Patellar Clunk Syndrome: Complication Following Knee Replacement Surgery
In general, 
Total knee replacement (TKR) is a highly successful procedure. However, complications, although relatively rare, can sometimes occur. One such complication is known as 
Patellar Clunk Syndrome.
To understand this condition, it helps to first understand a little bit about knee anatomy and function (Figure 1). During knee flexion and extension, the patella (knee-cap) rides within a groove in the femur (thigh bone).
Figure 1: Basic Knee Anatomy
In knee replacement the worn ends of the bones are “resurfaced” with metal and plastic implants. The patellar groove is part of the metal femoral component that is implanted onto the prepared femur 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.
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. 1 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.
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 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
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nice and impressive presentation. cheers!
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.
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!!
Greetings,
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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.
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
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
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
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?
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.
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
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
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
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
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?
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
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
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????
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
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?
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.
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.
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?
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 ?
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.
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
Susan,
Thanks for your post. I’m glad it worked out well for you.
Did you go PT after the scoping surgery?
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.
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
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.
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.
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 . . .
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
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
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.
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!
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:(
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 . . .
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
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.
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.
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!
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 . . .
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?
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.
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!
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?
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?
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.
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)
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.
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???
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.
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
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.
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
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
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.
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?
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.
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
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.
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.
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
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.
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
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!
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
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.
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
[...] 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 [...]