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Revision TKR Mechanical Loosening

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New problem. Been awhile since my last post, I keep thinking if I don't go to this forum, things will get better. Not so.
Back in October, 2012, my surgeon had to go back in and resurface my patella, as it was disintegrating. That was #5 through the quad. All back to healing and doing quite well UNTIL I started having a terrible pain in my tibia. Shooting pain down the bone, with substantial swelling at the joint. SO, back to the ortho for pain meds and xrays. I couldn't imagine what the deal was, then he explained that the implant had come loose from the tibia bone and was basically rattling around in there. I asked if he could just shoot some super glue in there, but, alas, no. The whole thing has to come out AGAIN. This will be the 3rd implant!! The first was just 5 years ago. Arghhhhhhhhh
I was to upset to remember much of what was said. I have an appointment on Wed. next week, where I will take my friend and husband with me.
My question is, should I wait to have this done? I am still working as a hairstylist about 30 hours a week. I am currently on 30mgs of oxicodone a day and I can already tell that I am developing a tolerance. The surgeon suggested next year, but I'm not keen on taking meds till then!! I'll have to go to a rehab center for drugs when this is all over!! I'm also worried that there will be further damage to the tibia.
Thank you ahead of time for all you do here, hedgep
 
Good luck, and please get a second opinion!
I had problems last year, and I went for 3 second opinions, the best thing I could have done. And I now see another OS for follow up.
 
Ohhhh. "mechanical LOOSENING!" Darn these loopy opioid pain meds! To my addled eyes, it looked like "mechanical licensing;" my singing partner & I have recorded a Warren Zevon song but can't put it on our album and have it pressed till we can show the pressing plant a mechanical license--and his publishers & estate don't subscribe to the automatic online licensing services like Harry Fox Agency Songfile. As Emily Littella used to say on the early years of SNL, "That's very different. Never mind."

I'm watching my R knee carefully, as the top 8" of my tibia is made of spit & scotch tape (actually ground-up bone harvested from my iliac crest mixed with epoxy, held in place by a plate, pins & screws) and has been since '96. Acc. to X-rays, the OS thought he'd have to remove only the knee surfaces and a couple of screws. But when he opened me up he found the tibial repair matrix had begun to disintegrate from the top down, so he had to saw off some tibial bone and remove 4 screws. (No, he didn't do the original repair). Every now and then I can feel some pain in the remaining tibial hardware and get some nasty shin splints right over the screws--I can see the muscles contract! Once it recovered from its TKR, it was taking over quite a burden from the L knee (which turned out to have been in much worse shape than it felt after I lost weight--before the weight loss it was locking up and buckling, crunching and grinding; on the table, it was just as far gone as the X-rays and MRI indicated). I'm getting some twinges in the R knee ever since pre-op PT when I had to do high step-ups and wall-squats--the OS and 2 PTs (unaffiliated with him) say it's overuse and will subside as the L knee strengthens & heals. but I'm following this thread quite closely.
 
hedgep.....thanks for posting here in your thread! Glad I could get it opened up for you. I agree that you need several opinions before making a decision on how to proceed. Be sure they are surgeons that are totally unassociated with each other. You may need to do some driving to a large city or teaching hospital to find the calibre of surgeon you need for this evaluation. I'm taggin Josephine to see what she has to say about this situation.
 
Jamie, I have another thread that I started some time ago under the title, "UTI 3 days before TKRevision". I must have started it in desperation when I noticed my old thread was closed. Not sure how to incorporate the two, just wanted you to know. I am grasping at any and all help I can get.
In His Hands,
hedgep
 
hedgep,

Howdy! Are you sure that you and I haven't paths before! LOL. You sound so much like me I could almost write your story for you! My leg came loose from my implant and they put me in a brace for several months. Mine was because of infection though so I had to wait! To make sure all residual was clear. Why is your doctor wanting to wait? My Revisionist put me in the brace on crutches and told me to try not to put much weight on that leg for fear of cracking the tibia. I don't know where you live, but my revisionist is wonderful! He helped create the revised knee that I have and it will not dislocate because it swooshes, is the best way I have to explain the noise it makes when I do something silly to really test it! :heehee:
 
Look on google for Gerhard Maale. He has a website. Good luck to you! :console2:
 
hedgep said:
My question is, should I wait to have this done? I'm also worried that there will be further damage to the tibia.
Click to expand...
A very justifiable concern. Problem with loose implants is that they work up against the bone causing it to become hard and dense. The cement needs honeycomb bone (shown below left) to anchor into, so if that's compromised, so will the new fixation risk being. The alternative will be using a device with a longer tibial stem to anchor it (below right).

[Bonesmart.org] Mechanical Loosening
[Bonesmart.org] Mechanical Loosening
 
Thanks Josephine, I've been waiting for your input!! I go in on Wed, to go over the plan of action. As far as looking for another surgeon, it just gives me great anxiety. Dr. Hull took on the problems the other surgeons wouldn't or couldn't fix. He found the bone infection, thus the temporary knee replacement, then the present TKR, which was doing great until...... I feel like he is still the best OS for the job. In my area, anyway.
I will probably go for a second opinion just because, but not ready to give up on Dr. Hull just yet. Will post the outcome of the appt on Wed later that day.
Thanks everyone. The Lord is with me, so who can be against me???
Blessings,
Hedgep
 
It's all scheduled. I will have the RTKRevision done on August 12th. After much research and 2cnd opinions, I have come to the conclusion that my surgeon is the best in the area for this revision. He took me on when it was a big mess and infected before, fixed all that and I was doing well. This loosening is most likely the result of having a previous infection.
He spent a lot of time explaining the procedure and how this next replacement will stay in place. It is a two part piece for the tibia. First a sleeve, then the rod, which will have a longer stem than the last. It will rely on being cemented to the sleeve to hold it in position. There is a very small possibility that the femur implant will be left alone. Although he said, if there is one single iota that it is not aligned right, it's has to come out. We, as in he and I, do not want to have to tweak this thing anymore.
So yah, it looks like I am on my way to a new knee,again, and, oh yes, now I remember that this includes surgery and PT. ugh
I am feeling better to have it settled and Lord willing, I will have good news in the future. I will update you all when I'm on the other side of anaesthesia.
Blessings to all.
 
Hugs to you. I know this is tough to be dealing with, but you are moving forward and have the BEST attitude about it all. We're here for you if you need to talk while you're waiting for this next step. I'm praying it will get the job done once and for all for you.
 
hedgep said:
This loosening is most likely the result of having a previous infection.
Click to expand...
Exactly so.

Your new implant sounds intriguing. If you can find out the name of it and get the post-op xray to post here I would be much obliged!
 
How exhausting and frustrating, all this time, persistent problems, and multiple surgeries. You are a trooper. But then, what choice to do you have?

Is all your infection cleared now, or is that another step in this process? In any case, your surgeon has a plan for a tibial implant that will be permanent, by the sounds of it. You've really done your homework. Sometimes that's the hardest part. Best of luck. Keep us in the loop.
 
Tomorrow's the big day. 3rd times the charm???? Praying this is the last step for my R knee. It's been a long, grueling 5 years, and I am more than ready to move on.
Well, enough of that!!
So, I will get back on here as soon as my fingers work well enough to type after surgery. Never realized how fumbly they can be while on morphine,haha. But, seeing as this is #6 through the quad, same knee, I kind of know the drill.
Blessings,
hedgep/Paige
 
Sending you best wishes.
 
hedgep sending prayers and healing thoughts across the miles to you. What a long ordeal you've been through and I so appreciate your kind and encouraging words you left for me. I feel so much better since starting a very gentle therapy three days ago - mostly very light massage. I will be thinking of you tomorrow and praying it all goes perfect for you. This time it's going to work...right? :yes!:
 
Just read your whole thread. All I can say is that this time it's going to work!! Good luck tomorrow...I'll keep you in my prayers.
 
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