Revision TKR Partial Revision Failure

[Cementless]

@Josephine,
The OS revision doctor I picked said:
1. He does not use the Mako Robotic Arm for revisions (thanks for the info anyway).
2. He only inflates the tourniquet for 10 mins while he does the bone cement. I have some small varicose veins that might hit where the tourniquet is applied that I am concerned about.
3. Definitely decided against a press-fit fixation.
4. It is Siverlon dressing with adhesive, not Silvercel: "Silverlon® Island Wound & Surgical Dressings are multiple layer and incorporate a silver wound contact layer, an absorbent rayon pad covered with a film transparent (urethane) layer and an adhesive border".
5. I ask him one of the BoneSmart questions about what kind of approach he uses regarding "muscle-sparing", and he said he cuts thru the muscle...."that the ones that spare the muscles, have more revisions".
6. Since he said patients that have spinals, do better....I wonder if that is true for patients that have osteopenia and a bad/weak back? I also need to ask my cardiologist or Electrophysiologist if a spinal may flare my AFIB???
7. I am concerned about being put on Pregabalin 75mg in the holding area and hope this will not continue post surgery. I am sensitive to meds and need to be careful with extra stuff that is not really needed. I did not have this with my previous LTKR. One time only should not be a big deal. I have lost 31 lbs since Feb 16th and read where Pregabalin has a potential for weight gain.

More questions as I think of them.

 

[Josephine]

He only inflates the tourniquet for 10 mins while he does the bone cement. I have some small varicose veins that might hit where the tourniquet is applied that I am concerned about.

Don't worry. You'll be fine.

It is Siverlon dressing with adhesive, not Silvercel: "Silverlon® Island Wound & Surgical Dressings are multiple layer and incorporate a silver wound contact layer, an absorbent rayon pad covered with a film transparent (urethane) layer and an adhesive border".

Then tell him you want the Silvercel instead.

5. I ask him one of the BoneSmart questions about what kind of approach he uses regarding "muscle-sparing", and he said he cuts thru the muscle...."that the ones that spare the muscles, have more revisions".

I don't agree but he's the surgeon!

6. Since he said patients that have spinals, do better

This is very true.

 

[Josephine]

Cementless, I edited your post here as it didn't seem very easy to read!

Equipment Required (List)
Frozen Section
Angled Curette Set
Curette Set
Dr. Kreuzer Revision Total Knee Extras
Drill Bit Set
Extensor Mechanism Allograft (Tibial Tuberosity
Patella Tendon
Patella and Quadriceps Tendon)
Femoral Head Quantity 2
Flexible Osteotomes (All Sizes)
Gigli Saw
Grey Revision
Innomed Knee Extraction Set
Moreland Cemented
Moreland Cementless
Osteotome Set
Power Drill and Saw
Short Synvasive Saw Blade for Component Removal
Small Frag Set
Steinman Pins
TBD Vendor Hinged Knee Instruments
TBD Vendor Revision Knee Instruments
Total Knee Instrument Set
Vise Grips
Winquist Screw Removal
Zimmer Trabecular Metal Femoral Sleeves and Cones
Zimmer Trabecular Metal Tibial Sleeves and Cones

I am staggered at this list! MY goodness, I would have hung my head in shame if my surgeon had had to list the instrument requirements like this! Generally my surgeons would discuss the case with me in my office a day or week before the surgery and we would plan it all together! After all, I knew more about th4e equipment in my theatre than anybody else did!

Other Medications - Hibiclens shower the night before and morning of surgery Bactroban Nasal 2% Apply in each nostril q 12 starting 5 days prior to surgery for a total of 10 days Vancomycin 1.5 grams if patient is over 72kg or 1 gram if patient is less than 72 kg IVPB to be infused in holding area one hour prior to procedure
Ancef 2 grams if patient is over 70kg or 1 gram is patient is under 70kg IVPB to be infused in OR prior to incision

If patient has a rash allergy to penicillin, administer Ancef (Cefazolin) as a test/challenge dose per SCIP (Surgical Care Improvement Project) protocol. If patient has difficulty breathing with penicillin, administer ANCEF as a test/challenge dose per SCIP protocol.

Pepcid (Famotidine) 20 mg po x 1 dose to be given in holding area
Zofran 4 mg IV/PO in holding area
Celebrex 400mg in holding
Pregabalin 75mg PO
Acetaminophen 1g IV to be given after Ancef (or Clindamycin)
Dexamethasone 4mg IV following Acetaminophen
Tranexamic acid 1 gram in OR before incision and 1 gram at closing, pending no contraindications;
Facility; Surgery to be ordered - Revision Total Knee Replacement (27487);
Time frame unit - day(s);. 2.
Failed Total Joint Counseling
Aseptic Loosening Knee

But this I can understand!

 

[Jockette]

Since he said patients that have spinals, do better....

This is very true.

Why is this true? I have low back issues that are finally at a manageable level and so I didn’t want anything put into my back, so I requested general anesthesia and they agreed without an argument. I came out of it fine.

Although now that I think more about it, I had a lot of trouble urinating after the surgery and about 4 am they had to insert a catheter, just long enough to empty my bladder.

My blood pressure also dropped the day after surgery for a while in the afternoon that concerned the PT enough that he ended our walk early.

Would those things not have happened with a spinal?

 

[Jamie]

Cementless, I'm so sorry to have been rather absent from your thread as you worked through all this. I am very thankful that one of the surgeons I recommended has turned out to be a good choice for you. You've had Jo's expert advice, but I'll say that I feel the same as she does. This surgeon's attitude and choice of a cemented prosthesis seems a good choice for you.

You've done a wonderful job working through all the details! I feel that you are in good hands with this doctor and will look forward to hearing from you once you have the revision. Although no one can guarantee perfection, I believe you have an excellent chance to see some improvements in the outcome. The only thing I might suggest given you history would be to ask him if he would use the Aesculap knee and if not, why? If he is at all skilled in that implant, it might be a good option for you. But, do trust whatever he is recommending for you. He knows your case now better than anyone.

 

[Dizzy]

When I had my patella revision in July, they sort of suggested going with a spinal. I was hesitant, as I didn't want to be aware of what was going on. They were suggesting it like that was a good thing to be aware!!!! Well, I decided against it and had the general anesthesia. I was happy with my decision and had no complications from it.

 

[kneeper]

In my preop appointment with the anesthesiologist, he indicated that they prefer not to give a general if they don't have to. I got the impression GA is harder on the patient. He did have me bend over & looked at my spine and asked if I had back problems. All looked ok for the spinal so I went with it even though before our talk the idea of a spinal kind of scared me. They also give you something to knock you out so you aren't aware of anything.
I think it is an individual decision based on your health history etc.

 

[sistersinhim]

I've had both and I by far prefer the sedation of the GA. I am hungover and sick for days after a general. We I wake up from sedation, it's instant and no throwing up! I pray I never have to have another GA!

 

[SusieShoes]

For my surgery I had spinal and it worked wonderfully. I saw the operating room and in what seemed two seconds later I woke up in the recovery room with none of the foggy-headedness of GA. I really liked that part, being clear-headed right away.

It really is an individual decision. Both work!

 

[Cementless]

I've had both and I by far prefer the sedation of the GA. I am hungover and sick for days after a general.

You do prefer the GA? Just a tad confused here.

I pray I never have to have another GA!

 

[Celle]

For medical reasons, I can't have a spinal, but have to have a GA.
I always tell the anaesthetist that I vomit easily and he/she gives me something to prevent that. Doing it that way, I don't have any problem having a GA.

 

[sistersinhim]

You do prefer the GA? Just a tad confused here.

Oh man, auto-correct and I didn't proof read. Sorry! I do not prefer the GA. I am always really sick afterwards no matter how much anti-nausea stuff they give me! The sedation is a piece of cake!

 

[Cementless]

I have a diet concern regarding my upcoming revision surgery on Oct. 8th.
I have been on a special diet (Optavia/Medifast) since Feb. 16, 2018 and have lost 31 lbs. According to the Medications to Stop Prior to Surgery (2 weeks prior to surgery) there are Multivitamins and Herbal Medications that need to be stopped. My Optavia/Medifast diet has added vitamins but I do not take a multivitamin. It does NOT contain any Herbal Medications. TheOptavia/Medifast products contain 50% of the Vit D daily requirement, 20% of Vit A daily requirement, 20 % of Vit C daily requirement, and 20% of Vit E daily requirement.
I have had radical hair loss on this diet but once I lose 20 lbs more (my goal), the hair loss will stabilize. I would not think it would effect my bone and tissue healing.
The OS protocol is no more than 2000 mg daily of Vit A, Vit K, & Vit C. No more than 4000 mg of Vit E daily.

What say ye @Josephine?

 

[Josephine]

All outside my sphere of expertise, I'm afraid.

 

[Celle]

After surgery is not the right time to be trying to lose weight. Your body needs normal food, high in protein, so that it can repair itself. after this major surgery. Forget the diet foods for a while.

 

[Cementless]

After surgery is not the right time to be trying to lose weight. Your body needs normal food, high in protein, so that it can repair itself. after this major surgery.

@Celle, this diet is high in protein. Thank you for your input.

 

[Cementless]

@Jockette, it is my understanding that the hair loss is from the nutrients going to the muscles and organs and the hair and nails get it last. Once I reach my target weight (lose 20-30 more pounds), then I will be at 140-130 lbs. Then I will be on the maintenance plan and can slowly introduce things I have been eliminating, like some fruits, carrots, food with natural sugars, etc.

 

[sistersinhim]

This is a question you need to ask your OS. He can guide you. Oh, and congrats on your weight loss. I know how hard it is to do!

 

[Cementless]

I have to tell you all about how impressed I am with this OS revision dr. that BoneSmart recommended.
I have been on their Pt. portal with ALL my questions and concerns.
Today around 5pm, I get a call from his office asking me to wait that Dr. Kreuzer would like to talk to me if I have a minute. He gets on the phone and is very friendly and says he is about to go into a meeting but would like to answer any questions I have. WOW!!! I was so shocked that I was almost speechless! Thank goodness I had my list of questions written down and could grab them in a hurry. Here are some of the answers he gave me:
1. I can stay on my diet.
2. About the TED hose and if I have to wear them: "The only thing I have to do is pay taxes!" lol His humor is great! He said, he would prefer me to wear them but it is up to me. I will see my cardiologist tomorrow and will ask him. I reminded my OS revision dr. that I did not have to wear them with my LTKR and that I will be on Eliquis 5 mg bid for the rest of my life.
3.

Then tell him you want the Silvercel instead.

He said they can use Silvercel without the adhesive.
4. He told me that they got the bone cement samples and will be sending them to my allergist so I can be retested for the bone cement allergies.
He is sooooo thorough! He is such a happy, energetic dr./person!!! Meet Dr. Stefan Kreuzer!!!

I just had to share all this with you guys. I ask him if he thought my revision would be better than what I have now and he said, "YES!"
Btw: he just got back from Taiwan doing research on knees and hips.

5 mins after our conversation ends, I get another call from his office/medical assistant asking me if I would like to make an appointment to come in for any other questions. WOW again!!! I told her I was fine using the Pt. Portal. I feel so good about this upcoming revision. They are really putting my mind at ease.

 

[Desertgal]

Fabulous!!