8 Months after TKR Serious Grinding
My TKR surgery, 3/3/22, was "unremarkable" Seems that everyone including the surgeon expected that I would be right back on my feet and would have no problems – because I am fit and healthy and active. There was slight crepitus early on that was deemed innocuous. The PT guy thought there might be patellar tracking issues, but after a while it seemed like there was a distinct catch upon straightening my leg from a flexed position. It seemed to fit the description of "patellar clunk" which the PT guy had never heard of!!!! At my 3 month appt, my surgeon, after feeling the grinding when I straightened my leg, almost winced and said something like – " it's too early to panic; only 3 months" etc. Let's see how things are at the 6 month appt". Meanwhile at around 4 months the PT guy noticing that the situation wasn't improving said that I should see the surgeon before the 6 months. Due to scheduling I only got in to see him a few weeks early. Nothing was decided except that it was an unusual or rare situation. Apparently out of 150 surgeries that Dr W had done this past year, I and one other person had a catch like this on straightening. The surgeon suggested that he could open the incision and clean out scar tissue, which is what he had done with the other patient with this problem. ( This fellow seems to be doing well several months after the corrective surgery; I spoke with him about it to find out what his experience was like)
I am very hesitant to have surgery again and of course there's no guarantee that the scar tissue won't recur ( assuming that is what it is) Plus I asked the surgeon about a less invasive procedure – such as a scope to correct the scar tissue. He feels that he prefers the open surgery. ( I'm thinking in his practice ( he does a LOT of TKRs) perhaps he doesn't do scopes very often? dunno) Anyway, he suggested seeing another surgeon. Made 2 referrals to guys who are supposed to be great. Neither would see me. 🙁 My cousin, a nurse suggested I see a sports med guy who she says is brilliant and who helped her with her knees. That referral which I first initiated Oct 15 or so is in progress – and obviously is taking a while!! Meanwhile I am not even sure that it's an appropriate referral….but I guess I will find out – if the Doc says he won't see me. Then on to the next referral?
Meantime the knee is NOT getting better. I do have full ROM – but what good is it when every time I stand from a sitting position, walk down stairs, try to step up I get this terrible grinding- and it's painful, depending on how much pressure I am putting on the joint. I am still doing exercises that the PT guy gave me ( second PT guy) Trying to keep the muscles strong. (Also – I walk most days and swim and am pretty much on my feet and moving around a lot unless I am at my part time job which involves a lot of computer work. – can walk a few miles but it gets a bit stiff and sore. Have not been able to get back to hiking and biking. ) PT guy also tried dry needling to try to release the scar tissue – but some of it seems to be right between the kneecap and femur, so hard to get the needle in there. The first PT guy, btw also tried ultrasound to break up the scar tissue.
The knee is still often a bit warm to the touch compared to my other knee and a bit swollen – but not terribly. This is all really stressing me out. And is sometimes depressing. I wonder if my expectations were just too high? I thought I would get back to normal – which for me is a LOT of physical activity.
Something HAS to be done. I am willing to wait this out for a while – maybe get some more PT, keep working it to see if the grinding will lessen with time, but I can't live with this forever, for sure!!! At this point I feel like I am on my own. I know I have to advocate for myself. I know I may have to have another procedure, but I want to figure out the best approach – plus I want to have a clear diagnosis. Can MRI ever be helpful in visualizing what is happening with TKR?
I've been reading other people's posts in this forum for a while so I thought I'd see if anyone has had a similar experience or has any suggestions.
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I also had patella clunk syndrome. My surgeon was very hesitant to open the knee before 1 year for fear of infection and also sometimes it does correct itself. At 20 months and after more therapy he said we should scope the knee.
My knee was scoped on Sept 1 and is sooo much better. I did do about 4 weeks of therapy after.
I'm not familiar with this situation. I had success with having both knees replaced. Question – did you do all of the post-op stretching exercises – the ones that are boring, repetitive, and hurt somewhat? The only time I'm aware of scar tissue forming is if those exercises are not done. Anyway, you don't have to answer. Just be honest with yourself and your surgeon.
If you did all the post-op exercises, and I think you did because you say your ROM is good, this sounds like a one in one hundred problem where the patella prosthesis is not tracking in the groove in the femur or maybe the implant. I suppose that could cause scar tissue.
The last person to post seemed to have this problem and the scar tissue was removed with a scope. But if the underlying issue is an improperly aligned patella (or maybe a problem with the femoral prosthesis, then your surgeon is probably right and it's best to do another surgery to 1) remove the scar tissue and 2) fix the problem. I don't think this can be fixed with a scope.
Sorry, that's all I can think of. All the best to you in getting this fixed.
Yes – I was very religious about doing all of the exercises – and still at 10 months I do exercises that the last PT gave me and do a lot fo walking and some yoga.
Quite a few things have happened in thelast couple of months. I had some "cupping" and acupuncture. The acupuncturist also showed mehow to do Graston technique ( some call it muscle scraping) to help break up scar tissue. I have been doing that as well. My surgeon ordered an xray to rule out "malrotation of the femoral component". Thank goodness that was ruled out!! After the xray report indicated "small join effusion", I started using a knee wrap – just an old one that i had around the house. That seemed to finally get rid of the last bit of swelling – just from the compression. I also have been using a brace and that seems ot help. I walk several miles most days and it is getting easier. But the grinding is still a problem. I can feel the lumps – which I assume are scar tissue – along the scar and when I bend my knee ( I have full range of motion) I can feel them above the knee cap. Hard to tell if they are in the patellar tendon – but that seems to be where it's really bumpy. And when I staighten my leg or stand up from seated position it really grinds and hurts!
Seeing another surgeon next week just to see if he has any insights. Also planning to go back to my orginal PT guy and see if he has suggestions. At my 1 year appointment Mar 3, we'll assess.
Interested to hear more about your patellar clunk! Did it hurt when you straightened your leg? Did it make it difficult to stand up from a seated position? Could you see your knee cap "jump" a little when straightening your leg from a flexed position? Do you know if you had a posterior stabilized implant? It seems like patellar clunk is a pretty rare complication and I have read that it is more commmon with that type of implant. Hope you are still doing well!