Revision TKR Can’t seem to get a win

barbender

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I had a on the job injury Aug 15th 2018 . I was delivering automobile parts and as I stepped off my truck my right foot went forward and my thigh but my right knee snapped backwards and twisted shredding everything beyond repair.

On Sept 26th 2018 I had a total knee replacement which failed as a result of my workers comp not getting me into PT for almost a month after surgery and sending me a CPM machine 3weeks after discharge from hospital.

As a result I had to have a manipulation under anaesthetic which failed miserably resulting in a 2nd Revision on January 30th 2019 where the ortho surgeon had to shave bone off my femur and my tibia and install a smaller knee to allow movement of my ligaments and tendons to bend. Well even with going straight to therapy and having my CPM machine the revision failed and I just had a 2nd MUA and that failed.

After the day of the MUA I went straight to therapy for 5 days straight and first day I got 105 degrees, 2nd day 102 degrees, 3rd day 100 degrees, 4th day 94 degrees and 5 day 80 degrees flexion.

To add insult to injury the whole time I could barely walk as my Dr just informed me that during the MUA he tore my quad muscle. So now he’s stopped my therapy for a week and I’m just sitting at home healing.

I don’t know what the next step is till I see him in 3 more days cause I’ve almost lost all flexion in my knee so basically I have to start all over again. So in 9 months I’ve endured 2 knee replacements, 2 MUAs and possibly looking at a 3rd surgery.

Has anyone been in this position before???

Any advice would be greatly appreciated!!!!
 
Your knee never had a chance to heal and the swelling kept your knee from bending. After this surgery all your knee needs is rest, elevating and icing. Your main job needs to be letting your knee heal and get that swelling down. When the swelling comes down, your bend will improve.

The following are our basic guidelines and should help get you started. As you read more on other members recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

Knee Recovery: The Guidelines


1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
For one thing, you never gave your knee a chance to heal and recover from surgery, so it stayed swollen. You can't bend a swollen knee. MUAs just cause more swelling and trauma to an already traumatized knee.
 
Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control :ok:. This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new:). You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there:yes:.
 
@barbender,
Welcome to BoneSmart, glad you joined us!

You and your poor knee have been through a lot.
Do you have a complete quad tear? Are you in an immobilizer?
IMO I would not let the same surgeon touch me again.

Recommend you seek a second opinion for your TKR, from a surgeon specializing in Revisions, they have the education and background to determine what is happening with troubled knees. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.
You can cash pay if Workmans Comp will not pay for a second opinion.

For now you need to let your knee heal.
 
@barbender ... I completely agree that you need another surgeon or two to take a look at your knee and evaluate that torn muscle. It may be difficult to switch doctors with a Workman's Comp claim, but you at least need to get some opinions, even if you have to use your insurance and pay whatever copay you have.

Can you tell me who your current surgeon is? If I know that, I can help you find someone who will be totally independent of him so you get a good opinion. You may need to drive a bit to either Orlando or Tampa to find a good revision surgeon. Are you willing to do that?
 
My orthopedic surgeon's name is Dr Walter Choung in Beverly Hills FLORIDA. Name of the place is Narure Coast Orthopedic and Sports Medicine.

Thank you for the information everyone. It was very helpful and if there’s any more information please feel free to give your input. Yes my knee has been through a lot especially with having 2 TKRs within 4 months of each other. I see him again this coming Monday and will definitely keep everyone posted.
 
Thanks for providing the surgeon's name. Dr. Choung appears to be a general orthopedic surgeon as he does a wide variety of procedures. He averages 82 knee replacements per year which is on the low side. Especially with a problem knee needing a revision, you really need to be seeing someone who specializes in fixing problems. This means a surgeon who sees a lot of knees that must be revised and does those revisions successfully. I'm sorry, but from what you've written that does not describe your current surgeon.

I strongly suggest that you not commit to any additional procedure until you have at least met with one or two revision specialists. Would you be willing to drive to Orlando to get additional opinions?
 
So sorry, you are having to go through this. Sounds like you have been through quite an ordeal with your knee.

I had a TKR last june and it didn’t work. Knee was very unstable and very painful. Dr said my ligaments were bad and I needed a hinged knee replacement. So I finally agreed to that in December and surgery on January 29th.

Dr gets in there and decided the ligaments were ok after all so instead of the hinged knee that I had agreed to, he replaced the femoral component and spacer with larger ones. I went back for my 2 month followup on Monday and told him my knee was still unstable. Within 3 minutes of being in his office he examined my knee and told me that
My ligaments were bad and I need a hinged knee replacement! Hello! That’s what he was suppose to do in January instead of giving me an unnecessary surgery that didn’t do me a bit if good!
Only set me back further.
So I can certainly emphasize with you.

But like others said, definitely see another surgeon. Which is also what I plan to do but won’t be able to do that for another 10 months. (One year post last surgery) but that’s what I plan to do as I don’t trust my original surgeon anymore.

Bad part is, he was recommended to me by the best orthopedic clinic in the south. He is suppose to ve very experienced with trauma and complicated cases. He is the one who fixed everyone else’s mistakes. Probably gonna be hard to find another surgeon. I might have to try another state.

I hope you can get another opinion along with necessary procedures and you will be well on your way to recovery.
 
I feel for you. I have also had 2 TKRs on my right knee and 2 revisions and then a scope last June. After my first TKR my regular orthopedic surgeon could not figure out what to do so after almost 2 years I went to a revision specialist. A brilliant man who figured out in 20 mins that my entire cementless TKR did not “stick”. After my 2nd TKR and a revision they finally determined that I am highly allergic to Nickel. It’s a blood test not covered by insurance that detained this. My cemented prosthetic was completely loosened my my body rejecting it.

Definitely get another opinion, even if you have to pay cash. Good luck!!!
 
1. I had a total knee replacement which failed as a result of my workers comp not getting me into PT for almost a month after surgery and sending me a CPM machine 3 weeks after discharge from hospital.
2. As a result I had to have a manipulation under anaesthetic which failed miserably
3. even with going straight to therapy and having my CPM machine the revision failed
4. I just had a 2nd MUA and that failed
1. I very much doubt your not having PT or CPM as promptly as you thought was appropriate would cause your knee replacement to fail.​

2+4. Does that mean your ROM never improved after the MUA?​

3. can you please tell me how you quantity a 'failed'? Does that mean you never got good ROM, it was stiff, painful or something similar?​
Dr just informed me that during the MUA he tore my quad muscle. So now he’s stopped my therapy for a week and I’m just sitting at home healing.
That's bad but his recommended 'treatment' is entirely appropriate.
I see him in 3 more days
I suggest you fire him and find a new surgeon, just as my colleague Jamie suggested. I wouldn't see him again, not ever!
 
Well I went to see the ortho dr. Again today and he wants to give it another 2 weeks of me using hot towel for 15 minutes and do what home exercises I can stand without pain and ice for 20 minutes (3) times a day . They asked me my pain level and I told him I was still around a 7 even with pain meds and would u believe the dr. Said we’ll i can tell your feeling better, not much probably but just by your visual features your getting relief by doing home therapy and giving your knee a rest from going to therapy ! He’s like you may think your feeling like your pain isn’t getting better but it is ! I was like wow you diagnosed my pain level by looking at me . SERIOUSLY !!!! So does anyone have any recommendations or know where I can get a second opinion .
 
Hey Barbender, sounds like you been through the wringer man. I feel for you. I definitely would drop this quack and find another. I'm sure someone here will have a recommendation. My doc was a colonel in the Army and goes through a ton of knees and has seen it all in that dept. I feel like he done bang up great job on mine and have been happy with him. I hope you find a good one and get on the right track.
 
Thank Brother I appreciate that , when I go back to see him in 2 weeks if all he has to say is some more rubbish then I’m going to fire him right to his face and will go find another Dr. Hard part is finding a Dr. who will see me after learning this dr. screwed up my knee so badly . But I know god has a plan and in the end things will work out . Morgan and Morgan has taken my case for both medical and Workman’s Comp . So I’m positive in the end I’ll be very happy but most importantly I want my knee back !
 

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