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Revision TKR 4 TKR Failures, Please Review

Miles

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59 yr male, 6'2', 220 Lbs, non smoker, non drinker, no outstanding illness or health issues. Previously highly active.

June 11, 2016: Left Medial PKR. Zimmer components. Never recovered and medical authorities told me to give it more time. I was convinced tibial plate was loose as I had severe "start-up" pain and never ending inflammation and swelling. After frequent X rays been read as "no issues" I insisted something was wrong and had a bone scan in Jan. 2018. The scan indicated the tibial plate to be loose.

March 26, 2018: Left Medial PKR revision. Tibial plate removed and replaced. Zimmer components. Never recovered. This time I recognized the symptom's of loose tibial plate immediately as it was the same as previous. Dr.'s didn't doubt me this time and I was referred to a new surgeon at my request.

Nov 30, 2018: Left TKR. All components removed, bones recut and TKR installed. Zimmer components. 10 months later I was finally feeling like I had come through this and was starting to have some normal relatively pain free days. After 2 months of reasonably good days I began to have pain again. The pain was initially different this time: outer front upper side of knee extremely tender and great difficulty on stairs, (particularly down) and trouble walking for more than 15 minutes or on any slopes. Suprapatellar pouch seems thick and swollen, tender and any knee flexion aggravates it. Extremely tender spot on outside of knee just beside center line of knee cap. Intense inflammation at night or any time I rest the knee. Also having subtle pains identical to previous loose tibial implant.

Jan 2020: X ray indicates 2 mm line of lucency at tibial implant. L knee aspiration indicated cloudy fluid but normal WBC. Blood test revealed CRP spike of 35.1. Surgeon suspected infection resulting in loose component. Bone scan for WBC at joint showed little activity. Repeat blood test showed CRP return to normal. Surgeon advised arthroscopic surgery to get deep joint tissue samples for infection test and to remove scar tissue as possible and visually check knee.

Feb. 10, 2020: L arthroscopic surgery. 3 Tissue samples taken - no confirmation of infection. Heavy staining in suprapatellar pouch. Some scar tissue removed, no other issues found.

March 25, 2020: Constant pain outer side of left knee and suprapatellar pouch area tender. Always inflamed at rest and at night. Pain on stairs, sitting up or down, getting on or off toilet, anything involving bending knee while bearing weight. Difficult to sleep. Also frequent pain reminiscent of loose tibial implant; pain when weight bearing weight in medial tibial area.

I have been told to wait another six months for another x ray to view components and lines of lucency.

I'm at the end of my rope and feel like this has been mismanaged from the start. Could some one please review and comment? I will happily provide any more details as needed. I am a healthy active young man and this knee has me completely hobbled.

Thank you.
 
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Miles

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I have a few questions please.

Would an MRI be a useful tool to diagnose the tissue and scarring issues in this knee?

What is the most effective way to diagnose a loose implant?

I've had so many x rays and they are never read correctly by the radiologists. My tibial plate was loose twice and over 6 x rays were never read as recognizing it. One radiologist reported seeing a broken drill bit in my knee which was not true. The surgeons seem to disregard any x ray reports and make their own decisions. The most recent x ray finally says the tibial implant is likely loose however the surgeon says its likely not and he has seen this before. Pain tells me it is loose.

Has anyone ever heard a story of events similar to mine?

I've had 4 surgeries on my left knee in less than 4 years and desperately seeking some advice.
 

Jockette

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Hi, Miles, Welcome to Bonesmart, we’re glad you’re here.

I’m going to ask @Jamie to come review your posts and advise you.

I also have a partial, mine is a Patellofemoral, and it has never felt right, either. I have some symptoms of a loose implant but all my X-rays are “fine” and my original surgeon, as well as 2 different second opinion surgeons, in 2 different states, don’t see anything to fix. I am not in constant pain so I am managing with this annoying and very disappointing partial. So, I understand a little bit of your frustration even though I have not suffered as much as you have.

I am told that a bone scan can indicate a loose implant, as it doesn’t always show up on an X-ray, but none of the surgeons I’ve seen feel there is a need for me to have one.

Have all the surgeons you’ve seen been in the same office/group? Did you have your surgeries in a small town or a big city?
 
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Miles

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Thanks for welcoming me and your reply Jockette. Both surgeons were from the same group in a small city,(pop. 150,000).
I truly am at my wits end. 4 years of surgical recovery and I'm no better off than when I started. I'm feeling all the emotional aspects one would expect which only add to the grief.
 

Jockette

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I suspect that Jamie will recommend you go to a bigger area for another opinion. We also recommend second options to be by someone who has no association with your previous surgeons, to really get a new set of eyes, and thoughts, on your case. I don’t know anything about the health care system in Canada, so I don’t know if you can do this.

I live I n Delaware, a tiny state, and had my surgery here. For my second opinions I went to the Philadelphia and Baltimore areas, as those cities are much bigger and they see more cases. Not that that ended up being much help to me, but I would do it again if my knee gets bad enough to need attention.
 

Jamie

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@Miles ... I'm so very sorry to hear you've had these unresolved problems for so long. As Jockette mentioned, it's going to be important for you to get to an experienced knee revision specialist. It's a little bit more difficult for me to make recommendations since you're in Canada, but I do have a couple of surgeons if you are willing to travel.

Toronto, Canada

Revision surgeons for hips and knees:

Dr. Jeffrey Gollish
Sunnybrook Health Sciences Centre - Holland Orthopaedic & Arthritic Centre
43 Wellesley St. E., Suite 315. Toronto, ON M4Y 1H1
(416) 967-8730

Dr. Markku Nousiainen
Sunnybrook Health Sciences Centre - Holland Orthopaedic & Arthritic Centre
43 Wellesley St. E., Suite 315. Toronto, ON M4Y 1H1
(416) 967-8730


Ontario, Canada
Dr. Richard W. McCalden

London Health Sciences Centre
Western University
London, Ontario, Canada
Speaker at 2018 ICJR workshop on problem hips and knees
Recommended by Randi who had a knee revision.
Phone: 519-661-2111 x34477

It is my understanding that under the Canadian healthcare system you are able to see surgeons out of your immediate area, but I don't know what administrative requirements there might be to do so. If you decide to pursue one or more of these doctors, I would appreciate you sharing the process with us so we are better able to share that information with other Canadians in the future.

Of course, right now with the coronavirus outbreak around the world, I'm going to assume that Canada is under many of the same restrictions as we are in the USA for elective surgeries. You will likely need to wait a while to actually get to see one or more of these surgeons. But it wouldn't hurt to get started with the process so you'd be ready when things open back up.

Please continue to let us know how you're doing. We're here to help in whatever way we can.
 

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