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Can components come loose?

Discussion in 'Knee Replacement Recovery Area' started by muskratsuzie, Nov 1, 2010.

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  1. muskratsuzie

    muskratsuzie Member

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    Hi. I have bilateral patellofemoral knee replacements and when I am walking, during extention of my right leg, I feel a 'clunk' and hear at least 5 or 6 loud clicks and have a burning sensation with each step. If I am only taking a few steps it doesn't hurt too bad, but when it is farther than that, the pain becomes intollerable. I have been back to my OS for the problem (also with dislocations despite the replacements) but he claims there is nothing wrong from the x-ray pictures. I am very frustrated as I feel there is something going on. My original OS moved to another state, and I am seeing another in the same office who also specializes in knee replacements, but I just don't feel he is taking me seriously. I cannot change doctors until next May when the insurance policy is renewed. Has anyone else experienced the 'clunking?' Any help would be greatly appreciated. Thank you!
     
  2. Jamie

    Jamie Administrator

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    Hi, Muskratsuzie....welcome to BoneSmart! I'm glad you found our forum and decided to join us.

    I'm sorry to hear you are having pain after your surgery. It sounds significant enough that you need to have someone take a serious look at what is going on in your knees. I recommend that you seek a second, third and maybe even a fourth opinion from surgeons totally unconnected with the practice where you are going now.

    "Intolerable pain" means that there is something that needs attention. The noises you are describing could be ligaments moving over the implants. It concerns me that the kneecaps are dislocating....that would seem to indicate a problem too.

    Our forum nurse, Josephine, is away from BoneSmart for a few days, but I'm going to tag her so that she sees your post quickly once she is back online. @Josephine:

    Please keep us posted on how you're getting along. We'll be here for you as long as you need us!
     
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    • muskratsuzie

      muskratsuzie Member

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      Thank you very much for the quick response! I have been dealing with the dislocations most of my life (since age 13 & I'm 36 now) and wonder if it will ever be any better. The OS prescribed DonJoy hinged braces to keep the knees aligned, but from all the surgical scars, I find them very uncomfortable to wear. Plus it doesn't help the issue with my right knee clunking. Also, a bit of background info. in case it helps: I began having surgeries on both knees at 14 due to falling from dislocations, then as a young adult, was in a bad car accident where the dashboard fell on my knees and legs. I had more corrective surgeries after that. More recently, I had a work-related accident which required me to have the PFKR's. I will need to find out about getting another opinion, if it will be allowed through the insurance. I also appreciate you tagging the fourm nurse for when she gets back. I'll post when I have any new 'news.' ~Suzie
       
    • Jamie

      Jamie Administrator

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      Suzie, you can use the BoneSmart Clinic Locator (link is in the gold tool bar at the top of every page) to find other surgeons in your area. You'll type in your zip code and the distance you are willing to travel and a list of clinics will pop up with web site addresses. Take a look online and make a list of possible surgeons. Then you're going to need to call their offices and talk because you have such unusual circumstances. I'm sure you'll narrow that list because you want to find the one or two surgeons who have dealt with problems like yours.

      I believe your best bet will be a practice associated with a major university or teaching hospital. That's usually where the more specialized surgeons wind up. Let me know if I can help you in your search. All I would need is your zip code.
       
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      • muskratsuzie

        muskratsuzie Member

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        Thanks again! I did a search and found several clinics that might work (depending on insurance). I need to call and find out what steps are next to obtain another opinion. Today turned out to be a bit too hectic to get anything else done. I'm thinking that my problem may have to go on the back-burner for a few weeks, as my daughter is having oral surgery Nov. 24th for impacted wisdom teeth & a molar that is laying sideways beneath the gum line. Add that along with car troubles.. sigh Anyhow maybe I will at least be able to get the process started and records transferred etc. I'd like to be able to go to a university hospital, but the traveling would be an issue. I will keep you posted.
         
      • Jamie

        Jamie Administrator

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        Yes, Suzie....do let us know. You're part of our family now and we care about how you are doing!
         
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        • Josephine

          Josephine NURSE DIRECTOR, BONESMART Administrator

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          Hi there, Suzie. Sorry to hear about your seemingly unending problems. You certainly have a catalogue of them.

          It would be on that account that my first reaction is should you have had partial replacements in the first place?

          In any of the previous surgeries, did you have a repositioning of the tibial tubercle to help with the patellar dislocations? If you did, would I be right in thinking they were not a resounding success?

          When I have your answers I'll be in a better position to respond to your query.
           
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          • muskratsuzie

            muskratsuzie Member

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            Hi Josephine, I have had a tibial tubercle transfer on both. That did not help with the dislocations unfortunately. Even though the opinion was out of pocket, before I had the partial replacements, I was able to get an opinion at Duke University with Dr. Toth. She recommended the partial replacements as did 2 other orthopedic surgeons. I'm not sure what else to do at this point, other than seek more opinions again. Thank you for your time and help!
             
          • Josephine

            Josephine NURSE DIRECTOR, BONESMART Administrator

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            Well, the partials might have addressed some mild arthritic changes in your joints but will have had no beneficial effect on the maltracking patellae at all! The only way to get that attended to is with a total replacement and a patellar button. Has anyone suggested this as an option?
             
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            • muskratsuzie

              muskratsuzie Member

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              No TKR option was offered. That's what I thought all along, but after getting 3 separate opinions, I figured they knew more than me, so I didn't question it again. At this point, even if I could find a doctor who said I need TKR(s), I'm unsure I could get it covered as I've had to go on Medicaid. [My husband of 15 yrs walked out on my daughter & I last year and quit his job, leaving us without insurance]. My experiences with Medicaid so far haven't been good. I am thankful to have it, but it seems it is in place to simply 'patch' a person up to shuffle them out as quickly as possible. I still am going to pursue getting another opinion and go from there. I greatly appreciate your help!
               
            • Jamie

              Jamie Administrator

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              Suzie, I'm so sorry to hear about your personal situation. Don't discount Medicaid completely. Sometimes you just have to understand the system to get the things you need taken care of. And you sometimes must be VERY persistent with government programs like this.

              Unfortunately a lot of doctors don't like Medicaid patients (Medicare too) because they must accept greatly reduced payments and it can take a while to get paid. So they may tend to fluff you off. Not saying this WILL happen, just that it might. So be on the lookout for it and be tough. This is a time you MUST be your own advocate and assertive where medical care is involved for you or your daughter.

              If you have any problems getting what you need, post here and it is possible that one of us can give you some ideas on what to try next. Don't give up on what you need!!! ((((HUGS)))))
               
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              • muskratsuzie

                muskratsuzie Member

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                I do have a question/problem, if anyone might be able to help. I have been seeing a pain management doctor for the last 2 yrs. He would like me to switch to a more permanent pain medicine. I am currently on percocet 7.5/325mg three times daily, and the one he wants me to switch to is exalgo 8mg once daily. I am a bit nervous to switch to exalgo from the side effects listed and also the dependency issue. Right now, on the percocet, I can go a day without taking it and not have any withdrawl symptoms, but if I begin taking exalgo, I will be hooked, which makes me nervous. I realize that I will more than likely be on some type of pain medicine most of my life because I also have fibromyalgia/chronic fatigue, plus the car accident left me with permanent pain. Any thoughts/suggestions about switching to exalgo?
                 
              • Jamie

                Jamie Administrator

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                Well, my first question would be why someone would want to switch you from something that works to something else. What is he telling you are the benefits of making this change?
                 
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                • muskratsuzie

                  muskratsuzie Member

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                  He said that exalgo is better on the liver and kidneys for long-term use, whereas percocet has tylenol in it, which can eventually do damage.
                   
                • Jamie

                  Jamie Administrator

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                  My concern would be that what I've read about exalgo is that it should only be prescribed for people who have become opiate tolerant and will have long term chronic pain. I'm not a doctor or pharmacist, but it was my understanding that Tylenol was safe to take as long as you stayed within the 4000mg per day limits.

                  There are routine blood tests that can be done to determine if your liver is starting to have any problems. It would seem to my un-medical brain that it would be better to continue on with the drug that works and monitor your liver functions carefully.

                  What I read about exalgo would give a person pause about starting it. For one thing, it was just approved this year and hasn't really been in wide use long enough for my taste...since there is a viable alternative.

                  Why don't you have a chat with your GP and also your pharmacist about the idea. I think you're wise to think about it before jumping in.
                   
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                  • muskratsuzie

                    muskratsuzie Member

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                    Yes, I am not anxious to switch, especially when the percocet works for me. I felt as if the pain management doc was trying to 'sell' me on the exalgo. I came out with a pamphlet, a prescription and a discount card for it. Maybe the pharmaceutical company had just been there trying to get the doctor to prescribe it. I see my GP in December, and I'm taking your advice to discuss it with him. Thanks yet again! :)
                     
                  • Jamie

                    Jamie Administrator

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                    Don't overlook your pharmacist too....they are VERY knowledgeable on drugs....sometimes even more so than doctors. If you have one you go to regularly, you might have a chat with them....couldn't hurt just to ask them what they think of the drug.
                     
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                    • Josephine

                      Josephine NURSE DIRECTOR, BONESMART Administrator

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                      You should read this site. There are comments from users which seem about 50/50 on whether it's any good. But I agree with Jamie.
                       
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                      • RestAssured

                        RestAssured Forum Advisor

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                        Hi MuskratSusie!:D
                        Is your name from a song by the Captain and Teneil? (sp) I remember that song was popular when I was 5 years old and I would run around singing it!:hehe:

                        Anyway, I wanted to address the Medicade issue. My Mom is a nurse, and she said this is the best time to be on medicade, because the surgeon's know they will get their money and not have to deal with the insurance companies that are nickle and diming them to death. Since Obama made Medicade lucrative, more doctor's are eager to work with these patients. I hope that helps you. I know you must be very frustrated!:shk:
                         
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                        • muskratsuzie

                          muskratsuzie Member

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                          Hi Sonja,
                          Yes, my mom & dad played that song all the time when I was little. They told me I was MuskratSuzie & of course I believed them. :rotfl:
                          I am checking out several OS's, hoping that I get approved to have another opinion. The one I saw recently took x-rays, tested my knee caps, said "they are dislocating" and told me to wear braces. I did try the braces but they are extremely uncomfortable to wear around all my incisions. I still have the pictures from the last partial replacement surgeries, so you can see I have alot of scars. Please tell your Mom I appreciate her sharing the info. about Medicaid; it does help! Praying I'll get these knees fixed one of these days! :thnk: ~Suzie
                           

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