PKR 15 months out, I have a problem...

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I had my left partial (oxford) knee replacement done in 2014 and unfortunately things started to go wrong after about a year. I have been back to the surgeon three times now, complaining of intermittent, significant swelling which regularly immobilises me and I have just been fobbed off. Last time I was told that it was general arthritis and that swelling was a typical feature of this. He wanted to give me a steroid injection but I do not see this as a long term solution and it has a risk of infection.

For over 6 months now, my knee swells when I walk for more than about 5-10 minutes. I work 3 days a week in an office, and it is fine, then typically I go shopping on my first day off and while I am out it swells with little warning and I end up laid up in bed unable to walk without crutches for 1-3 days. It comes on suddenly while walking and starts with a funny, fluttery sensation in the medial joint space (or at least the same area that was the focus of pain before the op). It happens every weekend, almost without fail. I have to carry crutches in my car (automatic transmission so luckily can still drive) as when it goes I am usually out and about and can just about make it to the car but by the time I have driven home I cannot walk unaided at all.

I recently went for a second opinion with another local knee surgeon. He said I had advanced patellafemoral arthritis and general arthritis throughout and implied that I should have had a TKR instead, my GP said the same thing. The original surgeon did not take up to date x-rays for a year before the operation, which I now think was wrong, as they may have shown the spread of my arthritis. A partial should not be done if there is arthritis in the rest of the knee, surely? The new consultant mentioned a "slight overhang" or "lip" to the implant but sounded very casual and did not give me the impression it was a problem. I have had lots of physio, all exercises aggravate it, and I am now using a kneehab daily and game-ready ice /compression when it swells. I am wondering if this overhang could be the cause of the irritation, i.e. my ligament may be rubbing over it. I have little faith in the consultants being up front and honest about what has happened as they all know each other.

I need to find a knee revision specialist, so I can be sure this will be dealt with successfully. I am 46 years old and devastated to be so disabled and facing the prospect of another huge operation, which is likely to cost me the job I love due to the time off required. And I am scared of what the future holds if the next one does not last long.

I have googled found specialists who have expertise in revisions but they are all too far away. I am on the south coast of England and can travel a bit, but not to the other side of the country. Can anyone recommend a surgeon?
 
I'm sorry you have such problems with your knee, @Clarabel .
@Josephine lives in England and she may be able to help you find a revision surgeon.

I had a PKR which served me well but which eventually needed to be revised to a TKR. Although I was apprehensive beforehand, the actual revision surgery and recovery were no worse that my original knee replacement. Nowadays, TKRs can last 30 years or more, so don't worry about the revised knee not lasting long. I expect mine to last for the rest of my life.

I think that when you had your PKR your surgeon would have been able to see if you had arthritis in the rest of your knee and he would have done a TKR then, if it had been necessary. Unfortunately, it isn't that unusual for arthritis to advance, making a revision from a PKR to a TKR necessary. That's one reason why I wouldn't have a PKR on my second knee, but said that I wanted a TKR.
 
He said I had advanced patellafemoral arthritis and general arthritis throughout and implied that I should have had a TKR instead, my GP said the same thing.
Those two doctors had it right!
A partial should not be done if there is arthritis in the rest of the knee, surely?
Correct.
The new consultant mentioned a "slight overhang" or "lip" to the implant. I am wondering if this overhang could be the cause of the irritation
Don't be side-tracked on this. It's easy to think "something is responsible for this - this is something, it must be responsible"! The long and short of it is that you have a grossly arthritic knee and need a TKR.
I have little faith in the consultants being up front and honest about what has happened as they all know each other.
You're not wrong!

Would you like to give me an idea of where you are in Dorset so I can do some research for you? I use the UK surgeon/hospital profiles search site for my research! Maybe give me the names of at lease six hospitals in your area to start with.
 
Thanks, I have private health insurance so could go anywhere but don't want to travel more than an hour. I have looked at the local consultants' stats and would be inclined to see the one with the highest number of revisions but I can't find anyone in the South who has done more than 25 revisions a year.

I am not really convinced my symptoms are related to my arthritis, as the swelling is so sudden and acute and there is no pain until 24 hours into the swelling. And surely I should not feel pain or discomfort in the medial compartment as there is no arthritis in that area. The need for a revision may be the same either way but I think the implant overhang could be causing irritation and without that I would have had a few more years before I needed the revision. All speculation though and, as I said, I doubt if any of them will be honest with me.

Thanks for your help with consultants.
 
Just an update on my knee:

After seeking a 3rd opinion on my frequent (weekly) severe and sudden swelling I finally found a surgeon who showed an interest in finding out what was going on.

He referred me to a rheumatologist to check for RA etc. Bloods were all normal except raised ESR and CRP. She commented that as I had a nickel allergy I could be reacting to the implant.

I then had an arthroscopy to investigate (MRI was out due to the metal of the existing implant). It turns out I have PVNS throughout the joint and very little cartilage left in the lateral compartment.

Even without the PVNS the severity of the arthritis means I need a revision to TKR. He will remove the joint lining / PVNS at the same time and use an oxinium implant to avoid any nickel reaction. Unfortunately the PVNS may well return and further surgery is probably not an option due to risk of infection with an implant. I cannot go on as I am though and this is the best option.

I would be interested to hear from anyone else with PVNS and their experience with this condition.
 
We have had a few members with that but not many. But I made an article about it PVNS: Pigmented villonodular synovitis. There is also a list of all threads on this site that mention this topic but they're all quite old so members within them would most likely have not not been on the forum for some time.

Hope you get some good treatment.
 
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