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MUA Agilitymom's revision recovery<<

Jamie

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It just so happens I know Dr. Fabi. Is that who you would like to see for an additional opinion? If you have difficulty getting in to see him, I may be able to speed that up for you. Just tag me and let me know.

Here is another good option for you in San Diego. I know Dr. Jankiewicz as well.
Dr. Joseph Jankiewicz
2929 Health Center Dr
San Diego, CA 92123
(858) 939-6502
 
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agilitymom

agilitymom

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@Jamie yes please. I have an insurance authorization to see Dr. Fabi. I contacted them and the office person said I would need to get him previous surgery notes and records before he would decide if he would see me. I got them to him in 24 hours. It has been about 10 days since then. I know it has been the holiday season so I am trying to be patient.
Any help you can give me to speed up the process would be wonderful. I see the new surgeon tomorrow, Tuesday, and I really would like another opinion to make sure I am headed in the right direction this time. This new doctor seems knowledgeable and very competent with a great reputation from my brother in law, also an orthopedic surgeon. First 2 surgeries were done by a Navy doctor but he has disengaged me from the Navy system because he does not think anyone there now has the expertise to help me.
Thank you.
 

Jamie

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I've asked our CEO to help in getting you an appointment with Dr. Fabi. Can you share with me why you felt he was the best person to see?

Also, could you let me know who your other civilian surgeon was? You can either let me know here in your thread or via a personal message.
 
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agilitymom

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@Jamie I am currently seeing Dr. Stephen Copp at Scripps. I like him but he has changed his opinion both times I have seen him. At 7 months post revision he said he definitely saw lucency on xrays. Then 3 months later would not admit to it. I go back today after 4 months and he asked me to bring my husband back as we would have some very important decisions to consider.

I am at a loss as to a revision specialist here in San Diego. I saw Dr. Fabi in a 1 day summit on the internet through Bonesmart. He seemed very knowledgeable. I would like another opinion on my knee. If it loosened up, or was never exactly right, very quickly after the first surgery and my Navy doctor did the surgery exactly the same the second time then it may be loose again. Who knows but I would feel better with a second opinion before potentially having a 3rd surgery.

Thanks for any thoughts or help you can provide.
 

Jamie

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@agilitymom Dr. Fabi is an excellent and enthusiastic surgeon. However, given the information you've provided, I think you should also see Dr. Joseph Jankiewicz, the other name I gave you. Would you be agreeable to us providing a point of contact at his office for you?

How did your appointment go today?
 
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agilitymom

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@Jamie my appointment went well. Dr. Copp thinks my problem is arthrofibrosis. Due to the length of time he does not think an arthroscopic lysis of adhesions will help so he wants to do an open one. He said that while he is in he will check the prosthesis and if he finds any problems he will perform a revision at that time. I mentioned that none of the xrays or scans showed any problems last time and when the Navy doc went in the prosthesis was very loose.
He also said that there is a chance it will not help the pain completely but should give me better ROM. I also requested a patch test for metal allergies as I have sensitivity to almost all jewelry. He did not think it was an issue but agreed to it.
I am fine for a contact with dr-joseph-jankiewicz. Not sure I can get a referral but can try.

Thank you.
 

Jamie

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How about checking on the referral first before we let them know to be looking for you. I did hear some good words about Dr. Copp and his ability to handle more difficult cases, so you may be just fine staying with him as well.
 
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agilitymom

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@Jamie I just got off the phone with my insurance company and Dr Jankiewicz is not authorized. I have to see an authorized provider or pay for the whole thing which I cannot afford at this time. HOwever I am glad to see that you have heard good things about Dr. Copp. He came highly respected from my brother in law, Dr. Lorenzo Pacelli, a local orthopedic surgeon himself.
 

Jamie

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That's a good recommendation then in addition what I learned about him. I think you can feel confident working with him.

Just one thing, though. The patch test that you've asked for to determine if you have any metal sensitivity is not generally considered the best for this. To do it right, you need a blood test that goes off to a specific lab for testing. Here is a web site for more information. You want the kit for the Orthopedic Panel #2. It's expensive ($573) and normally not covered by insurance. But since you know you have a metal sensitivity, it might be something to consider. You can purchase the kit, but a doctor (could be your surgeon or your GP) must order the blood test and provide a prescription that you include when the blood sample is sent to the lab.

There are two implants that can be used when a patient has a known metal sensistivity - the Aesculap Gold Knee and the Smith and Nephew Oxidized Zirconium knee. You might check with Dr. Copp to see if he is trained in either of these products.
 
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agilitymom

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@Jamie, thank you for the info. I will look into the blood test and ask my GP for it. I am going to ask Dr. Copp about the 2 prosthesis you mentioned when I see him again.
Thank you so much for your guidance.
 

Jockette

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If I ever get the chance to have that blood test done I will be happy to pay for it. Knowing yes or no about any allergy ahead of time would be worth the cost. I’ve had enough issues since surgery that I do wonder about an allergy or sensitivity.
 
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agilitymom

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@Jockette i totally agree on the blood test. I have many fillings and crowns that may need to be replaced in time. I also have an artificial disc in my spine along with a 4 level fusion. It could be I have too much metal in me. My son calls me bionic and my hubs calls me unlucky. He says if anyone is going to be allergic to nickel it will be me.
 
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agilitymom

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@Jamie I have gotten the results from the patch testing and boy was it weird. Not conclusive for nickel but definitely positive for neomycin which the allergy doctor says is used in lots of bone cement among other things. I asked 2 questions: 1. Why do I have such aggressive reactions to cheap earrings and other cheap jewelry? 2. Since my first knee replacement was so loose it came right out and bone cement was used, is it possible that the reaction to neomycin, if it was in the bone cement, caused the loosening?
The doctor answered that no test is perfect but that I exhibit all the classic symptoms of nickel metal sensitivity. He also said that it would not be conclusive that neomycin was the culprit but he would strongly advise not using any bone cement or at least one that does not have neomycin in it.
So after discussing the results with my husband we agreed I need to order the blood test to be sure. Sending for that today. Sometimes I wish things could be more conclusive but that is not the case.
 

Jockette

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While many do well with uncemented implants, they have their issues and I don’t think I would ever agree to having one.
 

Jamie

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I think you are wise to spend this money. This is why we don't recommend patch testing as the results can be inconclusive. The blood test is much more dependable. Thanks for letting us know this latest update.

I cannot say why you would have a severe reaction to some jewelry and not get a metal sensitivity in the patch test. It is possible that a sensitivity to a component of the bone cement was at least part of the reason for your loosening, but no one is going to be able to say that was the cause. The cement could have been improperly applied. Or your implant may have loosened for "unknown" reasons....it just happens sometimes. But, going forward, you want to be as safe as possible and that is why I think you're wise to have the blood test and see what it says.
 

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