TKR Accuracy of 3-part bone scan and CT Spect 2.5 years post TKA?

[HopefulRunner]

I am at my wits end. There has to be a logical reason as to why I'm not improving.

Hello, I am six months. Still pain and life not back to normsl. I just started rehab again, my quad muscle super tight so hence the pain. Please the cortisone shots eat all and any bone and just makes thing worse. I use ache away oil with cbd made by a herbalist here in Maine. That does help. It is a long road for sure.

Hang in there! Six months seems like a long time, but it's not. This is a ridiculously slow recovery for some of us, unfortunately. If you have Airrosti providers in your area, I highly recommend them. They help with tight muscles...trigger point release. Was magical in helping my tight hamstrings and hip flexors. I was walking unevenly (thought my left leg was suddenly too short after the surgery but it was just tight muscles causing the problem.).

 

[kneeper]

And many health plans offer therapeutic massage as part of their complementary medicine programs.
I wonder if a physical medicine doctor (physiatrist) might be able to determine what's going on, since the implant itself is apparently fine. My understanding, based on my dealings with one for a non-tkr issue, is that they really look at the whole body and figure out what is causing the problem and then figure out a treatment plan.

 

[Samsrf]

@HopefulRunner Did you do allergy testing prior to surgery? I am youngish TKR receiver (43 @surgery) and talked to a lot of older people who had gone through the surgery. Most complications and revisions patients I encountered (10 TKR people) were due to allergy to something in the implant. I am in Southern California so we have lots of choices of good doctors and my doctor (who is amazing) told me not to worry about allergies but I wanted the test for piece of mind. Had to pay out of pocket for it ($600+) but a small price to pay for reassurance. I did have a metal allergy but my chosen implant did not have that metal in it. Allergy may be worth looking into if the actual implant seems ok.

 

[Paddy W]

Please Help!
I'm a 50-yr-old female, a former runner, in good shape. History of 2 ACL reconstructions on the left knee from soccer injuries when I was younger. But have hiked, run, and been athletic for years since then with very few issues. Was out running in Feb 2021 and suddenly stopped in my tracks due to sharp knee pain. MRI showed bone on bone but not bad enough yet for TKR. Rec'd cortisone injection. Within 48-hrs, I stepped off my front porch and my knee popped. Severe pain and couldn't walk. Turns out to be a meniscus root tear (rare) which it devastating to runners and really anyone who is active. Long story short, my knee went downhill fast.

Ended up having it scoped in April and then total TKR in July 2021 here in Ohio. Chose a reputable surgeon for the TKR who does a lot of these procedures. However, I'm now 1-yr post op and the knee is not better. Consistent swelling and pain. This subsides (mostly) if I get a cortisone shot or lots of anti-inflammatory meds. But once I stop the drugs, the pain and swelling immediately is back.

The range of motion is good, I've worked hard to rehab but limited at times due to pain/swelling. Ride the Peloton bike and walk. But have pain EVERY DAY. Some days are worse than others where I can hardly walk or bend my knee and feel like I need a pain pill. Just being on it for an hour or two is problematic. Have tried taking it easy for a few weeks, etc., but NOTHING helps long term.

Got a second opinion in March. Doc says the knee feels tight and that "maybe" the spacer is a bit too thick. But otherwise, the implant is placed properly, etc. MRI and X-rays are all good. Doc who performed my surgery ran tests for infection, all negative. He disagrees the spacer is too thick and says he's never had to replace one in his 30 years, blah blah blah. LOL. He's now consulting with another doc in his practice to review my case.

I am at my wits end. There has to be a logical reason as to why I'm not improving. Seriously, zero improvement in the last 6 months. I don't know where to turn at this point. Have had pain fairly consistently on the medial side near the tibia where the screw was for my ACL surgery. Also some random lower leg pain near lateral side of shin on occasion...kind of throbbing (not while working out). Living the rest of my life with my knee like this is NOT an option. Willing to travel anywhere in the U.S. to see another surgeon but don't know who is good with revisions etc. (can't fathom having another surgery, but something clearly isn't right). Open to suggestions, surgeon recommendations, etc. PLEASE HELP! Thank you!!

Similar story to myself. But as well as the pain and swelling the joint clunks when walking.

 

[ihavetwins]

@HopefulRunner

Any update?

 

[HopefulRunner]

Hoping someone can help. I’m 2.5 years post-TKR. Have had pretty much constant pain and swelling ever since I had the procedure. X-rays keep showing up as normal. My surgeon and 2 other docs over the years have told me “nothing is wrong” or to just get a nerve block. Unacceptable because I know my body and without a doubt knew something was off from the very beginning. Finally had a doc order a 3-part bone scan and CT SPEC. Had the test yesterday and saw results in MyChart this morning. Summary indicative of loosening or infection. Highly doubt it’s an infection because I’ve had numerous tests in past for that, which were negative. I haven’t talked yet to the surgeon who ordered the tests but plan to this week. In the meantime, can anyone tell me how accurate these tests are? Either way is a losing situation. On one hand, it’s validating because I’ve known something has been wrong for a while. And it’s gotten worse over the past few months. But the thought of revision surgery is depressing. I’m a 51-yr-old former athlete and this is whole thing has been a complete nightmare.

 

[sistersinhim]

First off, find a new doctor that deals with problem knees. They are called revision specialists. This new doctor needs to have no affiliation with any of your current doctors so he can look at your knee with new eyes. They know what to look for in knees that regular OSs don't. You can take all your tests with you since they are yours.

Since your knee has never been right, I'd never go back to the doctor who did the replacement. He had his chance and to suggest a nerve block is unacceptable! You need it fixed, not covered up! You are way too young to be disabled! Please let us know how you are getting along and what you decide to do. We are here for you.

 

[HopefulRunner]

First off, find a new doctor that deals with problem knees. They are called revision specialists. This new doctor needs to have no affiliation with any of your current doctors so he can look at your knee with new eyes. They know what to look for in knees that regular OSs don't. You can take all your tests with you since they are yours.

Since your knee has never been right, I'd never go back to the doctor who did the replacement. He had his chance and to suggest a nerve block is unacceptable! You need it fixed, not covered up! You are way too young to be disabled! Please let us know how you are getting along and what you decide to do. We are here for you.

Thank you. The doctor who did my surgery is supposedly one of the best in the country and also does revisions. That’s what makes this even worse. Sigh. One of the docs who did my 2nd opinion said even he would have used my doctor if he needed surgery. If the bone scan results are accurate, I know I’ll need a revision specialist which are not easy to find. I’m willing to travel though, which I did for the first TKR. But right now I can’t bear the thought of having another surgery.

 

[sistersinhim]

But right now I can’t bear the thought of having another surgery.

Boy, do I understand this. But, if your knee isn't getting any better, it will continue to be bad or even get worse. You are too young to put up with that. This is a decision that only you can make. I pray that you do what's right for you! We are here when you need us 24/7!

 

[Jockette]

But right now I can’t bear the thought of having another surgery.

 

[benne68]

I'm so sorry to read that you are facing revision surgery, @HopefulRunner.

Before making a decision, you might want to get a tele-consult with one of the specialists at Hospital for Special Surgery. They are #1 for orthopedics in the U.S. and deal with a lot of difficult cases.

Wishing you the best of luck in finding a solution.

 

[Layla]

I am sorry you are dealing with pain and facing uncertainty. It's sad and unfortunate that you've felt something wasn't right all along.

I will second contacting Hospital for Special Surgery or tagging, Jamie, from Admin to see if she'll check her resources, if you're interested. I wish you comfort and hope you receive answers soon.
@HopefulRunner

 

[Jamie]

Bravo for the doctor who arranged this test for you. It is a nuclear medicine procedure that is done specifically to detect infection or loosening that is not showing up in x-rays. And, even though you had negative test results for an infection in the past, it is possible to have one that develops slowly and under the radar for some time. Please let us know what you hear from the doctor that ordered the test. Is he a revision surgeon you are considering?