TKR Knee Fine then 18 months later pain

[sistersinhim]

Can you go to a different doctor that is out of your area? You need a fresh set of eyes to examine you and your tests results. A revision specialist is one who deals with problem knees than a normal OS does. I suggest you search one out. You do not have to settle for this pain. It was good for 18 months. Now, it's not. Something is causing that.

 

[CapeCodder]

If there is no loose body in the joint would a revision specialist still be able to help if a revision is not needed? I have searched for a revision specialist and nothing comes up. It just brings up orthopedic surgeons. I guess I could find another top rated surgeon in my area for a second opinion?

I am guessing my surgeon will suggest PT. I have found that some PT's are very knowledgeable and have seen a lot of different problems with knees so maybe that is an option.

 

[sistersinhim]

Loose implants don't always show up. I will ask Jamie to see if she can help you find a revisionist surgeon. @Jamie

 

[Pumpkin]

f there is no loose body in the joint would a revision specialist still be able to help if a revision is not needed?

Before I had my TKR, I had a large loose body that was removed with arthroscopy. If the loose body is causing problems likely they will remove it. Hopefully the specialist will be able to determine the cause of your continuing pain and recommend treatment.

I have searched for a revision specialist and nothing comes up.

When you find the top surgeons, call their offices and ask if the surgeon does revisions or complex joint reconstruction.

Keep us posted on how your search is going,
Chris

 

[Jamie]

If there is no loose body in the joint would a revision specialist still be able to help if a revision is not needed?

A revision specialist is best whenever you're dealing with a problem with a knee replacement. They have more opportunity to see a variety of problems and fix them. That's not saying that surgeons who do fewer revisions each year wouldn't be good, but you'll just have a better chance of success with a revision specialist. Sometimes they don't put that exact term in their biographies, but you can also assume that a surgeon who is a "reconstruction specialist" and who does at least 150 revisions a year would be a good person to consult with.

I don't have any surgeon recommendations for Maine. Unfortunately, there are fewer surgeons in your state than in some of the areas with more population, so choices may be a lot more limited. If you're not happy with what your local doctors are telling you, you may have to drive to a larger city in another state. Let me know (tag me here in your thread) if you'd like some help locating a surgeon out of state.

You really do need to get to the bottom of what's causing this pain.

 

[CapeCodder]

@Jamie Thanks for the reply Jamie. Could you locate a reconstruction specialist in either New Hampshire or Massachusetts? I would be willing to travel if my current surgeon cannot figure things out. I am not sure how to tag you so hoping whoever sees this message will be able to.

 

[sistersinhim]

I added the tag to Jamie for you. Here's how to do it: Just add the @ in front of their user name. I will tag you now. @CapeCodder. You should get an alert on the little bell up top in the dark blue line

. That tells you that someone has tagged you to get your attention.

 

[Jamie]

I have these recommendations for you to check out in Boston. Unfortunately, I don't have any surgeons on my list from New Hampshire. The really good guys are at the larger hospitals in larger cities, so if you can get to Mass General, you should be in good shape.

Boston, Massachusetts

These surgeons are available at Massachusetts General Hospital:

Melnic, Christopher M., MD
Kwon, Young-Min, MBBS, PhD
Bedair, Hany S., MD

 

[CapeCodder]

I spoke with my surgeon today. He reviewed the CT scan with another surgeon and found no loose parts. I asked if there could be soft tissues catching inside the joint. He said the only way to tell would be to explore the joint. Opening and see if there are adhesions and soft tissues catching inside. Does this seem like a reasonable option? My knee keeps freezing up on me every four or five days. Always after sitting for a short period of time. Must be how I bend my knee a certain way. When it happens I cannot put pressure on my leg and the knee is really sore and tight when I bend it. There seems to be a big bump in the back of my knee when this happens. After three days I can walk some but it is unstable. Burning pain down my leg and bottom of foot is sore. After 3 or 4 days I am back to about 60% but it still feels sore and unstable. I will sit down again and out of the blue the process starts all over again. I do not think this is something that will just pass ad it has been 6 weeks. I could get a second opinion but would have to go to MA and the process could take months. Their answer more than likely would be the same. My surgeon does about 350 or more knee replacements a year and is highly respected.

 

[Jamie]

Normally it's not advisable to open up the knee to "explore" because of the increased risk of infection when you do that. But you are the one who has to decide what you want to do with your knee.

You've already suffered for 6 weeks with this problem and it's not getting any better. Your current surgeon, no matter how good he is, has no answers other than to "explore." My advice to you would be to start that process of getting another opinion. Sometimes a new set of eyes on your knee can work wonders. You don't know that second opinion would be the same as what your current surgeon is saying and to me, it's a safer and better option than exploratory surgery.

 

[CapeCodder]

Its been 7 months since my last post and my knee is still having issues.For the month of August it would swell up every three or 4 day. Dr. would drain it and it would swell again. Always when I was sitting down. Swelling would happen in a few minutes. When he drained it it would be complete blood. It stopped swelling for September thru December. Knee still never got back to where it was before I started having issues. First 18 months were great until the swelling started happening. In October I had a knee X-ray, ct scan and bone scone. The bone scan showed some blackening on both ends which cold possible indicate loosening. I did PT for 6 weeks. No pain in knee but just doesn't feel right. Burning and tightness which I never had before. New years eve all of a sudden it swelled up again. I was in so much pain and could barely walk. Dr drained it. Complete blood. Dr suspects it is a vessel leaking in knee. I met with a vascular surgeon about getting a genicular ablation of the vessels in knee. They only do about 5 of those a year here in Maine. There are risks to it and they cannot be 100% certain that is what is causing it. I did go bowling the night before it happened on New Years so I am thinking anytime I exhaust the knee and fully bend the knee it may trigger this. I went back to my surgeon recently for another X-ray. It showed no loosening. He takes into account all the X-rays and scans. He said he could go in and clean scar tissue and see if there is loosening but it is risky due to infection. We decided that I would see how it went during the summer and check back in the fall as I was only having tightness and burning in knee. No pain really. Well a week later I was in the yard playing basketball with my daughter and when I got done it didn't feel right. Pain behind the knee and when I walk a lot of clicking. Knee feels very tight. Not major pain but some pain. Just doesn't feel right. I am pretty sure I am not walking correctly so the bottom of my leg and foot hurt some. I just do not think waiting until the fall is going to solve anything. There are no revision specialists in Maine. I cannot afford to pay for surgery out of state as my insurance would only cover 40% of it. I do like my doctor and he is very well respected. Not sure what my next step should be. Any one have any suggestions? Thanks.

 

[WFD]

@CapeCodder - I only just saw this series of posts. If you are still looking for a revision specialist I can recommend Dr. Matthew Werger at St. Elizabeth's in Brighton, MA. He is Chief of Arthroplasty there, is a revision specialist and did my revision. He is a highly skilled surgeon. One caveat - he is a believer in aggressive PT and if that does not work for you, you may have to take charge of your PT plan. My results were initially good but I developed a lot of scar tissue, which is not his fault - I have unfortunately a tendency to develop a lot of scar tissue.

However, if you are looking for an arthroscopic inspection and clean-out, then I can recommend Dr. Thomas Gill, Chair of Orthopedics at St. Elizabeth's. He has been team physician at various times for the Red Sox, Patriots, Bruins, and the Boston Ballet, and is considered to be one of the best arthroscopic surgeons in the country. He does not do knee replacements or revisions, however, only arthroscopic procedures. He did an arthroscopic lusis of adhesions and MUA for me about 2.5 weeks ago and things are going well so far.

Can you negotiate with your insurance company and get them to give you in-network rates for out-of-network services, based on the lack of the necessary specialists in Maine?

 

[Jockette]

@CapeCodder Have you been tested for infection?

 

[CapeCodder]

Update on my knee. It swelled up on me on April 8th. That is the 7th time it has done that since July 2021. I sat down at a restaurant and had my knee bent. After a couple of minutes, I realized that I should not have my knee bent but it was too late. It swells up in a minute. Limped out of the restaurant.

Texted my doctor the next day and he got me in and drained it. All blood that he drains. He is under the belief that it is synovial tissue getting caught when I bend my knee a certain way which is causing this fluid. It has happened 7 times since July 2021.

Have done the CT scan, bone scan, and X-rays. He says everything looks fine. He said if it keeps up then he would have to go in and clean out the tissue. Wants me to use it a lot over the summer and see how my knee responds. After he drained it, it takes about a month to feel better. I never get back to 100% of how it felt before this all started to happen.

End of May my knee started to feel great again. About two weeks ago after a 30-minute walk, I felt a little pain in my knee. The next morning my knee was sore and It hurt to put pressure on it. No swelling to speak off. I can still walk but it can be painful. When I straighten it out it is sore. Sometimes it feels ok but after sitting and having it bent it is sore walking. After a week of limping, I texted the doctor and asked if I should have it looked at. His response was "I would give it more time. There's not much we can do at this point.". Almost sounds like he has given up. Is there a chance this issue will this issue just work its way out? It's been a few weeks.

I did find another doctor in Maine that I was thinking of seeing for a second opinion. I do like my current surgeon though. Do you think these doctors talk back and forth as I would not want my current surgeon to know I got a second opinion. This guy gets me right in when it swells up. Not sure if they would all do that. I am a little on edge as I think this could be something I have to live with forever.

 

[Pumpkin]

Do you think these doctors talk back and forth as I would not want my current surgeon to know I got a second opinion.

A good surgeon will not mind you seeking a second opinion, another set of eyes looking at your knee may see something your surgeon is overlooking.
We recommend you seek a surgeon specializing in revisions/complex joint reconstruction, they have the experience and knowledge dealing with difficult knees.
You can start your search with our Surgeon Locator at the top of the page.

Since you are on the east coast you can also look at HSS in NYC, or large university medical centers near you for a second opinion.

Jamie left some recommendations for you in post # 28.

 

[sistersinhim]

I agree with Pumpkin, you need a surgeon that specializes in problem knees. It is obvious that your current doctor doesn't know what to do. No knee should swell as yours does. You should travel away from your area to find a revision specialist that has no contact with your current OS.

 

[Jamie]

Sadly, this is not likely to be something that will just work itself out with time. You really do need to see a revision specialist for another opinion. You want someone who has seen and fixed a problem like yours before. You may need to travel to find a surgeon with this expertise, but it could make all the difference going forward.