Revision TKR Metal Allergy or Infection or Something Else

[becticu]

Wow, I am so glad he finally listened to you. He didn't have much choice considering your test results. I just spent the weekend in Fl visiting my Mom. I was speaking with a lady from their church that ended up with a total knee and 2 revisions due to allergies. She said she has a ceramic knee now. I will get her number from Mom and ask more details. Since you and I live in the same town we could actually talk on the phone when I find out anything from her. It might not be helpful but then again maybe it's what you need! Thinking so you and sending good thoughts and prayers.


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[Jamie]

I agree with Pumpkln that it would be a good idea to contact the surgeon at Mayo so she can be made aware of the specific allergies you have.

With those allergies, you do need a very special surgeon to be sure you get things right this next time. I know you don't want an additional surgery, but I'm afraid it will be very unlikely that this will resolve itself without a different implant. You won't want to be on steroids for long periods of time and my concern is that the symptoms will return once their anti-inflammant properties are no longer available for your body.

This is kind of a far-out suggestion, but I'll make it anyway. We have had a couple of members who saw a surgeon in Dallas....broken link removed: https://www.dfwsarcoma.com/, Plano, Texas. He has done some great work with infections and the problems associated with them. I don't know if he would consider your case, but it sure wouldn't hurt to contact his office and have a chat with them. If he would consider it, he sometimes will do an initial consult via phone and mail so you don't have to travel to get started with him. You would only need to go to Dallas if he agreed to help you.

Another option to try would be the Hospital for Special Surgery (HHS) in New York City. I know that is a long ways for you to travel as well, but if it meant you could get your knee back to normal, it would be worth it. If you are interested in this option, tag me and I'll help you select a surgeon to talk with.

I'm glad your original surgeon is supporting you now. This obviously is beyond his experience, so don't feel bad about moving to a more specialized surgeon. It is imperative that you find someone who has seen and dealt with this type of problem before. And....I don't for a minute believe that you'd need to travel to Europe or Asia. If that's true, it will be a shock to me!

 

[sistersinhim]

I completely agree that you need a surgeon much more specialized than the one you have now. He has already had his chances and has left you worse off than before. You need to find a different one that is highly specialized. Jamie can help you do that.

 

[jboles]

My new OS thinks the "gold knee" https://www.aesculapimplantsystems.com/products/orthopaedics/knee-arthroplasty manufactured in Germany, might be suitable for me. You may want to research it as well, since it seems we have similar allergies.

 

[newlybionic]

There is a member who had a very serious allergy to her implant. She was able to get an implant made for her that solved her problem. I will tag her so she can give you some info and you can ask her any questions you have that she might be able to answer. @borymms4 can you tell her about your implant?

 

[borymms4]

My implant is the gold knee,Aesculap implant.

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[borymms4]

With this knee implant there is absolutely no metal in contact with ur body or exposed. It is gold coated all the way around everywhere. My os said it is the only one that is truly cleared for metal allergies

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[Born2teach]

Today I saw the rheumatologist to get the results of the blood panel. She indicated that the blood work showed no indication of lupus, arthritis or other auto-immune condition. I did have a slightly elevated C-Reactive Protein and White Blood Count. She initially suggested we double my steroid dosage to see if we could knock down the inflammation. I reminded her that I had positive results a year ago with the antibiotic Augmentin and wondered if we could try it again. She was agreeable to letting me have a 10 day prescription for the antibiotic to see if we could some major improvement. I see her again in two weeks to let her know how I did with the antibiotic.

 

[Born2teach]

Hi @borymms4,
Thanks for the suggestion of the Gold Knee. When I read about the metal content, it seems that the top coat is ZrN which I think is zirconium. That is one of the metals I am allergic to and is also what my current knee replacement is. You mentioned you thought is was gold coated. Do recall where you heard or saw that information? I would like to explore that some more. Thanks.

 

[Josephine]

He said infection is still a possibility we cannot rule out since the lymph nodes behind the knee are enlarged.

Lymph nodes get enlarged with any inflammation so it doesn't meant infection.

Allergy to the Metal - With my numerous metal allergies, he indicated that if that is the cause, I would have to travel to Europe or Asia to find a device that would work for me. The FDA, here in the USA, has not approved any device which is free of the metals I am allergic to.

Nonsense!

*Nickel - highly reactive (My first implant was nickel - DuPuy, Attune)
*Zirconium, Cobalt, and Iron - reactive (My current device is Zirconium - Smith & Nephew, Oxinium )
*Molybdenum & Vanadium - mildly reactive (I've never heard of these.)

I have! They are all routine materials used in implant manufacture.

The prednisone is SLOWLY reducing the swelling

But don't keep on taking it because you have a reason for the swelling and cortisones are not going to resolve it.

It is gold coated all the way around everywhere

It's not gold, just gold coloured!

My os said it is the only one that is truly cleared for metal allergies

Correct.

the top coat is ZrN which I think is zirconium. That is one of the metals I am allergic to and is also what my current knee replacement is.

Yes it is zirconium but but it's zirconium oxide (ZrO2 –also known as zirconia) and one of the ceramic group of materials.

Biolux produce a knee replacement coated in Zr02 which would be ideal for you. There are two types as shown here - the Ceramtecone is all Zr02 and with the Biolox, only the femoral component is Zr02 with an all plastic tibial component.

 

[Born2teach]

Thank you for the input Josephine. I appreciate your wisdom and knowledge in this department. I am curious to see if the antibiotic helps. Since, all the aspirations and even specimens taken during surgery have come back negative, I can't imagine what else it could be at this stage of the game. I guess time will tell.

I hope your recovery is going well and you are enjoying a beautiful day.

 

[becticu]

Hi Vanessa, I wanted to check on you! Did you go or the second opinion on June 19? Has anything Dr F changed helped at all?
I had my two week check with M yesterday but basically she just aggravated me! I'm still struggling with flexion. I'm a tortoise on this one! Let us know how you are!

 

[Born2teach]

Here is the newest on my knee.
I've seen or talked to to at least 3 other orthopedic surgeons and no one seems really know what is going on with my knee. The majority of doctors believe that I am allergic to this knee, too. In which case there are no FDA approved knees for me in the US that are free of the metals I am allergic to. The ceramic knees available in Japan and Germany are currently for first time TKR patients, so finding one for a 2nd revision is not likely.

One surgeon is following up on my request to see if the maker of my current knee (Smith & Nephew) can do a custom femoral head that would replace my current one without having to take out all the hardware attached to it. The surgeon is wondering if we could make it out of oxidized titanium (I'm not allergic to titanium). It's a long shot, but at least he is looking in to it.

As of now I am working with a really wonderful rheumatologist who is willing to experiment with me to try to stop my body from reacting to the implant. She has started me on prednisone,for no longer than 3 months, to knock down some of the swelling and inflammation. She added hydroychloroquine, which is a slow acting (1-6 months) medication used for malaria, arthritis, and lupus. Even though I don't have those diseases, she thinks it may calm down my body's inflammation. So, now we wait and see if it does anything for me.

 

[becticu]

Vanessa, I'm so glad you checked back in and I'm sorry you don't have any answers yet. I can imagine how frustrating it is! I'm glad you found a good rheumatologist that is working with you. I see mine on this next Tuesday. I know we both had the same OS but my rheumatologist is a male so I guess we don't share that.

I've named the right knee "Beelzebub" so that should give you an idea of how she's doing....please keep us updated! Chatt town has been really hot with lots of rain the last week or so, hope you had a good 4th.

 

[jboles]

@Born2teach I also have metal allergies and my LTKR is scheduled 9 days from now. Last week my OS was certain that I needed the Aesculap implant now yesterday I get an email saying he believes that I would be better off with the Smith and Nephew with a poly tibial component. May I ask what level was your reaction to zirconium? I also had tests done at Orthopedic Analysis. I'm also mildly reactive to titanium.

 

[kneeper]

Sorry you're having such a tough time. It does sound like at least you have a doc who is exploring all the options.

 

[Born2teach]

Hi @jboles,
The level of reaction I had to zirconium was listed as "reactive" to the Orthopedic Analysis testing I had done. My understanding is that the femoral head is the only component that contains the zirconium in my revision replacement. It does however contain rods that are titanium. With that said, you are having a first time replacement and the metal components may be completely different than a revision piece. I wish you all the luck.
Keep us posted on your surgery.

 

[Born2teach]

Hi @becticu,
I am sorry to hear that this most recent knee is giving you trouble. Continue to take it at a pace that feels comfortable. I hope you are getting the range of motion you are striving for and getting around better, too.
I saw our orthopedic surgeon last week, and he says to continue working with the rheumatologist to see if we can take down the swelling and inflammation. It looks to be a long term endeavor, as the medicine can take up to 6 months to work. Since, there are no other options, I am committed to making the most of this option.

I had a nice 4th of July with family visiting. As you know, rain was a major story for the holiday. We were able to get catch some fireworks on the lake and relax. I hope you had a great 4th, too.

 

[Josephine]

It does however contain rods that are titanium.

Born2teach, to the best of my knowledge, knee implants don't have rods. Can you clarify?

 

[Polkadot]

My doctor did not learn of my metal allergy until the day of surgery. The questions were always about medications and seasonal allergies, and I didn't think about how I get hives if I wear cheap jewelry until a nurse in pre-op asked me "Does anything else besides [a particular antibiotic, and latex] cause your skin to react?" When I told her I thought that nickel was a culprit, but that I hadn't been tested for it yet, she contacted the doctor. My surgery was delayed about an hour while he obtained a ceramic knee replacement for me. This was in Detroit, Michigan, not Europe or Asia.