TKR Knee Wobble Question

[HokieGCC]

Hello Everyone,

I can't thank you enough for your encouragement and valuable info. Here is my update...

The x-rays were good today showing no advancement in bone resorption. That combined with the blood test has my second 2nd opinion Doc happy and it appears things are ok. I asked him what he could tell about the quality of the implant and he noted my Tibia was a press fit and there is not tons of data on how well those do. He said my alignment looked good both from the patella tracking and placement of the implants.

It appears to me most of the issue is me managing my expectations. I am a lifelong competitive runner and a year ago I was considering my 4th marathon literally now (this fall) and now I find myself working on going up and down stairs and getting out of a chair w/o my arms. I just haven't successfully calibrated myself yet.

Regarding the football game I realized there is a route to the stadium that doesn't have steps. It was a little longer and hilly but only like 3 steps. In the stadium itself there were around 30 steps so that wasn't too bad. I am guessing the walk was a mile and half each way. Sitting in the stands wasn't much of an issue. We were standing much of the game as it was back and forth the whole time. The BIGGEST challenge by far was the jam packed sidewalks and roads with fans (many likely not sober) at night...coming and going. Going was worse. This was WAY different than walking by myself in the neighborhood. It tests your balance and reaction time. This is a "tip" that seemed to have helped me. At home I intentionally do my evening walk in the dark for the purposes of re-gaining spacial awareness other than just my eyes. That seems to have helped me deal with the heavy crowd in the dark.

 

[patriciad]

So glad to hear your good news. It must have eased your worries to hear from that everything surgically is good and it’s now a matter of healing. I am supposed to be going to a concert at the NFL stadium at the end of October and will have to walk a fair distance from parking and climb up to the nosebleed seats so your experience was very helpful to read. I’m having a bit of a setback currently so not sure if I’ll make the concert but fingers crossed I will be able to manage. Thinking of taking my stick.

 

[HokieGCC]

@patriciad I sure hope you can make the concert and your setback will reverse soon. Taking a stick if nothing else would notify people around you to be a little more careful. Going real early will help getting there but exiting is where the bigger challenge is. Good or bad I also take an Aleve when I have a big day ahead of me. Not too often but maybe one every week or so. That does help as well.

 

[HokieGCC]

@patriciad did you make it to your concert?

 

[patriciad]

I did this past Friday and was thrilled with how my knee performed. Our seats were 3 rows down from the top of the stadium so at least 60 steep steps to handle plus a long walk half around the outside of the stadium from our parking. I didn’t take the stick and chair danced with much knee jiggling for 2 plus hours. Felt stiff on the reverse journey but no ill effects the next day or need for Tylenol that night. I am very happy with progress right now and hope it continues smoothly. My next challenge is to get back to riding my bike so I need a couple of gym sessions on a stationary before trying that.
Thanks for remembering about the concert. I hope you are continuing to improve also.

 

[HokieGCC]

@patriciad awesome! You are well on your way! Since I have gone to two more football games. Made it ok. I bet the bike goes quickly for you.

 

[HokieGCC]

Hello Experts - I just returned from my surgeon with x-rays in hand. I noticed something on the one attached. Near the bottom of the large tibia pin (not sure what it is called) is a dark area tracing along with the large pin. Is that concerning? My Doc says it is normal but to me it looks like bone loss there.

 

[HokieGCC]

Well I think I have my answer. I saw another surgeon this afternoon. This time I went with a Nationally Recognized surgeon in FL. He said that my Tibia implant was likely moving or loose. Looks like I am headed for a revision. I have an in-person visit scheduled for Tuesday in FL to confirm his initial diagnosis.

I am learning the hard way ... the surgeon is everything. Don't be fooled by "there are millions of TKAs and you will walk the very next day!" optic they try to create.

 

[Pumpkin]

Glad you will be having an inperson visit to confirm your diagnosis.
Good luck!

 

[patriciad]

Oh no! You seemed to be doing so well but I guess problems have continued this past month. I am in Tampa, Fl and wondered if your new surgeon is from this area. You are right the surgeon is everything so make sure they specialize in revision surgery. Good luck.

 

[HokieGCC]

@patriciad I am visiting Dr. Leone at Holy Cross. Do you know of any others that might be top shelf Doctors?

 

[patriciad]

There are a number of surgeons here who are highly ranked. Both my surgeons were official surgeons to the Tampa Bay Lightning team.
I just looked at Dr Leones website and to be honest he looks great. His communication and blogs are very informative and although I would definitely recommend my last surgeon I think you have found the right doctor. He is a revision expert it seems as the blog on the revision he did for the lady in the Bahamas is very impressive and I wouldn't hesitate to see him. Keep us posted. It’s been a long journey for you so far.

 

[HokieGCC]

Thank you @patriciad. I like him so far. His initial diagnosis was backed up by another local surgeon today. Infection needs to be ruled out and both say the tibia component is loose. I think I can handle the revision but the thought of an infection has me terrified. This makes my 3rd and 4th surgeons on the case.

 

[HokieGCC]

Oh ... and I was able to get another ESR and CRP blood test tis morning. Waiting on results now.

 

[HokieGCC]

Tests normal. I will take that as good news.

 

[patriciad]

How are you progressing?

 

[HokieGCC]

@patriciad well I have my answer(s).

They don't think infection but we did an aspiration anyways to rule it out (ESR and CRP are both real low). My fluid was clear from the aspiration. Assuming no infection ....

I have a press-fit tibia (no glue) component that is supposed to fuse to bone. Unfortunately, it has come loose and is being supported via fibrous ingrowth. The fibrous ingrowth allows movement which ends up causing pain. I thought my pain was bone pain and indeed it is. There are two courses of action (1) give it more time and see if it stabilizes and eventually fuses; or, (2) re-do the whole thing.

So ... my plan for now is to pretty much eliminate walking and when I do always have a brace on and see if that provides an environment for things to stabilize. If that doesn't begin to work after a month or so then I'll get a re-do probably with Dr Leone (who I am very impressed with).

What really bothers me is that I have been complaining to my surgeon for 3 months about the pains I was having and it was HIS x-ray that was the "smoking gun". He had to know. This is the x-ray shown above. All he said was (and I quote) "keep taking your Tylenol and doing your exercises". I wonder If I did bracing and rest 3 months ago if we could have headed this off.

The "good" - I now finally know.

The "bad" - It really looks like a re-do.

Thank you for checking in.

 

[patriciad]

What a journey you have been on and I am so sorry to hear your news that the joint is unstable. The positive is that you finally know what you are dealing with and what the fix is. Obviously you don’t want to have a redo but the uncertainty of improvement and if that improvement would be long term is something to consider. I wish you luck with your decision and do think you’ve found an excellent surgeon this time around. Sending healing wishes.