Revision TKR Partial Revision Failure

Jamie said:
Another suggestion for you since you report that your legs tire easily when you are exercising is to talk with a vascular specialist about the possibility of having an ultrasound study done of your lower extremities. It normally would depend on whether you had other health issues (cardiac problems, high cholesterol or diabetes) whether this could be a problem.

I agree with Jamie but be aware that they need to order the right test. I saw my cardiologist (routine) and ask him to check out my varicose veins. He ordered a Lower extremity doppler ultrasound. Wrong test! When I got there, it was a 30 min test that checks for DVT's and edema. That was a waste of my time and money!!! The tech said the varicose vein test takes 2 hrs./and hour on each leg. I told my cardiologist's office I still would like to have that done before the end of the year but ONLY when I have 2 hrs to kill!

The test that was done showed no DVT's but edema around the outside of my knee where I feel the swelling and pressure/uncomfortableness. I still think there may be an issue with my patella button but the OS says no! (The PA said yes/maybe).

@Jamie, would and MRI or a CT scan give more info on a loose patella button? If it was loose, is it as major to repair a loose patella button?
 
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A vascular surgeon will know the proper test. And you're right, @Cementless, that the test I'm talking about takes much longer than 30 minutes. It involves both ultrasound of your legs and abdomen as well as blood pressure readings for specific areas of your legs and feet. It's a very comprehensive test that provides the doctor with accurate information on blood flow from the abdomen to the tips of your toes.

It might be possible for an MRI to detect some problems with the placement of a patellar button or soft tissue problems in that area, but it's not a guarantee. It would be unusual for the button to loosen, but if a surgeon had to go in to do repairs, the procedure is not as major as a TKR, obviously, but it is still an invasive surgical procedure that requires an excellent surgeon and a period of recovery time.
 
It's not a frequent problem and an image showing that could be difficult to get because of the femoral component of the implant. A quick search on the web gave me this image, but this knee has more problems than just a loose patellar button.

upload_2019-8-31_17-29-34.png
 
I cannot tell you that. Sorry. I'm not by any means an expert at reading xrays or other imaging like Jo is, so the best I can do in these cases is to research and try to find images.
 
@Jamie, did you ever have the ultrasound study we have been talking about and if so what did you do to help the situation?
 
I didn't personally have this type of ultrasound test, but my husband had a couple of them over several years and I sat in the room with him for all the tests (and talked with the gal administering the test about what she was doing) as well as discussed the results with the vascular surgeon. It's a very comprehensive test that shows exactly how well your blood is flowing to your legs and feet.

My husband had a condition where blood flow was reduced to both legs because of clogged arteries in his abdomen that required stents at two different times to open up those arteries. His symptoms were legs that got tired quickly and some aching in the legs. He couldn't stand or walk for any length of time. For years we thought it was related to his spinal stenosis and even saw his neurosurgeon with the idea of him needing more spine surgery. Fortunately we decided to wait on the very, very serious spine surgery that was hesitantly proposed by his surgeon. It turned out not to be his spine at all. It was clogged abdominal arteries and the stents did the job. We were so very thankful that we didn't rush into that spine surgery. He had already had three spine operations and had a lot of hardware that would have needed removal. Our wonderful surgeon was not too keen on the idea because of the extensive recovery. So, his hesitation gave us the pause we needed to hold off and eventually find out the real problem.

I'm not saying this is what you have going on, of course. I'm just suggesting that it could be something to try and rule out as you're working to get to the bottom of what's going on.
 
I am still wondering if anyone on BoneSmart has ever had a loose patella button? Not sure if I have one or not. PA said it looks like "a loose patella button" on July 16th, OS said, "the patella button is not loose!" The outside of my revision knee is always swollen and does not feel right. Very tolerable though....I am just aware of it!
 
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Update: Great news....My CT scan today did not show any loose patella button and the femur and tibial implants looked good. They were not loose either! I think my pain is from the IT band. My TENs unit helps plus ES Tylenol prn.:merry-xmas-smiley-emoticon: and :happy-new-year-smiley-emoticon-4: :christmas-carols-smiley-emoticon:
 
That is great news!!! :banana-santa:
 
@Cementless I live in pearland texas and wondered if the surgeon is really good. Who was he I know the name but can’t quite remember.. I’m so glad you are doing good. I am allergic to nickel. How long has it been for you and was it a lot harder the second time around. I was looking at Dr
Incavo at Methodist but don’t know. It is a hard decision, I am also ostopenia. and wondered is that is why mine is loose. Thanks you for your response.
 
@Jean houston, my revision specialist is Dr. Stefan Kreuzer, INOV8 Orthopedics, 10496 Katy Freeway, Suite 101, Houston, Texas 77043. Office # 346.571.7500; Inov8ortho.com
My L. Knee revision was done October 3, 2018. I too have osteopenia and metal allergies.
He is the best and loves doing revisions....he does many!!! Send me a PM if you want to talk.
Cementless (aka, June)
I don't check this website very often since I am doing so well.
 
@Cementless, yes I reserached him. He is on my insurance but Invo8 isn’t on it. How did you know it was loose? Is there a special X-ray they can do? My nickel count is 4.1. Were you always in pain, or did it happen later on. How long the second time around did you start feeling better? Who was your first doctor, if you don’t mind saying. They say mine is loose, lots of pain.what hospital did he do surge at.
 
@Jean houston, a regular x-ray should show if your knee replacement is loose. Then they do a bone scan that should confirm it. They also, do blood work to rule out infection. My original knee replacement hurt from the beginning. It was hard to lean over and touch the floor without tibia pain. My original Ortho was Dr. Gregory Stocks at Fondren Orthopedics. I was only the second pt. he had done without using cement! A red flag should have gone up but I was so ready to have the knee replaced. Let that be a lesson to all....do your research!!!
Dr. Kreuzer had me do all sorts of patch testing with an allergist and found that I could have my revision with cement. As long as Dr. Kreuzer is on your insurance plan, don't worry about the INOV8 part. You owe it to yourself to at least make an appointment with him and discuss you knee.
Hope that helps.
 
@Cementless did dr Kruezer talk a lot about your problem and explain things. I went to dr Incavo and he never gave me the time of day. I went to two others and they explained a lot of things to me. I left my first doctor because he said it takes time for you to heal. 21 months is to long. I put up with that from him for a year. And he had been my doctor for 4 year. My leg feels wet on inside and stiff, lots of pain and tight compartment. I’m glad you are happy with your new knee.
 

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