to continue jogging on the treadmill, but I'll keep it to under 30 minutes, and a fairly level grade with good shoes. It feels amazing to do. I'd literally given up the idea that I would ever run again 10 years ago.

I had my 4 month review with the surgeon a couple days ago; he generally uses me as subject matter for his residents, so 5 doctors pile in a room and ask how it feels and how my mobility is, and he brings up my old xrays with all the old osteotomy screws and presents the "before and after", like I'm prize pig at the fair. I guess it's rewarding to change someone's life for the better with successful operations, I'm glad for both of us that it's worked out so well.

So in an average week I generally bike 3 times on the trainer for about 30-40 minutes, hard enough to get a good sweat on, run on the treadmill 1x, and play hockey 1x. I do get a bit of swelling after the hockey, and I generally take a day off post to let it settle a bit, but for 4 months, it's more than tolerable. If it never got any better than it is now, I'd say that it was all worth it, and I'm fairly certain it'll improve to the level of the other knee.

Funnily enough, stairs (descending) still remain a psychological and somewhat physical problem. I guess I've felt so unstable for so many years, I just default to going one at a time on the handrail, and that won't change despite the improved function. I still get a twinge in both knees if i step down with full weight on a bent knee.

The other benefit to more activity is better health; I've dropped about 15 pounds in the 4 months post, and eating habits really haven't changed. That's definitely a plus, considering the lockdown weight was getting noticeable.

Anyway, great stuff RGB, looks like you'll be skiing the way things are going! I hope you'll continue to update.

[Brandon123]

I had my 4 month review with the surgeon a couple days ago; he generally uses me as subject matter for his residents, so 5 doctors pile in a room and ask how it feels and how my mobility is, and he brings up my old xrays with all the old osteotomy screws and presents the "before and after", like I'm prize pig at the fair.

[WaveyDave]

I’m pondering PFJR. How are you guys doing with these now? How long do you think they’re likely to last (ballpark) and what kind of level of activity is realistic?
Thanks for all your posts on the forum. Knowing we’re not alone in this is good for the sanity!

[Dave33]

I’m pondering PFJR. How are you guys doing with these now? How long do you think they’re likely to last (ballpark) and what kind of level of activity is realistic?
Thanks for all your posts on the forum. Knowing we’re not alone in this is good for the sanity!

Hi WD,

I'm about 8 months since my 2nd replacement. Still get some swelling with heavy activity, but expect it will settle, like the other one did, which is completely pain free. One thing that I've found it both situations, is that it takes much longer than the standard patient guide notes to see final state improvements. - i'd say my first wasn't completely perfect until about close to 2 years in.

Durability? Really hard to say. My surgeon told me to expect between 20-30 years, due to the improvements with the implant materials technology (crosslinked polyethelene, etc); and the fact the the patella really isn't under much load apart from exercise, so it sees less wear than the other compartments day to day. I think that if it's aligned well by a good surgeon, one should expect a decent result.

Again, level of activity is a grey area. You'll hear from surgeons that say "go live your life, enjoy it!" and those that tell you to only do the bare minimum to preserve it. My surgeon was in the former category, and I told him right up front what I intended to do once I had them done, and he didn't try to put me off in any way.

Personally, I'm doing the following now: 2D a week- hockey (no bodychecking), 3D a week -road cycling, approximately 30K rides at around 29-31KPH average speed. I don't intend on running again, but I can jog a bit without pain.

As the 2nd implant improves, I'll probably pick up a bit more distance on the road bike.


Hopefully RGB will chime in on his weekly activity; he's had his replacement a fair bit longer than I, and does some different sports as well.

Any other questions, feel free.

cheers

[RGB]

Hi all. I think I'm going to regret getting into this discussion but I'm unable to restrain myself. To be clear, I'm not a medical professional so nothing I say beyond my own personal experience should be acted upon without your own research. Also, I did all my reading/research on patellofemoral cartilage damage more than 5 years ago before I had my PFJR. I haven't read anything much since apart from the occasional discussion on this forum. I'm not going to restate my history - I'm sure it's somewhere on this forum for those interested.

First let me venture that I think PFPS and pain due to patellofemoral cartilage damage are not necessarily the same thing. PFPS can be present without obvious cartilage damage and so it's not always clear what's causing patellofemoral pain. I never researched this further because I had clear extensive cartilage damage but, without such damage, my first port of call to address resistant PFPS would be something along the lines suggested by SuspectDevice - a 6 month course of Celebrex, a cessation of aggravating activity and a very gradual reintroduction of strengthening/activity. That's probably what I'd do with minor cartilage damage as well - only because the alternatives are not great and, if it works then the time and effort will be well worth it.

With extensive patellofemoral cartilage damage, the options are not great. Chondroplasty has nothing going for it. If I was older (I was late 40s when my damage became apparent) I would not bother with microfracture (even with stem cells a la Dr Saw), PRP or stem cell injections (fat, blood or bone marrow derived). I researched those, believed some of the hype, invested a good deal of effort and money and, for me, they were a waste of time. The research supporting them is patchy at best and the simple fact is that, if they worked reliably, everybody would be doing it and there wouldn't be any discussion on this forum. There will always some early adopters (both doctors and patients) but until there are good widespread results the chances of you or me picking the one technique that solves what is a very hard problem are small. Some of the techniques might work better for younger ages but that wasn't my position so I didn't pay much attention to this. Also, these comments are very much restricted to damage to the patella or trochlea groove. The stats are better for damage elsewhere. At the time I did my research, MACI results weren't that great for patellofemoral damage. The surgeons that I consulted that offered MACI refused to do it for me because of this and I agreed with them.

All of this leads to PFJR as a solution. My PFJR is 5.5. years old. Is it perfect? No and there's not a day goes by that I don't wish I had a 'normal' knee so I could do a wider range of activities (climbing and trail running mostly). Is it better than before? Absolutely. Previously I could climb and descend one flight of stairs a day without pain. Biking, skiing and extensive walking, especially on hills were completely out of question. Now, I've learned to mountain bike and, in a few years, I've gone from beginner to riding Grade 5/6 trails which give more than enough adrenalin for most of us. Uphill is more of a problem than downhill. I can do around 2 hours of really steep uphill a week. Any more and the knee swells. I can ski but not as far or fast as I'd like. 4 hours a day, every second day is about my limit. Does it feel natural? No and I try not to load it beyond around 90 degrees of flexion. But it's pretty good. Is it deteriorating over time? Maybe - I'm not sure. I'm getting older (60 this year) which makes it hard to tell what's the knee and what's the rest of my body. My plan is to give it another 5 years or so and then think about a TKR. A word of warning though - there's a good recent paper that shows that the revision rate of TKRs after PFJRs is much higher than the revision rate after just a TKR. So part of me wonders if I should just have gone for a TKR. However, I think I would have been worried about my mountain biking with a TKR - I've had some pretty spectacular falls and I could well have damaged a TKR prosthesis. So my TKR will be reserved for when I stop mountain biking.

That's it. Feel free to disagree with the views I've expressed - they're really those of an amateur reading technical papers, supported by an evidence base of one knee. So certainly subject to challenge. Regards to all.