Awaiting revision and very scared

[tabbykit]

@Josephine - sorry I do not remember the dose of Tramadol, but I had been taking it post-surgery at the hospital with no problem, it was only on doubling the dose that I suffered the bad reaction.

@Jockette - I have been told that the reason my ROM is so bad and my knee so painful is due to adhesions - they told me that was because I was unable to do physio in those first two weeks .... at my 6 week visit to the surgeon she threatened a MUA if my ROM did not increase. I told my physio, hence her forcing the bend to measure it. It did get to 90 bend with that, so MUA was off the table (although I had read up on it and had decided I would refuse it anyhow as I had read some negative stuff about it). I have since visited an orthopedic consultant yearly, to see if anything might be done but have been told the only option is a revision, but there is no guarantee I would be better off - hence my reluctance.
So yes, looking back, my ROM was better earlier on and has got worse and worse despite my stretching everyday to this day.

@Celle - yes my GP did say after this whole thing that I could try Paracetamol as it should not cause any reaction - so I did, around the clock for about a week but found it made no difference, so gave up, and did not ask for anything else as I could manage without by then.

 

[Jockette]

Thank you for answering all our questions.

Went to consultant who specialises in revisions and he says I should have the revision. He said my knee is unstable and xrays showed the patella is not in the right place. He says the outcome should be good.

Do you like this surgeon and have confidence in him? I think it’s good that he feels you’ll get a good outcome. He’s not the one who did your original replacement, right?

 

[tabbykit]

Jockette, it is a different surgeon. He specialises in revisions and seemed confident of a good outcome (but then he would say that!). One thing I'm wondering, and perhaps you can answer - looking at these threads it seems some folks have new knees with the long stem - why do some have that and some don't? Also reading about some having allergic reaction to nickel, bone cement etc - is this worth getting a test for prior to surgery?

To add to my previous response, could you please ask Josephine if she has names of good UK surgeons? Wondering if mine is on the list or anyone recommends him.

re my signature - it should be Right TKR May 2015, Right Arthroscopy 2000, Left Arthroscopy 2008 (also needs TKR)

 

[Jockette]

@Jockette- to add to my previous response, could you please ask Josephine if she has names of good UK surgeons? Wondering if mine is on the list or anyone recommends him.

@Josephine

I’ll ask a moderator to add that information to a signature for you.

 

[lovetocookandsew]

@tabbykit In my experience, the long stem is done on revision patients. I had just the knee hardware with my TKR, but for my revision, my OS used the long posts. While I'm not sure of the exact medical reasons and terminology, it has to do with bone and stability after a revision, if I recall correctly. I'm sure Josephine or another knowledgeable moderator or person will be able to go into it more if necessary.

I understand your reluctance and fright going in to a revision, or deciding on one. I went back and forth for several years before going ahead with it. As it turned out, one of the posts was loose and I really needed the revision. It was a difficult decision, and one I didn't take lightly. But, now I'm glad it's over with and that I did it. Is a revision a perfect solution? For some it is, but from what I have seen most people who've had it done are glad they did it.

It is a scary thing to contemplate, especially for those of us who've already had a TKR and know what to expect. But one thing to think about is looking ahead to your life and see if this is how you want to live it, or if you want to take the plunge and hope for a great outcome that allows you to take your life back. I chose to take the chance, and am glad I did. The constant knee pain I had is gone now and my knee is much better, pain-wise. I do have some lingering issues, but even knowing these, I'm glad I went ahead with the revision. Good luck!

 

[Josephine]

would appreciate any information from Josephine

I'm sorry, my questions are for post-op members.

I am now curious to know if the adhesions are formed from the aggressive PT

Not exactly. What happens is that the knee gets stiff and angry but that's not adhesions.

 

[maryo52]

I had the same concerns as you and I've had an awesome recovery and good stable hardly-any-pain outcome. And my orthopedist said my revision was straightforward. I did choose an OS who had done 10,000 knees. My original TKR was from rural hospital doctor. The difference is night and day.

 

[tabbykit]

Thanks all for your encouraging words. I now have a list of things to ask the surgeon when I see him again. I was referred to him by another orthopaedic consultant at my usual hospital (NHS). He said this man was a specialist in failed and problem knees. He works in NHS and privately, and says he does 250 knees a year. I will be seeing him privately after my NHS appointment with him. Unfortunately I cannot find a list or 'reviews' of surgeons here (in Scotland at least), but would have liked to know if anyone else knew of this man. My original TKR surgeon was also apparently highly regarded, if somewhat lacking in bedside manner (or indeed basic human compassion!)

 

[tabbykit]

I have another question - my right (unoperated) knee is now extremely painful, can hardly sleep. I was told a couple of years back that it need a TKR but was not advisable as I was having such problems with the left TKR knee ... so, my question is, how much will this affect my recovery after the revision (on June 17th), and secondly, how soon after that is it likely I can have the right TKR? Anyone have experience of recovering from TKR or revision when the other knee is really bad too?

 

[Jamie]

@tabbykit....Jo may have missed your question about your surgeon. Why don't you post his name here along with where you live in the UK and tag her to ask again if she knows him or knows of other surgeons who are specialists at revisions. You tag her by typing the "at" sign (@) and then her username Josephine with no space in between. That way she'll receive an alert to respond.

 

[rosieNZ]

What a tough position you are in. You will get some good technical answers here.
I can only talk about my personal experience (may nor be yours).
I waited too long for my second TKR. I couldn't weight bear in the end even though I had a good knee replacement with knee no 1.Your surgeon will advise you. Many people have bilateral replacements. Is this an option for you? If not, having 1 knee surgically corrected sounds like a priority. Read stories of people who git their second knee operated on a few weeks after the first to see how they managed it.
Best wishes. It all works out in the end.

 

[tabbykit]

Thanks, Jamie and rosieNZ, I will tag Josephine in the next post. I cannot imagine having a bilateral replacement/revision, and it has never been offered. Not sure if it is as common here in the UK.

@Josephine, can you help re info on UK surgeons? I am in Scotland awaiting my revision to TKR on 17th June, and wondering if anyone knows of my surgeon or has any information about who is best for revisions. Had TKR 4 years ago, never had a good outcome (now disabled and very limited mobility) and now it is loose and very painful. NHS consultants have said each year that I could have a revision but would probably not have a good outcome. The most recent consultant said there was someone in Edinburgh who specialised in problem knees and revisions, and referred me (I am not in Edinburgh health area). Referral letter did not give his name. I have now seen someone there who seems good, optimistic, and tells me he will definitely be able to help me, and he tells me he has 'excellent' results with revisions - but I guess he would say that. I contacted my local NHS ortho dept to check that I had in fact seen the person intended ... but they tell me they do not name surgeons but trust the other ortho department to pass the letter on to the most suitable person. I can't help wondering if it was just 'next in the queue' or if this is actually the right man. Is there any info about this or about surgeons in Scotland? I have searched and cannot find anything. Thanks in advance!

 

[Josephine]

wondering if anyone knows of my surgeon

Well I can't until you give me the name.

NHS consultants have said each year that I could have a revision but would probably not have a good outcome.

I could say that if you had an infection or a peri-prosthetic fracture but just a loosening shouldn't pose too many problems. It may be that the surgeon who said this doesn't do too many revisions. There are some who don't.

The most recent consultant said there was someone in Edinburgh who specialised in problem knees and revisions, and referred me (I am not in Edinburgh health area)

I know this is not the case in England but am not sure of Scotland's attitude. However, there is no harm in trying if you can find out the name of this surgeon. Then you could ask your GP to refer you to him.

I have now seen someone there who seems good, optimistic, and tells me he will definitely be able to help me. Is there any info about this or about surgeons in Scotland?

Sadly, I don't know of a place where one can go to get statistics on Scottish surgeons. Wish there was!

 

[tabbykit]

@Josephine, his name is Frazer Wade, he practises in Edinburgh both private and NHS - this is (as far as I can tell) the person I was referred to by my ortho consultant in my local area (Scottish Borders). Can I also ask you, is a loose implant always revised to have a 'long stem' implant? I asked the surgeon and he said he would use 'medium stem' - does this have any bearing on having a good outcome? Thank you!

 

[Josephine]

he practises in Edinburgh both private and NHS

They all do, my dear! It's the only way they can afford to work for the NHS!

Can I also ask you, is a loose implant always revised to have a 'long stem' implant? He said he would use 'medium stem' - does this have any bearing on having a good outcome?

Not at all. Invariably they will use a medium stem but in no way does that affect your recovery. Remember, I'm facing this same issue myself.

 

[tabbykit]

@Josephine, thanks, but you say you're facing the same issue - I read your recovery threads and seems you had a marvellous outcome! Can I ask another question please - since this crappy TKR 4 years ago I have been told numerous times that my problems are due to adhesions, and that is due to not having physio for the first couple of weeks as I was so ill with responses to various meds. For the revision, is the surgeon really able to remove all the adhesions easily without ill effect (on ligaments etc - pardon my limited anatomical knowledge!)? This new surgeon said in response to that question that it was not a problem and he had to bend my leg to 130 degrees to put the new implant in. Hard to believe that will happen!

 

[Celle]

since this crappy TKR 4 years ago I have been told numerous times that my problems are due to adhesions, and that is due to not having physio for the first couple of weeks

They may believe that, but I think it's most unlikely.
If you have adhesions, it's more likely to be due to aggressive PT therapy after those two weeks.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

 

[Josephine]

I have been told numerous times that my problems are due to adhesions, and that is due to not having physio for the first couple of weeks

Absolute nonsense! Not a smidgen of truth in it.

For the revision, is the surgeon really able to remove all the adhesions easily

No

he had to bend my leg to 130 degrees to put the new implant in. Hard to believe that will happen!

Of course he could but then, don't forget he will have cut the joint open completely.

Spoiler: open knee

 

[tabbykit]

Josephine, I'm somewhat alarmed to read that you say the surgeon will NOT be able to remove all adhesions - if they (or some) are left in situ surely this will to a large degree hamper recovery with the revision?

 

[tabbykit]

Sorry I did not tag my last post so will repeat it
@Josephine, I'm somewhat alarmed to read that you say the surgeon will NOT be able to remove all adhesions - if they (or some) are left in situ surely this will to a large degree hamper recovery with the revision? Thanks!