MUA 1 Week post op

[KarriB]

Just read your post about the pt suggesting the implant may be the wrong size. My best friend had a TKR a year before me. Her knee would only bend enough to go up stairs. The OS did an MUA with no success. She went to see a revision specialist who ended up doing my emergency infection surgery, but he said the implant that her original OS put in was too big for her knee. He gave her a brace to wear until she wants it revised because it also slips in and out.

 

[Celle]

It is unusual for an entire implant to be the wrong size. What can happen, though, is that the plastic spacer between the two metal components can be either too thick or too thin. It it's too thick, that can prevent the knee from bending properly. It it's too thin, the knee will feel too loose.

Replacing a spacer is a much less serious undertaking than replacing all the hardware.

 

[KarriB]

I had heard that was very rare, but the implant itself slips and slides. The revision specialist said it will need taken out whenever she's ready. I'd never heard of anyone else having the wrong size implant. The knee itself is much larger than her natural knee and still swells three years later. When my friend went back to her original OS because she was still in pain with swelling and poor rom a year later he told her the pain was due to her getting older (52) and she'd after to learn to live with the pain. So off she went to get other opinions. Two surgeons said the implant was too big for her bone.

 

[KameronSteele]

I had heard that was very rare, but the implant itself slips and slides. The revision specialist said it will need taken out whenever she's ready. I'd never heard of anyone else having the wrong size implant. The knee itself is much larger than her natural knee and still swells three years later. When my friend went back to her original OS because she was still in pain with swelling and poor rom a year later he told her the pain was due to her getting older (52) and she'd after to learn to live with the pain. So off she went to get other opinions. Two surgeons said the implant was too big for her bone.

@KarriB
OMG, that is crazy that the original OS said the pain and swelling were due to her age! What an insult! and your friend with the TKR then MUA, was she also having pain or just unable to bend? Does she at least have 90?

@Celle ,Will an xray determine if the spacer is too big?

 

[KarriB]

If the spacer was all they would replace, she would have had it done. But she says she's not ready to do the whole surgery again. My spacer was replaced in the washout surgery and she saw that it wasn't as bad as a full TKR. She was in pain all the time and still is at times. But she has been fighting cancer for 20+ years and just isn't up to another surgery. My friend's TKR was due to a sport injury, so her other knee is ok so far. She is under the care of a pain clinic due to the cancer, so I wonder if that sometimes helps her knee pain. I'm not sure what her rom is, but she does have to go down stairs sideways because it won't bend enough to go down correctly. Meanwhile, I have no problem going straight down.

 

[Celle]

@Celle ,Will an xray determine if the spacer is too big?

It may do, as long as X-Ray taken is sensitive enough to show the spacer.

I'm going to pass this whole query about knee replacements being "too big" over to @Josephine .
I don't think your PT is the best person to diagnose if the implant is too big, but if you continue to have problems, seeking a second opinion from a surgeon who specialises in doing revisions could be a good idea.

 

[KameronSteele]

Just out of curiosity I decided to compare my xray with ones I found on google. Mine was THE only one I could find that the tibia component hangs over the back -exactly where feel the pain when I try to go beyond 90 (where the tibia and fib come together) ! This would make sense as to why I feel the pain b/c the components are closer together when flexed. Thoughts?

 

[Pumpkin]

You have overhang on the outside of your knee, 1 to 2 mm is usually OK. Is that where your pain is? Celle has tagged Josephine, she will be able to help you localize your pain.
You have posted a front view, can you post a side view that will show the back of your knee? Thanks!

 

[KarriB]

Josephine had told me a few months ago that it's very rare to have the wrong size implant. My friend went to another revision specialist after that who agreed with the first revisionist. Definitely get a second opinion if the pain continues. Hopefully Josephine can help you figure out the pain.

 

[spinnerdiva]

@KameronSteele - unfortunately he did not tell me what he thinks it is when I saw him . My PT thinks it is a small muscle tightening up that we can get relaxed but cones right back .
Please let me know if they give you some insight ! It is very aggravating !

 

[bonini]

@KameronSteele Hi - I've been watching your thread because it reminds me so much of my first TKR experience, 14 years ago. I was 45 years old and in excellent physical shape. I also had an MUA, about 5 weeks post surgery. I am not suggesting that you'll have the same outcome... But, to this day, that knee only bends to 90. However, I can do anything (almost, not deep squat) and have modified much in my workouts, etc to have a full life (no pain). Now, I am recovering from my other knee, done August 19. Right out of surgery, this new right knee has had awesome ROM and is already doing work for the old left TKR. I'm telling you this, because even if you don't get more ROM (which I bet you do!), you can still be active and healthy. I don't think I would opt for a second MUA if the first didn't help.... But that's MHO. Best to you!!

 

[Josephine]

Can you tell this soon if the MUA was successful or not or does the swelling have to go down first before one can determine that?

Not necessarily for you but the surgeon should tell you what he got it to whilst you were under. That's the key. But that's not your expectation immediately after the MUA.

mine expectations were go to sleep at 90 degrees and wake up with full ROM since i had full pre-TKR

Wildly over optimistic my dear!

im exactly where i was pre-MUA-90 degrees which is unacceptable

But did he tell you what he got you to whilst you were under?

Before I had the MUA, i asked the OS, if this doesnt work then what. HE said, he'll do 2 MUA's then a scope

Sounds like this will be your option then It's called an open lysis and @skigirl had it done.

As for 'too large' implants, they are usually either the femoral component or the plastic spacer.

Cameron, I need better xrays than you have posted. I need the front to back on and the side view and please post them using the "full image" option else they won't be of diagnostic quality.

 

[KameronSteele]

I'll try to get better pictures but so far this is the one I have.

But did he tell you what he got you to whilst you were under?

And he said, "Loud pops of the capsule…flexion was up to 140deg (your heel touched your butt). Take the pain you must work through all that.."

That's all I got from him. I'm considering seeing a revision specialist but don't know if its time yet. If my OS had just told me what to expect or better yet, not expect, at least I could say, "ok, I have no more ROM after the MUA than before but w/ PT I can get it..." then I'd feel better but he has told me nothing. My pain is OFF THE CHARTS when I try to bend past 90 but all my OS says is... work thru it. Really??!! Let me saw off your bones and then you try to bend your leg, it'll hurt but just work thru it!! Jack butt! Sorry, I'm just mad!!

I'll try to get more xrays to post. Thank you all so very much and to all my US bonesmarties happy thanksgiving!!

 

[KarriB]

I understand your frustration. When do you see the OS again?

 

[KameronSteele]

supposed to go today but i moved to another city, 4 hours away. i plan to not go back and look for another OS.

 

[Celle]

I have read that some surgeons will not take over another surgeon's case until a year after surgery. It could be worthwhile checking that out.

 

[KarriB]

That has happened to a few TKRs I know. It was a real struggle to get a new OS, insurance may have been dictating the choice.

 

[KameronSteele]

I have read that some surgeons will not take over another surgeon's case until a year after surgery. It could be worthwhile checking that out.

Oh dear, thats not good and good certainly be an issue.

That has happened to a few TKRs I know. It was a real struggle to get a new OS, insurance may have been dictating the choice.

Im sure its all about the insurance. Maybe once I tell them I moved to another city from where my original OS lives, that will help. Insurance didnt have any problem with the new PT, but PT services are quite a less more than OS. Can you gals remind me who had an MUA here? I'd like to ask them if what my knee is feeling is "normal..?" Thanks !

 

[KarriB]

Moving is a good excuse. When a friend was looking to switch to my OS just 2 months after her TKR due to complications, he said he couldn't see her for 9 months. I felt so awful for my friend as we knew she had an infection but her OS wouldn't admit it.
@tigz had an MUA and commented on your thread. I believe there's an MUA label beside the names of those who've had them.

 

[Celle]

@KameronSteele
If you look for the grey MUA prefix to threads in the post op forum and select the MUA, a list will come up of all the people who had MUAs.