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[REVISION TKR] Removal of Adhesions

Discussion in 'Knee Replacement Recovery Area' started by skigirl, Apr 20, 2012.

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  1. skigirl

    skigirl Moderator

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    I saw my OS for my third year check up and he agreed with me that the adhesions in my knee had gotten worse over the winter. At first it sounded like velcro ripping when I would squat, but now it sounds like crackling. He feels that the synovial lining has gotten inflamed--perhaps from the adhesions.

    At any rate, I am scheduled for surgery on Monday am to remove the adhesions. Since so many people have talked about this problem, I decided to keep a diary so that one person's experience would be on record.

    I have to admit that I have more second thoughts about this surgery than about my tka's. I just finished a great ski season and have started biking. I am not looking forward to another rehab. although, my knee sometimes aches and there is a noise and sometimes a "pulling" in my knee--but it seems to be working okay, so why am I doing this?

    Also, yesterday, the nurse mentioned to me that I was also scheduled for a potential poly replacement. The nurse suggested that it would be examined for wear---but, I pointed out it would be impossible for there to be wear after only 3 years.

    The doc told me that sometimes he has to put in a thicker poly when he removes the scar tissue---that caught my attention--WHAT? I told him I don't want him to ruin my rom and mess with my knee at all. It is working fine. I am feeling very negative about the potential poly replacement---that can only be for the worse for me.

    so, I am sitting here second guessing myself and wondering how late I can cancel the surgery. I did meet someone who told me that his knee felt much better after this surgery with my doc. But, I am still agonizing over this decision.

    At any rate, I will keep a diary of my decision, if nothing else. Kelly
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  2. Janet2012

    Janet2012 Don

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    Good luck with all that. At least Ski season is over. But your comments about the plastic spacer has me thinking. I had the impression that knee implants wore out because of the wearing down of the spacer, and I wondered why they couldn't just replace the spacer. I guess, in theory they can. So I wonder why the whole thing has to be redone? (not in your case, of course). Assuming the implant hasn't come loose, or ultimately does it? Josephine or someone will come along and answer that, perhaps. Thanks for the space, Skigirl! :)
  3. PooShay

    PooShay Sr Bonesmartie

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    Kelly. What's "poly".
  4. karmigirl

    karmigirl Post-Grad

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    PooSahy,

    I think she is talking about the plastic spacer they put in the knees. It is made of polyethalene(sp?)
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  5. skigirl

    skigirl Moderator

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    Janet, yes they can replace only the spacer--that is why you get an X-ray each year to see if the spacer is worn.

    If the cement comes loose, then you need a revision. Hopefully that is many years in the future.
  6. Janet2012

    Janet2012 Don

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    I didn't know that, thanks! I think my OS is retiring in 4 years, so I should find out who will be following up after that. I think that's the only downside with this doctor.
  7. Jamie

    Jamie Administrator

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    Boy, Kelly.....I can sure understand your feelings about going in for this surgery. What did the surgeon say would happen if you didn't do it right now? Obviously only you can make the decision about it. Wish I had some magic guidance....but alas....I don't! But...I do have faith in your ability to think things through and work out what is best for you. You've done that like a champ so far with your knees and you will this time too.
  8. Jazyb

    Jazyb Post-Grad

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    Hi Kelly
    Gosh you have got some thinking to do this weekend, I wish you all the best with that and good luck.
  9. skigirl

    skigirl Moderator

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    Jamie, I woke up this am with that question in my mind. I think I am going to call the office and ask that question. Kelly
  10. maryo52

    maryo52 Sr Bonesmartie

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    I totally sympathize with your reservations. You want things better but . . . why mess with success?

    I'm still trying to figure out what is wrong with my knee but I suspect I'll find myself in a similar spot as you, having a remedy proposed that seems severe in light of how able I am.

    Might you seek a 2nd opinion? That was my PCP's suggestion.

    I guess either you'll work through your hesitation, or you'll change your mind . . . but it seems as if being comfortable with surgery is important before doing it, huh?
  11. Josephine

    Josephine Administrator

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    Kelly, these late issues aren't at all like the early adhesions people get immediately after surgery. It's just a sticky bit that needs a snip and sooner it's done the better.

    Your ROM is still good, isn't it?

    As for the plastic insert change, I'd be a bit leery about that too. Only reason I can think is that if the patella is a bit stuck down, freeing it might make everything a little bit slack so a bigger spacer would certainly be appropriate.
    But I have to be honest, I have never seen a spacer replaced either for this or for wear.

    Regarding wear in joint replacements, in a hip it does happen because of the ball and socket configuration. But in a knee, it's a platform that the femoral component sits on and wear isn't quite such an issue.

    Of course, we could pull in @Orthodoc: here to adjudicate! Am I right in this or not, sir?
    I'll happily stand corrected if I'm not!
  12. RestAssured

    RestAssured Forum Advisor

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    Hi Kelly,

    Gosh I understand your hesitation! If the knee feels good except for some crackling, why mess with a good thing? To put in a bigger spacer might work against you. Can you tell the doctor remove adhesion only and leave spacer alone?:what:

    Are you in pain, or is it an annoyance? A lot of things for you to think about think about this weekend! I know that you will sort all of this stuff out. You are one smart cookie!:biggrin:
  13. skigirl

    skigirl Moderator

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    Yes, I just spoke with him on the telephone and he said that he would only do it--if like Jo said, when he removed scar tissue if things were a bit lax. He knows that I want to ski next year and will make sure the knee is stable for skiing.

    Thanks Jo, for some common sense. You are right--it is just something that has to be taken out and will not make my knee frozen like my friend's who does have severe problems. I feel much better, sometimes fear just runs with us---by passing reasonable thoughts.
  14. skigirl

    skigirl Moderator

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    Yes, Jo, my rom is still good, but it has gone down a bit--it is 140 right now. He thinks the tissue there is holding it a little stiffer. so, I suppose that if I do have to have a new spacer, the release of the tissue should make the rom at least 140 again. I am just not into having to rehab again. I will hold onto the thought that the spacer will not need to be replaced. K
  15. Campervan

    Campervan Sr Bonesmartie

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    Hi Kelly, not sure if this'll help you or add confusion. When I saw my surgeon at 2 months post op he told me he'd not fitted a high flex implant as the National Register was showing early signs of wear at the rear. He said he'd fitted a non high flex and to expect around 135 ROM, which for aggressive skiing I don't think will be enough..
  16. skigirl

    skigirl Moderator

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    Margaret---I have to admit that this news did not reach me in the us. My OS has always known that I was a skier and he operated on my knees with the knowledge that I would continue to ski and to teach skiing. Yes, I would not be happy with a rom of 135==but would find a way to ski anyway---that is when the craziness strikes!! The only part that he was talking of changing was the plastic insert--the fake meniscus in your fake knee!! The rest of the knee is doing just fine. But, I don't have a high flex knee--I have a Stryker Triathelon. Kelly
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  17. skigirl

    skigirl Moderator

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    Jamie, I went on a two hour ride (20 miles) and on my ride, I was thinking of the fact that the nurse this morning was mainly concerned with the forms in the office. "Well if you do decide to cancel, let us know so that we can add that to your chart" While most of my support and useful info came from a friend who lives in Kansas and a nurse who lives in London. The marvels of the internet. Both of you were so helpful and actually, I feel semi normal right now. I am eating a very high protein diet before the surgery too which is pretty nice. i don't usually get to eat four slices of Easter ham all by myself!!

    Thanks again for your concern and your helpfulness. Kelly
  18. Orthodoc

    Orthodoc Forum Advisor

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    Hi Skigirl,

    Sorry to hear of your predicament.

    I wish you well on deciding on your up coming surgery.

    Reading through your thread, I was not able to clearly understand if you were considering surgery because of the pain, the cracking sensation or a lack of motion. Going ahead with surgery is not easy decision and is best left between yourself and the doctor who knows your history, exam, xrays, etc... Of course the advise for a second opinion is always a reasonable option.

    As per the question of poly (polyethylene) wear that was asked:

    Three years does sound a bit premature to have significant wear, but it is not impossible. I will attach a pic which shows what significant wear patterns look like. I would not expect your poly to look like this given your current level of function. There are multiple reasons that early wear can occur.

    There are a couple of surgical ways that scar tissue can be managed after a TKA. The knee can be "scoped" for debridement of this tissue, or an open (arthrotomy) can be performed. It sounds like your OS is recommending the latter as there is a discussion of poly exchange. If the knee is opened with an arthrotomy the OS will evaluate the poly for at least two things. First, he/she can see if there is premature wear or other signs of failure. Second, he/she can re-assess the ligament balance to determine if a poly of another size would fit your new knee better. If the soft tissues have stretched out over time, it is reasonable to consider exchanging it. Also, if the OS needs to clean out the soft tissues in the back of the knee for some reason, he/she will need to remove the old poly and put in a new one (possibly the same size).

    I hope some of this info is useful.

    Orthodoc

    poly wear.jpg
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  19. jerseychick

    jerseychick Forum Advisor

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    Wow orthodoc! Those are great pictures showing wear of the insert. What causes the insert to wear that way? @Orthodoc:
  20. skigirl

    skigirl Moderator

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    Wow, those were scary photos!!

    I am having the surgery for three reasons: 1. I hate the sound and it is louder than ever. 2. I have begun to notice some "pulling" at my knee cap which is from the adhesions tightening. and 3. my doc feels that when adhesions are there they can potentially cause the joint to deteriorate.

    He did say that he would put in a bigger poly insert if the adhesions had caused the ligaments to become lax. Again, he is concerned about my skiing.

    Thanks for the advice--it is always difficult to step into the middle of someone's diagnosis. My doc is not a likable person, but he is an excellent surgeon. I respect his surgical skill. I have had second opinions with physical therapists, a nurse, a PA and most beneficially with JO!! Kelly
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