Revision TKR 16 Months Post TKR

[JamesW57]

Hello all. I had my 1 year post surgery Dr.visit. I explained, and he could see I still have a lot of swelling and pain. I’ll post his comments but long story short he said my previous surgery and this one has caused some large scare tissue issues. He thinks the knee will eventually burn its self out (not sure what that means) but it could be still a year or more away. He said the final outcome will most likely not be as good as thought. He said additional surgery would be a bad thing!

His notes:
James is a 58 y.o. male who presents today one year status post right total knee arthroplasty with removal of hardware in the proximal tibia on 7/18/2023 with Dr. Gillen. He then had a closed manipulation under anesthesia of the right knee with Dr. Vosburgh on 9/26/2023. He feels the manipulation helped in the long run. He returns with concerns with swelling and the knee making clicking noises. The swelling is consistent throughout the day. He is taking methocarbamol and tramadol at lunch time. He takes the tramadol PRN at night time. The patient ices the knee multiple times a day.

Lower extremity: The incision is benign. There is an effusion present the knee as well as diffuse swelling. Range of motion 0-110 degrees. The knee is stable to varus and valgus stress. There is no evidence of patellar instability.

Review of Relevant Data:
Pertinent Labs and Radiology have been reviewed.
X-Ray Knee Right 2 Views Right
Satisfactory position alignment of cemented posterior stabilized total
knee implants. No obvious loosening or surgical complication is noted.
Patella Baha is noted with some calcification along the course of the
patellar ligament. No acute bony abnormality is noted.

 

[EalingGran]

said my previous surgery and this one has caused some falsification along my patella tendon

I presume you mean calcification?
I wasn't that familiar with the term patella baja but I looked it up and it seems it can occur after a TKR.
If you put it into the search box you will find information and others who have had this problem.
I am so sorry you have this problem. From the little I read there doesn't seem to be a clear consensus on treatment but it might be worth looking for a second opinion if things aren't improving.

 

[WFD]

My stepmother had calcification on the tendons in her shoulders. She would get a steroid shot and the symptoms would go away for as long as 5 years, but would always eventually come back. She would then get another shot.

You might ask your doctor about this.

 

[JamesW57]

Thank you for the reply’s. I will continue to research. This is so discouraging. If I find anything intriguing I’ll let you know and I hope you will do the same. James

 

[JamesW57]

Hello everyone. Well I am writing this at 11:30 at night. This pain, swelling and clunking is just overwhelming. So I have endlessly read and researched my diagnosis of “Patella Baja” on this forum and everywhere else I can find. My Dr. says no to revision. Could just be that he won’t. Long story short has anyone found a procedure, brace or anything that will cure or at least make this tolerable? Thanks as I am feeling desperate at this point!!

 

[mendogal]

Our strong recommendation in a situation like this is to seek a second opinion - with a surgeon who has no connection with either your existing surgeon or hospitals/surgery centers he uses - and who is specifically a revision specialist.

Our staff may be able to locate some in your area.

If for some reason this isn't possible, The Hospital for Special Surgery in NY offers remote independent consultations. They do charge a fee, not covered by insurance.

 

[Layla]

My Dr. says no to revision. Could just be that he won’t.

I am sorry for the pain, swelling, clunking and uncertainty your dealing with. The only way you'll know the answer to your question in the quote is with a second opinion and possibly even a third opinion if not satisfied with your second opinion. I hope you find answers soon and a plan that brings physical comfort. Keep us posted, we're here for you.

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. You can post any updates, questions or concerns about your recovery here.

 

[lrj]

My PT is wanting to try Dry Needling. Has anybody tried it?

I didn't do dry needling, specifically, but I did go for acupuncture every 7-10 days for the year leading up to surgery and 3-4 months past the second one. I found it to be beneficial. After surgery when I would go, the next day, I would see ROM improvements. Also helped with pain and swelling.
If I remember correctly, dry needling uses longer needles and stimulation may be used. Traditional acupuncture uses smaller needles that don't go as deep, and once they are in, you just sit there for 30-60min.
I would recommend trying either dry needling or acupuncture.

 

[mendogal]

My PT is wanting to try Dry Needling. Has anybody tried it?

I didn't do dry needling, specifically, but I did go for acupuncture every 7-10 days for the year leading up to surgery and 3-4 months past the second one. I found it to be beneficial. After surgery when I would go, the next day, I would see ROM improvements. Also helped with pain and swelling.
If I remember correctly, dry needling uses longer needles and stimulation may be used. Traditional acupuncture uses smaller needles that don't go as deep, and once they are in, you just sit there for 30-60min.
I would recommend trying either dry needling or acupuncture.

There are acupuncturists trained within the Traditional Chinese Medicine system who also will tweak or twirl specific needles just after placing them, at times when they feel it will be beneficial.

 

[EalingGran]

Surgical Treatment of Iatrogenic Patella Baja

Patella baja is characterized by a loss of patellar height and can develop as either an acute or chronic complication following a knee injury or surgical procedure. The purpose of this review is to describe the diagnosis and management of patella baja ...

www.ncbi.nlm.nih.gov

This is the best recent paper I found on treatment of patella baja caused by previous surgery.
What I found interesting was that it seems a degree of patella baja is not uncommon in the years following TKR due to quadriceps weakness.
It seems that there are surgical possibilities such as lengthening the patellar tendon but there isn't a definitive treatment.
Hope this is of interest and some use. It does refer to dry needling as well.

 

[JamesW57]

Thank you all for you very helpful replies, ideas and suggestions. I definitely want to get a second opinion and will gladly travel to do so. I am in the Topeka Kansas area but again I would take any help in finding a highly reputable revision specialist no matter where they are.. James

 

[Jamie]

@JamesW57 …. Are you willing to drive to Kansas City for a consultation with a surgeon?

If you haven’t checked out additional therapy, I suggest you find a therapist who has a DPA (Doctorate of Physical Therapy). You can Google the rehab clinics and then check their list of therapists to find out if they have this level of training. These therapists can diagnose and help with post-op issues. You don’t need a doctor’s order to see therapists anymore and have any treatments covered by insurance. If you decide to make an appointment, before you do, ask which of their DPTs specialize in problems after a TKR.

 

[Jamie]

I know you are currently in therapy, so if your therapist has these credentials, then my suggestion above may not be appropriate. In that case, you probably do need to consult with a surgeon.

 

[JamesW57]

I am actually not in therapy any more. I didn’t know about the DPA and am going to check into that. A little additional information I should provide is that I had a surgery I think called Elmslie-Trillat procedure to realign my knee cap probably 20 years ago. My current knee Dr. said the Patella Baja is much worse with some patients that have had this procedure. He also said that the scar/calcification along my patella ligament is also worse because of this as well. He said the build up is substantially grown since my last X-ray 11 months ago. I can’t thank you all enough for being with me and all the thoughts and ideas. Got to be an answer out there somewhere…

 

[Jamie]

This does add some factors that need to be considered in treatment options. It definitely supports the idea that a surgical solution may be the best. You definitely need to find some revision surgeons who have dealt with these issues before. That could be a challenging task, but I’m sure there are surgeons out there.

Knowing this, it may be a good option for you to pursue a video review of your case by the surgeons at the Hospital for Special Surgery in New York. There is a cost associated with this that may not be covered by your insurance, but it would be the most likely place for you to find surgeons who have dealt with this problem before.

 

[JamesW57]

Thank you Jamie I will give them a call and see if we can set up something. I can’t thank you enough for the suggestion. I could deal with the lack of ROM but this swelling, heat and constant pain is just not ok at all. I get through it but it’s a huge struggle every day!! Especially given that I have always been extremely active throughout my life! You have given me some hope though. Thank you and I am always open for any suggestions and thoughts! James

 

[JamesW57]

Hello my TKR Friends. Wanted to let anyone interested know my status in case you happen to be in the same or similar place. TKR completed on 18 July 23. MUA completed on 28 Sept 23 (i was at about 80 degree flexion and 2 extension with no gain). Following MUA i was able to get to about 110 and still 2 after about 3 months.

Met with my surgeon for my 1 year check up and still had high volumes of fluid on the knee, Pain constant all day, and as of now I am at 95 and 5. He said he wouldn't do another surgery and thought it would burn its self out. Finished with, ill see you in another year.

So i took some bone smart advice and I went to see an orthopedic Dr. from out of town that also works with revisions and he has been amazingly engaged. He said i should be where i am? His immediate concern was possible infection. Secondly was loosening or fracture possibilities. So, he had me do blood test which came back ok. He then Asperated it and they came back negative for infection. He then had be complete a radiological bone scan which came back normal. I am scheduled to see him on 3 December in the office to discuss next steps. I have no idea what he will say. I am guessing MRI/CT scan. Who knows.

I am just really happy that someone is doing something to try and resolve this as I am just plain tired of the pain and inability to do the things i use to at least somewhat. It has really help me physiologically but as we move further the worry does increase that what if this is just it!! I have been doing a little research but obviously i have no idea what i am doing and most time reading but with my symptoms and these other possibilities negated I am thinking heavy scar tissue/calcification. I have had 2 arthroscopic procedures done on that knee in the past and an elmsile trillat procedure done.

Any thoughts? Hoping for a positive diagnostic appointment on the 3rd. Take care every one.

 

[Jockette]

His immediate concern was possible infection. Secondly was loosening or fracture possibilities. So, he had me do blood test which came back ok. He then Asperated it and they came back negative for infection. He then had be complete a radiological bone scan which came back normal. I am scheduled to see him on 3 December in the office to discuss next steps.

Since all of the above came back normal, have you ever had a metal allergy test? I’m not saying that's what it is, but the test would rule out an allergic reaction.

For anyone who would like to get a full metal allergy test prior to any joint replacement surgery, you can get the test done in the USA by ordering the test kit from https://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP (or any lab) can do the blood draw and send it in for testing. You will have to have a doctor's order for the lab to run it.

 

[benne68]

So glad to read that you found a good second-opinion doctor, @JamesW57. I'm sure it's a relief to find someone who cares about your outcome. It does sound like he is being thorough.

I don't have any other suggestions. But please do come back and let us know what you learn at your upcoming appointment.

 

[Layla]

Hi James,
Thankfully you found a revision specialist viewing your case with a fresh set of eyes. It sounds like you trust and have confidence in him. I wish you all the best with your appointment next Tuesday. I hope the visit leads to a plan to resolve the ongoing pain. Please keep us posted, we'll be here.
@JamesW57