TKR Lesions caused by metal sensitivity

[ucsbgal1971]

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.

That is so sweet of you Diana. I have been having problem accessing and responding here lately and I haven't been able to check my alerts. I am now in the process of interviewing various doctors again. It would be nice to get together to share info. etc. Thanks.

 

[ucsbgal1971]

Jamie and Karri, Thank you for mentioning that I should see a revision specialist. I had never heard of that kind of doctor. I can imagine they say that they do revisions but finding an actual specialist sounds very important. Thanks.

S 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

 

[ucsbgal1971]

Opps, I don't think I posted correctly. I am not too computer savvy and have forgotten how to reply. Jamie, you recommended Ran Schwarzkopf but he is a professor. I had a bad surgery at UCLA where the trainees were participating in my surgery. I am absolutely terrified to go with another doctor who is training others. Do you agree or is it safe to your knowledge?

 

[ucsbgal1971]

I filed a complaint with Smith and Nephew company regarding the implant because when I called with questions, I was told the only way that I could get my questions answered is to file a complaint. Now I think they are worried that I am going to sue them and that is not the case at all. All I want is to fix the problem. They are mistakenly sending me copies of their emails to one another about my case and one person asked if I had a second surgery to fix the problem. I am wondering if maybe a revision isn't necessary and if I could just have some kind of repair surgery. Now that they are worried that I am going to sue them, I probably will not get the answers that I am looking for. Darn! Hopefully, they won't contact my doctor because if I decide to stay with him, he might get ginchy as well.
I wish this wasn't such a litigious society and people would just try to help one another without fears of financial loss.

Jami, do you know if the person who you know who had a replacement done by Dr Penenberg that was not successful had an Oxinium knee? I am wondering if this is a common problem with this type of knee? I don't want to bash the knee or the company but it would be helpful if people who have had problems with the Smith and Nephew Oxinium knees would share what they experienced.

 

[Josephine]

So far as I know it's not a problem with Oxynium knees.

I had a bad surgery at UCLA where the trainees were participating in my surgery

"participating" does not mean they took any part in it other than to hold a retractor for the surgeon and they certainly wouldn't do anything without being under the direct supervision of the professor. Even junior doctors (interns I think you call them) are not permitted to do more than that. But they have to be allowed to come into the theatre and see what goes on else we'd never have any new surgeons at all!

 

[ucsbgal1971]

Josephine, I had three reconstructive bladder surgeries at UCLA following a botched hysterectomy at another hospital. The first corrective surgery was botched so I had a second to repair the damage from the first and then I had to have a third to repair the damage from the second. After the third, I gave up and decided to live with what they left me with and it hasn't been a picnic to say the least. I was told that if I had my surgery at UCLA, the residents would be doing the surgery and that I had no other choice if my surgery was to be done at UCLA.

The problem was I had no other choice but to stay at UCLA other than go to another teaching hospital, USC, because everyone I went to said my problem was beyond their capability. I was actually offered payment if I would have my surgery at USC because they wanted their trainees to experience my situation. I guess it is very rare. That totally scared me away. The professor oversaw what was going on but it was not his hands that performed my surgeries. At least that is what he told me.

From that experience, I am not willing to become a guinea pig for another doctor who is training. Perhaps it is different where you worked. All I can go by is my personal experience. I understand that they have to learn somehow. I just don't want to possibly add to my suffering with ongoing knee problems because the bladder problem has been a real challenge in itself. I am not willing to take any more risks. I have been in too much pain for too long.

Thanks for the info regarding the Oxynium knee. That is good to hear. I don't know why my doctor doesn't care for that kind of implant. I was totally sold when I did my original research about it. Maybe I just got a lemon or maybe my doctor didn't install it correctly. I think I will probably never know. I just hope that I don't have to go through a revision if all I need is a lesser type of repair surgery.

I am beginning the investigative process again by interviewing various doctors. The truth is I can hardly bear to start the whole procedure of trying to find the best doctor, go through another major surgery, and then face another long recovery. I feel paralyzed with fear much more now than with the first surgery. Thanks for your feedback. You and the others on this site have been invaluable to me.

 

[Josephine]

I am totally shocked and appalled that this professor allowed his minions to perform your surgery. I would like to think this was a peculiarity of the urology department and that orthopaedic surgeons wouldn't do that. That's why they have to be board certified and all that. I know that in the UK the registrars (surgeons in training to become consultants) are only allowed to do a knee or hip replacement with his boss assisting.

Maybe I just got a lemon or maybe my doctor didn't install it correctly

No such thing as lemons in joint replacement manufacture. Each item is checked and reviewed for quality assurance. According to the latest NJR summaries, variances in outcomes are usually due to variances in surgical skill!

 

[ucsbgal1971]

Josephine, It is good to know about the quality control and it helps me to know that perhaps my problem is because of surgical skill. I really wanted to stay at Cedars Hospital because they are ranked so highly, but if Dr Penenberg really isn't the greatest after all, I guess it is time to move on. I am so frightened. I interview my first doctor tomorrow and have to be up by 4:00 AM to get there on time so will sign off early and get to bed. 4:00 AM comes very early for me. Ugh!!! I truly appreciate your feedback. I don't know what I would do if I didn't have this site. It truly is a life saver. Thank you.

 

[ucsbgal1971]

angel 1978. I somehow overlooked your post. Thank you so much for your prayers and feedback. I wonder if mine is a tracking problem as well. I will ask the doc about it. Sorry to hear you have been through so much. I guess this whole ordeal is no picnic for any of us. It sounds like you are on the road to recovery and I am sure that is good news. Take care.

 

[ucsbgal1971]

Karri, Thanks. That is useful information. Take care. Pam

 

[chereb]

Good luck today x


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[Josephine]

"Dr. X utilizes the most advanced techniques in primary and revision hip and knee surgery including: minimally invasive surgery, alternative bearing surfaces, partial knee replacement, and multimodal pain management offering patients a faster and less painful recovery. He is one of the first surgeons in the region to offer his patients robot assisted partial knee replacement and hip replacement.

Sorry to be a party pooper on this but all of it does not necessarily indicate a revision surgeon on quality. He might well be but all that doesn't prove it.

The robot assisted technique utilizes 3D modelling to achieve more exact implant positioning and is clinically proven to improve patient outcomes."

And this is just advertising hyperbole.

but if Dr Penenberg really isn't the greatest after all

Honey, he doesn't have to be 'the greatest', he just has to be good!

 

[Josephine]

Oh gosh, I didn't know all that - thank you so much for educating me!
After 50+ years, I need a little educating!

 

[ucsbgal1971]

I saw a Dr. McPherson in Los Angeles for another opinion. He works out of St Vincent Medical Center. He is recommending the Aesculap 7-layer multilayer coating Advanced Surface implant because of my allergy to nickel. Apparently, the implant has been used in Germany for ten years but it has only been in the United States for a year or two. Does anyone know about or had experience with this implant? I am very concerned about a doctor putting in an inplant that he hasn't had much experience with, and also I am worried that after the revision, if it doesn't work, then am I facing an amputation. If bone is lost in a revision then I would imagine that revisions are indeed limited. I have just about decided to not do anything and try to live with the pain and inability to bend my knee. I couldn't even drive if my right leg was amputated and I am alone. This is such a mess. BTW the Aesculap inplant is quite attractive, gold and zirconium. I think it is the only one of its kind.

 

[ucsbgal1971]

Josephine, I am not sure to what you are referring. I must have missed a post as far as educating you. Have you heard of the Aesculap Advanced Surface Implant? Also, Dr McPherson withdrew fluid from my knee to see if I have an infection and apparently I do not. Wasn't that risky to insert a needle in there and did that not now put me at risk for infection? Dr Penenberg never did that and kept saying that I do not have any symptoms of infection so did not take the risk of withdrawing fluid. I am very concerned now that I have been subjected to infection. I don't know who to trust anymore. I was so frightened after he numbed my knee and withdrew fluid that I came home and took my antibiotics for the dentist. It was probably too late since you are supposed to take those before dental work.
Oh my! This whole thing is terrifying me.

 

[Pumpkin]

I am worried that after the revision, if it doesn't work, then am I facing an amputation.

I have had a revision, they freshen up the surfaces, a small amount of bone is removed. You can have more than one revision.
I will tag @Josephine so she sees your posts and concerns about the sample from your knee.

 

[Josephine]

I am very concerned about a doctor putting in an implant that he hasn't had much experience with

Darned right! HE might be very experienced and do lots of knee replacements but I'd sooner a surgeon uses something he has lots of experience with.

also I am worried that after the revision, if it doesn't work, then am I facing an amputation. If bone is lost in a revision then I would imagine that revisions are indeed limited.

Not at all! If bone is lost, it can be built up using bone or bone substitutes. This is done a lot but usually on patients who have bone disease or tumours. Considerable amounts of bone loss can be made up using bone grafts. In fact, femoral heads (the top end of the hip bone) are donated by hip replacement patients for this very reason.

Wasn't that risky to insert a needle in there and did that not now put me at risk for infection? Dr Penenberg never did that and kept saying that I do not have any symptoms of infection so did not take the risk of withdrawing fluid.

One would assume that he donned sterile gloves, painted your knee with iodine and used sterile drapes before doing the aspiration with sterile needle and syringe? In this case, you have not been put at risk. I understand that the other surgeon declined to do an aspiration but some are more cautious than others. FWIW, I would never let anyone put a needle in my knee anyway and I suggest you don't either.

 

[Clipless]

Pam, don't listen to scary amputation stories. Happy thoughts!

 

[ucsbgal1971]

Well, it is too late Josephine. He already did it. He did use gloves and iodine but not drapes. I would hope that the syringe and needle were sterile but who knows. I have got to put this out of my mind because what is done is done. I need to develop more courage to speak up and say no. I always freeze up and do whatever the doctor says. I don't trust them anymore and I think I have good reason.

It is good to hear that they can rebuild bone or replace it. I know that amputation is rare but it seems like the rare things happen to me.

The PA from Dr Penenberg's office just called me and told me that the MRI of my back is not good at all. I already knew that. I think they are trying to blame the back pain I am now experiencing on the back problems. It isn't. It is from the way I am carrying myself to accommodate the knee. It hurts in the muscles. I think I have a weak core. When I use my cane, I remember to stand up straight and my back doesn't bother me. Dr Penenberg's PA was trying to tell me that my knee pain is from my back and that I should see their back specialists.

My major problem is pain under the kneecap when I bend the knee. I won't swear here but I felt like saying a swear word. I have been crying all morning. I guess this has been a long haul and I am not up for any more problems with this knee and I don't want to go off and start all kinds of back tests when I have no major back problem that is bothering me now. I had sciatic pain in 1994 from two herniated discs, had six shots in the back and have not had a problem since. The fact that my muscles are hurting is not from that back problem. That pain is different and intolerable. The pain in my back that I have now is not nearly as severe. If I sit down, it goes away.

Maybe this is the nudge that I need to move on to another doctor. It is obvious Dr Penenberg is worried about lawsuit so he is trying to find something else on which to blame my problem. I wish lawsuits didn't even exist so doctors could stop playing the blame game and just help to fix the problem!

I have made an appointment for tomorrow with the CEO of St Vincents Medical Center where Dr Mcpherson operates. The CEO is going to take me around the hospital so that I will feel more confident there.

I totally hate this. Sorry. It has been a bad day. Is it normal to have pain under the kneecap when you bend the knee? Maybe I need to just live with this. I thought all the pain was supposed to go away. I traded one knee problem for another which is actually worse. Fooey!

I have also contacted the Aesculap regarding their implant and have asked if they can refer me to a doctor who has experience with their product. Apparently, they have special tools and a navigation system that is used to put in one of their implants and they claim to save bone with their procedure. I doubt that most doctors will be willing to go through training and purchasing of special tools so maybe this implant won't catch on here because most doctors here don't want to acknowledge the allergy factor according to Dr McPherson. He has seen 46 patients who have had allergic reactions to their implants and has done revisions on all of them. He recommends the Aesculap implant and has written a paper and given a presentation on the allergy problem. He told me that he is discouraged that so many doctors are unwilling to accept that allergy to the implant is possible.

Will let you know what I find out. The Aesculap implant has a 7-layer multilayer coating designed for performance and potentially reduces metal ion release. They are the only alternative coating technology that is applied to all surfaces. The ceramic surface layer can lead to improved scratch resistance and good wettablility (?) for better articulation. That all sounds wonderful but then the question is how does the implant function?

 

[ucsbgal1971]

Pumpkin, Thanks for letting me know about revisions. I was fearful that if the revision didn't work, I would be out of luck. You have given me some peace of mind. Thanks again!