Revision TKR Instability Question

[SusieShoes]

Getting used to your new TKR and the gait changes that come with it can definitely cause hip and back (and sometimes other body parts) pain. My back hurt — on and off, more or less — for the first month or so after my surgery when I would go on little and then longer walks. I also had minor hip discomfort, calf pain, and some foot pain. Eventually it all sorted out. No such pains today.

Stronger exercises at three months should be okay. Your knee will tell you if they’re not. You still need to take care to not overdo the exercises or activity, and will still want to elevate and ice for any swelling.

Don’t know much, alas, about the neurobiology of pain. Our minds can create phantom limb sensations and pain, though, so there’s definite interaction between the perception and reality!

 

[rah2435]

I hate to keep harping on this but... my left knee is so lax and hurts so much when I walk (it mostly buckles and feels like the inside tissue is being scratched...and inflamed). Interesting thing is that it doesn't hurt AT ALL when I awaken in the morning. It starts when I get out of bed and start using it.

I keep thinking that there must be something structurally wrong. Is there some kind of test I can ask to get performed that could determine if there is something going on?

I know I can't get an MRI...right? It's like I'm missing a tendon (like someone who had an ACL injury) and that the knee or something is rubbing against my soft tissue in a weird way or ... I don't know. I feel desperate.

I mean, the new knee makes it clear to me that something is really wrong with the older one. But what?

I want to be able to stand and walk without pain!!

thanks
Rich

 

[KarriB]

You can have an MRI, there are special machines for people with metal. An x-ray may help your OS to see if there’s a problem.
I had pain when walking for quite a while until I began to build up the muscles around my knee with a walking regimen. When I walked at work it hurt, shopping, standing for too long even at 2-3 years and I had strength work at PT. But walking was the only thing that helped. If your OS says everything is fine you might think about building walking (knee) stamina slowly. Now I intentionally walk a few miles everyday and have no issues with shopping, standing etc.

 

[SusieShoes]

If you are sure something is wrong — and your surgeon tells you there’s nothing wrong and nothing he or she can do — you should consider getting another opinion. A second opinion or even a third or fourth if needed. You need to find a surgeon who isn’t connected in any way with your current surgeon, not even as a golf buddy. You want your knee to be this new surgeon’s only consideration, not the feelings or reputation of your first surgeon.

A new set of eyes might be able to see what your first surgeon doesn’t.

And you can get an MRI. The implants are made with non-ferrous metals and images can be collected with adjustments that take those metals into account. If an MRI is needed, you can safely undergo the imaging.

 

[rah2435]

walking regimen

Yes - I'm trying this. I'm trying just short walks (10 -20 minutes) at a time. Thanks.

 

[rah2435]

nd you can get an MRI. The implants are made with non-ferrous metals and images can be collected with adjustments that take those metals into account. If an MRI is needed, you can safely undergo the imaging.

Great info. Now - how can I get my insurance company to pay for it.... hmmm.....
I know it's partially a "nerve" issue. I get those kind of pains. I think. I don't know. Ugh!
I just know something isn't right on the left leg. Yesterday I was DETERMINED to stand and walk regardless of how much it hurt (and it really hurt...not muscle pain, nerve pain ... i think...). I CAN DO IT! This is good...so I'm not REALLY cripple... but it really hurts when I do.

The surgeon I'm working with is really good with me. I don't know who he plays gold with though LOL!
I'm seeing him again in 5 weeks and we may try some shots in my leg and if that lessens the pain a rhizotomy!

 

[Jockette]

Did the same surgeon do both knees?

 

[rah2435]

Did the same surgeon do both knees?

no. he did the good one.
He did do a spacer swap on the left one too - two years ago.

thanks @Jockette

 

[KarriB]

Definitely see your OS if writes a script for an mri your insurance will most likely pay for it and get his opinion then if the pain continues a second opinion. If you can explain where the pain is @Josephine may be able to help you.

 

[Josephine]

my left knee is so lax and hurts so much when I walk (it mostly buckles and feels like the inside tissue is being scratched...and inflamed). I'm trying just short walks (10 -20 minutes) at a time.

Actually, 20 minutes is not a short walk at 13 weeks if you are having problems.

I know I can't get an MRI...right?

Yes you can - read this MRI scans and joint replacements

Is there some kind of test I can ask to get performed that could determine if there is something going on?

The only thing I can think of would be a GAIT assessment to make sure you are walking correctly.



I'd really like to offer you some structured advice again but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[rah2435]

Actually, 20 minutes is not a short walk at 13 weeks if you are having problems.

Hi @Josephine and thanks once again for caring! Actually the 13 week knee doesn't bother me much at all. It's the 5 year one that does.

GAIT assessment t

They do this at PT - I'll ask them to do it again. When I first started PT they did this and told me I did look a bit off but nothing major - considering my now .9 CM LLD.

Are you willing for me to do that?

of course.

 

[rah2435]

Ok – I haven’t written here for a while but I’m hoping someone will be able to shed some light on these mysterious events that are still occurring with my left TKA.

I just had the right one done last March and so far – it’s really good.


The first one – my left – continue to give me a LOT of trouble.

Short history:

1) Left TKA in September 2013

2) Never felt right – later found that I had femoral nerve damage, leg length discrepancy (left leg 1 ¼” longer after surgery – down to ¾ or so” after second knee done) and mid-flexion instability.

3) Had spacer swapped out in 2015 – helped somewhat with stability but added a few millimeters to my LLD

4) Recently had nerve test study done (again) and was told that the femoral nerve has healed – but now I have trouble coming from my back.

5) The way the left knee feels is so hard to describe. Mostly, after standing or walking for just a bit, the knee feels sponge like … awful and it seems to stiffen up, or feel like it does (I can still bend it) balance is a problem.

6) Went for a like 8th second opinion – doc think it’s my back. He didn’t want to hear about the LLD ( I had it x-rayed, he didn’t look).

7) What is going on???? When I look at my two knees in x-ray – you can see the big difference between the spacer sizes. I’m wondering now if the spacer has ALWAYS been too long, the femoral nerve damage took the muscle away creating the laxity, and now that the muscle may be coming back…. The thickness of the spacer is causing things to stretch and feel awful? ( An earlier neurologist told me the femoral nerve damage was “stretch damage”)

8) SO – I’m getting shots in my back – and wondering if I need another spacer swap or maybe an entire revision.

9) I just want to be able to stand and walk without it being such a challenge. Standing in particular is very hard. Queues are impossible for me.



Anyone?

 

[sistersinhim]

I'm so sorry to hear you are having such a problem with your left knee. I am going to tag @Josephine, our forum director and nurse, to address your questions.

 

[Jockette]

I understand a bit how you feel. My partial is almost 2 years old, and has never felt right. I’m getting ready to seek a third opinion since my second one was no help at all. That was almost 7 months ago.

 

[Josephine]

What a litany of issues! I'll do my best to address them

7) What is going on???? When I look at my two knees in x-ray – you can see the big difference between the spacer sizes.

Do you have these films? Can you post them for me? A few tips on posting xrays


Can you show me the site of your pain using this chart?

 

[rah2435]

Hi @Josephine - thanks once again

Do you have these films? Can you post them for me?

I don't but I called and requested copies. I should have them within 7-10 "business days" I'll post them when I received them

Can you show me the site of your pain using this chart?

It would be D-LF3 ... not really anything much in the back of my leg. Pain will be ZERO when I wake up in the morning. Goes to about 6? when walking and standing... the more and the longer I walk or stand the worse it gets.
I also get nerve pain at times : A-LF4 (and a bit higher) to D-LF4. I also get some numbness/tingling in my left foot - outside of foot and toes. this also increases with walking and standing.

I had an MRI done of my spine and also a nerve study test that does show stenosis around L3-L4. This has gotten worse since my initial left TKA. I guess walking the way I do doesn't help my back. I had no known back issues prior to that 2013 surgery. The nerve conduction study also showed that my femoral nerve damage is gone! (some good news)

thanks again.
Rich

 

[Josephine]

So similar to this?

That looks to me like Hamstring pain
The green could be sciatic pain

 

[rah2435]

The green could be sciatic pain

yup :-/

 

[rah2435]

Do you have these films? Can you post them for me?

here's we go @Josephine

 

[Josephine]

Sorry, rah, those films are not of diagnostic quality.