TKR I really didn't know what I was getting into!

[Josephine]

Should I let her go ahead with diagnostic tests?

Can't hurt for now

My guess, based on certain facts, is that the problem is tibial tray overhang

Weren't you going to try and get me some xrays pictures? I'll need both views, side and front-to-back

Should I tell my surgeon that I want a second opinion?

For what purpose? You don't need her permission and it's inadvisable to involve surgeon #1 with this anyway.

And should I really put up with my level of pain and disability

No you should not!

I can try to get in to see him earlier, but I have no connections, he's very busy and his "gatekeeper" is protective.

Why not write him a letter? She'll have to show him that.

I'm getting so confused that I don't know what's right for me any more!
I just know that I want to get rid of this chronic pain asap and be able to walk normally again.

Question in sentence #1 answered in question #2!!

I had no idea it might not work.

Did you really not? When you has do sign your consent form, were you not given a list of possible complications which would have included things like infection and blood clots. In there should also have been things like "no resolution of pain" and "it might not work". These are required in the UK otherwise the patient can be said to have signed their consent without proper information.

 

[Knees4Me]

@Josephine - Thanks for your advice, as usual.

I think that was another person who was going to send you X-rays. I can't download them from the hospital's intranet site onto my iPad or iPhone. My desktop computer has been out of commission, but if I get it going, I'll try to post the images to your attention.

That's a brilliant idea to write a letter to the revision specialist. I will!

And no, I really didn't know there was a possibility that my TKR could not work or go wrong. My GP pushed for it and said "they don't consider it knee surgery anymore." On the other hand, my surgeon did tell me that it was "a big surgery." She came out of the OR smiling, according to my husband, and told him that everything had gone well. The next day she told me, while doing her rounds with her residents (I hope she didn't let them operate on me!), that my knee turned out to be "challenging" to work on, that it "didn't look the way it did on my X-rays", and that she had to change the original surgical plan she'd made for me because I was "bigger on the top than on the bottom." At the time, I had no idea what she meant because I was doped up in a hospital bed.

I was shocked to discover later that tibial and femoral components do not come in custom sizes and the surgeons put in a standard size, then close you up - and hope for the best. When I asked to talk to her about my continuing chronic pain early in October, she told me that only about 10 per cent of patients have any pain from a larger component. Lucky me. I suppose there could be another problem. I want every test to determine a correct diagnoses before I go under the knife again. This has been an awful year and I don't want to be in the same situation another year from now. I am also becoming extremely unfit since I can't do any aerobic exercise without my knee hurting when I bend it - even swimming! I worry about my general health.

No, I don't remember signing anything, but maybe I did without reading the fine print. I believed the supposedly expert doctors who told me that everything would be fine and I'd "get my life back." How uncharacteristically naive of me! Apparentally, some Americans sue their surgeons when they're left with painful tibial tray impingement and other problems. I don't know if any have been successful. We're not as litigious here in Canada.

 

[Jamie]

Let me tell you that patients may sue their surgeons here in the US (there's always a greedy lawyer out there to take your money) but the cases that are actually won or settled will be few and far between. It's difficult to prove negligence. I suppose some may be settled for "nuisance" value, but my guess is the attorney takes a huge chunk of that and then the poor patient still is left with a problem joint. It's not a route I'd recommend in very many cases! So don't be disheartened about that.

I'm sorry that your plans for travel have taken a turn. Unfortunately you are the only one who can make the decision as to whether you should wait for the surgeon who's supposed to be really fabulous or go with the number two guy whose reputation isn't quite as talked about. You know.....that doesn't mean he's not good. And it also doesn't mean that the "top" guy might have an off day with you. There just are no guarantees when you're working with human beings!

If you want to travel, I say do it. Using wheelchairs in airports isn't bad...it's GOOD! You get to go to the front of the lines. You board the plane first. People make sure you get where you need to be and they take care of all your luggage for you. What's not to like about that!!! Enjoy your royal treatment and tip well. It makes you much more rested during travel. I know because that's something my husband and I learned. We relished our pampering when he needed a wheelchair.

As for walking with a cane or walker, I see people traveling all the time like that and having a great time. You just have to adjust your mind to look at the memories you're making with your husband. And plan your outings so that you can enjoy them. Maybe rent scooters at your destination. We did that on a trip to Disney World and had a blast. You don't really have to be handicapped to benefit from a little help with a lot of walking! We were fresh all day and night and saw many other younger people tired and stressed from miles of walking.

 

[jaschembra]

To my knee-twin Judy, if you are able to view your X-ray from the hospital site on your iPad, maybe you'll be able to take a picture of it with your iPhone? I did that in the doctor's office - while it was up on his screen, I took a picture with my phone. I feel your disappointment regarding being recently retired and wanting to enjoy it. I retired 3 years ago and 4 months into it, I had the right knee scoped and my chronic pain on both knees began. I'm still very grateful to be retired though.

I wish you well on your OS visit.

 

[jboles]

I’m sorry you’re having so many issues. My left knee is 6 months old and my right knee is just one week. I have good flex and extension in left, but it clicks and still has some pain. I hope it continues to improve. I understand what you mean about doctors just pushing you to sign documents. I think if they really sat you down and went over in detail everything that could, and sometimes does go wrong, I’m not sure they would be doing as many replacements as they are doing. They are really quick to tell you how you’ll get your life back, they just don’t tell you it will be a year away, at least mine didn’t.

 

[Jockette]

They are really quick to tell you how you’ll get your life back, they just don’t tell you it will be a year away, at least mine didn’t.

Same here!

 

[Josephine]

they don't consider it knee surgery anymore

Eh?!!! What a pillock!

she told me that only about 10 per cent of patients have any pain from a larger component

I'd say that would be a very over-done guestimate. More like 2-3%

I don't remember signing anything, but maybe I did without reading the fine print

I doubt the US of Canada are any different to the UK in this but they have to get a signed, informed consent from a patient, otherwise any surgery of treatment would be considered to be battery or assault and the due process of the law would be very severe.

if you are able to view your X-ray from the hospital site on your iPad, maybe you'll be able to take a picture of it with your iPhone?

If this would be for the purposes of posting it for me to view, it MUST have a very high resolution. I know my phone is set to 15,000 x 10,000 pixels. Anything less is not fit for diagnostic purposes. And the photograph must also be taken straight in front of the screen and not at an angle.

 

[Knees4Me]

@Jamie - It's such a small world! Two days ago a friend asked me, because it looks like I'll need a revision, if I'd like her to get the name of the surgeon another of her friends had perform a successful TKR. I said yes, please, because I want a second opinion, preferably with a revision specialist. I waited a day while she got the info from her friend. And guess who it was?! The very Dr. Jeffrey Gollish whose name you gave to me a few days ago! He's the one who's a colleague of my original surgeon, at the same hospital where I had my operation!

@Jamie @Celle @Josephine - What do you recommend that I do? Should I ask my surgeon at my appointment with her on Thurs., if Dr.Gollish is the surgeon who does the TKR revisions in that hospital...or if she consults with him about her cases before she goes into the OR? I already know from my last appointment with her in October than she plays to do my revision, if I go ahead with one. She said she doesn't want me to be in pain.

With my degree of pain and disability, I really don't know if I can wait months or maybe even years to get a consult - and then a revision - from the surgeon at another hospital. And that's IF he'd agree to take on my case.

@Jamie - Re: wheelchairs - I don't know if I told you, but I did use wheelchairs at both airports when my husband and I recently took a one-week vacation to Jamaica. For the first time in my life, there was no way I could walk the long distances. (Before my surgery, even though both knees were very arthritic, but with much less pain than now, I managed with walking poles.) On one hand, I was embarrassed because I thought I really should not need a wheelchair at this point in my life. But I was also exhilarated, because my husband and I were both whisked past all the long lines of tired people waiting to go through security, customs and immigration. I even joked to my husband that we should always get a wheelchair, whether I need it or not! But, of course, I would never take one away from those people who truly need it.

 

[Lywn]

My heart goes out to you. I took over my own PT. I had a similar experience as the 70 year old. I was in severe pain for 30 hours afterwards and told the nicer PT I would never let anyone touch my knee again. My knee was like a water hose...the more water that runs through a garden hose, the harder it is to bend it. Some of my exercises I should never have been doing in the first place. I just do the stretching exercises because that is my greatest problem. 4 months out and I know now I still have time to bend and straighten. We're all individuals and sometimes surgeons and PT's treat us all alike. We're not in a competition or a reputation building race. We're individuals who just want to get well and have a life again.

 

[Josephine]

What do you recommend that I do? Should I ask my surgeon at my appointment with her on Thurs., if Dr.Gollish is the surgeon who does the TKR revisions in that hospital...or if she consults with him about her cases before she goes into the OR? I already know from my last appointment with her in October than she plays to do my revision, if I go ahead with one. She said she doesn't want me to be in pain.

I think all of that.

 

[Jamie]

Yes, I'm in agreement with Jo. I think you need to have a frank discussion with your current surgeon about who should do your revision. If Dr. Jeffrey Gollish is a colleague and does more revisions, you should respectfully ask to have a consultation with him before deciding who you would like to do the surgery. Don't worry about offending your first surgeon. These folks are professionals and they know how to handle such requests. After all, their primary desire is to see a good outcome for you.

 

[Knees4Me]

@Josephine @Jamie - Thank you both for your sage advice. I had my one-year review this past week. I had understood from my orthopedic surgeon - when I saw her in October about my continuing pain - that she may have to do a revision because my X-rays showed a very slight tibial tray overhang. She said if I was still in pain by my one-year mark that we might need to discuss revision surgery. So I was trying to steel myself mentally when I saw her two days ago.

This time, my OS actually had new X-rays taken (which she said looked good), looked at my knee and physically examined me herself. In October, she didn't do so much as look at or touch my knee. She let her resident do it, then swept in and looked at my X-rays. But this time, she was able to pinpoint with her fingers the exact spot of my knee that hurts whenever I bend my it, e.g., when I stand, walk, cycle, sit down, stand up, go down stairs, etc., which she diagnosed as a knee cap problem: patellar tendinitis. (After reading everything on BoneSmart, I can't help but wonder if the aggressive rehab I had for 10 weeks post surgery left me injured!)

The OS's prescription for me is more time...and physical therapy (which threatens to bankrupt me!) to increase flexibility and strengthen my "lower extremity core." She also sent me for blood testing "to be on the safe side" to check whether I have an infection, but she thought that possibility was low. She said if I don't hear from her in about four days, I don't have an infection. She said to rub Voltaren on my knee and take Tylenol, as needed. She also said I should continue to lose weight (I've lost about 10 lb.) and get my lower back assessed in case there's a nerve causing pain down to the knee.

Then she said she'd see me in TWO YEARS! I guess she figures she's covered all the bases and her work is done!!

So...I got good news (no revision surgery) and bad news: she told me that about five per cent of TKR patients will have chronic pain for the rest of their lives. Jolly. I hope I'm not one of the unlucky few! (The odds do seem to be in my favour, but you never know!) That fact combined with this difficult past 13 months have given me pause about rushing to have my arthritic bone-on-bone right knee replaced. The jury is out whether I'll have the same surgeon operate eventually. I'm keeping my place in line for a consultation with "the best knee guy in town", but the wait is 14 or 15 months. I'll try to get in earlier.

For anyone on BS who's interested in my continuing knee odessey, stay tuned. I'll post on any progress or lack thereof. Thanks again for everyone's support, suggestions and advice through the this long, frustrating experience. I wish you all good health, including good knees!

 

[Josephine]

she diagnosed as a knee cap problem: patellar tendinitis. (After reading everything on BoneSmart, I can't help but wonder if the aggressive rehab I had for 10 weeks post surgery left me injured!)

Without a doubt!

The OS's prescription for me is more time.

Oh ... is there an echo in here? WHERE have I head that before!

..and physical therapy

No, no, no! It was indubitably PT that caused this in the first place. More PT is not going to make it better!

She said to rub Voltaren on my knee and take Tylenol, as needed.

Don't waste your money on Voltaren gel. There is proof that it doesn't even penetrate through the skin never mind as far as the knee! But Tylenol is good. 1,000mg 3-4 times a day should do the job.

Then she said she'd see me in TWO YEARS! I guess she figures she's covered all the bases and her work is done!!

Yep, looks that way!

 

[jaschembra]

Well... the really good news is... she doesn't think you need a revision. I know we've discussed this in the past and my return to PT in Oct really helped my patellar tendinitis - as it turned out. I don't think it was and neither did PT. She deep rubbed that area over the scar and my burning and stinging went away. She thought it was some scar tissue.

But each is different as we definitely know from reading BS. We are in similar boats travelling this slow water and if I had to have an emergency TKR on my right knee, right now, I would choose a different OS, just because of my length of pain.... I would stay on that wait list too.

Here's to us eventually getting pain free! It will happen. I just know it.

 

[Knees4Me]

@Josephine - What do you suggest would work to relieve pre-patellar bursitis pain...more than 2½ years post TKR? Thanks!

 

[Josephine]

@Knees4Me A cortisone shot would be worth a try or if it truly is pre-patellar bursa, then perhaps a possible remedy might be excision, assuming you can find a surgeon willing to do it.

 

[Knees4Me]

Thanks, @Josephine. Not sure which word you meant to use rather than ‘memory’. My GP just told me injections are expensive. It may be hard to get a doctor who’ll even give me a cortisone shot! But I’m willing to try anything once to get some relief from this chronic pain. And my other arthritic knee is complaining, so maybe I’ll need two shots! I’m not keen to go down the TKR path again just yet!!

 

[Josephine]

Not sure which word you meant to use rather than ‘memory’

I have now edited it - it should have been remedy!

My GP just told me injections are expensive.

Well not if they achieve the desired result! What a meanie!