TKR Desperate for recovery advice<

Im sorry, the doctor in buffalo is
Dr. Marcus Romanowski. Jamie the doctor that you recommend in PA... who is it? maybe I am missing a link.
 
@buddydog
I am truly wondering if we had the same surgeon, by the description you have presented of the manners of his “staff” and his arrogance. Any chance you used one of the doctors at Magee Hospital?

I am suffering similarly to you at the eight month period now, and feel they are washing their hands of me! Revision is probably in my cards- I am thinking. Although they refuse to acknowledge any issues, they have condescended to administer an allergy test for that knee that I am having this coming Wednesday.
Very difficult when your pain continues and they seem to regard it with little concern!
Hope you get some answers soon.

Kathy
 
@Kathy0427 I removed the suggestion to pm details because we like everything to be on the forum. Besides which, surgeons and hospitals names are regularly posted on this forum.
 
@Jamie please let me know the name of the doctor. Not sure I followed if you provided the name.

I have a feeling he may be near Philly which is far. I am in Erie so closer to Buffalo, Cleveland, Pittsburgh. And oh boy... that revs up the anxiety as far as the insurance goes. It figures I finally find the doctor I am most comfortable with, however, if the insurance war continues, I will be out of network in July. I pray I get the answer soon! thanks!
 
Here is the surgeon in Pennsylvania:

Philadelphia, Pennsylvania

Gwo-Chin Lee
University of Pennsylvania
Philadelphia, PA
Speaker at 2018 ICJR workshop on problem hips and knees
Also works with bone infections

But I have others in Cleveland. It might be your best bet:

Cleveland, Ohio

Dr. Viktor Krebs
Cleveland Clinic
Primary and revision hips and knees
Speaker at 2018 ICJR workshop on problem hips and knees

Dr. Bernie Stulberg(Cleveland) - works with high BMI patients
Dr. Ken Greene(Medina/Cleveland Clinic) - works with high BMI patients


Virtual doctor appointments are available from Cleveland Clinic:
The Cleveland Clinic ortho site suggests they have a very reasonably priced virtual visit and a remote consultation review.

Virtual Visits with Orthopaedics

Select patients now can see our providers online from their home or office by using the Cleveland Clinic Express Care® Online tool. This service allows patients a fast, secure and easy way to receive care from their healthcare team in a live virtual visit using a smartphone (iPhone or Android), tablet or computer. The benefits of choosing a virtual visit include no travel or parking, less waiting, significant time savings, no facility fee and the convenience of seeing your physician from wherever you choose.

Virtual visits with an orthopedic surgeon.

New patients with common knee injuries or knee pain.

Established patients scheduling follow-up care appointments such as:

Post-Surgical & wound check visits
Fracture care follow-up
Injection follow-up
Musculoskeletal injury follow-up
Per-operative teaching prior to surgery
Ask your physician if a virtual visit follow-up appointment is right for your follow-up care.

What is the cost of an orthopaedic virtual visit?

New patients: $75
Follow-up visits: $49
Post-surgical visits: $0*
Fracture care visits: $0*
*Within 90 days of incident.
If you would like to use Express Care Online for your next visit, please call your provider’s office. If you are eligible, our team will schedule your virtual visit and provide details on the cost of your appointment and setup instructions.

MyConsult

The MyConsult online medical second opinion service securely connects you to the specialty physician expertise you need when you are faced with a serious diagnosis. Following a thorough review of your medical records and diagnostic tests, Cleveland Clinic experts render a medical second opinion that includes treatment options or alternatives, as well as recommendations regarding your future therapeutic considerations.
https://my.clevelandclinic.org/departments/orthopaedics-rheumatology/appointments-locations
 
thank you!! Krebs is well known - huge waiting period. i will look into the others!
 
Pm’d my drs name, but I’ll give it here also. Dr. Michael Pagnotto at Tri-State Orthopedics operated a month after my original TKR. You should know that after my infection washout/spacer exchange I had NO therapy for over a month. Dr. Pagnotto had my knee in an immbolizer for 4-6 weeks and after that prescribed non-aggressive therapy which meant heel slides with no aide and walking around my house.
 
It just gets more confusing. I just got another opinion out of state - in case my insurance does not get resolved and I can't retain my local surgeon.

This new ortho said that my original knee that was done last year at this time that I'm still having problems with, still probably retains arthritis under the knee cap (no resurfacing was done/button) and scar tissue; there is a lot of movement (?); and surprisingly, he said that my, posterior (I believe) cruciate ligament was removed. He doesn't believe in removing ligaments nor did he say he would revise it. He said he would use a Zimmer implant, I believe. My first knee was an Oxinium. Not that that matters much if you have a good outcome.

He did say that my other knee is bone on bone and bowing, and that he believes in resurfacing the knee cap if it needs it; whereas my original surgeon said that it weakens the knee cap and studies show there is no reason for it.

I am not happy that my pcl was removed - I thought I voiced that prior to surgery. I guess, if I had a good outcome I might feel different. The local surgeon that I am scheduled with does not believe in resurfacing either. He's a great guy and I have to get the surgery soon (May 22) because of the insurance changing ... but I am just not sure what to do!

Can I get some feedback from others as to what method their surgeon used??? pros / cons?? I am a wreck trying to make a decision here.

Also, is it suggested that I refuse at home nurse/therapy visits? I can't leave the hospital until certain activities are achieved. I am so torn with the fear they instill about 'scar tissue' forming and no going back!
 
Last edited:
buddydog,
In the US most surgeons resurface the kneecap, in Europe they do not resurface the kneecap. There is much variation among surgeons.
I agree with the second surgeon, if the kneecap has arthritis it should be resurfaced.
Ask your first surgeon why he does not resurface the kneecap if there is obvious arthritis?
I am going to tag @Josephine to help address your questions.

To be discharged from the hospital you need to be independent with in/out of bed, walking far enough to get around your house, and be able to do the same number of steps that you have into and in your house.
 
My surgeon also reconstructed the knee cap---I am concerned that you have movement in the first knee? what does your current surgeon say about that? A lax knee is not good. and there are some problems that can come from laxness. I think that is worthy of a discussion with the surgeon before you allow him to do another knee that might not be satisfactory as well.

Since he gave you a knee with laxity and did not resurface the knee cap, I think you need to have a frank discussion with him prior to allowing him to do the other knee. I understand insurance issues---but, this surgeon has not met your needs with the first knee.
 
he believes in resurfacing the knee cap if it needs it; whereas my original surgeon said that it weakens the knee cap.
There is a differential between surgeons about this. However, it does remain that if the PCL is damaged then it needs to be removed and a cruciate sacrificing knee installed. That's not a choice, it's a medical necessity. Much the same thing applies to the issue of the patella.

Finally, I am not at all sure why you feel you are being required to choose between these two procedures.
Also, is it suggested that I refuse at home nurse/therapy visits? I can't leave the hospital until certain activities are achieved.
I think you are confusing the pre-discharge criteria with your at home PT. Of course you have to fulfill the criteria for discharge first.

And who suggested you refuse therapy visits and for when?
I am so torn with the fear they instill about 'scar tissue' forming and no going back!
Scar tissue is a much over-rated thing. It is actually pretty rare and the principle reason for stiffness is swelling and pain, NOT "scar tissue".
 
Number one, about the PCL. If the PCL is in bad shape they must use a prothesis that performs the work of the PCL. It's no big deal. Most likely your PCL was frayed by your arthritis.

Whenever you want someone to do a good job, you have to let them do it their way. The tricky part is finding the right someone. Find a surgeon with lots and lots of experience and you can further look on ProPublica surgeon ratings to make sure s/he doesn't have a high complication rate. Then trust them with the details. Because, truth be told, they really don't know for sure what they're going to do until they open up the knee and see what they're dealing with.

The criteria for release from the hospital is that you can walk using an assistive device, and do steps. They should also make sure you have a pain management routine that's working.

I too had laxity and wore a rigid hinged brace for 6-7 years to try stabilize the knee. Ultimately the knee continued to get more unstable and then my components loosened and I required revision. Again, as I said, the best one thing you can do is find Dr. Right. He may not have the best interpersonal skill. It's his TKR skills you want.
 
I am sorry for the confusion! And should probably quit writing while I'm ahead so as not to aggravate anyone else and because it is quite daunting for me also.

I am talking about 3 surgeons; one last year that did my first knee. I had a very difficult time recovering; he was a few hours away; the knee continues to pound at night and audibly grind and pop with pain. My kid calls it a Pretzel bag squishing! I called several times and fulfilled my check ups but was told just to give it time. It's been about a year and I have no intention of going back. He did not believe in resurfacing the knee cap. This would not have been an issue had I recovered ok but subsequent PTs and physicians said that much arthritis remained and they 'think' this is the issue.

Because my other knee is really declining; I was able to see a well regarded local surgeon who I am comfortable with, didn't rush me out in ten minutes, and he scheduled me for TKR in May. Unfortunately, this surgeon's facility is no longer accepting my insurance after June 30 but will continue basic care for 90 days. He too believes as my first surgeon, that there is no evidence that resurfacing the kneecap will help and that it only weakens the kneecap. They are trying to get me scheduled and rush the pre op services before the insurance expires. I can ask more questions to his PA when I am scheduled for pre op but there is not much time. He also thinks I should give the original knee more time and talked about possibly revising a plastic insert. If I didn't like him so much, I would chuck it all and go elsewhere.

Because of all the angst with this insurance, I sought another surgeon's opinion out of state last week. He is the 3rd one in this mix. He said that there was laxity, he believes in resurfacing to remove arthritis and placing a button, and said that my PCL was removed; inferring more laxity. I understand that if it was damaged it needed to be removed (I don't see that in the surgeons original notes).

In response to Josephine... As far as PT goes, I was given advice from the forum not to push the PT and allow the tissue to heal - am I wrong about that? PT pushes it beyond anything else. I think in my early thread I was told I was overdoing the PT. I do understand that there is criteria that has to be met before leaving the hospital.

My concern with the two procedures is that if the resurfacing is not done, I am terrified of ending up with another bad knee. And quite possibly, this is not even the reason why the knee isn't right. It's just another doctor's opinion.

I will take Josephine's advice and try to get to Cleveland soon. I am up just against losing this local surgeon (due to insurance) that I am comfortable with in the hopes of finding someone else - and that has been very difficult.

Thanks for your patience and replies.
 
So, wow, that's a lot to sort out. Well, to put your mind at ease, know that the PCL issue is not contributing to your laxity. Laxity is caused by wrong sizing of the spacer and/or failure to balance the ligaments.

It would be a shame to rush into surgery because of the insurance issue but it's totally understandable. Have you had the chance to inquire how many knees this latest surgeon does a year? I didn't ask that question for my original surgery, which also was done by a local surgeon I was comfortable with. Maybe your local surgeon has a busy practice, but mine did not.

When I went for second opinions I was advised by my PCP to get two second opinions, and that did give me the information I needed (both said I had laxity).

Too bad that insurance concerns force us to make decisions that maybe are not the best decisions. But, yes, if I were in your shoes I would find a very experienced surgeon for a consultation in Cleveland. It might settle some of your uncertainty. Sometimes you can get an appointment quite soon. Good luck!!
 
Just to clarify the question of the PCL for you - if the cruciate ligaments have to be removed, a prosthesis is used that compensates for the missing ligaments. Removing these ligaments does not result in an unstable knee.

I've copied the following from this article: Knee replacement surgery types and suggested videos

"There are two types of this implant: cruciate sparing and the cruciate sacrificing. This is to do with the two strong ligaments that cross over inside the joint and prevent the femur from sliding off the top of the tibia when the knee is flexed. They also control the bones when some rotational movements are made such as in sports like skiing and football.

aflagsforworship-co-uk_jo_pic_images_anteriorcr-jpg.36783


Cruciate sparing
This preserves the cruciate ligaments if they are in good condition. The implants have a notch to accommodate them
ai48-tinypic-com_s4t9jc-jpg.36784


Cruciate sacrificing
When the cruciates are in poor condition or even ruptured, a prosthesis is used which has a peg on the plastic insert and a notch on the femoral component to take over their functions of keeping the joint stable.
ai47-tinypic-com_24cfx5i-jpg.36785
"
 
THANK YOU for your prompt replies.. that is helpful! my local surgeon, his surg coordinator says, does about 7 tkr per week. do you think thats acceptable? the ortho in buffalo does many more. when i meet with the PA for pre op i will find out more.
 
I am still waiting on insurance and scheduled for Wednesday! I am stressed to say the least and having more pain in the other knee that was replaced last year at this time. I'm still on the fence which is insane. Just remind me please, what exercises should I be doing if I go through with this? Apparently I was doing too much previously. I have still not recovered my quad/hamstring strength in my first TKR and there is actually a dent in the quad towards medial side that wont contract much (despite exercising) and pain still in kneecap. Also, this doctor uses a drain - I have read that that leads to more avenue for infection... is that a typical procedure? Thanks for patience.
 

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