Patellar Clunk Syndrome: Complication Following Knee Replacement Surgery

In general, Total Knee Replacement (TKR) is a highly successful procedure. In fact, according to the American Academy of Orthopaedic Surgeons, more than 90% of patients have well functioning implants 15 years after surgery.1 Unfortunately, complications, although relatively rare, can sometimes occur. One such complication is known as Patellar Clunk Syndrome.

Patellar clunk syndrome can result in the following symptoms:

  • “Patello-femoral” knee pain (pain in front of knee in region of knee-cap)
  • Knee “popping” or catching during bending and straightening as in rising from a chair

To understand this condition, it helps to first understand a little bit about normal knee anatomy and function (Figure 1).

Knee Anatomy

Figure 1: Basic Knee Anatomy

During knee flexion (bending) and extension (straightening), the patella (knee-cap) rides within a “track” or groove in the femur (thigh bone), known simply as the patellar groove. This motion is smooth and no pain or disruption in this motion is felt during normal activity. In a patient with Patellar Clunky Syndrome, however, this motion is not smooth and can become painful. So how does this occur?

During Total Knee Replacement, the worn ends of the bones are “resurfaced” with metal and plastic implants. The patellar groove on the femur (thigh bone) is part of the area that is replaced and is part of the metal femoral component that is implanted onto the prepared thigh bone during the total knee replacement procedure. At the end of this groove there is a transition between the metallic implant and the native bony surface.

Refer to the X-ray image below of a knee where a total knee replacement prosthesis has been implanted (Figure 2-patella is not visible in this view).

knee-replacement-prosthesis

Figure 2: A-P view of a total knee prosthesis taken by
F. P. Jacquot from the original radiograph (Wikipedia)

 

Following knee replacement, scar tissue can sometimes form at the top or “superior pole” of the patella. During particularly deep flexion, this scar tissue may move below the end of the groove in the femoral component and then “catch” on the end of the groove as the patella moves back with knee extension. It is this catching and then forceful release with extension that results in the “clunk” and pain characteristic of this condition.

This condition is more prevalent in a type of knee replacement known as Posterior Stabilized, or “PS” knee replacement, although it has also been reported in Cruciate Retaining (CR) knee designs as well.2 In PS knee designs, where the posterior cruciate ligament is removed, the patellar groove tends to be shorter to avoid contact (in extension) between the end of the groove and a plastic post on the tibial component found in these types of designs. Consequently, the patella can come off the end of the groove during lesser degrees of flexion.

Additional Resources:

The article at this link compares the incidence of patellar clunk in two total knee replacement implant designs. It contains some illustrative images of knee replacement implants and discusses the parameters in the design that can help to reduce the likelihood of patellar clunk.

http://www.pediatricnews.com/fileadmin/qhi_archive/ArticlePDF/AJO/036100550.pdf

The publication cited at the end of this article provides more detailed information and a review of some of the literature on patellar clunk.

1″Total Knee Replacement-OrthoInfo – AAOS.” Total Knee Replacement-OrthoInfo – AAOS. N.p., Dec. 2011. Web. 07 Nov. 2013.

2 Niikura T, Tsumura N, Tsujimoto K, Yoshiya S, Jurosaka M, Shiba R. Patellar Clunk Syndrome After TKA with Cruciate Retaining Design: A Report of Two Cases. Orthopedics. 2008: 31:90

Comments

124 Responses to “Patellar Clunk Syndrome: Complication Following Knee Replacement Surgery”

  1. rajoo6 on April 27th, 2009 11:21 am

    nice and impressive presentation. cheers!

  2. Penny ODonnell on June 5th, 2009 4:39 pm

    So how is patellar clink syndrom diagnosed and what is the treatment for it?

    I had TKAs three months ago, and for most of the time since then I have sharp pain whenever my right knee is released after it has been flexed. A typical scenario is sitting in a chair with my foot under me on the floor. When I move my foot forward extending the knee there is sharp pain, a catching feeling.

  3. Karen DeWitt on August 2nd, 2009 4:34 am

    I am now 9 days from my bilateral lesser invasive knee replacement surgery and so far I must say it has been a great experience. I am turning 50 this year and was dealt some bad genes, family history of osteo arthritis. I have also been a very active athlete my entire life. The most difficult thing was being confident that now was the time to do the surgery. My surgeon said that in light of how long knees last now (about 22 years) I should not wait until I am suffering. Although I have continued to work out up to the date of surgery (swim, weight train, eliptical machine, biking and spinning classes) I have not been able to run, golf, and play other sports I always enjoyed for more than 8 years. Over the past year, stairs and walking became more and more painful and as I worked out I could feel there was very little, if any cartilidge remaining in my joints. I am thankful that I keep my legs strong and did all I could to stay physically active, I feel this has been critical to my quick recovery. After surgery my doctor did say that there was next to nothing left of my patella and that the joint was bone on bone. I know if I had not been in such good physical condition I would have felt much more negative affects of my arthritis. Today, 9 days post surgery, I am walking slowly, but can do so without a cane. I already am at 95 degrees flex and 6 degree to straight. My doctor uses a lesser invasive technique, this was also critical to a speedy recovery. My doctor said when all is said and done I will have no restrictions and should be able to enjoy the sports I have been missing over the past decade. More importantly I will not have pain as I walk and go about my daily living.

    I would like to encourage other people out there to work to keep your legs strong, this will always help you continue to function on a daily bases as well as feel fewer affects of your arthritis. Weight train, swim, cycle. Secondly, consider lesser invasive or minimally invasive total knee replacement surgery. I chose bilateral because I was physically fit and I did not want to spend two summers recovery and returning to all the things I have missed. I would do bilateral all over again. Thanks to my surgeon I am on my way back to an active life style!!

  4. Brian Gregory on September 1st, 2009 7:39 am

    Greetings,

    In these though economic times, having a knee replacement is becoming less and less accessible.
    One of the viable alternatives have been to get surgery done abroad. In fact, the price drop can be as much as 70 to 80%, when having your surgery performed in Morocco, while keeping a high standard of quality of care.

    You would ask why? Because mainly, cost of the life in Morocco is cut in half compared to Europe or North America.

    Let me introduce to you Knee replacement surgery in Morocco:

    Performed by Certified Surgeons:

    All of our surgeons, have had their training in the U.S. and Western Europe. They have more than 15 years experience including international practice.
    Meet our orthopedic surgeon, Dr Ali El Kohen, his international experience encompasses practice in Insall Scott Kelly Institute for Orthopaedics at Beth Israel Medical in New York as well as an AO-Fellowship at the Harvard Medical School.

    Stay in Quality Accommodations

    We work with some of the best rated hotels in Morocco, known for their quality of service and hospitality. Riad Salam is a sea side hotel, where you would meet with a superior quality of life and a refreshing ocean air.

    In Accredited Medical Centers
    All the private hospitals, that we work with, have international accreditations. This requirement ensures that our patients will always receive their surgery in the best possible conditions, very similar to what can be found in North America and Western Europe.

  5. John Reeves on April 16th, 2010 2:56 pm

    I had TKR 10 weeks ago and have had clunking whilst walking from the beginning but its been getting slowly worse. Its now audible. I return to see the consultant in coming weeks (NHS timescales). Is there a likelyhood of needing the patella (re)-lining. Is it keyhole surgery. What else might it be? I dont fancy major surgery again – the recovery was hell. I wish I’d kept the old knee.

    Thanks in advance for any feedback.

  6. gayle helms on June 24th, 2010 7:03 pm

    Hi my name is gayle helms.and Im looking for some help to understand more about petalla clunk syndrome.Is it caused due to surgical error or5 what I have been so miss lead about whats wrong with my new knee I am totaly confused .Iv been to several different doctors since I developed this problem and no one would tell me whats realy wrong with it only that I had to choses I could have it operated on or live with the pain,until i call one doctors office and talked with a doctors assistant who exaimaided me almost a year earlier and told me I had ben diagnosed with petalla clunk syndrome and that was the first time any one actully told me what was in fact wrong with my new knee. the knee cap showes to be tilted and rubbing on the prostieses. I also need to know what its going to take to fix it

  7. John Reeves on July 2nd, 2010 2:04 pm

    You have my sympathy Gayle. Have you had the clunking from the beginning? I have, and am still being told by the NHS consultant that it is normal. I am going to get a formal 2nd opinion from a private knee expert. I believe something was not done correctlly in the operation – possibly a misalignment.

    Anyway, Gayle, I believe the clunk syndrome happens for some people after the prosthesis has been in for quite a while, not from day 1 after the operation. For normal syndrome sufferers, the bone starts to overgrow the prosthesis, over time, making a ‘spur’ which then rubs on the patella – hence the clunk. The normal clunk syndrome does not apply to new TKRs – that’s why I’m not happy.

    Good Luck. I’ll write again once I’ve had my expert opinion.

    Cheers, John

  8. Dawn on August 3rd, 2010 5:00 pm

    For those who are experiencing “patella clunk syndrome” it does not mean that there is something wrong. This is just the normal wear on these types of components. Some people may be bothered by this more than others but almost all of us will experience this and some will have pain and some will not.

    I had to have a total replacement due to the surgeons mal-practice. The first time around, it clunked so hard that I thought others could hear it. The first prostehsis was an older model which weighed about twice as much as the newer models of today. It also contained high amounts of nickel to which I am very allergic to and it was too big for the space in my knee which resulted in him removing more tissue than he should have – I now have a big indenture above my knee that should not be there.

    I still have a “clicking” but for the most part, I hardly notice it all. Maybe it’s because the first one was bad that it makes this seem like nothing.

    Talk with your surgeon about this, express your anxiety and if you do feel like you are getting the right answer, make an appointment with another surgeon who specializes in these types of procedures.

    Just remember, it can take up to a year before you are fully recovered.

    Dawn

  9. JAYNE HANSON on August 10th, 2010 3:44 pm

    FOURTEEN MONTHS AGO I HAD TKR – WAS DILIGENT ABOUT THERAPY AND NOW AM AT 150 DEGREES – FOR TWO MONTHS IT WAS ALL UPHILL WITH THE RECOVERY – THEN ONE DAY I WAS DOING A GOOD DEAL OF WALKING SO I USED AN ELASTIC SLEEVE ON MY KNEE – THAT NIGHT I HAD SEVERE PAIN AND SINCE THEN HAVE A ‘VERY TIGHT KNEE’ MOST OF THE TIME AND CAN’T WALK MORE THAN AROUND THE BLOCK WITHOUT THE ‘SLEEVE’ – MY KNEE OVERHEATS AND I HAVE PAIN UNDER THE KNEE AS WELL AS ON EITHER SIDE – IT VARIES. VEINS IN THE KNEE RISE TO THE SURFACE AS WELL AS IN OTHER PARTS OF MY LEG SINCE THE SURGERY – I HAVE NERVE PINCHING AS WELL – COULD THIS BE A MISALIGNED PATELLA?

  10. John Reeves on August 16th, 2010 8:43 am

    Good advice Dawn; I hope your new joint turns out OK. I suggest you get immediate expert attention Jayne. It doesnt sound good. Good luck to you both.

    I’ve just had a private 2nd opinion closely followed by another chat with the surgeon. They say my cluncking is from soft tissue catching on the prothesis. It is therfore not what I feared, ie a fault with the prothesis. I am reassured because it may go off slowly and it means I wont need to have major surgery to fix it. If I do want to be rid of it, I could have the patella resurfaced but I am advised this may produce futher issues! So, I have decided to see how the next 3/6 months goes.

    I have found something interesting. It seems opinion is divided amongst surgeons about resurfacing the patella at the same time as doing a TKR. Via google, I found this http://www.wheelessonline.com/ortho/indications_patella_resurfacing1.
    This suggests it should be done with the TKR to allevaite pain and improve stair climbing – no mention of clunking though.

  11. admin on August 17th, 2010 1:57 am

    Hello Dawn,

    Thank you for your comment and perspective. I did want to clarify something on patellar clunk.

    Although there may be some benign “clicking or clunking” and total knee components do wear over time, patella clunk syndrome is not related to implant wear. In some patients excessive scar tissue can form at the top of the patella and this scar tissue can catch on a certain part of the implant component that is placed on the femur (thigh bone). The tendency for this scar tissue to catch on the implant can be influenced by implant design and placement of the implant on the bone by the surgeon (that is, poor design or misalignment of the implant can increase the likelihood of patella clunk syndrome in patients that are prone to excessive scarring.).

    I hope you have found this information helpful.

    Regards,

    Admin at totalkneeweb.com

  12. admin on August 17th, 2010 2:07 am

    John Reeves,

    Thank you for your comments and sharing your experience and perspective. Some years ago, I recall that leaving the native patella in place with knee replacement was more common in European countries than in the USA, where the patella was mostly resurfaced. From the reference you cited, it appears that resurfacing the patella is more the norm these days regardless of location.

    Please feel free to visit the forum on this site and begin a topic or leave a comment there…It may be more “user-friendly” with respect to conversing with other visitors than the comment section here, but feel free to post where you wish.

    Thanks again,

    Admin at totalkneeweb.com

  13. John Reeves on August 18th, 2010 6:55 pm

    Thanks Admin.

    My clunking was from day 1; hence my worry over ‘bad’ engineering/fitting and my entries on this forum on April 16, July 2 and Aug 16 above.

    Regards,

    John, age 61, UK

  14. Kathy on September 16th, 2010 6:39 pm

    Good day all,

    thanks for all of the info as it appears I may have this condition. My TJA was performed in june of this year and in August I developed a shifting type of sensation in the superior part of the prosthesis and considered that perhaps it was an adhesion, now it is possible it could be this patella clunk syndrome. Tell me, does this occur going down stairs and up stairs as well?

    thank you,

    Kathy

  15. Mark Hellenbrand on September 17th, 2010 7:22 pm

    I am 8 weeks out from TKR and have a clunking in my knee when I get to full extension walking. This resonates in my bones whe it clunks and is annoying. It causes irritation to the left(outside
    ] of my knee and causes irritation, the more I walk the more irritated it gets. Also if I put my foot flat on the ground whe sitting and move my knee side to side it clunks.Does this sound familiar to anyone?

  16. John Reeves on September 20th, 2010 5:08 pm

    Yes Kathy,
    I get the clunking the most going up/down stairs/slopes. I dont suffer as Mark does.
    Dear All – I’ve found that the best form of physiotherapy has been cycling. My range of movement, muscle re-development, clunking and general ease of movement has VASTLY improved since I started cycling daily only 8weeks ago. I had to start with the sadle at its highest setting and now have it down to the original pre-TKR position. Try it – its fun too.
    Best to all. John

  17. Brian Crook on October 29th, 2010 6:16 am

    Hi Everyone. I had a TKA some 18months ago. and this was in fact the 15th, yes 15th, operation on that knee. It staret off with a simple meniscus tear, followed by septic arthritus infection, whoh cwent undiagnosed, basically wrecking teh surface of my thigh bone. I wont bore you with all teh details but keyhole after keyhole, then a cartilage transplant, then a tibial osteotomy, then finally a TKA but without pattelar resurface. The joint is brilliant, but Ihave sufferd with crunching and clicking in the joint for about 6 months and for obvious reasons put off seeing teh surgeon. Finally gave in last week and its Pattelar clunk – only solution is a knee cap resurface, so thats operation #16!!!! This is scheduled for 14 December and I’ll let you know how I go on. Just a note, I totally trust my current surgeon – he is brilliant. If anyone wants to mail me directly, my mail is briancrook@blueyonder.co.uk

    Good Luck everyone

  18. FIONA ABBOTT on December 23rd, 2010 3:19 am

    I wish my symtoms were like everyone elses – my TKR was 8 years ago -I have never had a problem until about a month ago I happened to turn turn answer a phone and I was in the most pain I have ever experienced – a co worker said they heard a pop – all I felt was pain – I could not move my leg – it took over 2 weeks before I could walk on my leg but after a month I still feel as if it could go out – just today my doctor mentioned patella clunk syndrome – I really had to look it up to ensure it was real – according to all the x-rays the knee replacement is solid and all x-rays and blood tests show everything is fine – he has recommended arthrosposic surgery to see if something has not been damaged that cannot be seen on an x-ray – has anyone had surgery after having been diagnosed with this????

  19. admin on December 24th, 2010 3:57 pm

    Fiona,

    Just wondering, do you know if you have a mobile bearing type knee replacement?

    The effects of patellar clunk syndrome are typically experienced during a flexion/extension type motion…you said you were “turning” when you had the problem….

    admin @totalkneeweb

  20. Deanna on January 16th, 2011 4:18 am

    I had TKR 10 wks. ago. My knee was doing fantastic till 10wks. Therapy was pain-free and I had 130 degree bend. Then all of a sudden I am having a great deal of pain while standing and while having my leg straight sitting. just wondering if a slight fall onto my knee 3 nights before could have caused damage somehow. I was trying to get out of bed, and while my foot got caught up in the sheets, i fell a few feet off bed onto my knee. Any thoughts?

  21. soreknee on January 24th, 2011 3:58 am

    My LTKR was done in the US 6-29-2010. Surgery and recovery went well. My new knee was totally quiet until 12-5-2010 when it started making creaking noises every time I bent it or got up/down. I was on a 3-hr airplane flight when I first noticed it.

    I now have patella crepitus, aka patella clunk. Cause? Tissue build up in groove under patella. My surgeon said he cleaned this out during TKR surgery, but tissue can grow back. “Nothing to worry about. This part of knee can be ‘cleaned out’ with arthroscope if it gets worse.”

    My ortho surgeon (OS) said I should put seat of my exercise bike as high as possible and do terminal knee extensions of 30 degrees to zero rather than full extensions.
    Comments welcome.

  22. John on January 28th, 2011 4:10 pm

    My year old TKR is slowly stopping its clunking but yes, I too get the creaking/grinding on every bend albeit not painfully. Yep, cycling bikes/machines worked wonders for my knee’s rehab.

    Best to All.

  23. Tim Damer on March 25th, 2011 4:16 pm

    Very interesting to read all these comments – I didn’t know this website existed!
    I had TKR in August 2010 (UK) and all OK until January this year when sharp and painful clicking /catching symptom become apparent together with sharp nerve pain (in certain positions) on outside surface of knee and leg.
    Saw Consultant (Feb 2011) and he reckons that tendons are catching on the implant and that nerve pain is all part of the same problem. Hmmm . .
    Would really appreciate if contributors could offer any advice re diagnostic procedures which might pinpoint the problem. Some contributors have mentioned arthroscopy – is that an option? Or possibly some form of scan?

  24. Mike on April 25th, 2011 1:45 pm

    I had TKR 3 years ago @ age of 50. Physical therapy was very painful but i kept pushing every day . It took me a year to achieve a pain free status. Now i am experiencing a loud clicking sound while walking, along with daily mild swelling and mild pain. I was only able to achieve a 100 degree bend following physical therapy. Would this have anything to do with my current situation? I’m very active outdoors , keeping in mind not to “overdue” physical activity. Is a visit to my Surgeon in order ?

  25. soreknee on April 27th, 2011 1:50 pm

    According to my knee surgeon, arthroscopy is an option IF the pain gets worse or problem becomes more severe. On another knee forum, someone said they got an infection from arthroscopy. I am NOT willing to take that risk at this point. My next checkup with surgeon is June 2012.

    Tim: Re. scan–I’m not sure if a MRI or CT would be show what’s happening with scar tissue. Good thought on your part.

  26. Susan on April 27th, 2011 2:19 pm

    I had patella clunk for about a year until it got so bad that it would pop and feel like it was going to dislocate. I went to the doctor and he went in an scoped my knee and cleaned up a lot of scar tissue. It was sore for about three weeks but it doesn’t pop anymore and feels a lot better.

    m

  27. soreknee on April 28th, 2011 2:59 am

    Susan,

    Thanks for your post. I’m glad it worked out well for you.
    Did you go PT after the scoping surgery?

  28. Susan on April 28th, 2011 11:43 am

    They didn’t see it on an xray. Everything looked fine. The doctor thought it might be scar tissue or that I might have needed a bigger spacer put in which would have been about half as bad as a total knee. Didn’t want to go through that pain again. The scoping was a diagnostic tool and it was all that was needed. I even saw the CD of the surgery and there was an awful lot of scar tissue there.

  29. Brian Crook on April 28th, 2011 2:17 pm

    Further to my post on 29th October 2010, I had my Patellar resurfaced after suffering with clunk after a joint replacement 2 years ago etc and although it was once again a big operation it has really cured the problem. Only problem was that I had a fall down a steep slope about 3 weeks ago and thought I had wrecked the joint but luckily??? I had just torn the medial ligament which forced me back on crutches for a coupole of weeks and set my rehab from the pattelar resurface back a little.
    I note a post that talks of concern about infection caused following key hole surgery – there is a 1 in 40,000 chance of this complication and I was the one some 8 years ago, and got a ‘septic arthritis infection in teh centre of my knee. Unfortunately the surgeon must not have been trained properly and allowed the infection to rage for a number for weeks before I got a second opinion, fired him, and found someone who was competant – unfortunately the damage was done with damage to the surface of my femur. Since then I have had a total of 16 operations including articular cartilage graft, tibial osteotamy, numerous key holes and obviously a knee replacement and now pattelar resurface. Having said that if peopel are suffering pain I would say go for the surgery but at the first sign of infection, get back to the surgeon and get the antibiotic treatment – it is a totally treatable situation if addressed early. As always I am happy to talk personally about my experiences – as my long suffering physio says – ‘You could actually give physio for knees as you know so much about them and have gone through a hard 16 rehabs!!!’
    My email is briancrook@blueyonder.co.uk.

    Good luck to everyone

  30. Susan on April 29th, 2011 1:45 am

    No PT. It wasn’t that bad and you just have to make sure you bend it every day. This is my fourth week out and have no problem with movement. Don’t notice any popping or clicking anymore either.

  31. soreknee on April 29th, 2011 2:56 pm

    Susan and Brian,

    Thanks for your additional posts.
    Brian: It’s no fun to be a statistic. I’m glad you survived all those surgeries. Thank you for sharing your experience with us.

  32. Tim on April 30th, 2011 10:42 am

    Thanks to ‘soreknee’ and others for their contributions. Saw my Consultant on 11th April re ‘clunking’ + nerve damage and he has agreed to arthroscopy. Hope this works and avoids infection!
    Best wishes to all – will keep you posted . . .

  33. Brian Crook on May 1st, 2011 7:00 am

    Tim

    Good luck with the keyhole – if you get any sign its not ok after the op get straight back to your surgeon and demand attention

    Brian

  34. Sarah on May 1st, 2011 5:31 pm

    Hello,my fellow kneemates !! So thankful to have found this site ! Finally ,able to not feel so alone in this journey .Had my TKR 1-31 2011 on right knee .I an 51 years young and have been physically active my entire life ,just got the OA genes from Dad . Surgery became my final option after trying everything else . Went into it hopeful that all the pain I had been experiencing would finally be relieved .I was in the hospital longer than I anticipated due to excessive blood loss ,resulting in a blood transfusion on day 2 .got home after 4 days without any P.T. Started P.T. one week out .So ,off to a slow start, but have been making up for lost time ever since . I have 125 degree movement ,but I am in such pain despite working out and doing all excercises . My knee is stiff and I have a clunking sound and ‘feel’ while doing my daily walksand riding my recumbent bike. I am in more pain Now than before !! Saw my surgeon week 12 and he said possible scar tissue above my knee , ‘just keep doing P.T. . see you in 3 months . Is this how I am supposed to live ? Constant pain is very wearing physically and emotionally , I want to recover , !! Do I go back to him and complain ?? Thanks for listening ,Sarah

  35. Susan on May 1st, 2011 11:06 pm

    Go back to your doctor and demand he scope you out and remove the scar tissue. That is what is causing your problem. I had clicking for a year and a half and my doctor said it was OK. Then I started with the popping or clunking and pain and feeling like the knee would dislocate. After the scope, 5 weeks this Tuesday, I am feeling pretty good. Don’t settle for less you have been through enough.

  36. Tim on May 2nd, 2011 10:33 am

    Hi Sarah – agree with Susan but your Consultant may not wish to intervene after only three months as some scar tissue problems do appear to ‘settle down’. S/he will also consider possible risk of infection?
    Like you I got pretty desperate with pain + no progress but was advised to wait six months before adopting the ‘Susan’ approach.

    Am just surprised – bearing in mind that there must be thousands of TKRs carried out each year – that there doesn’t appear to be a diagnostic procedure which can capture the MOVEMENT of the knee post op (and thus reveal clunking /scar tissue problems?) as opposed to x-ray which of course is just a static image. Hope that scoping will help in my case . . . Susan I hope that it continues to work for you!

  37. gloria on May 27th, 2011 3:26 pm

    I had a LTKR on 2/9/11/. Did not have my knee cap resurfaced. I have had cluncking since the day I came home. 12 weeks of intense PT, but all along, I had clunking and pain, and was worried I wasn’t healing correctIy. I started doing steps up and down, one step after the other in early April.
    Now in late May, going down stairs in intolerable, lots of painful clicking and clunking when stair climing and simply walking, feel like my knee is catching on someting on the inner side of my knee, and hurts while getting up and down on the left outer side of my knee. Disappointed?? YOU BET. I see my OS again in August. He mentioned he could clean scar tissue with scoping, But I wonder, do I need my knee cap resurfaced?? I’m so frustrated because I have friends that have had completely wonderufl replacements. And now I’m having so much trouble. Has anyone had a replacement with a non-resurfaced knee cap and ended up like this? My doctor seems to think this is going to be better in time, but I’m getting worse with each passing week. So sad:(

  38. Tim on May 28th, 2011 2:36 pm

    Oh Gloria, I can really identify with most of your condition and so you have my sympathy! My symtoms very similar (see previous posts) and I go for Arthroscopy next week (Tues 31st) so will let you know how that goes. I didn’t know about resurfacing and its possible effect, but will certainly ask the question!
    In the meantime stay brave and know that better days lie ahead . . .

  39. Brian Crook on May 28th, 2011 8:12 pm

    Hi Gloria

    I had a knee replacement without resurface kneecap in April 2009, my 15th operation on that knee. I also suffered from grating, clunking and pain until eventually I returned to my surgeon who agreed to resurface the knee cap which I had done in December 2010/ It completely removed teh grating and clunking and I was going reasonably well on my rehab until I fell down a slope with my leg under me with full weight on joint – pain was so bad I passed out, and had to drag myself back to the house/ I had to go back to local hospital for emergency treatment which was useless and eventually saw my own surgeon, who said I had actually just strecthed the medial ligament – something that they sometimes have to do following surgery, so he was pretty relaxed about it. BUT my knee has never really recovered since and I am suffering alot of pain and swelling si I fear another consultation but only after my holiday in teh sun in June – which may help.

    Get the knee resurfaced would be my advice – its another big operation, but you have been there before.

    Regards

    Brian

  40. Susan on May 29th, 2011 7:03 pm

    I am now over two months out from key hole surgery and everything is great. Don’t even notice my knee any more. So glad I had it done. No problem with infection either. Every thing I have done even dental work I have to have antibiotics, whether by pill form or I.V. because of risk of infection. So I didn’t give that a second thought. I have had left and right total knee 5 and 7 years ago and a year ago last April I had a total hip.No sense going through all that and then having a problem with clunking.

  41. gloria on June 3rd, 2011 2:43 pm

    Susan,
    What was the reason for your “key hole” surgery? Was it to eliminate painful clunking coming from the kneecap, or another symptom?? And thank you to Tim and Brian for sharing their experiences. All info is of such great help to me, and to know others are experiencing the same symptoms as I. Thanks again and again. I hope to hear from Tim soon regarding the successful outcome of is 5/31 arthroscopic surgery. Hope things are going well.

  42. Gary Stiemsma on June 22nd, 2011 3:53 pm

    I’m 3 months out since surgery and doing great. When I started walking without the aid of crutches/cane I also started to feel a clunk as I walked, Now I’m walking up to 3 miles a day, 4-5 times a week, AND, now I can also HEAR the clunking as I walk, (no pain from the clunk at all, just feels wierd).
    One idea for those who have a problem riding a stationary bike, if you can’t get the seat high enough or if it’s to uncomfortable to sit on the seat, try positioning a chair behind the bike and peddle from the chair, this really worked for me, and I felt the bike really made my recovery process speed up. NOTE: the chair was not my idea, I had a GREAT therapist!

  43. Tim on June 22nd, 2011 5:32 pm

    Hi Everyone
    Following unsuccessful TKR in August 2010, had recent arthroscopy 31st May and then review with Consultant on 13th June. Unfortunately no improvement: knee still catching /clunking and severe nerve pain on outer side. Unable to walk very far at all without painful after effects. Have now been referred to a ‘revision’ specialist at a regional hospital (UK). Am now pretty fed-up with all of this and – given that some 75000 TKRs are carried out in UK each year – you would hope that they would get it right first time. But hey, it ain’t life threatening – - well at least I hope not!!
    Best wishes to all . . .

  44. Sharon Cassone on June 27th, 2011 5:14 pm

    I had 2 TKR’s done, the right one in July 2008 . It involved a procedure called a VY -quadplasty. In addition to the TKR, some tissue from my thigh was shaped into a V and a Y and used to secure the patella in place and prevent dislocation. After surgery I was not permitted to participate in traditional PT as I had to wear an immobilizer for 8 weeks! It was like starting all over agian getting flexion. I have never reached 95 degrees but I am closer than my MD thought I would get. (I am stubborn). But the more weight I try to lift, the more swelling I get. Then it’s back to elevating and icing when I should be walking. That leg had previously given me trouble since a hyperextention may have been responsible for meniscal bleeding…I awoke 1 day about 3 weeks after the hyperextention and had a knee the size of a grapefruit! Drainage was unsuccessful as blood had clotted in knee area. I was sedentary, developed DVT’s, was started on coumadin and the assumption was that the original sweling episode had something to do with a lifetime of dislocations and arthritic build-up. I ultimately needed PT for almost a year prior to surgery to bend it far enough to have the TKR. I entered surgery at 60 degrees flexion. Ever since, I still have the sensation that any outward lateral movement may result in a lifelong tendency to dislocate. Meanwhile, the left knee was deteriorating faster than the right one was healing. That TKR was done June of 2010, just over a year ago. In doing the repair, my LEFT kneecap was ground down to 16 millimeters….too thin to permit the attachment of the metal and plastic liner….so the very thin patella isn’t tracking well. It hurts so much that lifting more than 3# ankle weights is horribly painful. There is a sunken appearance on flexion to 95 degrees and when I extend it, there is pain behind and thru the kneecap and a clunk that is audible.I must use a walker . Occasionally, I can manage with a cane but do not wish to fall. I am still on coumadin. Where do I go from here? I am tired of pain meds but cannot do PT without them! I am a nervous wreck being at home alone and on my feet. These 4 years have taken a toll on my confidence, mobility and self-respect. What do you advise?

  45. Sharon Cassone on June 28th, 2011 12:46 pm

    How long between posting a question and getting a reply? I posted June 27, 2011 and wondered if I might get feedback today. Thank you.

  46. sunbeltsue on June 30th, 2011 3:52 pm

    Sharon,

    So sorry for your situation. Wish I had some medical advice, but you will be in my prayers.
    During my darkest hrs post-TKR + pulverized wrist in MVA, I turned to prayer and audio tapes by Belleruth Naparstek, Louise Hay and others. You likely can find these from local libraries or purchase online.The tapes help you relax, fall asleep and reduce stress–which helps you heal.
    God bless!

  47. jeff on July 14th, 2011 3:33 pm

    Had R TKA in 10/09. Did extremely well. Am a PT. May 16, 2011 I T-Boned a guy who pulled out in front of me. Hit the guy at 45 mph with right leg braking. Had soreness that has progressed to “clunking” with increased pain. Knee feels strained all the time. Have never seen a TKA “clunk” in 25 years as PT. OS initially wanted to scope knee, but never mentioned it last visit a week ago. I think the spacer is damaged and from looking on this site, it appears patella tracking has been changed by accident. Am I on track? Os was very “mum” this week when I showed him the “clunking”. The “clunking” occurs when I hold the femur and swing lower leg in and outward. Anyone else have this symptom?

  48. Rebecca on August 15th, 2011 6:17 pm

    I had 2 failed partial (unicondylar) replacements on the right knee. (both pieces of plastic popped out and were floating loose, causing my knee to fail and drop me on the first, and lock up on the second) I had TKR (Smith & Nephew unit) 4 mos ago, April 2011. From day 1 it is loose and clunks so bad the PT wouldn’t work with me till I got clearance. My doc pretends not to hear it, and the PAC hears it. Both acknowledge it’s very loose…literally like a piece of equipment not well-fitted, but say they wouldn’t touch it for at least a year till the tissues heal. Won’t theorize what’s wrong…as if everything is an admission of liability. Very frustrating… it’s getting worse, ( I believe as it wears unevenly) and is now swelling, and painful, with some of the same symptoms as before surgery. Since you can’t demand your money back, or return the parts for new ones, what is the recourse? Especially as I know have no medical insurance?

  49. jeff on August 16th, 2011 3:24 am

    Rebecca,
    I am in Missouri and the malpractice statute is two years. Attorneys love medical mistakes. Shouldn’t cost anything to consult with one. Don’t give up. There should be nothing to “heal”. Either it is “in” correctly or it is not.
    I am calling my OS to schedule a 6-week follow-up. I still have pain and can’t walk as I did before the MVA. I am having him scope the knee. I was thrilled with my TKR until my MVA.

  50. Tim Damer on August 16th, 2011 11:13 am

    Rebecca, are you UK or if not which country are you posting from?
    My experience very similar to yours! I had a unicon in 2003 which fell apart shortly afterwards (not cemented properly) and so needed to be ‘revised’. This finally gave way last year and I had TKR in August 2010. The TKR has never worked properly (catching /clicking badly and severe nerve pain every time the knee moves ‘off-centre’ so maybe alignment?).

    My Consultant is nonplussed by this and referred me to a senior colleague who explained that the research shows that TKRs following unicons are more problematic than straight TKRs. He thought that my expectations were unreasonable (really!) and that the original consultant had done a good job – God knows they do stick together, don’t they? Anyway he suggested that a CT scan might be helpful and that patella resurfacing was a possible option (but why was this not done at the time – some of those who have posted on this site have had it done, some not; I don’t know what the criteria is for the PS procedure or why it isn’t default). I see him again at the end of September so watch this space . . .

    I am really sorry to hear about your predicament: are you able to ask for further diagnostics (arthroscopy when the swelling goes down? That works for some people) or alternatively a referral to another consultant for a second opinion? I see that you have no medical ins but would you be able to pay for that second opinion if necessary?
    In the meantime, best wishes – and don’t give up hope!
    Tim D (Darlington, UK)

  51. John Reeves on August 16th, 2011 5:33 pm

    Sorry to hear this Rebecca. Its 18 months since mine and I still have the same clunking I got from day 1. I’ve given up trying to get a consistent understandable explanation; like you say, they seem to want to ignore it. I even paid for an idependant 2nd opinion which helped none. i suspect the experts dont know or are protectting themsleves or manufactuers of the prosthesis(s).

    I have just met a guy who is 5 weeks out of his Op and he has the very same clunking which he cant get a sensible explanation of; Yes, his doc cant hear it too!

    I’ve no idea what the recourse is. Maybe the groundswell from those like us will eventually achieve recognition and some positive recognition and resolution.

    Good luck and regards, John.

  52. Rick C. on August 16th, 2011 7:40 pm

    I had both knees replaced – the right one in July of 2009 and the left in October of the same year. While initailly the right knee seemed ok I discovered a “clicking” almost immediatley. The doctor told me it was a clunk and not to worry. This happens in both knees frequently and it has been going on since shortly after the surgeries were complete. I have tried to find out if this is a problem as it is uncomfortable and irritating to say the least. In the surgeons that would evaluate me since the surgery they said the my ligaments might be “loose” but the joint replacement looked good. I know this is not right – I expereince as much pain and discomfort now as I did prior to the TKA’s. Can someone point me in a direction where I can get some help???

  53. Rick Pope on August 17th, 2011 4:43 am

    TKR right on May 10. Age 56 290# fairly strong. Recovery was fairly rapid and fairly total, pain manageable. On coumadin to prevent DVT (not a serious risk for me) for 3 weeks, when that stopped I was able to take ibuprofen. Swelling & pain dropped immediately. As recovery progressed, “clunking” started sporadically. It was explained as the patellar metal button sliding along the femur metal end, and that it “would wear in”. Knowing mechanics and structures, this didn’t make much sense. At 90 day followup, clunking was worse – keeps me up at night and is slightly painful. Doctor then explained it as the plastic joint lifting slightly from the tibial metal end and slapping back down. He said this could have been avoided by making the connecting tissue tighter, but at the expense of decreased range of motion. He went for good range, and indeed I have about the same range as before surgery. “It will always clunk to some degree – for every patient. Give it a year” Well I need to have my other knee done (both were bone on bone for two years, foolish of me to wait so long in hindsight), and I am a little bit squeamish about having two “clunkers” for the rest of time. In fact I had a panic attack (which is not my style – like Robert DeNiro in Analyze This) today in anticipation of next week’s surgery. Somehow I am not confident that I am getting the straight answer.

  54. Brian Crook on August 17th, 2011 6:54 pm

    I have a long histpry of knee problems following a septic arthritis infection which was followed by numerous keyholes, then a articular cartilage graftm then a high tibial osteotomy, then finally a knee replacement without patelar resurfacing. the replacement was OK and worked quite well although there is a very mechanical noise which is due to the rotationm of the knee as I had a high bend or asian joint. Unfortunately I had patelar clunk problems and knee cap pain which meant a patelar resurface – th ereason for not doing it as part of the KR is the risk of fracture due to the high bend achieved with my joint. I took the risk, and had a very long rehab, not helped by a fall with my knee under me which set me back but strangely actually helped by an involuntary stretchig of the ligaments – don’t try that at home !!!!. With the support of my physio who is amazing(she has been with me throughout the 8 years of trouble) and is an expert in these matters, I am no more or less pain free. great bend and actually getting there – I was 46 when I started this trouble. My tip is get a great physio, work hard and have faith – my best wishes to all

  55. Rick C. on August 18th, 2011 2:10 pm

    To Rick Pope – As I said earlier I have had both knees done and they both “clunk”. This happened immediately after surgery. I wish you well and hope your next surgery reveals better results. If I knew then what I now know I would have never had these surgeries. The pain and problems are not much different than prior to TKA.

  56. Brian Crook on August 18th, 2011 8:02 pm

    I suspect some correspondents are confusing patelar clunk with the clink of a knee joint. As in my previous post my joing has always made a click – in fact I can sit in my chair and make it do it by flexing my quads – this is the mechanical movement of the joint. I did however have patelar clunk and grinding which was very painful but which was cured with a patelar resurface. The joint clunking is painless and you actually forget about it very easily – its just a mechanical thing

    Brian

  57. admin on August 19th, 2011 1:48 am

    Hello Brian,

    You are correct in differentiating Patellar Clunk from “clicking” noises. See our related post

    http://www.totalkneeweb.com/knee-replacement-“clicking”

    on this related topic.

    Admin at
    http://www.totalkneeweb.com

  58. Rick Pope on August 19th, 2011 9:24 am

    Thanks all for comments so far. I learned that I have a Zimmer device. I had been lax with stretching & exercise for several weeks, and I now think I subconsciously had a good reason: the pain diminished to nuisance levels where pills were not needed. For two days now I have resumed the PT regime and the clunking has gone off the chart. Each clunk causes only a slight pain, but since it happens with almost every knee movement, it adds up enough to warrant a pain pill. Hydrocodone usually takes the edge off and I can function, but sometimes I have to add an oxycodone IR to sleep. My cardiologist insisted on a nuclear echo & chemical stress test which I had done today. I am half hoping he won’t clear me for surgery which is scheduled for Tuesday. Usually I don’t have trouble making a decision, but the path ahead is not at all clear for me here. The left knee is bone on bone (as was the right) so I cannot live like this. I don’t think there is any nutritional approach (I take all the supplements) to repair the bone on bone situation. I want to trust my surgeon who says I should be thankful that my recovery is as rapid and successful as it is, and accept that the clunking will take a year or even two to diminish. But of course surgeons notoriously tell white lies so their credibility suffers. The knee is much better, even with the clunking, than before surgery, and without repair the problem would have progressed. So I would grin and bear it if I thought the clunking would get no worse, but being an engineer I know that any mechanical joint that does not run smoothly will wear out prematurely. I need to be confident that it will get better as the ligaments and tendons tighten up.

  59. Rick C. on August 25th, 2011 9:17 pm

    I need to ask a question…. How often does the clicking happen in joint after it has been replaced? Is there anyone else that experiences your knee just giving out? My knees clicking (I have been told it is a clunk) with about 75% of the steps I take. It happens more frequently with minor exercise – bike riding, swimming. Is this typical for anyone else?

  60. John Reeves on August 27th, 2011 10:03 am

    18 months on, and since day 1, I get click/clunking with every step and yes its worse in exercise. BUT its not got worse, so I notice it less as I subconsciously accept it.

  61. Sue Coleman on September 27th, 2011 5:58 am

    I have had a TKR on right knee 7 weeks ago and am still on pain killers have had excessive swelling they tell me, left hospital with a 65 degree bend and now am at 105 degrees but am experencing the feeling of the knee kind of clinking and moving more so side ways when I am sitting if I go to move my upper body I can feel it moving I think it is the knee cap, it has been resurfaced, it feels really weird, does’nt hurt and I can’t hear it but it just feels like it is clunking, very unnerving also feels like this when sleeping if I roll from side to side is this normal should I be worried about this .

    Sue

  62. Rick Pope on September 27th, 2011 12:29 pm

    Sue Coleman,

    Definitely talk to your doctor, or more commonly, a nurse practitioner at the doctor’s office. Swelling is helped by “RICE” rest, ice, compression, and, most important, elevation (knee higher than heart, and foot at least a little higher than knee). Doctor may recommend ted hose.

    I had right knee TKR May 10 and left knee Aug 23, age 57 290#, was seriously bone on bone. Recovery excellent (I am built like a football tackle and am aggressive as a combat marine) BUT I have serious clunking both knees. More discomforting than painful, but, like with you, unnerving. I don’t suffer any satability issues, but maybe that is because (a) I am built like a tank, (B) I did aggressive pre-hab before each surgery, and (C) my long-ago karate training, Overall, pain is a issue, and I am resistant to medications. Some days I take 6 oxycodone IR 5mg; other days 1-2 hydrocodone will do the job. I was having lots of pain because I was walking my dogs 30-45 minutes daily. I backed off the endurance and pain reduced. Two useful tools are idealstretch.com and StretchOut strap from http://www.optp.com – check with your therapist. Be persistent with your doctor and therapist – IMO daily stretching and range of motion is critical, but strength and endurance are secondary and can be reduced when overly painful. I am not 100% satisfied with my doctor explanation that clunking improves over first 12 months but will be always be present to some degree. Apparently there is a tradeoff between too tight – no clunking but seriously limited range of motion – and looser – which means full range but also clunking.

  63. Gary Dunn on October 2nd, 2011 9:34 am

    I guess I’m just another unlucky one.. I had TKR three and a half months ago and my recovery was doing well and I had minimal Pain until the clicking started.. I had some x-rays and the doc’s say the op went well and all looks good “although my patella is slightly to one side. He has given me a series of exercises to perform to strengthen my muscle on the left side of my right knee. I guess he thinks this will straighten my knee cap? Also my knee area is still numb on the outer side for about 15cm long over a large area.
    Will the numbness go away? It’s only been 3 and a half months can I expect the clicking to go away? I’m in pain sleeping problems and this cost 28,000 usd in Dubai… God I’m un-happy can anyone give me anymore advice.

  64. Rick Pope on October 2nd, 2011 2:39 pm

    Gary,

    Three months is early in recovery. Are you faithfully doing daily exercises and RICE therapy? Nerves take up to a year to regrow, reprogram, and stabilize. I have regional numbness and other nerve “artifacts” that come and go. I take pain RX liberally when needed, but only when needed. Some days nothing, other days several oxycodone IR. They are reluctant to prescribe oxy but I present a well-argued case. I take two OTC naproxen 220gm daily as well as a ton of vitamins, very carefully researched, which I believe reduces inflammation and aids greatly in recovery. Be persistent with your doctor and don’t hesitate to get a second opinion – just make sure the second doctor isn’t a golfing buddy of the first!

    Rick

  65. El on October 8th, 2011 2:19 am

    Hello I am about to undergo the tkr on both knees. I am 52 and have tried all the conservative measures before going down this road. My mobility is so limited I can barely walk two steps. I have read everyone’s notes and am a little bit afraid now. I am tired of this pain been dealing with knee problems since 1989 and pain as well as a couple of surgeries. Can anyone who has had the surgery re-assure me that it will be okay? I do know that the rehab is the most difficult part and I plan on doing it religiously. Any feedback would be appreciated.

  66. Sheri on October 8th, 2011 6:05 pm

    I had my total knee replacement in May this year. Now when I stand up people near me can hear the grinding noise my knee makes as I stand up. I’ve described the noise like a ratcheting. It feels like a lot of popping in my knee. It happens nearly every time I stand up, or extend my leg. One day it stopped for an entire day…the day I last saw my doctor! I have another appointment scheduled, but trying to figure things out for myself. Does this sound like the “clunking” you’re describing? It is not simply the breaking up of scar tissue, as my doctor suggested. Thanks for any insight!
    Sheri

  67. Judy Campbell on October 11th, 2011 4:16 pm

    I had both knees replaced last year, the first in July and the second in August. I had so many friends go through this surgery with 0 problems. I had such high expectations with mine believing my high tolerance of pain and total immediate recovery from brain surgery 20 years ago had to be in my recovery favor. I had blood transfusions w/both surgeries, my legs were so swollen and black and blue up and down from knee to ankles. Thought this was normal at first until seeing other patients. I did my therapy, my walks and was told by hospital staff they would remember me forever for doing better than anyone after TKR. After many months, I wonder if the Drs pay them to make these comments and they make them to all the patients. Obviously, I am very unhappy. I hate taking medication and was on pain killers for almost 2 mos after surgery and finally went to Naproxin. Remained on Naproxin until my hair started falling out then just quit taking them and am tolerating the pain which is now worse than before surgery ever was. My surgeon told me both knees had severe bone to bone damage and thought TKR was my only option. My PT was so proud of my progress but I guess just thought my pain was normal. I have seen my surgeon 5 times since surgeries. Each time, I told him about the pain and noises I was having and was told I would have those that it normally takes a year to recover (I kept thinking of all my friends who had done great and w/o medication 3 mos after their TKR). I can bend my knees well, I can walk well, I can climb stairs, not so good going down but the clunking when I bend my knees and the excruciating pain every time I get up from sitting is wearing on me. I constantly (w/my husband’s help) have to keep reassuring myself they will get better. During my 1 yr exam, my surgeon finally listened to what I had to say and became immediately concerned that they might be infected. I was scheduled for an MRI and returned the following week . Upon entering the door of the office I was in the first words he spoke were “good news, no infection”. He then commented I may have to live w/the pain or he could do the arthroscopy to remove the fragments potentially causing the clunking and pain I was telling him about. Although I don’t want to live the rest of my life w/this horrible pain, I am so scared to have anyone touch my knees again and need some good recovery results from this type of surgery. I would appreicate any comments. Thank you!

  68. Brian Crook on October 12th, 2011 6:10 pm

    Hello everyone – I have commented on this before from my own experiences, but just to reiterate. Yes I did have subsequent problems with Patelar clunk after having my knee replaced but this was because teh surgeon decided not to resurface the patelar, which was done as a subsequent operation, and after much rehab and very very careful and focussed PT has now all setled down. Yes my knee makes a noise but that is just the joint moving – in fact I can make it make noise as a ‘party piece’. But I am now pain free, swelling free, and can do most things I want to do. My only issue is that after guarding my left knee for over 8 years due to 14 bouts of surgery over that time, my subconcious still tend to control that I lead with teh other knee, which has now deteriorated and will probably need some work on teh meniscus in teh next few months. Despite that kind of surgery, and the maltreatment I received following that simple operation, I now have complete confidence in my surgeon and team, and will go get it done to enhance my standard of living.

    In summary it has been a long, painful and sometines depressing road, and I feel for every one of you who is struggling, but my only advise is – good surgeon, great PT, patience and stick with it.

    Best wishes to all

    Brian

  69. Brian Crook on October 12th, 2011 6:15 pm

    ps Forgot to say of anyone wants to call me, please drop me aline on email – i’m in UK.

    We can set up a call.

  70. Tim Damer on October 14th, 2011 10:08 am

    Well Brian, you are almost a mirror image with your experiences (including UK and left knee)!!
    I had TKR in August 2010 following collapse of partial replacement done in 2003. First 3 months seemed OK then very painful ‘catching’
    problem developed. My consultant referred me all over the place for second opinions and I have now ended up with a revision specialist at University Hospital North Durham called Steve Scott.

    Mr Scott has offered patella resurfacing (why not done originally?) but explains that it will only have a 50-50 chance of success and that every new surgery brings diminishing returns. Well I think we both know that (!) but my inclination is to go for the resurfacing as cannot continue with present levels of pain.

    Really pleased that you are emerging from a long and arduous experience and best wishes for your continued recovery. I am on tim.damer@ntlworld.com
    Kind regards, Tim D

  71. Take my knee. Please. « Life in the Boomer Lane on December 22nd, 2011 1:03 pm

    [...] streaming by, all eyeing her suitcase, with thoughts of stealing her underwear. And then to get Clunk.  Which is an actual disorder after knee replacement that results in one’s knee sounding like [...]

  72. Cliff on February 8th, 2012 12:24 am

    I had a TKR on my right knee 11/10/11 and so far everything is going OK except for one thing…the knee clicked like a castanet right from the first step in the hospital and still does, only it seems to be getting worse. The Dr just shines it off with “oh the knee has to settle” but after three months it does not seem to be settleing. The question is am I going to be stuck with this clicking knee for the rest of my life. Will it, in fact, stop clicking in the future. If not, is there a procedure to correct this problem. I hope so ’cause it is driving me nuts.
    Any comments would be appreciated.

  73. Cliff on February 8th, 2012 12:27 am

    had a TKR on my right knee 11/10/11 and so far everything is going OK except for one thing…the knee clicked like a castanet right from the first step in the hospital and still does, only it seems to be getting worse. The Dr just shines it off with “oh the knee has to settle” but after three months it does not seem to be settleing. The question is am I going to be stuck with this clicking knee for the rest of my life. Will it, in fact, stop clicking in the future. If not, is there a procedure to correct this problem. I hope so ’cause it is driving me nuts.
    Any comments would be appreciated.

  74. Rick on February 8th, 2012 4:08 am

    Cliff, I had TKR left May 2011 and right Aug 2011. Clunking (not clicking) was a big problem. It would come and go, but at times I would clunk loudly several times with every step. Not really painful but very disconcerting and would wake me at night. Surgeon said (a) give it a year and (b) it’s a tradeoff during surgery – tighter reduces clunking but also reduces range of motion. Looser increases clunking but also increases range. I was bone on bone for 2 years and had severe bow legged and other deformities that limited his options. I jave 145 degrees plus flexion and maybe 10 degrees short of full extension (but I probably always had that limitation). I am age 57 5’10″ 300# heavily muscled (and way overweight) and had a brown belt in karate (inactive for 10 years) . I did all the exercises diligently, not just the stretches but walking, treadmill, elliptical, rtecumbent, bosu, rebounder (jogging in place). Pain, swelling, and clunking. I argued for, and got, Oxy IR for the pain and used 0 to 3 every day. After Christmas I snowbirded to FL and have been bicycling every day and just got a Total Gym XLS. Also remodeling and caring for 2.4 acres outside. Within days everything tightened up and I am now 99% pain free, swelling minimal, walking is no longer unpleasant, I think the reasons for the improvement (a) simply time to recover (b) bicycling as hard as I could (c) many squat variations on the Total Gym (which they used in PT). I also take LOTS of supplements including Wobenzyme from Douglas Labs (really helped swelling) and Alcis lotion (also helped swelling). Plus the usual ice packs and elevation (an hour a day with knee above the heart). That’s my story which may or may not reassure you, your mileage may vary.

  75. Cliff on February 9th, 2012 11:58 am

    Rick, thanks for input. I also had real pain the first month but my Dr gave me Oxy right off the bat. I stopped taking it the second month because pain was ok without it. Am doing PT for the second time because when I complained about the clicking he had to do something so he sent me to PT again, lol..
    So far you are saying what everyone is saying…give it time so, since I have no choice, I will give it time. I too am big and overweight but I try not to let that slow me down, lol.
    Again thanks for input and good luck to both of us.

  76. kay on March 6th, 2012 5:05 am

    Havehad clicking for the last 3 years since total knee replacement. All went well after surgery but now when walking my dog at night sometimes knee gives way, feels like it lets go and knee goes towards ground and take another step and it rights itself. have been back to specialist twice now and all he says is Loose more weight, but is difficult when it has not become painful to walk and knee is very tight and pain down left side. It made a great suggestion that I have lap banding and was prepared to write a referral for me, I have already lost 30kg to have knee op and kept it off and I ended up tell surgeon to recommend lap banding for himself as he is a partically big man who says his back aches during long hours of surgery and can affect your concentration, sorry but was not happy with this comment and wonder if he became tired during my surgery.
    Have had knee xrayed and nothing has shown but thinking of seeing a new surgeon although they do not like to fix anothers problems, do you think this is the correct course of action to take.
    I weight 100kg and am trying to loose another 20kg currently.

  77. Cliff on March 7th, 2012 1:19 am

    Kay, did you have clicking in knee right from the first step? I have a feeling mine will never go away. My surgeon had two surgerys, one before mine which ran late. He didn’t get to me til after 6pm and I think he was tired and gave mine short shrift. Its been 4 months since surgery and except for the clicking and still some weakness in leg, am walking pretty good without pain. Knee still gets stiff when I sit or lie down for a while.
    I think I made two mistakes…one, I elected to have this done and two, I picked the wrong doctor…oh well live and learn

  78. Raunee on March 14th, 2012 7:10 pm

    I had TKR Feb. 9, 2012. 5 weeks tomorrow. Some of you talk as though you took minimal pain meds, others sound like you have taken a lot. I was on oxy 40′s twice a day for three weeks, then lowered to oxy 20′s twice a day. With percecets as needed throughout the day. (1-8) a day. I will be taken off the Oxy’s at the end of this week. I’m a little worried about the pain, but also worried I may go through withdrawals. How have you all handled the withdrawals from pain killers. Maybe I won’t experiece them, but I’m worried.

  79. Rick on March 15th, 2012 2:01 am

    Raunee, I had complicated surgeries and fair amount of pain. Oxycodone 10mg every hour in hospital and several per day for 6 months, vicodin when pain eased. Oxycontin same as vicodin for me. I am resitstant to most meds. Keep up aggressive exercise, therapy, ice, and rest. Advil is effective for pain, Nuprin too (I own’t take RX nsaids – too dangerous, nor tylenol). Generic nuprin works, but advil tablets are the best for me. I found withdrawal minor, almost inconsequential. Douglas Labs Wobenzyme was very effective in reducing inflammation and indirectly pain. What finally pushed me over the edge to no pain RX was total gym (for easy squats) and regularly outdoor bicycling. I would suggest taking as much pain rx as you need subject to maintaining clear headed enough to honor your job and family commitments. Plenty of quality (not cheapo) vitamins including silymarin to help the liver clean up all the meds.

  80. Cliff on March 18th, 2012 5:27 pm

    No clicking knee huh?

  81. Raunee on March 21st, 2012 4:13 pm

    Total Righ Knee Replacement Feb. 9 2012. So I go to my Dr. yesterday for my 6 week check up. My range of motion is great, doing well he says….. So I ask him a couple of questions about the popping and clicking in my knee. and a couple of other questions I’m concerned about. I have been reading all the “threads” on this web site and it seems, no matter what everyone asks their Dr., the Dr. will say that is normal. Sure enough, he says the it is “normal” Oh well, we will see if it gets worse or better.

  82. Rosalie Ovitt on April 25th, 2012 8:46 pm

    I had TKR both knees on October 13,2011. Was doing great until a month ago. Left knee catches when I first stand up and hurts like h.,,! Dr. said it was scar tissue build up. Makes more of a squishing sound than a clunk but I can feel the clunk when I stand up straight. Dr. said it’s normal and will wear itself down. So glad to see these “threads”. Makes me feel a lot better. Best exercise I found. Go to a casino. You can walk around, sit down, maybe even win a little something. Going to enjoy as much life as I have left. I’m 70.

  83. Richard - VA knee job on April 27th, 2012 2:45 pm

    My clunk started at about 8 wks,I’m on a device called an extensionator to get my leg to straighten.Crunching and cracking is getting worse,plus the pain is just lovely.Been told they can’t go back in for sometime because of potential infection problems.I’m interested in some of the e-mails about smoothing the knee cap.My problems are worse than before surgery,trying to stay positive.As long as I don’t have to bend knee i.e. standing straight up I’m fine

  84. rabbit supplies on April 29th, 2012 5:40 pm

    this is a tremendous weblog post, one of many perfect from these which i have come across so far. i am adding your rss to my reader, see you every single week

  85. Rick on April 30th, 2012 1:14 am

    Talk with doctor about easing up on extensionator. I didn’t have full extension even before surgery, partly because I walked on balls of my feet since childhood (i.e. NOT heel first) which seemed like a good idea at the time (to ease impact) but I am advised is bad for several reasons and contributed to my knee problems. Anyway, the therapists SOMETIMES push too hard. Yes, you want to get full range back before scarring sets in. But you have to balance the pain and problems caused by aggressive PT for extension against overall recovery. Keep swelling down with ice, rest, elevation which may entail sacrifices of time and activities.. I don’t like RX nsaids, but did some advil (better than generic ibuprofin for me. Wobenzyme from Douglas Labs (follow instructions about between meals) worked wonders for my inflammation. I always used lots of vitamins, esp A & D for healing – educate yourself, doctors know almost nothing about it. I was generous with pain RX – oxycodone 10mg (vicodin and oxycontin had very little effect). I needed the pain RX to be aggressive with my therapy and to keep moving in general. At 9 months I got a Total Gym (for controlled squats) which pretty much completed my recovery and ended need for pain RX. Still have clunking and some cracking. Surgeon advised clunking is a devil’s bargain tradeoff with reduced range of motion. I suspect that clunking is their dirty secret – perhaps the weakest part of the whole deal. Will be up for my annual soon (left knee May 2011, right Aug 2011). I am much better than before surgery, but don’t expect to ever be back to old self. Better than crutches, or walker, or wheelchair, to be sure. Knees slow me down, but only because I am careful and avoid kneeling or risk of falling off ladders, I still do chores around house and yard, karate workouts, exercising.

  86. Joanne on May 21st, 2012 7:21 pm

    I had my first TKR July 6th and the other knee done September 28th. My left knee has not stopped hurting (not intense pain, but pain nonetheless) and my right knee seems to have the clunking, catching on something issue. I am so glad to find this website because everyone tells me that at this point I should have not pain and I feel like they think I am faking it. Believe me I am not. I am 65 years old and this has really affected my quality of life. Don’t even like going to the movies because getting up after sitting for a while is painful. Finally made an appointment with the surgeon for this week.

  87. Rick on May 22nd, 2012 12:22 pm

    Joanne, I encourage you to take an aggressive role in your recovery, because this will help regardless of your condition or stage. Push hard on the doctor regarding (1) PT and exercises that you should be doing every day, (2) nutrition & supplementation, and (3) effective pain killers. My Eureka moment came in January (surgeries previous May & Aug) when I got a Total Gym and did controlled squats. Pain virtually stopped overnight. I still have discomfort and stiffness and very real limitations (no hard long walks or bike rides, and never ever kneel, which makes getting up and down to do house maintenance and playing with grandkids a little bit tedious). THe clunking I fear is unavoidable.

  88. Shirley Westbury on August 15th, 2012 5:13 pm

    My two TKRs last year went beautifully. Had one-year check up and was told didn’t have to come back for two years.
    Since then left knee makes cracking and crunching noises when I get up out of a chair. There is no pain. Just crunching and cracking noises most always when I get up out of chair — left knee only. Is there a simple explanation for this? Is this “normal”.
    Thank you very much.

  89. John Reeves - UK on August 16th, 2012 8:10 am

    Me too Shirley! Mine was 3 years ago. I dont get pain but it sounds loud and painful to others.

  90. soreknee on August 16th, 2012 8:27 pm

    Hello Shirley,

    My L TKR was done @ Mayo-Phoenix June 2010. PT/rehab went very well. The same sounds you describe started in December 2010 and continue today. Only occasional pain. OS said it might be scar tissue.
    I rarely think about it now.

    My R tkr done in 20003 is bothering me now.

  91. Judy Campbell on August 17th, 2012 2:53 am

    I had TKR on both knees in 2010 had blood transfusions w/both surgeries which were a month apart. Since the surgeries, I have walked great from almost day one, the pain, clunking and crunching was also there from day one. I walk approx 1-2 hours every evening, I do exercises every evening, and I ride my still bike of the morning….but the limitations I now have and the pain I suffer when I get up after sitting is excruciating and symptoms I never thought I would have to live with. The bottom portion of both my legs get very cold and numb, constant massaging helps but I just wish I didn’t have to deal with it. I was advised by my orthopedic surgeon, I could get arthroscopic surgery to check it but I prefer never to have any surgery again unless I am in a serious accident. I truly believe through all my previous 20 years of pain, my new knees are more restrictive and are more painful.

  92. Sheri on August 20th, 2012 12:53 am

    Right knee replaced May 2011. I continue to have crunching, grinding and pain. I’ve had my knee x-rayed, and scanned. I’ve had it injected, three PT regimens, worn patches of various medications and continued to take naproxyn and tylenol throughout. The docs tell me that they have ruled out a loosening of the prosthesis so now we wait two years before going back in to clean out scar tissue. Currently using Voltarin gel on knee, doing stretching exercises, in addition to the naproxyn and tylenol…So as I read your posts I just want to point out hat you do need to let your doctor know about your symptoms as they may indicate that your device has loosened.

  93. soreknee on August 20th, 2012 5:24 am

    Judy,
    I am so sorry to hear of your continued pain–bummer.

    I have no clue where you live . . . have you considered getting a second opinion from a different knee surgeon?

    Another thought: Once a month I go to an osteopathic physician (DO, not MD) for osteopathic medical manipulation of my back, knees, R shoulder. This hands-on treatment of soft tissues keeps me limber and mobile. Their job is keeping me OUT of surgery and hospitals. Medicare and secondary insurance pay about 90% of cost. It is well worth the $$$.

    God bless and get well.

  94. Dawn on September 24th, 2012 1:38 am

    For Sheri who posted on Aug. 20, 2012. What reason did your dr. give you for having to wait two years before taking care of the scar tissue. Usually when there is scar tissue, your dr. would take you to the operating room, put you under and use physical force to break up your scar tissue. They do not cut you open for this procedure. If scar tissue is broken up this way early enough, they would be no reason to do arthroscopic surgery to cut scar tissue out.

    This may have more to do with the type of insurance you have. My insurance company will only pay for arthroscopic surgery every six months but my dr. would never say that’s the reason he wants to wait – lol!

    I think it’s time you got a second opinion if for no other reason than to put your mind at ease that your dr. is looking out for your best interest. I can’t imagine seeing a dr. who told me I had to wait two years in pain before anything can be done.

  95. Kay cannon on September 28th, 2012 5:45 pm

    After many years of knee pain and scoped 8 times I was down to bone on bone in both knees. Scheduled both knees 2 weeks apart. Rt knee first. Had post op anemia and ended up with blood transfusions and on oxygen. Recovery was exhaustive and so painful. At my checkup I needed to be rushed to emergency cause I couldn’t breathe. Very scary. Nurse tried to kill me by giving me double shot of coumidin. I. Don’t have alot of platelets. After hospital stay and a week in rehab returned home with oxygen. Took a long time to recover from anemia. 4TH. week developed bronchitis. After 2 WEEKS I barely got clearance for the left knee. I must have been crazy but I only had the summer off to get both knees done . The day of surgery I asked my surgeon to check out the rt. knee. It felt funny. He said the knee was loose and would look at it in 6 months. All went well on this one. Both knees had terrible bruising. Pain pills had little effect. Pt was very difficult. I toughed it out and had no choice but to return to work at the 4th week. I used a walker and the pain after work was horrific. No sleep at night. It was really a struggle. At 6 months I saw my doctor about the loose rt knee . He said I needed revision sooner than later because of further risk of bone loss. OMG the revision was so much more painful than the original tkr. It’s been 7 months and I’m still in alot of pain it gets so stiff when I sit. All this time I have also been dealing with.a clunk and catching in my left knee when it flexes sitting down or going down stairs. It’s painful and really loud. Dr. Finally said it’s patellar clunk. Good grief! He will clean it out. And said might have to do a revision. No No! I don’t think I can go through another revision. Drugs just don’t work. All they do is make me do strange things which are pretty scary. Sorry this is so long I just hope it ends soon so I can get my life back.

    The

  96. Norrie Little on September 28th, 2012 9:05 pm

    You would think in this day and age there would be a knee prosthesis that would be nearly as good as the one we were born with. We can put a remote vehicle on Mars but we can’t make a replacement knee with a lifetime guarantee. I go to see my surgeon next month to discuss TKR having suffered pain for the last 15 years. My intention was to go ahead with TKR as I have bone on bone wear due to an initial ACL injury and too many operations. The only thing in my favour is I am not overweight, perhaps some of the comments and complaints are more to do with being overweight?
    Having said that, I am very unsure about going ahead with this procedure, and dread having it done only to find out a new super knee prosthesis is around the corner or better still stem cell technology finally comes to fruition. Is there anybody out there who can help me decide?

  97. Inger on October 7th, 2012 9:52 am

    Thanks to all of you sharing your experience – I has been a great comfort for me knowing that I am not alone.
    I had my first TKR February 7th 2012 and suffered almost all problems afterwards that you can think of apart from infection (nerve damage paralysis, pain etc.). After 3 months intensive physiotherapy I had full extension and walked well and thought life was great. However, in late June 2012 I suddenly developed a “clunk” and an agonizing pain when walking down stairs or flexing my knee. A heavy 3 weeks treatment of NSAID combined with other drugs did not help slowing the inflammation and finally, I have just had an arthroscopic surgery by another specialist on the 25th of September …so what now? It seems OK for now – but as I am diagnosed being a keloid former (aggressive scar tissue former ) – I fear the future. I now get a three times as much physiotherapy and exercise as standard people do and a prolonged program as well- but can I keep it going?

    I live in Denmark, Scandinavia – so I do not have any insurance problems, so please advice – if you know ANYTHING that can stop this scar tissue forming process.
    Any experience???

  98. Rick Pope on October 7th, 2012 11:59 pm

    Inger, I had TKR in May and August 2011. Knees were very bad, bone on bone, and the knee joints were “misaligned” so the surgery was tricky. Overall did well, but certainly not great. Still have some swelling with exercise, significant clunking, minor permanent nerve damage. Recumbent bicycle OK, but walking more than 200 yards hurts. Anyway, Wobenzyme was instrumental in reducing swelling during recovery. I understand that Wobenzyme is widely used in Europe. I got mine from Douglas Labs, which I was advised was the best in America. Make sure you have a good supplementation program of quality (natural) vitamins. There are many sources of education for this on the web – doctors in general know little about this, even outside America where they know zero and are hostile about it.I find that TKR’s are hot – lots of friction – so be sure to cool down with ice packs or just run cold water in the shower for a few minutes.

  99. Peggy Hanes on December 12th, 2012 5:12 am

    I had my knee replaced December 22, 2011 and had an awesome recovery. I have total range of motion and my knee feels much stronger BUT I also had what I call “BAG OF ROCKS UNDER THE KNEE CAP SYNDROME”. Aka patallar clunk snndrome. I had the knee scoped Oct. 5, 2012 and I am still healing. My scar tissue was so bad my surgeon said it was the worst he had ever seen. I was told NOT to do any bending exercises, I can do leg lifts and isometric exercises. I am taking Aleve 2x a day and using ice for swelling. The Doc. Wants to see me in two years I pray to GOD that the swelling finally goes away for good so I can at least walk without thinking of my knee:)

  100. Walt Duda on March 1st, 2013 6:04 pm

    On 9/11 12 I had both knees replaced by a terrific surgeon, nine days later I walked out of the hospital unassisted. After two months of regular PT I had 120 degree flex in both knees. To help keep the healing process and flexibility improving I purchased a Nordic Track stationary cycle which I use regularly. From day one my left knee never felt as comfortable as my right one. Since then I.ve noticed at times I can hear the knee pop as I walk. I’m 79 and am as active as I was at forty and this audible pop was at first a nuisance. Lately I am experiencing pain while walking and discomfort while lying in in bed.
    I have a high pain thresh hold but two days ago the pain was bad enough that I ceased all activity and used a nsaid which I really don’t care to use. I am a very heath oriented person and dislike ingesting drugs in any form. It’s been two days now but the discomfort still persists when walking along with a snapping sound. My right knee could not be better if it was the original. The surgeon used a robot and triangulation to get the leg as straight as it should be. It’s been five months now and I’ve postponed complaining about because I’m aware it takes time to heal from a major surgery but I guess it’s time I made my surgeon aware of my problem. Any suggestions?

  101. Rick Pope on March 2nd, 2013 3:52 am

    Walt, 5 months is still early. Pops and clunks are inevitable. That said, consult your doctor sooner rather than later, Call him now to see if he needs to see you right away or it can wait. Ice packs (the really big ones that last a while) and elevation are needed after every exercise period and one or two more times daily. Check out WOBEnzyme from Douglas Labs which really helped my inflammation (pain and swelling). General supplementation really helps (see lef.org for starting information) but most doctors know little or nothing about it so you have to educate yourself. I had a Townie bicycle (the pedals are about 8-12 inches forward from a typical touring bike (so therefore easier on knees) but which still aggravated my knees; now I have a Sun EXSportCX recumbent which I can ride for an hour with no knee pain. Unlike most recumbents, it is not low slung which would make getting on and off impossible. Similarly, your Nordic stationary may be too vertical a position. I have a recumbent exercycle which I used starting 4 days after surgery (backwards at first) with no pain. A Total Fitness gym let me do deep full squats at any resistance level starting with mild load (my surgeons rehab place had one) which finished my recovery. My retraction is good (I can smoothly squat with my butt touching my heels no pain no strain down or up) but extension is not 100% (but it wasn’t 100% even long before surgery). A good rebounder (not a cheap trampoline) is good for marching and core strength. A Bosu helps core strength and for quick 30 second semi-marching (not picking foot up entirely off the bosu) it is in the living room so I can use it many times a day, including while watching tv. I never used nsaids or tylenol; instead use natural supplements for inflammation (owbenzume, fish oils, etc) and oxycodone for pain (had to argue with doctor that I am not a junky and not selling it – having detailed journals helped convince him). Vicodin is too weak and has the undersirable tylenol.

  102. Rick Pope on March 2nd, 2013 4:15 am

    Walt,
    My exercycle is by Lemond but has a broad seat with a tall back (webbed so it breathes) The seat back gives support so you are pushing in a natural manner. My bicycle is http://www.sunbicycles.com/product_detail.php?short_code=EZ-Sport+CX&cl1=RECUMBENT again with a full seat back which allows you to press the pedals easily and naturally. The rebounder is from http://www.cellerciser.com/store/
    Rick

  103. Susan Munoz on March 2nd, 2013 1:04 pm

    I had the clunking a couple of years ago after having my new knee for around five years. X-ray didn’t show a thing so the doctor went in with a scope and found scar tissue that would move off the implant while bending it causing it to snap. He used a laser and got rid of the tissue. No more problems

  104. Elizabeth on April 3rd, 2013 12:18 pm

    I had a total knee replacement late October, 2012. It was doing so good that some days I had almost forgotten I had my new knee. I have better bend in the new knee than my other knee which, thankfully so far, is good! I can straighten perfectly and no pain. BUT in the past week my knee has started to clunk, click and crack. I was so sure others could hear it but my hubby says he does not.
    There is little or no pain – just a feeling like the outer part of the knee is beginning to recover from the numbness.
    I am wondering if this is normal? Has anyone else experienced this? It almost feels as if my whole knee, thigh and hip are clicking.
    I wonder if there have been contributory factors? Of necessity, I drove my husband’s sports car 10 days ago, necessitating me having to stoop further to get into the car and had more difficulty getting in and out than I would have in my own car. Then I have been standing a lot, making curtains! The weather has also been Baltic. Could any of these affect the situation?
    I am doing my exercises every day and using the exercise bike. Can’t do any more! Very disheartened and disappointed. ANY HELPFUL SUGGESTIONS?

  105. Rick Pope on April 4th, 2013 9:11 am

    Elizabeth, Clunking seems to be a fact of life. Good nutrition and supplementation is essential – doctors know little or nothing (that is how they are trained) so educate yourself, lef.org is a good start. Beside basic supplements, Wobenzyme greatly reduced my inflammation – Douglas Labs PS formula is supposedly the best. Daily use of ice packs really helps, esp after exercise. I love the huge flexible ice packs from Torex Mojility – they are affordable at amazon.com. I notice that my knees heat up – my osteopath says it is simply the friction of the artificial joint (more than a natural joint) which with reduced natural circulation removes less heat. I found regular bicycles (even my Townie which is easier, but still not easy, on the knees) and normal exercycles REALLY rough on the knees. I have a recumbent exercycle and a recumbent road bike (not a super low rider) which I can ride for 40 minutes without knee pain. Try to change up your posture – when standing a long time, take a break every 10-15 minutes, do range of motion, sit for a minute. Isometrics on the legs, glutes, and low back (10 seconds each, total time less than a minute) offer some quick postural relief. When getting in and out of ANY car, take it slow. You are off balance, contorted, and after driving, stiff. A few seconds extra time moving carefully can save a lot of pain. If stiff after even a 20 minute drive, do isometrics and whatever range of motion you can before existing. I have minivans and SUV’s, but even still I find my thigh gets stuck under the steering wheel. Not a big deal, just need to take a little time. I won’t even ride in normal cars when possible. Aggressively treat the symptoms with ice, stretching, rest, and (if any swelling) elevation. Taking a few minutes saves a lot of pain and probably increases the lifespan of the joint.

  106. Michele on August 15th, 2013 10:59 pm

    I’m another one with a total knee replacement. It was 2 years ago. Everything was fine even with some clicking once in awhile.
    BUT, I am now experiencing an odd sense of weakness! With some numbing. Sometimes on the side or what “feels” like on the inside.
    Anyone else feel this temporary occasional weakness & numbing?
    I fear so much it will give out on me or collapse.
    Do I need more exercise? Is my overweight condition the cause? While I push mow my lawn it doesn’t happen. YET while walking thru a store it does. And I panic.
    Can anyone offer advice please?

  107. Sheri on August 24th, 2013 4:09 pm

    Michele, if this is just beginning after two years I’d suggest a visit back to the surgeon. At two years they start to look for loosening of any parts.

  108. Sheri on August 24th, 2013 4:20 pm

    A progress report:

    I had my total knee in May 2011. This January I finally broke down and got a second opinion where I was told to back off. He said that I was keeping it constantly inflamed by continuing to push it to do everything I want it to do. I spent the next 2-3 months using my knee to walk only. I stood up bearing weight on my good knee only. One-stepped it up and down stairs, where I couldn’t totally avoid them. I really “babied” my new knee. At the end of this rest period I slowly began to introduce more activity. Today I am walking up and down stairs without even holding a rail. I have no more pain in the evening. In fact, now that I think about it, it just doesn’t hurt anymore. Period. It was a journey, not an instant event, but it’s better now than it;s been in many, many years…just like I was promised before I had the surgery.

    Please see my earlier posts to see my journey.

  109. Rick Pope on August 24th, 2013 6:00 pm

    Michele, I had TKR both sides 2011. Partial numbness is a very common side effect, from the knees on down. It gets worse at times but never goes away. At times driving is painful (pressure on gas epdal). Proper nutrition and supplementation can help a lot in some case (educate yourself, doctors are not trained in this, and buy *only* high quality stuff), especially B bitamins and alpha lipoic acid. I have to exercise every day or suffer cramping, more pain, etc. I am football player size, heavily muscled, but also I am 110# overweight which, to be blunt, makes everything worse, Wear good shoes (cross trainers, no high heels, no dressy stuff, no sandals) with good insoles (Shock Doctor’s Ultra worked wonders for me). If you think your fear is emotional, try meditation etc and revisit your physical therapy exercises. Toe risers ((without using hands, on one foot if possible). Knee lifts. Squats (total gym is good) Swimming & water aerobics. Sometimes just getting your core strength back (bosu.com) will help. But if you really fear it, don’t hesitate to get medical advice to rule out serious stuff. I just had my two year checkup with the knee surgeon (all is very well, and my case was complicated). He referred me a a neurologist for the numbness – who bluntly stated “your symptoms are very common after TKR and there is really nothing to be done about it” but, after asking if I wanted to spend more money on a long shot, referred me to another neurologist for an EMG (I also have carpal tunnel caused mainly by advanced cervical arthritis) I view my TKR’s not as replacements but as a “very excellent pair of crutches”. They let me get around unassisted, and took my pain from 7-10 to 1-3, but they are nowhere near my originals. Maybe again that is just me because I let my knees get very bad before TKR, but it is fair to say that my life is worked around my knee limitations. Not a problem for me (everyone is different) socially or work wise, but it is a high maintenance thing.

  110. George G on September 6th, 2013 7:25 pm

    I too had a TKR on 22 May 2013 in the UK. Knee was crunching and clunking from day 1. Surgeon as with other feedback given by others above ignored my concerns and kept repeating that it will take at least a year for things to improve. I have been told the same thing now on three different occasions. Initially I could feel my knee crunching more than hear it, over the last 12 weeks it has got worse and the noise louder. Every movement of my leg causes it to clunk loudly, even when I am lying down or in bed. I have a high pain threshold and can generally tolerate pain quite well, but this is wearing me down physically and mentally as I seem to banging my head against a brick wall. I take painkillers regularly (Co codamol 30/500 and Tramadol) but it doesn’t ease the pain. I have read several reports in this forum where people have had similar problems but few where successful solutions have been found. I know 12 weeks is not long in terms of recovery from TKR but this is getting worse by the day and lack of action and understanding from the surgeon and my GP is really frightening. I don’t get any straight answers to my queries only stock replies of keep doing the exercises and wait. The problem with this is that the exercises make it sorer and stiffer, supplement by spurious leg pain and increase of the numb area on the outside of my knee.
    I would be grateful for any feedback where this or similar post TKR problems have been successfully diagnosed and/or treated.

  111. Rick Pope on September 16th, 2013 2:52 pm

    George,

    Four months is early. Continue your exercises, especially range of motion and strength training. You may not be able to place full weight on the leg, so exercise in water or use some other method to reduce the load (Total Gym worked very well for me). I recently started walking backwards and sideways (stepping in front of base foot 25 times, then stepping in back) helps. Cold baths (start luke warm if you need to, then run cold water) help (better than ice packs). A friend has had excellent results with Curamin for knee pain (no surgery yet) – it helps me a little. Only pain killer for me is oxycodone which is hard to get (DEA rules). I now only use 2-3 a month, but was 3-4 a day at the 12 week stage. Advil works better (12+ pills a day) but of course hard on liver, so be sure to take silymarin (milk thistle). Proper nutrition and supplementation makes a big difference – educate yourself since surgeons (and most doctors) generally know ZERO about this – not their job. Take quality vitamins – not junk sold at drugstores or discount stores – most brands have low effective doses, wrong forms or the vitamins, or many adulterants or contaminants. There are plenty of good web sites to educate yourself – lef.org, oherb.com, mercola.com – even amazon reviews if you know how to read them.

  112. Glen Stainton on October 3rd, 2013 5:19 pm

    I had a total knee replacement in Oct. 2011, and it was great for almost a year. Then I started having problems when I went to take a step after standing in the same place for some time. I felt a sharp pain which made it difficult to take a step, usually requiring 4 or 5 attempts before I could do so. About I month later the problem occurred when I went to sit down. Many years ago I had most of my patella removed due to an injury. As a result, my “femoral component” is the largest used and my “patellar component” is the smallest. I had arthroscopic surgery in July and they removed a piece of tissue that had grown into the area, and I was pain free for a week. Then my problem returned although less frequent and almost always less painful. I am due to have a full knee replacement on my other leg, but am reluctant to do so until the problems with my new knee are resolved. I would be grateful for any feedback.

  113. Rick Pope on October 9th, 2013 2:32 pm

    Glen, Since you just had surgery go back to that surgeon (ot to the surgeon who is going to do the other TKR if different) for advice ASAP. The new TKR will put additional strain on the other knee. You want to be as healed and as strong as possible going INTO the next TKR. Read my previous posts for advice on reducing the inflammation. I suggest concentration on range of motion exercises and reduced impact/load exercises especially in water but also total gym or recumbent bikes. Get a prehab rx and delay the surgery until fully recovered unless there is compelling reason.

  114. Knee Replacement Complications Overview : TotalKneeWeb.com on November 21st, 2013 11:33 pm

    […] involves interaction of the scar tissue at the top of the patella with the femoral component. See our article on Patellar Clunk Syndrome for more […]

  115. Pamela on March 25th, 2014 11:38 pm

    I am now at 15 weeks post op left tkr. I have had nothing but trouble. My knee is worse than ever prior to surgery. Every step I take I can feel and hear clicking about 5 clicks per step followed by a deep clunking. I have zero energy. I can’t sleep as even turning over in bed will awaken me with such sharp pains generally on the lateral aspect of my knee. When walking it feels like something inside keeps catching causing sharp intense pain. I have gone for a second opinion and they did lab work and X-rays resulting in the same answer, just keep pushing PT and give it time. Lab work is clear, no infection. Extra ‘play’ in the joint causes some of your complaints. This is crazy, I have totally lost my way of life,I am unable to do things as simply completing the groceries and due to not being able to return to work after the 12 week FMLA, I have now been released from my position at the hospital and my status changed to per diem. As there is no way I can afford the cobra cost of insurance I will lose that as well on 3/31/14. I can’t hold on like this much longer. I have 4 young children at home and I am in constant pain and exhausted! If this is ‘okay’ and we’ll just take time why is it getting worse. Sorry so long,I just don’t know what to do. Thanks for listening, any input would be welcomed. PAM C

  116. Rick Pope on March 31st, 2014 3:50 am

    Pamela, Have faith I needed lots of oxycodone at that point. Ice is your friend – get the huge ice packs from amazon. Use them at least twice a day, and after exercise. Good nutrition is essential – that means quality vitamins. Start at LEF.ORG for a basic education. I made a breakthrough when I started Wobenzym tablets which dramatically reduced the inflammation (and pain) overnight. Be sure to walk – with perfect form – up to a mile a day, minimum 1/4 mile. If you can get access to a Total Gym, do deep squats, starting at the easiest elevation (least amount of incline). Advil is your friend (it worked much better for me than generic ibuprobven, Aleve.) I would avoid RX nsaids unless they really helped, and *never* take acetominiphen.. I am 3 years postop and still have problems – serious muscle cramping, neuropathy. At least I can walk without crutches! See the book Pain Free by Egoscue – you may find some exercises useful, but really take to heart his insistence on PERFECT form. The bad news is that it’s a lot of pain, work, and limitation, but the good news is that you can with brains and hard work make if better. Rick

  117. Glen Stainton on March 31st, 2014 7:19 pm

    Pamela, in the case of my tkr problems they x-rayed the knee 3 or 4 times and sought opinions from other ortho. surgeons, but nothing showed up. My problems have almost disappeared over time and with plenty of exercise. I also wear a brace to help stabilize my patellar component when playing golf. It seems to help. Every once in a while I get a hint of the pinching , but it is almost pain free. I am planning to have a tkr on the other knee this October. I sincerely hope that they are able to identify the cause of your problem and rectify it. Glen S.

  118. cathy on June 17th, 2014 1:58 am

    Please can some help.i had partell knee replcmnt 92,had a tkr 2013 had tkr over part,since day 1 ive had catching pain clunking night pains,the more i walk the more clunking and pain i cannot gaite normal steps my knee doesnt fuction that way ,had physio they could help she said had been the first she had seened havingn been done this way
    ,ortho pod xrayed found a large boney growth on side btwn femur and knee,he sent me off to physio to stenghten total wasted time.im not happy as it is not normal i can hear the clunking loudly,it surely cant be normal not to be able to walk normaly ive had 8 mths of it im due back to ortho pod nxt friday any answers???.thks cathy

  119. cathy on June 17th, 2014 1:59 am

    Please can someone help.i had partell knee replcmnt 92,had a tkr 2013 had tkr over part,since day 1 ive had catching pain clunking night pains,the more i walk the more clunking and pain i cannot gaite normal steps my knee doesnt fuction that way ,had physio they could help she said had been the first she had seened havingn been done this way
    ,ortho pod xrayed found a large boney growth on side btwn femur and knee,he sent me off to physio to stenghten total wasted time.im not happy as it is not normal i can hear the clunking loudly,it surely cant be normal not to be able to walk normaly ive had 8 mths of it im due back to ortho pod nxt friday any answers???.thks cathy

  120. Ginette on August 9th, 2014 8:57 pm

    10 weeks post RTKR. It has been a difficult recovery. I had a blood clot so antiinflammatories are not possible for the time being. I am slowly regaining ROM to an acceptable level after continuous PT. However, I have pain when I walk, the prosthesis seems to rub against something ( scar tissue?) . This gets worse as the day progresses as the area becomes inflammed , swollen and increasingly painful. I also feel pinching around the knee cap.

    My favorite activity is walking and right now I have to keep all walking to a bare minimum.

    Will this eventual subside or is there a more serious problem?

  121. Rick Pope on August 16th, 2014 10:51 pm

    Ginette, Check out nattokinase and serrapeptase for the clot, and ginger, bromelain, and boswellia for the inflammation. Try ice packs and elevation (knee higher than the heart) after activity and before bedtime. If you have not already done so, have a physical therapy assessment to make sure your posture and body mechanics are perfect. Walking with a rollator (walker with wheels) allows you to concentrate on proper form and range of motion. 10 weeks is early, you can expect improvements for up to 12-24 months. Your best resource is your surgeon and/or his nurse. Be sure you have good waking shoes, consider Shock Doctor insoles from amazon etc. At some point consult a physiatrist or sports medicine doctor (check around) to make sure that you don’t have other postural problems or weaknesses, which are very common with and without TKR. All of the above have helped me. I am 3 years post-op (TKR both) and still have serious pain in the feet, ankles, big leg muscles (knees are only a little sore now and then). It’s a work in progress. Best Regards

  122. George G on August 17th, 2014 7:41 pm

    I am following up my information posted on 6 September 2013. It has been a long hard struggle to try and resolve the issues I have with continual clunking and crunching from my knee since TKR in May 2013. Surgeon, physio’s and arthroplasty after team all ignored my concerns and I ended up putting myself through hell to try and resolve “weak muscle” issues etc. I was on so much morphine at times I didn’t know what day it was. To cut to the chase if you have problems like I experienced don’t give up or get fobbed off. I eventually paid for a private consultation where it was confirmed that the joint had failed and I need revision surgery to resolve it. Nothing I could have done would have affected my knee or outcome. The main issue is to get some independent advice and complain formally till you are listened to. In my case its not particularly good news but at least I know what is required to resolve the pain and mobility problems

  123. Becky Slatzer on October 7th, 2014 2:46 am

    I have some questions/concerns. I had TKR on right knee in April 2014. Did therapy for 4 wks, couldn’t get past ROM of 65 degrees. Doc did manipulation under anesthesia and got me to 125 degrees. I digressed after wks of PT and now at 110 degrees. I’m fine with that really but now have developed this clicking/popping and catching feeling on the outside of the knee. Quite painful to walk, sit sleep etc…anyone experience this?? Doc keeps blowing me off. Should probably seek 2nd opinion. It just doesn’t seem right…

  124. Rick on November 11th, 2014 7:24 pm

    Becky, Pain after 7 months is not that unusual. Is the pain the knee? Or the muscles? Etc? After 3 years, my muscles (quads, calves, butt) are still *very* painful after exercise and still cramp up if I don’t exercise. I find Advil more effective than generic ibuprofen or even oxycodone. I am going to try SAMe. Ice is your friend. But it sure sounds like a second opinion is called for. Suggest you interview the doctor or at least his/her dedicated nurse to get someone who is willing to help you. Clicking and clunking is the “elephsnt in the living room” that surgeons pretend doesn’t exist. They say it means nothing and there is nothing to be done for it. I am not so sure. As an engineer, I cannot help but think something is misaligned and/or wearing at an advanced rate. Educate yourself about vitamins and natural anti-inflammatory stuff (start att lef.org) and only buy quality brands.

Got something to say?