Revision TKR Multiple Knee Replacements

[Jockette]

I am so sorry to read your long and difficult experience.

I had a Patellofemoral replacement also, but no other procedures like you have. I will be one year out on Tuesday.

I have had a long, difficult recovery, but yours makes mine look like a piece of cake. I am sorry I did it. The glowing promises of partials compared total replacements did not come true for me.

Are you seeing a local OS or are you seeing someone at HSS? Was your surgery at HSS? I just read through your thread but I’m not clear on those 2 things.

I know it’s hard to get second opinions before a full year, but you’re almost there and I think at this point I would seriously consider getting another opinion. Easier said than done, I know. I have a name for a second opinion on my knee, in case I need it, but I’m not ready yet to do that.

I hope you can get some appropriate help and solutions. I’m so sorry your experience has gone this route.

 

[Pumpkin]

Momma-me,
I am going to tag @Josephine to address your concerns.
Sorry to hear how much you have been through since your surgery.

Recommend you seek a second opinion for your TKR, from a surgeon specializing in Revisions, they have the education and background to determine what is happening with troubled knees. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.

 

[Josephine]

Patello-femoral replacement along with MPFL tightening and OATS procedure

To be honest, I think having these three procedures done all at once was the problem. An OATS procedure can have a long painful recovery all on it own.

I'd like you to go back to posts number 22 and 30 and reread the advice I gave you then.

Then I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Momma-me]

Thank you Josephine. I have re-read your advise.

Ask away!!!

 

[Momma-me]

Pumpkin,

Here's the back story....

The surgeon who did my "clean out" and meniscus "repair" was in Rochester NY (where I live). That procedure was the beginning of the end. After that, my knee swelled up like a balloon and the swelling did not resolve for 6 or more months. I was in extreme pain and could not ever walk after that!!! My surgeon and my PT seemed baffled by that. That surgeon thought I had "CRPS" (which I did not IMO). I went to PT faithfully and just never recovered. The pain got way worse after that, and I really regret having that done... (too late now)

After that scoping, I sought out 2-second opinions as to why I could not walk and why I was still in so much pain (actually MORE so than before) and the first one told me I was "too young" for a knee replacement, and the second one looked at my MRI and told me that my situation was "too complicated" for him. ??

I kept digging and found HSS and went there for a consult. The surgeon there said absolutely she can help and I had grade 4 arthritis under the knee cap. She told me that my other compartments looked "ok" so she recommended a patellar femoral replacement. She told me my patella had been dislocated many times, (MRI reported a very stretched out MPFL) and it tracked laterally and high. I told her that I also had a 10 out of 10 pain in the lateral femoral condyle area when walking. She said yes, according to the MRI, there is a small "pothole" there and when I was in surgery if it looked like it would benefit from a cartilage plug (OATS), then she would make that decision at that moment. I said fine.... do what you need to do.
Whilst in surgery, she discovered that the "pothole" was 3 times the size it showed on the MRI and my cartilage in the lateral femoral condyle just "crumbled away". (her words). She filled it with cadaver cartilage. Then she tightened my MPFL with sutures because she said it was "stretched out". And then I received the PKR.
Typing this out makes me feel like this is so insane.

NOW... I have medial pain, (sometimes sharp but always burning) and "catching". I cant bend my knee without it sticking and its painful. That is a new development.
... and I am wondering...

Could this be arthritis that spread to this are because of my improper gait and walking on a bent knee I don't know!

And ..... my other knee is having sharp stabbing pain from taking the load for 2 years.


What do you 'experts' think?

 

[Celle]

NOW... I have medial pain, (sometimes sharp but always burning) and "catching". I cant bend my knee without it sticking and its painful. That is a new development.
... and I am wondering...
COULD THIS BE ARTHRITIS THAT SPREAD TO THIS AREA BECAUSE OF MY IMPROPER GAIT AND WALKING ON A BENT KNEE? IDK???

It sounds as if the arthritis has spread to other compartments of your knee. That often happens and it has nothing to do with anything you did.

Arthritis spreading to other knee compartments is one of the main reasons why partial knee replacements later have to be revised to total knee replacements.

In light of what has happened with your first PFR, I would advise against having the same surgery on your other knee.

 

[Momma-me]

Thank you for your response. Can it spread that quickly? I had an MRI 8 months ago and it didn't show arthritis in that medial joint. I am thinking the same as you... it just seems quick to have spread but I guess we won't know until I have another MRI, which, unfortunately, is not until April 12th!!!!

 

[Celle]

I had an MRI 8 months ago and it didn't show arthritis in that medial joint. I am thinking the same as you... it just seems quick to have spread but I guess we won't know until I have another MRI, which, unfortunately, is not until April 12th!!!!

I told her that I also had a 10 out of 10 pain in the lateral femoral condyle area when walking. She said yes, according to the MRI, there is a small "pothole" there and when I was in surgery if it looked like it would benefit from a cartilage plug (OATS), then she would make that decision at that moment. I said fine.... do what you need to do.

At that point, I think there was already an indication to do a TKR, not a PFR and an OATS, as you already had cartilage damage.

Although your surgeon recommends them, I'm not a fan of PFRs. That's because here on BoneSmart, we have had more people who have trouble after a PFR than people who have had a successful, uncomplicated outcome.

 

[Momma-me]

Can you direct me to any posts of people who have had a failed PFR and then a revision to a TKR? OR any other advise? I am scouring the internet and not finding a whole lot.
You are right... a TKR would have been a better route, in hindsight. The MRI showed a "pothole" in that lateral side but it appeared to be "small" (Cant remember the mm dimensions). The surgeon didn't know until she got inside my knee, that it was so large and deep. I think it surprised her. I remember her telling me after the surgery that my knee was in "way worse condition that she originally thought"

 

[Jockette]

What does a pothole mean?

 

[Momma-me]

I was led to believe that it was a small hole in the cartilage. AKA.. a cartilage defect.

I am just using the terminology that was used with me. My PT said it a million times... Before this PFR, I kept telling her that I am having debilitating pain in that area, with catching, and she kept saying, "well, we know you have a small pothole there"... And according to the MRI, it seemed like a "small" defect. (Apparently, it wasn't so small when they got in there to actually see it... )

 

[Jockette]

Wow. I can’t believe all what these professionals have put you through.

My PFR is not healing well, in my opinion. I’m not happy with it. I am so disappointed in my outcome. I trusted my surgeon to do the appropriate thing for me and I thought by only needing a partial that I was catching my arthritis early and that this partial was all I would ever need. I even defended his diagnosis when a couple of my friends questioned the partial. I was annoyed with my friends thinking of course my surgeon knew what he was doing. I no longer feel that way.

I recently googled partial vs total and got a whole different take on partials and found that there are surgeons who won’t even do them.

Before surgery I only googled partials and got glowing promises.

 

[Momma-me]

Jockette... I am so sorry to hear all of this. I can completely relate. I am beyond disappointed and frustrated. Can I ask where you had your surgery? What is the plan for you now?

 

[Jockette]

I had my surgery in Dover, Delaware. People I know have been happy with my surgeon, but they had totals done.

If I hadn’t had the surgery and instead met him socially I’m sure we would be friends. He’s a very nice person. But more than once he has told me to do things that Bonesmart says not to, so I tend to get aggravated at my appointments.

I have my one year check up tomorrow. I have a list of 9 concerns to discus with him. I don’t expect solutions as most of my issues seem to be rare.

My main concern is the way my knee feels when I lean forward, like when I load and unload the dishwasher, even the slight lean forward while hand washing the leftover dishes, making the bed, brushing my teeth, etc. The only way I can describe the feeling is that it feels like someone jammed a hunk of wood into the knee on the lower lateral section. When it’s extreme it’s hard to bend it. I’m not sure it’s actually painful but on a scale of 1-10 of discomfort it’s an 8 or more. I also get a sharp pinching feeling if I stay leaning forward, like when brushing my teeth.

I’ve wondered if it’s a patella tracking issue so recently I taped it with kinesio tape and I did not get that feeling when leaning forward. But, I didn’t expect to have to tape my knee after surgery. It kind of defeats the surgery, don’t you think?

My surgeon has seen me often the past year, 2 weeks, 6 weeks, 10 weeks, 18 weeks and 7 months. He takes X-rays every time and they have always been fine. He wanted to see me again at 10 months but I talked him into waiting until the one year mark. I don’t know if he sees all his patients this frequently or he knows more about my PFR than he’s telling me.

So, we’ll see what happens tomorrow.

On page 26 of my thread I posted an 11 month update if you’d like to read my other concerns.

 

[flyaway79]

I had a PKR 6 years ago because I “just” had bone on bone under my knee cap. I believed it was the right thing to do. I then ended up with microfracture surgery for a quite large area of torn cartilage in the same knee 1.5 years after that. He went in to “take a look around” and found that. Not what i was expecting at all! Always had issues and problems from them on.

Finally 1.5 years ago I had a reversion (with different surgeon) to a TKR. While I have great ROM and returned to an active job and full activities at 6 months, I still am experiencing issues. My X-rays are all good and my surgeon says all is great with the implant. Since I’ve had so much that has gone on surgically with this knee I don’t expect that I will ever be pain free with it. I’ve come to accept that but hope it continues to improve as time goes on.

I have the exact same bone on bone under my other kneecap and while my surgeon says they could do a partial on that one too, he highly recommends I go for a full replacement on that one based on my experience with my first one. I couldn’t agree more and will most likely be having that done sometime next year. My surgeon said he belives the TKR on that one will be very successful and I will not experience the problems I had with my first one. Sure hope so!

I know there are many people who have had successful PKR’s but I sure wish I had gone straight to a total my first time around.

Good luck with your appointment! I hope you get the answers you are looking for

 

[Beckadeez]

My doctor gave me the choice between a PKR and a TKR. I’m SO thankful I chose TKR after what I’ve read on here about failures of PKRs. My doctor had told me I’d eventually go from a PKR to total, as the lateral compartment would get bad, as well. I feel so bad for you and others who have had this issue. PKR shouldn’t be offered at all, in my opinion. All the unnecessary pain. I hope you get relief. Hugs...

 

[Celle]

In defence of partials, while many of them do fail early, I had one that lasted me for 11 very active years before it had to be replaced.

It wasn't a PFR, though, but a medial compartment PKR.

 

[sistersinhim]

PKR shouldn’t be offered at all, in my opinion. All the unnecessary pain. I hope you get relief.

Not to mention all the extra expense of the surgery and meds and the loss of income from being out of work! Oh and the stress on the body!

 

[Momma-me]

I just heard from my doc (well, the PA) and I cannot get in for an MRI or to see her until April 12th. I asked, "what do I do in the meantime?" And she said to just stay on my crutches. That's a whole month of not knowing what is going on....Easy for her to say. I have been on and off (mostly ON) crutches now for almost 2 years!!! UGH.
And my insurance will not cover the gel injection (synvisc one) for my other knee, because it has only been 3 months so I had to order it from a Canadian pharmacy and pay out of pocket. I am not working right now so this is just all TOO MUCH!

I am going to a different PT tomorrow. I have been with the same woman now for 2 yrs. Every time I go, I do the same routine... bike, machines, step up, monster band walks, blah blah. I just feel like maybe it will help to get a new set of eyes on the situation...

Thanks for reading.

 

[Celle]

I am going to a different PT tomorrow. I have been with the same woman now for 2 yrs. Every time I go, I do the same routine... bike, machines, step up, monster band walks, blah blah. I just feel like maybe it will help to get a new set of eyes on the situation...

Good idea! A different point of view from another PT may help.
On the other hand, if going to PT for 2 years hasn't helped, why keep going at all?