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[TKR] Implant loose soon after surgery.

psych96

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I had a TKR 1/10/19. I was a very active person and in pretty good shape prior to surgery so figured should be easy. The 1st month I was the poster child for recovery. Had 125 ROM then and by 6 weeks @ 135.

However, at PT I was given wrong exercise to do and it gave me IT Band syndrome and pes bursitis which set me back for several months.

I continued to work at PT and gained quad strength so could do more, still had great ROM but a lot of stiffness,swelling and discomfort, especially at night. Dr. kept telling me it was early days like they say here but there was no improvement over the past month and then started regressing.

Finally on the 3rd or 4th post operative visit (usually only 1 within 6 weeks and then don't see them for another 3 months but I was in more often due to pain and lack of progress) after I told him I simply could not live like this as things had gotten so bad I couldn't do any of the things I used to do, he ordered bone scan and surprise I have loosening of implant.

I am so upset about this, angry that no one listened and just not sure how I can get through another 5 months of downtime.

My surgeon is referring me to someone at his institution who does the revisions but should I trust them. I hate to say I have really lost faith in the medical profession. As soon as he saw the bone scan that was it, his assistant called to say I was referred out.

How does this happen. I have no PT coverage left as the place that I was going to went way over my medicare and supplement coverage limits (somehow got them to approve twice the normal allotment) without letting me know so there is no more funding for PT this year.

I cannot afford PT out of pocket so don't know what I am going to do. I am single and live alone and can't see another 4-5 months of being stuck in my house.

I also wanted to mention that continued pain is not necessarily part of normal recovery.

I have followed this site and just want to say if you are still in a fair amount of pain or are regressing this is NOT normal.

Yes recovery can be a long process but you need to be sure there aren't other things going on and my regular x-rays were OK. You need to demand that they do something. I don't think they would have done scan if I hadn't been in tears and told them I couldn't go on like this.

I already have chronic low grade treatment resistant depression that I manage with exercise so really afraid what is going to happen now that I won't be able to exercise.

Anyone else get the diagnosis of loosening of implant this soon after surgery. Is it the surgeon's fault, the implant or what. How does this happen. Well if you made it this far, thanks for listening/reading.
 

Pumpkln

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@psych96 ,
You'll notice that I have moved your newest post and started your recovery thread. For several reasons, we prefer that you have your own recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • With your own recovery thread, you will see the posts and advice others have left for you.
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
 

Pumpkln

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psych96 ,
The country you checked is Uganda??? Your insurance sounds like USA Medicare with a supplement??
Let us know, an administrator will change it for you, Thanks!

Sorry to hear you have a loose implant so soon after surgery. I am going to tag our Forum Nurse and Director, @Josephine to advise.

Recommend you seek a second opinion for your TKR, from a surgeon specializing in Revisions, they have the education and background to determine what is happening with troubled knees. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.

If you see the surgeon you have been referred to, make sure they do a lot of revisions every year.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

lovetocookandsew

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I understand your frustration as I also had issues after my TKR, which turned out, at least in part, to be from a loose implant, so finally agreed to a revision. I believe the problems started at around six months post TKR. I didn't put any blame anywhere as to how it may or may not have happened; my goal was to get it fixed and get on with my life. I chose to do absolutely no PT after my revision as I have learned over many surgeries that, for me at least, PT as it often is today is not helpful to recovery from this surgery, and, IMPO, is often more harmful. Instead I spent my initial recovery icing and elevating my knee, and walking around my house and yard. I read the activity progression article every single day to help remind me not to do too much, or too little, at any given point in my recovery. I gradually increased my activity as my knee recovered and pretty soon time had passed and I was at a month, then three months and so on. This recovery was so much better than the original one, that it actually shocked me....in a good way. It really drove home the fact that no two recoveries are the same, as my recoveries were night and day.

You shouldn't be stuck in your home for five months...as long as you're off pain meds and your doctor clears you, you can drive well before that time frame. I don't remember the exact time I was driving but it was somewhere around six weeks, if I recall correctly. It's frustrating, and we get angry, upset and the rest of the emotional scale, after a failed TKR, but at some point we have to bite the bullet and get it done in order to take our lives back. I wish you nothing but the best as you go through this journey. Please, keep us posted, and feel free to ask questions, vent and share as needed-that's why we're here!
 

Josephine

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As soon as he saw the bone scan that was it, his assistant called to say I was referred out. How does this happen.
My feeling is that he doesn't do much in the way of revisions so it's probably best that he referred you to someone who does.

I take it it's the tibial component that's loose? It usually. And is your TKR cemented or uncemented?
I cannot afford PT out of pocket so don't know what I am going to do.
That's okay, you really don't need PT anyway. So long as you walk about and use your stairs (assuming you have them!) and so on, that's really all you need. I never did any exercising for either of my knees and yet got excellent outcomes both times.
 
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psych96

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Thanks Josephine. I really don't know if it's cemented or not. Somehow I get feeling it might be cemented but not sure. I have not really been told anything at this point. Not even sure if should be doing much on knee as it has gotten quite painful to even walk. I was just worried as I saw something, I think on this site, about not having whoever does your revision have any relationship with the original surgeon. I am still wondering what caused this. Anyone out there had to have a revision as outlook seems questionable from what I read. Just remembered they said the issue was on lateral side which I guess is fibula?
 

Lindylee

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I'm so sorry to hear of the problems you're having. You had your surgery just 11 days before me and I can't imagine how you must feel, but just wanted to send a virtual hug :console2:. Good advice from those who have posted. I hope you find a surgeon who can reassure you and that you can move forward with a successful revision and recovery.
 
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psych96

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Thanks Lindylee. Hope you are doing well!
 

Josephine

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Not even sure if should be doing much on knee as it has gotten quite painful to even walk.
Then don't walk on it! You're 21 weeks out now so surely don't need too much of it anyway.
I am still wondering what caused this.
I'm still wondering what caused mine! Looking at the xray, it looks to me like the bone has died back from the cement for some reason but why that should be is anybody's guess.
 
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psych96

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I decided to do some research on the Dr. my surgeon's office is referring me to who they say does their revisions. I am a bit hesitant as he only has 7 years experience and does not show up anywhere on Internet as someone recommended for revisions. On the other hand 2 other doctors at this institution (Rothman Orthopedics) who have 10 and 20 years experience are listed as in top 5% for this. Why wouldn't they refer me to them. My distrust of the medical system is making me wonder if I am just being referred to the newest kid on the block. Given his lack of experience (in the scheme of things 7 years doesn't seem that much to me--before I retired I was a psychologist and my knowledge at 7 years versus 15-20 was night and day although I recognize that these are different fields) I am not sure that I feel comfortable with him. What do others think. On the other hand I am having enough difficulty walking that I don't want to wait forever either. Needless to say I am just freaking out a bit about this whole thing.
 

Celle

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Why not go and see him and ask about his experience with revisions? You may find he is very knowledgeable, but if you feel you'd rather see someone else, you do have the right to request that. It often happens that people ask for second , or even third, opinions.
 
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The new guy may specialize in revisions. When I was at my 8 week check up I asked my surgeon if he did revisions. He's well known and respected in these parts for TKRs and THRs so I was curious if he also did revisions. He said he did, but he also told me they were recruiting someone at their institution who's only done revisions his entire career and considers no revision outside of his scope. That would mean when he had 7 years experience he also already had 7 years experience doing revisions. I'd take that over someone with 20 years doing TKRs who's only done a few revisions. In any event, I see no reason why you couldn't ask for whoever it was you wanted to do yours.
 
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psych96

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Thanks for all good input. I did go see this Dr. He saw me for about 5 minutes. Said bone scans are useless the 1st year out, so no real indication that implant is loose even though the report suggested this - but I do understand it is difficult to do these scans this early.

Said he wouldn't want to do a revision (good news) at this point as joint seemed OK and x-rays OK, but ended up saying I had complex regional pain syndrome (worse news if true).

However, I'm not convinced this is the issue as I don't have a lot of burning, tingling, pain on touch. Most of my pain is with weight bearing, stiffness, slight ache at rest sometimes.

I can actually rub all around my knee and while it feels funny and some slight discomfort it is not all that painful; can sleep on my stomach. He pushed into my knee all around and said since it hurt all over and that it was shiny (no one else can see anything different between my two knees other than scar) that that was what it was.

I really am wondering if this is the stock answer to continued pain after TKR.
Has anyone else had this experience.

Was told to go to pain clinic. Do have appointment but I'm afraid they are going to want to put me on Lyrica or Neurontin and I really don't like taking meds that may not even need and that have bad side effects.

My understanding of CRPS is that people are in such pain they are will do to anything (my pain is not like that--just difficult getting around and not improving).
And of course the pain clinic is associated with institution that did the original replacement.

Has anyone else had this experience, any advice. Thinking I need to go to different institution for 2nd opinion.
 

sistersinhim

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I totally agree that you need to go to a different doctor that has no contact at all with your current doctor.
 

Calgirl

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So sorry you are having these problems.
When I was 7 months post op after TKR and still having pain my OS said I think you may have CRPS and spelled out the entire name and told me to go home and look it up!!! This was a prominent OS in San Diego!!

I told him to send my x-ray to Pain Management UCSD. His reply was we have Pain Management in their practice.
The next day I received a call from their pain management to ask when do you want your LUMBAR SYMPATHIC NERVE BLOCK set up. I told them I wasn't going to have anything without seeing their doctor and they said they could set up appointment. I NEVER set up appointment with their pain management and NEVER went back to that OS again.

My general practioner, PT and other OS denied that diagnosis. And of course when I looked it up I knew that I didn't have those symptoms.

When I went to Pain Management at UCSD, RF ablation of the genicular nerves around the knee was done. However, it did not help with the pain.

Some OS will not even see you until you are one year post op. Certainly would not do a revision within that year.

I was never without pain after my TKR. I started taking Gabapentin (Neurontin) one year post op which "masked" the pain.
I saw 8 OS who did xray, MRI, CT scan and they couldn't find any problem.

I went to Rheumatologist who did multiple blood tests to see if they was any underlying problem to why I had pain. I turned "no leaf unturned" to find the reason for pain.

Gabapentin helped with the pain until tibial component was loose.

Revision surgery done 7/17/18 and operative report found loosening in both tibial and femoral component.

I'm now 11 months post op and still have discomfort during the day and pain at night of about level 4 and still have stiffness. . I'm still on Gabapentin but is really not masking the pain as it did before. Nerve issues seemed to be the problem after my surgeries.

I think I'm doing better than after my TKR as I have a 2nd home in the mountains which has 18 steps to get to entrance to home. When I go I usually make 3-4 trips up/down daily. I'm able to walk about a mile. After 2 years I've accepted this as my NEW NORMAL. My other knee is bone on bone and unless I'm in excruciating pain, I will NOT have TKR on that other knee.

I did Yoga before these knee problems, then did chair yoga. Since surgeries have not done any. However about a month ago, I started a chair yoga class which has really helped.
 
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psych96

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Well the saga continues. As I had posted previously, initially my surgeon ordered bone scan and as results indicated possible loosening of implant, sent me to their revision surgeon. This Dr said bone scan useless as bone still healing, said a revision would make things worse and then said I had CRPS and referred me to pain clinic.

He was horrible; no empathy and to drop that diagnosis on someone without really knowing criteria was totally irresponsible and cruel in my book (I couldn't believe I had it). Went to pain clinic and they almost laughed and said I didn't have CRPS but there was nothing they could really do for me as pain in knee not localized.

Next step was a consult at a different hospital. This Dr also said bone scan useless as takes a year for bone to heal. However when he moved my leg below the knee back and forth (made a horrible noise which he said is not unusual) but also said seemed like too much movement. He thought it was possible that my ligaments were loose. So he gave me a brace to wear for a couple of months and if that works then he said I would have 2 choices; wear a brace for life (this is a fairly large brace with some metal so that will not be an option for me) or have a revision.

Has anyone had anything like this. What made ligaments loose and why revision. I am so upset with all these different opinions and my faith in medical profession is just about 0. Although at least this Dr is trying to do something. If brace doesn't work then back to drawing board.
 

Celle

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I'm sorry you seem to be getting the runaround with your knee.
It seems to be that, if your knee doesn't improve soon, the problem of the loose ligaments could possibly be fixed by having the plastic spacer between the metal components of your knee replaced by one that is slightly thicker.
We have had people here on BoneSmart who found that solved the problem.

You do have the right to choose which surgeon you choose for a second opinion - and it should be one who specializes in problem knees and who has no connection (either professional or social ) with your current surgeons. That way, he/she can look at your knee with new eyes and form an opinion independent of your current and original surgeons.
The only snag is that many surgeons are reluctant to give a second opinion until about a year has passed since your surgery. That's because some problems do solve themselves as time passes, and also they don't want to appear to be stealing another surgeon's patient.

You can start by looking for a surgeon in your area by using the Surgeon Locator (in the blue bar at the top of the page. This facility isn't complete yet, so you could also tag Jamie, give her your zip code, and ask if she has any suggestions for you.
 
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We have had people here on BoneSmart who found that solved the problem.
I was such a person. I had loose ligaments and clunking of the knee.

The next larger size spacer fixed everything.

When I asked him why he didn't get it right in the first place, he told me some people have a greater degree of "give" in their ligaments than others. He said he would never have knowingly left it that loose during the operation so it had to happen after.

Whether or not I believe that is irrelevant. The bottom line is the spacer revision surgery was a total success. It's been 9+ years and everything is working well. So much so that my left knee had no trouble being the support knee during my recent RTKR.
 
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psych96

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Thanks everyone for your responses. I have just asked for all my records as my sister in NC knows an ortho who is willing to take a look. But everyone I have seen, including new Dr. who is at Pennsylvania Hospital here in Philadelphia said xray looked good.

I had original surgery done at the Rothman Institute here in Philadelphia and the surgeon is the lead ortho for the Philadelphia Eagles and Phillie baseball team so thought I was in good hands.

So is the spacer issue a mistake in original surgery. At this point don't think I will go back to Rothman as they have given me a bit of a run around and really no hope. At least the surgeon at Penn is looking for answers although hate to wait another 2 months. I got his name from a friend who has a friend who used to do quality control as Penn Hospital so she got 3 names of "good" surgeons and this one was first I could get appointment with.

Not sure how to tag Jamie but will look into it. Thanks again, I really appreciate it. So wish I had never done this as this is a million times worse than before.
 

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