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41 year old facing revision

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Pa guy

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am 41 yr old, had a TKR in feb of 08, now facing a revision on jan of 09.
Was told knee was 5 degrees out of flexation, and the insert is 4 to 6 CM to small, along with arthritis forming on the patella and needs resurfacing.
Have been enduring a lot of pain, instability, with a lot of loud CLUNKING border line of knee dislocating.
Had several tests done from blood work to bone scans, arteriogram.... all were neg except the bone scan that showed mild to moderate edema.
Has any one encountered this? Any suggestions on the cause, and has anyone had improvement after revision?
Should I seek legal advice?
 
Pa, so sorry you have having such a difficult time. There are others much more qualified than I am to speak to your problem, just wanted to say will keep you in my prayers and good luck. Glad you found this forum, you will find it is a fount of good advice and that Jo, our moderator, is wonderful as well as being wonderfully informed plus has problems with her own knees so she is sensitive to the issues we face. Hope you find relief soon, know you must be terribly frustrated. I would be. Good luck, again, Rowdy
 
Thank you very much rowdy.

Frustrating is putting it mildly, 6 surgeries in the past 6 years and facing my
7th in Jan.
Nice to find a place with supportive and understanding people, hope i can contribute equally with my experiences here in the forum.
Thank again for the prayer.
 
Oh my - that IS rotten bad luck, Pa. I feel for you.

First point ~ I hope you've gone to a different surgeon for the revision! That would be essential in my book!

Secondly, I would have expected it to be noticed
at the time of your op that your femoro-patellar joint was in need of attention. This was either because it was okay and has suffered an extremely rapid progress of arthritis in the succeeding 11 months (which I doubt) or simply a lack of vigilance. Also, tibial inserts mostly come in 3mm stages so it seems to have been misjudged to the tune of TWO sizes!

Were I in your shoes I would be thinking about getting some advice.
 
Thank you for the reply Josephine, yes this is a different surgeon,
I had 3 opinions before i made my decision to do the revision.
I am assuming when you say "tibial inserts" your referring to the plastic insert?
Each of the 3 opinions gave me mixed signals on the patella, any where from having a lateral release prior to TKR caused the patella to track to far off creating wear with the new knee, and having DJD the arthritis may have been over looked, and the patella should been resurfaced to prevent what i am currently enduring along with other possibilities...
Reason i chose the OS i am going with is, him being open and straight forward with me. He basically told me whats wrong and he will need to wait till he goes in to see to what extent. Also stated that this is a newer knee (STRIKER) that many surgeons do not have a great deal of experience with.
With my age being so young that the original OS may have chose to go 1 size smaller to prevent excess wear and extend the life of the Knee.
Several people i spoke with also advised me to speak with an attorney, from which i will do once the revision is over and see what all needed to be done and re-done.
I have a lot of mixed emotions on what to do next including the revision, with my past experiences it becomes difficult to think positive.
Thank you very much for the reply, for your your response had added a question i would like to bring up with my OS.
Your advice, experience, and knowledge is greatly welcomed and appreciated
 
Yes I meant the plastic insert.

The three comments you had aren't really differing
opinions, each stands independently as a valid criticism of the procedure. But the suggestion that the surgeon chose a smaller insert to avoid wear would not ever be the case. The size should be what it has to be for proper function. Just like your shoe size!
 
Being I will not know exactly what the issue was with my knee until after the revision, you bring up a very valid point.
The way you use shoe size to put things in laymen terms, brings a question to mind.
Being the replacement has such a vital function, why don't the inserts and other mechanical parts come in a much wider variety of sizes, as each persons anatomy so widely varies?
 
The inserts are commonly in 3mm steps - 15, 12, 9 and 6mm. The surgeons and firms that did the early work on them changed from time to time (I'm talking about 20 years back!) and in the end that was considered to be more than adequate. The femoral and tibial components come in small medium and large which also fit the greater majority of knee joints very well.
 
From my understanding the revision will be virtually like a TKR as far as hospital stay, recovery time, and so forth?
That there is also a higher risk factor of complications, the possibility of the knee worsening if any improvement at all, infection, scar tissue, fracture and lower lifespan of the TKR, along with others.
 
Pa guy: So glad you are finding the forum a help. I told you Jo is a fount of good, sound info, as well as advice. As for the others here, all I can say is they have all been wonderfully supportive. The closest comparison I can make is that we are a family of sorts, only not as disfunctional as most. LOL.

I know you must be very frustrated but you sound as though you have a good handle on the situation now and can proceed accordingly. I am just glad you have found this forum and will look forward to your future posts and will keep you in my prayers.

Good luck. Rowdy
 
Rowdy thank you very much!
This forum is indeed a godsend from many aspects.
The medical experience along with the personal experiences, advice and struggles bring a lot into perspective.
Helps bring hope, strength, knowledge, and the realization that one is not alone in there battles or there benefits.
I was one who fell into depression with the lack of support, knowledge, low expectations, and fear of the unknown.
Researching and personal issues tend to bring a lot of questions that even medical professionals can't or will not answer.
It is forums like this that offer support, understanding from all perspectives.
Remember it is the dysfunctional that keeps the functional going and vise versa LOL.
Even though we all have a good handle on our situations, it is all to easy to lose grip.
Hope i am able to contribute as many of the people here, such as yourself and Jo have already done for me and I'm sure countless others.
 
From my understanding the revision will be virtually like a TKR as far as hospital stay, recovery time, and so forth?
That there is also a higher risk factor of complications, the possibility of the knee worsening if any improvement at all, infection, scar tissue, fracture and lower lifespan of the TKR, along with others.

Yes revisions should be pretty much the same as primaries once the surgery is done. Neither should there be any greater risk of any of the problems you cite than with a primary. The only 'might' is the degree of ROM afterwards but that very much depends upon the condition of your knee beforehand.
 
Thank you Jo,
that put my mind a little more at ease.
As the days near the anxiety grows even more then the first time, being i fully know what to expect.
Not looking forward to the procedure at all, but trying to keep high hopes that this will be the fix.
Thank you all for the prayers and wishes!
 
The way you are feeling right now is why I opted for bilateral instead of doing one and going back, I knew I would never do it or drive myself crazy worrying about it and it is something to worry about. Just try to stay focused and remember we are all praying for you as well as pulling for you. God will look after you. Rowdy
 
My honest opinion is you made the right move in getting all over and done with at one time. The Anxiety is the worst part to deal with by far.
With me going today for my EKG and Surgical clearance only adds to it, darn near ready for the white coats and funny farm lol.
Thank god i got the holidays and kids to help keep my mind off it, at least for the next few days lol.
Thank you again for the words of encouragement and the prayers!
 
Had my pre-surgical clearance appointment with my OS on Sat, had several questions I had brought up, most important being the risks if any involved with a Revision, got a bit of worrisome news.
Was told everything can be worse after a revision. There is a higher infection rate, a higher limp rate, a higher limb length discrepancy rate, higher rate of lost ROM, and so forth, including the general risks involved in any surgical procedure.
Though he had stated that it does not mean i will not get an extremely satisfying revision, that the risk of worsening results were higher.
He reassured me i should have little to be worried about, that these were rare, but the risks are there and are higher with a revision.
Being i had multiple surgeries (this being my 6th or 7th one) scare tissue is his biggest concern.
Using advise from the "How to choose a surgeon and a prosthesis" section of the forum, i also included the questions from there, with very pleasing results.
My OS provided me with the information showing he was among the top 5 in the State for low infection rate, long and short term incidences, including being the top surgeon in last 2 years in total joint revisions done, also top 20 in the Nation.

This site is truly a godsend, even my OS said he was impressed with the questions,research i had done.
Told him a lot came from BoneSmart.org, said he wished more people would join sites like this along with asking detailed questions such as i had.
Downfall to it was most patients are much older and set in there ways, they don't want any part of dealing with a computer, not to mention anyone telling them what they should or shouldn't do out side of a physician.

With 7 days left the anxiety is by far the WORST to deal with, more so then when i had the original knee done, I'm sure it has a lot to do with being aware of what's ahead, but helps knowing i got people here for support and encouragement from which i can not thank you all enough for!
 
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