Revised PKR to TKR Agilitymom's revision recovery<<

[agilitymom]

@Celle my MUA was January 23, 2019.

Saw the new surgeon for 2nd time two weeks ago. His whole story changed. Now he does not think anything is wrong. Wants me to go to PT. When I reminded him of his previous statements of micro movement and xray issues he did say that the xray shows where the implant is not attached to the bone in one place.

He wants me to wait to see him for 4 months. When I asked if it can get better he said it could and asked if it could get worse he said probably. I am confused and in pain. Not getting better at all. Seems like I am just going through the same exact mess as last time.

 

[Celle]

Wow, that was a confusing appointment for you!
If the implant isn't attached now, I don't think it's likely that it will attach. I agree with your surgeon that it will probably get worse.

However, I do understand that he doesn't want to rush into doing a revision and wants to see what happens in the next few months.

I don't agree with his recommendation for PT, though. If the implant is loose, rather than helping, PT may cause it to become further unattached.

If you go to PT, make sure it is very gentle, with no strain on your knee and definitely no weights or machines.

Do you have any copies of your X-Rays that you could post, for Josephine to look at?

 

[agilitymom]

@Celle I can’t get them to load on my pc. Will try again tomorrow.

 

[Celle]

OK. Thank you.

 

[Jockette]

I’m sorry there doesn’t seem to be a clear answer as to what’s going on with your knee.

I’m not happy with my Patellofemoral, but at least I always get the same answer. My xray is fine, end of story.

I don’t have visible swelling but it often feels swollen. I’m not in much actual pain, so I’m managing for now.

Going into this surgery I had no idea there could be so many poor outcomes. I knew so little.

 

[sistersinhim]

How disappointing your tkr didn't turn out the way you expected. Have you thought of going for a second opinion or is it too early for your insurance to cover that?

 

[Josephine]

he did say that the xray shows where the implant is not attached to the bone in one place.

In other words, it's loose!

When I asked if it can get better he said it could and asked if it could get worse he said probably.

If it's loose, there is no way it will 'get better'. No way at all. It needs a revision.

 

[agilitymom]

@Celle here is a copy of the xray. Also here is what second opinion surgeon said at first appointment.
"The significant radiographic findings of lucency between the femoral component and the cement mantle were noted.
There does appear to be some lucency around the cement bone interface on the anterior flange and chamfer cut of the femur however the xray is poor quality. There is some abnormality in the bone of the distal femur which was not there in postop xrays."

 

[Celle]

Thank you for the X-rays. I'm not sure if they are clear enough for @Josephine to be able to read them.

 

[Josephine]

Just about.

Re: patellar implant: This is clearly a patellar button

Re: loosening of the femoral device

"The significant radiographic findings of lucency between the femoral component and the cement mantle were noted" As indicated with yellow arrows

 

[agilitymom]

Thanks @Josephine . Been a while since I have been on since I am having spine issues again and have not seen my surgeon for my knee in several months. I do go this week to see my surgeon. Luckily the Navy has acknowledged that I need more of a specialist than they can provide and have given me permission to continue seeing the new civilian Dr.
Any suggestions as to what questions I should ask the new surgeon as to what he would do for a possible loosening?

 

[agilitymom]

Finally saw the new surgeon regarding pain and swelling in my revised knee. I am at 11 months post surgery and am still unable to stand for longer than 5 minutes before swelling and pain begin. My knee also is warm to touch and constantly swollen. It is not a huge amount but definitely way more than my good knee. Good knee is 11 1/2 inches and revision knee is 13 1/2 inches measured without having done much standing or walking. Goes up to 15 or more after walking and standing. Dr. gave me a cortisone shot yesterday to see if swelling and pain will go down. Said it would indicate problems with the joint lining. I assume that is the synovium. If it does nothing for the pain and swelling, then would indicate it is possibly a problem with the components and possible loosening or something else.
Has anyone in Bonesmart world had this problem? In reading a bit, looks like a MRI may be beneficial to determine if there is synovium issues and what type they are. Any suggestions? Dr won't see me again until January.

 

[Celle]

Do let us know if the Cortisone shot helps, and how long the improvement lasts.

It is possible for a loose implant component to irritate the synovium and keep it inflamed. If that's the case, nothing but replacing the loose component will help things to settle down again.
An MRI might help to clarify matters.

 

[agilitymom]

@Celle it has been 3 days since the cortisone shot. Reduction in swelling by an inch but no reduction in pain. Dr said it could take a few days for it to work. On my last TKR of this same knee, when Dr opened up my knee he said he just barely touched it and it was so loose it ‘flew across the room.’ In that case there was also no indication besides pain and swelling that anything was wrong. Trying to be patient. Not my strong suit.

 

[Celle]

I'm sorry the Cortisone hasn't produced any reduction in pain.

 

[sistersinhim]

it has been 3 days since the cortisone shot. Reduction in swelling by an inch but no reduction in pain.

It's good news that your swelling is going down. Hopefully, so will your pain level. In my experience, it would take more than a few days to notice pain reduction in mine.

 

[agilitymom]

@sistersinhim thanks for the info. The Dr. said I should feel a bit more pain the second day and by the third start getting some relief if this is going to help at all. Still hopeful.

 

[agilitymom]

@sistersinhim do you know anyone who may have the name of a revision specialist in San Diego area? The new surgeon I saw in September thinks I need a 2nd revision. I have gotten approval from the Navy to get a 2nd opinion but not sure whom to call. I have sent my records to Dr. Fabi in San Diego but have not heard back whether he will even see me or not. Thanks.

 

[sistersinhim]

It's very good news that you have approval for a second opinion. Jamie is the one that knows about surgeons. I will tag her for you.

@Jamie, will you help agilitymom locate a surgeon in her area?

 

[Jockette]

I’m so sorry you feel the need for a second opinion and possibly another revision.