Revision TKR 2 Years and 2 Months of Persistent Recurring Swelling and 9/10 Pain!

umanemo

new member
Joined
May 24, 2018
Messages
6
Age
62
Location
RV in Europe
Gender
Male
Country
United States United States
I was treated for my chronic osteoarthritis by receiving both knee implants (Bi-Lateral TKR) in March 2017 and all went well, Wounds healed nicely, the pain eventually went away and I was off and running like an ostrich! (Well walking, but it seemed like a good metaphor) I am American but live in Europe. I had the surgery done in VA. I then had only a few weeks P.T. before I had to catch a ship home only 6 weeks after the implants. The Dr. said O.K. to go and no problem with the scars and that I could use the hot tub onboard along with the gym equipment and the exercise regimen the P.T. had suggested. These two weeks at sea (a repositioning oceanliner) were no problem and about the best thing that could happen for a post-op patient. All was good.

The next 12 months were just incredible. Bicycling, walking, getting under to repair or getting in and out of the RV and even hiking up into the elevated bed every night, all was good. I walked an average 2 - 6 miles several times a week visiting the big cities all over the continent without even a thought of my knees and the pain slowly became minimal as expected.

I am a freelance photographer and am always bicycling or walking around and to my subjects. I bend, crouch, and lean over pretty much as all photographers do to get the perfect angle for composition. But on one day in May 2018, I was a mile into a souq in Essouaria, Morocco and I had just crouched to get a shot when I felt my right knee begin to tighten. Then it swelled, really swelled and I was shortly completely incapacitated with the inability to bear weight on the leg along with extreme pain 10/10 and "-0-" ROM, I mean Morphine indicated pain! (Thankfully I have some remaining from my recovery period and they help me from total agony for the initial several hour's duration of this pain during these events.) This severity of event continued to happen throughout that year 6 or 8 times separated by 4-6 weeks each with pretty much the same symptoms. But this year the events have become more frequent but with less duration and less painful and I am able to bear weight on the knee within a few hours vs. a few days. Nothing notable triggers it. It just happens while walking cautiously, just after getting up in the morning or even this morning I was woken up to an event while I hadn't even gotten out of bed yet! There is no obvious hematoma, just obvious swelling and pain. Note: the right knee was the most painful when the natural joint suffered from bone on bone osteoarthritis.

I have seen two Ortho's over here with xrays and also had an evaluation with MRI's in the USA when I returned to Florida in January for a few weeks. No one sees anything obvious or has any explanation. Micromotion was ruled out by the US exam too. My original Ortho suspects tissue impingement but the second Ortho didn't see anything obviating that diagnosis. So I wait for an event to swell my knee up sufficiently for a fluid draw to be analyzed (for the possibility of low-grade infection) but as I am nomadic that is complicated and has to occur conveniently where there is a hospital nearby and there happens to be an Ortho on the floor at that moment!

All this detail is intended to spark any similar circumstances that others may have experienced. Please if anyone has an explanation and/or course of action everything is welcome information. I have studied myself several hundred pages of studies related. The low-grade infection seems to have the least favored outcome as if that's persistent it will indicate total revision - not a good option.

I do wish to have no false positives in the testing for this infection. Has anyone had testing of the fluid following the protocol that involves "messenger RiboNucleic Acid (mRNA) using reverse transcription-quantitive polymerase chain reaction (RT-qPCR) that allows for specific species identification of the infecting organism - thereby reducing the factors to implant specific infectious organis"? This testing can be done by any lab that performs tests for HIV. Same equipment. (Tough question I am sure but hey, that's what this forum is for - someone may have heard of this test as there are hundreds of us here for just that kind of exposure)

I hope to hear from someone who has any leads or direction for my condition. So sorry I have not been brief but I just wanted to get it all out there so there would be fewer questions or misdirections. Thank you for reading my description of my problem.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
18,209
Age
64
Location
Delaware
Gender
Female
Country
United States United States
Hi and Welcome to Bonesmart.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns. She has many years of experience with joint replacement, so she’s the best one to ask.

I know it’s been 2 years, but all new members get a copy of our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Atlas_aus

member
Joined
Mar 31, 2019
Messages
236
Age
57
Gender
Male
Country
Australia Australia
Hey mate,

Fellow photographer here.

There is nothing worse than an intermittent fault... Be it a car, computer or in your case a knee.

I have yet to have my surgery but wish you success in finding out the cause.
 
OP
OP
U

umanemo

new member
Joined
May 24, 2018
Messages
6
Age
62
Location
RV in Europe
Gender
Male
Country
United States United States
Last edited by a moderator:

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,937
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
I do wish to have no false positives in the testing for this infection.
That would be a big ask. In my experience, some 70% of tests for post-op peri-prosthetic infections come back negative.
 
OP
OP
U

umanemo

new member
Joined
May 24, 2018
Messages
6
Age
62
Location
RV in Europe
Gender
Male
Country
United States United States
Thanks, Josephine. I'm sure you're right! I'm sure of it too.

If I could get a reply from anyone who's been there - done this, that"s why I asked.
Has anyone had testing of the fluid following the protocol that involves "messenger RiboNucleic Acid (mRNA) using reverse transcription-quantitive polymerase chain reaction (RT-qPCR) that allows for specific species identification of the infecting organism - thereby reducing the factors to implant specific infectious organis"?
 
OP
OP
U

umanemo

new member
Joined
May 24, 2018
Messages
6
Age
62
Location
RV in Europe
Gender
Male
Country
United States United States
And the Pain Continues...

I wrote the included description of my saga back in April of 2019. Here's an update.

Yesterday I stepped out of my RV and the signs of another session with painful swelling of my right knee. A twinge of tightness and the sensation of the synovial cavity filling with fluid. It comes on very quickly after those signs become noticeable so over the 'Years,' I have found a protocol that works, to quickly get up my tall steps and back into the camper, grab the bag of frozen peas and get on the couch on my side where I can lay my right knee on the cushion to the right side of my body and wait for the ice to do its thing, an hour or two later that might be enough but the next 24 hours or so there is residual painfulness, about 2/10. Then there are those sessions, 1 in 3, where I know it's going to be bad, and in those cases, I pre-empt the inevitable and squirt 3 to 5ml of Oramorph into my mouth and swallow the magic elixir, then "R.I.C.E." After more than 50+ swelling and pain sessions, I do more than qualify to know the intensity level to expect so, I adjust the dosing as necessary. It's a sad fact but true. But when I am caught out and away from all prone position possibilities, it becomes an excruciating endurance marathon but I do always carry with me a few 4mg Hydromorphone for 'just in case.' This is why mobility is once again questionable just as it was before the Bi-TKA, both psychologically and physically, and I have again become a prisoner held within a very limited range of distance from my camper. It's frustrating and overwhelmingly depressing, to say the least, to not be able to mentally free myself to trust that I could to just go out and walk anywhere without an abbreviated plan. Today's session? became the 1 in 3. (read: w/morphine.)

Why have I endured all these sessions without treatment? I am not a masochist, but the most obvious excuse is that no medical professional from Morocco(1), Spain(2), the UK(1), or the USA(3), has been able to definitively diagnose this issue with certainty and I am uncomfortable with their uncertainty, therefore cannot commit to their blanket decision that "we'll just do a total revision of the knee." Four Hospitals, 3 Clinics, and two private practices have not come to any concurring conclusion for the cause. Oh, they all do the bend and straighten, pull and push, twist and tug exam and X-Rays to no avail. There have also been CT-Scans, High Contrast metal extraction MRI, Ceretec WBC Scan, and lastly the very expensive - Triple Phase Bone Scan scintigraphy with technetium-99m. I have no detachment of components nor do I have any significant infection, but "some indication of 'pooling' in the area of the femoral component," as the nuclear imaging analyst points out in her report. three times there have been attempts to aspartate the fluid for analysis (for infection) but there was no fluid able to be drawn. Until the last exam by the latest orthopedic surgeon where he insisted the others "didn't know where to draw fluid" and eureka his well came in on the first jab! But it was blood, 50ml immediately filled the syringe and I hadn't had nor wasn't having a swelling session. Diagnosis: "No infection, no loosening, Renovation." This is where I am today as I write this.

Has anyone suffered all these indications? If so what was the diagnosis? What was the treatment and was it durable? Has anyone suffered these or similar symptoms and found relief?

In 2019 I came across a post that mentioned, "Recurrent hemarthrosis following TKR", I also consulted by E-Mail with my orthopedic surgeon who did the implants in 2017 and his first assumption was "Impingement". Just throwing that out there because it falls squarely into the table of contents here. So why are all the surgeons so quick to rip the implants out and replace them when for all practical appearances they are sound? And what about Arterial/Venial intrusion, can't that be minimally invasively addressed with arthroscopy and devitalization of the vessel? Just thinking out loud here for filler.

Sorry for the lengthy diatribe but I am depressed, and about at the end of my rope here. Can anyone help?


Thank you.

See post #1 from April 26, 2019:
 

Pumpkln

MODERATOR
Moderator
Joined
Oct 27, 2011
Messages
22,792
Location
United States, West
Gender
Female
Country
United States United States
@umanemo
Sorry to hear of your continued swelling and pain with your knee.

You have had a lot of testing and imaging, have you had a metal allergy test?

You'll notice that I have merged your newest thread with your original recovery thread, so we have your full story in one place. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
 
Last edited:

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
39,785
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Yesterday I stepped out of my RV and the signs of another session with painful swelling of my right knee. A twinge of tightness and the sensation of the synovial cavity filling with fluid.
Until the last exam by the latest orthopedic surgeon where he insisted the others "didn't know where to draw fluid" and eureka his well came in on the first jab! But it was blood, 50ml immediately filled the syringe
Hi @umanemo I'm sorry you still have this problem.
After reading your latest post and seeing the two comments I've copied, it seems to me that it's highly likely that your problem is caused by intermittent bleeding into you knee. Something must be occasionally damaging a blood vessel and causing it to bleed. I also read an article about recurrent hemarthrosis and it sounds like the most probable cause.

According to this article
https://www.jsesarthroplasty.org/article/S1045-4527(19)30008-2/fulltext
the most likely causes are:
  • Coagulopathy - bleeding disorders
  • Impingement of hypertrophied synovium, and
  • Pseudoaneurysms.
Impingement is the most likely cause.

It would be a good idea to make sure that you don't have any bleeding disorders, and then to ask for an angiogram of the blood vessels leading to your knee, to exclude a small aneurysm in one of those blood vessels. If those tests all prove normal, that would leave impingement as the cause.

At that stage, I think the only treatment possible would be to let a surgeon look inside your knee, to see if he/she can remove the cause of the impingement.
 
OP
OP
U

umanemo

new member
Joined
May 24, 2018
Messages
6
Age
62
Location
RV in Europe
Gender
Male
Country
United States United States
After reading your latest post and seeing the two comments I've copied, it seems to me that it's highly likely that your problem is caused by intermittent bleeding into you knee. Something must be occasionally damaging a blood vessel and causing it to bleed. I also read an article about recurrent hemarthrosis and it sounds like the most probable cause.
It does give pause for thought... I just wish that there was somebody on the forum who could weigh-in with just this condition. It does seem that the medical system is too quick to jump on the revision bandwagon. It does seem likely, as in the article you forwarded, that the study of the patient's condition could include the angiogram when there have been signs of bleed or the symptoms I have described.

I am waiting for follow up from anyone who display's my symptoms. Many thanks for your input!!!
 

New

Active Antibacterial

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
51,921
Messages
1,389,499
BoneSmarties
32,441
Latest member
Lisa’s Petals
Recent bookmarks
0

Top Bottom