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Revision TKR Instability Question

Recommend you see your surgeon, and start looking second opinion for your TKR. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.
You can use the Surgeon Locator in the blue banner at the top of this page.

You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one 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.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
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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.
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@rah2435
I also gave you an rather lengthy explanation (in Post #296) about the different hardware used when your cruciate ligaments have to be sacrificed,. Together with Pumpkln's explanation, you have all the information you need.

It may be a good idea to look for a second opinion at this stage, as well over a year has passed since your surgery. You'll need a surgeon who specializes in problem knees, and one who has no connection at all, either professional or social, with your current surgeon.
 
Pumpkln said:
Recommend you see your surgeon, and start looking second opinion for your TKR. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.
Click to expand...
Celle said:
You'll need a surgeon who specializes in problem knees, and one who has no connection at all, either professional or social, with your current surgeon.
Click to expand...
Yup - that's who I went to see. Dr. Lee at Univ of Penn in Philly. I was told he was one of the "go to" docs for problem knees. When he did my revision he told me a hinged knee was a possibility he would consider when he had me on the table. He didn't opt for that. Instead he replaced the femoral component with a larger one and replaced the spacer again. He told me at the time that I should be very happy with this - and still says this. He told me what I need is pain mgmt.
I guess I could try someone else but I DO NOT want any more surgeries. UGH! I'm hoping there's something else I can do to make this more stable.
thanks again @Celle - I do remember your insights from before.
Rah
 
rah2435 said:
The Doc told me that this type is very limited in movement so he avoided giving me this
Click to expand...
I have a hinged knee, with -5 degrees extension, and 130 degrees flexion, that is very stable.

To make up for the instability you will need to strengthen the muscles around your knee to provide the support your ligaments would be providing. A PT or a personal trainer can help you.
 
Rah,

Rothman Orthopaedic Institute in Philly

Dr. Danielle Ponzio a board certified Orthopaedic Surgeon who specializes in knee joint replacement and complex revision joint replacement.

Excellent OS she has a great bedside manner listens to all of your concerns but most of all, she and her team know what they are doing.
 
Pumpkln said:
To make up for the instability you will need to strengthen the muscles around your knee to provide the support your ligaments would be providing. A PT or a personal trainer can help you.
Click to expand...

thanks @Pumpkln - yes we've talked before. I've done PT and continue to do so. But it just seems to me that my muscles continue to atrophy. It's a bit scary.

Rah
 
So are you currently in therapy to strengthen your muscles around your knee and in your leg? You don't mention pain....only instability and the inability to stand. Those can sometimes be helped with strength and gait training. If you are in therapy and it's not getting better, switch therapists. There is no point in going if you're not benefiting from it.

If the therapy doesn't help, then your only alternative would be to seek out another surgeon. You'll have to ask yourself if having another surgery (if a hinged knee is recommended) is worth it rather than having a knee that doesn't work properly. I can tell you we have had a number of members with hinged knees and they do just fine. It's true that you will lose some lateral range of motion, but for most people that's not an issue. They can walk, bend their knee, exercise, and do normal activity just fine.

Please consider at least talking to someone. Letting your muscles atrophy is never a good idea.
 
Jamie said:
You don't mention pain....only instability and the inability to stand.
Click to expand...
Yeah - I didn't mention pain but I do get pain. In my knee and my leg. I know I have back issues and something like sciatica but - I shouldn't be this unstable. I also have been getting some tingling in my left foot since the surgery. My right leg is doing MUCH better. ... it's so frustrating.... thanks for your advice and help!
 
Jamie said:
Those can sometimes be helped with strength and gait training. If you are in therapy and it's not getting better, switch therapists.
Click to expand...
@Jamie - I should mention that I was in PT pre- COVID until my insurance ran out then I was going to the gym. I do have a bit of a leg length discrepancy (1 cm.) and I think that "gait training" would help - I haven't really done any of this. Is there something I can do at home that would help?

thanks again,
Rah
 
Rah,
Your PT visits should have reset the first of the year. If so suggest you schedule a few visits for gait training and to determine if a lift in your shorter leg will help.
 
Pumpkln said:
lift in your shorter leg
Click to expand...
yup - I use one. I also recently went to see a podiatrist who took molds of my feet. I will be getting personalized inserts soon. You're right about the insurance year - but going to a PT place ... may need to wait until the vaccine. Until then I'm doing my own PT - or trying....
 
Your podiatrist can help you with gait also, since you have to go into pick up your inserts, let them know you would like gait training at the same time.
Be sure you are using a heel to toe gait.
 
Rah, BoneSmart is now partnering with a physical therapy group that has developed an app that provides exercises specific to you based on your gait. It's a home exercise program that analyzes your gait as you walk daily and use the app. You talk periodically with a therapist, who guides you as you begin to improve your strength and gait.

For the present, the use of the app is free to you. Would you be interested in participating?
 
Great! I'll send you a Personal Message (PM) and you can provide the details I'll need to get you going with the One Step app.
 
I've forwarded your information and you should be hearing from One Step soon.
 
Hello Bonesmarties,

So, I've been away for a few years now. Hello everyone.

I have a major issue I'm going through right now that I'm hoping someone on this forum may be able to assist.

I have two TKRs - the left knee was revised twice, once for a spacer swap and the other for a new femoral component. Both cases to address issues with stability. The revisions were successful but instability remains.

Now my right TKR, which has given me issues before, is starting to wobble. Actually quite seriously. To the point that I fear putting weight on it. Just standing in the shower if seems to be unsteady, like it is slipping. I went to see TKR surgeon, pain management specialist, and spine specialist. I've had both knees X-ray'd and my back examined with X-ray, MRI and Cat Scan.

My knee surgeon told me that the X-rays looked good. The tracking and the prosthetics in both knees looked good. My spine is another story. I have stenosis and degeneration. Also nerve conduction study's show enervation from lumbar spine. I have burning and numbness now in both legs. It started quite a while ago with the left leg, which is still worse, but now I am feeling it in the right as well. The right also seems to swell up a bit.
Thinking seems to be that the instability is due to stenosis and not the TKRs and maybe it has been the cause of my instability. MY spine surgeon (whom I trust) wants to do a minimal IO Flex on both lower right and left which he feels may (probably will) help the nerve pain and numbness and also help my standing an dwalking, hopefully correcting the instability. The idea being that my quads are not responding to PT or exercise due to the nerve issues. I've done quite a bit of PT over the past year or two and my legs do not seem to be responding in terms of increased strength.

As I was standing in the shower today I could not help but think that my right TKR just feels "loose". It's such a frustrating thing. I trust both surgeons - and I have seen quite a few in the past 10 years. But, before I agree to any spine surgery.... I don't know ... I want to be sure I won't need another TKR revision (right TKR was done in 2018).

Does anyone have experience with TKR instability due to stenosis or nerve issues?

thanks.
 
rah2435 said:
Thinking seems to be that the instability is due to stenosis and not the TKRs and maybe it has been the cause of my instability
Click to expand...
I am sorry you are struggling with instability of your joints and trying to figure out the underlying cause.
I don't have instability but I do have spinal stenosis. I remember the confusion of trying to work out what was causing what, between my hips, knees and back. I was lucky because straightening my leg did help my hips and back- but it can be hard trying to disentangle things when you have multiple joint pathology. The hips, knees and back can definitely interact and it may not be at all obvious which is the main source of problems.
Sometimes you have to get a few opinions to help you decide. I also found it helps to take someone with you to appointments and write things down. Both questions beforehand and notes from the consultation.
Good luck!
 
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