TKR Lesions caused by metal sensitivity

[2hips2knees]

I am so glad to hear your MUA went well, Pam! Hopefully your recovery will be much easier now.

 

[ucsbgal1971]

Mary, I didn't know that was possible either except the knee would kind of pop out when I was doing exercises with my legs elevated. I hope that it won't do that again. I am going to try to avoid exercises with my legs elevated from now on. What is that old joke? Doctor, doctor, it hurts when I lift my legs. The doctor replies, " then don't lift your legs anymore, $200 please." I just got back from my first PT appointment and my ROM was 98 even though the knee is visibly swollen and red. I think once the swelling goes down things will be great. The only thing that I notice is the knee feels very heavy now when I lie on my side and do the clam exercises. I don't notice the weight so much when walking, sitting or lying down but only when on my side and trying to lift the leg so I won't be doing that much either.

 

[ucsbgal1971]

Hi, I had a right TKR in Sept, 2013 so I guess I am a year and 7 months out and things are getting progressively worse. I am scared to death. I had a Smith and Nephew Oxinium knee put in because I am allergic to nickel.

I never was able to bend my knee very well and did get to 125 ROM with my physical therpist literally pushing my knee to that degree. I could never get to 125 on my own. I am now probably less than 90 because I cannot sit in a chair with my knee bent without pain and sometimes I can barely bend my leg at all and I cannot walk up and down stairs.

I had a manipulation in Feb, 2013 and that seemed to make things much worse. The pain in under the knee cap. I can't do a rotation on my recumbant bike, it is very painful to bend my leg enough to get in and out of the car etc., etc. I actually have pain 24/7 whereas I only had pain when I walked prior to my surgery.

I now have back pain because of the way I am walking to accomodate my knee so I go from the bed to the couch and that is just not good at all. I have total regret that I had this surgery. My surgeon suggested a cortisone shot. I am really afraid of that because I am afraid the needle will introduce bacteria that will cause an eventual infection. Has anyone heard of having a cortisone shot after having a total knee replacement?

My doctor has been sloppy and forgot to tell me that I needed antibiotics before dental work. He is so busy I guess I fell through the cracks and I really am not sure that I can trust him now.

If anyone has insight into why I can't bend my knee, why it hurts, and whether a shot is safe, I would be so appreciative.

I was told that I have patellar clunk syndrome and the surgeon goes back and forth as to whether I need another surgery. When I did certain exercises in physical therapy like putting my heels on a large ball and drawing the ball towards me, my knee would literally jump up. The physical therapist's hand would be knocked upwards off my knee when I did that exercise and he has felt that there has been a problem with the implant since the beginning. My doctor keeps sending me back to physical therapy but my physical therapist says there is nothing more they can do to improve my situation.

I read that the incidence of infection for people who have had cortisone shots prior to replacement is quite high so having a cortisone shot now really scares me. I don't know what if anything I did wrong so that my recovery hasn't been so good. I feel my knee all the time and the pain is worse now than before the surgery. I don't know what to do and I am not sure I am up to another major surgery though I think that may be necessary. I would appreciate any insight into my problem. Thanks.

 

[ucsbgal1971]

One other thought. I have been hesitant to post here because I don't want to discourage others from having the surgery. I have read some real success stories here and I know that this surgery can be wonderful and give people their lives back. Like everything in life, not all cases are going to be successful and I guess I am one of the unlucky ones. I hope that my situation will not dissuade anyone from going through with his/her surgery because I think that I am in the minority. Hopefully someone here will know what is happening to me and what I should do next.

 

[fiberlady]

So sorry ro hear you are having so much trouble. I am sure one of the admins will be by to give you some advice and suggestions. Have you thought of getting a second opinion from a surgeon that does revisions? Seems to me you could use a second opinion. It certainly couldn't hurt. My doctor never told me about the antibiodicts before going to the dentist either, there is a lot of controversy over this as to whether or not you actually need to take the antibiotics, however, my dentist is the one that insists I take them. I have heard of people getting cortisone shots, and my doctor even recommended it for the pain I am experiencing in my new knee. I have never heard of anyone having a problem. I am sure someone more qualified here can shed some light on this for you. Good luck to you and you have come to the right spot for support and help.

 

[Celle]

Hi @ucsbgal1971

I'm sorry you are having such trouble with your knee. I'm going to ask @Josephine, our Nurse Administrator, for her advice.

It was kind of you to think of the effect your questions might have on others, but you obviously need help and that's what we're here for. Don't hesitate to ask as many questions as you want, and to even vent and moan, if you need to.

 

[Josephine]

@ucsbgal1971 As you can see, I merged your other two recovery thread to read through them all! However, I need to pop out to the shops now so I'll do it when I get back. Nice to hear from you again but I'm sorry it's under these circumstances.

 

[chereb]

I would say listen to your body as you know it better than anyone. Find a revisionist and take it from there.
I had my primary in November 2014. Around 7 weeks i thought things were very slow as i have had many knee/leg recoveries and i seemed to get nowhere. I was barely getting past 70 flexion. On a 3 month follow up with a nurse she basically told me everything was perfect and it was me who needed to work harder. I insisted something was wrong as it was my body and i should know. I left in tears of frustration at being told i was basically a whiner and needed to accept this was recovery. Went back to os a few weeks after who said it was fine do more physio. I continued with a rom of 95-110 and constantly in pain. Couldnt stand for 5 mins without it really swelling. Had a second opinion last November at 1 year. I had lateral ligament instability and was advised to have a revision to a rotating hinge knee. I went on the list and questioned if i was doing the right thing going ahead as this was the second surgery from the same os to go bad. The revision guy said i would get 10 years out of the knee. Im 43 at the moment. Anyway i went ahead and am currently 7 weeks post op. It is like night and day. I am recovering well and getting good rom and more importantly the pain is gone. My os is thrilled at how well im doing and so am i. Im still recovering but its nothing compared to how the primary was.


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[skigirl]

I also think that you need a second opinion from a surgeon who is not related to your surgeon---in a different practice, for instance. I see that you are in California---there should be a revisionist within driving distance of you. A surgeon who specializes in revisions is more apt to see what is wrong with your knee and to suggest alternatives.

 

[ucsbgal1971]

Hi Joesphine! I wasn't sure if you were still here. I haven't been on the site in quite some time. Thank you for merging my old posts with the new. It really makes things more clear to see what I wrote previously. I had forgotten some of the things. I hope you are doing well and look forward to any input you may have.
Thanks again,
Pam

 

[ucsbgal1971]

Thanks skigirl,chereb, celle and fiberlady for responding. I am so glad I posted here. My son has been less than sympathletic and blames me for the problems with my surgery so I haven't had much support. I stopped doing the exercises at about a year out because they caused more pain and I have thus gained weight because I have been so sedentary. He is angry with me for stopping the exercises and for gaining weight. He is probably right but the pain just got to be too much. It helps to have a compassionate ear for once. I think you are correct about seeking out another opinion from a revisionist. I wish I knew how to find a good revisionist in the Los Angeles area. My doctor is supposed to do revisions so go figure. If anyone here has any revisionist/doctor recommendations, I would welcome them.
Thanks,
Pam

 

[ucsbgal1971]

BTW, I read that there is a doctor in Connecticut who does 3-D images of the knee and makes a custom fit knee. I wonder if anyone here knows of this doctor or procedure? I am willing to travel to Connecticut if that would be the answer. Does anyone have any info regarding this new procedure?

 

[ucsbgal1971]

Chereb, you have given me hope. I am so glad to hear that your second surgery is going so well. Maybe it is the implant after all. I am allergic to nickel so that limits my possibilities I think. I wonder if they make a rotating hinge knee that doesn't have nickel in it.

 

[chereb]

I have no idea if there is nickel in it. But been there thinking all hope was lost. I had an osteotomy which failed and a revision osteotomy before my TKR. After the TKR problems started i fell into depression as you do blame yourself as you agree to the surgeries. Im in the UK so no help to you regarding surgeons but im sure someone will come along to advise.
Good luck and i hope you manage to see a good revisionist and find out what is happening with your knee.


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[Clipless]

Hi Pam, here is a revisionist to consider:
broken link removed: https://www.bertjthomasmd.com/orthopedic-surgeon-santa-monica.html

It sounds like he does a lot of complex revisions.

 

[ucsbgal1971]

Diana, Thanks so much! I will check him out.

 

[Josephine]

My surgeon suggested a cortisone shot. I am really afraid of that because I am afraid the needle will introduce bacteria that will cause an eventual infection. Has anyone heard of having a cortisone shot after having a total knee replacement?
I read that the incidence of infection for people who have had cortisone shots prior to replacement is quite high

Yes, I've heard of it and it might work but it's only a temporary fix. And I don't know where you read that but it's not true. The injection would be carried out under fully sterile conditions.

My doctor has been sloppy and forgot to tell me that I needed antibiotics before dental work.

That's been proved to be unnecessary as announced in 2013. Evidence insufficient to recommend prophylactic antibiotics for dental procedures

He is angry with me for stopping the exercises and for gaining weight. He is probably right

Of course he's not!

I read that there is a doctor in Connecticut who does 3-D images of the knee and makes a custom fit knee. I wonder if anyone here knows of this doctor or procedure?

I am afraid you wouldn't be suitable for this surgery now you've had a total. It's only suitable for those who have not yet had any surgery.

Finally, having now read through your thread, I am of the opinion that your knee was not done properly in the first place. Talk of it being dislocated and your surgeon's casual approach to your pain and difficulties, not to mention the inability to move it well. I support the suggestion that you should see a good revision surgeon and see what he has to say.

More opinion is that you were made to do far too much PT and had problems getting pain meds. Little wonder you ended up with a chronically inflamed leg which is what I think you have.

 

[Josephine]

I wasn't going to do this but on second thoughts I will - I'm going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications are you using (if any), how much are you taking (in mg please) and how often?

3. are you still icing your knee and if so, for how long?

4. are you still elevating your leg, if so, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT exercises and exercises at home are you doing? How much and how often? (and detailed details would be appreciated, please! **Reps, sets and sessions** and all that)

** If you're not familiar with this, it goes like so:
1 lift of your leg = 1 rep (repetition)
5 reps and then a brief rest = 1 set
5 sets and finishing = 1 session.

 

[KarriB]

If I were you I'd be looking for a good revision specialist. I was blessed to have one waiting for me at the hospital with my infection, but if your not experiencing fever, or seeping from the wound chances are you don't have an infection. I've never heard of cortisone causing infection, but my dr. does believe it stunts the healing process

 

[ucsbgal1971]

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

The pain varies from day to day depending on how much activity I have. Sometimes it is about a 3 but other times it is an 8 or 9 depending on the amount of activity I have done. I get pain up to the middle of my thigh and sometimes under the knee and on the inside of my leg at the knee, and under the knee cap. The pain on the side is a sharp pain and it aches in my thigh. It is stabbing under the knee cap. When I awaken in the morning, I am so stiff I can't bend the leg at all. I have to use my hands to pull or force my leg into a bent position. Sometimes I get a burning type of pain in my skin around the knee. Most of the pain is under the kneecap however. That pain is the worst. I am the most comfortable when I keep the leg perfectly straight but then it freezes up if I keep it straight too long. I have to lift my leg with my hands when getting in or out of my car and it always stabs me under the kneecap because I have to bend the knee to get out of the car. Needless to say I have stopped driving unless I absolutely have to because getting in and out is so painful.

2. what pain medications are you using (if any), how much are you taking (in mg please) and how often?
I take Advil occasionally not even every day. I do have a few Hydrocodone left but am saving them for times when the pain is severe. I am afraid of medications because I had my liver enzymes go up once from a bad reaction to a medication so I just tough out the pain. I think the lack of pain control is why sometimes I feel like I am going crazy and I cry a lot. I don't want to become addicted to anything though and have an additional problem so I believe it is better to do without.

3. are you still icing your knee and if so, for how long? No I stopped that. The truth is I basically gave up because it is not getting better and nothing seems to help. I guess that is why I came back here. It is my last ditch effort to try to get help. Every time I go to the doctor he says something different. Once he said that I have patellar clunk syndrome and that I would need surgery. He then had me wait another couple of months and then decided I should go back to physical therapy. My physical therapist who is highly regarded refused to see me any more because he says there is nothing more that he can do. He believes that there is a malfuncition in the implant. My surgeon never took the time to read his reports though so that makes me angry. Then my surgeon wanted me to swim. I don't have access to a pool so I was never able to try that out. I don't feel comfortable swimming in public facilities anyway. He wants me to lose weight but even at a 1000 cals/day I don't lose anything because I can't exercise. The truth is with all of the pain, I eat a lot of prepared foods which aren't good for me because they are quick and easy to prepare. It is exhausting to try to fix a complete meal so I have given up on trying to diet. I have found dieting while in pain is just too much for me at least.

4. are you still elevating your leg, if so, how often and for how long? I am either in bed or on the couch day in and day out. I elevate my leg when I am on the couch but not when I am in the bed.

5. What is your ROM - that's flexion (bend) and extension (straightness) I think I can extend my leg fairly well and without pain. Bending is another story. I get terrible stabbing pain when I try to bend it. I don't know what the numbers are but I am guessing I have less than 90 degrees ROM flexion because I can't sit upright in a chair with my leg bent. I think it would be 90 degrees if I could bend it sitting in a chair. I think my extension is the same as before the surgery but I don't know what the number is. The leg doesn't go perfectly straight but it isn't uncomfortable in that position.

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., I do things in spurts. I have no assistance so I have to do housework etc. I can stand up for about 5 to 10 minutes at a time so I go back and forth from the couch or bed to whatever I am trying to accomplish. It takes forever to do the dishes for example. I can almost load the dishwasher in one fell swoop but I have to sit down and rest before I can finish loading it and turning it on. I am totally out of shape and weak from being so sedentary for so long. It is scary. Also my back hurts when I walk because I am favoring the knee. I can shop for groceries if I hang on to a basket and my grocery store has a motorized cart for disabled people so I use that whenever possible.

7. what kind of PT exercises and exercises at home are you doing? How much and how often? (and detaileddetails would be appreciated, please! **Reps, sets and sessions** and all that) I have given up on exercises. I have a recumbant bike but can't do that now and I have a small floor peddler. My knee hurts so badly after about a minute on the peddler without tension that I can't walk at all the next day so I gave up on that. The pain was so great I thought I should try resting my leg with no exercise but then it froze up on me. My leg has become so stiff that I can't do heel slides anymore either. I really need help because it feels like a viscious spiral downward.

** If you're not familiar with this, it goes like so:
1 lift of your leg = 1 rep (repetition)
5 reps and then a brief rest = 1 set
5 sets and finishing = 1 session.

If you need any other information, let me know Josephine. Thanks in advance for your help.
Pam