Revision TKR Multiple Knee Replacements

[Momma-me]

My surgery last May was so intense and I had been through the wringer so I definitely needed to go to PT. Any my surgeon had instructed me to keep going. But, I saw someone different today who did a thorough exam and told me some things that I had never been told before. And gave me some new stretches to do.
He thinks quite certainly that my medial pain is torn cartilage (he said meniscus) and that my patella is riding so high, it is not going back into the "groove" it's just stuck. (I knew I have patell alta; my other knee has it too.)
Even when I lie on the table and squeeze my quads, my patella doesn't budge. Also.. I have poor extension. My other knee hyperextends quite a bit, and my operative knee can barely get straight. So we have some things to work on. May not fix things entirely, but I am hoping for some improvement, nevertheless.

 

[Jockette]

On the other hand, if going to PT for 2 years hasn't helped, why keep going at all?

I agree with Celle. PT has not improved your knee. You’ve been working it for so long maybe it’s time to stop and just do your daily activities. Maybe giving your knee a long rest from exercising will at the very least reduce your pain level.

I’ve been reading Bonesmart for almost a year now and have read many members experiences with too much exercising, and long term exercising and often it just keeps the tissue inflamed.

While I have not had a great outcome I can only imagine the more discomfort/pain I would have had if I continued to do the things PT recommended.

I think you just might see more improvement by stopping all the PT efforts and giving your whole leg a chance to rest.

 

[Momma-me]

Can any of you tell me what this means?

"peripheral high signal at the posterior horn junction of the meniscus.
Thin cartilage on the condyle more than the plateau"

 

[Babushelen]

@Momma-me Maybe tag @Josephine. There. I just did it for you.

 

[Momma-me]

@Momma-me Maybe tag @Josephine. There. I just did it for you.

THANKS!

 

[Josephine]

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...

I'm sorry, Momma-me, I read that an laughed out loud! Have you ever heard of the old saying "doing the same thing over and over again and expecting different results"! I rest my case!

"peripheral high signal at the posterior horn junction of the meniscus. Thin cartilage on the condyle more than the plateau"

The 'high signal' and the 'thin cartilage' are one and the same thing. Wear and tear.

 

[Momma-me]

Thank you Josephine! I had another MRI on Saturday... awaiting results...
If I have thin cartilage and wear and tear in my meniscus or condyle that is causing pain... (esp if things have progressed or gotten worse over the last 6 months) given my situation... can I ask you your opinion?

 

[Momma-me]

@Josephine I am wondering if you (or anyone else) can be more specific in explaining this:
"chondral heterogeneity centrally is located over the condyle"
Is this a normal or abnormal finding?

ALSO... what does a thickened MCL "proximally" indicate? If anything?

I am just trying to figure out what could be causing the medial pain. ?

Thank you

 

[Jockette]

If you want to tag someone, just put @ in front of the name with no space between.

 

[Momma-me]

Hello
Has anyone ever had this done after a partial replacement?

I had a PFR last may but continue to have a lot of inflammation inside the joint and some scar tissue/tissue that is inflamed that is causing alot of pain and "catching"
The doc is recommending Euflexxa (all 3 vials at once) into to knee.

Anyone?

 

[alexthecat]

@Momma-me
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.
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.

 

[skigirl]

There is always the serious risk of infection when anything is injected into the joint. Also, I wonder at the use of Euflexxa for inflammation? That is off label I think. It sounds a little like he can't think of anything else to do. I would want a second opinion before I did anything this drastic.

 

[Momma-me]

Thank you. IDK.. I'm just at a loss. I don't know what to do anymore

There is no advancement of arthritis in the other components. My OATS is healing fine. I have a sharp medial "catching" on flexion and have PTSD from the pain. (I am just afraid to bend it) I could never walk after the first procedure without a limp and pain.
Because I also had a flare up of CRPS last July, (or whatever it was), this has been a long process. No matter what I do, I cannot make this better.

She is putting me back on meloxicam, prescribed a voltarin gel patch, back in a straight leg brace, back using my quad stim machine, and in 3 weeks, I am getting the euflexxa in the operative knee, and monovisc in the non operative. (That one has arthritis under the knee cap and has become excruciating.) My back has gone "out" (for lack of better word) and am seeing the pain specialist tomorrow.
My body has spiraled backwards all because of this one knee and I am Completely beside myself and lost.

I went to Hospital of Special Surgery for the PKR after several other surgeons in my area who said they couldn't help me. So... now, I feel I don't know what to do..??

Any advice or even encouragement would be greatly appreciated..

 

[Celle]

I'm going to ask @Josephine to advise you.

However, this is what I think:
It's eleven months since you had your PKR. I'd be inclined to look for a second opinion, from a surgeon who is skilled in dealing with problem knees and who has no connection, either social or professional, with your current surgeon.
You need someone who will look at your knee with new eyes, uninfluenced by your current surgeon's opinion. These surgeons see problem knees every working day and they can often see a problem and a solution that has eluded the original surgeon.

To get a completely independent opinion, you may have to go out of your area.

 

[sistersinhim]

I agree with Celle. It sounds like your knee is out of her 'league' and you need someone much more experienced with problem knees.

 

[Josephine]

NO MATTER WHAT I DO, I cannot make this better.

I think I've said to you on more than one occasion that you were doing far too much exercising and also bad exercising such as using gym machines. I really hate to say this but I must - apart from unwise surgical procedures which weren't your fault of course, you've been on a very unwise course of rehab and caused a chronic pain and inflammatory state in your knee. I just really hope and pray that your doctors can help this abate.

 

[Momma-me]

I HAVE gone out of my area... when I went to HSS, last May, it was my 4th opinion (after all the surgeons in my area either said my problem was "out of their league" or that I was too young for a replacement).
I have been told that HSS is top notch so not sure where I would go from here...??

Yes, I do have a chronic state of inflammation. It started with the original injury. I had the full workup done (to see if I had some sort of auto-immune situation, etc..) because after the scope, my knee remained very swollen, hot, red, and would not heal. It stayed in a chronic state of inflammation and the doctors could not figure out why. I had 2 other consults after that, to no evail, until I went to HSS. (It is a 7 hr drive for me to get there).
That is when the doc there said she could help me and I had the surgery (PFR, OATS).

My quad was severely atrophied because I had not walked in so long. But I never left PT. We have tried very hard to find the balance between getting my quad back to strength, and protecting the joint. It has been very difficult to find the balance.

I tried to go back to work (just part time) in January, but I was on my feet alot and my knee just went down hill from there. I was still limping and not walking right when I went back but I was hoping for the best. Apparently that was the wrong decision.
My patella is now sublexing upon flexion and I have inflamed tissue that is catching and causing pain. My knee joint in general remains painful.

I am just so frustrated. Beyond frustrated. I just don't know what the answer is..

Thank you for listening....

 

[sistersinhim]

I am so sorry you are going through all this. I wish I had something I could say that would help. All I have for you are my prayers.

 

[Momma-me]

So sorry to keep asking questions.. but this forum is the only place I know of who might have an understanding of my situation.

I am wondering a couple of things:

Can inflammation inside the joint cause the patella to maltrack/snap/get stuck in flexion?

Can a TKR help in resolving this issue? Or residual pain/crunching feelings, etc?

My surgeon has suggested that if the Euflexxa doesn't help, she can go in arthroscopically and remove some inflamed tissue.

I am NOT feeling confident about that. My last arthroscopic surgery resulted in complete failure; a procedure which may seem quite "benign" to some, left me disabled.
I would rather go to a TKR but not sure if it would even be an answer?

My OS has not ever brought it up but I may want to ask her when I have my phone consult with her tomorrow. Being that my arthritis in the other components has not spread (I know I had the OATS but it seems to be healing fine; MRI indicates a subchondral cyst behind the graft... don't know what that means exactly). MRI also indicated chondryl "thinning" on medial side. But my OS does not seem to think any of this is an indication for TKR.
I know she wants to exhaust all other options first and I am sure she is thinking about the fact that my quad is struggling to get stronger and the fact that I had 2 bouts (now resolved) of CRPS.
But, I also know that I CANNOT live like this either.

I don't want to make any mistakes with this after all I have been through.

 

[Celle]

@Josephine is the expert on all this, but this is what I think:

Can inflammation inside the joint cause the patella to maltrack/snap/get stuck in flexion?

I don't think so.

Can a TKR help in resolving this issue? Or residual pain/crunching feelings, etc?

You know, patello-femoral replacements don't really have a good history. Many of them end up being revised to a TKR and I think this is the answer for you, too.

My surgeon has suggested that if the Euflexxa doesn't help, she can go in arthroscopically and remove some inflamed tissue.

No. Please don't let her do that.

It seems to me that you have had a series of "holding" operations, aimed at putting off having a knee replacement - first the arthroscopy , then the PFR and OATS - and none of them with spectacular success.
I think your surgeon can't see past trying to save the PFR - maybe she's an enthusiast for PFRs.

But really, why let her mess around doing more "minor" surgeries on your knee?
She is out of her depth and your knee has had enough of this mucking about.

Go and see someone else. Have a TKR if that person recommends it.

I am NOT feeling confident about that. My last arthroscopic surgery resulted in complete failure; a procedure which may seem quite "benign" to some, left me disabled. I would rather go to a TKR but not sure if it would even be an answer?

I agree with you. Go for the TKR - but don't let your current surgeon do it. She has had enough chances with your knee.

MRI also indicated chondryl "thinning" on medial side. But my OS does not seem to think any of this is an indication for TKR.

I know she wants to exhaust all other options first and I am sure she is thinking about the fact that my quad is struggling to get stronger and the fact that I had 2 bouts (now resolved) of CRPS.

But, I also know that I CANNOT live like this either.

I think your surgeon is fixated on trying to "fix" your PFR.
What is she going to put you through while exhausting "all the options"?

The only drawback that I can see in going for a TKR is that the CRPS may return - but it is also likely to recur after all these other procedures your surgeon is proposing.

Go and see a surgeon who specializes in problem knees and does revisions frequently.