Revision TKR Need advice for 6th revision

[Cjackso21]

I am hoping to make others aware of 2 reasons I have had 4 revisions since my first TKR in 2012. My first TKR was cementless (press fit) due to my age and that the cement fails first. The entire knee was replaced 1.5 years after this as the components did not “stick”. This right knee was my 2nd TKR, left was successful. After 2 revisions for knee cap issues I still had problems with the right.

I finally paid $600 for a blood allergy test. Results showed I was highly allergic to nickel. The top stainless steel component contains up to 35% nickel.

After waiting 18 months for a custom titanium replacement, I had the revision a year ago. My body completely loosened the component. I just had arthroscopic surgery to remove scar tissue. Let’s pray that’s the last surgery.

So, do not use cementless TKR AND find out if you have a nickel allergy. Reactions to cheap jewelry is currently the only screening done pre-operatively.

 

[Celle]

Hello @Cjackso21 - and

Please will you tell us the dates of all your knee surgeries, and which knee, so we can make a signature for you? Thank you.

I'm sorry you've had so many problems with your knees and I hope they are all resolved now.

I agree that it's a good idea to be tested for metal allergies, especially if you have some reaction to jewelry, but unfortunately the only reliable test is still expensive and most insurance companies don't cover it.

Did the same surgeon do all your knee surgeries, or did you search for a surgeon who specializes in problem knees? It's often a good idea to seek a second opinion if the first replacement fails.

 

[sistersinhim]

Welcome to Bonesmart. We have had quite a few that had metal allergies found after the tkr and had to have a revision. I believe a metal allergy test should be part of the pre-op exams.

 

[lovetocookandsew]

Welcome. I'm having a revision in a little less than 2 weeks due to all the problems I've had since the TKR, most likely due to a nickel allergy. My insurance did cover the testing, and it came out reactive to nickel. I agree-if you have a problem with jewelry TELL YOUR SURGEON and get tested before the surgery. I never thought about it and it's not a usual screening question on any form, so it was missed. Hopefully they will, or already do, ask patients about metal allergies as a matter of course. Good luck and hope it all takes now so you can avoid any more surgeries.

 

[jo4121]

My revision was also a cementless original LTKR...almost a year ago. The OS said I was young in Knee replacement years (58), and this is his standard procedure. However, it never felt good. Always swayed from side to side and front to back. I never trusted going up or down stairs. So, finally, I had enough and he suggested a revision. He has had 3 revisions so far out of 90 replacements with similar demographics and cementless original TKR ... he is rethinking the whole cementless approach. I had surgery in a major teaching hospital in the Midwest, and now this is part of his next study. I'm just glad to 'er done, and move on with my life. I am a teacher, so the summer is my rehab time until August 23rd. Good luck with your surgery & recovery. I will be greatly interested in your outcome!

 

[Cjackso21]

Ok the list of surgeries is long:
1987-Left knee ACL repair, Andrews procedure. Did not work, ACL was not torn
1990?-Right ACL repair to partial tear, tore it after surgery anyway.
1995-2x Left knee arthroplasty ?
2003-Right knee ACL replacement.
2008-Left knee Cement less TKR (at 45)
2010-2 x Right knee scopes.
2012-Right knee Cement less TKR
2014-Finally at TKR specialist- right knee revision to cemented due to loosening
2015-Right and left knee revisions to remove prosthetic knee caps. Left from bone damage, right did not stick
2016-New TKR specialist (1st moved). Right knee revision to add tantalum insert and rebuilt kneecap
2016-Still issues so finally did $600 not covered allergy test. Allergic to Nickel.
4/2017- revision to replace upper component with titanium. Custom part to match bottom component took 8 mos. to get.
6/7/18- Scope to I think remove scar tissue but have not talked to doc. yet. CPM machine for 6 hours a day. Just found out it’s not covered by insurance!?

 

[Cjackso21]

I went back to my original OS for a different issue last year. He was the one who finally agreed to sent me to the TKR “super” specialist. He was glad I was not there for my knee and when I told him all of the surgeries and that his original cementless TKR did not stick and asked if anyone else has had that problem him said “oh, I don’t do cementless any more. They don’t work” !

I have a cementless TKR on my left that did work and does have Nickel that I’m allergic to BUT my specialist is convinced the bone and tissue have encapsulated it so it’s not reacting. I have no prosthetic knee cap as it failed some time ago and they removed the cementless one it without replacing it. I have pain from that but it is tolerable. He wouldn’t go back in because he is afraid it will expose the Nickel and cause it to react.

Does anyone know if there are any other options for my left knee cap? I imagine once my right is finally working my left will be my next problem.

 

[SusieShoes]

Do you have kneecaps at all? If only the buttons were removed, was the remaining bone left in place?

@sistersinhim has had her kneecaps removed. Maybe she can offer some insights about patella options.

 

[sistersinhim]

It is true that I have had both kneecaps removed. I will help you anyway I can. I was told years ago that I'd never be painfree, even with a tkr because of all the previous surgeries that I have had. That is also true. But, I am better and can do things now that I was unable to do for over 20 years!

I will try and answer any questions you have.

 

[Cjackso21]

I have a rebuilt kneecap on the right knee that uses a tantalum insert “sewn” between my kneecap and cemented to the prosthetic.
But my left had the cement-less prosthetic removed but I still have my original kneecap with nothing to replace the prosthetic.

 

[Cjackso21]

Hello, I wanted to let you know that my knee replacement top component loosened also (which was after many other revisions) and we did a blood test for allergies. $600 not covered by insurance which is why it took so long for me to do. It came back that I was highly allergic to nickel! My body rejected the top component which has nickel (in the stainless steel). It was completely loose by the time I had my surgery which took 6 months to have while waiting to for the custom titanium part.

 

[Pumpkin]

@Cjackso21,
Posting the link to "Tight band" feeling across the front of my knee , noticed you comment about this link in another thread. This way if you want to find the article again you can find it easily in your own thread.
You might want to take a look at the library index for more helpful articles you may have missed.
Here is a link:
https://bonesmart.org/forum/threads/library-index.14830/#

 

[Josephine]

My first TKR was cementless (press fit) due to my age and that the cement fails first. The entire knee was replaced 1.5 years after this as the components did not “stick”. He wouldn’t go back in because he is afraid it will expose the Nickel and cause it to react.

I don't know of any knee surgeon in the UK who uses cementless knees for the simple reason that there is not enough implant inside the bone to provide a good bond between bone and implant. That's why they fail. I would venture to suggest that that was the primary reason why it came loose and the rest was co-incidental.

 

[Cjackso21]

Hello,
It seems I have suddenly had severe pain when trying to walk. The first steps are agonizing, with some pain in my knee but most radiating up what I believe is a anterior tendon? It started yesterday with the same pain but on the posterior side. I have had many revisions on my right knee after my TKR in 2012 with the last over 2 years ago due to a Nickel allergy that caused my body to reject the top component. Since this I have had problems with stability and some pain with first steps and always swollen. A scope last yea and a recent MARS MRI did not show any cause but showed signs of inflammation and fluid. I have just started a new job that requires walking long distances to just get to my desk. I relocated to Chandler AZ so I don’t have an OS yet. Does anyone know any OS TKR specialists in this area? Any idea what might be causing this severe pain? There was no event, just a 5 hour drive to San Diego to finish cleaning up our old house. Thanks! Appreciate any feedback. I also had a Toradol shot 3 weeks ago to try to help with the swelling and pain. It seems like I felt better last week but then this.

 

[alexthecat]

@Cjackso21 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.

 

[Pumpkin]

Sorry to hear you have continuing challenges with your TKR's. You may want to use our surgeon locator at the top of the page to assist finding a surgeon.

 

[Cjackso21]

After many revisions for knee cap problems after RTKR, I was told that the blood test to determine allergies showed highly allergic to Nickel so I had my top component replaced in 4/2017. Since this have had issues that my San Diego doctor could not figure out. We then recently moved to Chandler AZ and I continued to get worse so I found another doctor that my new PCP recommended as a good “re-do” doctor as he claimed. I went to him and had testing done that showed the top component is loosening again and we are waiting for results of testing of an aspiration for infection done last week. My knee is also very unstable (bends sideways etc.). This doctor (Dr. Siram Ahmed of Scottsdale) recommended that he replace the entire knee with a special knee that helps stability but this part only comes with Nickel (I assume it’s stainless steel). My left knee has stainless steel and is fine but my San Diego doctor thinks scarred prevented it from reacting. I have no idea if this new doctor in Scottsdale knows what he’s doing, although he reassured me that he has done many complicated revisions. We scheduled surgery for 10/15. All of the other 2nd opinion doctors that were very booked and cannot get in. I found one that was not but don’t believe he’s done complicated surgeries like this. My knee is getting worse each day so I don’t want to wait but I don’t know how to determine if I should trust this doctor. I see him on Wednesday this week. I would like folks opinions on what I should do? Please...

 

[lovetocookandsew]

Personally, having an allergy to nickel myself, I'd never allow anyone to put an implant with nickel in my knee. Otherwise, it's a good probability that your knee won't accept it and will have issues again. There's a doctor in Texas, Dr. Gerhard Maale, who comes highly recommended by many on this site. If possible, I would try to get in touch with him, or his staff, and see what he says. Other than that, I'd not be too quick to go along with his suggestion of a new implant containing nickel.

 

[Jockette]

Oh my, I’m sorry you have been through so much. I don’t know what to tell you, but I don’t think I would agree to let them put a nickel implant in, after being told I was highly allergic to it. How can that possibly help?

I’m sure you are in a lot of discomfort but I think I’d still try to get some other opinions before making a decision on what seems like a possibly iffy surgery. Recovery is tough enough under the best of circumstances.

I agree that the surgeon who doesn’t have a lot of experience with complicated surgeries is most likely not a good fit for you.

Sending hugs and prayers as you make these difficult decisions.

 

[Jamie]

@Cjackso21 ... you'll notice that I have merged your latest thread with your recovery thread. It is important for us to keep all your recovery information in one place so that we don't have to go searching back through multiple threads when we need to provide advice for you. I left your new title so that it would clearly state what your current concern is.

What is the name of the implant that Dr. Ahmed proposes to use with this revision? Since you've tested positive for nickel allergy, it would not seem wise to replace any components in that knee with a nickel product.

I have checked Dr. Sarim Ahmed in Phoenix (address: 18444 N 25TH AVE, STE 210, PHOENIX, ARIZONA 85023) on the Pro Publica site. Is this the surgeon you're seeing and you just had his name spelled incorrectly? If this is the surgeon, it doesn't appear that he is an experienced revision specialist and he performed fewer than 20 knee replacements under Medicare during their reporting period. He may not be the best doctor for your situation. Since you're seeing him this coming Wednesday, ask him the name of the implant he plans to use and exactly how many cases he's dealt with where there is a problem with a metal allergy. "Many complicated revisions" doesn't tell you much. If he hems and haws, you have your answer.....he's not the right doctor for you.

There is an implant that can work for people who have metal allergies and you may want to call around and see if there is a surgeon in the Phoenix area who uses it so you could get a consultation. It is Aesculap's Gold Knee. You can read more about it here.

In looking at the Aesculap surgeon listing provided by the company on this link, the closest surgeons to Phoenix are in Nevada. So it may be that you'll have to drive to meet with someone to discuss this option. I looked at Dr. Tait (Henderson, NV) and Dr. Andrew Scott Martin (Las Vegas, NV). Meeting with both would be a good idea. Dr. Tait had a fairly high complication rate on Pro Publica, but he also had a higher volume which is good. The higher complication rate can be a factor that a good revision specialist sees a lot of difficult cases and that can result in an increase of post-op problems. So it's worth discussing this with him. There was another surgeon listed in Long Beach, California, Dr. Serena Young, but knee revisions did not seem to be her specialty.

Another option would be Smith and Nephew's Oxinum knee. You may have more luck finding a local surgeon who is experienced with this implant. These are surgeons that I know of in the Phoenix area:

Phoenix, Arizona

Dr. Mark Spangehl, Mayo Clinic

Dr. Christopher Beauchamp, Mayo Clinic

Dr. Eral Feng

Dr. Mark Davis

Dr. Amber Randall

I've also asked our CEO if he knows of any appropriate surgeons for you in the Phoenix area. He recommended I contact one of the surgeons who is in Phoenix that we work with. So I've done that and will let you know when I hear back from him.

Please don't rush into this revision. You've had problems with loosening not caused by infection. You've tested positive for a nickel allergy. If you're going to need another revision, you want to do everything possible to make it a success. You need an implant that will provide the least exposure to nickel AND the services of a very skilled revision surgeon.

If you want to discuss this further with me, please make sure to tag me in your post so that I see your questions or conversation quickly. To tag me, you type the "at" sign (@) followed by my name with no space...like this: @Jamie .