"Most Unusual" Multiple TKRs

[wendylyn]

This my first time here on this site, as I just registered tonight. Not sure how this site works, but am just about desperate to get some info.

My TKR case history is what is best call "most unusual" by two OP's. I've had 4 TKR's and the one and only one on my left knee is great, and I wouldn't even know I had a bionic knee but for the scar. Now the right knee, there's the most unusual part of the saga. I had the 1st TKR on r/knee in April 2003, broke it by feeling too good and doing both spring and fall cleaning all at once. I some how broke the tibia, patella, and the fibula. When the pain got too bad by Jan. 2004, I got an X Ray which showed the breaks and was scheduled for a 2nd TKR/revision in April 2004, which was done with no problems.

By August of 2004 I had a "clean out" of knee. That didn't help, apparently because even after several aspirations for the lab to check for and infection, no infection was diagnosed. For the next few months my right knee continued to weep copiously, from Sept. 2004, with a blister type opening weeping despite coverings. Finally in Nov. my original surgeon was totally unable to fathom what was causing the pain, weeping, and by Dec., my need to use a wheel chair if out side the house.

My original surgeon sent me to another surgeon who did the radiologic testing on the knee/leg. They took blood out, the nextday put it back, then the third day they took "pictures" of the leg/knee. Just as the new surgeon thought I had a huge infection, and needed a third knee replacement/revision. In Jan. 2005 I had my second knee removed and a "cement" (actually a sort of plastic I believe) spacer was put in the joint space. I was home for close 8 wks. on daily doses of very strong antibiotics.

After all the infection was deemed to be gone, I had the third TKR put in with no problems, and I recuperated much more quickly than the surgeon expected. I did all the obligatory rehab at both the hospital and at home. I still do daily excersises and am still using a quad can.

My surgeon has done follow ups since 2005 and X Rays were such that he proclaimed my knee doing well at each visit, including recent one in Feb. 2009. Now a new surgeon says there is some loosening on the lower part of the prothesis above the tibia. Now I must find out if there has been any lowering of the tibial component since each of the past X Rays, if so there's a real problem, (surgeons words). They will test again for infection and inflamation.

Now to explain why I have written this essay of a grey/blonde TKR patient. I would like to know if anyone else has ever run into this type of problem, and what they've were able to do to correct it. By the way both of the surgeons who did all the surgeries said they had never seen a case like mine in all their years of practice, (and there are a lot of yrs of practice between them!) and that I was one for the books.

Anybody got any thoughts, cause I'm all out of ideas, and am at my wits end!

Thanks and regards to all here and the starter of this forum. BTW I've never been a forum person, but as you can see......:pnc::pzld: Annnnnd I seldom use these cute little icons either, but this is a sign of my utter frustration.

wendylyn

 

[Jamie]

Hi, Wendylyn! Welcome to BoneSmart. We're glad you found our forum. I have moved your post to its own thread so you will receive more attention from our members. Sometimes new posts like this get lost in an existing thread.

You have certainly had a time of it! So sorry to hear of all your problems. I don't know that I recall anyone on the forum having had 3 TKRs on one knee....that just doesn't happen all that often.

If I may ask, are you near a major city where you have many options for doctors? And since you had a surgeon who was keeping tabs on you, was there some reason you had a new surgeon (the one who says the knee might be loosening) look at it? I'm thinking that, given your history, you might want to get the opinion of one or more revision specialists (that's a different specialty than the original knee replacement) before doing anything drastic.

If you check some of the old threads on the forum (do a couple of searches and you'll find plenty to read), you will see that we have had several members with infections that have gone through what you have. It may make you feel better to know you're not the only one. These things happen sometimes, but in most cases they can be addressed, fixed and you can go on through recovery.

I know it must be terribly frustrating for you to have dealt with your knee for all this time. Our forum nurse, Josephine, will be checking in here soon (she's in Great Britain and sleeping right now!). She'll be able to provide a more detailed medical perspective of your situation.

Post any time you feel like it. This is a caring group of folks who love to be available for support to anyone needing it. It always helps to talk to people who really understand what you're going through. Sometimes our families and friends (if they haven't had joint replacement surgery) just don't really "get it."

 

[Texas]

Hi Wendylyn. I am so sorry for what you have been through. That really broke my heart. I sure hope you can soon be on your way to someone finding out what is really wrong, fixing it and you being on your way to real recovery. Please post anytime. We all try to help one another. I really would wait on Jo for this one as Jamie said. Good Luck to you and hope it gets straight soon. Oh and welcome to Bonesmart !!!!!Someone will figure this out and you WILL be ok.........

 

[aussie]

Welcome Wendylyn,

Wow you have certainly had a lot to deal with, but you must be an amazing person to have dealt with it all and stayed sane.

Welcome to the forum and every good wish to you.

 

[Josephine]

Hello,WendyLynn. That is one dreadful story. I really feel for you. But, sad to say, I have come across a few patients with similar histories both in hips and knees.

The main problem sometimes is that when they remove the prosthesis and put in that cement spacer, they don't wait long enough to make sure all the infection is gone. You don't say how long between the 2nd and 3rd replacements but you did mention 8 weeks. In my experience, those procedures usually have a 3 to 4 month gap between implants. And then the bloods have to be clear of bacteria for at least 6 weeks before they will proceed.

With infection in the presence of a metal implant, what happens is that certain, very opportunistic bugs that travel in the blood, find a nice safe haven on the metal and settle there. Because the implant is inert, the immune system, in the form of the white blood cells, cannot 'see' them. They kind of exist under the the WBC's radar, if you like. Then they begin to create their own special form of pus which is an odd, sludgy grey fungus, actually less than 1mm thick. As this develops on the surface of the implant, it causes a loosening between the metal and the cement - the only time that happens. Most other loosenings happen in the cement/bone interface but that's another story (lecture!).

So, when the implant and the cement is removed, there is always some fall out of minute particles both of the cement and the sludge so any that gets left behind will, of course, start up the infection again. Hence one of the reasons they put the cement spacer in is that it's a special cement loaded with gentamicin antibiotic. The other, of course, is to maintain the length and structure of the joint anatomy. They may also have given you gentamicin via IV for a while and orally for a while after that.

So, the possibility is that the knee may have been redone too soon so the infection reasserted itself which is a dreadful shame after all you've been through.

I would suggest this .... make sure the surgeon who does this next one specialises in treating infected knee revisions. Some do specialise in revisions but there are some to whom all these guys send their problem infections. The technique is not quite as straightforward as some (even surgeons) sometimes think. And it's always being updated and upgraded so you need a surgeon who is going to be really on top of this, not just someone who thinks he'll 'have a go at it'! May take some phoning around and if you ask your current surgeon(s) they will happily refer you or reassure you if they are already in that category.

I wish you well with it. You deserve better fortune than this, bless you!

 

[beth1954]

I just have one question that I'd like to know about.....What is a quad can?

 

[Josephine]

I did all the obligatory rehab at both the hospital and at home. I still do daily excersises and am still using a quad can.

Yes, I'd like to know that too, Beth!

 

[Linda2]

Welcome to our group! I certainly hope you get answers to your questions and a solution to your nightmare in a timely fashion.

I'm going out on a limb and guessing she left the "e" off from quad cane--one of those canes with the four little feet. We'll see if I'm Nancy Drew material or just out to lunch.

 

[JudyS]

WendyLynn
My heart sure goes out to you. You will probably be in shock when all this is fixed adn you finally have matching pain free knees.
Welcome to a great place. I am glad you found us and hope you stay a while, you sure need the suppport.
I am a hippy although i did have knee surgery last Dec and am still having to baby that knee and not allowed to do everything yet. My hip replacement was awesome, like your good knee. I do understand your frustration as I am dealing with lots of spine problems that don't want to be fixed or something.
Answer Jo's questions so she can help you, she is wonderful .
Keep us informed and feel free just to vent your frustration with your day, I sure have been doing that here for over a year and I always feel better with everyone's love:wub:
Welcome again I'll be praying for you
judy

 

[calling_all_angels]

Wow,
And I thought my knee's were a pain in the hinnie!!!
Wendylyn! Your story is just so unbelieveable to read,
I have no idea how you have managed to live it!!! You
must really be quite a wonderful person!!!!! I would have
been a basket case. You Rock!!!!!! Please keep posting
we will all be praying for you every step of the way!!!

 

[Josephine]

I'm going out on a limb and guessing she left the "e" off from quad cane--one of those canes with the four little feet. We'll see if I'm Nancy Drew material or just out to lunch.

of course! Thanks Judy .....

 

[tooyoungforthis]

Hi Wendylyn, I am so sorry for you and all that you are going through,listen to Jo and Jamie they do know what they are talking about,I am getting ready to have a revision in July and i am not looking forward to all that pain but i do know at the end of it my knee will be great.My prayers are for you.

 

[Judles]

Welcome Wendylyn! So sorry to read of your difficult dilemma! Like everyone has suggested.....do your homework and find the BEST revisionist you can. When you have faith in your OS, you will get answers to your imortant questions! Stay focusedn and best of luck! Post so we know how you are doing! Once everything is sorted out, you will feel amazing!!!!!!

 

[skigirl]

In pt, I have a five pound coffee can with a towel wrapped around it. The put the can under my knee and a weight around my ankle. I fire my quad and lift the knee until it is straight. I hold it for three seconds.

Today was the first time that I really felt my quad firing---and the first day then that I could hold the knee completely straight. I can only use a 2 lb weight---I use a 12 lb weight on the other leg.

Anyway, I suspect that that is the quad can Linda is talking about. Kelly

 

[Josephine]

Well I never!

 

[wendylyn]

First of all I want to thank you all for you kind words and prayers! For all of you to respond so quickly and in such a caring fashion brought tears to my eyes, (and lately I just haven't allowed myself tears). I was brought up as one of those "buck up", and don't bother other people with your problems, so to have a place where I won't feel I'm alone with the ups and downs of an unusual situation, I appreciate it more than you know.

In about twelve hours I'll be driving to the hospital, (where everyone knows my name and face! feeble attempt at humor). They will test for infection, and do the ESR for inflamation.

Thanks again everyone, you all made my day as they say!

wendylyn

 

[JudyS]

WendyLyn
Make sure you let us know the results. We'll be waiting
judy

 

[wendylyn]

The infection in the TKR was diagnosed in Dec. 2004, the TKR was removed the 28th of Jan. 2005 and the "cement" spacer put in, loaded with antibiotics. I was in the hospital for 19 days, then went home on two heavy duty antibiotics Rifampin, and Levaquin for eight weeks. They decided against a Pic Line, as they felt that the oral antibiotics would do the job, as well.

After the eight weeks at home I returned to the hospital for the third TKR. I recovered very well and even more quickly and thoroughly than even my surgeon had expected. I was monitored quite a few times after the surgery, and continued to do well. The only disclaimer my surgeon said was "remember this was a large amount of work on this one leg, it will take time to get back to normal".

Each subsequent follow up was done with an X Ray, and an examination of the knee. This surgeon who did the third TKT was the second surgeon to work on my knee. My original surgeon sent me to this second one as he felt he wanted someone else to check it out. This second surgeon is one of the best in the area, and as it turns out moved to operating in NYC only but seeing patients on LI. Half kiddingly this second surgeon told me to not break the knee again, as there wasn't much more bone left! I have very long stems in both the tibia and the femur.


As of last week I'm on my third Orthopedic Surgeon, and he's the one sending me for the tests, and wants to check the past X Rays, to see if the lower component has "dropped" further into the tibia. A couple of weeks of waiting, not too patiently, nor too calmly, and I should have some answers from the new orthopedic surgeon.

In case I didn't mention the quad cane (seems my very calm and serene brain and fingers didn't mesh too well the other night! it was a cane not a can! LOL). I'm using the smaller four footed one, as when I tried the one with the more spread out legs/feet, I almost tripped myself.

Don't know if I mentioned this or not, but the left leg was done, and I wouldn't even know it wasn't my own it's so perfect. Also, if I weren't too eager to rush into things, the first right TKR would never have started all this. These TKR's are so great under normal circumstances, as is evidenced by the still great left knee.

Sorry these posts are like mini essays, and I promise to try to keep my posts a bit shorter.

Josephine, I've picked up so much info on TKR's and have had so much done, the new doctors PA thought I was a retired nurse. Guess you could say I do a lot of researching online, sometimes finding more info than I sometimes want. Imagine a weak smile on my face here.

Thanks again for this great and most needed site and forum, and all your encouragement.

wendylyn

 

[Texas]

Well this certinly is not your fault one bit....You should know alot about these replacements you have had way to much experience. And the spelling. Im the worst. I keep calling/writing someones name (o here) BRAIN. instead of BRIAN. Hes a sweetheart and just went with it...lol...You'll be fine, because you seem like a very strong person....

 

[Jamie]

Wendylyn, God bless you, hon. Your saga is the one no one wants to hear about, but your spirit and determination are beyond amazing. I am praying so hard for this to be the time the magic works for that knee. If anyone deserves to be pain free and walking, it's you! Please don't hesitate to talk with us whenever you need support or a friendly voice. We care about you and will support you 110% through the days and months ahead.