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[TKR] 3 Years Post Operative Severe Complications

Discussion in 'Knee Replacement Recovery Area' started by kaceypop, Mar 8, 2019.

  1. kaceypop

    kaceypop new member
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    Hello all,

    Three years post op after left a TKR. I have been diagnosed with knee instability that causes continual knee effusions and limited flexion. I have had the knee drained on three separate occasions now and cortisone injections, in an attempt to control the inflammation. I have had extensive physiotherapy throughout this process. It appears that revision surgery is the only option (which I am trying to avoid after having such a harrowing ordeal).

    My diagnosis is extension flexion mismatch or poor gap balancing. Has anyone else heard of this and ifso, how is this diagnosis confirmed?

    I am trying to persevere with this condition and still perform daily physiotherapy to maintain ROM and to help strengthen the muscles supporting the knee however I was hoping to become more active by using a knee brace. Could anyone recommend a good supporting knee brace?

    Karen
     
  2. Didot

    Didot junior member

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    Three years sounds like a lifetime. I have no knowledge of what might be happening, but offer lots of healing vibes your way. May a solution happen for you soon.


    Sent from my iPad using Tapatalk
     
  3. Lindylee

    Lindylee graduate

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    So sorry to hear you're having problems. My main reason for going ahead with TKR now was instability in the joint and I dread the thought it might come back. I don't have any helpful advice I'm afraid, but, hopefully, one of the moderators will be along soon to offer something constructive.

    Can you do a search for 'brace' on the forum and see if there are any other posts? Take care and I wish you well.
     
    Last edited: Mar 8, 2019
  4. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi and Welcome to Bonesmart!

    I’m sorry you’ve had such a tough time. I am going to tag @Josephine
    our forum administrator and nurse director to address your concerns.

    I’m 2 years post op with a Patellofemoral partial and worse than I was before, so I understand.

    Even though it’s been 3 years since your surgery I will leave you our Recovery Guidelines that we give to every new member.

    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.
     
  5. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Have you seen a 2nd opinion doctor? It sounds like you need a fresh pair of eyes looking at your knee.
     
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  6. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @kaceypop ,
    Sorry to hear you are having instability issues with your knee.
    I had a flexion instability, my knee was always painful and swollen.
    I had a revision to a hinged knee, my knee is now stable and I have my life back.
    Something to consider as you move forward.
    Josephine is in the UK and can help you find a surgeon who specializes in revisions if you decide to go in that direction.
     
  7. Celle

    Celle FORUM ADVISOR Forum Advisor

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    @kaceypop

    Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:
     
  8. kaceypop

    kaceypop new member
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    Thank you all for your lovely comments, and support, and it’s nice to hear that revision may be a way forward. I just can’t seem to find the strength to face it but I think this is due to the fact that my other knee is starting to complain (pattelofemoral arthritis).

    I’m sorry, I’m new to the forum and am unsure whether I can reply to you all individually? My husband will be so thrilled that I can have a moan to somebody else!

    The date of the surgery was 25 February 2016. With regards to the brace, I need to do a bit of research but it’s quite confusing.
     
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  9. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Just reply, you do not need to address everyone individually. If someone has posted in your thread they will receive an alert when you post.
     
  10. kaceypop

    kaceypop new member
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    I have seen approximately 8 surgeons to date and had too many appointments to mention. After my second follow up appointment with my original surgeon, and despite my post operative complications at 3 months, (still using crutches and quads wasting) the surgeon discharged me from his care. In desperation I sought a second opinion and ended up in the Acute Knee Clinic at CUH, where I spent three months and saw whichever OS was available at that appointment. This gave rise to multiple opinions which became very confusing, however I was put in touch with the extended scope physiotherapist who was excellent. After 2 months of intensive physiotherapy, I managed to walk without crutches and little evidence of a limp.

    The physiotherapy was then cut short when one of the OS in the Acute Clinic diagnosed fixed posterior subluxation with possible extension flexion mismatch. I was offered a revision and my care was transferred to a different OS who was more experienced at this surgery. My trust of the surgeons at this point had completely eroded and so I payed privately once again and sought the opinion of a very renowned UK specialist. He suggested that I not rush into anything and suggested that there was always some sort of laxity on the anterior drawer test with this sort procedure.

    Since then I have remained under the same OS who, for the last year, has tried to manage this complication with intensive physiotherapy, drains and cortisone injections. However, the inflammation caused by the instability recurs and at my last appointment in December I met with 3 OS’s (one a professor). The opinion given by the professor was “if I were you then I would have the revision”.

    I feel unable to make any decisions at the moment with my right knee deteriorating and, as this is more painful, will be having this investigated on the 28 March. I hope he doesn’t suggest replacement surgery .
     
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  11. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Oh my, you have quite a history with that knee and numerous OSs. I have no idea what I'd do if I were in your shoes. I am going to tag @Josephine, our forum director and nurse to address your questions.
     
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  12. Momma-me

    Momma-me member

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    Oh my goodness... I truly hope you get the answers and on to healing!!
     
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  13. kaceypop

    kaceypop new member
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    Thank you, any help and advice will be gratefully received.

    This has all been very difficult and continues to be! I feel extremely disappointed in the surgeon who initially operated on me. It is bad enough that the operation didn’t go to plan but for him not to be supportive in establishing a diagnosis, or securing a rehabilitation regimen in the interim, has been very upsetting.
     
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  14. JDinCT

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    @kaceypop Sorry to hear you are having such issues. I will preface my next statement by saying I am NOT at all a medical professional, but have been more than few situations that required acute critical thinking and decision making....

    If I was in you situation, I would undoubtedly go with a revision surgery for your bad operative outcome. Seems this will not get better with time... and the experience so far is quite opposite... it has only gotten worse with time. And now you have further complication of the other knee giving issues. It is indeed a difficult situation, but I would no longer trust the original OS nor any of his ongoing attempts at correcting the situation.

    If you lived in the U.S.... I would have a very clear recommendation for a surgeon and hospital.

    I had a similar situation with my second arthroscopic surgery on my left knee. I had selected a well known surgeon that practiced at a very well known hospital. However, three weeks into my PT, my knee simply would no longer improve and actually got worse than pre-surgery. I visited with the original OS twice and he only offered temporary solutions (cortisone shots) without a permanent well thought out solution. I ended up leaving his practice for a Sports Medicine physician that was able to quickly pinpoint my issue and fixed the problem without additional surgery.

    The lesson learned for me was to move on when you are not getting clear and concise answers to your medical questions and problems.

    Best of luck!
     
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  15. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    kaceypop, which hospital are you attending? Is it the Warwick Hospital or the Cov & Warwick? What's the name of the surgeons you have thus far seen? I should tell you I know a few chaps in that district so perhaps I can direct you to a good one.
     
  16. kaceypop

    kaceypop new member
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    Thank you for your reply and advice JDinCT. I am so concerned about revision surgery as I’ve been told that I need a constrained device that will only last 10 years!

    Thank you for getting in touch Josephine.

    I am currently under the care of Pedro Foguet at University Hospital Coventry and Warwickshire.

    To date, I have seen Mr S Krikler, Mr Tim Spalding, Mr M Taylor, Mr Andy Metcalfe, Mr Miguel Fernandez, Mr T.J. Wilton, Mr Craig and Professor King. (If I didn’t know much about the anatomy of the knee prior to the surgery, I do now!)
     
  17. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    WHO told you that? Because it's NOT true!

    Andy Metcalf is a friend of mine!
    And I worked at the Cov & Warwick many years ago, about the time the cathedral was being built! geezer.gif

    Also Pedro Foguet has a fairly prodigious surgery record: 143 TKR 34 revisions last year
     
  18. kaceypop

    kaceypop new member
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    Oh my word Josephine, this is so interesting. Coventry and Warwick Hospital no longer exists now!

    Andy and Pedro are both lovely and really genuine. I’ve met with Andy on two occasions and Pedro is trying very hard to help me persevere with physiotherapy (which has not long ended). He has administered drains and cortisone injections in an attempt to help me avoid revision surgery.

    I was told that a constrained devise would only last 10 years because of the post that sits in the middle knee, apparently it takes a lot of strain? This has really put me off having the revision as my recovery was so protracted last time. (The last drain and cortisone injection in October and intensive physiotherapy last year).

    Until recently, no one has really been able to advise me about what to do but in December I, had an appointment and, met with Pedro, Mr Craig and Professor King. Professor King said that if he was in my situation, he would have the revision.

    How long does a constrained device last?

    I have read that some people have a thicker liner inserted and this sometimes works. This is less invasive but no one has suggested this to me. Do you have an opinion on this @Josephine ?

    Thank you Karen
     
  19. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Yes, but WHO told you that? I am far from convinced that this is the case. So far as I know, they tend to last about the same time as ordinary knees which is between 15 and 30 years. They are pretty sturdy, substantial devices as you can see here

    hinged 1-horz.jpg
     
  20. maryo52

    maryo52 FORUM ADVISOR Forum Advisor

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    I was you for 8 years. I had an effusion the entire 8 years of my original TKR. I wore a brace because of the instability. I took the philosophy that eventually a problem would develop that would necessitate a revision then, to my horror AND relief, that did come to pass. The implants came loose and I've now had a revision with a nickel free implant (Zimmer biomes titanium).

    Trust me, I dreaded the revision horribly.

    Comparing recoveries (2010/11 vs. now), I can see so clearly that my first surgeon was likely an average surgeon not having his best day when he did my knee. My recent surgeon was top-drawer and he gave me an excellent outcome. I found him through research and actually had seen him for a second opinion in 2012, so when I learned the implants came loose I went home and made an appt with him. Now it seems like a bad dream that I lived with an unhappy, lax knee for 8 years. I feel like a new person. Friends who called me in the hospital the day after surgeon were amazed at how good I sounded. Every day since surgery has been a good day.

    I see a couple of things that concern me in your story. There is little use in draining a knee with an effusion, it just fills right back up in 2-3 days, which you know. Secondly, I was told that a cortisone injection was out of the question, number one because it can introduce bacteria, and also because the cortisone makes the area more vulnerable to infection. If there's anything worse than a poor TKR, it's an infected TKR.

    I would recommend my brace, with was an Ossur Oasys which was great because I could adjust the degree of valgus, and it fit snugly and didn't slide down.

    Someone suggested a second opinion, and you had a list of doctors' names! Gosh, same here. I have seen 8 orthopedists over 20 years for my knee. The thing I finally got right was to land myself with a surgeon who had tons of experience and skill.
     
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