Revision TKR Partial Revision Failure

[Cementless]

Do you have benefits from having a TKR and revision? What, if anything, is better than before you had the surgery?

Yes and no. My kneecap feels like the original failed TKR in that it feels like it is loose. My femur and tibia seem fine. Not a lot of pain. I have no limp or issues standing for long periods of time. What worries me is that every time I am on uneven ground (ex: walking the dog on a slope or stepping off a curb) my knee feels like it could break into.

 

[Jockette]

I know it’s such a hard decision, to stay with what you have, or move forward and try a fix. Been there, done that. You know my situation, I have more limitations now than before my surgery, but I don’t have enough trust for me to try a fix, not that anyone has offered me one. I’m also “good enough” that I’m not even interested in any more opinions at this time.

My biggest concern is what is my kneecap going to be like in two years? My precious husband has Parkinson's and is the one I rely on to drive me and take care of me after I have surgery. He has had Parkinson's since Sept. 2019 and each year he requires more meds. I don't know what he will be like in a couple of years (or me as far as that goes).

I also had a husband with a Parkinson’s type disease, so I know exactly what your concerns are there, both with and without a new surgery.

 

[Cementless]

I just read this: (I think I am talking myself out of this surgery!)

Wearing a hinged knee brace, cast, or splint:​

You may need to wear a hinged knee brace, cast, or splint after your surgery. These devices normally cover your leg from your upper thigh to your ankle. Your knee brace, cast, or splint helps support and protect your knee. Ask your caregiver for directions about using and caring for your knee brace, cast, or splint.

• Hinged knee brace: The hinged knee brace can be locked in certain positions. Right after surgery, your brace will be locked in a straight position. Over time, your caregiver will adjust your brace to allow more movement.
• Cast: You may need a cast after surgery. When the cast is removed, caregivers may teach you special exercises to help strengthen your leg.
• Splint: You may need a splint after surgery. This splint may be made of plaster and helps keep your leg straight.

 

[Jockette]

Personally, I don’t think I could ever tolerate a bulky hinged knee brace, unless my doctor gave me solid reasons why I needed one.

It might be a good idea to get some sort of a knee brace, or sleeve, designed to support the patella, and see if it helps. Get one from a local store, or Amazon, so you can return it if you don’t like it. There are lots out there, so you might have to try some different ones. (I did this when I had plantar fasciitis a few years ago, I kept the 4th option I tried.) (The one the foot doctor “gave” me was the worst of them all, and it was really hard to get them to take it back!)

 

[Cementless]

It might be a good idea to get some sort of a knee brace, or sleeve, designed to support the patella, and see if it helps.

I have a great one that I wear 50 % of the time. It really helps stabilize my knee. I wear it especially when I go to the grocery store or need to be out and about for long periods of time. I wear it on airplane flights.

 

[Cementless]

My knee brace.

 

[Jamie]

@Cementless.....where did you get that quote? It's not typical advice and I'd be curious as to who is putting that information out there. Braces do have a place at times, but they can be detrimental if worn for long periods of time. Muscles can atrophy and your knee can become dependent upon them. You don't want to brace a knee after surgery unless your surgeon advises it for some particular reason.

 

[Cementless]

.where did you get that quote? It's not typical advice and I'd be curious as to who is putting that information out there.

Patellar Fracture Repair (Aftercare Instructions)​

https://www.drugs.com/cg/patellar-fracture-repair...

Mar 02, 2022 · You may need to wear a hinged knee brace, cast, or splint after your surgery. These devices normally cover your leg from your upper thigh to …

• Estimated Reading Time: 6 mins

@Jamie, I was just looking for any information after Patella surgery.

 

[Jamie]

Thank you so much. Now the information makes more sense to me. Drugs.com is a good resource.

 

[Jockette]

@Jamie I agree, seeing that quote in its context, of using such a brace after surgery on a patella. When I first read cementless’s post, I thought she wanted to use a big brace now, as a precautionary.

 

[Flashlight]

Maybe you could research orthopedic doctors in your area that might specialize in this type of surgery. I'm not sure if you mentioned that you received a second opinion. It seems like your doctor has done your previous surgeries and you aren't sure if he should do this one. Good luck to you. Your husband is newly diagnosed. Praying he will be in good health for some years to come.

 

[Cementless]

@Jockette, I do wear a soft knee brace 50 % of the time when my knee feels unstable.
I hope if I decide to have kneecap revision surgery that I don't have to wear one of those big restrictive braces!

 

[Cementless]

Answers my orthopedic surgeon gave me yesterday over the phone:

Question: Could you elaborate on what kneecap revision surgery would do to my Left Knee besides "essentially obliterate my kneecap. You said, my x-rays show "significant osteolysis".

Answer: He said, he would not remove the kneecap. He would (attempt) to put a cemented patella button in but the ONLY reason to have this surgery would be if I am A LOT of pain. (which I am not). Also, an MRI would not show osteolysis because of the artifact. He is going by my symptoms. He also said, a cemented patella button would not improve the stability of my kneecap. No need to consider kneecap surgery at this time. He recommended coming in every 6 months to get an x-ray for comparison. I agreed.

Question: Would this surgery effect the femur and the tibia components? Is there a way to stabilize my kneecap without obliterating my kneecap?

Answer: Not really away to stabilize the kneecap except to try and exercise as much as my knee would tolerate. My comment: I am concerned the longer I wait to have kneecap surgery, the worse off everything will be. Answer: It is OK to wait. My kneecap will not break into. My comment: You also said, I may be worse off having this surgery. Answer: He said he has only replaced 2 press-fit patella buttons and he regrets doing one of them. You cannot tell if it is loose until you get into the kneecap. My comment: Sometimes, my knee just feels like it will give away. I am 75 yrs. old this month and really don't know what to do. I can tolerate my knee for now, but I feel like it is a "time bomb" ready to go off. Answer: He reassured me my kneecap should be OK as long as I am not in a lot of pain.; the kneecap will be MORE unstable even with a revision. It may get better on its own.

Should I ask him how many Patella Press-fit kneecap revision surgeries has he done? I know he has done A LOT of knee revisions, 100s. 2 press-fit replacements with a cemented patella buttons...regrets one of them.

My biggest concern is what is my kneecap going to be like in two years? My precious husband has Parkinson's and is the one I rely on to drive me and take care of me after I have surgery. He said if my husband is unable to take care of me, I can always go to rehab for awhile....I told him I would not like that.

 

[Jockette]

It sounds like he really listened to your concerns and gave you good answers.

If it was me, I’d be very hesitant to do a surgery that he has little confidence in.

I don't know how to help you with your concerns for the future. Sometimes the things we worry about don’t come to pass, but the worry robs us of today. (I’m telling myself this, too, as I type it!) However, I don’t have an unstable knee. I do understand that is a concern.

 

[Cementless]

@Jockette, my orthpedic surgeon really did listen to me. He gave me hope that my knee should not break into with osteolysis. I am no longer looking into having kneecap revision surgery, since it would not improve my knee stability. What little pain/discomfort I have is very manageable.

Sometimes the things we worry about don’t come to pass, but the worry robs us of today. So very true!

He said, "is it OK with you, sweetie if we follow your knee every six months with x-rays to compare?"
He did put my mind at ease and was very honest in his answers, not defensive or condescending.

Besides, I don't have the time in my life to handle these types of surgeries anymore. I function very well, so why rock the boat and make setbacks with the time I have left. I plan to be around for another good 10 years, and I want them to be quality years.

 

[Cementless]

Feeling a little down these days. My leg seems a little worse. Sometimes it doesn't seem very strong when I walk on it. Disappointed in this revision. I find it so hard to believe nothing can be done to make my leg stronger. It effects my left hip (trochanter bursitis). I am limping occasionally. Also, at times I have shin splints in that leg. I rode my stationary bike for 31 minutes a couple of days ago and my hip and knee were killing me afterwards, esp. the next moring! I had to take a Celebrex and ice both the hip and knee. Just don't know what to do or how to proceed.

 

[Jockette]

I wish we had a solution for you. It seems some of us just have elusive issues.

 

[skigirl]

I think you should ride the bike for 5 min for one week, then 10 min for the second week. Walk around the gym and do the treadmill at low pressure for 5 min, then 10 min. Take your time, be comfortable with one before you add the second one.

It is a mistake to jump into 30 min---you have to work up to that amount of time and give your muscles a chance to develop. overworking, causes you to think Oh no I cannot do this!!!

try to walk for a half mile a day after two weeks, try for one mile a day. I have a dog so it is easy to have someone to talk with!!! Surely you have a friend who needs help with a dog! Take life easier and work up to exercising.

I found one Step to be a good solution, they give you a 10 minute exercise program. I did it once a day for a month and then moved to twice a day. It was easy and I did not have to go to a gym. 'don't despair, those muscles are just waiting to build themselves up but you have to do it slowly.

 

[Cementless]

@skigirl, thank you for the wonderful caring advice. I have been doing my leg lifts pretty regularly. Also, some trochanter bursitis exercises, plus using a tens machine. On Fridays, I do a great zoom exercise program with my husband for an hour. It is hard for me when we do the leg squats. We live on 15 acres, and I have to be very careful walking my dog because it is on uneven ground. My tibia (lower leg) feels like it could break into. I am very unstable walking. I do have a treadmill but never use it. Feel discouraged.
I sit quite a bit at the computer, and I am sure that does not help my trochanter bursitis.

 

[Cementless]

Update: I have an appointment with my ortho surgeon on Dec. 1. I decided something must be done because of my limping and pain in the L. hip, knee and tibia. It is getting to where I hate to walk about. My quality of life is going downhill.