Revision TKR 3rd time’s a charm?!

[Jen53014]

New to this forum and boy I wish I’d found it years ago! I had left TKR in 2016 and the tibia (lower) component loosened so I had a revision in 2020 to replace that part. Last fall (2023) I started to feel like something was amiss on the knee again. Tried PT and aleve - symptoms got worse (lateral weakness, pain). Doctor has advised the spacer should be changed out to provide more stability as he notes there’s definite movement. Doctor has determined the post (not sure that’s the right term) is cracked or broken. He is not sure if he’ll use same rounded with less space in post (focus is post) or square type that’s wider and should be more stable. Drawing he made of current (1) and the options he’ll use (2 and 3).

My question is if there is any other component replaced during this revision. I made a comment about asking if he’s going to make sure all the other components are still secure (X-rays look fine) and he said something along the lines of replacing the femur component. I’m not sure if I heard that right.

 

[Jen53014]

Oh and this has been 3 different ortho doctors because the first 2 have retired.

 

[benne68]

Welcome to BoneSmart, @Jen53014. I'm sorry that you may be facing another revision.

Is this newest surgeon you've seen a revision specialist or just an orthopedic surgeon? Revisions are tricky, so you want to be sure your procedure is performed by someone who handles many of them each year. Given that you've already been through one revision, I think it's important you find an expert before agreeing to another surgery.

Also, have you sought a second opinion from a revision specialist not affiliated with the practice of the surgeon who has proposed this?

If you need help finding a revision specialist, please let us know. Our administrator (@Jamie) can share a list of specialists in your area.

 

[Jen53014]

Thanks! All 3 ortho docs have been in different practices. While my current doctor is not a revision specialist he does many. I feel comfortable with his plan - replace the spacer and check all other components replacing as necessary.

 

[Jamie]

With what you’re describing, it does seem that the prudent approach to a revision would be to replace all three of the implant’s components - the stem and tibial tray, the plastic spacer, and the femoral component to ensure that they all function well together. Determining exactly what needs to be done is why you want to have a surgeon who is very experienced at revision surgery. It’s vastly different from a primary knee replacement and can involve not only the components, but also the correct balancing of the ligaments once the implant is placed.

I’m not sure what you mean when you say he does “many” revisions. I hope he has the experience that you and your knee require. This is an important decision, so don’t feel bad getting additional opinions if you have the time and inclination to do that.

Just let me know if you’d like some recommendations for additional opinions.

 

[Jen53014]

Thanks - by “many” I meant he is experienced in revision surgery, but it’s not his specialty as he does initial joint replacement as well.

My doctor is going to assess the components when he has everything open to replace the spacer. I’m not keen to have the other components replaced unless they’re loose or not aligned. If everything is intact and the instability is solely because of the spacer that’d be the only part replaced.

What I’ve read in this forum is that “just“ having the spacer replaced is much easier recovery since the bone isn’t bothered (couldn’t find the right word and settled on bothered).

 

[Jamie]

Yes, you’re correct that a spacer replacement is not as involved a surgery as replacement of other components. Hopefully that is all you’ll need.

 

[Jen53014]

Have spent the pre op time doing pre hab. I’m fairly active and do a dedicated 30 minutes of the morning rotating through cardio, strength and balance - occasionally combining all 3 (YouTube videos are awesome!). I take my dog for 2 walks (most days) of 2 miles am and 1/2 to a mile pm. (This used to be more, but has gradually decreased due to knee.)

When I found out I needed this 2nd revision I switched gears and started doing about 20 minutes of dedicated leg exercises (PT recommendations from last 2 knee surgeries) and some cardio/strength plus 10 minutes of recumbent bike (3 days on and rest 1 day on bike). I’ve cut back my dog walking distances as my legs are tired after my morning routine (don’t worry the pup gets extra ball fetching as a substitute!).

Surgery is thursday May 9, 2024. I have definitely felt like my knee is getting worse - not constant pain, but some movements stop me in my tracks. What are others doing for prehab? Have you wondered if you’re over doing prehab?

 

[Jamie]

As long as what you’re doing in pre-hab isn’t causing you pain or swelling afterwards, it’s fine. But you do want to avoid going into surgery with an inflamed knee. So if you are having a lot of pain now, I’d ease off on the exercises now and let your knee rest.

 

[Jen53014]

As long as what you’re doing in pre-hab isn’t causing you pain or swelling afterwards, it’s fine. But you do want to avoid going into surgery with an inflamed knee. So if you are having a lot of pain now, I’d ease off on the exercises now and let your knee rest.

Wow…that’s an interesting observation. I never thought about an inflamed knee and how that could complicate. Side note: I called for antibiotics because I had a dental scheduled and they said no - postpone for 3 months after surgery. Glad I didn’t have any antibiotics on hand. So many things to know and yet you don’t always know.

 

[mendogal]

My prehab was two knee sparing exercises: glute workout with resistance bands and straight leg raises. Plus a little tai chi. That's all my knees tolerated.

 

[Jen53014]

My prehab was two knee sparing exercises: glute workout with resistance bands and straight leg raises. Plus a little tai chi. That's all my knees tolerated.

I’m doing those two plus some others and have added in wall push ups to add a bit of strength to my arms. Plus 10 minutes on the recumbent bike - only 2 minutes is at hard resistance.

 

[Jen53014]

@Jen53014, have been added to the May surgery list! You are now officially a May Marvel!

Welcome to the BoneSmart forum. We’re so pleased you have joined us here. We want to share your journey with you, so please start a thread of your own in the proper forum. By starting your own thread, you and your questions and concerns will receive the attention they deserve.

For additional help, look in the white toolbar under the blue one, click on "Help & Information," then click on "How to Use This Forum." You'll find lots of info there to help you navigate the forum.

We are here to help in any way we can because We Care!

Where do I start a new thread after surgery? I have a preop thread already.

 

[Jockette]

@Jen53014
You can start a Recovery Thread in the recovery forum,

Knee Surgery Recovery Area

For post-operative knee patients, on the "other side"

bonesmart.org

Look for the orange “button” that says Post Thread:

 

[Layla]

Hi there Jen,
Stopping by to wish you all of the best tomorrow!

Since your surgery is tomorrow, please feel free to start your recovery thread today, while your head is still clear. You will likely receive best wishes over there and your thread will be up and ready to roll when you're resting comfortably back at home post op. Hope to see you there soon.
@Jen53014

 

[Jen53014]

Question of the day (when you’re triple checking everything before you leave ) - I bought a stool softener and I notice now it says stool softener plus stimulant laxative (docusate sodium 50 mg + sennosides 8.6 mg). All the advice recommends stool softener - did I buy the wrong thing? I certainly don’t want something that makes a BM “urgent” as we know I’ll be slow moving. I do know that the pain meds do slow my system down considerably and I’ve always needed something to kickstart

 

[Jamie]

You did purchase the wrong stool softener. Any time there is a stimulant added, you can run the risk of your bowels becoming dependent on that stimulant action to work properly. Companies just love to sneak that in to their products and frequently don’t put the stimulant part in large enough letters to see when you’re shopping.

If it’s unopened, you may be able to return it. But you do need to be sure you are taking something like MiraLAX or Colace that is only a stool softener that pulls water from your body to help you go more easily without that laxative effect. You can take a stool softener for extended periods without worrying about your body needing it when you stop.

The only time one of the stimulant products would be beneficial is if you had not had bowel movement in three or more days. Even then, it should be used sparingly. You can also drink prune juice or eat dried prunes. The flavored ones are pretty good if you’re not a prune fan….kind of like candy.

 

[Jockette]

You can follow Jen’s recovery:

Revision TKR - May 9 2024 Revision TKR - again

Well I’m all ready for surgery tomorrow. It’s 6:30 pm here and I’m in my PJs after my shower with my special soap. I’ve done my sheets and towels and regular laundry. I’ve made several meals for the freezer (and a few for hubby for the next few days). My darling daughter has sent me the best...

bonesmart.org