Revision TKR My implant is loose

[Soozy]

Hi I'm just looking for some support as I'm going through a difficult time at the moment. I had a left TKR back in September 2017 and the recovery of this has been difficult. I had a lot of swelling particularly after doing my exercises but also when I just sat with the leg down. I ended up having 5 months off work with swelling being the main problem.

On my 1 year checkup, an xray was taken which showed a dark area at the top of the tibia after having to see my consultant privately he took a look at the xray and said it was loose.

I've had bloods done to check inflammatory markers which were normal and and a full body bone scan which showed a lot of activity in that knee suggesting an infection. I had my knee aspirated which showed a negative result. The consultant is still convinced that the implant has become loose due to an infection. I am currently waiting to see him again next week where he will decide my fate.

While waiting for a revision the pain I am experiencing is getting unbearable when weight bearing. It is more in the upper shin area on the inside of the leg but when I take the weight off the pain goes. I get the stiffness in the knee and surrounding muscles which I can handle but the pain in the lower leg is just awful even though I was taking 50mg of Pregabalin and regular co-codamol 30/500mg strength. I've been given crutches now and I am now on sick leave.

Has anybody got any advice on what I should be asking the consultant next week to ensure the best outcome in the long term. I'm very worried, I'm turning 50 this year and was planning a trip to Japan not recovering from revision surgery

 

[ArmyVet]

I wish I knew what to say to you to help, but I thought I'd let you know I am going through the SAME thing in the SAME place!!! My original TKR was April 30, 2018, and I've been hurting since January. My doc took xrays and found the problem, and did the aspiration last Tuesday- I'm waiting for the official results now, but from the first preliminary results, I think I have an infection!! I will have the full results on May 7th, if not before, but all I can think about is "How fast can they fix this?", because my knee hurts worse now than it EVER did before the original TKR and recovery!!! I can't even do a lap of the grocery store without the scooter with the basket!!

I plan on keeping up with you to try and help as we go thru the same thing (almost)!! You can do this!!

 

[Celle]

Hello @Soozy - and

I'm sorry you've had to come to us with this problem.

It does sound as if your implant is loose. That can happen occasionally, without any infection.
Once it's loose, an implant does need to be replaced.

It's usually the tibial part of the knee replacement that comes loose and the problem is likely to get worse if it's not fixed.
For now, you should avoid any unnecessary exercise, which might increase the amount of loosening.

Do you have a copy of that X-Ray that you could post for our Nurse Director, @Josephine , to look at? She has lots of experience and she's pretty good at reading X-Rays.
A few tips on posting xrays

One thing you should consider is seeing a surgeon who specialises in problem knees. These surgeons are very good at doing revisions when something has gone wrong. As they see problem knees every working day, they can often spot a problem and suggest a solution that has eluded the original surgeon.

You need a surgeon who has no connection, professional or social, with your current surgeon, so that he/she can form his/her opinion of your knee, uninfluenced by the opinions of your current surgeon. You may have to travel for that second opinion.

 

[2tkr]

I would get a second opinion. A new perspective can’t hurt.

 

[Jamie]

Where are you located in the UK and who was your surgeon for the primary TKR? Jo is located in the UK herself and can likely recommend some surgeons for you to get a second opinion. Be sure and tag me when you respond. You do that by typing my username with the "at" sign in front of it (no space) like this: @Jamie

 

[lovetocookandsew]

@Soozy I'm sorry to hear your implant is loose. I was in the same boat and had a revision last June. I understand what you're going through-and I know the feelings you're likely having. If the implant is loose, there's really no option but a revision, from what I was told. Other than that, I asked my OS about the new implant, why I was having issues, if metal allergy was possibly the problem so had the LTT metal allergy test done, recovery time after.........The one thing I didn't know about, so didn't ask about, were the long posts they put in for a revision, so those were a surprise.

I don't know if you're using the same doctor, but I think it might be a good idea to find a revision specialist for another opinion and advice. My poor OS is always patient with me and my looooong list of questions I bring in every app't-he actually makes a little joke and tells me to pull out my list. But he answers every single question every time-that man has the patience of a saint! Start writing down every little thought and question that pops into your head, then condense the notes down to concise questions for your doctor. Good luck and keep us posted!

 

[Soozy]

@Jamie yes I forgot to mention when I received the news about the bone scan my original surgeon referred me to a revision specialist. It is this consultant that is looking for an infection before carrying out the revision and I see him again on Wednesday.

@lovetocookandsew I have mentioned to the revision consultant is it possible I could have an allergy to the metal and he didn't dismiss this. It might be worth asking if I can be tested for this first.

@Celle I haven't got any pictures of the xray taken but the first one that was taken the radiographer reported it as normal and in alignment but when the consultant looked at he said it was loose. The second xray which was taken a week ago the radiographer said to me "you do realise it's loose" so I'm guessing it's more obvious now.

Thank you for your replies, I think I'll make a list of questions before I go in to see him x

 

[Jamie]

You're right on target, Soozy. See about getting the metal allergy test. You may have to pay for it out of your pocket as I doubt the NHS would cover it. It's about $550 American dollars but it has proved worthwhile for a lot of members. Just the peace of mind of knowing it's NOT a metal allergy can be quite comforting when you're facing a revision.

It sounds like you are in good hands with a revision surgeon, so I'd say just keep doing what you're doing.

 

[Soozy]

Hi all, I saw the consultant today and I'm having my implant removed next week. He's going to treat it as if it's an infection that has caused the loosening. So he'll take the joint out, take samples to look for infection, put a plastic joint in with Vancomycin beads. I asked about whether I could have a metal allergy and he dismissed this straight away and said he just wants to get this joint out ASAP

 

[Jaycey]

@Soozy Do you have a surgery date? I'll put it in your signature for you. Sounds like you have a good surgeon. Taking steps to get this corrected quickly is great.

 

[Soozy]

@Jaycey providing my pre op assessment is OK on Friday it should take place on the 8th May

 

[Jamie]

Soozy, I'm glad your surgeon is dealing with this right away. Should there be no sign of infection when the testing is done, you may want to bring up the issue of the metal allergy testing again.

 

[Bifgrif]

Soozy, I am very sorry to hear that! I went through the same thing. The tibial tray came loose. I am curious if you know the name of the manufacturer of the implant. The DePuy Attune implants have a higher than normal failure rate. I think the FDA has issued a class 2 recall (voluntary) on these models. A newer revised Attune model was introduced about one year ago. Best of luck going forward.

 

[Soozy]

@Bifgrif I have no idea what make of implant I've got at present. I've been assured that my case is quite unique so I'm presuming there has been lots of successful TKRs with the same make. Thank you for wishing me luck, I'm praying this revision works

 

[Josephine]

I get the stiffness in the knee and surrounding muscles which I can handle but the pain in the lower leg is just awful even though I was taking 50mg of Pregabalin and regular co-codamol 30/500mg strength.

Have you considered using a TENS machine? I have a loose implant and while oral meds (Tramadol and paracetamol) work reasonably well, there are times when the TENS is better.

I've been given crutches now

Good! I'm using walking sticks and even keep one upstairs beside my bed for night time use!

Has anybody got any advice on what I should be asking the consultant next week to ensure the best outcome in the long term.

You can't 'ensure the best outcome' either in the early phase or the long term.

The DePuy Attune implants have a higher than normal failure rate.

Loosening has nothing to do with the implant. It's all about how well the bone was prepared and the implant embedded. You ca read more about this here Cemented and uncemented hips. It doesn't matter that the article is mostly focused on hips.

radiographer reported it as normal

Radiographers don't report on xrays. They are just xray technicians and shouldn't be offering opinions on films anyway.
Reading xrays is the job of a radiologist who is a doctor.

my original surgeon referred me to a revision specialist

Would you tell me this surgeon's name and which hospital he works at?

it should take place on the 8th May

Lucky you! My loose tibial implant first showed itself in August last year, was confirmed in December when I was put on the waiting list. Projected time before booking - 8-10 months - which makes it somewhere between September and October!

 

[Soozy]

Reading xrays is the job of a radiologist who is a doctor.

Ok the radiologist reported it as being normal and in alignment.

Looking back I think my implant became loose a couple of months after my initial TKR but the surgeon dismissed it without even getting it xrayed. They now think it's an anaerobic bacteria that has caused the loosening but I guess we'll find out when the implant is removed and samples are sent for histology

 

[Bifgrif]

Josephine, I am somewhat confused by your statement that "loosening has nothing to do with the implant". If there is loosening in the knee and if the loosening is cause by a design flaw in the implant, would this not be due to the implant?

 

[Josephine]

Did you read the article I left you, about cemented and uncemented implants? In there I've clearly described the details of implanting devices and how and why they come loose. Invariably, a loosening is never caused by the implant. There are no circumstances where it would. One exception is in the uncemented TKR where one device had a poor covering of surface material that was supposed to 'bond' with the bone but failed to. But that was a good few years ago and that device has been taken off the market.

So now we are left with bone preparation and the use of cement as the primary causes of loosening. There are other situations where the bone might die back from the implant or cement but that is nothing to do with the device.

 

[sistersinhim]

Good luck on your surgery today.

 

[Soozy]

I'm now 2 weeks post op. They did a first stage revision with vancomycin beads just incase there was any infection. It turned out that there wasn't any signs of infection present during the operation however there was a cavity which indicates there had been an infection which had gone on its own, who needs antibiotics? So infection was the cause of the implant becoming loose. Recovery is going well and I'm very happy with the scar it looks much better than the previous one. The downside to all this is that I have a plastic joint at the moment so I still need to go through a revision operation sometime in the future. My surgeon said that this one can last up to 2 years. Just glad it's over for now