TKR First of two knees done

[alex_mom]

I saw my PCP (primary care physician) this morning and he referred me to their system's orthopedic clinic. I have already heard from that clinic and have an appointment in three weeks with a doctor he mentioned, at one of their satellite clinics that is reasonably easy to drive to. I hope to "interview" this surgeon on his knowledge, capabilities, including revision experience etc, and learn if he thinks I need to see someone else. I went to this same clinic location for my knee injections for 3+ years prior to surgery, so there is a history on file. I did not have them do the surgery solely due to the location of the main hospital clinic (traffic, parking, etc.). Well, things change and times change.....

Getting my surgery and X-ray records from the operating surgeon's office is ... um... interesting so we will see how that goes.

EALING GRAN- Thank you for the article link. It says, "IFP pathology is often successfully treated nonoperatively with physical therapy. " which is consistent with everything I have read online. What confounds me is that these horrible pinching episodes with unbearable pain began three weeks AFTER I went back to PT. Hmmmm..... Well, the second opinion should be interesting. BTW, the link would not work in Firefox Browser, but did in Microsoft Edge browser which I rarely use, but gave that one a try, and ... voila!

JOCKETTE - I'm plowing through and am 2/3 into your Drama Queen PF topic and making notes of things to ask the second opinion surgeon based on your experience. Wow, you have been through a lot! (((Hugs!!!)))

 

[benne68]

I hope to "interview" this surgeon on his knowledge, capabilities, including revision experience etc,

This is really smart.

Let us know how your meeting with him goes. Also, let us know if you need any other surgeons' names for a second opinion.

Getting my surgery and X-ray records from the operating surgeon's office is ... um... interesting so we will see how that goes.

They are YOUR records -- not the surgeons! -- so the practice cannot refuse to provide you with copies. They are required by law to give you copies or send them to the office of your choice.

 

[Layla]

They are YOUR records -- not the surgeons! -- so the practice cannot refuse to provide you with copies. They are required by law to give you copies or send them to the office of your choice.

I agree. Not sure if you tried yet, alex_mom, but my surgeons office asked me to sign a medical records release form, after I requested copies of my records while there for an appointment. They sent me office visit notes and surgery notes within a couple of days.

 

[Legseleven]

I had to sign a form and agree for my operating notes and existing radiology images to be released from last year, it’s standard practice and works well.

 

[Jockette]

What confounds me is that these horrible pinching episodes with unbearable pain began three weeks AFTER I went back to PT. Hmmmm.....

Remind me where this pinching is? What activity were you doing during your PT sessions? And, how far post op were you?

 

[Layla]

I hope to "interview" this surgeon

Love this because it feels like a healthy way to view these appointments. May the best man for the job win!

Hopefully the next appointment brings some insight, reassurance, and a little more peace of mind as you continue seeking resolution that brings you closer to feeling like yourself again. It is understandable to wonder why the pinching episodes / excruciating pain below the patella began six months out. Even more puzzling is the timing for some not experiencing this until 5 or 6 years post op! I read it isn't necessarily activity that activates the pain, but "the condition", Hoffa's, increases the mechanical load or puts the tissues into a position where an already irritated and scarred area gets pinched enough to become symptomatic. I am sorry...it sounds truly debilitating. I hope you find answers soon.

Wishing you comfort and safety as you navigate the weekend.

 

[alex_mom]

I wasn't clear about the challenge in getting my records. I know we have a legal right to our medical records, but the surgeon's patient portal links to an outsourced website to request them. That website's form was not easy to navigate, thus my frustration. I had called the OS office and left messages twice the day prior, asking for a callback and had none. Seriously. They don't know if I needed a refill on the Celebrex or what, there is only the prompt to leave one's name after pressing #2 for a callback if I don't want to sit on hold until .... forever.

 

[Jockette]

there is only the prompt to leave one's name after pressing #2 for a callback if I don't want to sit on hold until .... forever.

The office of my original OS had many options on their answering message, but none to actually ask to speak to a person. I finally realized I had to choose the option to make an appointment, to get to speak to someone, no matter what I wanted. That was 9 years ago, but I imagine these days most offices have the system that you just encountered.

 

[benne68]

Sorry about that, @alex_mom! I had a similar experience this morning trying to get through to a doctor's office to request a test. Those "multiple choice" menus never have what we want and then you end up going in circles trying to find the right one. I like Jockette's solution and am going to try it when I call back.

 

[alex_mom]

Update: This week, I saw a different ortho surgeon to whom my PCP(primary care provider) referred me. (Turns out this Dr. is also a revision surgeon). Gave him a printed out hard copy of the rundown timeline from date of surgery to now. Also told him if this is not within his realm nor interest of practice, then please send me to someone who can help, I am looking for a solution since Things Are Getting Worse, especially after I started PT exercises again.

As he poked and prodded my knee, it turns out there is more pain in the pes anserine bursa than the IPFP/Hoffa's fat pad area when pressure is applied. I have a decades-long history with P A Bursitis that comes and goes, mostly staying gone. Poking and prodded was not done by the original TKR surgeon who could have determined this, 4 1/2 weeks ago. Hmmm.....

This surgeon has referred me to an orthopedic surgeon who appears to be a lower body soft-tissue injury specialist (after looking at her specialties online) for injection to the P A Bursa and possibly a nerve block to the fat pad area. That surgeon will probably evaluate and go from there. The first available appointment was four weeks out, and now we wait.

So, hopefully making progress.

Apparently my original TKR surgeon doesn't like to deal with post-op soft tissue drama. Fine. I'm done with him and he won't have the chance to do the other knee in the future. We live in an area with lots of options, and for that I am grateful.

 

[benne68]

Apparently my original TKR surgeon doesn't like to deal with post-op soft tissue drama.

This is very common. These surgeons are "bone doctors" and soft tissue isn't in their wheelhouse.

It sounds as though this latest appointment was really helpful and that the referral to this soft tissue specialist will be a better fit for you. I'm sorry you have to wait for the appointment, but it does sound positive.

Please keep us posted. Your experience is really helpful to others in the community.

 

[Layla]

Also told him if this is not within his realm nor interest of practice, then please send me to someone who can help, I am looking for a solution

This is a positive step. You were upfront with him about your needs and he was honest enough to recognize what you need is out of his area of expertise. Hopefully the door that's been opened brings a fresh perspective, leading to answers and relief. Wishing you many moments of comfort over the next four weeks.

 

[alex_mom]

This is a bit lengthy and I apologize, but it might help someone else....

I am coming up on eight months post-op, and there is an update. The original appointment scheduled to see the soft tissue orthopedic surgeon was in two more weeks, but there was an opening and I was seen today. She did an ultrasound guided cortisone shot to the Pes Anserine bursa and I go back in five weeks for an assessment. She said there could be a series of injections but it all takes time and there is a time limit regarding health insurance covering it. (I get that!)

I asked about the pain when I press down on the M Gracilius and M Sartorius tendons and she said that is referred pain from the Pes Anserine because they feed into the PA bursa.

This doctor told me women are more likely to have post-TKR problems with the pes anserine bursa due the difference in our bone anatomy from hips to ankle. She didn't say V-angle but I knew what she meant.

She also said she would not address the Hoffa's Fat Pad problem today because they like to start with one problematic area, see how the injection goes, and go from there.

Here's a new tip from this surgeon --- she suggested I take Allegra (fexofenadine) for three days to ward off any possible cortisone flares. I have had flares the last few years from shots to my knees. This is a different type cortisone, but just in case . . .


In hindsight, when looking back at "What changed before the awful fat pad episodes began?", the round of PT I did in late July added squats as the only truly new exercise. Granted, I need the strength there and it was immediately helpful for getting up off a seated position without aid. However, that 90° angle of my knees and the effort to straighten up might have thrown an already inflamed fat pad over the edge into crisis mode. I have since stopped doing the deep squats and continue with all the other exercises.

 

[Legseleven]

Thank you @alex_mom for your update, a very helpful post and I’m pleased to hear you have a sympathetic medic and a sound plan. Please keep us posted.

 

[Layla]

Eight months to date since your TKR. I wish it was a pain free anniversary. I hope the cortisone injection brings you speedy relief. Thanks for sharing your journey here.
Happy Eight Month Anniversary!
@alex_mom

 

[EalingGran]

Granted, I need the strength there and it was immediately helpful for getting up off a seated position without aid. However, that 90° angle of my knees and the effort to straighten up might have thrown an already inflamed fat pad over the edge into crisis mode

I avoid squats, as especially if my knee turns inwards at all then they can be painful.
Have a look at my excellent pilates teacher's side lying/ no squats glute strengthening YouTube class. Google Katja pilates and it comes up.

 

[alex_mom]

The cortisone shot to the pes anserine bursa gave positive improvement within 24 hours. The Allegra (fexofenadine) did not prevent the red facial flush 24 hours later but it disappeared in another 48 hours. That's okay; just being pain-free in that bursa area has helped immensely.

We will see what happens in four weeks when I go back. (fingers crossed!) This has truly become a journey.

 

[benne68]

So glad to read the injection provided fast relief. I hope it is sustained.

 

[Layla]

The Allegra (fexofenadine) did not prevent the red facial flush 24 hours later but it disappeared in another 48 hours. That's okay; just being pain-free in that bursa area has helped immensely.

A little of this -> for more of this -> made the flush worthwhile.
Glad you're feeling better and fingers crossed it lasts. Keep us posted alex_mom and thanks for sharing your journey here. Wishing you a pain free week.

 

[alex_mom]

So far, the bursitis pain is reduced by 80-90% right now. Hopefully it will last a while. I have felt so good that I'm getting some housework chores done that have been avoided since before my TKR, including HVAC filters and vacuum bags changed! Until now, it has been the bare minimum due to the pain.