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Maine girl - revision

Discussion in 'Knee Replacement Pre-Op Area' started by maryo52, Oct 26, 2018.

  1. maryo52

    maryo52 Sr Bonesmartie
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    Hello, I am not new to the forum. I previously was a regular on the recovery forum after my 2010 TKA. Short story: lots of pain, arthrofibrosis, MUA, arthroscopic lysis of lesions, and finally decent range of motion . . . but the TKA has excess laxity, it's been stiff due to a significant effusion the entire 8 years of its life, and now there appears to be loosening.

    The radiology report from recent X-rays says, "Right knee arthroplasty aligned anatomically. There is a joint effusion present. There is some radial lucency adjacent to the arthroplasty tibial component, both posteriorly and laterally, and the possibility of loosening need be considered. Bones appear to be somewhat demineralized."

    I'm a super healthy person (no drinking, no smoking, eat right, exercise, etc.) The demineralized part, I take personally. Or maybe that's a normal response? Your thoughts @Jamie?

    This is what I get for choosing an orthopedist whose practice is close and who people say they like and not checking his experience level.

    I have appointments in the next 3 weeks to see Dr. Andrew Freiburg at Mass. General in Boston, and Dr. Gonzalez Della Valle at the Hospital for Special Surgery in NYC.

    I'm putting my thoughts together for all the logistics that would be involved in having a surgery far from my home in Maine. In the meanwhile, I'm back working out at the gym with a general toning program I learned from a personal trainer and doing everything I can to keep a positive frame of mind, because underneath, I'm terrified of going through my hell from 2010 and 2011 again.
     
  2. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello Mary,
    I'm really sorry you have to have further surgery, Here's hoping that this time is the charm and everything goes without a problem.
     
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  3. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I share your fear! Hugs and prayers this will be a better experience. :console2:
     
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  4. Jamie

    Jamie ADMINISTRATOR Administrator

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    We're here with you, Mary!!! Try not to worry. I'm going to tag @Josephine to answer your question about the condition of your bones. That's more her area of expertise than mine.
     
  5. Scully

    Scully new member

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    Hi there, I feel your pain. It is frightening to have to go far away for surgery. I know this b/c I just did it 4 the 2nd time last Monday. My knee surgeries took place 350 miles from my home in the Sierra Nevada Mtns. But so far I have NO regrets even though the drive home is rough, I won’t lie to you. But you can do it w/ help from family or friends and be much better off for it. My advice is choose the best surgeon possible. Someone who has done 1000s of TKAs over his career. Loves what he does & is knowledgeable about the latest in pain management. Also a great hospital w/ excellent nursing & anesthesiology staff is just as important. The good thing is that really great knee & hip surgeons usually use really great hospitals. You can do it ME girl & get the TKA you deserve; you will find the logistics of travel will fall into place as you move along the space between finding & settling upon that top notch surgeon. Ask now for a hotel list from your two prospective surgeons. As my knee heals I will keep you in my thoughts & prayers
     
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  6. maryo52

    maryo52 Sr Bonesmartie
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    That's pretty much where my thoughts are going, Scully. The NYC surgeon I'm scheduled to see has his own website. It's got information on everything imaginative. Very comprehensive. When I looked complication rates for surgeons, his was the lowest even though no doubt he gets complex cases.
     
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  7. maryo52

    maryo52 Sr Bonesmartie
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    I have one or two (or 50) questions.

    For me, the usual way the loose tibial component presents is when I get up from sitting. The first few steps are very painful. Then it's OK and I'm fine. Today the lameness is much more persistent, and I don't know yet whether the situation has worsened or it's just a bad day. BTW The component isn't toggling so much as it's rocking back and forth, and I suspect is slips out while I'm sitting.

    I have appts. to see two different revisionists - Nov. 1 and Nov. 12. One question I have is, how urgent is it that I have a revision? Also, are there things I should be doing -- or not doing -- right now?

    On a day like this, it's hard to imagine myself flying to NYC never mind flying down and back while waiting for a surgery date. @Josephine @Jamie
     
  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    What's the difference. It's moving. That's all that matters.
    That rather depends upon the degree of movement and/or pain. If the implant is only slightly loose, then you might go a while with minimal pain but if the pain gets really bad, then the device might be very loose and might damage the adjacent bone with micro-fractures or crumbling. That's why I would always advice getting it done ASAP. Not as an emergency as such, but nor to wait for weeks or months.
    It can be but I think it needs to be confirmed or refuted by a bone scan.
    Well, you don't want to over stress it with excessive walking or other activity.

    Hope this all helps
     
  9. Jamie

    Jamie ADMINISTRATOR Administrator

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    That's the word from the expert! Just try and take things easy until you see at least one of your surgeons. You'll know a lot more about what you need to do or not do then. Best of luck, Mary. I'm so glad you're seeing these new doctors.
     
  10. maryo52

    maryo52 Sr Bonesmartie
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    Looking forward to Thursday for more info. Thanks for everyone who took the time to chime and and/or answer my questions.
     
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  11. maryo52

    maryo52 Sr Bonesmartie
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    Don't worry, you say. Well. I had my first "interview," in Boston. My knee is quite effused and so it was aspirated. There was 60 cc taken. My labs show elevated C-reactive protein was 10.8 (normal range below 8) and my ESR was 28, well above the normal range of 0-20. The fluid aspirated had lymphocytes, neutrophils and macrophages. I don't know what that means except I know they are white blood cells and that's an indicator of infection. Of course they will culture the fluid.

    On the drive back from Boston I started making myself accept the possibility of periprosthetic infection. It just seemed to be such a likely possibility. I expect I will get a call tomorrow about this.

    OMG just blown away . . . and telling myself I'll get through it, one day at a time.
     
    Last edited: Nov 2, 2018
  12. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    maryo52,
    What a shock for you, hard to get your head wrapped around that possibility.
    Glad to hear the surgeon is thorough and taking a good look at your knee.
    Sorry you now have more questions than answers, hope you receive the results soon.
     
  13. maryo52

    maryo52 Sr Bonesmartie
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    Thanks Pumpkin. So I remember you from "back in the day." I suffered a long while after my TKA and was on Bonesmart quite a bit.

    You know, more and more of my friends are developing serious medical problems. Several close friends have gone to the great beyond. I see this as an opportunity to stop taking life for granted, stop seeing myself as a victim. OK, so I'd totally sucker punch my original OS if I ran into him (he's retired and in Canada, but you never know). I do wish my beloved dog wasn't also experiencing a decline. So there's nothing to do but stay strong. I expect to get a call tomorrow or Monday, hopefully tomorrow.
     
  14. maryo52

    maryo52 Sr Bonesmartie
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    So how do people feel about being able to see your lab results before getting a call interpreting the results? So at first look at the results of my synovial fluid assay I was thinking OMG infection! But I was able to find out normal values with a little detective work today and am thinking no infection. Apparently the pneumococcal vaccine I got this week can explain some of my lab results (sed rate and C-reactive protein) being elevated. Still waiting for "the call." Heading to NYC in a week to check out another OS.
     
  15. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Hi maryo52,
    I remember how you went through a lot with your knee in the early days.

    I am OK with getting lab results before I see the doctor. Most of the results I get have the norms, which provide some reassurance.
    :fingersx: for no infection, and you can proceed with a revision when you are ready.
    All the best for your visit with the second OS next week.
     
  16. Jamie

    Jamie ADMINISTRATOR Administrator

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    Mary, I'm not sure I'd worry so much about infection this long after your TKR. You have consistently had problems with it, so I feel like something else may be the issue. Be sure you talk over the possibility of metal allergies with your surgeon when you talk with him next. It might be helpful to be tested for that and, if you do get that test, make sure it's the proper blood test and not a skin test.
     
  17. maryo52

    maryo52 Sr Bonesmartie
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    I got the serum metal allergy blood test and it did show that I was highly reactive to nickel. The Boston surgeon pointed to my wrist and observed that there was lots of nickel in my watch band and was that causing me a problem? (no) He says that he can use nickel free components if I want but because there are so few used, the revision component options are more limited. (He went on to say he knows the researcher who started the lab where the nickel allergy was evaluated and the OS said that researcher himself was skeptical about the whole nickel allergy thing.) As far as infection, I did have a tooth abscess a while back. I'm not exactly worried, but I am working on a mental strategy that spares me from disappointment.
     
  18. maryo52

    maryo52 Sr Bonesmartie
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    Eight years ago I looked forward to TKA. Afterward my thought, pretty much continuously for months, was, "What in the world were you thinking, girl?" Well here I am at another knee juncture with a surgery date of January 9th in Boston and looking forward to it again. Hopefully this one will be a better experience and last a good long while. The surgeon said, "I love fixing knees." And good news, my knee is not infected.
     
  19. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    That’s so great that your knee is not infected and you found a surgeon who loves fixing knees!

    Best wishes for a successful surgery!
     
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  20. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    Good news about no infection. And I think it's great that your surgeon loves fixing knees. How rewarding it must be to give so much back to a patient. A surgeon who wants good things for you is someone to get on your team!
     

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