Revision TKR Partial Revision Failure

[Cementless]

@Josephine, I guess my dilemma is by consenting to a revision with "bone cement" which I am "mildly reactive" to, I still run the risk of rejection from the bone cement? Also, to get rid of the cobalt in the original implants, the femur and tibial portions both have to be removed. My femur implant is intact and I almost have osteoporosis in the femur. The catch 22 is it will weaken my femur more with a new implant. Does that make sense? My patch test did show moderate allergic reaction to cobalt.

 

[kneeper]

It does seem logical that if the bone didn't grow in properly with the uncemented that uncemented is not the way to go with round 2.
As far as the osteopenia, is that something your GP or other doctor is monitoring?
Also I think they can do a bone graft with a tkr to give your bone around the implant some "help." I think Josephine mentioned that in an earlier post and it's not a big deal.

 

[Josephine]

by consenting to a revision with "bone cement" which I am "mildly reactive" to, I still run the risk of rejection from the bone cement?

Mildly reactive is not a problem. And you would be far better off with a cemented knee than an uncemented. According to recent statistics, the uncemented varieties don't have a good record for staying put.

Also, to get rid of the cobalt in the original implants, the femur and tibial portions both have to be removed. My femur implant is intact and I almost have osteoporosis in the femur. The catch 22 is it will weaken my femur more with a new implant.

Yes they will have to be removed and 'almost' have osteoporosis is not the same as having it. Besides which, the cement will serve to strengthen the bone and support it because, if properly applied, the cement will embed itself into the matrix of the bone and thereby support it. Like this

 

[Cementless]

@Josephine, if you had to make a choice, would you keep the original femur implant with the cobalt and have another DePuy cemented cobalt implant with a sleeve put in the tibial portion or 2. Change out both implants (femur & tibial) to an non-cobalt cemented knee?

 

[Cementless]

@Jamie, if you had to make a choice: 1.Would you keep the original DePuy femur implant with the cobalt and have another DePuy cemented cobalt implant with a sleeve put in the tibial portion or 2. Change out both implants (femur & tibial) to an non-cobalt cemented knee? Please see my recent updates with the first revision OS.
Would like input from the board members please.

 

[jboles]

Yes, mine is cemented. I don't react well to calcium supplements, and I'm not to the point of taking medication for osteoporosis just yet, so I'm trying eat more calcium containing foods to try and prevent the osteopenia from progressing. Also, much to my dismay, I'm totally gluten free, so my body will absorb the nutrients it needs. It had never crossed my mind that the osteopenia could cause the implant to loosen.

 

[Jockette]

Also, much to my dismay, I'm totally gluten free, so my body will absorb the nutrients it needs.

I don’t understand, shouldn’t our body absorb what it needs?

 

[Cementless]

@jboles,Yes my bone is soft from osteopenia and the x-rays show where my implant has sunk into the tibial plate and caused loosening. I am losing bone. I don't understand why my femur implant is doing well and not the tibial portion. I have more osteopenia in the femur.

 

[jboles]

@Jockette In response to your question, I have celiac disease, the simple explanation is, an autoimmune response causes the intestine to become inflamed and the villa in the intestine aren't able to absorb the nutrients. That's why I was anemic, because I wasn't absorbing any iron. It also causes osteopenia/osteoporosis, in some people, if left untreated, that's why I'm on a gluten free diet.
I'm sorry to have sort of hijacked @Cementless thread.

 

[Cementless]

The Revision OS I saw yesterday does not believe in the blood analysis or the patch testing for metal allergies! He said,"I would just have to learn to live with a swollen knee and any irritation from an allergic reaction". I don't feel comfortable with his attitude. He is covering for his partner that did my original LTKR.​

 

[Jockette]

This is why you go out of the area to a surgeon who has no association with the original surgeon.

 

[sistersinhim]

He said,"I would just have to learn to live with a swollen knee and any irritation from an allergic reaction". I don't feel comfortable with his attitude. He is covering for his partner that did my original LTKR.​

Run from him and his group. That attitude stinks. Ask him if he'd like to live that way? Go out of your area to find another OS with no connection at all with your current group.

 

[Cementless]

@sistersinhim, yes I feel the same way! I am hoping to be forever grateful to BoneSmart for recommending my next revision OS. I have an appointment with Dr. Stefan Kreuzer on August 24th. Dr. Kreuzer helped develop the metal patch testing with my allergist!!! They have been working on this for years together. Obviously, Dr. Kreuzer believes in metal allergies causing rejection and inflammation in implants. He was #1 on the list that Jamie sent to me.

I am taking advantage of seeing yesterday's OS revision surgeon by getting an order for another
Chicago Orthopedic Blood Analysis for metal allergies which will include the bone cement and Cobalt. I feel the time and money spent will be worth it for a third test/opinion. Also, I should have his recommendations in writing soon (before I see Dr. Kreuzer). I had new x-rays done yesterday which will be helpful on the 24th.

Yesterday, the OS revision Dr. scared me and said don't wait more than a couple of months to have the revision because I am losing bone. The implant is sinking in my tibial plate due to my osteopenia.
When I think of all the walking, stair climbing I just did on my recent vacation to the Biltmore Estates and Dollywood…..hope it didn't make things worse. I definitely was the cow's tail on the trip but what a trip!!!

 

[jboles]

I believe Orthopedic panel 2 is the one you want, it test for metals and cement. Good luck with the new OS on the 24th.

 

[Cementless]

@jboles, I just got my appointment moved up to Aug. 14th! Getting nervous. I guess I should let him bring up my options instead of telling him what the other OS revision dr. said....see if they think a like?
@Josephine, do you know anything about the Mako Robotic Arm assisted technology? Do they drill probes in the bone to get there information (worried about fractures with my osteopenia)? Also, how high up do they place the tourniquet on a TKR? I wonder if it will press on my varicose veins on the back of my thigh (which hurts)? I plan to request sutures instead of staples (no glue). Didn't you do that Josephine? I hope, I don't have to wear TED hose. I didn't last time since I am on blood thinners for AFIB.

Geez, the real pain has not even begun!!!

 

[Jockette]

I guess I should let him bring up my options instead of telling him what the other OS revision dr. said....see if they think a like?

This is what I would do.

I would ask all those other questions in your post.

Hopefully you will actually get to discuss these things!

 

[arizonaone]

I agree with Jockette . And I certainly would not leave until all.of my questions were answered. You should feel really comfortable with your OS and it begins with communication.

 

[jboles]

I guess I should let him bring up my options instead of telling him what the other OS revision dr. said....see if they think a like?

I think that's what I would do too!!

 

[lovetocookandsew]

I think I'd just ask my questions and see what his thoughts and procedures are. If you go into your first visit telling him what another doctor said or did, it might make him worry you're a complainer or a pain, and he may not want to help you. I also try to avoid telling my OS his job, but still let him know my thoughts.

Believe me, he will let me know (gently) if I cross over into his job, and I let him know when I don't necessarily agree with him. But that communication has developed after years and years of him being my doctor. I would never have felt it appropriate to be this free with him on the first appointment (plus it took a while for him to discover what a pain I am, and now he's stuck with me ).

It's like your spouse; on your first date you would never tell him some of the things you can discuss after getting to know him well, but the first date was kind of feeling each other out to see if you were even compatible enough to have a second date, and so on.

Ask all your questions (my doctor always laughs and tells me to bring out my long list of questions as he knows I always have a ton), and see what he has to say, and go from there.

 

[Cementless]

@lovetocookandsew, thank you!!!