TKR Malaligned Valgus knee following TKR

[1958slewis]

Hi to all from the UK
Thought I would post an update, nearly a year since my TKR. I continued with all my exercises, including daily walks. I still have a clonking sound from my knee and it feels lax or loose at times. I have slight pain on the outside of the knee and referred pain, still, in my right buttock and hip, due, I think, to the valgus alignment. The knee feels fairly stable and has not given way.

I have seen my original consultant and we have reviewed the long leg X rays. He was apologetic about the 'valgus deformity', as he put it, and has said that it is due to the tibial component positioning. We were in agreement that my knee is certainly performing better than before the operation.

I asked to be referred to a revision expert to discuss options. I saw him recently and had a frank conversation about the way forward. He agreed that the knee is aligned significantly valgus, at about 13 degrees. There is no middle ground and to correct it would need a revision by replacing both components. He offered to put me on his list straight away but we agreed that, at this time, as I am not in constant pain and have mobility, that a revision was not justified at this time. He did state that the implants would undoubtedly wear more quickly due to the deformity and slight instability. He will review me again in 6 months.

I will see how the knee progresses over the next 6 months and monitor if I think there is some deterioration or worsening of symptoms. I am very fortunate to be able to walk, cycle and play golf occasionally and the knee has not given way. It swells up when I overdo it truly is a lot better than pre TKR.

I think I have a tough decision to make. As you all know, the operation is traumatic, and do I opt for another one, with all the risks that entail, when, at the moment it is functioning fairly well. I am nearly 62 and could probably cope with a revision and the PT afterward but may not be able to 5 years down the line. But there are no guarantees with these types of operations, as a quick read of the Forum here confirms. Also, I have to bear in mind that I may be incurring damage to my hip or ankle, for instance, due to the misaligned components.

Sorry to have rambled on a bit. Any thoughts would be welcome. x

 

[1958slewis]

Hiya Sara, strangely enough I have just posted an update. Thanks for your enquiry.

 

[1958slewis]

@Sara61 , please see above post

 

[Naturelover]

Hi Steve
I don't think you are rambling, you are expressing your thoughts and feelings regarding a very difficult situation. Your new knee is much improved vs pre TKR and it is functional for the most part. I agree with waiting and monitoring your knee. Like you said, there are no guarantees and why go through surgery again and the possible risk of a poorer outcome?

I am fairly active with my new valgus right knee. I am currently seeing a physical therapist for pain in my lower right back and hip. Of course I wish that my leg was straight, but overall my quality of life is vastly improved since my surgery....

Wishing you the best going forward,
Karen

 

[1958slewis]

Hi Karen
That is great news, that your knee has improved a lot, and long may it continue for you.
It is indeed one of those conundrums isn’t it? I can do all those things I struggled with, pre TKR - long walks, golf and cycling - so why take a risk and opt for revision surgery. I think some of my reasoning is based on the hip discomfort I have now and whether it will lead to a hip replacement 5 years from now, that I wouldn’t have perhaps needed had the components been put in at the correct angle.
Hoping that you remain in good health moving forward Karen.
Best wishes, Steve

 

[Mrs. Ciz]

@1958slewis
I’m so sorry to hear that your new knee is crooked. I had never heard of a valgus knee until I read your post and had to look it up. After all the pain we go through for TKR, we should have a perfect result! Did you surgeon use any sort of robotic arm or computer assisted surgery program when he did your TKR? Not sure if that makes any difference what so ever. If the experts on here say it does make a difference, maybe look for that if you pursue a revision. I know myself - I’d be worried about ruining my hips or wearing out my new knee too quickly just the same as you. I’m hoping and praying that PT will help correct the problem for you.

Best wishes!

 

[Sara61]

@1958slewis How strange we must have been writing at the same time - " they say "great minds think alike "
Glad to see your your new knee is much improved vs pre TKR and it is functional for the majority and thst you are able to enjoy golf, cycling and walking. I agree that you should wait awhile, unfortunately there are no guarantees, but just keep an eye on your hips and hopefully with time you will be able to do what's right.
I'm a wee bit younger than you, I was fortunate to have no issues after 1 year however still have a slight clicking ( mostly on bending) which I try mostly to ignore, I have an appointment in November to start the process for my right knee as it too is now playing up...the joys of getting older ...
Stay safe in these very strange times x

 

[1958slewis]

Hi to both @Sara61 and "Mrs. Ciz"
Thanks for your thoughts. I don't believe any sort of robotic assistance was carried out on my knee. I was the last to go down to theatre at about 3pm and he had already carried out 3 before mine, so not ideal . I have a lot to be grateful for and am probably erring towards not opting for a revision but time will tell and I might hold a different view in 6 months time. Hope your second knee goes well Sara. Lets all try and remain positive x

 

[Celle]

I'm glad you asked for, and received a consultation for a second opinion. It sounds as if the revision expert was sensible and careful. I like that he is going to see you again in 6 months, too. By then, you may be experiencing symptoms that help you to decide whether to proceed with a revision, or not.

I am nearly 62 and could probably cope with a revision and the PT afterward but may not be able to 5 years down the line.

Don't let your age be a factor in making the decision. People in their 80s and even older have had successful knee replacements. My mother was 85 when she had her second knee replacement and her recovery was uneventful.

The PT also shouldn't be a factor, because it needs to be gentle and undemanding.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase, whether you do formal exercises or just let your activities of daily living be your exercise.

 

[1958slewis]

All agreed and thanks for your observations.