OP
OP
Cementless
Insider
United States
I am feeling anxious about my upcoming appointment with the second OS revision doctor, especially since I read the summary of the first OS revision doctor:
Here is what the first one said:
"X-Ray Knee
Procedure date: 08/08/2018
Findings:
X-rays were taken of the left knee. 3 views were obtained. Probably well fixed patella and femoral components. Loosened, subsided tibial component
Problem # 1: Mechanical loosening of internal left knee prosthetic joint, initial encounter (ICD-996.41) (ICD10-T84.033A)
This is a very complicated problem because the patient has 2 potential sensitivities that in combination allow for no current options in the total joint market. Have spent some time today with her and her husband helping her understand that there is currently no non-cobalt-exposing knee available on the market with press-fit fixation. Any non-cobalt exposing knee arthroplasty (Smith&Nephew or Aesculap) would have to be cemented.
I am not especially impressed with her exam, as I would expect a knee with an allergy to have a large effusion. Therefore, I wonder whether the cobalt allergy is in fact a real thing or just a mild reactivity, possibly related to an implanted prosthesis. Probably the main cause of her current pain is the loose component.
Conversely, I'm also concerned about trying further press-fit fixation in a patient with this level of osteoporosis and osteopenia, given the fact that press-fit fixation has already not worked out well for her. And reactivity to the methyl mathacrylate is mild on these tests, and so I don't know what to make of it.
The 2 options therefore would be:
1: Revision of the tibial tray to a completely uncemented Depuy mobile bearing revision tray and sleeve construct with a fluted stem, with retention of the cobalt–containing femoral component
2: Revision of the entire construct to a fully–cemented, non-cobalt-exposing Oxinium knee arthroplasty
Pluses and minuses have been covered as noted above. I would lean toward cementing an Oxinium revision construct in her knee. She understands that if metal and cement allergy testing is to be believed, then she may always have a knee that troubles her somewhat, no matter which operation he has.
She also understands that femoral and patella component fixation would also have to be checked intra-operatively, and these would be revised as necessary
Her husband has asked whether she can just maintain the current status and not have any more surgery. Given the changes that have occurred even over the last 2 month's xrays with tibial tray subsidence, I think it would be most prudent to proceed with revision sooner rather than later so as to have less tibial bone loss to deal with. This certainly would compromise non-cemented fixation further (if she chose the non-cemented option).
Finally, she insists upon getting an Orthopedic Analysis metal allergy testing done again. This is fine with me, although am not sure how much more it would add to our decision-making. I can call her with the results."
@Josephine, what do you make up this OS revision doctor not believing in metal allergies?
Here is what the first one said:
"X-Ray Knee
Procedure date: 08/08/2018
Findings:
X-rays were taken of the left knee. 3 views were obtained. Probably well fixed patella and femoral components. Loosened, subsided tibial component
Problem # 1: Mechanical loosening of internal left knee prosthetic joint, initial encounter (ICD-996.41) (ICD10-T84.033A)
This is a very complicated problem because the patient has 2 potential sensitivities that in combination allow for no current options in the total joint market. Have spent some time today with her and her husband helping her understand that there is currently no non-cobalt-exposing knee available on the market with press-fit fixation. Any non-cobalt exposing knee arthroplasty (Smith&Nephew or Aesculap) would have to be cemented.
I am not especially impressed with her exam, as I would expect a knee with an allergy to have a large effusion. Therefore, I wonder whether the cobalt allergy is in fact a real thing or just a mild reactivity, possibly related to an implanted prosthesis. Probably the main cause of her current pain is the loose component.
Conversely, I'm also concerned about trying further press-fit fixation in a patient with this level of osteoporosis and osteopenia, given the fact that press-fit fixation has already not worked out well for her. And reactivity to the methyl mathacrylate is mild on these tests, and so I don't know what to make of it.
The 2 options therefore would be:
1: Revision of the tibial tray to a completely uncemented Depuy mobile bearing revision tray and sleeve construct with a fluted stem, with retention of the cobalt–containing femoral component
2: Revision of the entire construct to a fully–cemented, non-cobalt-exposing Oxinium knee arthroplasty
Pluses and minuses have been covered as noted above. I would lean toward cementing an Oxinium revision construct in her knee. She understands that if metal and cement allergy testing is to be believed, then she may always have a knee that troubles her somewhat, no matter which operation he has.
She also understands that femoral and patella component fixation would also have to be checked intra-operatively, and these would be revised as necessary
Her husband has asked whether she can just maintain the current status and not have any more surgery. Given the changes that have occurred even over the last 2 month's xrays with tibial tray subsidence, I think it would be most prudent to proceed with revision sooner rather than later so as to have less tibial bone loss to deal with. This certainly would compromise non-cemented fixation further (if she chose the non-cemented option).
Finally, she insists upon getting an Orthopedic Analysis metal allergy testing done again. This is fine with me, although am not sure how much more it would add to our decision-making. I can call her with the results."
@Josephine, what do you make up this OS revision doctor not believing in metal allergies?
Weak bladder!
. I wish you all the best with your new surgery.
