TKR Loosening of implant.

Interesting. It seems to be getting worse, that’s all I know. Would this even show up on a CT scan? I’ll mention this Hoffa’s syndrome to my doctor when I see him again, which I hope is soon.
 
Moderator, could you please change my post title from “Nerve pain during recovery” to “Loosening of implant.”

I had a CAT scan on my knee, on Monday. I’m in a fair amount of pain.

Extremely bad news:
My knee replacement has loosened. I knew something was terribly wrong because of the pain. I’m going to need a revision I’m sure. Here’s what the CAT scan stated:

Approximately 2 cm lucency lateral patellar prosthetic component, likely reflective of early loosening. Small knee joint effusion.

I know exactly when my implant loosened: January 28th — the night I woke up with such horrific pain I thought I would pass out. I knew all along that it couldn’t have been nerve pain, like my initial diagnosis. My knee has gotten slightly worse day by day.

I don’t know if I can live through a revision. Is it just like the original surgery? Just as painful? Is a revision the only option for a loose implant? How could my implant have loosened so early in my recovery??!!

I see my doctor on July 2nd. If I need surgery (duh) I need to have it ASAP. My first official day back at work is July 31st.

We’ll see what my doctor will do. I’m most morose.
 
I am so sorry this has happened. :console2:
I’ll tag @Josephine to comment.

I honestly feel I have a loose implant, also, but my pain is tolerable, maybe because I had a Patellofemoral partial, and it’s location. My X-ray doesn’t show loosening and because of that, 3 different surgeons don’t see any reason to order a bone scan, or any other test. So I’m just waiting it out and managing.

Big hugs to you! :console2:
 
@bookread, I was in the same situation and almost 2 years after my original LTKR I had a revision. You need to find out why it came loose (if you can). I felt exactly the same way!!! I made it thru the revision and I am doing well. Thinking of you.
 
Thank you for your encouragement. I’m just dreading the thought of another surgery. We will see what happens when I see my orthopedic doctor on July 2nd.
 
I don’t know if I can live through a revision. Is it just like the original surgery? Just as painful?
Pretty much it will be like the original surgery but since there will be no need for any bone cutting, it shouldn't be as painful overall. But it seems that both you and I will find out eventually - I am facing the same.
Is a revision the only option for a loose implant?
I'm afraid so.
How could my implant have loosened so early in my recovery?
Actually nobody knows exactly why but usually it's because the bone has died back. I assume you had a cemented knee? In which case, the bone cement may not have been embedded well into the bone from the start. Then some micro-movement will have occurred and as it went on, so the die back will become more and more. It's not usually a sudden thing, more it happens slowly over a period of weeks or even months. I suggest you read this to understand more about the cement/bone interface Cemented and uncemented hips. I know this is nominally about hips but the overall topic is just about cemented implants.

But you must bear in mind that this is not your fault, it's not anything you did. It's just happenstance and misfortune. We'll have to keep tabs on each other and cheer each other along!

Do you have a date for your revision yet? I was diagnosed in November last year, though I knew myself in August!, and was told then that I'd have to wait til Oct/Nov this year! So I'm hoping that's now whittled down to only another 5-6 months to wait.
 
@bookread and @Josephine:
Yes, there were many reasons my implant was loose:
1. Mine was cementless
2. I have osteopenia
3. I tested positive for cobalt and nickel allergies
4. My OS did not properly align my implants/the cuts were wrong.
My OS was highly rated but I was only the 2nd pt. he had done a cementless knee replacement out of 5,000 cemented TKR. That should have been a red flag which I did not heed.

Make sure to have a OS that specializes in mostly REVISIONS!!! DO NOT use the same OS!!! That is the most important thing!!!

My recovery was so much better that the original TKR because I did not go to PT! I followed the BoneSmart way and did mostly ADL, along with very little PT on my own: some heel slides, leg lifts, etc. It made everything so much more tolerable! Ice, elevate and take those pain pills!

I will be 9 months post revision this July 3 and I do Pilates once a week. I am doing GREAT! My bend is 125.

So sorry you both have to have revisions but I am very happy with mine so far.
 
Wow. Thanks for telling me it’s not my fault. I’m soooo relieved to hear a revision may not be as painful. I had HORRIBLE pain the first three weeks of my TKR. I woke up from surgery in horrible pain and it continued for quite some time. I go see my OS on July 2nd. We’ll see what happens. I guess I have to find a revision specialist. If the surgery is delayed a while, will my knee get worse and worse until something breaks? It’s very painful now as is. I’m a bit scared about all this. The worst thing is ... I go back to work on July 30th (Kindergarten teacher).
 
If the surgery is delayed a while, will my knee get worse and worse until something breaks?
Well it's not very likely that anything will break but it's very likely to get worse and worse. I can tell mine is deteriorating already.Such fun, eh?
The worst thing is ... I go back to work on July 30th (Kindergarten teacher).
Well I strongly advise you not to. It's like your knee will get worse and being at work would make it worse as well. Discuss this with your surgeon or GP, whoever you think will be appropriate.
 
I met with my orthopedic doctor yesterday. He states that he looked at the CT scans himself and does not believe my implant is loosening. He mentioned a possible “cyst” under my knee cap. He’s at a loss of what is going on so he’s referring me to another doctor. I suggested that I need at least arthoscopic surgery so he can take a look. I know something is wrong because the pain is getting worse. We’ll see what this new doctor will do. I’m just so frustrated, and in pain. Have you ever heard about a “cyst” under the knee cap? It’s NOT a Baker’s cyst on back of the knee—it’s under the knee cap and is preventing me from bending my knee more than 90 degrees. I can bend it more, of course, if I use my hands to support the weight of my leg, but when I try to extend the knee, without using my hands for support, the pain is too great.
 
A second opinion is good, maybe even a third. If it was me I’d get an opinion from a surgeon who is not in any way associated with my original surgeon so the opinion is unbiased.

I’m sorry you’re going through all this. :console2:

I’ve had 2 second opinions for my poor outcome, both surgeons who don’t know my original, and no one will look past my X-ray which doesn’t show any problem. But there is indeed a problem with mine, it has never felt right. Thankfully I’m not in a huge amount of pain, but at times I am in a lot of discomfort. It’s very frustrating.
 
I suggested that I need at least arthroscopy so he can take a look.
Loose implants cannot be diagnosed via arthroscopy.
Have you ever heard about a “cyst” under the knee cap?
He might be referring to a bursa. There are many in and around the knee as you can see here

knee bursae.JPG


is preventing me from bending my knee more than 90 degrees.
And they will do this.

Bursa can be inflamed and thus enlarged because of over activity which makes it painful and swollen. The principle treatment is the usual pain killers, ice and rest.
 
Interesting. Would a cortisone shot ease the pain? Even if it is a bursa, it still doesn’t explain the burning pain on the lateral (left outside) of my knee that has been there since January.
I see a different doctor on July 17th. He works in the same office as my OS, but I’ll give him a try. If nothing is done, then I’m going to a totally different doctor outside the office I’m currently using.
 
Even if it is a bursa, it still doesn’t explain the burning pain on the lateral (left outside) of my knee that has been there since January.
Yes it would. If the bursa is inflamed, the inflammation will spread over quite a wide area of the knee.
Would a cortisone shot ease the pain?
It might and it might not. I'm afraid this kind of treatment is not an exact science.
 
Bookread, so sorry you are in prolonged pain. I ended up seeing 4 OS's before deciding on the Dr who did my TKR 2 weeks ago. The first 2 doctors were in the same group and they were saying PKR instead of a total. I came here and posted my confusion about PKR and TKR and was advised to seek out another independent opinion (last thing I wanted to hear but I went ahead out of their group for a consult and ended up with a TKR).

You may also do best to go outside a Dr's group for an opinion that is independent. I think that Drs who work together are not likely to contradict each other's opinions. Best to you!
 
Good news and bad news

Good news first—Hallelujah! After seven months of horrific knee pain I finally found out what is wrong with my knee! I just came back from seeing a new orthopedic doctor (same office as my original OS). I have one thing to say: IT PAYS TO GET A SECOND OPINION!!! This new doctor did a thorough physical examination on my knee, moving it this way and that way, looked at the results of the CT scan, and within five minutes (not kidding), he knew exactly what was wrong. Yay! That’s the good news—finally someone figuring out the cause of my pain!

Bad news: I have to have knee surgery, again. Yep, the doc has to open up my knee to fix the problem.

What exactly is wrong you might ask? Well, my surgery will be a knee revision with upsizing polyethylene component, with revision of the patellar component and lateral retinacular release. Basically that means the plastic button underneath my knee cap that was placed during my replacement in December has loosened and will be taken out and the bottom of my knee cap will be cut smooth, and a slightly bigger plastic button will be stuck on. And something else will be cut. I do not know what a “lateral retinacular release” means. Does anyone know?

The doc said my replacement is wobbly and it shouldn't be doing that. The good news is that he won't have to do anything with the femoral component or the tibial component or take any of the cement out! It’s mainly my knee cap area. AND it won't be as painful as the original surgery. Thank God because I almost “died” of pain with my replacement surgery in December.

I want the surgery scheduled right before Fall Break (teachers in our district have one week of vacation in October). That way I only miss two weeks of work, which is all I can afford. The doc said I can walk on it right away but going back to work after two weeks is pushing it. So with fall break, I’ll have three full weeks of recovery.

Anyway, I’ll let you know when my surgery takes place. This will be my FIFTH knee surgery, on the same knee (first surgery was in 1998).
 
That all sounds very positive Bookread. It makes you wonder how the other surgeon missed it. Good luck with your next surgery. I wish you a smooth and uncomplicated operation and recovery.
 
@bookread, do you have a xray picture of the kneecap with the loosen patella button that you can post? I am interested to see what one looks like.
 
@bookread Have you had that revision surgery yet? After a knee ultrasound recently, I was diagnosed with “pre-patellar bursitis,” a bursa under my kneecap and effusion or swelling. Apparently, my kneecap (patella) does not track properly.

This all adds up to pain from the time I get up in the morning until I go to bed at night. This has been going on since I had my left TKR, more than 2½ years ago. I have been back to my OS several times. She always says my xrays (and her handiwork!) look fine, and she “won’t open up that knee again.” She added, “I’m sure your pain is real,” but has offered no information about what could be causing it. She just says, “about 5% of TKR patients will always have pain” and advises continued physiotherapy ($$$$), exercise (ouch!!!!), extra-strength Tylenol and Voltaren, none of which work much.

My GP referred me to another surgeon for a second opinion, but his office hasn’t contacted me. I now have an appointment with a physiatrist to see if anything can be done to alleviate my chronic pain. Has anyone else reading this seen a physiatrist?
 

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