Revision TKR Lovetocookandsew’s long road to recovery

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Update. I saw my OS again Friday. I had x-rays of both knees before the appointment as my left knee is also causing some pain. We had a lot of discussion, the end result is as follows. First, he was going to a pain management symposium over the weekend, where there were to be pain management specialists from top places like Mayo, etc. Although a lot of the time was to be about addiction, he said he was going to speak to these guys about my problems with pain meds and see if they have any suggestions or new ideas, etc. He's also going to look into putting a pain medicine plan into my chart so any doctor who treats me will know exactly what to do and all my pain treatment will be consistent and proper for my body instead of generalized treatment. (I was recently hospitalized again for diverticulitis, the same pain management problems cropped up and I ended up with nothing for pain, which was a nightmare) He's the best one to do this as he's the one who has really seen firsthand what actually happens to me when I take narcotic pain relief. (He may have me see a pain management doctor also)

He also thinks it's time to pull out this implant and replace it with a gold knee. He says it'll be harder on me and more painful than the original surgery, so we will first need a plan in place for pain relief over the long term. He said there is way too much swelling at this point, and he also mentioned after moving my knee that my extension is still poor (we already know my flex sucks). There's no guarantee it'll take care of the problems, but I'm almost at the point where I'm willing to take the chance. I wasn't last time he and I talked, but I'm sick of the pain and restrictions this knee causes, so I am almost okay with taking the chance as long as we can figure out the pain problems. He was surprised since he had noted that I wasn't willing last time, but I told him I've reached my tolerance limit now. My left knee looks good, only has a tiny bit of softening which isn't a big deal, so the pain I'm having there is likely a result of the way I'm limping with my right knee and will hopefully resolve once my knee is repaired. The implant looks fine and shows no signs of loosening, so if I do have a revision he says it'll be more work to remove it than if it were loose. He also said it'll be more painful and a harder recovery than the TKR, which scares me to death.

We know I have an allergy to nickel; I think the issue in my OS's mind has been how much it actually affects me. He has mentioned that generally, allergies to the implants in knees should show irritation inside, and he saw none, or rashes outside, etc. I have disagreed with him in the past and we have talked about how if I only had a medium reaction to nickel in the test, then I might only have a medium reaction to the nickel, and maybe that has manifested itself as pain and swelling. I can't say what's in his mind, but I do think he has changed his opinion as to reactions, at least in regards to me. He really knows now that my body reacts totally differently than most people's. If 99.9% of people should respond a certain way, my body will be in the .01% and react in a totally unexpected and different way. So, if everyone who has an allergy should have certain symptoms, he now realizes I won't have those and will have other reactions. It took a while for him to personally see it, but he now has as he's spent more time with me. It was actually very helpful to have had him see what happens to my body on oral pain meds-it was like a light bulb went off in his head that day and all the backward reactions I've had finally came together for him. He mentions it every time I see him now, and he's still stunned over it. I think I'm the only person he's ever seen who has that reaction. He also mentioned that doctors now are so worried about addiction that they're over-reacting, and that's part of why they are so overly tight with me on the issue, even though I'm not one they need be worried about. That's why we need to do something in my chart so hospitalists and others know how to take care of me properly from now on.

Neither of us is certain that a revision with a gold knee will fix the problem, and that's why I've been so reluctant, besides the pain med part, but am almost at the point of willingness to take the chance. I think mostly what's holding me back now is the problem with pain meds, plus a little bit of worry about the result and the hell I'll have to go through again. I've already had something like seven surgeries just on this knee, two of them since the TKR. Nothing has helped to date, and I am frightened to go through all that again, let alone go through it for no gain.

This implant is well-cemented in there and isn't loosening at all, so he says it'll be harder to remove it. He showed me the newest x-ray and showed me how he'll have to very carefully chip around it to get it out and it'll take longer.

Anyway, he does seem to think I have too much pain and swelling at this point in time and a revision with the gold knee is worth trying, so we shall see.

Today I’ve been reading through my recovery thread-scared the daylights out of me just thinking about going through this again! Now I’m back at the point of saying no to a revision. Ugh.
 
Hi Kim, I've been wondering how you are. I really feel for you facing this dilemma, and having to make a very difficult decision. It would be interesting to know what your OS comes up with in terms of pain management for any surgery you have. I had similar problems after my surgery, though not as extreme as yours, so I really get that feeling of dread you must have at the thought of any more operations. At least now your OS has a good understanding of your reactions having seen them first hand. See what kind of a plan he can come up with for pain relief, and then decide what to do. You've been very strong to get through this. I'm praying that the right course of action will become clear and that you can have peace of mind about it.
Love, Tabby xxx
 
Hi Kim,
I'm glad your surgeon is still thinking of ways to help you.
I hope that he can get some good advice at the pain management conference and can then plan an approach to pain control that is tailored especially for you.
The implant looks fine and shows no signs of loosening, so if I do have a revision he says it'll be more work to remove it than if it were loose. He also said it'll be more painful and a harder recovery than the TKR, which scares me to death.
This implant is well-cemented in there and isn't loosening at all, so he says it'll be harder to remove it. He showed me the newest x-ray and showed me how he'll have to very carefully chip around it to get it out and it'll take longer.
The mechanics of removing your current implant is obviously worrying you. Perhaps I can reassure you a bit?
When I had to have my revision from a PKR to a TKR, both metal pieces of the PKR implant were still firmly fixed. And yet, that didn't seem to present too much of a problem. The replacement surgery went well and I didn't find my recovery was any more difficult than my recovery from the original surgery. If your surgeon can sort out your pain relief beforehand, I don't think that your recovery should be any more painful than the previous surgery.

I wonder if your surgeon was mentioning the potential problem with removing your current implant because he wanted to give you "full disclosure"? Or maybe he hasn't done many revisions? If the latter is correct, maybe you need to see a surgeon who specialises in revisions?

I'm not sure about the potential difficulty of removing a firmly-cemented prosthesis, so I'm going to ask @Josephine for her advice.
 
@Celle Thank-you for the info. I think my OS wants to give me all the info he can as he knows I like to know all the possibilities and like to make informed decisions. He's been my OS for something like 10 years so knows me pretty well. He actually does/has done tons of revisions. I'd like to hear Josephine's take also-she does have lots of knowledge and experience.
 
I'm glad your surgeon has plenty of experience with revisions. He was probably just trying to make sure you had all the information then, and possibly didn't realise it would worry you.
Yes, I'm still learning and I always value Josephine's advice.
 
This implant is well-cemented in there and isn't loosening at all, so he says it'll be harder to remove it. He showed me the newest x-ray and showed me how he'll have to very carefully chip around it to get it out and it'll take longer.
I think he's being ultra cautious. I've scrubbed for loads of knee revisions and when this situation presents, it actually takes very little effort to prize the femoral component off as it's really just a cap and there is no cement actually embedded into the bone like in the femoral stem of a hip replacement. Just a judiciously placed chisel and a couple of smart taps with a hammer soon see it separate away.

As for the tibial component, invariably, that's even easier to lift off as the seating is very shallow even around the post where it is quite shallow. So I wouldn't worry about it too much. Both bits will pop off quite easily I think.
 
I've been wondering how you were doing, Kim. It's good to hear your OS is looking for ways to manage your pain. Maybe when that feat is accomplished you'll feel better about a revision. @newlybionic had a revision soon after her TKR as well and has said her recovery was similar to the original TKR.
 
Kim, I am sorry you are having so many problems. Could you please refresh my memory about your pain med problem? I think you know I had my first diverticulitis attack after my TKR. My gastroenterologist and I believe it was a result of the opiod's effects on the intestines. My gastroenterologist retired and I am seeing a new one in a few weeks. Have you ever discussed this possibility with your doctor and what do they recommend? I continue to have pain and digestive issues a year later. THIS is why I would never want another surgery - what the meds did to my body.
 
@Timetolive It's a long story, but basically pain meds and I don't get along. They either do absolutely nothing for me, make me so violently ill that I can't stop vomiting, or I have other reactions I can't exactly explain. I was left only with oral Dilaudid, which does control my pain, but after a short time on it, I have an awful bodily reaction I can't explain, but is horrible. That was the reaction my OS saw after my last surgery in May-and he was shocked. I don't know if pain meds have anything to do with my diverticulitis or not. I've seen a GI doc for it, and they will do surgery if I have one more attack, which I really don't want. But if I do ever have another attack, or any other pain that needs meds, I need to have the pain med problem planned for as this last time the hospitalist decided I didn't need IV pain meds (it as also Dilaudid) any more and could go to oral, which I cannot take. He didn't believe me and d/c'd my IV meds, which meant I was in a lot of pain. In my chart there is an explanation but it doesn't really go into enough detail, plus he wouldn't listen to me when I tried to tell him. I had the same problem with a nurse after my last surgery, so we have to get this done asap, and my OS is the best one to handle it as he's either seen firsthand all the reactions I've had or read hospital notes from caretakers there about the problems I've had, plus listened to me in detail.
Let me know what your new doc says. I hope you can get your diverticulitis under control. I know I'm not totally over it either as I still have some pain and related digestive problems at times, but it is manageable as it is now. I don't want to go see my GI doc as I know he'll want to do the surgery and I'm not doing that unless I have no other options.
 
Hi Kim. I'm sorry to hear that you are still having problems with your knee. When I had my revision everything was replaced except the button on the back of my patella. According to my daughter it didn't take much longer than my original TKR surgery. I actually had an easier time with this recovery than with the original one. At most I only got to 110 flex before I started going backwards but now I have 130 flex. The first few days to a week or so were a little tougher but it mostly was related to muscle cramping in my thigh. My OS prescribed a muscle relaxer which helped a great bit. I used my ice machine almost 24 hours a day. I really didn't need narcotics after after the first two weeks. Hopefully you will have a similar recovery.
 
Hi all. I'm just wondering, has anyone had any experience with IV pain meds long term? If so, was it at home or in the hospital? How'd it work and how'd it go? I can't take any oral pain meds but one, and I'm terrified to take it anymore after the last time and the awful reaction I had. I need to have a revision, but am too scared to do it unless we have the pain med question settled. So far, I've not had a bad reaction to the pain med in an IV, but since I've never been on it for long, I'm not sure how it would go. I'd appreciate any comments or advice. Thanks.
 
Kim, I think this is something you'll have to discuss with your doctors.
I haven't heard of anyone having IV pain meds long term for a recovery from surgery and I'm not sure what the law is about it in the US.
@Jamie , @Josephine - can you help?
 
Thanks, @Celle . I actually am discussing it with my doctor and we're trying to figure out what to do. But I was just wondering if anyone else had the same problem with oral pain medicines and went through with the surgery using long term IV pain meds, or maybe had another form of pain meds that worked. I'd love to hear what Josephine and Jamie have to say as I know they have a ton of experience.
 
I do remember what a dreadful time you had with the oral medications and the havoc they caused with your digestive system. You definitely need to get something sorted out before contemplating the revision.
 

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