Revision TKR Multiple Knee Replacements

[Momma-me]

Hello
I had a patella-femoral replacement May 4th (with MPFL and OATS lateral condyle).

I had a twisting fall on Sunday which resulted in shooting medial pain and inability to bear weight and full straighten my leg without severe stabbing/burning medial pain. Dr. thinks sounds like torn meniscus or potentially MCL. I have applied the RICE technique, and over the past several days, it has actually only gotten worse.

My question is... IF it is a torn meniscus which requires surgery... with all the other problems my knee has had... would any of you advise just forgetting the meniscus surgery and revising my partial knee replacement to a full??

That would rectify the OATS graft pain and get rid of my meniscus (both lateral and medial) and just get on with it.

I am DONE with surgeries and knee pain. I haven't walked for 15+ months now.

I am seeing the surgeon next Thursday and getting an MRI so we will know for sure.
But I do not want ANY MORE SALVAGE PROCEDURES.

I am so depressed and feel like I cant take anymore... Im sure some of you can relate. :(

Thoughts??

 

[Celle]

Oh, you poor dear!
You were having a rough time anyway, and now this!

I totally agree that you don't need any more "holding technique" surgeries and my own inclination would be to ask for a revision to a TKR.
However, I don't know enough about the OATS procedure to be certain, so I'm going to ask @Josephine for her opinion.
It may be a little while before she replies, as she lives in the UK, but I'm sure she'll offer knowledgeable advice.

Meanwhile, continue with resting, icing and elevating your knee. It will help to calm down some of the inflammation caused by any damage done.

 

[Celle]

By the way, you'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
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[Momma-me]

Thank you. Yes, any thoughts and advise would be appreciated.

And yes, anyone may ask me any questions you would like!!

 

[PegGar16]

I can't advise you but I do feel for you..I have been there. Have a heart to heart with your OS, you need a final fix. I know it it hard, depressing and that you are tired of it all. Let your OS know that.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

My question is... IF it is a torn meniscus which requires surgery... with all the other problems my knee has had... would any of you advise just forgetting the meniscus surgery and revising my partial knee replacement to a full??

My answer to that is an overwhelming and firm YES!

 

[Momma-me]

1. My pain is 0-1 just sitting, doing nothing. Was maybe a 3 when I was trying to bear weight... (mainly d/t tightness from PFR and OATS.) OATS still feels like a deep horrible bruise.

AS OF TODAY (since I felt something "tear" on the medial aspect of my knee on Sunday), when I try to straighten my leg to full extension, with OR without weight bearing, I get a VERY SHARP, STABBING pain which is 8-10. Only on medial side. It also is an 8-10 when I roll over in bed at night. It sits me right up in bed and I have yelled out in pain.

2. As of last week, I was down to 1/2 tab (2.5 mg oxy), one time per day. Usually by the late afternoon. Tylenol (2 tabs, BID) and Advil (600-800 mg BID).
As of now... I am taking 5 mg oxy BID as well as Tylenol and Advil PRN. I had saved some oxy's from the last prescription and have a few left over.

3. swelling: Definitely moderate. Last week before the "tear" on Sunday, it was slight.

4. I have 115 flexion... Last week I had -10 deg. extension. Today, I am not sure. I can force it to full extension, but that is when I get a sharp pain on the medial side. If I breathe through the pain, it subsides, and I can keep my leg at full extension. BUT.. then when I try to bend it again initially, it will again, illicit that super sharp pain. (ALL MEDIAL)

5. As of last week, I was icing every night. Now, I am icing approx 3 times per day.

6. I am trying... that one is more difficult. Probably 1-2 times per day right now.

7. I can do next to nothing at the moment in regards to housework, shopping, etc.. I am on crutches and cannot bear much (if any) weight on my knee right now. Even with the crutches, I can only bear a little weight on a bent knee, as the extension portion of my gait is what causes the sharp pain.

8. Exercises
1 session
AGAIN... as of last week
step ups.. as many as I could on a 1" box until my leg got too wobbly. Only felt discomort when doing them. No pain.
straight leg raises x30
Hip AB and ADductors with 3 lb weights
"Compass Steps"... loading knee in cardinal directions
short arc quads x 30 sitting on edge of table or chair and extending leg

AS OF TODAY... I cannot even do a straight leg raise without sharp medial pain.

1-2 PT Sessions/week
All the same exercises are done at PT, except I am able to use these machines:
Hamstring Curl Machine/30lbs x30
Leg Press/50 lbs x50

etc., etc.

THANK YOU ALL FOR YOUR SUPPORT, THOUGHTS and ADVISE. I am so thankful for this forum. Please keep the encouraging words coming.

I saw the PT today and she says I am presenting with the symptoms of medial meniscus tear. She feels the MCL is intact. I have always had a very strong inflammatory response and we are "hoping" it is just that. (??)

The NP from my surgeon's office says it "sounds like" meniscal tear.. (we only spoke on the phone)... MRI will be definitive next Thursday, Aug 3.

My daughter is getting married in 2 WEEKS and I have my first grandbaby coming in 3-4 weeks, (give or take) and I am supposed to be her birth coach and help take care of the baby for a week post partum.

The thought of not being able to walk at these events or be on crutches makes me want to ball my eyes out. My other 2 daughters (I have 3 daughters) got married last summer, and I was also in a brace and on crutches for BOTH OF THEIR WEDDINGS and was not able to participate in ANY of the ways I wanted to. This was a result of the first surgery I had which initiated this whole downward spiral of events that seems to never end... :( :(

I hate to complain and be depressed... I am really working hard to keep my faith and trust God amidst the situation.

 

[Josephine]

My pain is 0-1 just sitting, doing nothing. Was maybe a 3 when I was trying to bear weight... (mainly d/t tightness from PFR and OATS.) OATS still feels like a deep horrible bruise.

Yes, at only 9 weeks that's the way it goes, I'm afraid.

As of today (since I felt something "tear" on the medial aspect of my knee on Sunday), when I try to straighten my leg to full extension, with or without weight bearing, I get a very sharp, stabbing pain which is 8-10. Only on medial side. It also is an 8-10 when I roll over in bed at night. It sits me right up in bed and I have yelled out in pain.

I can explain this

I had barely any ongoing pain, just what I refer to as a 'stone in the shoe' pain which came and went erratically. Sometimes it lasted for an hour, sometimes for a week but I knew what caused it so let me share that with you.

Arthritis has the effect of making our joints crumble like an old concrete step.

It breaks down, creating lots of grit and debris. Generally this stays in the pouches at the side of the joint but every so often, a bit gets into the weight bearing part of the joint and then we get that extreme pain and can't bear weight on the leg at all! Pain killers do nothing, nor do things like braces. We are just conscious of this horrible burning pain that all of a sudden goes away!

It's every bit as disabling as the constant bone-on-bone pain so many others suffer and is a very good indicator that a joint replacement is needed.

As of last week, I was down to ½ tab (2.5 mg oxy), once a day. Usually by the late afternoon. Tylenol (2 tabs, bd) and Advil (600-800 mg bd).
As of now... I am taking 5 mg oxy bd as well as Tylenol and Advil prn. I had saved some oxy's from the last prescription and have a few left over.

Taking pain meds bd is a fruitless exercise because most of them are only active in our systems for about 5-6 hours. So by the time you take the second dose, you've already been without any pain meds on board for several hours.

Definitely moderate. Last week before the "tear" on Sunday, it was slight.

Okay, gotcha.

I have 115 flexion... Last week I had -10 deg. extension. Today, I am not sure. I can force it to full extension, but that is when I get a sharp pain on the medial side. If I breathe through the pain, it subsides, and I can keep my leg at full extension. BUT.. then when I try to bend it again initially, it will again, illicit that super sharp pain. (all medial)

Whatever you do, do NOT ever force extension. Not only does it cause pain but it also causes swelling. You're only 9 weeks out so there is plenty of time for it to improve if allowed to do so on it's own. Remember our credo - no pain MORE gain!

As of last week, I was icing every night. Now, I am icing approx 3 times per day.

You never said for how long though. So if it's in the 20-30 minutes range then know this: you accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

I am trying... that one is more difficult. Probably 1-2 times per day right now.

Are you elevating with your leg totally straight though? Some PTs warn never to have your leg/knee bent when elevating and that's wrong. You need to have a little bit of a bend. It's not natural for humans to lie with their legs totally straight as it stresses the ligaments at the back of the leg and causes more pain! Here's some images to show you the good and bad ways to elevate

I can do next to nothing at the moment in regards to housework, shopping, etc.. I am on crutches and cannot bear much (if any) weight on my knee right now. Even with the crutches, I can only bear a little weight on a bent knee, as the extension portion of my gait is what causes the sharp pain.

Okay, got that.


1 session
as of last week, I was doing step ups, as many as I could on a 1" box until my leg got too wobbly. Only felt discomfort when doing them. No pain. - okay but don't do them
straight leg raises x30 - don't do these either
hip abductors and adductors with 3lb weights - never ever use weights - worst thing you can possibly do
compass steps"... loading knee in cardinal directions - again, don't do these
short arc quads x 30 sitting on edge of table or chair and extending leg - or these

AS OF TODAY... I cannot even do a straight leg raise without sharp medial pain - I am not in the least surprised!

1-2 PT Sessions/week - I'd cancel these if I were you
All the same exercises are done at PT, except I am able to use these machines:
Hamstring Curl Machine/30 lbs... set of 30 - don't care if you can, don't do them!
Leg Press/50 lbs... set of 50 - or these!

I must say I really gasped when I saw those last two exercises! Never, ever use gym machines. They are very hard on a knee that's just undergone surgery. In your present state, I would also advise you to do NO exercising at all and as little walking as you can.

 

[Momma-me]

Thank you for your thoughtful response. I will see the surgeon Thursday...(can't come soon enough) I can barely move at this point. Since last Sunday... things have gotten progesssively worse.. regardless of the rest, ice and elevation.

Please tell me there is an end in sight!!!! I'm ready for the TKR. My other knee has broken down.. they're both in so much pain.

We'll see what the surgeon says. I won't let her talk me into any more salvage procedures, but it's been SUCH a LONG road of pain and disability.. the thought of going thru another major surgery has me wondering how much resolve I have left.
You guys will be my lifeline.

Wedding in 9 days... In Hilton Head Island. Can barely move. "Bummer" doesn't even begin to describe it :(

Not sure if I have to pose this question in my own thread, or if its OK to post a new question?

I am wondering if I could hear any of your stories regarding how you went from a partial knee replacement to a TKR? What happened, what was the process, why did you do it, what was the timeline, and how was your recovery?

Just looking for positive outcomes/stories if anyone is able to share!

Has anyone had computer assisted knee replacement? Or robotics? I have been doing research on this and wondering if there are really any major benefits, as opposed to the old fashioned just "eye balling it" protocol?

Thanks!

 

[Pheebs52]

Well, my surgeon uses a computer to ensure perfect implant alignment. I found that idea much more comforting than simply *eyeballing it!* He's been doing this for quite a few years now (15, I think) and I'd think most Orthopedic Surgeons do as well? I can't answer the question on Robotics, but I'll bet someone else will be along soon who can.

 

[SusieShoes]

My mother had computer-assisted knee replacement for both her knees (two surgeries), as did my sister. Wonderful recoveries. I did not have computer-assisted knee replacement. My OS used tools--they don't really just eyeball it--and I've had... a really excellent recovery!

What it comes down to more than anything is the skill of the surgeon. If the surgeon is very skilled with his/her robotics, you will have a great result. If the surgeon is really skilled with a non-computer assisted technique, you will have a great result. A surgeon who isn't skilled at total knee replacement won't be better just because of computer assistance.

Do your research and go with the best surgeon you can find, who does LOTS of TKR, works out of a hospital with an excellent reputation, has very low rates for infections and/or blood clots, and who when you interview him or her gives you confidence you will work well together.

 

[Jajakio]

Yes. I just had my knee done and did the research. The skill of the surgeon is still involved but the stats I read indicated generally better results with computer assisted. But it is complicated. I opted for the conformis custom knee which Is 3down printed after CAT scan of existing knee. It is not computer assisted during surgery but the surgeon gets some computer drawn templates to match up prosthesis and existing knee. It was impressed with my surgeon telling me 20 -25% less bone loss and the idea of fitting the implant to the knee not cutting the bone to fit the new knee. I had my surgery just under 4 weeks ago and am happy. But i was surprised at how many choices are out there. I consulted 3 surgeons who all had good reputations and got 3 different approaches, the off the shelf knee with computer assisted surgery, a quad sparing side minimally invasive procedure with a "sports" knee, and the conformis custom knee I eventually chose. Honestly they all seemed doable to me. Lots of choices, most of them good. Skill of surgeon and number of surgeries he's done with the implant you are considering is still a big factor.

 

[VW54]

Mine was also computer assisted. They used a special X ray or the like to first select size of implant and from what I understood, the computer then saws away the bone to make it a "snug" fit.
Supposedly this also makes the implant less likely to wear down or loosen. I know from a German friend that there are videos that show how its done. I'm too squeamish.

 

[Pumpkin]

You'll notice that I have merged your two new threads with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[flyaway79]

I am recovering from a revision from partial to full TKR. I had my partial done 6 years ago. I then had another Microfracture arthroscopic surgery on the same knee about 1.5 years after that. Always had problems after both.

I had a revision on March 20th. So far so good. This has been a slower recovery than I had from my from my partial for sure. My doctor also advised me that I could expect a slower recovery this time because of the revision aspect.

I did PT for about 8 weeks and left because I felt like it was just aggravating it more than anything. My ROM came along in slow increments and when they released me I was at 113. Last week for my 4+ month check up with doctor I was at 130.

I still have tightness and lots of stiffness, especially with increased activity. But it seems to be getting less and less as time goes by. I'm now "almost" to the point of thinking this may have been a good idea

I do feel that this one will be the one that actually works!! Then it's on to my next knee sometime next year but going straight to a full TKR and skipping the partial.

 

[Jamie]

Momma-me....I can certainly appreciate your feelings about wanting to just get this over with and move on. You've been through so much in the past year or so. In know you're anxious for things to start going right. But please try not to overthink what should come next. You really don't have to decide what surgical procedure or implant is best. Your job is to find an excellent surgeon, willing to get you converted over to a full TKR and then let him or her decide what is the best way to do it. The skill of the surgeon is everything! Robotics are good in theory, but it still requires surgeon skill. You can get excellent outcomes with or without robotics if the doctor is a good one. There is no benefit in recovery time.

Get yourself steeled to the fact that you may hear people trying to talk you out of the revision to a full TKR because of your age. Be firm. It's crazy to keep going down this path of trying to do small "fixes" on a knee going downhill fast. Be sure they check out your other knee as well since you're having problems with it. If it's bad too, you can possibly get both done at once. Then you really WOULD be moving forward!

Let us hear how things go on Thursday.

 

[Momma-me]

Yes, I thought about getting both done at the same time! That is a scarey prospect but I know alot of brave men and women have gone before me and lived to tell! LOL
So.. we shall see.
Thank you again. I have not met anyone who has gone through anything like this before, so having support and advise here is helping so much.
I appreciate the advise on letting me "rest" in the counsel of a skilled surgeon. I DO feel as if I have one of those actually. The new injury as of late, was not her fault. I do trust my surgeon and the Hospital of Special Surgery in NYC where I had the procedures done in May. She knew right away what was wrong, as opposed to my surgeons here in Upstate NY. They all thought I was insane. My surgeon in NYC was literally a Godsend. I have to keep my faith and know she will have an answer. I AM going to push for a TKR. I am confident that is the only answer left and I CANT WAIT to get on with my life when this is over.
I will post an update when I can.
Hugs and gratitude to all...

 

[sistersinhim]

We are right here with you and sending up prayers for you!

 

[Pumpkin]

@Momma-me,
What are they suggesting with your PKR?

 

[Momma-me]

Hello everyone!!
I am back to give an update; I would SO appreciate some feedback and advise!

I had a Patello-femoral replacement last May, along with MPFL tightening and OATS procedure on lateral femoral condyle. (I know I know,...)

This has not gone well. I had a sharp snapping pain in the medial side of my knee last July ( 2½ months post op), which has totally debilitated me. Mind you I NEVER had medial pain in that knee before the surgery.

I went to the OS in September and another MRI was done and she said it was probably soft tissue damage and to stay off it for a couple more months. At that time I was still in my straight leg brace and on crutches but trying to bear weight on it. Since I had not walked for one year prior due to an arthroscopic surgery by a different OS the year before which failed, so my quad was basically non existent.

I have been in PT for 2 yrs. My surgeon said I have CRPS which I did not present with any of the classic symptoms, except that after that snapping feeling in July, my whole leg down to my foot swelled up for a whole month and was bright red. I tried to tell her that something happened. It was a distinct moment. But I got sent to the pain specialist and put on Lyrica. In my heart, I know this is not CRPS.

Anyway fast forward: I have been working on finding balance between strengthening my quad and healing from all of this torture! I was making VERY SLOW but steady progress up until a month ago. I still felt I was walking on a bent knee and something just wasn't 'right'.

The medial pain had subsided. I was doing more, trying to go back to work, gimping along, and one night I started having sharp pain in that knee. The same exact medial pain. Bbu this time, along with the pain, came patellar maltracking. Now, my knee is catching and snapping to the point that it hurts and I cannot bend it without it getting 'caught'.

I am using voltaren gel and taking meloxicam because it is slightly swollen. I have been off it for 3 weeks except to try to limp around the house a bit and it's getting worse. My OS told me to go back into my straight leg brace for one week to see if we can reset my quad and go back on crutches to unload the joint. I cannot do the straight leg brace.

My other knee cannot handle the load and I knew from last year's MRI that I have grade 3/4 arthritis under my patella on the unoperative knee. My OS told me that my other knee needs a patellar femoral replacement also (I am not a fan of this procedure anymore).

I am doing the gel injections in that one but it has only been 2 months and that knee is in so much pain, I am like a paraplegic. I feel trapped in my own body. I am going back to my OS in the next 2 weeks to see what the heck is going on. In the meant time, I feel like crying my eyes out. This has been the longest road and every time I think maybe there is hope or I can get over this hurdle I get set back again. I will be 50 this year but I am terrified that my life is over because I literally haven't even walked around a store; I cant work... I need my life back. Sorry if this sounds over dramatized but I just don't know how much more of this I can take.


Please... any suggestions/advise?

RIGHT KNEE Arthroscopic Surgery for a "clean out" July 2016 (FAILED)
RIGHT KNEE Patella Femoral Replacement, OATS, MPFL tightening May 2017 (So far.. not so good)
LEFT KNEE... Grade 3/4 arthritis under patella; 4 monovisc injections (STILL PAINFUL)