TKR Osteolysis - 6 years after TKR

K8 Orlando

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I had a left total knee replacement in May 2011; I considered the surgery very successful although recovery was slower than I wanted. As I said at the time, I know patience is a virtue, but it's not one of my virtues. I found this forum 4 weeks after the surgery and the help & encouragement & comfort I received were so very valuable. Looks like I will need you all again!

A few months ago (August 2016) I experienced severe left knee pain while on a trip. It was so bad on the plane home that I went immediately from the airport to the ER where they did an ultrasound and xrays. The pain started while sitting in the back of a very cramped car for 5 hours; no fall, no severe twisting, just a few very active days with lots of stairs at the hotel and other sites, then the car ride. And then an excruciating plane trip of another 5 hours.

The same surgeon who did the TKR diagnosed this as an MCL strain or tear and told me the recovery could be months long. He took xrays too. So I tried to be patient. Pain, swelling (huge!!!), severe limitations on my job, etc. Back to the doc every 3 weeks and physical therapy after 6 weeks. It improved and eventually I graduated from walker to cane, but the pain and swelling continued.

So, here I am, about 20 weeks "post injury" and I'm still having big trouble with the knee. I've done everything I could think of to be a good, patient, patient - including the loss of 25 pounds! I sort of had a meltdown in the doctor's office last week insisting there was something else going on besides a ligament strain or tear. He pulled up the xray again to show me how wonderful the implants looked and suddenly stopped dead still. That's when he saw on the xray that I apparently have quite a large area of osteolysis under the tibial implant and the whole thing has shifted slightly. How did he not see this before?!?

I'm going for a bone scan tomorrow to confirm the osteolysis, but it looks pretty certain that's what it is. If it is, he'll have to do a revision - hopefully just the lower (tibial) portion. But right now I'm torn between being devastated to have to go through the recovery again and a little bit of elation that it was finally confirmed there really is something wrong and it's not just my imagination. Is that crazy?

A couple questions:
  • Is recovery quicker if they just redo the tibial implant?
  • How angry should I be that he missed the changes in the bone in the first xrays?
  • If I've had these changes in the bone in just 5½ years since the replacement, how likely is it that this will happen with the new implant?
  • I tried to research options to revisions, but all I found was fusion (never bend the knee again) or amputation (WHA..?!?). Are there other options?
Thanks in advance for reading my long story and for any answers you can give me. I was so glad to come looking for bonesmart and find you still here!
Kate
 
Hello @K8 Orlando
I'm very sorry you've had to come back to us with this new trouble. I'm going to ask @Josephine to advise you.
Meanwhile, if you have a copy of your X-Ray that you can post, it would be very helpful.

Before you go ahead and let your current surgeon revise your knee, I think it would be very wise to seek a second opinion, from a surgeon unconnected with your current surgeon, and one who specialises in revisions. Those surgeons see problem knees every working day and often they can spot something that has eluded the first surgeon, and that can be fixed relatively easily.
Your original surgeon may not be the best person to do the revision. I'd certainly consider that.

It sounds as if, as well as osteolysis, you have loosening of the tibial implant. If so, that's never going to fix itself and you will need a revision.

Take heart, though. A revision is usually no harder to recover from than the original surgery was. I had a revision and I think my recovery from it was slightly easier.
Fusion is not the only option. We have had people on BoneSmart who have had up to three revisions on the same knee and eventually came out of it better off than before.
 
Is recovery quicker if they just redo the tibial implant?
If he can do that then yes, the recovery will be marginally better.
How angry should I be that he missed the changes in the bone in the first xrays?
Personally I'd be quite miffed.
That's when he saw on the xray that I apparently have quite a large area of osteolysis under the tibial implant and the whole thing has shifted slightly. How did he not see this before?!?
Because he wasn't looking for it! He broke rule #1 which was 'always look for the unexpected'!
If I've had these changes in the bone in just 5½ years since the replacement, how likely is it that this will happen with the new implant?
Well whoever does your revision (and I'd tend to suggest it not be him!) IF he finds a soft/weakened area of bone he will pack it with bone graft so it grows back nice and hard.
I tried to research options to revisions, but all I found was fusion (never bend the knee again) or amputation (WHA..?!?). Are there other options?
None, I'm afraid. And osteolysis is certainly no good reason for doing either of those things.

The other thing is that osteolysis is really just a medical term for when loosening occurs. I have a feeling that perhaps he used that term to make it sound more mysterious and maybe even an issue that he couldn't have been culpable.

loosening-osteolysis.JPG
 

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