Revision TKR Partial Revision Failure

[sistersinhim]

Hopefully, you can get some answers this week.

 

[Pumpkin]

your surgeon is able to give you some answers on the first.

 

[Cementless]

Update: Dec. 1st, 2022, with my ortho surgeon was not good. Very disappointed. I was his first pt. in the afternoon after he had been doing surgery since 6 am. He looked tired and stressed.
Again, he said, taking out my patella button would not correct my walking, if anything it would make it worse! He would have to shave off too much of the existing patella. My issues I am having are because I had a revision.
The pain I feel at times in my femur and tibia are because of the long rods (the tip). Sound familiar, @lovetocookandsew? He did say my patella button shows (some loosening?), about 81 % translucency and about 17 1/2 % attached to the patella which is enough to keep it from being completely lose. He said he has "regrets from removing a press fit patella button before and really does not want to attempt removing my patella button." I ask him if he could consult a fellow orthopod for more feedback as to what to do. He said, "there is not enough time in the day for him to do that"! He then started complaining about Medicare not paying enough. He said, I was free to go get another opinion on my own. He did give me a cortisone shot in my left hip for my very painful trochanter bursitis. I really felt he wanted to wash his hands of my whole situation.
He did order a triple phase bone scan to see if anymore light could be shed on my patella button situation.

My husband and I left there feeling like nothing was accomplished. We felt like I was on our own as to what I need to do. I do plan to make an appointment with my podiatrist to have new orthotics made to see if that will correct my limp.

He did suggest more exercising to strengthen my quads, like leg presses and to lose some weight.

 

[Pumpkin]

Sorry you got such a poor response from your surgeon, frustrating I am sure.

He did give me a cortisone shot in my left hip for my very painful trochanter bursitis.

A lot of times it is not bursitis but tendinopathy around the greater trochanter. You may want to find a PT who can treat tendinopathy, you will have to ask specifically about their advanced training.
Hope in the meantime the injection gives you some relief.

Good plan to see about new orthotics, they should help with some of the discomfort you are having.

 

[Jockette]

I am so sorry you had such a disappointing appointment. I would not want to be doing any leg presses with your patella situation, and my guess, any quad strengthening would also irritate the painful patella.

And it was rather unprofessional of him to complain about Medicare payments when you are there for a continuing problem.

I wonder if you could get a video appointment with HSS in New York city, just to get their opinion? I doubt you’d want to travel there to actually see them, since you are in Texas.

 

[earth2lise]

I feel your pain, so to speak! I am only 14 months out from my RTKR and was told by the second opinion ortho surgeon that my prosthetic is loose. I believe you have a similar prosthetic that would require part of my tibia to be cut in order to get the current prosthestic out which is a much more involved and complicated revision surgery. I am much worse off than before my RKTR and am a long distance hiker and athlete, so I am also depressed and frustrated.

And like Jockette, I am so distrusting now and am not anxious to look for a revisionist, but definitely need to as I can't live like this.

 

[Cementless]

Well, well, well:

Study Result

Narrative

PROCEDURE: NM BONE SCAN 3 PHASE CLINICAL HISTORY: Z47.1 Aftercare following joint replacement surgery, Z47.1 COMPARISON: None; TECHNIQUE: 25 millicuries of technetium-99m-MDP were administered IV, followed by blood flow and blood pool imaging of the knees. 3-5 hours later, delayed imaging was performed. FINDINGS: Blood flow and blood pool images demonstrate slightly increased activity in the proximal shaft of the left tibia, a nonspecific sign of hyperemia. Delayed imaging demonstrates moderately increased uptake focally at the inferior tip of the tibial component of the left knee prosthesis. Mildly increased uptake is present in the left proximal tibial metaphysis. Uptake in the left patella and left femoral condyles is in the upper range of normal. Minimal degenerative uptake in the right knee. IMPRESSION: Findings are suggestive of loosening of the tibial component of the left knee prosthesis. Although there is some associated hyperemia, infection is unlikely.

 

[Pumpkin]

Sorry to hear there may be loosening. It will be interesting to hear what your surgeon says.
He was probably grousing about Medicare because there is a 4+% payment cut next year.

 

[Jockette]

I’m so sorry your implant may be loose.

 

[lovetocookandsew]

I'm sorry you're still having problems.

 

[Cementless]

Question to all the BoneSmart experts: How would they revise a revision of the left inferior tip of the tibial component of the left knee prosthesis and the left proximal tibial metaphysis? The prosthesis is already so long!
Also, when they do another revision, do they remove the existing scar tissue that has built up?

Where is Josephine when you need her?

 

[Pumpkin]

That is a good question, wish I could help.
It will be interesting to hear what your surgeon has to say.

 

[Cementless]

Here is my latest x-ray done at the ortho surgeon's office on Dec. 1, 2022.

I gained 25 lbs since my last revision Oct. 6, 2018. I have lost 8 lbs since Dec. 1st. I am trying to get in shape.
I can't believe that stupid x-ray tech didn't ask for me to take the knee brace off before he took the x-ray!!!

 

[Cementless]

Here is a picture of my patella button. The nuclear bone scan said it was normal. My ortho said osteolysis 81%, but 17-19% attached/secured where bone is attached.

 

[Cementless]

No answers yet! The staff said they would show him the NM bone scan report yesterday! It is so frustrating thinking I am at the mercy of when the staff chooses to show the ortho my bone scan!!!
Question: When I had that hard fall on July 20, 2021 (landing on my revision knee), could that cause the loosening of the tibial component of the left knee prosthesis? Could I have had a reaction to the bone cement? At one time, it showed I was allergic to the bone cement back in 2016 when I had my first LTKR. That is why I had a cementless TKR.

 

[Jockette]

I’m so sorry that you don’t have an answer yet. It is frustrating to, yes, be at their mercy for when they get around to something. I’m sure they are busy, but knowing that doesn’t always help us who are anxiously waiting for them.

It sounds reasonable that both of your concerns are possible, that the fall could have loosened an insecure implant, and that you could be reacting the to the cement, since you have already been told it’s an issue for you.

I wish I had a better answer for you. Vent here any time you want.

 

[Cementless]

Well, my ortho surgeon finally called me this afternoon around 4 pm. I am so disappointed in his response to my NM bone scan. He said, "it showed no loosening in my patella button, also he did not agree that my tibial component is loose!" He says once he puts cement in it is always secure!!! He said, "he did NOT believe in NM bone scans!!! That is really contradictory, agreeing about the patella button but NOT the tibial implant being loose.
Again, he suggested I get a second opinion. I told him, no, I wanted him to take a look and see if the tibial implant was loose. He said, he "would go in there and hammer on it to see if it was loose". That I was not going to be happy with the results regardless. Obviously, he does not want to do the surgery. It feels like he really is trying to wash his hands of my situation. I told him to put me on his surgery schedule in February if he can.

@Jamie, Pumpkin,Layla and anyone else that can help me find a great revision ortho in the Houston, Texas area. I do think I need a second opinion. I really don't know if I want him to touch my leg again??? HELP!!!

 

[Jockette]

He obviously doesn’t want to do surgery on you, so why would you push him to do it?

He said, he "would go in there and hammer on it to see if it was loose". That I was not going to be happy with the results regardless. Obviously, he does not want to do the surgery.

That comment seems rather rude to me and would not give me any confidence to hire him to operate on me.

It is so hard to get an answer, and a solution, when the cause is elusive. I guess when surgeons don’t know what to do, they don’t do anything. But seriously, if they don’t know what the cause is, do you really want them going inside your knee again? I don’t want that with mine. I’m in the same situation.

It still scares me to have another surgery, and I’m hanging in there until I don’t have a choice. I am “managing” with a poorly done knee.

 

[Layla]

I'm so sorry. I sense your frustration and I am sure your situation feels very unsettling. Please consider taking your OS up on his suggestion to seek a second opinion, if for no other reason than the way in which you were treated. It would be difficult for me to put trust in a surgeon that spoke to me in that manner. We will see if, Jamie, knows of a revision surgeon in your area. Please check back tomorrow.

I wish you comfort and a good nights sleep. Hopefully you'll have a recommendation to go on tomorrow that leads to your relief.
@Cementless

 

[Jamie]

Here are several surgeons in the Houston area you can check out. Talk to more than one. Please don't use your current doctor. He's giving you lots of reasons why he's a poor choice. When a doctor tells you to seek another opinion, you need to go that route.

Dr. Stefan Kreuzer
10496 Katy Freeway, Suite 101
Houston, Texas
Phone: 346-571-7500
Specializes in hip and knee primary and revision surgery.

Dr. Terry Clyburn

Dr. Robin Goytia