TKR Polyethylene Disease

[kleo]

I think you should get a second opinion. I fooled around with a lax knee for 5 years and the original surgeon kept saying it was ok and to wait. i got two other opinions that said the knee was too lax and I needed a bigger spacer. I had it replaced and although it’s not perfect, it’s much better - more stable and much less painful.

 

[lionsm13]

Thank you for the feedback Kleo.

Again I guess you could say that I am somewhat perplexed as to what exactly I am supposed to do other than wait another month or two which is what I surmised after our meeting/appointment after waiting 3 weeks to see my OS to begin with and then what make another appointment and wait another 3 weeks and then make a plan w/the OS...

Not exactly sure of what or where he thinks my implant is at other than saying it is loose and that I might have stretched the tendon.

Guess it's all a waiting thing all the time.

 

[lionsm13]

Since noticing that my "loose" TKR feels better when using it more rather than just being as sedentary as possible does anyone have any advice on activity levels?

Beings how the OS has said that he is concerned about the looseness of it
will doing light exercise continue to contribute the looseness of it or does it make much if any difference at this point?

 

[Celle]

I would be careful about doing exercise. Just let your activities of normal daily living be your knee's exercise for now. If the cause of your knee's looseness is that the spacer has worn thin, you don't want to run the risk of breaking it. That happened to me and I wouldn't wish it on anyone.

It's possible that you'll need some revision surgery, to replace the spacer with a thicker one. Although that is a form of revision surgery, it's much less serious than having the entire hardware replaced.

 

[lionsm13]

I do not think the spacer has worn thin Celle.
Not according to the OS anyway at my appt with him last week.
He said that over all the spacer looked good.
His concern was the looseness of the TKR.

What I have not mentioned yet until this posting was that in the 2nd week of Sept I was riding my motorcycle with my wife with me.
I had stopped at a stop sign and then started to go again and then out of nowhere here comes another vehicle. I had to abruptly stop and when I did I lost control of the motorcycle and it tipped over to the right side of it with my wife and myself going with it such as in slow motion.
Fortunately the highway peg broke the fall but never the less my TKR knee took a bit of a bonk.

I did not have much if any noticeable pain at the time of incident or much of anything at all until 2.5 weeks later and then this is when the knee felt like it had just failed. Initially I was not sure it was due to the tip over or not. I'm sure it exacerbated what ever was going on with it at the time though even though it was not an immediate reaction.

At the almost 3 week point post tip over is when I went to the Urgent Care at the Orthopedics the next day after the knee felt like it had failed and was(wrongly told) by the P.A. then told I had "poly disease"
The OS said that this is not the case but that the knee is loose.

Still confused about this but I know that the TKR is not right.
I would hope that the "bonk" did not unseat the shank of the TKR in the cement in the femur and that this is why the knee appears to be loose?

The OS said that the tendon might have gotten stretched and that perhaps a spacer could tighten things but if not... Then the unthinkable.

 

[Celle]

I do not think the spacer has worn thin Celle.
Not according to the OS anyway at my appt with him last week.
He said that over all the spacer looked good.
His concern was the looseness of the TKR.

I think we're possibly talking about different things here.
I assumed that the spacer was too thin, causing the looseness, but perhaps your surgeon meant that one of the metal components of your knee replacement had come loose.

If that's the case, I would definitely avoid any exercises, and just go about your normal activities.
There's a slight danger that exercises might move a loose implant, so that it causes some damage to your bone itself.
While this is only a slight possibility, I think you'd be wise to play it safe.

 

[lionsm13]

As I am perplexed as well Celle as I wasn't really given much of an answer as to why I could be experiencing the pain and odd feelings that I am in my TKR, swelling, stiffness and pain at times other than possibly a stretched tendon, but it's quite obvious that it's much more than this.


Thus far I have had Xrays and a Bone Scan that did not show much of anything.
Nor did the CBC.
The OS said that all of the tests that I had done looked normal.

Is there any Imaging tests that would be more definitive, say a CT scan or something?

 

[Jamie]

A CT scan or MRI might show some damage to soft tissues that wouldn't appear in either of the tests you've had. The x-ray would most likely reveal any changes to the spacer and, if the surgeon is saying that it still looks good, then it's probably not your problem.

I'm glad you told us about the incident with your motorcycle. Sometimes with an injury like this it can be a while before problems show up. You certainly could have damaged some soft tissue with an event like that.

From the way you've described your conversations with your medical team, it sounds to me like they are talking about your "loose knee" in terms of functionality, not loosening of the components. Usually when a portion of the implant begins to loosen and bone dies back, it will hurt consistently - primarily when you are weight bearing or moving. This is what is referred to as joint implant loosening.

But a "loose knee" can occur when the implant itself is not loose. It means that soft tissue is stretched or the spacer is not quite the right size resulting in a knee that just doesn't feel right. It may buckle or feel unstable at times. You can have pain as well, but it may come and go. The fact that you say your knee can feel better with some mild exercise may indicate this is your problem instead of the implant being loose.

I have a couple of suggestions for you. First, make sure you pay attention to what you feel with your knee. If it hurts, don't push it. If some stretching or a little walking helps and doesn't hurt, it's okay to do that. If you feel unstable when you put weight on it, use a cane to reduce the risk of a fall.

Second, I suggest you seek out at least one other opinion on your knee. If you need help locating a surgeon who is not connected with your current doctor, start with our Joint Surgeon Locator (tab at the top of the page). Do some research to find a surgeon who works with revisions knees. I'm not suggesting that you need a revision....just that these are the doctors who see more difficult cases and are usually better at figuring out what is going on. Look for terms like "revision knee surgery" or "reconstructive surgery specialist" in their biography. If you want my help finding someone, just tag me by typing the "at" sign (@) followed by my username like this .... @Jamie I will need to know the name of your current surgeon.

 

[lionsm13]

Thank you, thank you Jamie !

Initially when my TKR had just felt like it had totally failed around 3 weeks ago I could not put hardly any weight on it what so ever, and since then it's gotten better but still feels odd and is achy and has weird inconsistent pains and feels much like it did when I had the TKR done 9.5 years ago.
However there is no swelling and if there is it is ever so slight, but still have increasing stiffness the longer I stand on it.

 

[kleo]

You’ve got to get some clarification as to what exactly is wrong with your knee. My knee was lax but it was unclear whether the wrong size spacer was used or the ligaments stretched after the surgery. The doctors were able to see that it was lax by wiggling it - no xrays were needed. In my case, I tried pt and exercises to try to tighten up the muscles but it did not help. You’ve got to get the doc to tell you what’s wrong or get another doc to do so.

 

[lionsm13]

I whole heartedly/totally agree Kleo.

Unfortunately I was told that there is not really any way to tell what is wrong w/it other than opening it up and my OS does not want to do that at this point and truthfully neither do I.

However in the next few months and esp. if it does not improve then I will be forced to deal with it as well as getting a second opinion which I am looking at but probably will try and give it a little more time at this time and hope that I am doing the right thing.

It is frustrating when one wants to aid and help the healing process but one does not know in what direction to go. Much like having to stop at a gas station and asking for directions rather than having a GPS.

 

[lionsm13]

Well here we are 4 months later.
Went to another local OS a 35 year veteran in the field who does the "Reconstruction" work at Monument Orthopedics where I live the other day and was told that I need a "Revsion".

Needless to say I was not AT ALL pleased.

If I choose to get the surgery there I was told that they use
Zimmer Biomet. Still trying to find out which model.

He said that I could go back to work in 3-4 weeks, part time of course.
I'm thinking that this is wishful thinking at best as I took 10 weeks off for my original and then went back part time and it was tiring even then.

Where I reside it is still winter and I am trying to put this off a bit so as not to have to walk on a walker on the ice.

For those of you who have had a total revision would you say that the revision is harder or different or easier than your original?
It would not appear to be so.

Going to see my original OS next week and see what he says.

 

[Jaycey]

He said that I could go back to work in 3-4 weeks, part time of course.

I hate it when surgeons set these unrealistic expectations. You are 100% correct, 10-12 weeks is the norm.

For those of you who have had a total revision would you say that the revision is harder or different or easier than your original?

This question is kind of like "how long is a piece of string". Literally every revision is different. Some see immediate relief. Others take awhile to get back to normal. The key is not pushing and listening to that new knee.

 

[lionsm13]

Yes as we are all different.
Yes listening to my pain.
Been there, done that.
Understand that..

 

[Lexus05]

I just had my spacer replaced in July 26, 2019 due to knee being very lax. My components weren't loose and my revision specialist OS didn't replace the metal components, but gave me a larger spacer and I have done great with that knee. Then I had a revision on my other knee Dec 12, 2019 and it's been 6 weeks yesterday. I had a partial knee in for 11 years and I got osteoarthritis in it and it needed revised.
This has been a lot rougher recovery that my spacer replacement but I have 0 extension and 120 flexion as of yesterday. If you have any questions, I would be more than glad answering any questions you might have for me. Best of luck. It's winter weather here too, so it's making recovery hard also.

 

[amymhere]

This sounds so similar to what I am experiencing right now. Not sure I want to opt for revision of my left knee. They want to put a bigger spacer in and redo the kneecap and put a button on it. However, my kneecap is tiny. As I get closer to that surgery I'm thinking what if they make things worse than it is now? I can live with it now. I took a fall a few weeks ago and suddenly my right tkr is hurting and I have to use a cane because I never know going from sitting to standing how it will be. I'm putting off getting it looked at until I have more info about it. My revision is set for 3/12 but I am thinking of waiting on it. Really makes you so confused when you don't understand what is happening but you know it's not right! Hang in there. I feel the confusion and pain!

 

[Lexus05]

If you are falling it could be your spacer is too small and it's making your joint too lax like mine did. It was well worth it to have the spacer changed to a size larger so I'm no longer falling. Recovery time wasn't bad at all.
'

 

[kneeper]

Sorry to hear you need a revision. Hopefully it will do the trick for you.

 

[lionsm13]

@amyhere

Update

I have now had two OS opinions on what I should do regarding my situation.

One OS said that I needed to do a revision.

The original OS said to just leave it alone for the time being and try to live with it as I will probably not be much better off in the long run even if I had a revision.

However he did say if it was just a spacer that they could do that and that recovery would not as bad, but he also said that you do not know until you go in and once you do then you have to be prepared for anything.


At this point I have decided not to get a 3rd opinion for the time being and just call it a day and try to live with it. It's not right but I did not have a stellar recovery and it seemed was in pain for a very long time following the TKR.

It's not as good as it was but it won't probably ever be even w/a revision so I'll pass on it for the time being.
Maybe down the road if things change more than they have or if things get worse I'll opt for a 3rd opinion or a spacer if it could more established that this was what was needed and called for.

Not real happy but it seems like one of those damned if I do and damned if I don't things as it is for many of us w/these TKR's.

 

[Steven S.]

Did the larger spacer restrict knee movement?