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Revision TKR Knee revision fail

napper

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I'm a 53 yr old female. I'm hoping I can get some insight.

I had a knee replacement in April 2015 then had to have it manipulated 8 weeks later. I was fine after that. However, a year later, I started having pain again. They did a bone scan but it didn't show anything. So they sent me to PT for 8 weeks to try to strengthen the muscles around the knee, hoping that would help. It didn't.

I then had a revision. They found a broken piece behind my knee. After the revision, again, I was fine. Now, three years later, my knee is painful again. It's clunking and hurts behind the kneecap whenever I walk. It also pops behind my knee like it did before the revision.

The surgeon sent me for another bone scan and this time I THINK it shows something. There are hot spots in the places on the front of my knee and one behind the knee. Exactly where it is hurting. It also had a hot spot on my left knee which is probably arthritis. That hurts, also, but I've been ignoring it.

Do these hot spots prove that I'm in pain and there is something wrong? I go see the surgeon on Friday. I wanted to know why to say when I see him.

Thanks for any advice.

---------------------
TKR April 2015.
Manipulation Eight weeks later
Knee Revision May 2016
 
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sistersinhim

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@napper, welcome to Bonesmart! I'm so sorry you are having pain again. Please give us the dates of all your surgeries on that knee. It will help us to advise you better. Also, I'll tag @Josephine to see if she can give you some answers.
 

Josephine

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Hi and welcome to BoneSmart!
proudly arthritis
"Proudly" arthritis? I think that's some predictive texting, is it not?
Do these hot spots prove that I'm in pain and there is something wrong?
I would think they do prove it but it might not mean there is anything serious wrong. I am currently getting pain in my left knee which is now 4 years old. I think it's probably something called Hoffa's syndrome. Your's may be something similar.
 
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napper

napper

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Redid first post.
 
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napper

napper

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Hi and welcome to BoneSmart!
"Proudly" arthritis? I think that's some predictive texting, is it not?
I would think they do prove it but it might not mean there is anything serious wrong. I am currently getting pain in my left knee which is now 4 years old. I think it's probably something called Hoffa's syndrome. Your's may be something similar.
Yes, I meant probably arthritis. Not proudly. Maybe there isn't anything serious wrong but something hurts to the point that walking isn't fun.
 

SusieShoes

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I think Josephine gave you a good idea about Hoffa's Syndrome. Impingement of the fat pad can cause the kind of pain you describe and, if nothing else, your surgeon should consider it. Also ask him what he thinks the "hot spots" mean. What are his thoughts about why you are in pain?

Also ask directly about the condition of your implant, particularly the tibial spacer. Are you a very active person? If you do lots of sports, spend lots of time at the gym, etc. it's possible your spacer has thinned. For most people this is never an issue, but for the very active it might be.
 
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napper

napper

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The results of my bone scan were just posted on the hospital site. Good news, no infection. Bad news, loosening of the prothesis. I'm not THAT active. Just normal living. We moved into a two story home about six months before my TKR. Went from a three level to a two level. We were looking for a one story home, but fell in love with this house. It hurts worse when going up and down stairs, so I wish this house were one level.

I see the surgeon tomorrow. I'm guessing he'll have to redo my replacement. I think he's NOT going to want to do it, but I am too young to live in pain for the rest of my life. And, unfortunately, it looks like my other knee is starting to get arthritic. I've felt it, but was trying to ignore it. Totally sucks. I've had about 40 surgeries in my life, and it's getting old. Doctors can't figure out my body. Too many issues to go into.

This is the report...

1. Increased uptake about right knee prosthesis predominantly about lateral tibial component which may be secondary to loosening. Scintigraphic findings not characteristic of prosthesis infection.
2. Increased uptake about left knee likely degenerative.
 
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napper

napper

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Anyone have opinions what I SHOULD do in this case? Do doctors expect you to live with a loose prosthetic?
 

Josephine

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Bad news, loosening of the prosthesis. I'm not THAT active.
Well first thing is that your activity has nothing at all to do with a loosening. Generally it's more to do with the implant not having been properly seated. It could even be that the MUA was implicated.

But I need to know the dates of your surgery - TKR and MUA.

Anyone have opinions what I SHOULD do in this case? Do doctors expect you to live with a loose prosthetic?
It's not a case of living with it. If it's not revised then the bone is at risk of damage. You have to have it revised. No choice for you or the surgeon.
 
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napper

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Well first thing is that your activity has nothing at all to do with a loosening. Generally it's more to do with the implant not having been properly seated. If could even be that the MUA was implacted.

But I need to know the dates of your surgery - TKR and MUA.
Thank you for this info. My dates are on my original message. I fixed it.

And no choice, as I found out today. I will be having the revision on Oct 2. I need medical clearance and see a dentist. The dentist is a pain. I hate going to the dentist.

The good thing about this doctor is he's awesome! He doesn't hold back on the pain meds. He understands me, after doing four surgeries on me. I have had SO many surgeries that my tolerance is high for meds. Normal pain pills don't work well. IV pain med has to be Diladid. Morphine doesn't touch me. That's what I worry about. Having surgery and then not getting proper pain management scares me.

I really am nervous. But, at least I have a month.
 

katchmo

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I hope you have a different OS than you had for the last two surgeries!!

Oops just saw where you really like your doc. But I'm concerned about two problems with two knees.
 
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napper

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I hope you have a different OS than you had for the last two surgeries!!

Oops just saw where you really like your doc. But I'm concerned about two problems with two knees.
It's not the sutgeons fault. It is one knee. I had the TKR, manipulation, surgery to fix something and now this. My body has always given me problems and tends to heal weird. I lost a kidney to staph when I was 18, spent three years in and out of the hospital with more stapg infects. Some then, my body hasn't been normal. I've had over 40+surgeries with all sorts of things. Some small, some really big.
 

Celle

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The good thing about this doctor is he's awesome! He doesn't hold back on the pain meds. He understands me, after doing four surgeries on me. I have had SO many surgeries that my tolerance is high for meds. Normal pain pills don't work well. IV pain med has to be Dilaudid. Morphine doesn't touch me. That's what I worry about. Having surgery and then not getting proper pain management scares me.
It's not the surgeons fault. It is one knee. I had the TKR, manipulation, surgery to fix something and now this.
I also think that it's time to look for a second opinion. Your knee has already had one revision, plus a manipulation.

Doing knee revisions, especially more than one on a knee, is skilled work.
It's time to let a surgeon who specialises in problem knees have a turn. Your current surgeon may be great with pain relief medication but he's not great with fixing your knee. Loosening of an implant is usually due to incorrect placement of the bone cement at the time of surgery. I really don't think that you should let your current surgeon have a third try at your knee.
 
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napper

napper

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I also think that it's time to look for a second opinion. Your knee has already had one revision, plus a manipulation.
You may be right. The xrays show that it was placed properly. I didn't think of the cement. I'll have a look around. Thank you.
 
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napper

napper

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I've reached out to the community and Dr. Kavanaugh is rated #1 in the area. He's not a young buck, he's been doing this forever. I truly think I'm a special case, but can't seem to find a specialty Dr in the area. I've had friends and my MIL have knee replacements through him and they did great. It's hard to explain my body.. Autoimmune problems, etc. So finding a Dr who can work with these problems may not happen. I might be better off just leaving it alone. I truly am tired and don't know if I can do this again.
 

katchmo

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One of the admins here can help you find a revision specialist in your area. Unfortunately I can't remember her name to tag her. But I urge you to get a second opinion. If in the end you decide to stay with your current surgeon, at least you got that second pair of eyes. @Jockette , @sistersinhim , @SusieShoes can you please tag that person?
 
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napper

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Hi all

I had my knee replacement revision one year ago Oct 2. It has never been normal, always unstable. However, the surgeon said to give it a year. So, I did. It has now become swollen and so painful I can't do much. Just walking a grocery store causes tremendous pain. The prosthetic knocks against my knee every step I take. The right side aches and a stabbing pain goes down my shin. I have an appointment with a surgeon who specializes in failed knee replacements. But, it's not until mid Jan. Trying to decide what to do. Wait, which I don't think I can or go to the
ER. At least there I they can run all the tests and I'll know what's going on.
Any opinion is welcome.

Thanks.
 

Jaycey

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@napper Sorry you are dealing with this problem knee. Sounds like you are on the right track getting an appointment with a specialist. Can you see your family doctor for some advice/medication to help get you to that appointment in January?
 

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