Revision TKR larrykay's Upcoming Revision

[Josephine]

It always is, turtle!

 

[larrykay]

Josephine, thank you for your comments. The OS is most likely going to use a long stem Zimmer to match the femoral component that seems to be sound. It is longer and has a mesh collar to let the bone grow into it. I hope this makes a better bond that the looseniong I have had with the cement separating from the metal stem.
Hot showers and warm wraps help me walk more normal and some Aleve evry few days especially whie doing PT to keep the leg in great physical shape 9 trndons and muscles). I have very good ROM and extension and able to exercise on my indoor bike daily.
My other concern is why the upper portion of the spacer is wearing down.
June 6 cannot get here fast enough.

1. If cement is correctly applied it cannot 'debond'. Cement is an inert substance, not dynamic. It's like polyfilla. Once it's put where you want it, it stays there no matter what until/unless regular movement of the screw or hook causes it to work loose. If bone cement is not pressed into the properly prepared bone, then it will lie across the top of the delicate bony spicules which cannot tolerate loading like that. The result is that these spicules break up and die back, hence the creation of space between the bone and the cement.

Not what is happening. it is between the post and cement

 

[Josephine]

I have had with the cement separating from the metal stem.

Sorry, but it just can't be. I have scrubbed for and seen any number of loose hips and knees and never seen that. It's always the bone/cement interface. Do you have an xray you can post?

My other concern is why the upper portion of the spacer is wearing down.

That's the weak spot of TKRs, they can wear. But if you're having a revision, the spacer will be changed too so don't worry.

 

[larrykay]

Josephine,
These are photos I took direct from the screen in the OS office. I have ordered a copy of them as well as the diagnosis report from him and also I have the 2nd opinion report that is from another similar surgeon who does the same work. A 3rd opinion came from my original orthopod. What do you make of this?
Larry

 

[Josephine]

Okay, I can see where the gap is between the cement and the prosthesis.

 

[newlybionic]

I had a revision using a DuPuy device. I needed both pieces redone. It also has a longer stems and it is the type that allows the bone to grow into it. My OS didn't use any cement at all. Hopefully your revision will go a smoothly as mine has been so far.

 

[larrykay]

All done! I had the revision performed this past Monday, June 6. Only 2 days in the hospital. the PT people sent me home as I had almost 90 degrees ROM and just around 0 degrees extension Scar is longer with very little swelling. Ugly as sin, like raw meat. I have had the visiting nurse service come to my home and do an hour rehab daily 3 times this week including today. Next week, they will do it daily on an accelerated aggressive course of rehab, paid by Medicare as I opted to come home instead of an inpatient facility.
Now for the details: My old tibial component was loose, separating the metal from the cement. The surgeon said it was almost "floating" in place. They had to scrape the cement from the bone as much as possible. A longer stem was used on the new tibial piece, a NexGen unit compatible with my original femoral component. They wrapped the cone with mesh to grow into the bone. They are going to "review" what happened and why it failed. But that is history for me now.

After next week, the plan is to go to outpatient rehab therapy nearby for 4 to 6 weeks to get me back to my normal activity level of spinning, skiing and biking. I am doing the exercises and icing several times a day. I am also using the CPM and increasing the range in small increments daily. I have it for 3 weeks gratis Medicare. And, more important I got off of the dreaded Oxy pills yesterday. I am only on Tylenol and Meloxicam ( Mobic) for pain.

it is slow and easy from now on.
Thank you all, and Josephine for your thoughts and wise mantra for recuperation>
Larry.

 

[newlybionic]

Congrats on getting your revision completed. It sounds like you are doing well. Be careful about doing aggressive therapy because it can actually slow down your recovery.

 

[Celle]

I'll be interested to hear how you get on with the accelerated rehab programme. My concern is that it will over-stress your knee, which still needs time to recover and heal from the trauma of the surgery, before you start a heavy exercise schedule.

 

[larrykay]

Almost 4 weeks after the revision... I found that the Medicare authorized "aggressive therapy" was anything but accelerated. The visiting therapist came every day until the end of the 2nd week. Their therapy was just watching me do the usual ankle pumps, heel slides and walking with a cane up and down some steps, a few leg raises and walking outside for a few minutes. The following week, I entered an outpatient program at Burke nearby. Now, they are so much better. A 10 to 15 minute massage stretching the muscles, and pushing for some additional extension, which I seemed to have already. Then another 1/2 hour standing on an inclined board, using the wobble board in every direction, and some light pedaling on a bike. Every day I used the cpm machine for an hour to an hour and a half.
yesterday, the therapist increased the number of repetitions om the exercises and introducing a few new ones.1> lying on the table on my back with a large medicine bal at me feet and pulling towards me as much as possible. 2> what I call a crab walk, sitting on a low stool with 4 wheels and using my heels to pull my self across the room several times,. I worked up a sweat and did it extremely slowly. The 20 minutes on the bike, icing and home. I the cpm machine is gone. I am walking fairly normally, a bit slowly and have very good range of motion. Zero extension and about 110 flexing. No swelling, the scar is rapidly healing. I gave up the Tylenol and Mobic. I ache a little, especially in bed..

This time around is a piece of cake, compared to what I wen through 3 years ago. Hopefully with 2 or 3 more weeks rehab, I should be discharge, especially as all the muscles start to soften up and stretch out.
keep tuned
the secret is to do it slowly at an even pace. no extreme exercises that cause pain.
Happy July 4th.
Larry

 

[newlybionic]

I'm happy that you are doing so well with this recovery. My revision seemed to be so much easier for me too. Maybe it was because the first one I had wasn't done correctly. I didn't do very aggressive therapy. My ROM is 130,0. It was 95,5 before my revision. I hope your ROM keeps growing too.

 

[larrykay]

4 1/2 months after the revision. I am 95% recovered. Finished rehab and back to my pre op activities(almost). I had my 3 month consult with the Doctor and he said to see him in 3 years.

No pain, walking, up and down stairs, or exercising. At the gym, I am doing all sorts of squats to build up the quads, glutes and abs. I m back to bicycling, but not as hard and as long as previously( probably due to age). I expect to celebrate my 80th birthday on the ski slopes this coming winter.

As for recuperation, it is time consuming, but the results speak for themselves. I have been fortunate to do as well. Hopefully the "revision) will last longer than my original TKR. I hardly have to concentrate on the leg, just a few twinges now and then to remind me that i had the knee replaced.
Thanks for all your support and knowledge. Just take your time, mobility does come back with repetition.
Larry

 

[Celle]

I'm glad you're doing well, Larry.
Do be careful with the squats. They are very hard on a new knee and can contribute to wearing out of the new spacer, if you go down too far.

 

[newlybionic]

I'm very glad to hear how well you are doing!

 

[ACDCJen]

@larrykay

Your recovery journey sounds amazing! Glad the revision is working so well. It's amazing all the trouble that "little gap" caused. I hope to be even half as active as you, and I'm 39!!!

 

[larrykay]

Thank you all for your good wishes. I hope you all have as good a recovery as i have.
It is just over 5 months out. I would say I have reached the point where I "forget" that I had the surgery. I do have some slight numbing on the side of the kneecap and I get "clicking" once in awhile.
I have gone back to my "spinning" class once a week, and just finished planning a ski trip in February to spend my 80th birthday with my kids and grand kids.
My best advice: take your recovery in a slow manner and do as the doctor says. Do not try and accelerate your recovery and don't worry about your extension or ROM. it will come back in time.
My doctor asks me to be a mentor and talk to his patients before and after surgery. I am a testimonial as to the benefits of knee replacement over long term disability. My daily quality of life has improved greatly.
Larry

 

[Celle]

It's great to hear how well you are getting on, Larry.

It's also good to know that you can help others facing a knee replacement. What a good idea your doctor had.

 

[larrykay]

Well, it is almost a year since i had the 2nd knee( revision) put in. I celebrated my 80th birthday in March skiing with 3 grandchildren and skiing an advanced trail ( black diamond) in Vail. I went back to spinning weekly, along with 2 sessions a week with a trainer doing combined weight and strength exorcises. Since Spring arrived, I am back into bicycling and other sports. I have almost forgotten that I had knee problems on and off for over 30 years .
I posted a blog and video at the Hospital for Special Surgery "back in the game" at <https://backinthegame.hss.edu/story/larry-kaiden/> ( cut and paste in your browser).

The purpose of this post , is to thank you all at Bonesmart getting me in not wanting to do the revision at all. I was very unhappy to have a TKR and then have it go bad in less than 3 years. I was very depressed and you guys were my inspiration and impetus to go forward and have the revision done.

I continue at my age to keep fit and stay active. Thank goodness that medical science has improved to this point that we can get joint replacements to re enjoy life once again.

Larry

 

[Celle]

What a wonderful follow-up report, @larrykay!

You have done marvelously well. It's terrific to read that you are enjoying such an active life again.
Oh - and thank you for the appreciation of BoneSmart.

 

[Jamie]

Thanks for taking time to let us know how well you're doing. You're one of our Amazing Knee Stories now! I'm thrilled that BoneSmart had a hand in all this and that you're enjoying yourself again. All the best to you!!!