Revision TKR February 24, 2025: Stage Two of Two Stage Revision

[WFD]

Anyway, just wondering if you have any tips on how to cope with this mentally

Hi @Oldped , I wish I had a magic answer. Do I understand that you had a lot of stiffness in your other knee after getting it scoped? Was it arthroscopic surgery or just a look-see? If you got scar tissue growth after just the latter, then that is concerning.

As preparation for your next meeting with the doctor, I would suggest you examine your medical history for some of the conditions that can predispose someone towards arthrofibrosis-

1. Inflammatory diseases, such as early-onset arthritis (I have that).
2. Autoimmune diseases, such rheumatoid arthritis (I carry the genes for RA though I don't display the disease), psoriasis (I have this), or lupus (I don't have this, strangely enough).

Some of the experts on treating arthrofibrosis advise against an MUA, saying that for people prone to scar tissue growth, the trauma of the MUA will just trigger more scar tissue growth. Instead they recommend an arthroscopic lysis of adhesions as a less traumatic alternative. You may wish to discuss this with your doctor.

It is a good sign that they are planning on meds and special PT, instead of the standard one-size-fits-all approach.

If there is an infection, getting rid of it is job number one - you don't want to let that get established, as it did with me. Nothing else matters until the infection, if there is one, is gotten rid of.

initially ok ROM then regression after painful pt

...makes me think that the painful PT might be the cause, or at least an important contributing factor. You may want to insist on a very gentle PT approach.

As far as coping with it mentally, I'm not sure what to say. You've seen my history so you know what I've put up with. I am also just about at the end of my patience though, after the last four and a half years of (as of this upcoming Monday) seven surgeries. This has gotten pretty old.

What has given me some peace is to think through the different outcomes and deciding I can accept them. When I had my initial TKR in October 2020 I had all kinds of plans for all the fabulous things I was going to do afterwards. Now I have decided that I can be happy if I am able to walk and stay on my feet for a good part of the day, be mostly free of pain, and be rid of the infection that I've had for the last three and a half years.

Do you have anyone that you can talk this through with? I find that very helpful, to put things into perspective and keep myself from obsessing over my knee too much.

Hope that this helps a little. Feel free to PM me if that would be helpful.

 

[Oldped]

@WFD Thanks, my head is just not working great, You’ve given me some encouragement. My prior knee stiffness was after scope, seemed to resolve on its own with activity. I have no family history or personal history of autoimmune issues. If I don’t have an infection, the plan is a referral to a Dr that is researching Arthrofibrosis, protocol includes a revision with hinged knee and meds after. I too would be happy to be able to walk, no pain, just a small life. Strangely enough I really don’t have much pain now, just a bit of achiness sometimes, wonder if no infection I should just live with stiff knee? rather than another operation with same outcome. I know that having poor gait will probably cause problems later (back,hip, ankle etc.) I can talk to my family, husband but don’t think they totally understand.

 

[WFD]

So I had my surgery yesterday. The surgical team removed the metal rods fusing my knee together, installing a hinged knee, covering that with a muscle graft (the entire medial head of my gastrocnemius), and a skin graft from my upper thigh. The entire operation took almost four hours.

During the operation they removed all my ligaments, as they are no longer needed and they would just be one more thing for scar tissue to connect to.

They found my patella heavily scarred up and was avascular (without any blood supply) and deteriorating. It wasn’t necrotic yet but they removed it to forestall the inevitable and also to make more room for scar tissue.

The surgeons reported that the operation went very well and were very optimistic. Now if only the infection remains gone. I am on IV vancomycin to help make sure the virus does not return.

The nerve block used was bigger than usual and higher up on the nerve, and my knee is virtually painless. The calf and the skin graft donor site are another matter. The graft should be wearing off soon so I may be in for a difficult night. I’ll make sure to get painkillers administered ahead of time.

The skin graft donor site is being kept exposed to the air so it can dry and scab over. It looks like I fell off my bicycle at high speed and got the worst case of road rash. I’ll have mercy on you all and not post a picture.

I really hope this is the last time. Surgeries just aren’t that much fun anymore .

 

[Jamie]

This was a very major procedure and it sounds as though it went well. I’m glad for you. I think you’re wise to anticipate the possibility of pain….I know you’ll be proactive and not let it get out of control before asking for medications. You’re a pro at this recovery thing and probably know the ropes more than your nurses…. . Hang in there. Hopefully this marks the beginning of your real recovery. My prayers are with you.

 

[Pumpkin]

Glad to hear the surgery is behind you, sending positive thoughts for your recovery.

 

[mendogal]

Congratulations on one more milestone. May the road ahead be smooth.

 

[Layla]

Let the healing process begin! Your BoneSmart buddies are happy surgery is behind you and you're on the road to recovery. Thankfully all went well and the surgeons are feeling optimistic. Wonderful news, WFD!

I really hope this is the last time.

We hope so too!
You're not alone, we all support you and we're rooting for better days ahead and complete healing.
Lots of comfort to you.

 

[WFD]

Thank you all for your support.

 

[Jockette]

They found my patella heavily scarred up and was avascular (without any blood supply) and deteriorating. It wasn’t necrotic yet but they removed it to forestall the inevitable

@sistersinhim has had both her patellas removed years ago.

The skin graft donor site is being kept exposed to the air so it can dry and scab over. It looks like I fell off my bicycle at high speed and got the worst case of road rash.

Oh my, that sounds so painful.

Like the others, I also hope this is the last surgery for you. Best of the best Wishes for a good recovery.

 

[EalingGran]

That all sounds pretty positive. I pray all goes smoothly for you this time. Keep us posted.

 

[sistersinhim]

Jockette is correct, I had both of my kneecaps removed in the early 90s. I am doing fine without them, just a little weaker knees than those with kneecaps. With yours removed, it's one less thing to have to heal from, and that's a good thing! My prayers are with you.

 

[WFD]

Thanks, all.

 

[WFD]

Two weeks from second stage of two-stage revision -

Hi,

Would one of the staff be kind enough to change the title of my thread to 'February 24, 2025: Stage Two of Two Stage Revision'?

I'm home now after 8 days in the hospital (my rear end is still numb from those crummy hospital mattresses). Everything seems to be proceeding nominally. I have the knee in an immobilizer brace at least until I see the PA on 3/21, which is a good thing, because after seven months with my knee fused straight I have lost the ability to control the knee when standing up - it buckles easily. It's not a strength thing - I've been doing isometrics throughout the whole time - I think I have to relearn how to use the knee.

The muscle and skin graft seem to be healing well as far as I and the visiting nurse can tell. The skin graft donor site is the source of 90% of the pain - the knee and calf hardly hurt at all. The knee is almost completely numb - I can hardly feel anthing when the visiting nurse cleans the wound when changing the dressing.

Not too much else to report - I've got a long and boring recovery ahead of me.

 

[mendogal]

It's good to learn things are proceeding!! Thank you for updating us.

 

[Jamie]

I changed your thread title for you.

This is a positive report. I know it must seem like a long road ahead, but you’ve done such a great job of navigating all this so far. I know you can make it. We’ll be looking forward to hearing from you whenever you want to post. You have a ton of supporters here in your BoneSmart family.

 

[WFD]

Thanks, @Jamie and @mendogal .

 

[EalingGran]

Good to hear from you and glad all is going well so far. Good luck!

 

[Layla]

Thanks for the update, WFD. It's nice to hear how you're doing...many of us are following your progress.
Wishing you only the best!
@WFD

 

[WFD]

Three weeks from second stage of two stage revision -

My recovery continues uneventfully, except for one thing. Last Wednesday when changing the dressing over the graft, the visiting nurse and I noticed a small hematoma, about the size of a quarter, had formed under the skin graft in one spot. I sent a picture to the surgeon’s office and the reply was that it wasn’t a problem and they’d see me on 3/21 (this Friday).

Today when changing the dressing, we noticed that where the rest of the skin graft was integrating itself nicely onto the grafted muscle, and the mesh shape was filling in, the graft over the hematoma was not filling in and was developing a yellowish border between it and the healthy graft. The nurse seems pretty experienced and he said it looked to him like the skin graft over the hematoma was failing.

I’ll discuss it with the PA on Friday but I suspect I have another procedure in my near future. It will be a lot less major but will still mean time with a wound vac and will extend the time I have to wear the immobilizer brace.

I so want all of this to be over.

 

[mendogal]

I'm sorry. I hope surgery can be avoided.