Revision TKR Partial Revision Failure

[Josephine]

When I ask her about his infection rate in the hospital he uses, she said, it has to do with the patient's own body and whether they premedicate prior to a procedure, ex: dental work.

That is such a crock! As Celle said, it was " just a throw-away one, from someone who doesn't know a lot." I agree 100%

I know you cannot compare my procedure to yours but when I was rolled into the OR everyone was wearing hazmat type gear in including hooded masks .

That's because they were using a laminar flow operating theatre! Not all theatres use this gear though about 96% of the theatres doing joint replacement have laminar flow.

Something like "absolutely no entry, joint surgery" I don't know if that's typical

Not really. Never worked in one myself but we did have very strict protocols on activity in and around the operating theatre.

I cannot find a Corning implant on the world wide web

I remember Corning. In its early days it mainly produces silicone implants such as finger and toe joints! But it was bought out some years ago - can't recall by whom. Probably Johnson and Johnson - they seemed to buy up almost everything at one time!

 

[arizonaone]

@Josephine - very interesting about the laminar flow. I googled it and the artiticle I found said that a study revealed only a marginal benefit to using the laminar air flow and that it was not worth the expense of building one in an OR . Did your experience find this to be true? Now I'm a just a little nervous that the infection protocol was useless.

 

[Josephine]

Absolutely not! It's been shown that where a laminar flow unit is installed, the infection rate drops by about 2% which is pretty significant. I know for a fact that no self-respecting ortho surgeon who does joint replacement would take a job in a hospital where the designated theatres aren't fitted with one.

Besides which "a study"? There's been many studies that support the use of them and the NHS - and I suspect US hospitals - wouldn't even build hospitals without a laminar flow.

 

[arizonaone]

@Josephine

 

[Cementless]

Apparently, both orthopedic revision surgeons I am considering use the Oxinium, Smith and Nephew implant (for those with metal allergies). The most experienced of the two only does a few of these a year and it will be cementless. When I read up on the Oxinium, Smith and Nephew, they have had recalls on the Oxinium Genesis II and Profix in the past. I don't think they last very long either.

@Josephine, do you have any knowledge of the Oxinium implants and their success rate? Can I live with my implant that is Cobalt based and showing signs of loosening or will my tissue and bone be destroyed?

 

[arizonaone]

@Cementless Just wanted to let you know that I had told my new OS that I found out that there was a recall on my implant and asked which he uses. He told me Dupuy I then said they have been recalled as well, haven't they? And he told me there have been recalls on all of them. Which appears to be true based on all of those attorney TV ads . Also it's probably only certain years/ models etc. .I guess when they are recalled the companies fix what is wrong and that's that

Hope this puts your mind at ease a little bit .

 

[newlybionic]

I hadn’t any osteopenia when I was fitted with my cementless implant. My OS uses it when he does revisions.

 

[Cementless]

I talked with the Orthopedic Analysis people in Chicago that do the blood Metal-LTT Analysis and ask how come there is such a difference with the Metal Patch testing. They use one's WBCs to see how they react with metals, particles, ions, etc. where as the Patch testing uses the skin. I sure am getting conflicting reports! The blood analysis says I am "mildly allergic" to bone cement. I did not react to bone cement on the patch test. I am pretty allergic so far to Cobalt and it was a normal reading on the blood analysis (close to mildly allergic). I show some reaction to chromium. Final results on Monday with the allergist.

 

[Josephine]

Folks, a word about recalls. Very often a recall is made for something as simple as a mistyped code on the label or poor packaging, failure to pass the quality assurance tests and such things. There might also be very minor variances in the manufacture of the device which, while it would not affect the user experience, was nevertheless, a variance and therefore not permitted. Such recalls are usually initiated by the firms themselves. Rarely are they made necessary by serious defects and certainly not by ones that are not found until after patients have had to have them revised.

 

[Cementless]

@Josephine, Josephine, Do you know anything about the Oxinium, Smith and Nephew implant for metal allergies? Both the revision surgeons I am going to see use this implant. So far I have a mild reaction to Cobalt, my skin turned blue and itches. Final reading on Monday the 16th. Maybe, this is part of the reason my implant is showing loosening?

 

[Josephine]

Only that it is the trade name for ceramic coated implants. This means that those with metal allergies are protected from exposure.

"During manufacture, broken link removed: https://www.chowhipandknee.com/knee-oxinium-oxidized-zirconium/ undergo a process that transforms the implant's surface into a hard, ceramicised metal while still retaining all of the durability of the underlying metal. In addition to being more durable than a true ceramic, this metal implant's ceramicised surface is more than twice as hard and therefore twice as resistant to the kind of scratching that can cause a cobalt chrome implant to wear out before its time."

 

[Cementless]

@Josephine, thank you for the information. I had my summary visit with the allergist that did the Metal Patch testing today and the results are, "I am allergic to Cobalt and should avoid implants that have Cobalt in them!" I guess that is why my implant is loose! The Chicago blood analysis showed it was a normal reading (close to mildly allergic). Now I need to have the knee implant removed.

 

[Josephine]

Yep, yep - that's the way it goes!

 

[Cementless]

Do I write a letter to the orthopedic surgeon that did my L TKR and let him know how upset I am that he did not pick up that I was almost allergic to Cobalt on his Orthopedic blood analysis? I showed positive on the Metal Patch testing. I don't plan to sue him but I am upset! It might hinder my referrals?

 

[Josephine]

It depends what response you expect or want from it. If you're hoping for an apology or an explanation (excuses!) then it would pretty much be a waste of time. But if you just want to let him know, then do it. However, the likelihood is that IF he replies he will probably say something like he doesn't think those tests are reliable.

 

[Cementless]

@Josephine, I agree with what you said in the above response, totally!
and

After rereading the the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy,
I am shocked that ALL of these exercises were the exact ones I did in PT!!! When I have my revision someday, I think I will opt for PT once or twice a week instead of 3 x week....which felt like too much! Do it the BoneSmart way! Trying to get my mind right for the inevitable.​

 

[Spex10]

Don't even do PT as often as that! I'm just pottering about and resting to let my leg heal. I walk about and keep my feet up when not doing that. I had my first PT assessment last week when I was 3 weeks out. Guess what? Extension 0° and flexion 90°.
I did weekly PT after my last TKR and that led to inflammation and adhesions. I was damned sure I wasn't risking that again. I quoted the research on efficacy of PT after TKR to the physios this time and they had no answer to it. I'm now scheduled to see them in another 3 weeks time. Bet they love me (not!)

 

[Cementless]

@Spex10, I had PT 2 days after I got home from the hospital having had my LTKR. I was so medicated, I had to rest on the PT bed while they talked to me about what exercises to do. This was also an evaluation. It was a total blur and waste of time!

 

[Spex10]

I can believe that! Maybe they have to be seen to be seeing patients.
The PT I have now on my occasional visits is excellent. Patient and sensible.

 

[Celle]

@Cementless ,
I have moved your post and the responses to it from kneepa's thread to your own thread. It didn't have anything to do with what was being talked about there and it sidetracked her recovery thread.

I see that you had already posted a duplicate , addressed to Josephine , in your own thread. We prefer that you don't duplicate posts.

By putting the above post in her recovery thread, you were disrupting her thread, which should be about her own recovery.
Forum etiquette: being polite when posting

Please post any updates or questions about your recovery in your own thread. We will see them there, as someone checks all the new posts every day.