1 April Update…
Surgery date is 24 May by Dr Brian Chalmers at HSS. I return on May for extensive pre-op appointments: medical clearance, discharge planning, pain management, blood work, x-rays, another aspiration (There is a small effusion in the knee)., endocrinology (osteoporosis, management) and nutrition. The last one is interesting as I started Wegovy .25 on 11 March. Took the 4th weekly injection yesterday. So far, I’ve lost 12+ pounds.
While we didn’t discuss the specific implant, according to the EMR, he’s going to use a Stryker Modular Rotating Hinge MRH. He also told me he’s requesting four hours of OR time.
I expect to be in the hospital 3 - 4 days and then off to rehab for 1 - 2 weeks. I am planning to use a facility in NYC. Then home to West Virginia. How I am going home is TBD. The flight is 1.5 hours from LGA to Roanoke followed by a 90 minute drive.
Logistics are starting to overwhelm as I have four small dogs at home and I really don’t want to board them for 3 - 4 weeks.
From the office notes (my comments are in italics)
- The knee has significant laxity to varus valgus stresses and easily more than a centimeter of laxity and anterior to posterior in flexion and mid flexion.
- We discussed technical details of this including removal of at least part of if not the full plate. We discussed removal of both components and placement of a hinged device. There was no discussion about type of device. Should I care?
- She has a well fixed tibial component with a tibial cone and we will plan to leave the cone if it is well fixed and remove any remaining cement in place a new hinge MRH tibial baseplate.
- We would plan to utilize a cone in the distal femur and cement and a shorter stem.
- I think we can correct some of the varus but not all of the varus without
doing an osteotomy which Ithink would be significantly more complicated with much higher risk of complications if we were to attempt that. Her primary plan would be to remove the femoral component, remove the distal screws and cut the plate and work in the distal segment. We will have a distal femoral replacement on backup if the distal bone stock is not adequate to support a condylar type of the implant. We discussed the complexity of the surgery at length.
- We discussed that she is at significantly elevated risk of complications given the complexity of the surgery, multiple prior surgeries, peri prosthetic fracture, varus deformity of the femur, adipose tissue around the knee and weight, and multiple incisions about the knee creating a skin bridge.
- We discussed that the biggest risk of surgery would be wound healing problems and
periprosthetic joint infection, medical and anesthetic complications around the time of surgery, loosening or wearing out of the components over time, continued pain and dissatisfaction with the knee, stiffness requiring manipulation or reoperation or dissatisfaction with the knee, and VTE. Don’t know what VTE is.
- We discussed the surgery would take likely several hours and she would be in the
hospital for several days after the surgery. We discussed we may limit her weightbearing or range of motion after the surgery to facilitate cone ingrowth and wound healing. I asked if the rehab/recovery for this surgery is comparable to a typical TKA revision. He said it was. Which is confusing since encouraging weight bearing and ROM is standard post-op care.
- We discussed the lengthy recovery and that recovery may take up to a year or 2 to regain strength and stamina in the leg.
I’d love to hear from anyone who has experience with a hinged implant and the recovery.