TKR Lesions caused by metal sensitivity

[Clipless]

Pam, here is another knee replacement/revision specialist:
broken link removed: https://www.ossburbank.com/shahan-v-yacoubian/

In fact Dr. Yacoubian did my TKR, many of my co-workers' knees, and has an excellent reputation. I didn't mention him first because I didn't realize he also does revisions. You want a surgeon who does lots and has a high success rate. I don't know where to find those statistics but Dr. Yacoubian is very approachable- just ask him. His office, PA, surgery scheduler, and support staff are all outstanding; I have never sat for more than a few minutes in the waiting room. When I called with a concern last month they squeezed me in the very next morning.

Whomever you choose to consult, Best Wishes for a great outcome!

 

[ucsbgal1971]

Thanks Diana. I will check him out as well. The thought of going through another surgery is upsetting. I just can't imagine doing it again especially since I am alone. I have been laid up for years and another year or so seems like too much. I can't stay this way though. Even going through checking out doctors and trying to make the best decision is daunting. I really don't want to do this again and I am really scared. My doctor was Dr. Penenberg out at Cedars. He is supposed to be one of the best and came highly recommended. In fact, he is the doctor's doctor so to say but my surgery didn't come out very well. My internist had his knees done by Dr. Penenberg and they didn't come out too well either. Dr P is a likeable enough person so maybe people are basing their ratings on his personality rather than outcome of his surgeries. Who knows. His office staff is not pleasant and it is not uncommon for him to be an hour or two behind so I would really appreciate a short wait time and pleasant staff for a change.

 

[Celle]

Let's see what @Josephine says when she has had a look at your answers to her questions.

 

[Clipless]

Pam, I live just minutes from you in Simi Valley. If you'd like a visit, bring a healthy lunch, or drive to an appointment I can help. I will pm you my contact info. Check your alerts.

 

[Josephine]

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.

Okay

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.

Toughing out the pain is very unwise. Untreated pain will cause the freezing up of the knee.

So have you discussed your liver enzymes with your doctor or GP? It would be much more sensible than just not taking them. You NEED pain killers if you have pain.

The truth is I basically gave up icing 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.

Not a problem.

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.

That's fine.

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.

Okay

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

Oh my! Poor you.

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.

You should make sure you use the mobility carts all the time.

I have given up on exercises. I have a recumbent 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 any more either. I really need help because it feels like a vicious spiral downward.

I understand.

I really think you need to get a second opinion. I can't remember if you've done this already but you need something done. (sorry - obvious comment)

 

[ucsbgal1971]

Thanks Josephine, A second opinion seems to be the general consensus here. I am starting to research doctors again and have made one appointment with a new doctor who does revisions. Do you know if there is a way to check out a hospital? The doctor seems to be highly regarded but the hospital he works out of is the oldest in Los Angeles. I thought it had closed down. It is St Francis Medical Center.

 

[Clipless]

I have another one for you.
broken link removed: https://www.jri-docs.com/our-doctors/dr-thomas-schmalzried/
Keep us posted, Pam!

 

[ucsbgal1971]

Thanks, Diana. I will check him out as well.

 

[ucsbgal1971]

I saw my doctor today and he says the implant has to come out. I have a Smith and Nephew Oxinium chromium knee because of a nickel allergy. The doc says he doesn't care for the chromium knee and that there is another titanium knee that he likes better and that works for people who have metal allergies. Is anyone familiar with a titanium knee that does not have nickel? I am worried that he is blaming the implant when it was really something he did that caused the problem. The knee is already loosening and it has only been 1 year 7 months and I haven't done any heavy exercise because of pain so it shouldn't be falling apart already I would think. Am going for a second opinion in two weeks but will probably stay with my original doc because of the hospital and anesthesiologist he works with. On top of everything else, I have neuroleptic malignant syndrome caused by anesthesia. They handled it well last time. I am fearful to go to someone who is not cognizant of how to handle that on top of the surgery. I had one doc refuse to do the surgery because of the condition and because of my allergies. Anyway, will someone please tell me about titanium knees? Thanks.

 

[busylizzie]

Hi @ucsbgal1971 I have metal allergies. I now have a titanium alloy knee and from the allergy point of view it is fine for me. It contains titanium, vanadium and aluminium. There is information about it at

https://bonesmart.org/knee/knee-replacement-implant-materials/

 

[Josephine]

On top of everything else, I have neuroleptic malignant syndrome caused by anesthesia. They handled it well last time. I am fearful to go to someone who is not cognizant of how to handle that on top of the surgery.

I keep learning new stuff on this forum all the time! That sounds like one pernicious complaint!


There are also some alternative implants in this Library article Metal allergies and knee replacements

 

[ucsbgal1971]

Hi Joesphine. I am not sure what you mean by "That sounds like one pernicious complaint" but thanks for the reference. I was looking for names of companies who make Titanium implants. I googled it but didn't come up with anything. Thanks.

 

[ucsbgal1971]

Busylizzie what is the name of your Titanium knee? Thanks. Pam

 

[KarriB]

Give your second opinion a chance, especially if it's a revision specialist. He or she may have a top of the line anesthesiologist on staff. You have quite a few concerns and I feel for you having to go through the surgery/rehab again.

 

[Josephine]

Sorry, as a schoolgirl I was always being accused of having swallowed a dictionary!
For 'pernicious' read 'nasty'!

 

[busylizzie]

@ucsbgal1971 It is a custom made Stanmore Implants fixed hinge METS SMILES knee. It also has a titanium nitride coating. There isn't much literature on the web about these knees.

 

[Josephine]

That's because Stanmore make them on site at the hospital and have done for decades! It started with their sarcoma unit. They have salvaged limbs with tumours which had consumed most of the femur, half the pelvis and maybe even down to the knee as well. This would all be resected and a custom made 'massive' implant made to replace all the bone removed plus the hip and knee joints! It's a pretty awesome procedure to see, let me tell you.

Here's an example of the implant

 

[Angel1978]

I have been reading through your thread. I hope that things improve for you. I had s partial in December and it did the same things. I had loads of pt and could not do it. It would pop and lock. And you could hear it and see it. Think there is a video in my thread. I hope that you can' get your knee fixed. And be happy. I know what you mean. I was there. Like others said second opinion won't hurt. I'm praying for you.
I was told it was patella tracking syndrome. Well I went to get second opinion in Huntington but there was a long wait for the sugury. So I went back to my doctor. And I was stern. I said I need my knee fix. I am in agony. And I assume he was ashamed. Cuz there was students in the room with him.

I had been there prior to him and he was busy and well I don't think he really cares at the time. But the last time in Feb I went. I was in tears. Don't wait around j would get a opinion.

I admitted I went to get 2nd opinion. I was afraid to tell him. And he then all sudden cared but it was more aide he had another doctor/ students in there and was measuring and they had never saw it pop lock jump move around knee. I pray that yours gets fixed.

So they took me to X-ray and like killed me. They laid me on a hard table on my belly and bent my knee up. I was in tears. And he saw that and he helped me get my leg down and me roll over. Right then i knew he cared. He was apologetic. They said my implant was lose and I heard rumer it was not done right. But also the tracking was not correct. Kinda like you said yours was jumping. Pt does help but sad when they can't help.

. So with your problem so sorry to hear. I would seek a second opinion. Because it's not fare to you to be in agony.. U should be living a life of fun and happiness.

I wish you the best luck and hope u do take the sights advice and get a opinion. Good luck and I'm praying for you....

Just a thought.. I had revision/conversion from partial to full and I am almost pain free. I could not get bend past 70-80 and extension was 23. But know I am 107 and he don't expect me to get to 120 and extension is 5-3 so that's good. It does take time to heal. And do get opinion it would not hurt. It will ease your mind. Xxx



Angel1978

 

[Jamie]

Sorry that I am just now catching up with your thread. I strongly agree that you need to at least talk with a couple of these revision surgeons. Yes, you have some issues that will need extra attention. But these guys are used to dealing with difficult cases! You can insist on meeting in advance with any of the doctors that you like who are on their medical team to discuss your concerns.

My problem is that this first surgeon...."doctor's doctor" or not....didn't get the job done for you. You don't sound like you have strong trust in him and this is such a critical factor. Quite frankly, I wouldn't either! Especially knowing that he had also done replacements on someone I knew and they didn't turn out very well. Revision surgery isn't just something a doctor "does" (although plenty of them will say they do it). You need a revision SPECIALIST....this is a surgeon who focuses on the tough cases and sorts out the problems created by other surgeons.

You are fortunate to be in California where there are many options for revision specialists. Here's another suggestions to check out:

broken link removed: https://www.orthopaedicsurgery.uci.edu/faculty/schwarzkopf.html

 

[KarriB]

Jaimie is absolutely correct. I had a second emergency surgery due to infection a month after my original and it was performed by the group's revision specialist. Even my original OS told me there was no one else he'd have wanted to work on me than their revision guy. Knowing what I know now, I would be sure the Ortho group has a revision specialist on staff.