Revised PKR to TKR 13 months post op TKR - Muscle spasms and filling with blood

[Barry Vine]

Oct 2017 I had bi-lateral Partial Knee Replacements. The left knee replacement failed as the bone on the bottom shifted. Nov 2018 I had revision surgery with Total Knee Replacement. Everything went well as 10 months later I was playing tennis again. 14 months Post Op, I was driving home (3 hr trip) and my left left (centered in the knee area) started to spasm and when I got out of the car I had problems moving the left leg. It felt like someone grabbed my knee and started to strangle it. I noticed that my knee started to swell and I had a big circular pocket of fluid on the outside of the knee as well. 12 days later and 1 or 2 episodes later I saw the PA at HSS (where I originally had the surgery) He drained the left knee and removed 60 cc of blood. I immediately felt a lot better. He told me it may fill with fluid again. Sure enough it has filled again and I have had another episode. I ice the knee all the time and try to keep it elevated. The spasms come and go randomly. Has anyone had anything like this happen to them and if so, what was the remedy. I have an appointment with the surgeon in 3 days and will be doing an MRI and MRA. I am totally frustrated and quite frankly paranoid to be alone at night.

 

[Jockette]

Hi and Welcome to Bonesmart!

Please tell us the actual dates of your surgeries and we’ll make a signature for you.

Is your doctor testing for infection?

I’m sure this is a difficult time for you, waiting for tests and results.

 

[Barry Vine]

Bi Lateral Partial Knee Replacement Oct 12, 2017
Total Left Knee Replacement Nov 8, 2018
I am sure they sent out the drained fluid on Dec 27, 2019 to check for infection. They also took new XRays and the implant is exactly as it should be. It is identical to the X-ray taken in Oct 2019 before these problems occurred.

 

[Jockette]

Thank you for those dates.

It sounds like your doctors are looking into looking into this well. I would be careful with your activities until you have an answer, rest when you can and don’t overdo.

 

[Josephine]

He drained the left knee and removed 60 cc of blood

Actually, the fluid was very likely tissue or synovial fluid which, because you had an inflammatory process going on, was tainted with bloody fluid from the tissues. I think your surgeon needs to order a nuclear scan in order to see what else is going on in your knee.

I went through a similar issue last year and this scan, though it confirmed the presence of inflammation, cannot define if it is infection or something else. You can imagine my concern but later, when both he and I had examined the plain xrays (yes, I can read xrays!) we noticed evidence of a loose implant. I had the revision in September.

 

[Barry Vine]

Yesterday, they removed another 140 CC of blood from my left knee. It is blood only and there is no infection. In 3 days they will be doing an MRI and MRA and hopefully they will find out which vessel is leaking so it can be cauterized. When the knee fills up with blood, the spasms can come at any time making the knee and surrounding areas totally immobile and extremely painful. The 80 minute ride to HSS was so uncomfortable. Imagine someone strangling your knee! The relief after the draining was immediate.

 

[sistersinhim]

Did you do anything that might have damaged your knee? It's strange that it's filling up with blood after all this time. Please let us know what you find out.

 

[Barry Vine]

I didn't do anything strenuous to start the bleeding. I had started to play doubles tennis 3-1/2 months prior without supports on the knees and was doing remarkably well.

 

[Barry Vine]

After doing a MRI and MRA, my surgeon at HSS recommended an Interventional Radiologist at Weill Cornell Medical Center which is associated with NY Presbyterian. The DR told me that I was a perfect candidate for the procedure that he does. It's basically an angiogram from the opposite groin to the knee that will seal off up to 6 vessels. The criteria was that the knee can bleed unprovoked and fill within minutes and that the pooling of blood starts on the outside of the knee. I am scheduled for the 2 to 2-1/2 hr procedure on Wednesday. DR said he has an 80% success rate.

 

[Jaycey]

@Barry Vine All the best on Wednesday! Sounds like you are in very good hands. Please keep us updated!

 

[Jamie]

Best of luck, Barry.....this treatment is a new one for us and we'll be waiting to hear your updates as to how it works for you. Thanks for posting about it.

Who is your surgeon at HSS?

 

[eaglemom]

This is very interesting. Something I've not heard of. Hopefully this will solve your problems. Let us know how you are doing.

 

[Barry Vine]

My surgeon at HSS is Dr Su. Dr Trost of Weill Cornell was recommended by Dr Su for this procedure.

 

[Macknit]

As an amateur in all of this, I too will be interested in hearing the rest of the story. Best of luck on Wednesday!!

 

[Barry Vine]

I had the procedure done at Weill Cornell which is part of NY Presbyterian Hospital. The procedure itself took about 1 hr 45 minutes. Dr Trost (interventional radiologist,) said everything went well. They embolized 3 vessels, 2 on outside of knee and 1 on inside of knee. The day after the procedure my knee tightened up again and it was once again very hard to walk. However, I found myself in the ER not for the knee but the groin. My groin (where the insertion site was) had swollen and was totally black and blue. I had an ultrasound and there was no danger or damage. They suspect that some capillaries burst near the insertion site. I was told to ice the groin today, elevate and stay off my feet. Dr Trost told me that it's possible my knee may tighten many times over the next month. I have a follow up with his office this coming Tuesday. My nightmare continues. Hopefully in the next month I will go back to living normally again. Just as a note, I have never experienced a DR and staff with more compassion than that of Dr Trost.

 

[Jaycey]

@Barry Vine thanks for the update. Wow - you are a real trooper! This does not sound fun. Hope all eases quickly for you. Hang in there!

 

[Jockette]

I hope that things will settle down soon for you and the rest of your recovery goes well, with no more incidents.

 

[Celle]

@Barry Vine ,
We haven't heard from you since January. I hope that means that everything is going well.
How are you getting on now?

 

[Barry Vine]

Update: The fluid in my knee was total blood. Just to give some history:
10/8/2017. Bi Lateral Partial Knee Replacements. (Partial in both knees)
5/15/18. I realized the left knee (which was always worse) was not performing as well as the right knee. I scheduled a follow up with my surgeon, Dr Su @ HSS Manhattan. He suggested I get X Rays locally to speed up the process. Before I saw Dr Su in 6/2018, I asked my good friend, Dr Gottesman ( a dentist) to look at my new X-Rays. He noticed there was a space where there shouldn't have been a space.
6/15/18. Dr Su confirms there is a problem, The bone that the implant rests on went south and the implant couldn't handle the stress. Remedy would be a TKR in the left knee
11/8/18. TKR in right knee. Unlike my all out approach to physical therapy the first time around, I did not rush the recovery this time around. By 9/1/19 I was back on a tennis court and I felt really good. I was playing doubles on hard courts in NY. When I was vacationing in Florida I played singles on HarTru (soft court) and I felt fantastic. I returned to NY and about 4 - 5 weeks later, I realized my left knee was swelling up.
12/27/19, the PA at Dr Su's office drained 60 of pure blood my left knee.
1/16/20. I returned to Dr Su's office and another 160 ml of blood was drained this time. Dr Su said it was extremely rare to see anyone bleed over a year after successful TKR and he recommended that I see Dr Trost, an interventional radiologist.
1/22/20. Dr Trost performed his procedure and thought it was successful. however the procedure did not work.
2/7/20 I had another 80 ml drained from my left knee.
Between 2/13/20 and 3/16/20 I had another 270 ml of blood drained from my left knee. I was forced to walk with a cane the entire time as the pain was intolerable
3/16/20 Dr Trost did his procedure again (literally the last day elective surgeries were allowed in NY due to COVID 19 and I am happy to report that it is now 12/29/20 and I have not bled since then.
I have since been given the go ahead to try and play tennis again. However, I have been getting 2nd opinions and Dr Vekaria of Orlin Cohen suspects the left knee implant is loose. He made his call by looking at the different shades on the xray. Dr Su says there is a chance it is loose, but there is absolutely no way to be 100% unless they open my knee again.

I do the exercise bicycle 30 minutes every morning and walk as much as I can. I am usually pain free and haven't taken Tylenol in months. I won't take Advil or Aleve as they are both blood thinners. Both Dr's agree that after the 2nd knee replacement, the scar tissue probably grew back to much and got caught on the implant.

I am going to Florida mid January and hope to try and play doubles tennis again. I will start very slowly and stop immediately if i have any discomfort.

For anyone that may have a bleeding problem, I strongly recommend Dr Trost @ Weill Cornell Medical Center in NY.

 

[Goma]

So glad you're improving,did the Dr say how the scar tissue grew into your implant.