Revision TKR Hmm. Not thrilled with the revision yet

[eaglemom]

I have no idea how you did non-weight bearing sistersinhim. Today I did try to have less weight on the right leg, but I'm not sure how good I did. I'll try tomorrow, but man o man that is difficult. You have my admiration for being able to do it for 6 weeks.

 

[sistersinhim]

It was extremely difficult, especially since I couldn't use crutches. My old knee is too weak for them. I then used the walker. You can't go down steps with a walker, so I went up and down on my butt. That was a real chore in the rain! I eventually got a wheelchair and a ramp. That helped a lot. At my 7 week checkup I was allowed to touch my toe to the floor. That helped a lot with my balancing.

 

[Jockette]

I eventually got a wheelchair and a ramp. That helped a lot.

I can just see you whizzing down the ramp in a wheelchair, thinking, look mom, no hands!!

 

[sistersinhim]

The first time we tried it, Marilyn was in the front as we went down it and I tried to hold it back with the wheels. Well, that was a Keystone Cop moment! One wheel went off the side of the ramp and I'm hanging on the chair, leaning the opposite way trying to keep it on the ramp. We then got the giggles. Eventually I got my rear on the ramp and she repaired the chair and finished the trip. For then on both of us were really, really careful.

 

[Jockette]

Not to minimize your safety, but there is some comedy there.

 

[eaglemom]

I'm glad no one was hurt in the using of a wheelchair ramp!! And thank you for a giggle - giggling with you, not at you.

 

[sistersinhim]

Oh yeah, we've laughed about it many times. It wasn't so funny when I was hanging on for dear life with my right foot and leg sticking straight up, though! It's good that God got us out of that situation safely.

 

[eaglemom]

I get to see the surgeon this week. As per my usual, I'm nervous. This time I really have no idea what he'll do. My gut says he'll say 6 week non weight-baring & then a CAT scan. As I've stated previously, I really have no idea how I'd pull that off. Of course that's what I think he'll say. Hopefully he'll have a better plan.

As for the thigh it doesn't hurt constantly as bad as it did. It does still hurt and when walking it is uncomfortable / hurts. What I'm really noticing is how sore my knee really has been. I'd guessing walking - all be it with a walker or crutches - on a stress fracture has me walking differently, thus the discomfort. I will say I'm most comfortable laying in bed with elevation and ice - that's my happy place!! I'm trying to be off my leg as much as possible but life keeps getting in the way!!!

This stress fracture has thrown me for a loop. I've never dealt with something like this, and hope I don't have to again. No matter what this knee is FAR from being reliable/pain free or even painless/less swollen/etc. I'm thrilled that I now have extension which I didn't have prior to revision #3. But now my ROM is barely 90 and it was better before the revision. Ugh. I'm not winning the knee battle, yet.

Odd question - if I'm put on non weight-baring, I can assume that means no driving (right knee) correct? That will be a huge issue, but I'm sure it can be worked around. We've used Urber before and that will just have to be the way to get around. Our friends are wonderful and I don't want to burn them out.

 

[jboles]

Oh my! Hopefully you won’t be non weight bearing, or it won’t be for long. I’m sorry you’re going through all of this. It is so disheartening when it’s just one thing after the other. Here’s a virtual hug

 

[eaglemom]

Oh, thanks for the hug jboles - I needed that. And here is one back at you. This afternoon I laid down and to my amazement woke 2.5 hours later. I didn't think I was too tired. What it probably is that pain uses energy, thus the nap. Oh the tails of TKR / revision recovery.

 

[sistersinhim]

I loved those unexpected, nice afternoon naps! They really helped me feel better. Sleep is healing and very good for you.

 

[jboles]

You’re probably correct about pain using energy, I know it’s draining... I’m feeling really low these days, just tired, a nap is usually nice though!

 

[eaglemom]

Well, tomorrow morning I see the surgeon. Yes I'm a little nervous what the next step will be. I only wish he had a magic wand to wave (and wave over everyone here) and magically we'd all be better. I'm not even asking for good, just better with less pain. I'll report back. Sadly I'm thinking it will be "wait and see." Hope I'm wrong.

 

[sistersinhim]

I pray your appointment is a success. Please let us know what you find out.

 

[eaglemom]

I'm in shock, seriously. Surgeon came in we very briefly chatted about the knee and he sent me for multiple xrays. He even had them xray my hips. Multiple ones on the knee in all sorts of different positions.

When he came back in the exam room he started off with "well, I have good news & bad news. Let me explain." What has happened is the extended rod in my femur is moving slightly -and caused the stress fracture. That hasn't changed. However, my bottom prosthesis is loose and sliding laterally. In other words both are loose. The plan is open me back up - he will remove absolutely everything hardware/prosthesis wise. He will then prepare both bones of extended rods. Now he'll inject the area with cement then insert the next long rods & wait for it to seal around the prosthesis. For the spacer he's doing a different kind - my mind was spinning and I did't catch it.

He then tried to aspirate the knee - ouch ouch ouch. He could not find a pocket of fluid and was pleased. Then massive blood draws. He kept saying "your knee has humbled me." He said he wanted to get me out of pain and onto recovery so "how about in the next 2 weeks we get you a new knee." Holy smokes! Yes please.

I felt going into the office this was a possible outcome but frankly figured he'd do multiple tests, wait and see before getting to this point. I never dreamed he'd again replace both top and bottom. Sigh, guess I'm special.
He said setting them in cement would be secure instead of relying on the bone - which clearly isn't holding the implants.

There you have it. My head is spinning. This will be new right knee revision #4. How insane is that? Ugh.

 

[Jockette]

Oh my!!!

So are you saying that you currently have cementless implants?

 

[eaglemom]

Jockette what he's used in the past in a glue. And he hasn't glued the entire stem, he doesn't like to do that. He feels with cement it will hold the prosthesis securely to the bone. And in a way strengthen the bone since the prosthesis isn't touching it.

Hope I explained that correctly. Frankly right now I don't know which end is up. Since my hubby doesn't drive and has a diagnosis of early on set dementia I've got to make certain his needs are met. He's helpful and an excellent nurse - after you've asked multiple times. (That sounds bad of me, but its just the truth of the disease.) We'll get through it, I just hate the routine change for him.

Two major surgeries in 7 months - and I think I'm tired now!!!

 

[Jockette]

I pray this next surgery is a final fix for you.

 

[Jamie]

This will be new right knee revision #4.

@eaglemom ... I'm confused. You say this next surgery would be revision #4, but I only see 2 revisions in your signature. Have you had a revision surgery that's not listed there? Or maybe you're counting your original TKR?

Your explanation of what the surgeon plans doesn't make complete sense to me. In those fleeting moments when you're talking with the surgeon, it can be difficult to get everything completely straight, so I understand that you might not have picked up on all the details as the surgeon went through his explanation.

There is no such thing as surgical "glue" that's used for joint replacements. Implants are either cemented or uncemented. The implant components are designed to be one or the other and there are specific guidelines from the manufacturer for how they are placed in a patient's body during surgery. It would be unlikely that a surgeon would use bone cement on any part of an uncemented prosthesis and equally unlikely that he would not use the cement on every part of a cemented prosthesis, so this is why your description that he only "glued" part of your revision implant left me a bit confused.

An uncemented implant is designed with a special coating that allows your bone to grow into it to form a strong bond with the implant. The cemented implant design does not have this same coating and instead relies on the surgeon's skill to force the cement into your porous bone while it's still in a workable phase of the hardening process. Both these procedures require a tremendous level of skill from the surgeon to get things just right. In a cemented implant, once the cement hardens, if properly applied it will form an extremely secure bond with the bone. Here is an image to show how the bone cement (yellow) is forced into the bone to forum the bond.

Without going back through all 27 pages of your recovery thread, can you quickly tell me why you had each of your revisions and any pertinent details about their failure just so I have your entire story straight in my mind? Were all the surgeries done by this same surgeon and can you provide the name(s) of your doctor(s) for me? I'd like to know a little more about their areas of specialization and see if possibly any are currently on my list of revision surgeons for the area in Texas where you are located.

 

[eaglemom]

Sorry Jamie, your correct I was quite busy listening to everything he was saying. I'll try to fill in the blanks.

Yes I now have uncemented implants. He was explaining that the bone grows into the implant - forming something like a glue to hold it. That was what I was meaning. Sorry for the confusion.

My original TKR was Oct 2013. Revision May 2017, Revision #2 Feb 2019. This next one will be Sept 2019.

My first was done by Dr. Tsay, Southlake, TX. The others have been done by Dr. Robert Schmidt, Ft. Worth, TX. (His practice, Texas Hip and Knee) is listed here on BS. He is known for his thoroughness and revisions. I guess as with all 'good' physicians he is difficult to get into. He has to review your past surgeries, etc before he'll accept you as a patient. I really like him, his beside manner is wonderful and his PA is almost as good as he is.

My original TKR the top component became loose, thus the revision. The next was because of instability, not necessarily loose, but not tight and a smaller spacer was used. This upcoming one is because instability and looseness of both components. The bottom on the medial side and the top at the top of the long post.

As an aside, I'm a KS girl, born and raised in central KS. Both hubby and I are KSU graduates.

Hope I answered your questions.