femoral component problems

[lee28]

Help! I had a tkr 18 months ago and ever since my range has been an issue. Hardly 90 degrees. I can not walk down steps, getting down on the floor I have to straighten my leg completely and when walking alot it just stiffens up. Lifting my leg back up towards my butt bending it at the knee I'm lucky to get it 5 inches off the ground. It just doesn not bend. I have visited two doctors and both have pointed at the femoral component being to large. My question is, has anyone ever had this issue? Has anyone ever heard of this. If so has anyone ever gone in for reconstructive surgery to correct the issue? Any pros or cons? I'm looking for advice at this point to help me weight the odds and make the proper decision for myself. Thanks.

 

[Josephine]

It happens, sadly. A basic mistake made by surgeons who are usually at the beginning of their career and the result of a surgeon who hasn't done enough replacements to justify his stripes! What I would call a hobby-ist knee surgeon rather than a specialist. To be a real specialist he needs to be doing in excess of 1,000 replacements per year. 500-1,000 is okay but anything under 500 is just playing at it.

So, you seem to have confirmation that the knee component it too large, which would seem confirmed by the descriptions of the problems you are experiencing, the answer is to get it changed for an appropriately sized one. Find yourself a GOOD surgeon and get him to do it soon.

 

[Texas]

If the surgeon says they can fix it I would. I wouldnt let it go longer, its been to long already. Im sure it can be fixed and you will be fine. Sure hope you get this straightned out soon. Try to take it easy for now...I would assume if thats the only option the con is you can get this fixed and get back to normal again. We all hope that for you......

 

[Jamie]

Wow, Lee.....Jo (our forum nurse) is going to have to weigh in on this....you should hear from her soon.

At least you have done the correct thing by getting two opinions. I'm assuming neither of these doctors was the one who put the knee in, right? If it was me, I would probably want to have the problem fixed so my knee would work properly. If you choose to do this, just be sure your new surgeon is VERY familiar with the process and has done a lot of reconstructive surgery.

Oops!!! Jo wrote to you as I was typing!!!!

 

[Simon]

Jo

I agree that the more replacements done the better but you have to consider location as well. My OS does less than 500 per year but has being doing them for more than 25 years. I checked the stats at the state insurance page and for Vermont there are less than 1000 TKA done for the state in 2008 so it would be hard to find someone that meets your range. So maybe in low volume states time in practice needs to be considered as well.

Simon

 

[Max Wallace]

The surgeon is the key to success with this surgery I have heard it over and over again on this site. Very rarely is there a problem with the components where errors come in most are human. Find a surgeon that specializes in knees many knees per year and have this fixed. When this surgery is done correctly at 6 months post op the knee should feel natural be very stable and pain free, that includes bending, stiars up and down, standing, walking etc.

Max

 

[Josephine]

I take your point, Simon, but the facts remain the same. You don't get excellence unless you're doing lots. And lots. And lots. A craftsman doesn't get to be a craftsman unless he executes his craft day in and day out. No ifs, ands or buts about it.

So for a primary replacement you might well be okay but when face with a situation such as Lee find himself in, should he be in an outlying community, he is just going to have to resign himself to travelling to where the excellence is and not make do with what's on offer locally.

 

[lee28]

Thanks everyone for you replies. I have to agree, the more they do the better it should be. In my case my OS, has done a large number and even presents seminars on the procedure. That's why it makes it so hard to believe this would have happened. But now looking at my records, none of my concerns seemed to be documented and not once where any type of measurements taken. I guess I should have not placed so much trust into one person on my future. But I'm still weighting the odds to see what the next step is. Thanks again everyone!

 

[Josephine]

In what way were you expecting measurements to be taken, Lee? In my experience, no measurements regarding choice of small, medium or large prostheses are ever recorded. Nor for the tibial components which come in a lot larger range. Usually they are simply eyeballed using trials at the time of implantation (operation!).

One other thought, you do know for certain that he did the op and not one of his associates?

 

[Brian]

... To be a real specialist he needs to be doing in excess of 1,000 replacements per year. 500-1,000 is okay but anything under 500 is just playing at it...

Jo, I don't know how this plays out in the NHS but in my hospital about 1000 knee procedures are done annually but by more than one surgeon. This is a hospital that has one of the highest numbers of such procedures according to the National Joint Register.

I was told that the man I was under had done around 5000 in total but I had his senior registrar and I doubt he had done 500 annually but as far as I was aware there was no choice and I was satisfied. The problem is that every surgeon has to start from scratch, albeit under guidance initially.

 

[Josephine]

Yep, therein lies the sting in the tale of the NHS, Brian!