Revision TKR Lovetocookandsew’s long road to recovery

[lovetocookandsew]

@Jamie @Pumpkln I have a question sort of relating to my Aesculap knee implant, so thought I'd ask it and see if either of you (or anyone else) can answer it. I should have asked my OS, but keep forgetting, although I may need to if no one has an answer. I know my knee is nickel free-or doesn't leach nickel-I forget exactly how it works, but I keep wondering what metal(s)the long rods are made from. I realize there may be various types and so differ depending on which ones the surgeon chose, or it may be that the rods have to fit the exact knee implant so are also nickel free, or maybe they're titanium, and so on. But I have been wondering, so thought I'd ask here and see if anyone had any knowledge or ideas on the subject.

I asked my OS the other day if he noticed any more remodeling of the bone on my new x-ray since the previous set showed little to none, (I forgot to ask him the day I had the recent x-rays done) and he said there was a "Slight increase density around the stems", which, while better than no increase at all, tells me my bone is not in any hurry to mature, so I can't help but wonder why. I've wondered if it's because my bone doesn't like the rods, or if it's my particular anatomy, which is always contrary, or what. I know some people get the same stem tip pain I have, but only for a short time until their bone fills in, but my bone is not really filling in, and the pain is not going away, and is actually gradually increasing around the bottom stem.

I don't get the unexpected sharp stabbing pains in the lower post that I get in the upper post, it's more of an ache in the lower that is getting stronger with time, but I still get the awful stabbing jolts of pain with certain movement on the upper post area, plus it still hurts around both post areas when I walk more than a short distance, stand for longer periods, try to walk up stairs, and so on. The recent bone scan did show that both stems are irritating the inside of the bone, which shouldn't still be happening, as the bone should have filled in, remodeled or matured by now, whichever phrase is the more correct one...lol. It's a puzzle to me (and maybe to my doctor also) as to why the bone isn't really maturing, and why I still have so much swelling in my knee and leg. Plus, lately I am actually getting pain in the knee area itself, which I hadn't been getting before. My OS thinks that the pain fibers are amplified in my whole leg and the chronic swelling isn't helping, and that's why my actual knee area has been hurting lately.

I know I've been on it a lot more without taking as many breaks to rest and elevate it between tasks due to how busy I've been with selling the house, etc, so maybe that's the simple explanation. But I would think at 16 months I wouldn't really be thinking about my knee and needing to rest it so much during the day, so that's annoying, to say the least.

 

[Jamie]

I wish I had answers for you about the "why" of your continued pain. I think this is going to be something you need to talk over with your surgeon, as he knows the details of your situation.

I believe the stems of the Aesculap prosthesis are also the same coated material as the actual joint components. If you look at this image, you can see the stem that goes into the femur has the gold coating.

 

[Jockette]

I have no answers for you either,

 

[lovetocookandsew]

Thanks for the picture. I see the stems, so next time I speak to my OS, I'll ask him if he used those particular stems, which will tell me it's my crazy body. I wasn't specifically asking about the pain itself as I know that has to do with the bone not filling in and hitting the stems with movement; rather the relation of the long stems in my leg to my bone not filling back in, and if they could be causing that problem. My first implant had nickel in it and it gave me problems from early on, which may have been from the nickel, so I was just wondering if the new long (very long) stems could possibly not be a matching set to the implant. My doctor is very well aware of my reaction to nickel, so would have avoided it if possible, but I wasn't sure if the stems always pair with the implant or if they use generic stems that could possibly have nickel.

 

[Jockette]

While I’ve never thought about it before, I would think the knee replacement hardware would come as a set, especially if it’s used in someone with a metal allergy/sensitivity.

 

[lovetocookandsew]

I need to whine a little, so here goes.....

Moving is hard at any time, but the situation with my knee makes it a lot worse. I don't know what it is about the movements of packing boxes that irritates things even more than usual, but whatever it is is no fun. Because my bone is not remodeling (filling in) around the long (VERY long) posts, I continue to have pain from said posts irritating my bones. I still have the sharp stabbing pain from the post tips that hits when I move in certain ways, plus sharp pain when I walk and other related pain from the dang posts.

My OS is aware of this and wants to give my bones until April to see if they'll somehow miraculously fill in, although it's unlikely a year and a half out. I do agree with waiting, but we are in the process of moving and it's not helping with the whole pain thing at all. Packing up our home is causing me a lot of pain, and frankly, I'm totally over this whole knee situation. Unfortunately, my knee isn't, so I just have to deal with it, even on the days when I can't take it anymore. And because I am unable to take any kind of pain meds, I just have to grit my teeth and tough it out. Hopefully the hot tub at our temporary rental will help after we move in, and I can relax and baby my knee for a while. Ok, whine over...............

 

[Pumpkin]

Sorry to hear all the packing and moving has irritated your knee. I will be relieved for you when you are moved into your temporary rental, and can use that hot tub.

 

[NightQuilter]

Yikes! What a pain - literally. You have good reason to whine. Enjoy that hot tub - it sounds like a divine way to pamper yourself after an excruciating move.

 

[Jockette]

I’m so sorry you’re hurting so much. I would think packing boxes means standing for longer periods of time, and, leaning forward over the box, which could shift the end of your post causing that pain, since the bone doesn’t seem to be filling in around the post.

I know that when I lean forward, to make the bed, for example, by the time I’m done my knee feels out of joint, like something has shifted. I get that feeling with bending, leaning, or turning too much. It’s an awful feeling.

Sending hugs that you’ll get through this difficult time. My last move caused me a lot of pain, in spite of the fact we even had professional movers!

April does seem like a long way away!

 

[lovetocookandsew]

Thanks, guys. I am looking forward to the hot tub and getting some rest-but at some point I'm likely going to be bored silly......lol. As for April, it is a ways away but if I can't take it anymore I'll just go in and see him.

 

[luvcats]

I'm so sorry you are still in this terrible situation.
Not that moving is ever fun under any circumstance.

 

[Jamie]

@lovetocookandsew
I'm sorry you're having to deal with pain like this. I know you probably don't want to deal with another doctor visit in the middle of packing and moving, but I do think you should consider an appointment if the pain is anywhere near constant. If it comes and goes depending on your activity, it's not such a big deal. But you know you have a remodeling issue and, if you have constant pain, your surgeon needs to know that.

 

[lovetocookandsew]

@Jamie The pain is basically constant, but the levels change from painful to "just shoot me now", depending on my activity. For instance, right now I'm relaxing with my leg up, after being off it all night; the lower post is noticeably aching, while the upper is calm for the moment. But a few minutes ago when I went in to get my coffee the upper was hurting as I walked and stood. Last night both the upper and lower post areas were killing me, and on Friday night the pain was so bad that I had my husband drive us to our daughter's house to put all our frozen food in our freezer which we had put in her garage. (our normal is I drive when we take my car, and he drives when we take his truck) Driving irritates everything because it's my right leg and the movements required to drive hurt, so driving long distances is something I avoid. Even driving to see our new house starts to hurt about halfway there so lately I've had my husband do most of the driving when we go somewhere together, which frustrates me as I like to drive.

My OS is aware of all this; he even knows I can't swim or tread water with the amount of swelling I still have. We've discussed all the issues still present; which is why he did the bone scan recently. It did show the posts are irritating the bones, so he knows what's going on and what he may need to do to fix the problem, but he wanted to give it six more months. I think we both know it's unlikely that the time will make a difference, but I don't want another surgery, so putting off dealing with it for now was agreeable to me also. The issue is it requires some sort of surgery to fix and I can't face that right now, and will still have a difficult time facing it down the road if he decides it needs to be done. He told me it not only means another major surgery, it means another long hospital stay, and so on, as we had to do after my revision. That is not something I want, but I may have no other option if this doesn't improve.

The good news is my knee itself for the most part is doing really well, other than the swelling problem, but pain-wise is generally fine, although long days on it without a break as I've been doing lately will result in it aching. If my bones would cooperate and fill in the space around the posts, I'd be great, although limited on activities still due to the swelling.

 

[sistersinhim]

You have a lot more stamina than I do. Going through what you are going through and having move at the same time would send me straight to the doctor to ask for relief. You are amazing. I pray your bones will fill in around the shafts and your pain is relieved. No wonder you are swelling with those things moving around like they are. We are here to listen whenever you need to vent!

 

[Jamie]

I understand. What you say makes sense, although I don't know I'd agree with the 6-month wait. But it does sound like that is what you need to do right now anyway, given everything else that's going on.

It has always been my understanding that bone growth is either stopped or greatly diminished when there is movement or constant inflammation in the area where the growth is supposed to take place. So, that would be my reasoning behind not waiting.

I know I'm telling you things you already know, but just try to keep your activity at a minimum until April to give your body its best chance. I wish I had a magic solution for you....

 

[lovetocookandsew]

Thanks, Jamie and sistersinhim.
I know waiting six more months is likely not going to make a difference, but I literally cannot go through any kind of surgery right now; especially a major one. I did think about getting it fixed while we are in the cabin since I won't have much of anything to do there anyway, as long as the recovery would be complete before we move into our new house in Feb. If it doesn't settle down after this first move, I may message him and ask him exactly what it would entail and go from there. But I suspect it's a long recovery again, so I think considering everything, waiting until we get moved and settled in our new house would be best. Who knows, maybe a miracle will happen and the bone will remodel by April......slim to no chance I know, but a girl can dream............

My OS told me it's not the posts that move as they're solid metal, it's bone that moves, and apparently as I move my bone hits the posts and causes pain. Once the bone fills in (and most people have that happen in a few months) that movement no longer causes pain. but since my body is always contrary, it's not filling in. He said 99.9% of people's bone fills in by a year or a little longer; apparently as usual I'm in the minuscule percent of people whose bodies don't comply.

 

[lovetocookandsew]

To make things even worse, getting out of the bathtub last night, I moved my knee a bit too much somehow, which pulled something inside there a bit. It's just tissues or whatever's in there that's already irritated by all the swelling, it's not the knee implant at all. But it is aching, so now I have that to contend with as well. I'm sure it'll settle down in the next day or so, but until then I just need to carry on. We're in the final couple of days of our first of two moves, so I can soon get off it and rest.

 

[Jockette]

 

[sistersinhim]

Just think of that wonderful hot tub you can relax in! When do you move in to this first move?

 

[lovetocookandsew]

We move on Friday, so you know where I'll be on Saturday!