Revision TKR Makoplasty at 26
- Thread starter kneedude1
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Good luck with your surgery. Your plan to take things easy during the first critical weeks following surgery is probably the best thing you can do to reduce the chance of problems with your recovery. Also, ensure the use of lots of ice to control pain, swelling and inflammation. Very important.
Good luck Monday!
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kneedude1
junior member
Hey @pumpkin thanks for reaching out. I'm still at the hospital and haven't been discharged yet. HSS is such a great hospital by the way. The care far exceeds anything I've encountered.
As far as the surgery, the doc says everything went well and he thinks I'll be able to resume a normal life when everything heals. Stability was addressed and the patellar pain should go away now that my knee is stable.
I definitely have some things I need to work out mentally. I have a lot of anger built up towards past surgeons, especially the one who did the high tibial osteotomy (totally ruined my knee). The doc is definitely taking an interest in my case which I really appreciate. I really wanted to find someone who didn't just see me as another knee, and I think that was accomplished.
Trying to stay positive and honestly just be patient. This is going to be a long recovery and I have to understand that.
As far as the surgery, the doc says everything went well and he thinks I'll be able to resume a normal life when everything heals. Stability was addressed and the patellar pain should go away now that my knee is stable.
I definitely have some things I need to work out mentally. I have a lot of anger built up towards past surgeons, especially the one who did the high tibial osteotomy (totally ruined my knee). The doc is definitely taking an interest in my case which I really appreciate. I really wanted to find someone who didn't just see me as another knee, and I think that was accomplished.
Trying to stay positive and honestly just be patient. This is going to be a long recovery and I have to understand that.
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Glad to hear the surgery is behind you, your knee is stable and you can move ahead.
Working out the anger you have for the previous surgeons is a process you will have to go through. Not easy but worth it in the end when you can direct those energies in a more positive direction.
Working out the anger you have for the previous surgeons is a process you will have to go through. Not easy but worth it in the end when you can direct those energies in a more positive direction.
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Almost forgot, here are the recovery guidelines, the articles are short and will not take long to read.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?
There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?
There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
kneedude1
junior member
Hello Bonesmart Friends,
Please read this post fully. And please help me. I'm losing hope.
I've gotten to the point where I'm almost embarrassed to explain my complications, because I feel as though I have made poor decisions in choosing surgeons, and also the complications have gotten so outrageous, I don't know if anyone here can offer advice for a situation as complicated as mine. In a way I guess I feel ashamed. I'm embarrassed to tell my friends because being crippled in your 20s is simply something I'm not proud of. But anyway, I'll try to explain what's going on below, provide an update of my "recovery", and also open this up for any of you kind people to offer advice.
I had my revision in the beginning of May to a hinged TKR. Immediately after I noticed my knee was incredibly crooked (overly valgus when I'm naturally slightly varus), so I complained to my surgeon. He actually agreed with me and revised his revision just 2 short weeks later to fix the alignment. Finally I get out of surgery and realize that the alignment was over corrected (is this really happening). Now I'm about 4 degrees more varus than my already varus good leg. My surgeon agrees maybe he is a few degrees off. At this point there is nothing that could really be done, and I don't see it worth going back into surgery to get fixed. I guess I will just deal with an overly varus leg. My good leg is varus, so at least it's not too noticeable to the naked eye. It is something I can look past.
Since then I have been recovering and trying to rebuild my muscles. I noticed immediately after surgery that my knee was still clunking around (sort of like a quarter thrown into a tin can), but I read that this is somewhat normal for some people so I come to the conclusion that further strengthening my knee could fix this.
I am now 3 months since the operation and am very unstable still. It's like trying to walk with the ground beneath you rocking back and forth. Visually, the varus/valgus instability is extremely clear as well. I guess one way to explain this is that it's as if my knee is a seesaw, the tibia is the triangle balancing post and my femur is where the two little kids sit and jump back and forth.
So I tell my surgeon about this problem (I went to NYC for the surgery and don't see him often so much of this communication is via email and phone). He explains that some play is normal, but agrees that my symptoms are not. He suggests that I fly to go see him, which I obviously am, and mentions that perhaps a larger spacer might be needed (reminder I already have a hinged TKR).
So right now, I'm fairly certain a spacer exchange will be the next thing I have to get done (I will literally scream if someone on here says something along the lines of "give it time to heal, it's still early" for their advice. I'm trying to get back to living life not patiently wait for a miracle. I have spent way too many hours researching knee complications that I feel I deserve some credibility).
Here is the good news: I have very little pain inside the joint, only on the quad which is getting better every week. I'm actually able to bike around 10 miles per day outside and have been for about 4 weeks now, but I can hardly walk. The reason being I don't have to worry about stability biking, but walking I do.
Here are my questions:
1. In your opinion, do you believe a spacer exchange will solve the issue? Personally I don't understand how it wouldn't. After all the distance between the two components in the hinged TKR is fixed and increasing a spacer size would certainly decrease the play... right?
2. I'm guessing not, but has anyone had a spacer revision in a hinged TKR?
3. Can someone offer me any advice, give me hope, that a spacer revision will fix this so I can move on with my life? Again, pain aspect is fine, it's just medial/lateral instability.
4. I'm 99% certain I will be getting a spacer revision and really need someone to give me an overview of the recovery. I've already read the the thread from skigirl. From my understanding the only healing that would be needed is the soft tissue, skin from re-opening the incision. I feel like I could pretty much walk fine the next day if that's the case, but have seen mixed reviews from 3 days to 3 months online so not sure what to believe.
5. Does anyone have any advice on how to stay positive? I'm in a deep depression from this.
6. This whole mess was created by surgeons. The high tibial osteotomy I got was the worst surgery ever and did me such a disservice. When I got that surgery the doctor told me that it would not hurt the success rate of a TKR if I decide to go down that route. I come to find out that the doctor has only done 5 HTOs in his whole career and knows very little about the procedure. His operation increased the tibial slope of my knee, which is why the 2 ACL surgeries I had after this operation failed within 2 weeks. It was like putting a skateboard on a hill. Obviously it will roll down.
It also destroyed my PCL and my collateral ligaments. Another doctor told me that he way over-corrected the bow of my leg with the HTO. I'm considering taking legal action. What do you guys think? Do I have a case? One thing I'm scared of is starting a lawsuit before my knee is in a manageable place because I don't want to scare my current surgeon from operating on me.
I just want to walk. I can hardly remember when life was good. Praying for a miracle here. Starting to consider amputation to be done with this nightmare.
Tom
Please read this post fully. And please help me. I'm losing hope.
I've gotten to the point where I'm almost embarrassed to explain my complications, because I feel as though I have made poor decisions in choosing surgeons, and also the complications have gotten so outrageous, I don't know if anyone here can offer advice for a situation as complicated as mine. In a way I guess I feel ashamed. I'm embarrassed to tell my friends because being crippled in your 20s is simply something I'm not proud of. But anyway, I'll try to explain what's going on below, provide an update of my "recovery", and also open this up for any of you kind people to offer advice.
I had my revision in the beginning of May to a hinged TKR. Immediately after I noticed my knee was incredibly crooked (overly valgus when I'm naturally slightly varus), so I complained to my surgeon. He actually agreed with me and revised his revision just 2 short weeks later to fix the alignment. Finally I get out of surgery and realize that the alignment was over corrected (is this really happening). Now I'm about 4 degrees more varus than my already varus good leg. My surgeon agrees maybe he is a few degrees off. At this point there is nothing that could really be done, and I don't see it worth going back into surgery to get fixed. I guess I will just deal with an overly varus leg. My good leg is varus, so at least it's not too noticeable to the naked eye. It is something I can look past.
Since then I have been recovering and trying to rebuild my muscles. I noticed immediately after surgery that my knee was still clunking around (sort of like a quarter thrown into a tin can), but I read that this is somewhat normal for some people so I come to the conclusion that further strengthening my knee could fix this.
I am now 3 months since the operation and am very unstable still. It's like trying to walk with the ground beneath you rocking back and forth. Visually, the varus/valgus instability is extremely clear as well. I guess one way to explain this is that it's as if my knee is a seesaw, the tibia is the triangle balancing post and my femur is where the two little kids sit and jump back and forth.
So I tell my surgeon about this problem (I went to NYC for the surgery and don't see him often so much of this communication is via email and phone). He explains that some play is normal, but agrees that my symptoms are not. He suggests that I fly to go see him, which I obviously am, and mentions that perhaps a larger spacer might be needed (reminder I already have a hinged TKR).
So right now, I'm fairly certain a spacer exchange will be the next thing I have to get done (I will literally scream if someone on here says something along the lines of "give it time to heal, it's still early" for their advice. I'm trying to get back to living life not patiently wait for a miracle. I have spent way too many hours researching knee complications that I feel I deserve some credibility).
Here is the good news: I have very little pain inside the joint, only on the quad which is getting better every week. I'm actually able to bike around 10 miles per day outside and have been for about 4 weeks now, but I can hardly walk. The reason being I don't have to worry about stability biking, but walking I do.
Here are my questions:
1. In your opinion, do you believe a spacer exchange will solve the issue? Personally I don't understand how it wouldn't. After all the distance between the two components in the hinged TKR is fixed and increasing a spacer size would certainly decrease the play... right?
2. I'm guessing not, but has anyone had a spacer revision in a hinged TKR?
3. Can someone offer me any advice, give me hope, that a spacer revision will fix this so I can move on with my life? Again, pain aspect is fine, it's just medial/lateral instability.
4. I'm 99% certain I will be getting a spacer revision and really need someone to give me an overview of the recovery. I've already read the the thread from skigirl. From my understanding the only healing that would be needed is the soft tissue, skin from re-opening the incision. I feel like I could pretty much walk fine the next day if that's the case, but have seen mixed reviews from 3 days to 3 months online so not sure what to believe.
5. Does anyone have any advice on how to stay positive? I'm in a deep depression from this.
6. This whole mess was created by surgeons. The high tibial osteotomy I got was the worst surgery ever and did me such a disservice. When I got that surgery the doctor told me that it would not hurt the success rate of a TKR if I decide to go down that route. I come to find out that the doctor has only done 5 HTOs in his whole career and knows very little about the procedure. His operation increased the tibial slope of my knee, which is why the 2 ACL surgeries I had after this operation failed within 2 weeks. It was like putting a skateboard on a hill. Obviously it will roll down.
It also destroyed my PCL and my collateral ligaments. Another doctor told me that he way over-corrected the bow of my leg with the HTO. I'm considering taking legal action. What do you guys think? Do I have a case? One thing I'm scared of is starting a lawsuit before my knee is in a manageable place because I don't want to scare my current surgeon from operating on me.
I just want to walk. I can hardly remember when life was good. Praying for a miracle here. Starting to consider amputation to be done with this nightmare.
Tom
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@kneedude1,
Sorry to hear of all the challenges you are having with your knee.
Until you decide what to do, suggest you obtain a brace to stabilize your knee so you can walk.
@skigirl had a spacer exchange for instability that helped a great deal.
@maryo52 uses a brace for her knee instability.
You will want to obtain a script from your doctor, to have some one fit you with a brace that will stabilize your knee until you have this all sorted out. Your regular physician can write the script.
Sorry to hear of all the challenges you are having with your knee.
Until you decide what to do, suggest you obtain a brace to stabilize your knee so you can walk.
@skigirl had a spacer exchange for instability that helped a great deal.
@maryo52 uses a brace for her knee instability.
You will want to obtain a script from your doctor, to have some one fit you with a brace that will stabilize your knee until you have this all sorted out. Your regular physician can write the script.
Josephine
NURSE DIRECTOR EMERITA
It's normal for a standard TKR but not for a hinged knee.
Actually no I don't think so. There should be a lot of latitude in these hinged knees that would make it unacceptable.
WHAT??? That's outrageous! Gosh I can hardly even bear to think about it!
Oh that's just perfect! Not only was your knee messed up by the replacements, the HTO was a mish-mash as well! I do feel for you.
Well, no-one on here has any legal expertise so we can't really comment on that. I just know that if I were in your shoes, I would already have started one!
I really wouldn't worry about that. Surgeons are more than used to people having lawsuits because of malpractice and I'd be most surprised if they wanted to drop you because of it. That is assuming your present surgeon has no connection with the HTO surgeon in any way. Not professionally or otherwise such as being a golfing buddy.
I really don't know what else to say to you. For one thing, I don't really know much about your case or your history so that makes it difficult. One thing you could do though, is to give me a photo of your legs so I can see how much deformity you have. It would need to include hips and bare feet and with you wearing shorts - like this
kneedude1
junior member
@Josephine Sorry I don't understand what you mean by this. Unacceptable or not possible? Can you please elaborate. Your response scares me, I don't understand why this wouldn't fix the issue. If there's play in the knee, a larger spacer decreases that play. Then the problem is solved.
kneedude1
junior member
@Josephine can you please elaborate why not? You have said in other posts for people that have laxity that a larger spacer helps, why wouldn't this help in my case. Can you please explain why your opinion is what it is?
What do you mean the latitude will make it unacceptable? I'm not comprehending what you mean by that sorry.
I think what Jo may be referring to is the overall construction of a hinged joint prosthesis versus a standard knee implant. With the standard implants, the surgeon has some latitude with spacer size because the upper and lower components are not fixed together as they are in the hinged joint.
When a patient has compromised soft tissues or loss of bone, a hinged joint provides the needed stability for the prosthesis. But because that stability is achieved by connecting the upper and lower portions of the implant, the size of the spacer should be a factor of the implant design and not something that is normally adjusted.
Please try not to overthink all of this until you've had an opportunity to discuss your options with your surgeon. You are in the right place at HHS and either of those doctors you mentioned earlier should be able to help you. (By the way, which one of them are you seeing???) You know....those of us here on BoneSmart have not seen you or your knee, so it is difficult to say exactly what needs to be done at this point. You have a very unique case which makes it even more difficult to talk here about options. I'm sure after all you've been through, it's difficult to trust any surgeon, but you need to have some faith in this doctor you're seeing. He knows your history, he knows your knee intimately and he is going to be the best person to develop a plan to go forward. Be sure and write out all your questions for your next meeting with him. And let us know how it goes. We're going to be here for you with whatever decision you make after the consultation.
When a patient has compromised soft tissues or loss of bone, a hinged joint provides the needed stability for the prosthesis. But because that stability is achieved by connecting the upper and lower portions of the implant, the size of the spacer should be a factor of the implant design and not something that is normally adjusted.
Please try not to overthink all of this until you've had an opportunity to discuss your options with your surgeon. You are in the right place at HHS and either of those doctors you mentioned earlier should be able to help you. (By the way, which one of them are you seeing???) You know....those of us here on BoneSmart have not seen you or your knee, so it is difficult to say exactly what needs to be done at this point. You have a very unique case which makes it even more difficult to talk here about options. I'm sure after all you've been through, it's difficult to trust any surgeon, but you need to have some faith in this doctor you're seeing. He knows your history, he knows your knee intimately and he is going to be the best person to develop a plan to go forward. Be sure and write out all your questions for your next meeting with him. And let us know how it goes. We're going to be here for you with whatever decision you make after the consultation.
kneedude1
junior member
@Jamie thank you, that makes more sense. I did speak to my surgeon over the phone and he did say the plastic spacer size could be adjusted in the hinged similar to a standard -- the trade off is ROM. I'll let you guys know what he says when I see him Tuesday. They scheduled me for a last minute appointment and I will be flying to NYC then. I'd rather not say his name at this time if that's ok.
Sure, there's no problem keeping his name to yourself. Or you can PM the name to me. I do try to keep track of our members' interactions with the surgeons we recommend, so that's the reason I would like to know. It helps me make better recommendations for others.
kneedude1
junior member
Hi Everyone --
So I will be having a spacer revision tomorrow at HSS which should help solve my instability issue.
I actually hung out with some friends yesterday and we walked all around NYC (about 2 miles according to my apple watch) and they told me they couldn't see any limp, only a bit of reservation when I went down stairs. This is a good sign seeing as the surgery tomorrow will only improve my ongoing instability symptoms.
One thing that I wanted to ask you guys about is medial pain within the joint that I am experiencing. I did have some medial knee pain today toward the end of the walk that was quite noticeable, although I was still able to prevent a limp (which was faster than I have walked since the knee replacement -- it really tested me). This only worries me because I've read here that pain inside the joint shouldn't really exist after tkr, so I guess I'm worried about some bone weakness on the inside of my knee. I'm about 12 weeks out from the past revision and curious to hear your thoughts on this. Is this abnormal? The pain could be soft tissue in the medial posterior corner of the knee but hard to tell.
I'm praying that this pain is just part of my recovery. There will be no bone cuts tomorrow, just swapping the spacer out. So hopefully that pain will decrease over time as the bone strengthens and the spacer swap will provide me with all the stability I need. If both are accomplished I should be able to achieve a decent quality of life.
Could you amazing people share your opinion on this? Essentially, I'm wondering if (a) at 12 weeks out a 2 mile walk without a noticeable limp at fast walking speed is an achievement and (b) should I be concerned about medial knee pain began to develop at about 1.3 miles.
So I will be having a spacer revision tomorrow at HSS which should help solve my instability issue.
I actually hung out with some friends yesterday and we walked all around NYC (about 2 miles according to my apple watch) and they told me they couldn't see any limp, only a bit of reservation when I went down stairs. This is a good sign seeing as the surgery tomorrow will only improve my ongoing instability symptoms.
One thing that I wanted to ask you guys about is medial pain within the joint that I am experiencing. I did have some medial knee pain today toward the end of the walk that was quite noticeable, although I was still able to prevent a limp (which was faster than I have walked since the knee replacement -- it really tested me). This only worries me because I've read here that pain inside the joint shouldn't really exist after tkr, so I guess I'm worried about some bone weakness on the inside of my knee. I'm about 12 weeks out from the past revision and curious to hear your thoughts on this. Is this abnormal? The pain could be soft tissue in the medial posterior corner of the knee but hard to tell.
I'm praying that this pain is just part of my recovery. There will be no bone cuts tomorrow, just swapping the spacer out. So hopefully that pain will decrease over time as the bone strengthens and the spacer swap will provide me with all the stability I need. If both are accomplished I should be able to achieve a decent quality of life.
Could you amazing people share your opinion on this? Essentially, I'm wondering if (a) at 12 weeks out a 2 mile walk without a noticeable limp at fast walking speed is an achievement and (b) should I be concerned about medial knee pain began to develop at about 1.3 miles.
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Walking without a limp is an achievement, means you do not need an assistive device.
It could also be this: Pes Anserine and MPFL pain
Most of could not walk 2 miles at a fast clip with out our knee reacting, your medial pain is your knee complaining about you doing too much. Suggest you ice and elevate.
Remember, you healing is starting all over with the spacer exchange, @skigirl had a spacer exchange and gave her knee time to heal. She was able to bike and ski after giving her knee the healing time it needed in the early days.
Sending positive thoughts your way for a successful outcome, good luck!
Let us know how you are doing after your surgery today.
skigirl
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You are twelve weeks out from a revision and will have surgery today. I had about three days of pain from the spacer exchange and noticed an immediate improvement in my stability. If your knee was not stable prior to this surgery, it is not surprising that you had pain after a two mile fast walk.
Right now your quads and hamstrings will be weak from surgery and anesthesia, it will take some time for them to be up and running. If you do too much while those muscles are not doing their job of supporting the joint, the joint itself has to take over and it does not like to support the joint by itself. Allow some time for healing and be sure your muscles are fully supporting your knee before you begin to do those distances. But, I hope that the spacer exchange will give you much better support.
Right now your quads and hamstrings will be weak from surgery and anesthesia, it will take some time for them to be up and running. If you do too much while those muscles are not doing their job of supporting the joint, the joint itself has to take over and it does not like to support the joint by itself. Allow some time for healing and be sure your muscles are fully supporting your knee before you begin to do those distances. But, I hope that the spacer exchange will give you much better support.
