Revision TKR Loosening, RA ?Second Revision

[StillShortie]

Morning all! (Or afternoon / evening!)

So knee is a bit achy this morning, not noticing any increased ROM but it is early days with 4 more lots of mobilisation booked in over next two weeks.

I have a question I wondered if one of the mods and / or Josephine could answer. All through I have had pain a real bruisy achy pain on the line between D & E at L2 / L3 a what could it be? Is there any chance it could be caused by loosening of the tibial implant? The reason I ask is that the radiographer who took my last X-rays (who is also a colleague) said that it looked as if implant may have moved a tiny bit, the X-rays were not reported by a radiologist as it wasn't requested however the clinical fellow who saw them said they are fine - I have an appointment this afternoon with a consultant (not the one who did the surgery as he has since retired) and I would like to know how insistent to be that he fully reviews the X-rays / does further scans to be absolutely sure. I am just a bit paranoid (as always) for a few reasons, limited ROM, investigations for sweating a couple of months ago which was thought to be hormonal and blood tests were normal (although very slightly raised ESR but normal for x months post TKR) and now pain seems to be increasing compared to 5 months post op so after lots of medical journal searches I just need reassurance that it it purely a ROM problem and nothing worse.

I am hoping that everything is OK and trying to look on the sunny side but just want to clear up the nagging doubt.

Shortie x

 

[Josephine]

the X-rays were not reported by a radiologist as it wasn't requested

It doesn't have to be requested. ALL xrays are reported on by a consultant radiologist as a matter of course. Also don't pay any attention to what a radiographer says or thinks. Radiographers are a world apart from a radiologist. One is a technician with special training in using an xray machine - a significant skill in itseld. But the other is a doctor who is highly trained in the interpretation of xrays.

I have had pain a real bruisy achy pain on the line between D & E at L2 / L3

Do you mean here?

It could be a number of things ... tendinitis or general soft tissue pain, for instance. I've had a pain and tenderness there for a couple of years and cannot kneel to save my life! Much too painful. I suspect this might be a similar thing for you.

Symptoms for a loosening would include a generalise ache/pain in the joint along with isolated sharp pains during walking or weight bearing.

 

[StillShortie]

Thank you so much Josephine and so sorry for not replying earlier we have had no Internet for days as BT are doing so called improvements to the village and cut everyone off!!!!!!

Yes I mean exactly there! It almost feels bruised all the time. I do also get sharp stabbing pains when I walk with the generalised aching so I have been worried, however.......

The physio I have been having - she has been doing mobilisation of my knee to increase flexion - seems to be helping. My first measurements before this mobilisation was 85 degrees and after two sessions I managed to get a massive 95 degrees which felt amazing and today I even walked down some shallowish stairs almost straight! hurrah! I have also had reduced pain - although I really haven't been doing much as I haven't wanted to do anything that may hinder the physio. I have another session tomorrow so I would love to still be at 95 degrees or at least be back at 95 by the end of the session. I am also working a long day (12.5 hour shift) on Friday so I am hoping I won't be in as much pain by the end of it as I have been after a long day recently but I will have to cross my fingers for that one.

My dream at the minute which may be a bit greedy is for the physio to work well enough to get to 110 degrees or at leas 100 - it's not much but will make a massive difference to me.

Thanks again

Shortie x

 

[Toothfairy]

Hi Shortie,
I am so pleased for you that the physio is helping. That sounds really promising.
Fingers crossed that the progress will be maintained.
Keep up the good work, hugs, Toothfairy x

 

[leejaa]

I hope you get your wish on the range of motion. Wonderful so far. Best of luck to you on working the long shift, I hope it is not too awful for you. Sending some healing thoughts and hugs. Lee

 

[StillShortie]

Update of how thing are going.

About the same I'm afraid to say. So bend is anywhere between 70 and 95 depending on if I have been at work / been shopping etc. or rested for 4 - 5 days. after initial hope of physio mobilisation it has been abandoned as hasn't actually helped, now I have 7 weeks of home exercises including some patella glides. the physios discussed me me at case conference and the outcome was they didn't think I was a candidate for MUA and the patella glide exercises plus a couple of others for 7 weeks see how it goes if no better then referral back to Orthos. so the story of orthos....

My. Surgeon retired very soon afer my op so not seen him post op (except the day after op), and have been passed on to another team, not yet seen the Consultant just his Reg / middle grade. X-rays done recently still not been reported by radiologist as it was requested they weren't reported. The consultant who I have been referred to does do some knees but is not one I would choose. Went to GP today for referral to a different consultant at a different hospital HOWEVER apparently then NHS is cutting back and for second opinions now you / your GP have to fight the case! So GP has requested reports on X-rays, I have phoned physio to send report of her sessions to GP and....... I wait again.

So nothing has changed bend still rubbish, pain still there, still can't come down stairs and can't pedal on a bike due to lack of bend. A bit peeved but I will still fit for second opinion.

Meanwhile I am looking forward to Christmas and wish everyone a happy Christmas x

Shortie x

 

[leejaa]

Best wishes on getting the approval for a second opinion. Considering your age and the limited ROM I am sure you will get approval. Sending warm healing thoughts your way.:xmas-kitty::slider santa:

 

[StillShortie]

Hi Everyone! I hope you are all well x

So what is happening with me - No change No second opinion allowed Anyway I have an appointment with OS (hopefully it will actually be consultant) in 4 weeks, so will see then what is the next step.

I have been doing a bit more reading and one thing that has occurred to me is that I don't know what my knee should feel like at limits of bend - I know that no two people will be exactly the same but I wondered if I could ask all you lovely Bonesmarties a questions?

My question is "at the MAXIMUM bend of your knee (wether it is 70, 90 or 140 or any other bend achieved) how does you knee feel? does it feel tight? painful? no pain? if there is pain is it sharp? dull? Tingly? Or something else?

Thank you in advance

Shortie x

 

[RestAssured]

Well, let me think. When I am bending it to 120, it feels a little tight, when I am doing yogalates and bring my knees to my chest, folded down to aprox 135 bend, it isn't as bad. I don't know why, but the knee is bent more and feels better! I can kneel without any problem though.

So, I don't know if I was of help or not.

 

[kneeper]

I'd say at maximum bend it feels tight.

 

[Ellejay]

I am only four weeks post op, but at 100 my knee feels very tight and if I push to 110 it is quite painful, so I cant go beyond that.

 

[StillShortie]

Thank you all very much very helpful - it is as I expected I guessed it should feel like a tight feeling - unfortunately mine is 10/10 pain if it is bent one degree past where it gets to (90 on a good day 70 the day after a day at work!) especially if I catch it on a step or somehthing.

I am just trying to put together what I am going to ask / question when I go to see my OS because I am getting a bit peeved (warning that was a bit of an understatement!) with the continued pain and lack of bend - I think I could cope with the bend restriction if it didn't hurt so bloomin' much all the time!

Thanks again - if anyone else can let me know how they feel when their knee bends to its limits I would be grateful x

Regards

Shortie x

 

[Toothfairy]

Hi Shortie, good to hear from you. I am sorry to hear that things are not good for your knee.
When I bend my left knee (almost 1 year out) to as far as it will go it feels slightly tight. My right knee at just over 5 months feels tight and a bit tender at maximum push. In normal day to day use I have no pain with either of them. If I have been overdoing things and done a lot of standing they feel a bit stiff but there is no pain. I can kneel but need to kneel on a cushion as it is a bit tender to kneel straight on a hard floor as yet especially with my right knee.
It is not good that you are still having so much pain. I hope that your review appointment goes well and that you can get some helpful advice.
I haven't had an appointment for an annual review, I must chase that up.
I do have an appointment for a 1 year review for knee 2 at the end of October.
I hope lfe is otherwise good for you and your family,
hugs, Toothfairy x

 

[DogLoverx3]

I'm sorry you're having pain :-( I'm almost 8 weeks and I've found that my bend, like Rest Assured's, is different in different positions (so odd). But when I'm at my 'max' it feels very tight and then hurts if I try to push it past.

Be sure to write all your questions down for your OS appointment so you don't forget anything and take in 2 copies, 1 for you and one for your OS. I tend to get all nervous and flustered and always forget to ask something, so last time I went in with a list of written questions and he actually appreciated it. His PA gave him the list before he even came into the room, so already had a head start on things. ;-)

 

[Campervan]

Hi Shortie, I have between 120-125 flex and if I try to push past I get discomfort around the knee cap and then again to straighten out. But my discomfort could be from my maltracking patella due to weak, but improving, quads from femoral nerve damage from my surgery over two years ago.

 

[StillShortie]

Thank you all again - I know everyone is different but it is good for me to know what I am experiencing isn't right so I can be more assertive at my is appt.
I will write down questions before I go so I don't get flustered. I've just got to think what to say / ask
Shortie x

 

[StillShortie]

OK so I go through periods of trying to ignore my knee and then go into research, thinking, considering time and unfortunately because of how my knee currently is I am in full blown research, thinking reading mode!

So where I am today: I am 11 months post LTKR pain is daily, analgesia is daily, bend is 90 at very best, I can't go down stairs properly, I can't ride a bike, if I catch my knee and / or push the bend pain 10/10. I am unable to be anywhere near as active as I want to be, I am just managing with analgesia to work one day a week. I struggle to get out of the car in a tight space. If I sit for any length of time I take a while to stand up and get moving. Whoever I meet comments about my knee when they see me walk things like 'are you still having problems with your knee!' Or (from a lady who had bilateral TKR around the same time as my LTKR) 'Oh! You are still limping!' I am not sleeping well (due to pain) I have tried all the exercises the physio can suggest including twice / three time weekly mobilisations who has now discharged me back to the OS as physio wasn't working at all.

So I have an appointment on 6th March with my OS who isn't my original OS as he retired, he isn't someone I would have selected to be under however I have tried for a second opinion through my GP but apparently the NHS now has new guidelines for obtaining second opinions and I don't qualify!

I have phoned my OS secretary to check that he should be in clinic when I have my appointment as so far with the two appointments I have had he hasn't been in clinic and I have had to see his registrar or middle grade. The last one I saw just suggested more physio which I was already having and told me you are young you don't want another operation!

So what am I asking when I see him?
1. Why is it painful
2. Why is my flexion rubbish
3. What is the possible cause?
a. Could it be infection.
b. could it be arthrofibrosis?
c. Could it be implant problem?
4. What can be done to solve it? ............anything? MUA (is it too late?) MUA with arthroscopy? Open Lysis of
Adhesions? Revision?

I am still thinking about questions but I also want to ask the OS things like:

Have you got experience in this? What is your expertise? Can you refer me to a different OS? - however especially when I am flustered I don't always ask these sorts of questions in a way that doesn't sound rude!

So much to think about - I do agree that at 43 I don't WANT any more surgery but that is far outweighed by the fact that at 43 I want an active life, to be able to do stuff with the kids rather than watch, and to work and do as much as I want to not what my knee wants!

ANY help gratefully received x

Shortie x

 

[DogLoverx3]

Oh Shortie, I'm so sorry you're having such challenges :-( That is my worst fear; that after all of this, it doesn't actually work. I am SO hoping you get the answers that you need/deserve and everything gets resolved but you ARE too young to not be able to live life the way you want, that's why we both had this done so early in life, right?

You need to make sure that whoever you speak with is a 'revision specialist'. They're the ones that go around and 'fix' the things from other doctors. Ask how much of their surgical experience is in revisions, their success rate, their infection rate and whatever else you need to ask to make sure that you choose someone who is going to make this right for you and, more importantly, someone that you trust! I'm going to tag @Jamie for you as she has tons of resources for tracking down good surgeons. I am unfamiliar with your insurance restrictions, but hopefully she will be able to help and maybe offer some additional questions for you to add to your list!

BTW, when I get flustered, I tend to phrase my questions in less than a PC way unintentionally, so I write out the entire question specifically and hand it to my OS or whoever else I don't want to stick my foot in my mouth with.

 

[StillShortie]

Thanks @DogLoverx3 the NHS here works really well for some things but can be quite restrictive on others! If I went private or had private medical insurance I could see who I want however it appears once you are under a NHS consultant that's it unless the consultant refers you on to someone else that's it - but knowing a few doctors especially surgeons they don't like to admit they are not god and can't do something! or that is how it seems to me! I know the NHS has limited resources (I work for the NHS and know what funding issues we have) but sometimes there is just too much red tape. I have tried but to no avail to get second opinion @Josephine do you know any more about this? At the moment I am on the view that appt is in 3 weeks I am going to go see what is said then ask my OS to refer me to a different consultant (I have one in mind, who is just a knee man! Current OS is knee and hip) and if he won't I will start emailing my preferred consultants secretary and see where I get, let's face it the worse he can say is no!

I have also decided to keep a diary for a week detailing all my knee pain (including pain score, area of pain and activity (or not) causing pain), analgesia taken, limitations and what restrictions it has caused. At least then I can give a full picture of what is happening.

Thanks again everyone x

Shortie x

 

[Ellejay]

That seems a really useful record to keep, you will have all the information to hand as and when you see an OS. Good luck with the e mails, hope you get to see someone that you want to.