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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Pain Below The Patella After Undergoing Knee Replacement?

I had a hemi-knee replacement in Feb, 2014, a lateral Vangard. i was doing well, regained my strength & RoM.I began experiencing pain below the patella when I initially would load my weight approx. 3 wks ago which has progressively increased. i had a MRI which indicated politeus tendon strain. Symptoms increased & I had a CT a few days ago which indicated a tibial plateau fx. & unstable knee component. Since my Dr. initially missed the dx, I have lost confidence in his treatment. We are limited with providers since we have Cigna & are required to utilize HCA hospitals in OKC (OUMC or OUMC of Edmond) only. I would welcome any comments & feel i must make a decision very soon re: sx. Thank you.
Wed, 18 May 2016
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Physical Therapist or Physiotherapist,  's  Response
hi,


thank you for providing the brief history of you.

As you already had a partial knee replacement and later stages you have popliteus tendon Sprain. Also, the tibial plateau is fracture and the unstable compartment I will advice you to have another corss consultation with other ortho as this looks a more of the failure of the first partial knee replacement.

Also, if you had full ROM and good mobility knee joint, certain issues shouldn't occur. but if you have applied an abnormal weight or have injured your knee then the plateau fracture can occur.

Also, pre partial knee replacement and post operation how is you bone strength. Are there any changes in the dexa scan report?

this report makes a lot of sense to understand whether the partial or full knee replacement has to be taken into consideration.

As the tibial plateau fracture needs an understanding and based on it the next surgical or conservative treatment plan can be decided. In a grade 1/2 degree of fracture it might not be advised to undergo any surgery but if the fracture is massive then a surgery might be needed.

Also getting a full knee ROM post TKR is not the only thing in the rehabilitation process, even the muscle imbalance needs a correction to avoid stress and strain injuries to the bone.

In my clinical practice such cases like yours are very uncommon and treatment will be totally symptomatic post all the parameters taken into consideration.

Regards
Jay Indravadan Patel
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What Causes Pain Below The Patella After Undergoing Knee Replacement?

hi, thank you for providing the brief history of you. As you already had a partial knee replacement and later stages you have popliteus tendon Sprain. Also, the tibial plateau is fracture and the unstable compartment I will advice you to have another corss consultation with other ortho as this looks a more of the failure of the first partial knee replacement. Also, if you had full ROM and good mobility knee joint, certain issues shouldn t occur. but if you have applied an abnormal weight or have injured your knee then the plateau fracture can occur. Also, pre partial knee replacement and post operation how is you bone strength. Are there any changes in the dexa scan report? this report makes a lot of sense to understand whether the partial or full knee replacement has to be taken into consideration. As the tibial plateau fracture needs an understanding and based on it the next surgical or conservative treatment plan can be decided. In a grade 1/2 degree of fracture it might not be advised to undergo any surgery but if the fracture is massive then a surgery might be needed. Also getting a full knee ROM post TKR is not the only thing in the rehabilitation process, even the muscle imbalance needs a correction to avoid stress and strain injuries to the bone. In my clinical practice such cases like yours are very uncommon and treatment will be totally symptomatic post all the parameters taken into consideration. Regards Jay Indravadan Patel