Just getting up and down out of chairs (with as little pushing up as you can get away with) is exercise in itself. Gradually it will get easier as your muscles get naturally stronger.
TKR Does anyone know of a Metal Allergy expert?
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Carol Anna
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Please don't worry about any excercise and just look after that knee and do daily activity which might not seem like much but for that new knee it is enough. This site taught me that. Daily activity might be something as simple and getting up to go the loo which for me in the afternoon and evening means going upstairs about 7 times. In the first few weeks I used a crutch and one step at a time but I have now progressed to stepping up as normal albeit more slowly than usual without pushing any excercise -I just felt my new knee wanted to do it - it also tells me that I am tired at the end of the day and I revert to using that one crutch - there are no medal for pushing too far.
Skybig
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So it's now been 7 months since TKR surgery and I though that I'd give you all an update.
Well my knee pain is much worse than it has ever been and it's more swollen than it was right after surgery. I've been back to the surgeon multiple times and he ruled out infection, the knee replacement is not loose, its sized correctly, its alignment is perfect, I can bend it 132 degrees and my knee cap tracks correctly. I've had fluid taken out of my knee and its been tested. I recently had an MRI and MRA and there are no vast quantities of scar tissue, but they did find that I have synovitis. The synovial lining is "thickening" and that is causing the excessive swelling. To me, it feels like something is getting caught up in the joint as I walk or bend it. They want me to have a ablation whos goal is to choke off the blood supply to the synovial lining in hopes that the swelling will calm down. If this doesn't work, they want me to have full blown surgery to completely remove it the synovial lining, some time in the fall. No one knows for sure if this will work.
The doctors think that I am probably having an allergic reaction my knee replacement. They aren't sure if I reacting to the foreign body (the knee replacement) its self or the metal that is made of. my TKR is made 100% out of Oxidized Zirconium (Oxinium) metal. Oddly enough this is the one that they use for patients with metal allergies! I was tested before surgery and it was found that I have a severe allergy to Nickel, Aluminum, cobalt and chromium (and some other metals) and that's why and an all Oxidized Zirconium knee replacement was used.
So here is my question folks...... If it is found that I am in fact allergic to my Oxidized Zirconium knee replacement the doctors don't have another knee replacement to offer me. So does anyone know if there is a knee replacement that is made of 100% out of Titanium (not an alloy) or a true ceramic material? Maybe something only used in a foreign country right now. My fear is that my only real solution at this point may cause me to lose my lower leg. So.....I am frightened to death.
Well my knee pain is much worse than it has ever been and it's more swollen than it was right after surgery. I've been back to the surgeon multiple times and he ruled out infection, the knee replacement is not loose, its sized correctly, its alignment is perfect, I can bend it 132 degrees and my knee cap tracks correctly. I've had fluid taken out of my knee and its been tested. I recently had an MRI and MRA and there are no vast quantities of scar tissue, but they did find that I have synovitis. The synovial lining is "thickening" and that is causing the excessive swelling. To me, it feels like something is getting caught up in the joint as I walk or bend it. They want me to have a ablation whos goal is to choke off the blood supply to the synovial lining in hopes that the swelling will calm down. If this doesn't work, they want me to have full blown surgery to completely remove it the synovial lining, some time in the fall. No one knows for sure if this will work.
The doctors think that I am probably having an allergic reaction my knee replacement. They aren't sure if I reacting to the foreign body (the knee replacement) its self or the metal that is made of. my TKR is made 100% out of Oxidized Zirconium (Oxinium) metal. Oddly enough this is the one that they use for patients with metal allergies! I was tested before surgery and it was found that I have a severe allergy to Nickel, Aluminum, cobalt and chromium (and some other metals) and that's why and an all Oxidized Zirconium knee replacement was used.
So here is my question folks...... If it is found that I am in fact allergic to my Oxidized Zirconium knee replacement the doctors don't have another knee replacement to offer me. So does anyone know if there is a knee replacement that is made of 100% out of Titanium (not an alloy) or a true ceramic material? Maybe something only used in a foreign country right now. My fear is that my only real solution at this point may cause me to lose my lower leg. So.....I am frightened to death.
There are some ceramic knee implants out there. Google them and you can find some information about them.
I hope you can get some answers really soon. Something doesn't sound right with your knee. Have you increased your activities or something else that could anger your knee?
I hope you can get some answers really soon. Something doesn't sound right with your knee. Have you increased your activities or something else that could anger your knee?
Skybig....back in August, 2020 I recommended that you look into the Aesculap Gold Knee as a good option for someone with metal allergies and you indicated you didn't pursue it because it was not available near you. It still might be an option for you if you were willing to have a revision.
If that's not something you want to consider, if you have not seen a surgeon with the Hospital for Special Surgery, I would definitely recommend that you do get another opinion. Here are some recommendations for surgeons there who might have some different ideas:
New York City
Hospital for Special Surgery (HSS)
Stavros Niarchos Foundation Complex Joint Reconstruction Center is a special program created with a $10M grant that deals with diagnosing and treating the most challenging knee and hip replacement problems. As part of the diagnosis, a committee of surgeons meets to discuss your case. There is a $500 fee for your case review. This center is headed up by Dr.Thomas Sculco.
Hospital for Special Surgery
535 East 70th Street
New York, NY 10021
212-606-1000
http://www.hss.edu/physicians_su-edwin.asp
Revision surgeons at Hospital for Special Surgery, New York City (in order of their work with revisions both hip and knee):
Dr. Goeffrey Westrich
Dr. Russell Windsor
Dr. Seth Jerabek
Dr. Michael Cross
Dr. Michael Parks
Dr. Bostrom
Speaker at 2018 ICJR workshop on problem hips and knees
Dr DeFelice
Dr. Della Valle (I have heard several good recommendations on this surgeon)
Dr. Jerebek
Dr. Westrich
One other suggestion is that you might want to have a consultation with a rheumatologist about your reaction just in case there is a possibility that the inflammation could be treated with medications instead of surgery. I don't know if that's a possibility, but it might be worth a shot.
Has your current surgeon tried cortisone injections?
In answer to your question about ceramic knee implants, they really aren't used much (if at all) here in the US. They have been tried in the UK, but I don't think there is widespread use there either for knees.
If that's not something you want to consider, if you have not seen a surgeon with the Hospital for Special Surgery, I would definitely recommend that you do get another opinion. Here are some recommendations for surgeons there who might have some different ideas:
New York City
Hospital for Special Surgery (HSS)
Stavros Niarchos Foundation Complex Joint Reconstruction Center is a special program created with a $10M grant that deals with diagnosing and treating the most challenging knee and hip replacement problems. As part of the diagnosis, a committee of surgeons meets to discuss your case. There is a $500 fee for your case review. This center is headed up by Dr.Thomas Sculco.
Hospital for Special Surgery
535 East 70th Street
New York, NY 10021
212-606-1000
http://www.hss.edu/physicians_su-edwin.asp
Revision surgeons at Hospital for Special Surgery, New York City (in order of their work with revisions both hip and knee):
Dr. Goeffrey Westrich
Dr. Russell Windsor
Dr. Seth Jerabek
Dr. Michael Cross
Dr. Michael Parks
Dr. Bostrom
Speaker at 2018 ICJR workshop on problem hips and knees
Dr DeFelice
Dr. Della Valle (I have heard several good recommendations on this surgeon)
Dr. Jerebek
Dr. Westrich
One other suggestion is that you might want to have a consultation with a rheumatologist about your reaction just in case there is a possibility that the inflammation could be treated with medications instead of surgery. I don't know if that's a possibility, but it might be worth a shot.
Has your current surgeon tried cortisone injections?
In answer to your question about ceramic knee implants, they really aren't used much (if at all) here in the US. They have been tried in the UK, but I don't think there is widespread use there either for knees.
Skybig
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The Aesculap Gold knee and the one that I received from Smith an Nephew are both made with zirconium. One uses zirconium nitride and the other zirconium oxide. Since I'm already having an adverse reaction to zirconium oxide I doubt that my surgeon would risk replacing it with one made with zirconium nitride, but I will surely ask.
I totally agree with your assessment about the Hospital for Special Surgery. It is where I had my knee surgery and they were fantastic. Coincidently my surgeon is one of the ones that you recommended above. Even though I'm not happy with my outcome thus far, I do not believe that any of it was the surgeon's fault. He's the one who had my blood tested for the metal allergies in the first place. He also convinced Smith and Nephew to make my knee replacement out of 100% zirconium oxide, both the femoral component and the tibial tray. Normally the tibia tray of the Smith and Nephew is made from a Titanium alloy that contained aluminum, which I'm very allergic to. Then he had to apply a lot of paperwork with the FDA to obtain "companionate use" approval for my custom made knee replacement and then follow it through the approval process. He kept me informed through the whole process, which took just about a year to accomplish thanks to Covid. My surgery went very smoothly and I was able to bend my knee amazing well after surgery. So I honestly believe that my surgeon did everything humanly possible to ensure that I'd have a good out come, but sometimes things happen and this time it happened to me. He also isn't "ghosting" me and seems genuinely concerned about how I'm doing. If I email him a question or express a concern he will generally respond immediately. So, if I were to do it all over again, I'd still chose the same surgeon.
I am scheduled to have an Ablation procedure that is supposed to choke off the blood supply to the Synovial lining in early May. Both my Orthopedist and the Interventional Radiologist feel that I will see significant benefit from the procedure and its the least invasive solution. If it doesn't work, plan B is to have Synovial lining surgically removed. They both feel that my "thickening" synovial lining is causing the pain and swelling.
I totally agree with your assessment about the Hospital for Special Surgery. It is where I had my knee surgery and they were fantastic. Coincidently my surgeon is one of the ones that you recommended above. Even though I'm not happy with my outcome thus far, I do not believe that any of it was the surgeon's fault. He's the one who had my blood tested for the metal allergies in the first place. He also convinced Smith and Nephew to make my knee replacement out of 100% zirconium oxide, both the femoral component and the tibial tray. Normally the tibia tray of the Smith and Nephew is made from a Titanium alloy that contained aluminum, which I'm very allergic to. Then he had to apply a lot of paperwork with the FDA to obtain "companionate use" approval for my custom made knee replacement and then follow it through the approval process. He kept me informed through the whole process, which took just about a year to accomplish thanks to Covid. My surgery went very smoothly and I was able to bend my knee amazing well after surgery. So I honestly believe that my surgeon did everything humanly possible to ensure that I'd have a good out come, but sometimes things happen and this time it happened to me. He also isn't "ghosting" me and seems genuinely concerned about how I'm doing. If I email him a question or express a concern he will generally respond immediately. So, if I were to do it all over again, I'd still chose the same surgeon.
I am scheduled to have an Ablation procedure that is supposed to choke off the blood supply to the Synovial lining in early May. Both my Orthopedist and the Interventional Radiologist feel that I will see significant benefit from the procedure and its the least invasive solution. If it doesn't work, plan B is to have Synovial lining surgically removed. They both feel that my "thickening" synovial lining is causing the pain and swelling.
I’m sorry this is happening to you but must complement you on getting the precise details about your situation. You seem very well educated in the factors involved, which will help you make the right decisions, when required.
Oh, how I hope that the ablation procedure help!
I’m not certain whether we should add that to your signature but if you don’t mind leaving the date here, I will ask the moderators their thoughts on it.
Oh, how I hope that the ablation procedure help!
I’m not certain whether we should add that to your signature but if you don’t mind leaving the date here, I will ask the moderators their thoughts on it.
I appreciate the detail in your post and I'm pleased to hear you are seeing someone at HSS. Even though things are challenging, I believe that's one of the best places to be in the entire country. Would you mind sharing which surgeon you are using there? If you don't want to do this on the public forum, you can send me a PM. I like to put a note by the surgeons on my list when we have members who use them just in case someone else develops a problems similar to yours. Based on your description of how the surgeon has worked on your behalf, I'd certainly recommend him to another member.
beesknee
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I don't have a ton of visible swelling but when the doctor looked at both my knees next to each other, the non OP knee cap is very well defined, while the PKR one does not have the nice definition around the kneecap. My doctor used the word thickening and did not seem too concerned. He did not use the word synovitis.
A bit nervous as I have have some mild thickening and a lot of grinding like you and I am at 9.5 months am still struggling with stairs.
A bit nervous as I have have some mild thickening and a lot of grinding like you and I am at 9.5 months am still struggling with stairs.
Skybig
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My upcoming procedure was just pushed out three more weeks due a Covid break-out in my home. My son, his fiancé and my wife have all come down with it. I however, have not, but they pushed it out anyway. All (including me) have been vaccinated and boosted, luckily so far all have mild cold like symptoms. My son and his fiancé believe they got it on flight home. Even though they wore masks on the plane, no one else did.
I believe that I may have inaccurately described my up coming procedure as an "ablation" when in reality it is actually an "arterial embolization". Arterial embolization is a procedure in which small pieces of a special gelatin sponge, or other material, are injected through a catheter to choke off the blood supply and hopefully shrink the synovial lining in my right knee by depriving it of the oxygen-carrying blood and other substances it needs to grow. To me it sounds rather sci-fi-ish, but I've got my fingers crossed!
I believe that I may have inaccurately described my up coming procedure as an "ablation" when in reality it is actually an "arterial embolization". Arterial embolization is a procedure in which small pieces of a special gelatin sponge, or other material, are injected through a catheter to choke off the blood supply and hopefully shrink the synovial lining in my right knee by depriving it of the oxygen-carrying blood and other substances it needs to grow. To me it sounds rather sci-fi-ish, but I've got my fingers crossed!
I'm so sorry to hear about the Covid outbreak in your family. Thank God it's not serious. I pray they heal quickly so you can get on with your procedure.
Skybig
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I had my knee replaced in Sept of 2021 with knee made 100% out of Oxidized Zirconium and I'm having some sort of allergic reaction to it. Before entering into this "process" my surgeon had my blood sent off to a lab in Chicago for allergy testing. The testing disclosed that I'm allergic to a lot of different kinds of metal and it was determined that Zirconium was my best option. After my initial surgery my knee was constantly very swollen and painful. I had a an MRI this past April that showed I had a very bad case of Synovitis. So in May I had an embolization procedure in hope that it solve my swelling/pain issue, but it didn't help. So we scheduled a full synovectomy (not orthoscopic) for late July or this year. Unfortunately, a week before the scheduled surgery, my knee completely locked at 80 degrees, so I was rushed into a week earlier than planned. I am about 9 weeks post synovectomy/revision surgery and my knee is still very swollen and painful. The surgeons at HSS in NYC believe that I am having an allergic reaction to the Zirconium Oxide and they aren't any other options at this point. I either have my right leg fused at the knee or I live with it an wait for someone to develop a no non-metallic knee replacement that the FDA will approve.
In the mean time I am trying to find a doctor who specializes in metal allergies so I can get a second opinion. I've read a lot about metal allergies and they are often associated with symptoms that I don't have.
Thanks
In the mean time I am trying to find a doctor who specializes in metal allergies so I can get a second opinion. I've read a lot about metal allergies and they are often associated with symptoms that I don't have.
Thanks
ski_bum
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@Skybig
That was a smart surgeon to test for metal allergies before surgery.
I am having a lot of issues after my second knee replacement.
No swelling, mainly pain in second knee but a change of weather drives my entire body stiff. Every injury gets stiff & painful.
Surgeon suggested I get a job at the airport as a weather man. funny but not!
Family Doctor ordered blood tests for allergies, infection, X-ray of hands for possible arthritis all negative.
He ordered a complete Nuclear body / bone scan and that will happen Oct.31st.
I will post results on my site when available.
Wishing you the best.
Don
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I am sorry you have to deal with this. You've been through a lot. While I am unable to offer advice, I am wondering if you've checked for a physician that specializes in metal allergies through the HSS?
Possibly another BoneSmart member will come along with some knowledge of a specialist.
I wish you the best as you seek information and make decisions. I hope you find relief soon.
I am breaking your post down a bit for the benefit of those reading here, so they have a better understanding. Please correct me if this doesn't pertain to your situation -
Synovitis - (or synovial inflammation) is when the synovium of a joint becomes inflamed (swollen). The synovium, which is also sometimes called the stratum synoviale or synovial stratum, is connective tissue that lines the inside of the joint capsule.
Synovectomy -
A synovectomy is a surgical procedure for the treatment of synovitis in which part of the synovium of a joint is removed. It may be performed either as an open surgery or with the aid of an arthroscope.The chosen surgical technique often depends on which joint is affected.
Synovectomies can be performed on knee, hip, elbow, wrist or finger joints, and they can significantly improve function and relieve pain.
Embolization procedure - a minimally invasive procedure that blocks the blood flow to the lining of the knee, known as synovium, that are inflamed. By blocking these arteries, there is a reduction in the amount of inflammation, that can help or eliminate the associated knee pain.
Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. I have edited your thread title to reflect you current concern. Please post any updates about your recovery here.
Good luck and best wishes.
Possibly another BoneSmart member will come along with some knowledge of a specialist.
I wish you the best as you seek information and make decisions. I hope you find relief soon.
I am breaking your post down a bit for the benefit of those reading here, so they have a better understanding. Please correct me if this doesn't pertain to your situation -
Synovitis - (or synovial inflammation) is when the synovium of a joint becomes inflamed (swollen). The synovium, which is also sometimes called the stratum synoviale or synovial stratum, is connective tissue that lines the inside of the joint capsule.
Synovectomy -
A synovectomy is a surgical procedure for the treatment of synovitis in which part of the synovium of a joint is removed. It may be performed either as an open surgery or with the aid of an arthroscope.The chosen surgical technique often depends on which joint is affected.
Synovectomies can be performed on knee, hip, elbow, wrist or finger joints, and they can significantly improve function and relieve pain.
Embolization procedure - a minimally invasive procedure that blocks the blood flow to the lining of the knee, known as synovium, that are inflamed. By blocking these arteries, there is a reduction in the amount of inflammation, that can help or eliminate the associated knee pain.
Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. I have edited your thread title to reflect you current concern. Please post any updates about your recovery here.
Good luck and best wishes.
The knee you received, Smith and Nephew's Oxinium Oxidized Zirconium implant, is one of the best choices for patients with metal allergies. Another is Aesculap's Gold Knee. You might contact the Aesculap company and see if they can advise you of surgeons you could consult with about your knee. Admittedly, you are at HHS, one of the country's premier hospitals for knee replacements, so I suppose it's possible that a fusion is your only option. But, I share your thoughts that it will be good to find some other opinions on the problem before committing to that procedure. Other alternatives for hospitals would be the Cleveland Clinic and Mayo Clinics. I don't have any surgeon recommendations that deal specifically with metal allergies, but do be sure you locate revision specialists (they may list "adult reconstruction" in their online biographies) for any consultations.
Please keep us up to date on what you decide to do and who you see.
Please keep us up to date on what you decide to do and who you see.
Skybig
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I too was told that the Smith and Nephew was one of the best choices for people with metal allergies. Apparently not "ALL" people....meaning it was NOT for me. We also looked at the Aesculap's Gold Knee, but it contains other metals that I tested poorly with. At this point, I need/want to find a metal allergy allergy specialist to get a second opinion on all this.
I wish we could be of more help to you in locating a specialist in metal allergies related to joint replacements. But this is something that is going to be fairly difficult, as there are not a lot of cases like this and research is very sparse. Try the larger clinics I gave you as a starting point. These are going to be your best bet for a "specialist."
Skybig
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I realize that I'm reaching here and I also realize that I may be literally one in a million. My issue is that my symptoms don't match typical symptoms of metal allergies.
I've read that metal allergy signs and symptoms include:
I've read that metal allergy signs and symptoms include:
- Rash or bumps on the skin
- Itching, which may be severe
- Redness or changes in skin color
- Dry patches of skin that may resemble a burn
- Blisters and draining fluid in severe cases
WFD
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@Skybig , is it possible that your zirconium oxide prosthetics are in fact hypoallergenic and your problems are no longer the result of metal allergies but that of arthrofibrosis? I have all the symptoms you report and have no metal allergies, according to the blood test I had done, using the outfit recommended here on Bonesmart.
Why I get arthrofibrosis is a complete mystery and I've found no explanation for it.
If you have arthrofibrosis then the surgeon should be able to diagnose that, based on an examination. Has that been discussed?
If this is true then there might be non-surgical options available, such as injections of corticosteroids that can address both scar formation, swelling, and even lingering allergic reactions from your old prosthetic parts.
Besides, you can't win the reverse lottery because I already did!
Why I get arthrofibrosis is a complete mystery and I've found no explanation for it.
If you have arthrofibrosis then the surgeon should be able to diagnose that, based on an examination. Has that been discussed?
If this is true then there might be non-surgical options available, such as injections of corticosteroids that can address both scar formation, swelling, and even lingering allergic reactions from your old prosthetic parts.
Besides, you can't win the reverse lottery because I already did!
