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Revision TKR Need advice for 6th revision

Jamie

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Dr. Chow has responded to me and agreed that under these conditions you should avoid any implant that has nickel. He is willing to call you into his clinic for a second opinion as soon as he can get you some time. Please PM me with your name, address and phone number so I can provide it to him. He is a well-respected surgeon who has worked with us here on BoneSmart for some time. You can trust him.
 
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Cjackso21

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Thank you everyone for you responses. It also figures that I have just started a new job at Intel and am working today on a 12 hr 3/4 day a week schedule which starts today. And thank you @Jamie for all of the work you have done. I was also able to reach my surgeon in San Diego who also advises not to use nickel. I guess I am also wondering, as is the new doctor, why my left, which has nickel, has not had a problem. Will hopefully have my husband start working on this tomorrow to see if we can get into any of these doctors.
 

Jamie

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It is not a given that you will have problems with an implant when you have a metal allergy. No direct cause and effect has been proven in any studies.

But....when you do have a known allergy or sensitivity, you might have a greater tendency for problems with the metal ions (small microscopic particles) that can be released with the friction of movement in an implant.

There isn't a lot of information out there on this theory, but it's something I've seen a few documents on lately. The thought is that if an implant is placed even slightly out of alignment (so slight it might not even show up in a x-ray), it can result in greater numbers than normal of these metal ions being released. They irritate the tissue. You get pain, swelling and inflammation. And that causes a process called osteolysis where the bone dies back enough to start the loosening process. I am not suggesting this is what happened to you. But it is a theory that's out there. There just needs to be more research done in this area.

So please don't try to second guess what may or may not have happened with this knee. I'm glad to hear your previous surgeon validated what we said here about not going with any implant that exposes you to nickel. The important thing now is to get you to a surgeon who understands your problem and can give you the best chance for success after so many failed revisions. You most certainly don't need another failure.

Good for you for taking quick action here. There is nothing wrong with meeting with the surgeon you have surgery scheduled with on Wednesday so you can ask him some of these questions we've suggested, unless you've totally ruled him out. But, please don't rush into the surgery with anyone until you are confident that you're making the right choice for both your implant and the doctor performing the surgery.

Please let us know how things progress.
 
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Cjackso21

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Thank you again for all of your help with this. I went to see Dr. Chow’s PA and she was amazing. Took at least 90 minutes and addressed all my questions and asked me to get lots of historical info, like my MARS (Metal Artifact Reduction) MRI. I forgot that I had one because it was inconclusive. The good news is that there does not seem to be an infection. But more labs were ordered. I feel like they will be more conservative with their approach rather than Dr. Ahmed. I have an appt. on Tues. at 8:30am with Dr. Chow! I just want everyone on this forum to know that if you really need help, Bonesmart really helped when I was desperate for help. Just need to ask for help :). Will post again after my appointment. Thanks, Carol
 

Jamie

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Carol, this news made my day!! Be sure and give Dr. Chow a big BoneSmart "hello" when you see him. I think you'll like him too.
 

lovetocookandsew

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I'm so glad you're going to get a new opinion, and from a doctor that our wonderful Jamie recommended to boot! I can't wait to hear what he has to say.
 

LindaO

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Let us know how your appointment goes!
 
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Cjackso21

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Wanted to let everyone know that Dr. Chow was indeed the most thorough and brilliant surgeon I have seen to date. And he was only giving a second opinion. He started out saying that Bonesmart was key in getting me in to see him. I have scheduled surgery with him, but because he wants an entire day and he is so good, it is not until 2/7/2020. I am going to see my original Dr. Ahmed next week to not burn any bridges and see what his opinion is relative to what Dr. Chow said. Interestingly, Dr. Chow agreed with Dr. Ahmed in that they do not believe I have an allergy to Nickel. Apparently there is yet to be conclusive evidence the the blood test (not covered by insurance and only one in the country that does this) correlates to component loosening. I also wear Silver jewelry and there is Nickel in this so I would have not been able to wear it if I was allergic enough to reject my part. I suspect there may not be a conclusion as to why the previous part loosened. But it appears my last revision to replace the top component with Titanium has loosened. He feels it is likely due to not have a specific part that is now standard. It is between the stake and the component and absorbs the impact somehow. I need to get more information on this. Sorry so long but hopefully some of this information can help folks!
 

Jockette

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I am so excited that you had such a good experience with Dr. Chow! Best of the best wishes moving forward!

So, he doesn’t think it’s a metal allergy/sensitivity after all? Did I understand that right?
 

Celle

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I'm pleased your visit with Dr Chow went so well. I'm going to tag @Jamie , so she knows her assistance in referring you to him was helpful.
 
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Cjackso21

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Now going in for my 6th revision on my right. New Doctor, new hospital, new city. Let’s hope this one works. Prayers are welcome!
 

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Hoping and hoping some more! I’ve read your thread and learned so much about how to approach a problem. Thank you!

Now, I hope to read that the problem has been solved with ease, but, as with most of us on BoneSmart, I’ll be glad to cheer with you through the good news and sigh with you through the tough times. Here’s hoping the tough times come less and less frequently and your new knee helps you find wholeness.
 

Jockette

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Sending hugs and prayers!
:console2: :prayer:
 

Celle

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Now going in for my 6th revision on my right.
@Cjackso21 - Please will you tell us the date of this sixth revision, so we can add it to your signature?
Best wishes for it. I hope this is the final surgery you need to have.
 
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Cjackso21

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Surgery was Friday 2/7/2020. Thanks to all for your thoughts and prayers! Doc said knee was worse than he had thought, but he was able, after over 4 hours, realign everything and did not need to use a hinged joint. Pain is much less than I thought it would be. I will make sure to let everyone know after my post-op more details. I believe we all can learn an amazing amount from this doctor’s approach but want to make sure I am right with the details before I post them. My hope is that we learn enough from me that others do not have to go through all I have had to. Bonesmart is for sure a good start!
 

Jockette

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Best wishes and prayers for your recovery. :console2:
 

Helizabug

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Great to see you’re on the other side!
 
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Cjackso21

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As most can see, I have way too much experience with TKRs and revisions. I am hoping to find a way to let folks know about how much better this latest revision has been so far. This would hopefully help folks can advocate for themselves for some of the improvements that my Doctor has provided. First of all, one simple improvement is the ice machine that was required by my doctor. So far it has been worth every penny of the $ 200 rental fee and purchase of a pad. It ices and compresses and has amazing pain relief with this. Secondly, there was a type of nerve block done at my pre-op exam. Not sure what was exactly done or how much effect it had but I suspect it has had a lot as my pain is substantially less. Third thing is no PT for 2 weeks. First week is ”couch potato”. I know the pain will come with PT but it is so nice to have the break first. Will post after my post op on Friday. Thanks for everyone’s thoughts and prayers.
 

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