Revision TKR Here I go again!<<.
- Thread starter Jordon6
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Jordon6
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Jo
I went today to get a second opinion. This ortho did X-rays, examined my knee (intense pain along a line inside my knee and outside)and based on my history and the way my knee looks and perform, said that the implant sounds loose from being either improperly placed or became loose as a result of something else like infection. He ordered bone testing X-rays to check but was very certain that the results will show what he suspects. He's also doing blood work to rule out infection. He said that he would NOT get it scoped cause he believes that's not the problem and this doesn't appear to be scar tissue.
Now I don't know what to do or who to believe! The thought of a revision makes me cringe!
I went today to get a second opinion. This ortho did X-rays, examined my knee (intense pain along a line inside my knee and outside)and based on my history and the way my knee looks and perform, said that the implant sounds loose from being either improperly placed or became loose as a result of something else like infection. He ordered bone testing X-rays to check but was very certain that the results will show what he suspects. He's also doing blood work to rule out infection. He said that he would NOT get it scoped cause he believes that's not the problem and this doesn't appear to be scar tissue.
Now I don't know what to do or who to believe! The thought of a revision makes me cringe!
I suggest you take the advice of the second ortho and have the testing done. That will either confirm what he suspects or eliminate it from the equation. You do need to know if there is an underlying cause for your problems.
If the second ortho is right, you will need a revision - it won't fix itself.
I had a revision and, although I was apprehensive about it, it turned out to be not such a big deal. If anything, my recovery from the revision was easier than the recovery from my original surgery.
If the second ortho is right, you will need a revision - it won't fix itself.
I had a revision and, although I was apprehensive about it, it turned out to be not such a big deal. If anything, my recovery from the revision was easier than the recovery from my original surgery.
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Jordon6
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Celle
Thanks good to know. I was really nervous about having a revision (if that's what I need). I teach first grade and took off 12 weeks to have the TKR done and I wondered if I could do it this summer and be ready when school starts back!
Thanks good to know. I was really nervous about having a revision (if that's what I need). I teach first grade and took off 12 weeks to have the TKR done and I wondered if I could do it this summer and be ready when school starts back!
I'm not sure how many weeks the school summer holidays are.
I do know that @referee54 , who was a teacher, went back to teaching 8 weeks after his bilateral TKRs. He managed, but found it was really too soon.
I think that having the tests and then the follow up appointments could take several weeks, so getting a revision (if you need one) done during the holidays might be pushing it a bit
I do know that @referee54 , who was a teacher, went back to teaching 8 weeks after his bilateral TKRs. He managed, but found it was really too soon.
I think that having the tests and then the follow up appointments could take several weeks, so getting a revision (if you need one) done during the holidays might be pushing it a bit
newlybionic
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I hope there is nothing wrong with your TKR. I just had a revision 8 months after my original TKR and I was totally frightened by the thought. It has turned out to be the best thing I could have done. I agree with Celle it was far easier so far than my TKR.
It's worth getting tested. I also think all that time on your feet isn't helping. I know when I first went back to work (teaching) it took months for that feeling of stiffness to reduce after being on my feet for a while.
Can you sit on a stool for minutes at a time while teaching?
Can you sit on a stool for minutes at a time while teaching?
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Jordon6
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Kneeper- how long were you out? I was out the first time for 12 weeks starting in October but I hate to take that long at the beginning of the school year. I do sit a good bit but I do a lot of walking too, my school is large and I have first grade so I have to walk them everywhere throughout the day.
It'll work out like it's supposed to! I'm trying to stay positive.
It'll work out like it's supposed to! I'm trying to stay positive.
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Jordon6
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So my bone scan showed several "hot" spots which my OS said that it still suggests the implant is loose. My knee is not painful anymore, partially because I not working. (I teach and I'm out for summer break) I still have limited ROM -about 95-100 and -5 extension. I just wonder why I have two totally different opinions and could it just be scar tissue causing limited ROM and increased pain ( surgeon #1 suggests) when I'm working. I'm totally confused. I want to do what's best but how can my surgeons differ. I feel my recovery is slow, so is this slow recovery or a problem?
If I get a third opinion, and it's different who do I believe. Is it just Russian roulette?
If I get a third opinion, and it's different who do I believe. Is it just Russian roulette?
newlybionic
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The only thing I can offer is that you try to go with a OS that does a fair amount of revisions a year and you have to feel comfortable with that doctor. They are used to seeing all types of problems and in my opinion I think they are the best to give you an idea on how to proved. It's hard finding the right one but in the end it's well worth the time.
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Jordon6
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Just got the radiologist report-"moderate and somewhat diffuse uptake of right knee present and interdeterminate when considering arthroplasty of less than a year" What does this mean? Does this suggest loosening of the implant is certain?
I'm not sure what that means, so I'll ask @Josephine to enlighten both of us.
I was able to time it to get 12 weeks.
Orthodoc
Former BoneSmart staff member
Jordon,
Thanks for taking me in the private message to come review this thread. This sure is a quite a difficult problem for you. Sorry to hear that you're going through this. Just to review, you had your surgery in September 2015 and underwent a manipulation under anesthesia which sounds at least partially successful. You've then had a second opinion showing a bone scan with moderate uptake. Your second opinion surgeon was thinking that your continued problems exist from either a loose prosthesis, malposition of the components, or infection.
Please feel free to correct me if this synopsis is not correct.
First of all the bone scan typically will be "hot" for about 1-2 years following a knee replacement. This type of scan is of only limited value within this time from a knee replacement. It sounds like your second surgeon is considering multiple different possibilities. However, I (if I were you) would want some more definitive evidence for which is the cause of your ongoing stiffness and pain before considering your next step which may be surgical management.
It does make a lot of sense to do a workup for infection just to make sure. Your surgeon should be able to tell whether the swelling in your knee is due to an effusion. If there is actual swelling inside of the joint then they can take a sample of that fluid and send it to the lab. That is one of the most definitive ways of determining infection. Some other options include checking blood serum values for ESR, CRP, and WBC. They could also consider a white blood cell tagged scan of the knee which would be more definitive for infection.
A review of your x-rays would be needed to help determine any malposition of the components. A very subtle sign of loosening may not be easily visualized on x-ray. The use of advanced imaging such as a CT scan or MRI is of limited value due to metal artifact from the prosthesis.
If you're problem were due to continued adhesions or scar tissue, then it's not unreasonable to consider an arthroscopy of the knee. In the right patient this type of procedure can be successful to help achieve further flexion of the knee. This surgery is less successful in achieving further extension.
Best of luck.
Orthodoc
Thanks for taking me in the private message to come review this thread. This sure is a quite a difficult problem for you. Sorry to hear that you're going through this. Just to review, you had your surgery in September 2015 and underwent a manipulation under anesthesia which sounds at least partially successful. You've then had a second opinion showing a bone scan with moderate uptake. Your second opinion surgeon was thinking that your continued problems exist from either a loose prosthesis, malposition of the components, or infection.
Please feel free to correct me if this synopsis is not correct.
First of all the bone scan typically will be "hot" for about 1-2 years following a knee replacement. This type of scan is of only limited value within this time from a knee replacement. It sounds like your second surgeon is considering multiple different possibilities. However, I (if I were you) would want some more definitive evidence for which is the cause of your ongoing stiffness and pain before considering your next step which may be surgical management.
It does make a lot of sense to do a workup for infection just to make sure. Your surgeon should be able to tell whether the swelling in your knee is due to an effusion. If there is actual swelling inside of the joint then they can take a sample of that fluid and send it to the lab. That is one of the most definitive ways of determining infection. Some other options include checking blood serum values for ESR, CRP, and WBC. They could also consider a white blood cell tagged scan of the knee which would be more definitive for infection.
A review of your x-rays would be needed to help determine any malposition of the components. A very subtle sign of loosening may not be easily visualized on x-ray. The use of advanced imaging such as a CT scan or MRI is of limited value due to metal artifact from the prosthesis.
If you're problem were due to continued adhesions or scar tissue, then it's not unreasonable to consider an arthroscopy of the knee. In the right patient this type of procedure can be successful to help achieve further flexion of the knee. This surgery is less successful in achieving further extension.
Best of luck.
Orthodoc
