Revision TKR Partial Revision Failure

[Cementless]

@Josephine, thank you soooo much for the explanation! Do they usually cement the head portions of the tibia and femur component and leave the long rods cementless?

signed: Twizzled

 

[Josephine]

Yes!

 

[Cementless]

I have been on a vacation that was badly needed with family. We toured the whole Biltmore Estate in Asheville, NC and the next day was spent at Dollywood, Pigeon Forge, TN. I will post pictures.
I can't believe my knee held out!!! It was very sore and I was the slowest one in the group. Climbed a lot of stairs up and down, walked for miles each days. My question to you people that have had a successful knee replacement:
how does a normal knee replacement feel? Should one still have pain/soreness if your knee replacement was a success with this type of walking and climbing? On the plane ride home, my legs, ankle and feet were so swollen!!! They are better now.

I interview my first possible revision OS this coming Wednesday, the 8th. I have not been thinking about having the knee revision, so I need to get my questions in order. So NOT in the mood to deal with all this!

I'm the one in the hot pink rain jacket...it rained the whole time!

 

[Cementless]

One more picture: Smoky Mountains of Tennessee!

 

[lovetocookandsew]

Beautiful pictures! It's so great to see you having fun, although I'm sorry you had to suffer so to have a little fun. I can't tell you how you will feel after a TKR and/or revision as I've not gotten to that point yet. After my TKR my knee was great for a short time after the initial recovery, but then began to go downhill somewhere around six months, so I never really got to find out how it should have been. I'm hoping this time it does as well as my first one did for that short time before it went downhill, but also keeps doing well for years and years to come!

 

[Jockette]

I can’t answer your question because so far mine has not been successful either, but just wanted to say I enjoyed your beautiful pictures!

 

[Cementless]

@Josephine @Celle @Jamie: Tomorrow I see the first OS revision doctor, I am trying to figure out what should be my 1st question to him. He is in the same group of OS doctors that did my original L. TKR. I must be careful what I say about his partner, who admits he did not have a lot of experience with cementless TKR (I was the second one he ever did). Oh hindsight hurts! I guess I could begin with, I have been told my implant is loose but I could live with it if I want to....it is a cobalt implant and recently found out I am allergic to cobalt. Do I let him know I am interviewing another revision OS before I make up my mind who to go with? I have printed out the BoneSmart list of questions to ask. Any other suggestions?

 

[Jamie]

Highlight your most important questions from the list and start with those. Then you'll be less nervous and you won't forget anything. Early on in the meeting you'll need to tell him all about the problems you're having with your knee. I'd let him to the diagnosis and see if he comes up with the loosening. If he doesn't, ask him if that's a possibility. If he says no, then ask him to explain why not because that is a concern of yours. Tell him about the allergy as well and see how he reacts. It's his diagnostic ability, his reaction to your questions, and his recommendations that will let you know whether or not he is the right person for you at this point. So let him do the talking once you describe your symptoms. You definitely don't have to tell him you're getting other opinions and I would not.

 

[Cementless]

@Jamie, he has access to all my reports (x-rays, bone scan) which show possible loosening of the tibial implant, no infection (blood work). I want to ask him about the blood analysis that shows that I am "mildly reactive" 2.0 to bone cement monomer and Cobalt as a 1.8 (2.0 being "mildly reactive") vs. the patch testing shows I am not allergic to bone cement but allergic to Cobalt. Does that mean the knee definitely has to come out since I have a Cobalt knee? I wonder if I should ask him for another order for the Blood Analysis Kit for Metal Testing/bone cement thru Chicago Orthopedic Analysis, his office carries it and I can double check the blood work?
@Celle, the above questions were for you and Josephine too.

 

[Celle]

I'm sorry, @Cementless, I am taking a few days off - travelling from New Zealand to England, to visit my daughter and her family.

 

[Jockette]

Personally I would look at this appointment as a practice run for the next opinion. I have read over and over here on Bonesmart that second opinions should be with someone with no association with the surgeon who did the surgery.

I went for a second opinion in June. Obviously if we are seeking a second opinion, things are not going well and we are somewhat upset about it. So we carefully line up our questions and concerns and we expect the surgeon to listen and evaluate our symptoms to he can help us.

My second opinion surgeon took my notes away from me (nicely) and said just tell me. Well I could only remember one or two concerns, I was so surprised he did that. I don’t think fast, so it just totally threw me.

He rushed the appointment, I spent maybe 15 minutes with him. The whole thing happened so fast I didn’t know what hit me. This was after a 2.5 hour drive to get to his office.

So. Be prepared that this appointment might not go the way you want. I certainly didn’t expect mine to go like it did. All the way home (a 3 hour ride this time because traffic was horrendous) I felt like a ballon whose air had been let out.

As a side note about the drive, if traffic had been fine, it should have taken an hour and 40 minutes, not the 2.5 and 3 hours it took us)

Best wishes as you go through this next phase. I’ve been on Bonesmart for about a year (I was almost 6 months post op by the time I had the nerve to join, though I’d been reading since 1 month post op) and I always felt bad for those members who had gotten to the point of needing a second opinion. Now I’m one of them.

 

[Cementless]

@Josephine, @Jamie,@Jockette: One important question I want to ask but maybe I shouldn't: was there too much bone shaved off one side of the tibial plate, since the gap was there at 6 weeks and got larger over time? The bone never did fill in the gap.

 

[Cementless]

@Jamie, the above question is for you too.

 

[sistersinhim]

If I had a known allergic reaction to the mental in my knee, I'd want it out of there! Plus, yours is loose. That's two things to strongly consider while making your decision.

 

[Cementless]

@sistersinhim, I agree!

 

[jboles]

I'm just now catching up on your thread. I also have metal allergies. I had the patch test and the blood test that you referred to. I have the Smith and Nephew implant. It's a different version than what they normally use, because I'm allergic to titanium in addition to cobalt and nickel and a host of other metals that I can't spell. The tibial component is only polyethylene because the one they normally uses is made out of titanium. I went through 3 different surgeons before I found one who researched enough to find an implant that would work for me. I'm having some problems, not with the knee (I hope) but with my foot and ankle. I have an appointment with my OS next week to see what his recommendations are. I've also developed mild osteopenia, caused by celiac disease. So I hope I don't ever need a revision. My OS said he was more inclined to go with what the blood test results showed since the patch test reacts to something touching the skin, not implanted in the body. I hope you find a new OS that meets your needs and takes the time to find the correct implant for you.

I live in NC and have visited Biltmore and Dollywood several times, it's beautiful, but a lot of walking for sure.

 

[Cementless]

@jboles, did the patch test and blood test show the same results?

 

[jboles]

It was close, but not exactly the same, more sensitive to some, less to others. The blood test showed me being allergic to more than the patch test, of course, they tested for more... My allergy doctor said if the patch test shows any allergies to metals, then he recommends the blood test. My OS never recommended either of the test, I had to initiate it on my own. I did so because I've always been sensitive to jewelry, and it doesn't seem to matter what it's made out of. Some gold bothers me, some doesn't. Most "cheap jewelry" bothers me. Seems like the only jewelry I can wear is silver, and I didn't show any reaction to gold or silver. Makes you wonder if some of the gold has something in it besides gold??

 

[Cementless]

@jboles, I am assuming your Smith and Nephew implant was a cemented one? This revision OS said ALL Oxinium Genesis II & Profix by Smith and Nephew that are uncemented have been recalled since 2011!!!
I have 2 options and neither are good!!! I will go into it in more detail after a nap, mentally exhausted. He said I need to have a revision in the next couple of months as the osteopenia has weakened my tibial implant and I have lost a lot of bone!!! The femur portion is intact. He does NOT believe in the patch testing or the blood analysis for metal testing and calls it "fake news".
My options are: 1. Keep the DePuy femur implant (with the cobalt), use a non cemented DePuy Cobalt implant with a sleeve for the tibial portion. 2. The best option: Use an Oxinium cemented knee with Cobalt (?) and change out the femur and tibial portion. He also said, some people (doctors/OS) would disagree with him trying a non-cemented knee again! "If the bone did not grow in it the 1st time, the bone most likely will not grow in it the second time!" He also, said "I would have to learn to live with a swollen knee from the allergies to bone cement and Cobalt"!
@Josephine, please respond to the above Catch 22.

 

[Josephine]

@Josephine, please respond to the above Catch 22

Sorry, I can't tell which out of your post is the Catch 22.

He also said, some people (doctors/OS) would disagree with him trying a non-cemented knee again! "If the bone did not grow in it the 1st time, the bone most likely will not grow in it the second time!"

So far as my experience goes, this is a given. The risk of trying the uncemented a second time is too great. And anyway, cementeds have stood the test of time since the beginning of joint replacements! That's like around 60 years or more.