I'm back, with questions!

[loribee59]

I'm going in to get a 2nd opinion tomorrow afternoon (2/23)with a surgeon who's very familiar with revisions (referred to by my OS within the building)

I think I talked about this before about this weird pain in my left knee...and regardless of everything I've done to it, I'm still having pain in the satorius area (see this thread)

I'm doing pretty good on my right knee...considering what was done differently compared to my left: my OS put in a smaller spacer (by 2mm!) and made my knee more hyper-extended, and although I can bend pretty good...I still need more work on the extension.

The left knee is more of a worry to him: because of my auto-immune issue, I tend to have scar tissues, and also with previous surgeries I had on my left knee...I developed them when I had it replaced. His worry is that I'll get MORE scar tissues, because it will be open once again, to replace the femoral part and to put in a smaller spacer. By replacing the femoral piece my femur will have to be cut into to make this work. He's worried that with the revision, that I'll lose more flexion/extension. He gave it a 50-50 chance of success with the revised surgery. Also, he told me that laser or regular excision of scar tissues don't always work...so what are the options out there?

Just walking around, I can really feel the difference in both knees...the right knee don't bother me as much, even for long distance, but my left knee would start to ache right where the pain is, within 10 minutes.

doing pool therapy helps with my right knee, but I'm not making much headway with the left. so little degrees of flex/extension *siiiiiiigh*

Would appreciate advice/suggestions asap.

thanks so much!

 

[Jamie]

Loribee....I'm so sorry to hear you are having these problems. Yours sounds like a pretty complex situation and I'm going to have to defer to Josephine for medical comments. But I wish you the best with your second opinion tomorrow. Please let us know how the appointment goes.

 

[Josephine]

because it will be open once again, to replace the femoral part and to put in a smaller spacer. By replacing the femoral piece my femur will have to be cut into to make this work.

I'm a bit puzzled by this - are they talking about using a smaller overall size or a just thinner spacer?.

If they cut back the femur, they'll then need a thicker spacer, not a thinner one.
And if they're talking about using an over-all smaller size spacer, then they need to change the tibial tray that takes it.

*confused*

 

[loribee59]

I dunno, but from what I can feel in my knees, my left knee was..."tight" whereas my right knee felt looser in terms of what was done differently. Plus, I never had previous surgeries on my right knee, so I didn't have any problem with my knee, only just the typical aches and pains that go with healing process.

But I was told that I could be given several options on how they're going to do it..more or less a contingency type of surgery. They may swap out the entire set, or cut the femur, or put in a smaller spacer-- but like Jo said, replacing the spacer would mean replacing the tibia part. So it's all down to what's really needed to be done to give me more mobility and less pain.

In my mind, with that 50-50 chance of success, I'd rather have that than to live with this pain I had for the past 3 years.

 

[loribee59]

Addendum: my OS and I looked at my xrays yesterday of both knees...the implants are exactly the same size, just the spacer size is different.

 

[Josephine]

Right - so they should only need to change the plastic spacer. It actually doesn't matter that I don't understand it as long as the surgeon fixes it, right? And God willing, he will. Please, do ignore my musings!

 

[loribee59]

Right - so they should only need to change the plastic spacer. It actually doesn't matter that I don't understand it as long as the surgeon fixes it, right? And God willing, he will. Please, do ignore my musings!

Musings or no, they're helpful! I'll let you know later what 2nd opinion doctor says...

I told a friend about that 50-50 chance, and I liked the way she thinks- "well, at least it's 50% BETTER than 0%!"

 

[Josephine]

You'll get no argument from me on that!

 

[loribee59]

Alright, I'm back with a report that it's a green light with my knee revision.

I'm scheduled to have it done on Monday, August 23rd (I need to build up hours at work to do this)

What my doctor said that yes, with scar adhesions, it will be difficult and challenging, but NOT impossible to do the revision on my left knee. Most of the revisions he's done was mostly due to stiffness and it was to revise the joint to release the stiffness.

However, by either replacing one component, or all, the risks to the surgery is about as much, or more, than the risk(s) I get from a regular TKR. I could get an entirely new set or simply get a smaller spacer, who knows...but he will try to get my left knee a bit 'looser' like my right knee. What I'm feeling now, is so tight I could hardly flex without triggering pain.

I did ask him if he had cases like mine and if the revisions were successful.... he says that his patients had slightly better mobility than what they came in before. If I can get that much 'slightly better' chance--I'll take that! It will be challenging to remove the scar tissues, as it involves the tissues, not the muscles or bones. I rather have a 50% more improvement than what I have now.

I wanted my original OS to assist him, but it'd be impossible to get him into the same op room as he is...so I asked him if I could have my original PA to assist him, he grinned saying that he had a PA just like my original one LOL I feel like I'm in good hands. I know the drill with pre-op, surgery prep, hospital care, home care, etc... so I know what's expected as well as the risks.

But in the meantime, while I'm waiting for the big day, I can keep up with my pool therapy, and healthy eating, as this will be the incentive to get my left knee to work better before, during and after surgery.

Would appreciate some input and/or encouragement! :D

 

[Jamie]

Lori, I love your friend's attitude. That's the spirit you need to keep going!!! Your surgeon sounds like he knows what he's doing and so I think you are making the right choice here. I'll do my part by keeping you in my prayers. I hope you can stay relatively pain free until August.

 

[Josephine]

Lori, you have nothing to worry about!! It's going to be fine and that surgeon sounds a really good bod.

 

[brs0660]

Lori...sounds like you are in good hands...start praying for them now!:pray:

 

[Nursepair]

Hey Lori, Sorry about your problem. My first knee never got it's flex back fully so this time my OS put in a smaller spacer and already I have more ROM than I had with my first at this 3 week stage.

Good luck. I am sure your OS ill have you all sorted out eventually. (((HUGS)))) Sue

 

[loribee59]

Hey Lori, Sorry about your problem. My first knee never got it's flex back fully so this time my OS put in a smaller spacer and already I have more ROM than I had with my first at this 3 week stage.

Good luck. I am sure your OS ill have you all sorted out eventually. (((HUGS)))) Sue

that's so awesome, Nurse! that's what I'm hoping--that I simply get a smaller spacer and just get my knee to loosen up, and scrape/debride the scar tissues.

the biggest concern I have is the possibility of having the entire implant replaced, and that it could shorten my leg AND dealing with risk(s) that are much moreso than the TKR the first time around.

I found a medical report about injecting something into the knee during surgery to prevent scar adhesions, and also a drug that was taken 2 hours before surgery and soon after the surgery to cut down chronic pain and help the patient have more mobility for 3-6 months post-op. I can always email that to my new OS, but will he accept me as a patient who's proactive? that would really suck if a doctor give me a brush-off about that...

 

[Jamie]

Lori, it's okay to ask a question like that, but I think it might be better done via a phone call to his assistant or nurse rather than an email. I have to admit I've never heard of anything like that, though. Do you have a link to the medical report?

 

[loribee59]

Pregabalin
one paragraph sticks out:

In addition patients that received pregabalin experienced a greater knee range of motion (ROM) following surgery with the ability to perform simple tasks when returning home such as climbing stairs with a ROM of 85 degrees compared to a ROM of 79 degrees for the placebo group. Patients can climb stairs at 83 degrees of knee flexion, descend stairs at 90 degrees and rise from a chair at 90 degrees.

Another: https://www.anesthesia-analgesia.org/cgi/content/abstract/110/1/199

And this one: https://www.mskreport.com/articles.cfm?articleID=3202
============================

Google this: Hyaloglide®, a hyaluronan derivative gel
problem is that most journals dated back in 2007 have studies on rats and rabbits and I've no clue if this gel was used on humans...but it really looks promising.

And this one, also looks promising, especially that it's used in orthopedic surgeries.

The viscoelastic cushioning fluid acts as a cushioning barrier between hard joint surfaces during the immediate post-surgical period before the synovial fluid has had a chance to be replaced naturally as well as to act as a replacement synovial fluid for a short period of time. It reduces postsurgical inflammation by creating less friction within the joint and acts as a joint lubricant. It also reduces postsurgical scarring by acting as a barrier to prevent blood from reaching tissue surfaces and forming adhesions. Postoperative joint swelling is reduced eliminating the inflammation which causes the joint to fill with fluids and recovery process is shortened by eliminating or minimizing post-surgical complications.

 

[Jamie]

Interesting information....and if you're interested in pursuing it, I would send him an email with these links AND make an appointment to discuss it. Give him your appointment date in the email and indicate that you have made the appointment specifically so you could go over this information with him as it pertains to your situation. Then, when you go in (just in case), take printed copies of the information also.

The important thing is to word your email in such a way so that you are not coming off as trying to tell him how to do his job, but more seeking information about how the material in these articles might apply to you.

Do let us know how things go!

 

[loribee59]

Thanks Jamie! (I have a niece named Jamie )

Think I'll schedule an appt with Dr C (my new OS) to ask him question about 3 months pre-op and what I'll do is email him with the information, and say that I'm due to see you on this date to ask more questions regarding the email (and bring papers too)

that way I can get most of my concerns out of the way. especially with the possibility of re-doing the whole implant... and dealing with the pain pills. I had a doozy of a time with pain pills back in August...NOT fun, I tell ya! Learned a lot of things back then and think I know what to look out for this time around.

 

[Josephine]

:skp: I'm saying nothing ...

 

[Linda2]

It all sounds unnecessary to me--only my very humble, nonmedical professional opinion. By the end of the first week or two any benefit is negated by the natural processes of the body. I would place more faith in adequate pain medication and regular heel slides.