Revision TKR Makoplasty at 26

[Josephine]

Hey, you're not even a week out yet so it's quite normal for your muscles to be a bit slack. I suggest you stop worrying about it.

Essentially I know I have a posterior stabilized knee and that might contribute to the clunking.

I very much doubt it.

Right now the clunk is caused by shaking out my legs or rotating my feet.

Mine still does that! After 9 years, I can still make mine clunk on demand and the usual activity that causes it is kicking the duvet back into place when it's slid off the side of the bed! The reason for the clunk is that your nice soft and impact adsorbing cartilage has been replaced with metal and hard plastic. Try tapping a plastic spoon on the table and see what I mean!

 

[sistersinhim]

Does your clunking happen often or do you just notice it at times / certain activities?

Mine happens every step I take. I just ignore it.

 

[smarttoys]

At over two years my knee doesn't make noise during normal activity but I can make it clunk quite a bit if I relax the muscles and shake my leg.

 

[AnnieC]

Too complex an issue for me to advise on, but you HAVE been through the mill.... Wishing you strength.


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[kneedude1]

So I saw my OS and he mentioned that the MCL might be a little bit lax because of the osteotomy that I had last year and that it should tighten over time but if it doesn't we could always reconstruct my MCL and it won't be too hard because it's not in the joint line. Has anyone had an MCL replaced after TKR?

 

[kneedude1]

Hello everyone.

Could really use some encouragement here as I am truly losing hope. The good news is my arthritic knee pain is much better. The bad news is that I'm wildly unstable and my knee is partially dislocating because of my medial instability. This is just so frustrating because previous surgeries caused this problem when I could have gotten the TKR to begin with after which I could have lived a pretty normal life. I'm just so angry with surgeons who think they are god.

Anyway, I'm looking for a good revision surgeon who can manage ligament repairs along with revision TKR. Does anyone have any recommendations?

I'm currently living in Atlanta but willing to travel if the doctor is extraordinarily skilled. I can't afford anymore mistakes and need someone who only takes on complex cases. I wish I could have a team of doctors study my knee, plan a surgery, and then execute. Is this possible?

Really appreciate any feedback.

 

[Pumpkin]

Kneedude1,
Instability of the knee, frustrating, I know first hand. My peroneal tendon tore and the lateral collateral ligaments were stretched out in a mishap about 5 weeks after my TKR.
My knee was unstable and causing constant pain.
I received a hinged implant during my revision, my knee is stable and works great.
My knee is the one on the right, click on revision to read about the implant and all that it stabilizes.
https://www.smith-nephew.com/professional/products/all-products/legion/

I will tag @Jamie to help you with finding an OS specializing in revisions/complex joint reconstruction.

 

[Jamie]

Knee dude.....I'm sorry you're experiencing problems with your knee. But I have to remind you that you are only a tad more than 6 weeks out from this surgery. It is doubtful that another surgeon would talk about a revision with you at this early stage. Based on your previous posts, I'm concerned that you may have not allowed yourself sufficient time to heal before trying to resume your normal activity levels.

What does your surgeon say about the feelings of dislocation you've had? Has he evaluated your concerns? Are you having pain? What kind of activity and exercises have you been doing? I'm going to tag @Josephine for you again and these are likely some things she'll want to know before offering advice for you.

 

[kneedude1]

I have never understood that logic among surgeons. The TKR was done improperly, I don't see why I should wait longer to get it seen. It is clearly on crooked and no amount of time waiting is going to fix my loose ligaments. My muscles are developed enough to prove that.

My current doctor has articulated that it might settle down as I continue to strengthen my knee but agrees that there are mechanical issues.

I'm really just looking for a list of surgeons that do complex revision TKRs along with ligament deficiencies. The instability is actually getting worse, so the longer I wait the more irreparable damage there could be.

 

[Josephine]

Has anyone had an MCL replaced after tkr?

Medial collateral ligaments don't get replaced! They get repaired.

The tkr was done improperly, I don't see why I should wait longer to get it seen.

It's a cautionary thing because most of these kinds of issues will settle down or change in due time and alter the overall picture. A surgeon wouldn't be considered much of a surgeon if he was to jump in so quickly before he had to whole picture.

It is clearly on crooked and no amount of time waiting is going to fix my loose ligaments.

Do you have an xray of this you can post for me? Just so I know what's being talked about?

 

[kneedude1]

Medial collateral ligaments don't get replaced! They get repaired.

Not necessarily true from my understanding. Surgeons can reconstruct via cadaver allograft, another tendon, or direct repair is what I've been told.

Here are my before and after x-rays. If you'll notice I am supposed to be valgus and now I am highly varus.

 

[Celle]

Since you've already had a knee replacement, it seems unlikely that the MCL would be repaired or replaced, if that is the problem.

However, as Jamie said, you will probably have no luck in finding a surgeon who will do this so soon after your TKR. Very often, an initial knee instability settles down as your muscles and tendons regain their normal strength.

 

[Josephine]

Surgeons can reconstruct via cadaver allograft, another tendon, or direct repair is what I've been told.

You said it yourself - that IS a repair!

I'm sorry. In order to judge your knee, I need an xray or even a photo of you from the waist down including both legs with the hips and feet. Like this but with bare feet!

 

[kneedude1]

Hello everyone,

I went to NYC last week to meet with two doctors. One at HSS and one at NYU. Both agreed that I need my knee revised and so I'm coming here in hopes of getting a few of my questions answered.

1. What is the recovery like for a revision. In particular for a hinged implant?

2. How long do hinged implants last?

3. Can you hike on hinged implants?

4. Does anyone know the reputations of Russel Windsor and/or Scott Marwin?

5. Can hinged implants be revised when they wear out? Can the plastic spacers be replaced etc.?


Thanks,
James

 

[Pumpkin]

I have a hinged implant, very stable, feels about the same at my primary TKR.

1. What is the recovery like for a revision. In particular for a hinged implant?

About the same as for a primary, of course every recovery is different.

2. How long do hinged implants last?

Should be about the same as for a primary TKR.

3. Can you hike on hinged implants?

I have a hinged implant and I hike.

5. Can hinged implants be revised when they wear out? Can the plastic spacers be replaced etc.?

Yes and yes.

Be sure to run these questions past your surgeon.

 

[Celle]

@kneedude1
Give your knee some more time to heal. It does take a long time to heal from a knee replacement - as long as a full year for all your soft tissues to heal completely. That's another reasons why surgeons are reluctant to leap in and do a revision before that time. Your knee is still a work in progress, not the finished article.

It's probably hard for you to accept because you're young, but being young and fit does not make your knee heal any faster. Complete healing takes just as long, whether you are 18 or 80. There is no way that you can speed up that healing process.

As your knee heals, your muscles will regain their tone and strength and your ligaments will readjust a bit as well. That loose MCL could tighten up a bit and , supported by stronger muscles, your knee instability could well become a thing of the past.
Remember that you surgeon said this:

So I saw my OS and he mentioned that the MCL might be a little bit lax because of the osteostomy that I had last year and that it should tighten over time but if it doesn't we could always reconstruct my mcl and it won't be too hard cuz it's not in the joint line.

 

[kneedude1]

@Celle my knee is chronically dislocating and every surgeon that I've seen since my original OS agreed unequivocally that I need a revision. Like I said I flew to NYC to see doctors at HSS and NYU and they all agreed that I need a revision and to do it. I don't think they would have agreed if they think that it will get better over time. So I'm not really looking for advice in regards to the chances that my current TKR will work out, I was just looking for those particular questions to get answered.

I have a hinged implant, very stable, feels about the same at my primary TKR.

Thanks for the reply on this @Pumpkln . Do you happen to know what brand your prosthesis is?

 

[Pumpkin]

It is a Smith and Nephew hinged knee.

 

[Celle]

my knee is chronically dislocating and every surgeon that I've seen since my original OS agreed unequivocally that I need a revision.

When these second-opinion surgeons say your knee is chronically dislocating, what exactly do they mean?
Do they mean that one of the components is loose and is coming disconnected from the bone? That does occasionally happen with the tibial part of the implant. If that is the problem, then indeed you do need a revision.

Or do they mean that the femoral part and the tibial part and spacers are no longer connecting? That would be very unusual.

Do you have a better X-Ray that shows the problem, so that Josephine can look at it?

So I'm not really looking for advice in regards to the chances that my current TKR will work out, I was just looking for those particular questions to get answered.

You got your answers from Pumpkln, and I hope they reassured you.

It is very unusual for any surgeon to be so sure at this early stage that you need a revision. I think that needs some explanation. I hope the surgeons explained it carefully to you. If you could tell us as well, it will be easier to advise you appropriately.

I am wondering, though, why you are asking about the hinged implant and who suggested that might solve your knee's problem?

By the way, the make of the implant is far less important than the skill and experience of the surgeon who installs it. If you do go for a revision, make sure that it is done by a surgeon who specializes in problem knees and who has done many revisions.

 

[kneedude1]

@Celle I don't have an x ray on me, but the surgeon showed it to me and my femur is behind my tibia. I agree it is unusual, but I have an unusual case. If nothing is done I could potentially get nerve damage due to the dislocation.

Is there someone on this forum that can give me insights into Russel Windsor at HSS or Scott Marwin at NYU? Currently deciding which surgeon I am going to choose and was hoping someone could speak to their reputations.