TKR Everything Comes to She Who Waits

[new knee in June]

@patient 99
Dear Carol,
What kind of a person do you think I am ? I don't know any "Rude" jokes or riddles
The answer is a Peanut.... Cute, but not vulgar....
First, you want a draw, now you don't I'm confused...Don't you love me anymore ?
Diana

 

[patient 99]

First, you want a draw, now you don't

Oh stop moaning.

Don't you love me anymore

My little Walnut, I am very fond of you.

ps: I love you really, but I am English and, well, LOVE makes us blush

 

[patient 99]

As you know (because I've never stopped banging on about it) I am going for a second opinion on 8 July. Because of this I've been reading posts where bonesmarties have had problem TKRs. It alarms me the number of revisions that are being offered BEFORE finding out what caused the original TKR to fail. The get out seems to be `every one is different and its not always possible to know what the cause is.' But how the heck can you put something right if you don't know what made it go wrong?????

At the very least you would think OSs would work through all the diagnostic tools that are available to them before offering revisions. Xray seems to be the most commonly used diagnostic tool and then biopsy. MRI scanning is noticeable by its absence. Given that MRIs show the soft tissue in detail it would seem obvious to use it if Xray and biopsy haven't identified the problem.

I will be pressing the OS on 8 July to find at the CAUSE of my TKR problems and only then will I consider corrective options with their inherent pros and cons.

 

[JustJeff]

@JustJeff Ignore message 1841. While you are `helping' me with the riddle more of your peas will go missing. And it wont be the Toothfairy - Know what I Mean

ps: do you grow anything other than peas?

the pea fairy. lol!

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[JustJeff]

@JustJeff Ignore message 1841. While you are `helping' me with the riddle more of your peas will go missing. And it wont be the Toothfairy - Know what I Mean

ps: do you grow anything other than peas?

I grow garlic, tomatoes, lemon grass, basil, fennel, dill, thyme, rosemary, cantaloupe, chives, lettuce, raspberries, mint, and lots of weeds!

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[JustJeff]

Today, fellow smarties, I increased my distance to convention hall. No, iceman, no 30 miles before breakfast. Still in awe about that! But 6 r/t mi.

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[patient 99]

I grow garlic, tomatoes, lemon grass, basil,

Wow. Is this in your own back garden (yard) or do you have what is so English - an allotment. The few friends I have that have allotments find the one problem is that they can't cope with all the tomatoes ripening at the same time, all the basil ripening at the same time etc. etc. They end up giving the veg away to friends/family. That always seems a shame to me. You put so much effort into growing the veg only to give it away because you have too much of each thing at the one time.

But its jolly good exercise and I guess it really doesn't matter that you have too much, you can just use the amount that's right for you. Which veg do you find is the easiest to grow in your neck of the woods? Rhubarb grows like a weed where I live. Carol

 

[new knee in June]

@patient 99
Thank You for the Love Right back at You Once Again, you bring up very
Good questions... My Take on this is.... Most people do get a correct diagnosis. Then they
Go over the plan to correct the problem with their O.S. For example, scar tissue is a reason
For limited ROM & can be painful. The answer would seem to be remove the scar tissue, not
A revision. But, a mis-alignment, or problem with the replacement might need a revision.
It is up to the O.S & the patient to discuss resolution.
If the O.S can see no problem, then it is up to the patient to get a 2nd opinion, As you are doing.
Every person is different, with different problems...some Major, some Minor. I don't think a revision would
Be done just because the O.S couldn't find an answer. As my O.S says...we do different things, not
Just surgery. ( I love him for that ) there are so many answers for different kinds of problems.
The trick is to find the problem, deal with it affectively, with input from the O.S. & patient.
Have a wonderful Sunday,
Off to work,
Diana

 

[new knee in June]

@patient 99
Carol,
Today is your lucky day, I don't know any Rhubarb jokes, Don't even know what it is....

 

[patient 99]

For example, scar tissue is a reason
For limited ROM & can be painful. The answer would seem to be remove the scar tissue, not
A revision. But, a mis-alignment, or problem with the replacement might need a revision.
It is up to the O.S & the patient to discuss resolution.

Absolutely. Couldn't agree more. My concern is that OSs seem to be offering solutions before the problem has been diagnosed. In my case the OS thought the solution was more physiotherapy. BUT HE HADN'T DONE THE DIAGNOSTIC TESTS to enable him to come to this conclusion. At least more PT is fairly benign, but offering revisions in similar circumstances is dreadful.

Diana, all I am really saying is where a patient is having problems, that ALL the diagnostic tests available should be used in turn until the cause of the problem is identified. Only then should solutions be considered. I accept that even then a very small percentage of issues may not show up, but at least the best that can be done has been done. xx Carol

 

[patient 99]

Hi Diana, rhubarb crumble with custard is absolutely wonderful. Now I have to try and say what rhubarb is - never thought of it before. Well it grows in my garden. The stalks are reddish and it has hugh leaves. You discard the leaves. The stalks are stewed in water and sugar, then the crumble is added and its put in the oven to bake. Yum yum.

You can't joke about rhubarb it has to be taken seriously. C

 

[new knee in June]

@patient 99
I couldn't agree with you more... Did you suggest a diagnostic test & they said No ?
I think Doctors only order what they think will help, for Instance if I had a CT scan on my kidneys
It would not be up to me to want an M.R.I. It's up to the doctors. I could suggest it, but if the doc.
Says No, then I wouldn't get one.
Sincerely,
Diana

 

[leejaa]

Carol, it seems like a great idea to actually know what is wrong before proceeding with a "fix" especially a fix like revision where you as the patient has the hardest job - recovery. I hope you get some answers for your issues - you have had such a trying and frustrating time. Best of luck. Lee

 

[patient 99]

I think Doctors only order what they think will help,

Chuckle. Diana You do force me to think. But I've got my teeth into this one so I will keep at it.

When their patient is in pain/discomfort I think its the OSs duty to keep investigating until they have tried everything at their disposal to find the cause of the problem. My OS took and Xray which he said looked good. I asked for an MRI scan because I believe its a soft tissue problem. He said I couldn't have an MRI scan because of the metal prosthesis - this I now know is untrue. So he stopped short. Why did he stop short. You think it was because he thought going further would not help. But there was nothing to lose in giving me the MRI scan and everything to gain. It didn't involve more surgery and the risks that go with it. If there was value in taking an Xray to show the bone and prosthesis then there was value in an MRI scan to show the soft tissue.

But I have drifted off my original point which was that before you try to put something right you should first do everything possible to find out what is wrong. Particularly where something as major as a revision is being offered. @Pumpkln knew what the problem was when she had her revision ie lax ligament @busylizzie knew ie, metal allergy. But it appears not everybody undergoing a revision knows what caused the first TKR to fail. That might be the only option that is left, in which case, I'd say fair enough. But to opt for a revision when there is still some diagnostic tests that could be done, tests that might show the cause of the problem doesn't seem right to me.

Don't I go on. Anybody know any walnut jokes?

 

[patient 99]

it seems like a great idea to actually know what is wrong before proceeding with a "fix"

A great idea. I don't think so Lee. I'd say it was a prerequisite.

Thank you for your good wishes. I am trying to leave `luck' out of the picture

 

[busylizzie]

My original surgeon's boss wanted to do a revision. They had already signed me off once and said I had to live with what I had. The reason was, 'We don't know what is wrong but a revision sometimes works, we will try a two stage revision'. This was why I asked for an independent second opinion at Wrightington. Needless to say, I didn't go with the original surgeon(s), they had had one attempt before at a revision to fix it and failed badly. Once I spoke to this new surgeon at Wrightington, my mind was made up and I transferred my care to him. We have worked together and I had so much more confidence that he would get to the bottom of the problem.

I knew from the beginning before the original TKR that I had metal allergies and the original TKR was an oxinium one, one I shouldn't have reacted to.

 

[new knee in June]

@patient 99
Your point is well taken I don't think anyone would have a revision, unless there was a medical
Reason for it. I also don't think a O.S would do a revision just to make a patient happy
Possibly a C.T scan could show soft tissue problems ? I am going to "Google" this & get back to you
You certainly make me think when I talk to you
Sincerely,
Diana

 

[patient 99]

they had had one attempt before at a revision to fix it and failed badly.

Thank you so much busylizzie. This proves my point. You have to know what the problem is before you try to fix it. If they hadn't diagnosed metal allergy, they would have done a revision again using the metal that you were allergic to. OMG. Didn't you do the right thing to switch to the OS at Wrightington. Best wishes for the future. Carol

 

[new knee in June]

@patient 99
I'm back.... "Google" says, C.T. Scan or M.R.I are used to determine soft tissue damage.
If you can't get an M.R.I, you certainly could suggest C.T.scan.
I love "Google"

 

[busylizzie]

@patient 99 , no the original surgeon already knew about the metal allergies before the original TKR and put a special oxinium knee in. It never worked properly and I had a painful, swollen, hot knee from day one with very little ROM. They couldn't fathom out what was wrong and did one revision to change the kneecap button and take samples and a synovectomy. That didn't resolve the problem and the original surgeon in consultation with his boss signed me off and said I had to live with it.

I had an appointment with my rheumy at the same hospital a few weeks later, he looked at my knee and he was appalled. He instigated tests and all came back negative except for a LUKA scan which measures concentrations of white blood cells. My knee showed up in that. No infection was found at subsequent aspiration. At that stage the rheumy had referred me back to the original surgeon's boss and it was then he said what I quoted above, that sometimes a revision works but they don't know why. I had very little confidence in him when he said that.