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I'm in a serious situation with my L knee

Discussion in 'Knee Replacement Pre-Op Area' started by HRLyons, Aug 9, 2017.

  1. HRLyons

    HRLyons
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    I need to ask if anyone who has needed knee revision due to loosening, mechanical failure, dislocations etc., with complex issues in addition to OA with your knee, if you had any other surgical option aside from revision to fix your knee please?

    I have a history of severe knee fracture, resistant muscle atrophy, nerve damage, RSD/CRPS, arthrofibrosis of the knee, and severe osteoporosis of the limb. The PKR needs to be revised but I am afraid the TKR may "fail" too. :bignono:

    I had a severely shattered, displaced fracture of the knee a decade ago and gone through the mill with surgeries on it. Including knee reconstruction/partial replacement. It's never been the same, nor pain free. Ive at best been toe-touch with wt bearing, requiring a brace. knee ROM is very limited due to the scar tissue. So it's been almost like having a fusion due to all of this. If a knee is destroyed that severely, sometimes it just may feel better to bedone with it.
     
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  2. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Hi and welcome to BoneSmart! I can tell you now that we've never had anyone with a similar history on here. Sorry.

    But I can tell you that with your history, it was very ill-advised for them to do a partial knee replacement. You'd have been better off having a total straight away. Partials have a very poor history of having to be converted to TKR. Having read all your history, I would suggest that your best remedy will be a constrained knee which gives excellent support to osteoporotic bone and muscle atrophy and prevents the extra, abnormal movement that would worsen things like arthrofibrosis and RSD. Here is a picture of such a knee which is specifically designed for problem knees just like yours.

    hinged 1-horz.jpg

    We do have one member who had a similar device to this implanted after a history of repetitive infections.
    I'll tag her for you but she's not on the forum much these days so it might be a while before she comes to you
    @RestAssured
     
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  3. HRLyons

    HRLyons
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    Thank you so very much! I really appreciate your support and advice! The ortho attempted to salvage bone as I was in my 30's. After clearing the scar tissue when removing the Fulkerson screws, he discovered a large defect in the medial compartment as well. Chrondroplasty didn't help. After 4 surgery, the specialists felt the RSD was too aggressive, risking revision. But now with the patello-femoral loosening, they're reconsidering it. I would love to chat with the other member with this! It's a scary complex sort of issue here. Thank you once again!
     
  4. HRLyons

    HRLyons
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    members pic.jpg
     
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  5. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Welcome to BoneSmart, glad you joined us!
    I have the constrained revision knee similar to what Josephine posted. It is very stable and works well.
    There have been a few members who had a prior pinning or osteotomy who went on to do very well.

    If you go to the recovery forum and click on a yellow revision prefix, a list of members with revisions will appear, you will be able to go through and peruse their stories.

    You may want to seek out a surgeon who specializes in arthrofibrosis.
    Arthrofibrosis: Names of US surgeons with experience in arthrofibrosis
     
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  6. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    I realise this was a while ago, but I think his caution was ill-advised. Though I suppose it's all too easy to be wise after the event!
    A minor issue but the screws are bog standard bone screws. It's just the procedure that is called a Fulkerson osteotomy and I remember scrubbing for very similar procedures back in the 70s and 80s! It was for the same reason but the one we did was called a Maquet (pronounced 'mackay') osteotomy.

    Fulkerson osteotomy.jpeg

    @HRLyons I wonder if you would be kind enough to provide me with a list of all your surgeries? Then I can put them in your signature and it will help me and other staff, to understand your predicament. Thanks very much
     
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  7. HRLyons

    HRLyons
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    Thank you very much for the information and for sharing, Josephine and Pumpkin.

    I appreciate the warm welcome and for your help.

    I'm happy to see about your procedures and success w/ your knees too.

    I used to work sub-acute care myself but even 10yrs ago, the RSD/CRPS wasn't really heard of. I had a MVA May 10 2007 and suffered a severely comminuted left patellar fracturewith damage to R PF joint.

    Surgery-
    5/15/07 L patella-ORIF with extensive soft tissue and quad repair
    9/27/07 L knee MUA with hardware removal
    1/26/09 L knee arthroscopy scar tissue debridement, Depuy PFJR, Fulkerson osteotomy, lateral release
    2/3/10, L knee, removal of osteotomy screws, medial chondroplasty, scar debridement
    Nov 2015, L knee OA, dislocations, progression of osteoporosis, "mechanical failure, aseptic loosening of PFJ replacement.

    Awaiting clearances for revision surgery. Also from 2010 to current a myriad of treatments and procedures for RSD and peroneal nerve injury. R knee- orthovisc series, cortisone injections
     
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  8. HRLyons

    HRLyons
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    I almost forgot to add zappy! Last surgery in 2011- 2/10/2011 Spinal Cord Stimulator implant-Precision by Boston Scientific
     
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  9. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Thanks for the information. We prefer only joint replacement information in signatures. As you can see, I edited most of your surgeries as the bare details are sufficient! Hope this is okay with you.

    You're right about CRPS being a fairly recent discovery. I remember when we had a new member who said she had RSD. I found very little online about it but kept searching over succeeding months and did eventually learn that RSD was a subsection of #CRPS. This is hashtagged on this forum so you can see when it is trending here. Our Library article on the subject is here Complex Regional Pain Syndrome (CRPS or RSD)
     
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  10. HRLyons

    HRLyons
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    Thank you for summarizing everything so efficiently Josephine. It looks great! :) I really appreciate the links to the AF docs too! I've heard of some but wasn't exactly sure where they were located. Considering the aggressiveness of CRPS, the scar tissue (which still affects ROM today) and the fracture risks going into revision, I might need a surgeon who can manage all of those things if that's possible? My ortho isn't a scar tissue or CRPS specialist but, he does alot of tough knee cases. Sadly his team can't run the "protocols" intra and post-op that'll help. And the CRPS doc is 2.5 hrs away. I hope the other member with it is doing ok! Unfortunately mine was discovered quite late. Thank you for adding RSD/CRPS to the library section too! Wishing you a wonderful day and thanks again!!
     
  11. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    If your present surgeon has admitted it's out of his league then you may have to travel. It would be worth it I think.
    We haven't heard from her in a while but she did pop in and tell us she'd opted for a knee fusion and was doing well.
     

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