TKR for severely hypermobile and arthritic knee

[jane1022]

Hi everyone,

My name is Jane, I'm 62, and I will be having a total knee replacement at the Hospital for Special Surgery in NYC on Oct. 6, with Dr. Westrich. My knee is severely arthritic--bone-on-bone in the "medial compartment" and quite painful and limiting.

It has been arthritic for years, but strangely wasn't very painful--until I fell on it this past spring, which seems to have finished it off--X-rays taken 1 month ago look drastically different from ones taken only 6 months ago. My doctor's PA tells me it is "bowed," but I can't tell anything except that it is quite swollen and painful even when I'm not actually walking or standing. My ability to walk is limited, and I wear a brace to do it. It does not "lock" nor does it "give out;" my main symptom is pain.

What makes my knee somewhat "special" is that it is hypermobile; that is, I have a condition which causes the tendons and ligaments that support my joints to be lax. My "bad" knee hyperextends 25 degrees, and my "good" knee hyperextends 35 degrees. Thus, I have no "good" ligaments to help support the prosthesis, so Dr. Westrich will use a prosthesis that doesn't depend on my ligaments for any stability--I think this involves having the prosthesis extend into the shafts of the tibia and femur bones.

Dr. Westrich assures me that after my surgery, that knee will no longer hyperextend. That will be different and probably good.

I have already had a total hip replacement (2/09) and a total ankle replacement (11/13), both on the same, left, side as my upcoming TKR. My ankle is still fairly swollen from my TAR, as it's called. That concerns me a little, since the knee will now also tend to swell a lot, but I'll have to see how it goes.

Question for the group on one concern: since I've had 2 replacements on my left side already, my left leg is 1/2" longer than my right. I do have a good surgeon, but can he avoid adding any more length to my left leg?

Just saying hello and looking forward to getting lots of good advice.

Jane

TKR scheduled 10/6/15 - left
TAR 11/13 (total ankle replacement) - left
THR 2/09 - left

 

[KarriB]

Your issues look like something @Josephine would be interested in. She'll be able to give you information.

 

[PolarBear60]

I'm pretty sure he can. He'll choose an appropriate spacer to give you the best range of motion and to maintain your proper height. The installation of the implant will also take this into account.

Josephine will have a more medically sound explanation.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[jane1022]

Thanks, KarriB and Polar Bear. I'm looking forward to hearing from Josephine!

 

[Angel1978]

Hi I am angel. I know they will chose proper spacer for you. As sated Jo will have more advice. She is the expert here. Best luck. Hang in there.xxxxxx


FaithMitchmommy
PKR December.1,2014
TKREV MARCH.2,2015

 

[momweb]

Hi @jane1022 I had a knee replacement of my right knee on June 22nd and one of the things my surgeon did prior to the surgery was a series of x-rays and measurements. He did measure the length of both my legs, so I'll bet your surgeon will do the same. It will do no good to have legs be limping. If not fixed somehow during surgery, then some type of orthotic, it seems might be required. Best of luck to you.

 

[jane1022]

Thanks, Angel and momweb. Yes, right now I am wearing an orthotic that corrects the half-inch discrepancy between my left (longer, has had 2 replacements, ankle and hip) and right legs. My worry is that the surgery could make my left leg even longer, in which case it would be difficult for an orthotic to compensate. I will need to make sure I voice this concern to my surgeon. I will probably have to go through his many minions, though, since he's a well-known surgeon from a well-known hospital. That's ok!

 

[jane1022]

Does anyone know how I could get Josephine to comment on my unusual case? Josephine, my condition is called Ehlers Danlos Syndrome, and my joints, and especially my knees, are very hypermobile, which of course complicates my surgery. It's not a common condition.

 

[KarriB]

Josephine was tagged, but you could send her a private message from the inbox. I know she gets quite a few tags a day.

 

[jane1022]

Help, in my ignorance, I don't know how to "tag" anyone. And, I saw her post asking that we not send her PMs, so I don't want to do that! Can you tell me how to "tag?"

 

[KarriB]

To tag you use the @ symbol before a name such as - @jane1022 . Sorry I didn't see a post asking not to pm.

 

[jane1022]

It's up above in this forum, in the section with all of the resources.

So--@Josephine, when you have the time, I would appreciate your reading my first post explaining my somewhat unusual circumstances, and giving me any comments you may have (reassurance also!). Best, Jane

 

[Josephine]

Sorry, I was at work yesterday so didn't get on the forum.

my condition is called Ehlers Danlos Syndrome

Yes, I'm very familiar with it.

since I've had 2 replacements on my left side already, my left leg is 1/2" longer than my right. I do have a good surgeon, but can he avoid adding any more length to my left leg?

I'm sure he can and will.

 

[jane1022]

@Josephine, thank you so much for replying! I have the hypermobile form of Ehlers Danlos, if you hadn't already guessed that. Obviously, my condition complicates the surgery. Have you seen any successful cases of knee replacement on folks with Ehlers Danlos?

My wound healing is normal, fortunately, but my knees quite severely hypermobile, so Dr. Westrich says the type of prosthesis will compensate for that. However, I haven't spent a lot of time with my OS, so I don't know what type of prosthesis he's using.

Both my joint replacements were successful, with the exception that my ankle is "tilted" four degrees according to my surgeon (Dr. James DeOrio, Duke University Hospital). My orthotic corrects this as much as possible, but my ankle remains quite swollen, which concerns me a little since it's the same side. Interestingly, Dr. DeOrio said he could not tell, when he operated, that my joint was not entirely normal.

My hip replacement was in 2009, and the surgeon used "the big ball." The surgery was entirely successful, and although that side remains just a little bit weaker than the other, I can't really tell that I've even had a hip replacement, it feels so natural. In that case, the OS (Dr. Steven Haas) was well aware that the soft tissue supporting my joint was lax; he tried to "tighten things up" during the surgery. Dr. Haas is happy with my results.

As I said, my knees are very loose, and I'm quite apprehensive. What has your experience with Ehlers Danlos been (I'm almost afraid to ask...)?

 

[Josephine]

Have you seen any successful cases of knee replacement on folks with Ehlers Danlos? Dr. Westrich says the type of prosthesis will compensate for that

Indeed it will. I've actually had dealings with a number of such patients over the years and depending upon the degree of HM, a stemmed knee with a constrained joint was used similar to this which seemed to manage the situation from what I heard.

Recovery and functionality after this surgery should be pretty much the same as any other knee replacement.
Hope this helps.

 

[jane1022]

@Josephine , thank you so very much for your reply. My doctors and nurses have never told me much about their other Ehlers Danlos experience, so I actually am so reassured by what you say about the recovery for patients with EDS. In my own experience, recovery is a bit more challenging than others on boards I have followed, but except for my ankle tilt, my results have been very good.

I've also had a calcaneal osteotomy/lateral column lengthening/iliac crest bone graft/tendon transfer to correct posterior tibial tendon insufficiency in my right foot/ankle, back in 2005, with a really superb result, so I remain cautiously optimistic about my healing form my left knee replacement.

However, my knees are so severely hypermobile that I admit I'm a bit scared. 35 degrees of hyperextension is enough that the chief of knee surgery at Hospital for Special Surgery told me I was "lax even for a person with Ehlers Danlos Syndrome." That did concern me. He said that several years back and told me to wait until I really "have to" proceed with surgery. : (

 

[Josephine]

However, my knees are so severely hypermobile that I admit I'm a bit scared

Well, they won't be after you've had that ironmongery put in!

 

[jane1022]

Hi @Josephine! Thank you for the photo--it looks exactly as Dr. Westrich described it to me. Would you give me the name of that prosthesis, that I may learn more about it? I realize it may not be the exact one he will use, but it is very similar to what he described to me. He stressed that the prosthesis, and not my impaired ligaments and soft tissue, will be entirely capable of stabilizing my knee.

It's going to be a bit weird having one knee that hyperextends 35 degrees, and another that will not hyperextend at all.

 

[Josephine]

To be honest, I have no idea of the name! But @RestAssured has one and will be delighted to talk to you about it. And she knows the name!

You might also be interested to know that 35 years ago,all knees were hinged and generally they worked pretty well! But they had no rotational ability as they were quite literally hinged (the Shier knee and the Stanmore). Except the Sheehan which kind of crossed the bridge between the old and the new with it's plastic topping on the tibial component. It had a small amount of rotational ability.
This is what we visited upon patients way back when!

However, right back at the start was this beast which was the very first knee replacement ever done anywhere and I scrubbed for the case! Unsurprisingly only one of these was ever done!

 

[RestAssured]

@jane1022

Hello! I have the Smith & Nephew HK knee. It is wonderful! 3 1/2 years later, I am running stairs, doing yoga, Piloxing, swimming, rock climbing, you name it!

One great thing about this knee is it can't dislocate. "Well it did on me, but then again, as Dr. Maale said, it's a one in a million shot!" He said if anyone could twist it 180 degrees it would be you!