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Messed up TKR

Discussion in 'Knee Replacement Pre-Op Area' started by Kevin Finn, Apr 23, 2009.

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  1. Kevin Finn

    Kevin Finn Junior Member

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    I just had fluid drawn from my right knee (TKR on November 10, 2008) to see if I had an infection. Fortunately, the results were negative. However, I have learned very much in the past few weeks regarding patient pain and patient rights.

    My surgeon told me that he could not attempt to get fluid out of my knee (It has been swollen and bulging since January) due to the risk of infection. Just two seeks later he told me I actually had a glob of blood in my knee and that he could not draw it out. He said to, "Keep doing what you are doing, but go easy."

    I left for a thrity day trip to California. I was able to make an appointment with a surgeon in Redding, CA who drew a vile of yuck from my knee in order to test it for possible infection. It turned out be negative (Thank God!), but here's the news---He took several digital xrays. He showed me the pictures and said there was no indication my surgeon used cement on my tibia plate. He said the patella button was only place where cement was used.

    This surgeon asked me how old I was. He was surprised I was sixty six. He implied that not using cement relies on bone growth into the tibia implant. My surgeon has NEVER spoken to me about this, but my impression is that he knew when I complained of constant pain and burning that bone growth had probably not taken place. I think he was just hoping I would heal and go away.

    I went to southern California and saw a friend of my son's who is an Orthepidic Surgeon. He also was surprised my tibia plate was not cemented. He also said his group ALWAYS uses cement on the tibia plate. He said if the bone does not grow into the prothesis, a revision may be necessary to install cement under the tibia plate.

    Why do I mention all this? Because I now know my surgeon's withholding of information from his patient is sickening! He apparently feels he has no obligation to involve his patient in decisions following complications. What if I had had an infection? He was willing to let me suffer without either explaining his reasoning or mentioning his decision to not use cement on the tibia plate.

    My guess is that it is unlikely the bone will adhere to the prothesis because of the "full area" in the knee is filled with blood and fluid, wetting the area and not allowing adhesion. I may be wrong, but I sure have the right to wondeer under the circumstances. What does this mean?

    I suggest that patients, when having long term complications, ask pointed questions and do so in writing. Althought I did with my surgeon, he ignored my questions and kept saying, "Continue what you are doing." He never asked me what I was doing. He will now receive a registered letter with several direct and pointed questions about my progress or lack of progress.

    Moral of the story: You can't rely on all surgeons to act quickly when faced with possible problems. If they want to live on hope, they have an obligation to explain why they are doing what they are doing. If they are evasive, they should not be trusted. The patient MUST take control of their own situation and demand an analysis from the surgeon. This should not be threatening to a good surgeon. If the surgeon is wurth his or her weight in salt, they should involve the patient in decisions and why they are taken.

    I have no interest in litigation, but I assure you all that my surgeon will regret not informing me of the fact he chose not to cement my knee. Maybe that was a good decision, but he should have told me when I expreienced constant pain and swelling near six months out from TKR!

    All surgeons are not equal. Second opinions are good when complications arise. Requiring information before surgery is reasonable. Placing total trust in a surgeon because one does not want to ask challenging questions is not good. KNOW WHAT KIND OF PROTHESIS IS LIKELY TO BE INSTALLED IN YOUR KNEE AND WHETHER THE SURGEON HAS HIS OR HER PHILOSOPHY REGARDING THE USE OF CEMENT.

    I hope this little disertation is helpfull. Jo gives great help to us all. My input is just from a "not too happy" patient.

    Kevin
     
  2. Judles

    Judles Alpha

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    Re: TKR Post surgical Staph Infection Questions

    Boy, Kevin! So sorry to hear of your breach of trust issue with your OS! Peta is ALSO having an issue! This is apparently a bigger issue than any of us have even thought of! A very BIG shame really! And it puts the patient in a very difficult position! :(
     
  3. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Re: TKR Post surgical Staph Infection Questions

    That's the case, Kevin. If the bone-implant bonding does not take place then you will need a revision. I have never seen uncemented knees used though they are available. I don't think they are very popular. The question is - did he use a prostheses designed for use without cement or did he use a cement-type one and just not cement it in? If the latter, that would be a serious case of malpractice, imo.

    You are quite correct. The presence of the fluid will have inhibited the bonding assuming he had used the correct type of implants. It may possibly be that the movement of the loose implant(s) may be responsible for that fluid.
     
  4. Jamie

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    Re: TKR Post surgical Staph Infection Questions

    Kevin, I am so sorry to hear this latest news, but glad that you DID find out additional information. Here's hoping your surgeon is finally a lot more forthcoming with you when you ask questions. You deserve answers to all of them! I wouldn't be so quick to rule out litigation, though, if you eventually find that he didn't put cement in when it was required. If that's true, he could go on and do that to other people! I hope you get some answers soon. You'll be in my prayers.
     
  5. gloucesterman

    gloucesterman Junior Member

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    Re: TKR Post surgical Staph Infection Questions

    Hello Folks, In a response to Kevin Finn's post above. I am Very Sorry that your surgeon has chosen to be less than forthcoming about your procedure, I have been in the same boat myself after my failed PKR.. It is devastating when you discover that the person that you trusted to help you may have done something which can have such a negative impact on your ability to even walk. I could go on but instead I wish you all the best and hope that you have good health soon!!

    On another note concerning infection I aslo had fluid taken from my knee recently as I had a dental infection and there was some concern with my TKR. I got lucky and the results are negative so I just had a root canal and in two weeks will have that tooth crowned. I have learned avaluable lesson in the process and am having my new dentist draw up a full list with pricing for all dental work necessary to make certain I am protected from the possibility of infection in the future! Dodged another bullet!!
    gloucesterman
     
  6. Kevin Finn

    Kevin Finn Junior Member

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    Re: TKR Post surgical Staph Infection Questions

    Is anybody still using this thread? I want to get some updates and share my miserable experience and get input.

    Kevin Finn
     
  7. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Re: TKR Post surgical Staph Infection Questions

    Yes, we're still here, Kevin. Shout away - we'll be reading and will post.
     
  8. Texas

    Texas Alpha

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    Re: TKR Post surgical Staph Infection Questions

    Hey Kevin absolutly, I think we would all like try to help or just chat if you need to......Please go ahead....
     
  9. Motherofmany

    Motherofmany Graduate

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    Re: TKR Post surgical Staph Infection Questions

    Kim,

    Whatcha doing up so early??? Nervous about seeing the OS? Maybe that's why we haven't heard anything. You're probably napping now. :zzz:
     
  10. Jamie

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    Re: TKR Post surgical Staph Infection Questions

    Kevin, please post if you have questions or concerns. We'd love to hear from you.
     
  11. Kevin Finn

    Kevin Finn Junior Member

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    Re: TKR Post surgical Staph Infection Questions

    My surgeon NEVER explained the surgery he was going to do or the risks associated with the surgery. I was hurting so bad in both knees I asked about having both done at the same time. Thank God I didn't. I'm eight months out and have not had a decent day. While I have asked my surgeon, both verbally and in writing, he has NEVER explained my surgery. Why do I mention this?

    Because I have had fluid in my knee since January. He NEVER explained why that might be the case. He said he could not withdraw fluid due to the risk of infection. Two weeks later he said the fluid was like a glob and could not be withdrawn. He said it could take a year and a half or longer to diddipate. He did not explain why he felt my knee was full of fluid.

    When I California, I visited a sugeon in Redding (they have an extensive program for knee and hip patients) and he took exrays of both knees. He showed me the right knee. It had a gap between the tibia plate and the bone. He pointed out it appeared no cement was used. He said he and his co-surgeons always use cement. He withdrew a vile full of fluid (a mixture of blood and clear fluid) which did not show signs of infection. I went on my way and was very appreciative of his help. He said it was possible I might need the knee opened and cemented in the future.

    My surgeon NEVER mentioned the use of a cementless prosthesis. He knew I was on warfarin for over two years prior to surgery. My guess is that my bone is oozing constantly. I also believe the fluid is seeping down into my calf muscles and tendons. I have miserable pain down my shin and in my calf muscles.

    When I returned to Missouri, I wrote to my surgeon and asked him if he used cement or not. I obtained a copy of the surgical notes from the hospital. I confirmed that cement was only used on the patella. My surgeon has ignored my request for information. I mean completely ignored my please for information and a diagnosis! It took three requests over two months to get copies of the MRI's taken of both knees prior to my right knee surgery.

    Even so, he has ignored my written request for an explanation of my surgery. He has flatly refused to tell me he did not use cement. My knee has been pusing out fluid when I stand or walk. My whole leg is sore, from the thigh, to the hamstrings, to my joint, to my shin, to my calf, to my foot. My surgeon eveidently used a cementless prosthesis. He NEVER told me why or that he did so. I found out from another surgeon and from the records I retrieved from Cox Hospital.

    I have said before, I beleive my surgeon is hoping I go away. He should be ashamed of himself! He could just tell me what he thinks should be done and admit , in hindsight, he would have cemented the knee. Especially knowing I was on blood thinner and aged 66. I know my bone is not adhering to the prosthesis. My knee is full of fluid.

    There is another chapter to this story. I will share it later. The point I want to share is this: Ask your surgeon if he or she plans to use a cemented or cementless implant! If you are older, bone growth may not be significant. If you are experiencing recovery problems, you should ask if cement was used to secure the implant! As a matter of fact, I think it would be good to have a survey completed.

    I have been told by surgeons with two groups that they NEVER use cementless implants. Imagine the time it takes for bone growth vs. cement. Imagine sealing the bone with cement vs. raw bone on metal and how long it might take to heal. Imagine a surgeon using the latter and NEVER discussing the decision, expecially after healing does not occur following surgery.

    This sight allows patients to communicate. Not for the purpose of building a legal case, but for the purpose of helping others. Not all surgeons are equal, and not all inform patients. Most probably do share information, bot others, like mine, look with disdain at the gall af any patient asking specific questions.

    Anyone who has seen the 40's movie, Gold of Sierra Madre with Humphry Bogart remembers when Bogart and his fellow miners asked a group of Mexican bandits for badges when they claimed to be from the law. The response was, "Badges---We don't need no stinkin badges!!!!!" Well, that's my surgeon.

    Hope you all are doing well. As I write, my knee burns, aches and is full of juice. I would rather have had it amputated than go through this pain. And especially since my surgeonwon't respond to please for help and information.

    He may see a U-Tube video about his conduct very soon. Good surgeons don't need to be concerned, even if they make a mistake. If they communicate and work in behalf of pateints, both the surgeon and his or her patient can work through recovery. No surgeon has the right to cut and run!
     
  12. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Re: TKR Post surgical Staph Infection Questions

    I so agree with the opinion about never using a cementless prosthesis in the knee, Kevin. I don't have a lot of experience with uncemented prostheses overall, but I would have thought that, due to the special stresses in the knee, a period of non-weight-bearing should have been required to let the bone ingrowth occur.

    As for the refusal to impart information, that is just down-right - well, the most polite word I can think of is 'stinking' - of him! In a survey done some years ago about complaints against staff in the NHS, the principle issue was always the lack of information and communication from staff to patient. Shortly after that, we had a minor accident occur on a young girl and her parents were incandescent about it. It was a stupid moment of lack of concentration on the part of a junior member of staff that resulted in a small scald on her thigh. It healed quickly but that wasn't the issue. The surgeon and my boss all wanted to cover it up with some waffle to the parents but I insisted on meeting them and explaining exactly what had happened and how come. Apologies were naturally given and an assurance that all staff would be given training to ensure that such a thing never happened again. I answered a few tough questions but was (I hope) polite and open in my answers. I did my best to be as transparent about it as I could. And it was appreciated by the parents. They even wrote to me a couple of weeks later to let me know the scald was all healed up with no residual scar! Transparency works!
     
  13. loggon

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    Re: TKR Post surgical Staph Infection Questions

    Kiven
    I believe you are in the States. Let me tell you it is time to lawyer up. You have a perfect Mal-practice suit .

    Trust me once the surgeon gets the paper he will not be happy.

    Also, get another surgeon right away. Sign the release to have all your records sent to him. You will then know what the surgeon did.
     
  14. ship4

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    Re: TKR Post surgical Staph Infection Questions

    Kevin,
    I am so very sorry! Are you considering seeing another OS, discussing your situation and having a revision with a cemented replacement? If I were in your shoes, I think that is just what I would do. I am pleased you did not have BTKR as you would most likely not be walking.
    I am a person who asks lots of questions. If I don't get answers, I go to someone else who will give me the answers I am seeking. I knew my OS holds an excellent reputation and I asked lots of questions, read the book, and also was prepared 6 months ahead of time. I was ready and waiting.
    I was not disappointed and have had an excellent recovery.
    I wish you well. As I said, I would be having a cemented implant put in which would work!
    I am so very sorry you are dealing with the discomfort and the pain with the cementless version.
    Please keep us posted as to how you plan to resolve this issue. I am too proactive for myself to allow myself to stay in an unacceptable situation as yours. Please let us know of your steps to resolution.
    Best,
     
  15. Jamie

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    Re: TKR Post surgical Staph Infection Questions

    Kevin, you need to get yourself to a revision specialist as fast as you can. You don't have to live like this!! And once you get that going, I'd find a good lawyer. If this guy did this to you, he's done it (and will do it) to others. Sad to say there is a small percentage of doctors that should have chosen to become pizza delivery guys instead of surgeons.
     
  16. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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  17. Judles

    Judles Alpha

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    So sorry to hear you're still having such trouble, Kevin! Revisionist specialist sounds like your next option! I hope everything gets resolved to your satisfaction! Demand NOTHING LESS!!!!
     
  18. maumeefootball

    maumeefootball Junior Member

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    Both of my replacements are cementless. They are specifically designed to be done in that manner and my surgeon was very up front about this fact.. He has been using these implants for years with great success. It is his contention that using cement is the wrong way to go. That eventually the cement will begin to crack and then the problems begin. He showed me the x rays of both knees taken at 5 weeks post op. One was completely knitted to the implant and the other just had a tiny bit left. He does a lot of revisions on knee replacements done by other surgeons and says they are almost 100% cemented originally. I guess again it all goes back to the skill set of the surgeon.
     
  19. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    That's just his opinion, maumee.

    I know he's a revision surgeon but just because 'some' people get problems doesn't mean the entire premise is faulted. Thousands upon thousands of people have their knees cemented in and yet the number with problems is infinitesimal. Added to which the overal number that are originally uncemented is extremely small as well, so of course the amount he sees thus far that are cemented is 100% cemented!

    In hip replacements, where a greater number of them are uncemented, so the number requiring revision is also greater.
    In my opinion his hypothesis is somewhat skewed! :skp:

    And you're dead right - it is all down to the skill of the original surgeon.
     
  20. dcdowden

    dcdowden Junior Member

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    I asked my OS about the issue of cement and he said that 90% of knee replacements are cemented. He also said that with the implant he uses the only part that is not cemented are some small posts on the tibial plate that are press fit into the tibia where there can be some bone in-growth. Last year, my OS replaced both my hips using a cementless press fit procedure. I am very happy with the outcome with the hips, and I was surprised to hear that knees were almost always cemented since he had previously said that hips were generally press fit without cement. My OS had also said that he still saw quite a bit of variability in the types of knee implants being used. Apparently a lot more OS's do knee replacements than hip replacements. He also said that he considered the TKR procedure to be easier than the THR from his perspective although the recovery would be harder for me.

    I am now scheduled for TKR on August 14. Hopefully it will go as well as my new hips have gone. It is great to be pain free in the hips and I am hoping to fix the bad knee that is still holding me back from doing everything I want.

    Doug
     
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