Revision TKR Isolated Polyethylene Exchange to Improve ROM?

Riddler

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I'm about 16 months out from TKA left knee. I experienced a great deal of scar tissue buildup and after very intense PT including any and all machines to improve my ROM. My extension is about 5 degrees and flexion is about 105. I can manage my life, but I still limp a bit and I'm not satisfied with my result. My surgeon states that because of my very tight knee joint (scar tissue mass and too thick plastic liner) he wants to swap out the liner/spacer with a thinner plastic liner (2-3 mm smaller). I would appreciate any knowledge and/or experiences with this procedure. All other components look terrific and in alignment. Should I agree to this revision or just suck it up and be grateful for a minor limp.
 
I understand your angst as I've been recommended to have a spacer revision surgery also. I am almost 10 months out from my TKA and have never regained full walking function. (Use cane and/or walker). My flexion and alignment are within normal limits but knee hyperextends. Also, contributing to dilemma is long-standing degenerative disc which had caused walking problems but I never had the recommended surgery before the knee gave out. Read via this Forum that replacement is usually a very successful operation and should help. If limp impacts your quality of life, I'd consider having the surgery. I am looking at that very decision and have to move forward as well. I am seeing a spine surgery next week to see which surgery recommended first. Good luck
 
@Riddler Welcome to BoneSmart! I have been on this board 10+ years and honestly can't think of one member who has considered this procedure to improve ROM. It is my understanding IPE may improve instability in the joint. You don't mention any instability.

One issue could be your "very intense PT". You have obviously found aggressive PT doesn't work. Have you tried backing off all that activity and letting that knee settle? Icing will also help.

We have many members who continued to see improvement in their ROM for many months/years.

Here is betrtschb's record of how his flexion developed over time:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees
I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.


And another record, from Campervan - she discovered that her flexion had increased even at 6 years post-op:
"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "
 
Jaycey ~

Thank you so much for your response! I've found it difficult to find any information about IPE (isolated tibial polyethylene insert exchange) and BoneSmart is the first site that I've found that has been able to help me gain some perspective on my knee issue. Will I continue to receive more info on my dilemma in the next couple of days? Anyway, I've already received more info than I've ever received. Thank you so much!

FYI, my knee is definitely not unstable. My surgeon even commented that it's very tight and I think that's because of the thick liner implant in the tibial tray coupled with the arthrofibrosis.

From the responses so far I may just continue to improve my ROM with time. That would be nice!!! I wonder if my ligaments and soft tissue will loosen up over time as well?

Thank you again. What a great site!

Riddler
 
@Riddler You will indeed continue to see improvement. Recovery can take one year or more as you have already experienced. Please don't push for ROM. Gentle stretches are all that is needed.

Do you have a bike? My colleague @Roy Gardiner can give you information on incorporating cycling into your recovery. He had bilateral TKR and went back to avid cycling. I've tagged him so that he can come and chat here.

Glad you found this board helpful. Stick with us. We have many members who are very active post op. It just takes time and tons of patience.
 
I definitely will.

Yes, I have a recumbent stationary bike that use 15 minutes daily. I would be interested in some guidance regarding its use. I tried my "cruiser" bike(real bike) the other day and found it difficult to pedal, but I had not loosened up at the point of trying it out.

So, perhaps I should give me knee even more time (already at nearly 16 months post-op) before I agree to revision surgery?

I appreciate your opinion.

Thank you very much,

Riddler
 
The decision is yours of course. At a minimum I would get a second opinion. But if it were me, I would give that knee more time and try a different strategy.

Roy should be along soon to advise you on cycling. Meanwhile here's a link to the cycling group he started in our Social Room area.
 
Hello @Riddler - and :welome:

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately in the future.
Thank you.:flwrysmile:
 
Hi @Riddler, I did very little PT and at close to two years my ROM continues to improve. I don't even think twice about kneeling on it. I would definitely get a second opinion from someone completely unassociated with your current surgeon before consenting to this procedure.
 
My left TKA was performed on 9/4/2019 (approximately 16 months ago). After about 12 months of "serious" rehab I've only been riding my recumbent stationary bike for 15-20 minutes daily. I just got burned out on the aggressive rehab after about 12 months. Again, I'm considering an isolated polyethylene exchange (a thinner poly liner) which my surgeon believes will provide greater ROM for extension and flexion. I'm only feeling pain when I go outside my ROM comfort zone (extension-5 degrees/flexion-105 degrees). I still limp which is annoying, but I certainly can exist and I can do most things. Still I'm not 100% satisfied with my recovery because it should be perfect. I forgot to mention that I'm in relatively good shape at 76 years old.
 
I just got burned out on the aggressive rehab after about 12 months.
Why such aggressive rehab? It really isn't necessary and, in your case, it seems to have been counter-productive. Your knee never had a chance to calm down and heal after the major surgery you had.
It sounds as if you received poor advice from your therapists.

I'm only feeling pain when I go outside my ROM comfort zone (extension-5 degrees/flexion-105 degrees). I still limp which is annoying, but I certainly can exist and I can do most things.
So stick within your comfort zone and try to forget about ROM. Instead, concentrate on trying to reduce your limp.

Make sure you walk with a heel-to-toe gait, like this:
heel-toe-gait.jpg
 
Hi Celle ~
Thank you for your prompt response. I meet with my surgeon the end of January 2021 to discuss the proposed IPE surgery ("poly swap"). Based upon some of the posts regarding aggressive p-t I'm thinking that I can reasonably expect continued ROM improvement for months, even years following TKA going easier with my knee. Do you agree with that assessment? Other than my limp I believe my TKA was successful(if that makes sense?). Anyway, I'm starting to think that the aggressiveness displayed by "professional;" therapists may not be the best approach for all patients including myself(it may be best for the their bottom line, but not for me!). From the many posts that I have read I should do a lot of walking and ride my stationary bike on easy-mode for a awhile and see how I do. As I said, I'm 16 months out from my TKA. Perhaps I should tell my surgeon that I'm not ready for more surgery until I let more time to pass to see if I can become limp-free. How does this strategy sound to you? Just live my life with normal daily activities and see if that's the best way to return to normalcy, not additional, revision surgery.
 
That would be my suggestion @Riddler. My range of motion has improved quite a bit during my second year of recovery doing no PT at all. The option to switch out the poly will still be there in the future, but I think it would be worthwhile to try backing off the aggressive rehab and see if it improves before adding more trauma to the area.
 
I'm thinking that I can reasonably expect continued ROM improvement for months, even years following TKA going easier with my knee. Do you agree with that assessment?
100% agree! Many of our members continue to see improvement in their ROM for many months - even years post TKR. Ice and elevate to control any swelling. And let that knee recover from all the trauma.
 
Jacey ~

Thank you! Can you help me search for more info on TKA Revision for a poly swap? I see that most posts are for "thicker" poly liners not "thinner" liners. My OS tells me that he thinks a smaller/thinner spacer will provide greater ROM and improvement in my ROM arc.

I appreciate your help!
 
As I said earlier in this thread, I can't think of one member who has had this procedure. I really think you need to get a second opinion. If you do any research you will see that this is done to stabilise the joint - not to increase ROM.
 
Hi Jaycey ~
I certainly don't want you to think that I'm being argumentative because I totally respect your knowledge, but I would be interested in your comments about this article that I found(interestingly, this article was published 15 years ago!):

https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.87B10.16228

Apparently there have been some successful exchanges with thinner liners. It's interesting that there aren't any posts on bonesmart. As you said, my knee joint is not unstable but firm and tight according to my surgeon. Mostly these exchanges are for unstable knee joints, but, I guess, I'm an outlier!

Thanks Jaycey!

Riddler
 
I think one reason why we haven't talked about exchanging a spacer to a thinner one here on BoneSmart is because we tend to just talk about a spacer exchange, without differentiating.
Most of those we encounter are done to insert a thicker spacer, because tendons and ligaments haven't tightened up as much as anticipated.

However, I don't see why exchanging for a thinner spacer shouldn't work as successfully, if the surgeon is certain that the current spacer is too thick.
The procedure would be the same either way.
 
The article is very old and I am not sure this approach is currently used. As Celle says, this procedure might work. Just because we haven't seen it here doesn't mean it's not done!
 
Any updates on this topic? I have been advised to get a poly exchange (thinner) to improve my extension about a year post TKR. Failing to find good data.
 

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