Revision TKR Instability Question

[rah2435]

trying again @Josephine
Sorry - the pain images - I just realized - were for the back of the knee..... This should be the FRONT ugh!!! Same area - just front not back. so - D-LF1 through D-LF4 and D-LF3. Sometimes it feels like the knee is tearing at the inside of my flesh when I walk. No effusion though.....

 

[Josephine]

D-LF1 through D-LF4 and D-LF3

Rah, there is NO LF1, LF3 or LF4.

The RFs are only 1 and 2 and the LFs are only 3 and 4.
In the front view the numbers go from 1-4 and in the rear view, they go 4-1
Just for your information, the coding on the grid is

Right Front 1
Right Front 2
Left Front 3
Left Front 4

and​

Left Back 4
Left Back 3
Right Back 2
Right Back 1​

 

[rah2435]

Please excuse my stupidity -
so based on

Right Front 1
Right Front 2
Left Front 3
Left Front 4
andLeft Back 4
Left Back 3
Right Back 2
Right Back 1

It's DLF3 and DLF4 - around the front and sides of the left knee. I also get pain (nerve pain) on the outside of my left leg which may be more than this chart handles (ALF4 and up...)ah. But just the knee pain and weird other feelings are around the knee itself - both sides of it and the front - around where the spacer is ... I guess.... Ugh! SO sorry - bad with this chart. :-/ It feels wobbly to stand on and sometimes feels stiff.

I have recently been diagnosed with "sciatica". But it feels like the knee is not right regardless of this. In fact - the issues with my back are, I feel, most likely due to knee surgery - specifically the left TKA done in Sep 2013. Nothing has been the same since. My left leg ended up longer (2.7 cm as I recall) than my right following the operation.

rah

 

[Josephine]

So like this

Have you discussed this with your surgeon? I think it may be appropriate for you to have a bone scan on that knee to exclude the possibility of a loose implant.

 

[rah2435]

Have you discussed this with your surgeon? I think it may be appropriate for you to have a bone scan on that knee to exclude the possibility of a loose implant.

Yikes! @Josephine ... that sounds kind of scary. No - this has never been mentioned. I assume we're talking left knee. It is cement-less...if that matters. The right is cemented.

What would make you think this?

I should mention here that these X-rays were taken by a surgeon named Dr Lee at Penn Univ. Hospital. My OS, Dr. Kahn, sent me to see this doc. Dr. Kahn told me he was a "go to guy" for diagnosing issues and "a second set of eyes won't hurt". Also, Dr. Kahn seemed to be interested in what Dr. Lee had to say about my leg length discrepancy.

I wasn't super impressed with Dr. Lee's attitude. When I tried to talk about my LLD he put that off as something that doesn't really happen. Wouldn't look at my measurement x-rays or anything else that my OS told me to make sure and bring along. He took his own X-rays (the ones I uploaded) and went from them. Gave my knees a physical exam, had me walk and stand up from a seated position. Checked my ROM (which is excellent) and felt the knees for laxity. He noted that he saw just as much laxity in my left as in my right. I had told him that my right knee felt great - I just had that done last March.

He did notice something about the femoral component of the left knee that might be a problem. Something, on the side/bent view. I wish I could remember what it was. It just looked like a spot on the x-ray to me. He told me it could "possibly" be responsible for my pain, but overall he thought things looked good and suggested that my back is likely the source of all my problems.

He told me he could do a replacement, but thought I should have my back "worked on" first. For now that means steroid injection into L4-L5 area. I had this injection last Friday. It seemed to help the sciatica a bit but - not the knee at all. It scares me that I do now have lower back issues that I did not have prior to my first knee surgery.

no mention of loosing but - I'll tell my OS when I see him.

thanks so much for caring!
rah

 

[Jockette]

It is so hard for those of us who don’t have a good outcome. I am also one that something is not right.

My surgeon offered me nothing at my one year check up, and my second opinion at 15 months only spent about 15 minutes with me.

I think there are times when they truly don’t know what to do or say so they pass the buck and blame it on something else. It’s very frustrating.

 

[Josephine]

I assume we're talking left knee. It is cement-less...if that matters. The right is cemented.

No it doesn't matter whether it's cemented or uncemented. Both can loosen.

He took his own xrays (the ones I uploaded) and went from them.

Rah, I've got to be honest - those xrays were about the worst I've ever seen! I am shocked to learn they were actually taken by a doctor! They actually look like they are screen shots from an MRI scan

This is the kind of xray I'd expect to see

 

[rah2435]

those xrays were about the worst I've ever seen!

it may be my fault. These were on a CD and there's some application you use to view them that I am not familiar with. I think it does some kind of 3d thingy... but these were the image files I saw.

:-/

 

[Josephine]

Didn't you just take a screen shot?

 

[rah2435]

Didn't you just take a screen shot?

The first time I did - and cut/paste into the post. The second time I uploaded 6 files that I "exported as jpgs" from the application.

 

[rah2435]

@Josephine - I have a follow-up with the OS who took these x-rays on Wednesday. I'll mention about checking for loose implant. The thought of a revision really scares me. Although - If it would mean I could stand and walk without feeling off balance and pain... I guess I'd go for it.

thanks
rah

 

[donnag1108]

Good luck on your follow up! I hope you get good news!

 

[Jockette]

I'll mention about checking for loose implant. The thought of a revision really scares me. Although - If it would mean I could stand and walk without feeling off balance and pain... I guess I'd go for it.

I also have symptoms of a loose implant and I dread a revision. My current recovery has been very difficult.

When I had my one year check up I wasn’t thinking loose implant, so that didn’t come up, but my surgeon did not offer any tests to find out why I still had so much discomfort and limitations.

I had a second opinion at 15 months, I did ask about a loose implant and that surgeon told me it was not loose. But he was relying on a 3 month old X-ray from my one year check up. He did not take his own X-rays and didn’t feel the need to order any other tests. In fact, he barely spent 15 minutes with me.

I am trying to get up the courage for a third opinion. It’s hard.

 

[rah2435]

@Jockette

I also have symptoms of a loose implant and I dread a revision

May I ask - what are these symptoms?

 

[Jockette]

My knee often feels out of joint, especially when I lean forward to do something, like making the bed, loading the dishwasher, leaning over the sink to brush my teeth, etc.

My knee is very sensitive to different angles. It loves my elevating wedge, but not the Lounge Dr that most everyone else loves, though I think my knee just got used to my original wedge and I didn’t try the Lounge Dr until about a year post op. Maybe if I’d only had the LD it would have liked that.

I absolutely can’t go down steps foot over foot. It’s painful and my knee won’t support my weight when it’s bent. I recently almost lost my balance because I couldn’t bend my knee and lean into the bend to get something on the lower shelf of a store refrigerator.

From what I understand, a bone scan is a way to find out if the implant is loose. I know it doesn’t always show up on an X-ray.

There’s an article in the library about a loose implant. I’ll go get it for you.

 

[Jockette]

Here is the article,
“TKR Symptoms of a Loose Implant”
https://bonesmart.org/forum/threads/tkr-symptoms-of-a-loose-implant.17510/

 

[Josephine]

The thought of a revision really scares me.

I know what you mean. I'm presently in the same boat!

 

[Jockette]

I thought of something else, I often feel something clunk/move in the knee when turning or picking my leg up to put it on an ottoman. I don’t hear a clunk, as many members do, but I feel it.

I also feel something move in my knee when just lightly putting body lotion on my legs. It’s a creepy feeling. I’m not sure if this is normal or not.

 

[rah2435]

ok - so... I saw my OS and he doesn't think it's a loose implant HOWEVER he has scheduled me to have a bone scan next week to be sure (Friday feb 1). Apparently the test is in two parts - three hours apart. So I get part one done at 11:00 Am and part two at 2:00 PM EST. If that is negative then he wants to give me a shot of ... I think he said lidocaine... to see if the "pain" is coming from my knee or not. (Remember - I do now have back issues at L4 and L5 - with sciatic like symptoms).

The thing is - I don't have swelling in that knee - it just feels very unstable and hurts. I know I have back issues but
1) this has been going on since 2013. I've not be able to stand with any real feeling of stability since then.
2) what came first - the knee issues or the back issues. I had no back problems before the surgery (at least I wasn't aware of any). Could walking with a LLD and screwed up knee cause my back to get worse - or was a silent-until-surgery back issue the culprit all along?
3) I know people with sciatica issues and back issues - but they have no issues standing and walking like I do.
4) The knee feels unstable even when the sciatica is not bother me.

AHHHHH!!!!!! more after the bone scan.

thank you all - again,
rah

ps:

I often feel something clunk/move in the knee when turning or picking my leg up to put it on an ottoman.

When the OS pulled on my knee there was a "clunking". He asked me if this bothered me and I said no. He told me "most people would't put up with that much motion". Meaning my knee was moving more than it should. yeah. He mentioned a spacer swap for a wider spacer! I told him I already had thi done once. ??

I'm presently in the same boat!

YIKES! You alway seemed to have so much success with your implants. @Josephine - I dreqd to think of you having issues......

of all the points list under the symptoms of loosening - the one that really fits me is:
Instability: there can be a sense that the knee may give way, although it may not actually do so it feels like it is threatening to do so

 

[Jockette]

the knee may give way, although it may not actually do so it feels like it is threatening to do so

I have that on occasion, also.