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Facing 3rd revision - Help

Discussion in 'Knee Replacement Pre-Op Area' started by spadezzzz2, Jun 11, 2019.

  1. spadezzzz2

    spadezzzz2 new member
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    I see surgeon Friday. I am facing my third revision and from what I know will be difficult. Here is what bone scan said. I would like to hear opinions on this. I am quite concerned about it.

    Radionuclide Bone Imaging, Three Phase Examination:
    Radiopharmaceutical: Tc-99m HDP (technetium-99m-hydroxymethylenediphoshonate) Dose: 21.3 mCi IV push
    BMI: Not available/78 kg
    Reason for Consultation: Right knee pain status post multiple replacements the most recent five years previously for evaluation of infection versus loosening.

    The quality of this examination is acceptable with regards to count density, processed images, data display and lack of important artifacts (including but not limited to motion and attenuation artifacts). Comparison with a prior exam of 10/13/2016 demonstrating evidence of right medial tibial ligament inflammation/enthesopathy with prosthesis loosening of either knee not excluded.

    Following bolus intravenous administration the radiopharmaceutical agent, perfusion imaging was obtained over the knees in anterior and posterior views with review of dynamic images demonstrating increased perfusion to the right lateral knee.

    Immediate blood pool imaging obtained in anterior and posterior views demonstrates increasing synovial activity at the right lateral knee and similar focal increase at the medial knee joint.

    Delayed osseous phase imaging performed 2.5 hours following tracer injection in anterior/posterior and lateral views over the knees demonstrates similar increase of osseous turnover along the tibial aspects of both total knee prostheses and increasing osseous turnover at the lateral femoral condyles bilaterally.

    IMPRESSION:
    Abnormal examination. Findings are consistent with resistant loosening of the tibial component of the knee prostheses bilaterally with evidence of collateral ligament inflammation laterally involving both knees.
     
  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @spadezzzz2 Welcome to BoneSmart! Goodness, you have had quite a history with this knee. Can you please give me the dates of your surgeries and which knee was replaced? I'll pop in information in your signature for you.

    Our medical expert @Josephine is the best person to give you input on your scan result. I've tagged her for you so hopefully she will be along soon.
     
  3. spadezzzz2

    spadezzzz2 new member
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    My last revision was 2013 both knees.

    I also have an elevated CRP. They tried to do a synovasure test but although there is fluid in my knee they couldn't find a large enough pool.
     
  4. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    It's actually quite straightforward, spade. You have a loose implant and though it doesn't say which one, the likelihood is that it's the tibial component. I'm in the same situation myself. So what are the surgeons planning for you? When is the revision planned.
    Thank you but we'd really appreciate more detail than this. For instance, full date of both primary TKRs and the full date of the revisions. I think that makes 4 surgeries in all - you have my sympathies!
     
  5. spadezzzz2

    spadezzzz2 new member
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    TKR was done on right knee 4/2008, TKR left knee ll/2009. Revision left knee 4/2013, revision right knee 9/2013. I do not have a patella in either knee. The revision supposedly was supposed to be the be all, apparently not. Surgeon says 2nd revision will be complicated especially I do not have a patella and possibly longer stem down into tibia. I will know more Friday as well as when it will happen. My right knee is extremely swollen, I guess the blood pooling.
     
  6. spadezzzz2

    spadezzzz2 new member
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    Oh, and my question for him will also be what about the left knee, i.e., should I wait for more symptoms with it?
     
  7. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Thank you for the dates.
    Do remember that this will be complicated for him, not for you. It does not mean your recovery will be complicated.

    Not necessarily blood. It's trauma swelling which is just tissue fluid.
     
  8. spadezzzz2

    spadezzzz2 new member
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    My visit to the surgeon was quite unsettling. The surgeon told me the doctor who did my revision should not have done what he did. Basically the top implant was shoved up into the bone and stuffed with a lot of cement, and that implant piece is one and one half inches up to high. He said hes not sure I would not lose my leg if he had to chip all the cement out of there because he does not know if there would be a viable bone left. He discussed possibly having to make an incision to get sample to test for infection since i have an elevated crp. Completely scared about this because if this is an infection brewing in there they likely would have to remove the hardware anyway and I could still lose a leg. He wants me to have another crp in 5 months and use ice and antiinflammatories, and get an acl brace to wear when walking a lot (I dont have a patella which adds to the problem). Knee stays swollen around and below. Anyone ever had to deal with this situation before?
     
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  9. spadezzzz2

    spadezzzz2 new member
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    I heard there is a really great surgeon in Texas. Does anyone know?
     
  10. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Removing your leg would be a very last resort and the risk of doing so is extremely small. Please don't worry yourself about it.
     
  11. spadezzzz2

    spadezzzz2 new member
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    I wish I could not worry, however, the surgeon the previous doctor made such a mess that there was a very good chance they couldnt get all the cement he jammed up there out wthout just leaving a shell of a bone.
     
  12. leejaa

    leejaa post-grad

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    @Josephine and @Celle, she asked about a surgeon in Texas. I remember that when I had my knees done in 2013 there was a forum member who had multiple infections but found this great doctor in Texas who got her through the infections and she had successful replacements. You all probably know of the surgeon.
     
  13. leejaa

    leejaa post-grad

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    spadezzzz2, I am so sorry for what you have been through and now to have to face this. I will keep you in my thoughts and hope that all turns out well for you in the end. I think finding the right surgeon will be the key for you.
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    It's Gerhard Maale in Plano TX. He is the 'go-to' person for these kinds of issues.
     
  15. spadezzzz2

    spadezzzz2 new member
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    I am in touch with him and getting appointment.
     
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  16. leejaa

    leejaa post-grad

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    Wonderful. I hope he will be able to solve any issues and get you over this. Keep us posted.
     
  17. Full Sail

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    Hi Spadezz2, I'm new to BoneSmart. In fact this is my first post.
    I was taken by all the difficulties you're having (as well as numerous others), and I'm wondering if you have been allergy tested for the metals?

    I'm due for a TKR in a month but they found out I was highly allergic to nickel and ALSO mildly allergic to the bone cement.

    Upon doing a lot of research I found that if you are allergic to the bone cement that they use, your body will break it down causing loosening and flaking.
    Naturally, if you're allergic to the metals they use, you can bank on pain caused by never-ending inflammation.

    My sister unfortunately was never metal-tested before she had both her knees replaced, and she has had a terrible time...always in pain, and what seems to me to be a loosening of the joint in one of her knees.

    I asked her if she was allergic to costume jewelry and she told me "yes", that she could never wear it because she always reacted to it.
    I feel so bad for her and place the blame on the surgeon.

    In my opinion it should be standard procedure to test people before operating! It sounds like your surgeon (since the knee was over an inch off) didn't do a great job during surgery to say the least.

    But you might have a double problem in that you might be allergic. The best way to find out is through a blood test (not a patch test).

    Currently, I'm waiting to find out what they plan to use for me. There is a Smith and Nephew knee on the market (Oxinium) that has virtually no nickel. I think it would work for me.

    But the bone cement is another issue, and I was told that there is no other option for that. Quite honestly, I don't believe that.
    I think it's most likely more a case that the surgeon has signed up to use a particular brand and he's under contract...or the hospital is. Money.

    I hope this helps in some way to figure out what might be wrong. If it's any consolation, I have heard of people (like you) who have found out after the fact that they are allergic, and they do well after having the allergen removed and replaced with a hypoallergenic implant.
     
  18. Celle

    Celle FORUM ADVISOR Forum Advisor

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    For anyone who would like to get a full metal allergy test prior to any joint replacement surgery, you can get the test done in the USA by ordering the test kit from https://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP (or any lab) can do the blood draw and send it in for testing.

    Unfortunately, this test is usually not covered by insurance, so you may have to cover the cost yourself.
     

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