Revision TKR May Have Loosening Of My Implant!

[nancy2]

Hi Bonesmarties!

Never meant to get any of you in trouble with the PM bit. But thanks Mary for helping me, truly ..I am a very tenuous person. But I agree it was very good to read about revision TKR and the whys of it, but I'm out there flailing around, not just the internet, but my PT, my friend who is a nurse in another state....just so few must do this revision.

Ok so here it is for people to read, I had wanted to see Dr. DiGioia, but he only does tkr, no revisions, he uses 3D robotics and his highly recommended. 3 sets of PTs from my area say that if you get him to do your tkr, you need never look back, he is that great - but that is irrelevant for me now, wish I had known that 10 months ago.

But my knee is messed up so he is a no go. Well his assistant called me back and gave me the name of Dr. Anton Plakseychuk, he is als UPMC (Univeristy of PItts. Med. ctr.) Ok then, well I try my best to look everything up about him I can, I find decent detail @ Childrens hosp. in Pitt. but not much else some other med websites but nothing that tells me he is a dr who does REVISION, now I'm getting concerned. I would feel a lot better if I could read up and him. He is originally from Russia and studied there and in Germany before settling in PA. Very little. I did find a place where patients could critique him. 2 said "No way" about 6 others said he and his hands were a gift from heaven or something to that effect....that's a 180 degree swing.

So my question to you all is have you ever heard of him? What did you hear? Please tell me. This is already devastating. For more reasons than I care to share with the everyone, sorry but somethings" must be played close to the vest."


Meeting the man, trying to sort out the right questions that are imperative for me to have answers. I did look up Hospital for Special Surgery in New York. That's not too bad, 4 out of 20 ( I read each one) say revision. But when I listened to their videos they don't speak to knee revision.

I think .. I'm like many people here, I have good insurance, but I do not have just thousands to throw away for out of network expenses, travel to get there. Knowing my employer is thinking not again, I work for a small concern. But I'll do it, honestly right now Dr. Maale in Texas is looking pretty good. I though HSS in NY did too but couldn't nail anyone down about revision of knee, ...hip revision yes. See what I mean about flailing around!

Ok if anyone has any suggestions on OS who do revisions please let me know, I cannot believe in USA we have 1 just 1 in Texas that's outstanding.

Oh has anyone had to have an aspiration done on their messed up TKR?
Ok well I will probably be posting before I leave in the morning and will post when I get back late afternoon or early evening. It is a little bit of a drive for us. Thanks EVERYONE:cat-kittyandsmiley:
Nancy

 

[Nyland]

Thank you, Sonja! Bless your sweet heart! You deserve a fabulous outcome!

 

[Nyland]

Hi Nancy,
Sometimes patient reviews are based on personality. I would rather have a skilled surgeon that a nice guy surgeon. Surgeons are not known for their bedside manner and I'm willing to bet that if there is a language or cultural barrier, it could be why some say no way. Just a thought.
Best of luck. Wishing you the best revision!

 

[Knitter4444]

Nancy..I just had an aspiration on one of my knee replacements. No biggie at all. Never had cortisone injections in knees but have had in hands and the aspiration was nothing compared. They aspirate looking for infection or perhaps gout. Not sure of any other reason

 

[nancy2]

Hi Sonja, Sandy, Josephine, Jamie Dawn, and any of the other Smarties I haven't named. I am finally home. We did not see the Dr. P. until about 1 Pm it was about a 2 1/2 hours wait! But here it is.

I'll do it in a time line maybe then I'll keep stuff straight.

First I was taken to get another set of series of Xrays. Then the Dr. came in (yes he is originally from Russian but can understand his English very well) He was forthright about what he wanted to say. 1st he did not like the Xrays brought from my Dr. who did the TKR -they were from 3 previous dates - 1 was BEFORE the TKR he really wanted to see those-but they were minis-he felt that was important, because 1 he stated he thought the TKR was done far too soon! That the possible reason for the problems I having are 1 because it was done too soon there is too much inflamation and that is why the "blood pool" from the bone scan went were it did the blood is around the inflamed part..as he was looking at bone scan disk he stated he felt "rather" strongly" NO infection. He changed the word "septic on my report and put and "a" in front of it!

So Sandy, how about that! He explained the difference, I knew but oh how I wanted to hear it again. He manoeuvred my knee, we talk about pain around the knee when I try to straighten it. Also said the prosthesis look quite intact!!! But then came what I feared I am a cowering idiot when it comes to needles but I remembers what Merry posted and I just hung in there and it was done in moments. He was very good with me.

He said he does do knee revisions, but we did not discuss anything further...I will get the results this Friday and he will talk with me.

No words of thanks and heartfelt gratitude for all of you.. this past weekend is one I hope to put behind me and you all helped.

But I must wait upon the Lord and pray that this test comes back negative for infection-he seemed to so strongly believe it would.. But I know we must wait.

OH just an FYI I found a website from AAOS and he was there-it took me to th Ilizarove Center in Russia. Prof. Ilizarove invented the mental um contraption they now use around the world for deformed bones and Dr. P studied with him.

Ok well he gave me a script for Diclofenac for anti-inflammatory which I"ve been on before the other I have never been on..Gabapentin 300mg. Pharmacist asked if I used to for seizures?? Heck no but he also explained it is used for nerve pain. So we shall see.

Ok I hope this post might help someone and if I can answer ? I would be glad to. I know Friday is a make or break day but I can't but help feel positive.

Thank you, you are in my prayers of thanksgiving and please keep me in yours. I will check my post when I come home from work each evening and I will be sure to tell you good or bad what comes on Friday.Nancy:cat-kittyandsmiley:

 

[Knitter4444]

Fingers crossed from San Francisco Nancy. So happy to hear that he doesn't think there is an infection and also that the prosthesis is intact. They get a rather immediate result to see if anything grows from the sample but then they also continue to grow it for a total of about 10 days to check for another organism that takes a while to show up. Hopefully all will be fine.

I had a nuclear bone scan a few days ago and go for my results tomorrow . Will be thrilled if nothing bad shows up but also need to find out the issues. I don't want have to keep on looking for the high handicap toilets when I am out. Quads are fine..knee does not like low anything..chairs etc

Keep us posted. I love your attitude. You have such strength.

 

[nancy2]

Merry,
Thanx for the reply and I will be holding good thoughts and prayers for you too. Don't know about my strength, but thank you for the support!
Well as my PT tells me listen intently to the Dr. first -then ask the ?s second.
Nancy

 

[PooShay]

MerryS and Nancy2. I hope your tests result in good news!

 

[nancy2]

Hi Everyone,

Well it' early evening here where I live in PA and I finally got word about whether the synovial fluid showed an infection or not. I did NOT get to talk to Dr. Plaksyechuk but his adm. assistant, she was very nice and told me he couldn't speak with me as "timely" as he had hoped but the results of the test showed there was NO GROWTH...NO INFECTION!!! YEA how about that! I had to pull over and talk to her, thanked her like 10 times and told her I still had knee pain- she said she would note that for the Dr. I don't know when I'll hear from him.

Simply, "Thanks be to God". I had no idea what answer I was going to get.

Especially since it feels like I twisted it this am - I tried to swing my legs up on the lawn recliner like to lay sideways and it hurt so bad I grabbed the whole knee (same pain like I used to have @ 6 month timeline) It is still very sore and I cannot flex it - can walk on it straight but otherwise it is really hurting.

I thought my PT had worked this problem out for me (she felt it was scar tissue that can catch and the knee cap area needs to be massaged) I thought we were past that, but evidently not.

Anybody have any ideas what this is and why it hurts so bad?

Otherwise I wanted to share the good news....no infection. Dr. P took xrays on Monday surely that would have shown if the TKR was loose, wouldn't it?

Ok I'm not meowing :cat-kittyandsmiley:about the pain right now, maybe if I ice it and stay off of it will help , but all advice appreciated.

Merry how is it going for you? I'll try to track you down on the forum, though I'm like the world's worst at this stuff-it takes me forever justto find my own thread.

Nancy

 

[Janet2012]

Nancy, that's great news! I bet it hurts less just knowing that!

 

[jancat]

Nancy, I am nuclear Medicine Tech and perform bone scans. The report would have said sepsis, because there was an abnormal accumulation of the isotope on all 3 phases of your bone scan. If the isotope distributed evenly in all 3 phases, then that would be normal. If it had abnormal accumulation on phases 1 and 2 then normal accumulation on phase 3, that most likely is cellulitis, and abnormal accumulation on all 3 phases is indicative of infection and/or loosening and needs attention asap! Sometimes infection and loosening can be diagnosed from an xray, but unfortunately better done by a radiologist than an OS. I have seen it many times. A pt comes in for a 3 phase bone scan, and we request that they bring any recent pertinent xrays with them. When the radiologist is checking the bone scan against the xrays, the evidence for infection/loosening was present on the xray but not picked up by the OS. The bone scan just affirmed what was present in the xray all along. Make sure you have a copy or disk of the bone scan and report to take with you when you go to the new OS. Wishing you the best!

 

[nancy2]

Thanks for explaining Jancat, yes it is a relief to know it is not an infection and Merry was right the aspiration to be able to test for it wasn't all that bad. I've had worse IV's-I am a "tough stick" as they say and am scared of needles-but am glad Dr. P did the test.
Janet2012 thanks for the supportive words!

 

[PhoenixS]

Hooray for you!
So happy no infection!!
See how much one measly letter can ruin our lives?
Do you plan to see this Dr. again for a treatment plan?
If your TKR is loose, it must be removed and replaced, infected or not.
Keep us posted.
Sandy

 

[Knitter4444]

Nancy..absolutely the best news. I am thrilled for you.
I think I posted that my bone scan was ok..knee looks great so now going to have hip injection (cortisone) which I tried to weasel out of. It makes sense as I am having my other hand joint replaced (thumb) and I will be sitting for weeks..don't need the hip pain which they think may be the reason for the knee pain.

But I rejoice with you about no infection. I too sweated that and it totally stressed me knowing what the outcome could be.

I hope your OS stays with you on this. Nuclear bone scan next? It is an easy test..just takes time. Injection and then you come back three hours later..
Thinking of you and wishing you all the best.

 

[nancy2]

Glad to hear about you Mary and thanks Sandy for the post and ?'s.

This happened to me around the 5-6th month it would hurt around the middle and below the knee cap. The PT slowly worked it out between massages and phy. therapy, stim machine and cold compress machine. It was not an issue the last 4 months-until today. If it was going to act up I wish it would've done it before I saw Dr. P.

i thought I knew what it was as I did a search and found a post Jamie had up and in part it said under this post:

Re: knee still tender after over a year because of wearing old shoes ​

​

Tashia.........I'm sorry to hear you have hurt your knee. The knee joint doesn't have a "socket" so what probably happened is that your patella (knee cap) got a bit off track. That can happen sometimes and it can be very painful for a while afterwards. You are right to do the icing and elevating. Take some type of pain meds too as long as it's hurting. Hopefully it will not happen again."

Jamie posted that a little awhile ago, I thought oh that's my problem and maybe that's how I'll solve it -but when I looked back tonight I think I see it was posted for someone who still had their "natural" knee and not a TKR. So now I'm not so sure what this is.

If Jamie or Josephine could weigh in on this I sure would appreciate it - I've looked thru the library and forums and that post was the only one I thought pertained to my problem-oops.

Anyway, yes I will call Dr. P and set up another appt. if he doesn't call me over the weekend-which I doubt. But again this is trying to go to Pittsburgh having the tests done at a completely different hospital system than my local one and they do not transfer info or tests - I am the "go between" for all the doctors. And like many of us...I just cannot miss that much work.

Honestly what Jamie stated sounds like what happened to me..I am icing it and heat series of 5 minutes each. Then taking a vicodin (haven't done that in a long time and pray I feel better in the morning)

Hey Merry isn't the bone scan I just got done what you are talking about? And for you well I was with my hubby when he got the cortisone shot in his hip and it seemed a little uncomfortable to him, but it was well worth it -it's been about 3 years now and he his doing well. So when you're with the Doc - just get your mind in your "happy place"!

Sandy, um we just had a friend go to a Dr. in a smaller area than where we're from the Doc revised his tkr by putting a "shim" in of sorts to tighten up his loose Tkr and he is doing well - so we'll see - I guess it's back to Dr. Plakseychuk-geez his name is long.
Night all and thank you, stay well.
Nancy

 

[Dhare63]

Good news Nancy, congrats!! Keep us posted and hope all keeps going in the right direction with your new OS.

Best,

Dawn

 

[Josephine]

he thought the TKR was done far too soon! That the possible reason for the problems I having are 1 because it was done too soon there is too much inflammation

That's a new one on me! If you leave an arthritic joint too long, the bone inflammation will get worse not better! I've seen it happen in my sister - twice (hip and knee) - it's called a pain storm.

OH just an FYI I found a website from AAOS and he was there-it took me to th Ilizarove Center in Russia. Prof. Ilizarove invented the mental um contraption they now use around the world for deformed bones and Dr. P studied with him.

Devices of the devil, those! Take hours to apply but brother, do they ever do the job!

Especially since it feels like I twisted it this am - I tried to swing my legs up on the lawn recliner like to lay sideways and it hurt so bad I grabbed the whole knee. It is still very sore and I cannot flex it - can walk on it straight but otherwise it is really hurting. Anybody have any ideas what this is and why it hurts so bad?

Because one or more implants are loose, probably the tibial one. Sorry, but best to be honest about it.

Nancy, I am nuclear Medicine Tech and perform bone scans.

Well I do hope you hang around with us, Jan. We could use someone with your expertise!

Sometimes infection and loosening can be diagnosed from an xray, but unfortunately better done by a radiologist than an OS. I have seen it many times. A pt comes in for a bone scan, and we request that they bring any recent pertinent xrays with them. When the radiologist is checking the bone scan against the xrays, the evidence for infection/loosening was present on the xray but not picked up by the OS.

Exactly so! I spent a considerable amount of my life working with various hip and knee revision surgeons as a result of which I've acquired the ability to often spot a loosening. I've always loved reading xrays and would eagerly join a group whenever the surgeon was teaching his juniors! I even got them to teach me one-on-one which was even better! As a result I could often point out things to junior doctors, like occult fractures.

I've spotted a few loosenings on here also. I never ceased to be amazed how surgeons can cheerfully go on telling their unfortunate patients that their xrays are 'beautiful' when the radiological evidence is staring them in the face! Not to mention a miserable, anxious patient in pain. :DOH:But that's the difference between a regular hip/knee surgeon and a revision surgeon. They can tell the difference.

 

[nancy2]

Morning Everyone,
I called new Dr. P's office this morning, they had a cancellation this afternoon so I am leaving in a couple hours to go and see him again.
I rested, iced, elevated knee all weekend long, but it seems to me to no avail. I must have torn something last Friday, I don't know-but I hope he can help me. It is still very sore and I had been sleeping quite well the last 1/2 year not so this weekend-even with Vicodin.
Josephine, thank you for weighing in with your experience and thoughts, I am one for being 100% in denial and I realized with what I have been reading and no relief from basics something wasn't right to begin with that's why I went for a 2nd opinion, I am just scared stupid of a 2nd replacement-especially when I am "home free" from a dreaded infection.

I will ask this again though, has anyone here on the forum had a knee revision done by any of the Dr. from HSS (Hospital for Special Surgery) in New York, and if so who and do you recommend them?

Thanx all I'll post when I get back home.
Nancy

 

[jancat]

Nancy- Did not have a revision but had my TKA done by Dr. Haas at HSS. The hospital experience was exceptional. I love my doc, too. He is in great demand,however so it can be tough getting in touch with him, but I will say that at my initial office visit I spent a good deal of time with him and never felt rushed at all.It took me 3 months to get my initial appointment with him.
I work in a hospital so am somewhat critical of them. This place (HSS) WAS awesome! My daughter needs ACL repair and am considering her having it done there just because of the great care I received from everyone at every step of the way.

 

[nancy2]

Thanx Jancat, I think sooner or later that's where I'll be headed. (Say you guys in New York and New Jersey go clobbered with snow, huh) Saw Dr. P. today once again he looked at the actual bone scan, went over the findings of the aspiration which showed NO infection (Yea) but is also the reason he is very hesitant to want to back in.
He said he sees and feels nothing that would denote loosening. Right knee is very much in line with the left and that he zoomed in on the cemented area and could not see any signs of loosening.
So he gave me a cortisone shot. 8 hours later it has mostly worn off. For a brief time today I could walk and do steps normally now it's back to the pain. Must try and be at work tomorrow.
He told me no sense in me coming back for 2 months as he hoped shot work work + let it ride out to the 1 year mark. Also I am to keep a journal to show him where the pain is how bad and what I can and cannot do till I see him again.
I can handle hitting a brick wall- I can dust myself off and get to the goal line, I've done it before when I nearly succumbed to pancreatitis (ERCP that went badly) . But this....so many brick walls and where's the goal line?

Oh well maybe he is right...see what happens in the next few weeks. But if I continue to get worse am calling HSS specially since Jancat was nice enough to let me know it can take awhile to get in. Thanks for letting me vent.
Oh one thing he did say NO PT. he said it's aggravated enough and may have been from the beginning ..So that's the lst time in 10 months no pT...but weather here is getting slightly better so I need to walk more.:cat-kittyandsmiley: