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Revision TKR Patella Button Failure

Double Trouble

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I found this forum the other day and decided I had to join. I wish I had found this last year when I had my Bilateral TKR done in October 2018! I was a mess before that operation and it would have helped my anxiety quite a bit by communicating with people who had already gone through the operation.

Last month, at my one year Bilateral TKR checkup, I found out that the button on my left patella had fallen off and was causing swelling and some pain. I really did not think much about the pain and swelling in the left knee leading up to this visit because I heard a TKR can take up to 1.5 years to heal and feel better. The revelation that a mechanical failure had occurred in my new knee blew me away. I did not want to go through the TKR trauma again…it was why I had requested to have a bilateral replacement in the first place!

I have Smith and Nephew Visionaire knees and was told by my surgeon that having the button fall off is very rare. He said he has done thousands of TKRs and has only heard of this happening twice. When he reviewed the X- with me, it definitely showed that there was something wrong. It was a side by side picture of my two knees, showing both patellas and the locations of the buttons on each patella. The right button was perfectly aligned high under the patella but the other button showed it was below my patella, sitting on the lower part of the knee. He was extremely apologetic and offered to do the revision right away. I really had no choice to have the surgery and a few weeks later I had my knee operated on again in November.

What I would like to know is this a rare occurrence as stated by my surgeon? Or does anyone know if this happens more often than stated?
 

Jockette

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Hi and Welcome!

I think this is a rare occurrence as I only remember one other member having surgery to fix the patella button. @bookread recently had hers redone

I’m sure needing a second surgery was very frustrating, especially after planning bilaterals so you’d be one and done!

Please tell us the dates of both surgeries and we’ll make a signature for you.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​


4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Cementless

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@Double Trouble, good post. I might be having a loose patella button with my revision. I saw my internist yesterday and she ordered a CT scan with and without contrast so we can see what is going on!
I will let you know when I know something. Take care.
 

Cjackso21

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Hello, so sorry to hear that. Hopefully this revision was not as hard as the original TKR. I had a loose patella button as well on my right but this was a cementless knee. It was also what made them realize that the entire TKR did not “stick”. And it coincidentally revealed a problem with my LTKR’s patella button as well. This one was also cementless from 2008 but did work. The problem was that it was causing bone loss so they took it out but didn’t replace it. This was maybe 5 years ago. So next year I plan to have it fixed. But have to get my right revision first.. that’s too long of a story to tell. But my loose patella was explainable due to being cementless. Hopefully all of the other components are in good shape. Good luck!
 

bookread

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I had my first knee replacement (left knee) on December 13th, 2018. It was excruciatingly painful and never stopped hurting. I knew something wasn’t right. Long story short, I switched doctors because my former doctor refused to do anything. I had my second surgery (same knee) on September 26th of this year. What a difference!!! My surgeon fixed everything that my original surgeon botched. He did not have to take out the entire replacement. He just took out my knee cap, made the patellar button bigger, and then put my kneecap back. Also, he made the plastic component on my tibia bigger and inserted a post between the femoral and tibial component. He also performed a lateral release because my knee was not aligned properly. I’m very happy with the outcome so far.
 
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Double Trouble

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Hi @bookread, glad you are happy with your outcome so far! So far, I am pleased with my outcome! When I flex my quad I don't feel clicking within my left knee and now there is no pain when I push on the patella ligament. My surgery only entailed taking the knee cap out and reinstalling a new patella button - not as entailed as yours. My pain level was tolerable over the past year so I cannot imagine going 9 months with excruciating pain!

@Cjackso21 - probably repaired with bone cement this time, I think my knee system originally did not require cement for the button. However, they did put in cement with the femur and tibia components.

I am a little past halfway through my mobility stage and doing all the PT myself. My bilateral knee replacement back on 10/2018 was not that long ago and I pretty much remember the PT that was done on both knees. Currently on the bike and getting more flexion out of it every time I ride. I am itching to do some strengthening for the knee but I don't want to push it too fast. The last time I pushed it I set myself back a few weeks.
 

Cementless

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@Double Trouble,
My surgery only entailed taking the knee cap out and reinstalling a new patella button - not as entailed as yours. My pain level was tolerable over the past year
Did they have to open you up again like a TKR revision? Is your scar as big for the revision? So, you say the surgery and recovery isn't as bad as a revision?
 
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Double Trouble

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@Cementless
They totally opened me up again, in fact my scar is a bit longer! I think because they did not do anything else other than fix the button, my recovery is moving along fairly quickly. I am definitely progressing a lot faster than when I had my bilateral replacements done! In fact I have begun walking down steps today and plan to be back at work this coming Monday.

I would have been further along in my recovery but I tried to get my knee bend going too early and actually opened my incision (not a pretty sight!). I was at 90 degrees right after the surgery and the PT group at the hospital told me that the sooner I get the bend to about 125 on the knee, the faster the recovery (not the right things to say to me, I have always had the no pain, no gain mentality). I never thought about the elasticity of my incision not taking kindly to more than the 90 degree bend so early after surgery. So, a few days after getting out of the hospital, I went from having a glued incision to a sutured incision and had to keep my knee straight for over a week because the incision would not stop leaking.... It has now taken me about 7 more days just to get to about 90 degrees to walk down stairs. If I had found this site earlier, I most likely never would have put myself in that situation. Well, lesson learned and I hope someone reading this learns from my mistake.
 

Jockette

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PT group at the hospital told me that the sooner I get the bend to about 125 on the knee, the faster the recovery
I am continually amazed at what PTs tell people! :doh:It seems too many of them don’t have a clue about this recovery, yet we are all sent to PT, and trust them to know what is best for us.
 

bookread

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I’m still not quite able to go down steps yet. It’s been 10 weeks since I had surgery. But I’m able to go up steps now. Just being able to bend my knee is without excruciating pain is heaven!
 

Jockette

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I’m still not quite able to go down steps yet.
I am well past 2 years post op and I can only go down stairs foot over foot if they are very short steps. I can go up, but need a cane or the handrail or both. I’m not happy at all with my outcome but 2 second opinions have not found anything to fix.
 
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Double Trouble

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@Jockette
I am so sorry that @bookread you are still having pain and you both are having issues with getting down stairs! My father in law had double knee replacement done about 12 years ago and he is also still in pain and has issues going down stairs. He has had his knees manipulated multiple times without any success. The surgeon says that his knees bend perfectly with no problem while he is under sedation and being manipulated. They have no idea what else to do for him.

I know I have been extremely lucky to be where I am at. I will never be Fred Astaire when going down stairs, but I am just happy to be going down straight! I hope and pray that your knees quickly respond and you are able to enjoy life without pain and restrictions!
 

bookread

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Thank you. I’m sure it will get better. It’s been a little less than 3 months since my knee revision. I’m sure it will improve.
 

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