Revision TKR Hood1980’s Revision

[Hood1980]

As far as the OS’s explanation for the misalignment, using the X-ray on the computer and the mouse, he quickly drew lines, showing my “native” leg at 6* and my operated leg at 10*. Drawing more line very quickly, wishing I could have snapped some pictures, he drew a nice straight line on the femur showing it perfectly straight and then another on the tibia with him stating it was off 5*. No explanation of how this happened and by this time I am so anxious? upset? Stressed? It’s all I can do to hold it together and my DH is writing everything down as quickly as he can. We agreed not to get confrontational, because I’m not going to use him, if I have a revision anyway. I do see in the notes that Computer Assisted Navigation was not used and neither was Custom Patient Instrumentation. Sounds to me that he made an inaccurate cut.


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[Jockette]

They do talk so fast and even if we’re not upset it’s hard to keep up.

It is beyond upsetting when procedures don’t go as planned, especially a procedure this big, and the resulting big impact it has on you, physically, emotionally and mentally.

I hope a new set of eyes can offer you a good solution. We’ve seen here on Bonesmart so many differing opinions from surgeons, and you have 2 more surgeons to talk to.

 

[SusieShoes]

I'm glad you got some answers to your questions. So many people get the "oh, it's nothing" or "the implant is fine, just learn to live with it" runaround from surgeons. As upsetting as it is to know your knee really is misaligned and needs to be fixed, there is a silver lining in that it CAN be fixed.

The implant Celle showed you a few posts back does compensate for the ligaments! I have a family member with an implant like that. Her knee is as stable as anyone else's, and she's doing great.

I know it's hard to trust medical procedures right now. Your first surgery, and surgeon, let you down and you're feeling down and out. It's a kick in the gut and takes so much out of a person. I hope talking with these other surgeons, who specialize in fixing problems like that with your knee, will instill confidence again. There's really so much hope.

 

[kayow11]

@Hood1980, and @Jockette, Ladies, please try not to despair over possible future surgeries. Believe me, I know how you feel and I've been there THREE TIMES IN THE PAST YEAR, but I did survive and fortunately finally had a good outcome. I know how it feels to not have a life either, and all your thoughts and energy being put into trying to get better with many setbacks.
I once read that 80% of the things we worry about, never comes true. I've been guilty of this many times but that phrase helps straighten me out.
I suggest that both of you see at least 2-3 revision specialists, besides your current OS that may have done your surgery and may also do revisions. If you need to have another surgery because you can't live with what you have now, then you have no choice but to do your research and go for it. It did help me to discover that my last surgeon felt quite confident in his ability to fix my problem. That made me feel better even though I knew he wasn't in fallible. Of course pray a lot and try not to worry so much.
I would bet that they all have different things to say. Don't dismay too much about what one says, unless all three of them say the same exact thing. And even then, remember your Maker has your best interests in mind, and you just need to pray for guidance and wisdom during all of this research and likely surgery, and then just trust. Be encouraged, you still could end up with a good outcome.
My last surgeon said I don't have any ligaments left in my knees, because the prosthesis replacement takes care of all that. I don't feel like my knees are unstable. They just don't bend very good because I think that's just me. I swell easily and seem to stay that way for a while. I think it's just my body's reaction to stress and trauma.
My last surgeon used the same type and brand of prosthesis that was in there because he was only replacing the top half of it, and it needed to be compatible with the tibial component. I know my issues may be different than either of yours, but there are usually solutions to these problems. It just takes the right OS, but we all know that there is no guarantee.
Anything negative can happen with any surgery. You can't go into it thinking that there is going to be likely failure, or other problems arising. You have a possible 30 plus more years of walking on your legs, so one or two years now is not the end of the world.
You need to try to do the right thing now and not worry about your current obligations. Things usually fall into place somehow, and you can't be responsible for every body and everything, especially when things come up for you personally where you will be incapacitated for a while.
I know that a lot of us women feel we have to hold everything together, our family, and sometimes way more. It is OK to be the recipient at times.

 

[Jockette]

Wise words, @kayow11 , thank you!

 

[kayow11]

@Jockette, you're welcome.
I like to be an encourager when I can. But I am also a realist and don't want people to have overly optimistic expectations either. I also shed many tears after my second surgery, realizing I would have to go through all of this again. It was quite depressing at times I admit, and I also felt angry at being a victim of someone's apparent carelessness.
Thankfully, I have a God I can put my trust in, and just leave my concerns there in His lap. I think both of you have the same views, and it is at times like these that we need to put our faith into action. So there it lays and we need to leave it there at His feet, and move forward.
That is one of the most wonderful things about this forum, that we can share our experiences and give personal advice from our own hearts to help others.

 

[Celle]

I’m sorry I’m telling y’all what my surgeon said. He wanted to be able to retain the femoral component and only replace the tibial one. I have read the articles prior to surgery and briefly just now. I’m not sure they would work together.

No, they won't work well together. If you're going to lose the cruciate ligaments, you will need both parts (femoral and tibial ) of the cruciate sacrificing hardware. Trying to replace just one part won't work.

If it were me, I'd be inclined to go to a different surgeon for your surgery.What this one said just doesn't sit well with me.

Concerning alignment of your legs, if you want to, you can post a picture for Josephine to look at. So she can measure, it should look like this picture and include hips and feet, preferably with shorts and bare feet.

 

[Jockette]

@Celle , she did post a picture and Josephine commented, it’s on page 7.
I don’t know the post number, it doesn’t show up on my phone.

 

[Celle]

Thanks, @Jockette - I'll look back for those posts.

 

[kayow11]

I agree with Celle, and that what your surgeon said to you doesn't feel good In my gut either. He is either unsure of himself, or unwilling in his heart to really do your revision.
I know you weren't really planning on having him anyway, but that is not the kind of surgeon you want to choose, to do this job.
An excellent surgeon will know what to do. I think it is common to have a knee prosthesis used where the ligaments are not needed. This is their specialty.

 

[kayow11]

@Hood1980, @Jockette, Remember too, that your misalignment, and mine, and Jockettes problem,(?) all fall into the small percentage of failures and problems. It is highly unlikely that another surgery such as the revision, would again fall into that small percentage category. We were just extra special and lucky the first time, ha ha.

Be hopeful that it likely will have a very positive outcome. But do your homework for your surgeon, and check him out best you can, with plenty of questions, and a couple office visits with any further questions, or even a repeat of some former questions, a couple times before the surgery date, just to make sure you feel good about him. I did this very thing with my last surgeon.

You have every right to do this, and they want the business anyway. It might set your heart at greater ease. After all this is done, sometimes you just have to go for it, unless you have a bad gut feeling. It's normal to have some uncertainty and nervousness about all of it. I sure did.
If you aren't having other problems or can't move forward, you can always wait a few months to see how things change or become stagnant. That will also help you make your decision.

I waited six months, and I didn't want to wait longer because I was continuing to have back and foot pain, along with increased knee strain. I knew it wouldn't improve unless I had a correction.

 

[Hood1980]

No. That just isn't true. Did you read what I copied above? A joint with the sort of hardware illustrated is just as stable as a joint with retained cruciate ligaments.

Thanks @Celle! That’s so good to hear, but was hoping to avoid the pain of going through a complete revision vs just the tibial component. Do you know if the complete revision is more painful? Pain meds don’t work for me, unfortunately.

I definitely will be going to a different surgeon! My first appointment with a revision specialist is next Friday!


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[SusieShoes]

... hoping to avoid the pain of going through a complete revision vs just the tibial component. Do you know if the complete revision is more painful?

Replacement of the spacer only can be less painful because it's a less aggressive procedure. There's no cutting of bone involved and less disruption of surrounding soft tissue. You're looking at a revision, though, which means replacing actual prothesis components (not just the spacer), and it doesn't really matter if it's one component or both, you're still dealing with a KR.

You're looking at another TKR recovery. The only good part about that is you have experienced what that's like and can maybe plan ahead. Make sure your surgeon knows your pain control will be challenging; tell him or her what worked last time. And plan for LOTS of elevating (it really helps!) and icing (also helps).

 

[Jockette]

My first appointment with a revision specialist is next Friday!

Same here!

We’re you able to watch any of the JRAD videos? If so, I am seeing Dr. Garino, he talked about pain management and rehab at home, the two things I was most interested in.

 

[kayow11]

My revision was only the femur component which was removing the titanium, bone cement, a little extra bone resurfacing, and then re-application of the cement and a new plastic meniscus replacement part.

He didn't have to touch the tibial component. I must say that my pain was somewhat less than the original surgery, and I feel that in some ways my function and ability to do a few more little things was accelerated with this last surgery.

I assume it was due less work done in the knee joint, and less disruption overall. However, it still was a knee replacement surgery with many of the same symptoms as before. Even though I am 10 weeks out now and farther along than 10 weeks ago with the other two surgeries, it still is a long rehab.

A good revision specialist will only do what needs to be done, and we have no control over how much that involves. I know it's nice to kind of know what they plan to do, but what needs to be done will be done, whether it's a full replacement, or partial.

My misalignment was about 10° off. It had to be fixed. No other options. I am so glad I did it, I am in recovery 10 weeks now, and most everything is looking up, ever so slowly

 

[Hood1980]

Thank you ladies for all the great advice and uplifting messages. I hope to be as positive as you soon @kayow11 and @SusieShoes, but I am not there yet. I am so happy to have you all for support and @Jockette to compare "notes" with! One thing my surgeon told me, that I hope is not true, is that 30% of patients undergoing revisions don't get favorable outcomes. That seems discouraging to me, especially since i went into this originally with such high hopes of having a better quality of life and now may have to settle for something less than that.

 

[Hood1980]

My misalignment was about 10° off. It had to be fixed. No other options. I am so glad I did it, I am in recovery 10 weeks now, and most everything is looking up, ever so slowly

My original surgeon said I could live with it if I wanted, but he knew I wouldn't want to, but I don't want to go through this again on the same knee! I wish I was as strong as you!

 

[Jockette]

We are not strong when we get bad news. That’s when the support of others holds us up. We acquire strength for the situation a little at a time as we go through it.

 

[kayow11]

Well stated @Jockette.
I think that Susie shoes and I may have a different perspective on all of this simply because we have worked in the medical field and have seen and heard many things.
I'm not convinced of the doctors statement of 30% of revisions not going well. I'm sure it depends on what is being fixed and if they have a good solution to repair it.
I know mine was straightforward per the surgeon, but I know anything can get screwed up, even the simplest things such as the original surgery.
Do you have symptoms from your misaligned knee? Or does it just look bad?
When I hear bad news, I dig in and fight. I look for other options just to prove them wrong. I don't want to be their failure or victim as they state could happen.
I don't think I have a strong pain tolerance either, but I refuse to be worse off than I was before surgery. Somebody has to fix this situation! We live in a country with great health care and very talented medical professionals. Most things can be fixed and I was willing to give it a third try, and thankfully it is so much better.
I can think of so many worse diseases or sicknesses or situations that could require another surgery, that would be much much riskier, with probably a less favorable outcome. This is bad enough I know, but it could be so much worse.
I still have some back pain but it is much more under control than before surgery. My foot pain, (inner arch pain), is less also, hopefully that will resolve completely too.
Please don't dwell at all on the thought that you are likely going to have a poor quality of life because of all of this. Don't accept that. Put on your mental armor and advance forward.
I wasn't positive of a favorable outcome before my last surgery, and I wasn't even sure the surgeon would do things correctly either.
But I did take the chance which I felt was worth taking, due to the other circumstances.
Do your research, see the surgeons with your questions, ask God for guidance, and then make your decision.
Life has no guarantees, but thankfully we have many choices, and most of us can make a decent life for ourselves and our family, no matter what is thrown at us.

 

[Jockette]

Put on your mental armor and advance forward.

I love this!