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TKR Loosening of implant.

Josephine

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I do not know what a “lateral retinacular release” means. Does anyone know?
Yes, I do! And I can explain it with this image. You can see how the ligament that's been cut is responsible for tethering the knee cap

arthroscopy-horz.jpg


I’ll have three full weeks of recovery.
I don't think that's a good idea. I know it's not an entire revision but 3 weeks is still a bit of a big ask! I'd suggest at least 6 weeks.




do you have a xray picture of the kneecap with the patella button
Patella buttons are plastic and plastic doesn't show up on xray but you can just make it out here as a shadow. The whiter area on top is the remains of the patella.

patellar button xray 2.jpg


advises continued physiotherapy ($$$$), exercise (ouch!!!!), extra-strength Tylenol and Voltaren, none of which work much.
You said it! None of these things will deal with pre-patellar bursitis! You might find this image helpful

Knee Bursa 2.jpg


She just says, “about 5% of TKR patients will always have pain
II'd say it was nearer 0.5%!
 

sistersinhim

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I've had two lateral releases and one medial release. I believe it will take more than 3 weeks before you are ready to go back to work. These tendons can be very tender and painful. When I had the first 2 done, I had to wear an immobilizer for at least 6 weeks. I don't think they do that anymore, so it's something you probably won't have to worry about.
 

Cementless

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Patella buttons are plastic and plastic doesn't show up on xray but you can just make it out here as a shadow. The whiter area on top is the remains of the patella.
@Josephine, does this particular picture show a loosen patellar button?
 
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Concerning the “lateral release,” why would a surgeon cut that? Isn’t that ligament needed to hold the knee cap in place? Wouldn’t that be a mistake to cut something that important?
 
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As for me returning to work after three weeks...it’s a necessity. Financially I won’t make it. I have to return to my teaching job. I’m just thankful that our district has a “Fall Break!”
 

Josephine

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@Josephine, does this particular picture show a loosen patellar button?
Sorry, no it doesn't. And I said this in your thread.
Concerning the “lateral release,” why would a surgeon cut that? Isn’t that ligament needed to hold the knee cap in place? Wouldn’t that be a mistake to cut something that important?
That's it's primary function but if it gets too tight then it has to be divided.
I don't think they do that anymore, so it's something you probably won't have to worry about.
Yes they do. Some surgeons might not but in general, it's still a popular procedure.
 
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I just had left knee revision surgery on September 26. I’m three weeks postop. The doctor did not have to remove the entire implant. He left the femoral and tibial component in place. The reason I had to get a knee revision surgery is because my initial knee replacement in December 2018 failed within six weeks. The plastic button underneath the kneecap became loose. It ook me nine months of excruciating pain to convince my doctor to do something about it. He would not, so I switched doctors, within the same orthopedic center. The plastic component underneath the kneecap was loose and it was the wrong size. I needed a larger size. The doctor also performed a lateral release. I had to stay in the hospital for four days because my incision would not stop bleeding. The doctor did not use outside sutures or staples. Which to me, was a mistake. Only inside sutures were used.
It is too soon to tell if the revision is working yet. I have already started physical therapy, but nothing I do in Physical Therapy is painful, so that’s good.
.
 

Jockette

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A loose patella button, that is very interesting. That probably doesn’t show on an X-ray.

I had a Patellofemoral partial 2.5 years ago that has never felt right. I have more limitations and discomfort now than before my surgery. I’ve had 2 second opinions in other states, and they say my X-ray looks fine, nothing to fix, we’re sorry you have discomfort. Period.

I’m not in a lot of actual pain and I do continue to see healing improvements even at this late date, but I would definitely not call my partial a success.

I have symptoms of a loose implant, but as I said, my main implant is supposedly right where it should be. But your case makes me wonder about the plastic button I know I have.

I also had a lateral release done and I continue to have most of my discomfort on the lower lateral side of my knee. I question how well mine was done.

I surely hope this revision is the answer for you, you’ve been through so much. Thanks for coming back with an update.
 

Jockette

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Did they diagnose your loose patella button before surgery?

Or is that what they found once they got inside your knee?

I would love more details, if you’d like to share them.
 
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I had a CT scan prior to surgery which showed my implant loosened. My first orthopedic doctor refused to believe the CT scan and stated, “Radiologists do not know how to read a CT scan of a patient with an implant.” He totally brushed it off and said it was probably “a cyst.” I was in horrible pain and it was getting worse every week. It took me eight months to convince him something is very wrong. He then gave up and referred me to another physician in the same office. I also had not been able to go up or down stairs for two years now. I do not think the first replacement surgery was done correctly. Why else would the second surgeon have to put in a bigger plastic component and why did it become loose within six weeks of the initial surgery? My initial replacement was off 5° and now it’s supposedly 0°, which is much better. I have not had a follow-up with my physician yet. I read the post operative report that I requested from the hospital. It’s hard to understand some of the stuff on the report. I meet with my doctor in the middle of November and I will ask him exactly what was done and then I will make an update on this post.
I also had extensive lateral gutter scar tissue (whatever that means). The scar tissue was removed from the lateral gutter.
The actual post operative report states:
“There was gross instability from 5° of genu recurvatem to 140° of flexion. There was a space between the patellar implant and the bone. The patella was removed in its entirety and revised to accept a new 29 mm asymmetric button, followed by a partial lateral patellar facetectomy and lateral release optimizing patella centralization of the trochlear groove. Following this, the polyethylene component was upsized 4 mm to a TS component. This restored knee stability to 0° Full extension and 135° flexion.
I have no idea what a partial lateral patellar facetectomy means in the report.
Only time will tell if this revision helped.
 
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Wow. The top area of my incision is burning really bad when I bend my knee to its maximum range. It’s like a fire. It is also extremely sensitive to touch! Is this normal after four weeks? No, I don’t have any signs of infection. Imagine you’re riding a recumbent bike and every time your knee comes up, it’s as if someone places a small fire on the upper half of your incision.
 

Celle

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I guess the top part of your incision is still healing after the revision. Perhaps you should cut back a little on doing the full flexion for a while, until it's less sensitive. There will still be sutures from the latest surgery beneath the surface that haven't yet dissolved.

You can also try de-sensitizing the area by touching it gently, and running different types of material over it, Start with really soft material and work up gradually to rougher material.
 
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I see a dissolvable stitch, on the bottom of my incision. It looks like fishing line. It’s very weird. The pain from the top of my incision is pretty bad.
 

LindaO

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I haven't experienced the severe burning sensation you have described but my upper and lower part of my incision is very tender. My incision is closed and my previous surgeon said to rub Vitamin E along my scar so I gently rub it along my scar and the sore area of my knee. I sort of massage it as I do it and it does seem to help a little.
I hope you find relief from the burning and pain. Keep us posted!
 
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I don’t know why I am “cursed” and always have pain no one else seems to have. I’m sooo afraid of another loose implant. My guess as to my searing burning pain that takes my breath away: is it entrapped nerve? Nerve pain from my knee waking up? Dissolvable stitches that won’t dissolve and are pulling every time I bend my knee more that 90°? I have no clue.
The pain originates from the very top of my incision and shoots downward on both sides of my knee cap. Maybe a stitch is hitting a nerve? I’m at a loss as to what it can be.
 

sistersinhim

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Your infant knee is little over a month old and unfortunately, pain is normal. Have you called your OS and told him about your pain? You could also ask for a different pain med since it sounds like the one you have isn't working well for you.

I would stop bending your knee so much that it's painful. It needs to heal and bending like that isn't helping it to do that. All it needs is gentle movements and walking around frequently. Are you icing and elevating? That always helped to lower my pain and swelling.
 
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Umm ... I’m not taking any pain meds. I teach and can’t be on any pain meds. No, I haven’t contacted my OS. I see him on November 17th. I figure I cannot get in earlier to see him anyway. I’ve kind of lost faith in doctors at this point in my life.
I ice my knee when I get home from work. I ice it more frequently on weekends. Okay, I’ll stop doing my heel slides and trying to bend it too much.
 

sistersinhim

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Is there a way you can elevate and ice while you teach, or maybe even at lunch? That should help some. I'm so sorry you are having all this discomfort.
 

Jamie

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I understand that you cannot take prescription pain medications while you are at work. But you can take Extra Strength Tylenol. I suggest you start yourself on a schedule where you take 1000mg every 6 hours through the day and night. Be sure you are not taking any other medications with acetaminophen in them (like cold or sinus medications), as the maximum amount of acetaminophen taken should not exceed 4,000mg in any 24 hour period.

Your revision surgery was just barely a month ago. It is probably a bit soon for you to be back at work and I imagine that is not doing your knee any favors. If you still find you have pain once you start the Tylenol regimen, you could supplement that with a Tramadol in the evenings when you're not at work.

Since you're back at work, you will get enough exercise going to and from and while you're there (probably more than you need, really). You don't need to do any additional exercises at home or go to therapy.
 

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