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TKR Patella Clunk

May 2020 Update!

Hi everyone!
I do hope that your TKR recovery is going well?

Here I am, two and a half years post my TKR. Time for an update and for possible opinions.

Despite post surgical complications (yet another clotting episode) I felt extremely pleased with the outcome of the surgery. The intense pain from the osteoarthritis completely disappeared.

Range of movement was within a very good range. All good!

Then, my new knee started to ‘clunk’! Medical team not concerned, explaining why/how this happens and how it is quite normal. Fine, a good trade off, I thought. I can live with a bit of clunking!

However, of late, my new knee is causing me a degree of pain and discomfort when engaged in a various range of normal movements.

Hard to describe, but an uncomfortable ‘mechanical’ degree of discomfort that is making me aware of movement to avoid the discomfort, as if the new joint does not fit!

Is this normal? I would welcome opinions.

Best wishes
 
Dear All,
I would welcome your input and opinion with regards to classification of a TKR failure.

I had a TKR of right knee in November 2018 and, despite a clotting problem (well doumented elsewhere on this forum), I was initially pleased with the outcome of the surgery, in that I no longer experienced the pain of osteoarthritis.

However, I have always experienced 'clunking' of the new joint, which I believe is quite normal.

Over recent months, the clunking has escalated to what I can only describe as a feeling of an ill fitting joint that in itself causes me pain and discomfort when flexing and bending my leg and upon standing from sitting and when sitting down.

Is this normal? Has anyone else experienced similar?

My brilliant surgeon advised me of his patient statistics prior to my surgery: 95% success rate, 5% complications, 5% of patients advising that it was the worse thing that they had done. I don't want to be in this 5%, but at the moment do not feel too happy with my new knee!

Any guidance from such an experienced forum would be very much appreciated!
 
Hi again @Scouseman .

I'm sorry to read that your knee is still causing a problem and that the problem seems to be getting worse. I found your old thread and I see that you complained about the excessive clunking your knee was doing then.

Because this is part of the continuing story of your Right TKR, I have merged your new question with your old recovery thread.

While knee clicking and clunking can be normal, it should not be painful. For that reasons, I think you need to see your surgeon again.

It may be that you need a revision, to fix what is causing the problem. Diagnosing and fixing the problem could be simple or it might need a bit more work than that. For that reason, I think you should ask to be referred to a surgeon who is skilled and experienced in doing revisions and fixing knees that are causing a problem.

Under the NHS, you are entitled to be referred to a surgeon of your choice
@Jaycey - are you able to suggest a suitable surgeon for Scouseman, who comes from Liverpool?
 
Hi Celle,
Thank you for the swift and informative response! Makes sense to merge with my previous posts.

One thing that is consistent across this excellent forum is the fact that we all know our own bodies. Despite my eagerness for my new joint to be fine, it just isn't!

What could be causing my significant symptoms? Can a new joint work loose? My last check up and x rays many months ago (I think it was a year) revealed that all was well, despite the clunking!

Not sure that a further check today would be as positive!

What would a specialised knee revision surgeon need to do to establish if a revision is required?

My new joint is a Genesis 2 type, if that helps matters?

Feeling very frustrated, but appreciate now complex this surgery is!
 
Scouseman said:
What would a specialised knee revision surgeon need to do to establish if a revision is required?
Click to expand...
He/she would need to physically examine you knee, probably get new X-Rays or maybe an MRI.

Fixing it could be as simple as replacing the spacer with a thicker one, slightly more complicated, such as balancing ligaments, or maybe completely different hardware.
 
Thanks Celle!
I suppose that I need to start the process to establish if a revision is required!
 
It is impossible to book a face to face appointment with my GP, so have been forced into a telephone appointment with him for Friday morning to commence investigations into potential TKR revision.

Interestingly, my surgeon is experienced in the field of TKR revisions, so I hope that he does not take this personally!
 
Had my telephone consult with GP this morning. Explained everything to him.

He advised that a referal to Orthopaedic specialist would result in an inital X Ray. Therefore, he suggested a visit to a local Health Centre for an immediate X Ray.

Radiologists at the Health Centre were not too impressed!

They argued that I require a face to face physical examination of the joint to make an initial assessment, before processing to specialist X Rays.

The X Ray that they would perform would, in all probability, look normal. That does not mean that it is normal, of course!

All I can do is wait for X Ray results next Wednesday amd push my GP for Orthopaedic appointment!
 
Dear Fellow TKR patients,
My TKR journey is well documented on this site. The responses have been informative and much appreciated.

I fear that something has gone wrong with my new knee prosthesis, two years post my TKR of right knee.

I suspected this early in Seotember, with my GP sending me for an X Ray. However, the radiologists advised me that an ordinary knee X Ray would report normal and that specialised scans of the knee would be required to identify any problems.

Things settled down for me, but have now flared up again, quite significantly.

I experience a lot of pain when coming downstairs, sitting, getting up from sitting position and for other general movements. Hard to describe, but very painful and just doesn't feel right!

The heavy 'clunking' of the new joint doesn't help, although I believe that this is quite normal.

My knee surgeon is one if the very best and also specialises in TKR revisions. My next TKR review with him is not until November 2021.

Can anyone provide an opinion with regard to possible cause of my symptoms and advise what steps I need to take to have my TKR assessed?

Many thanks in advance!
 
@Scouseman
You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
Please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we will get it changed for you.

If you need an urgent response to a question, just tag a member of staff.

I read through your recovery thread and it appears this has been an ongoing problem for quite some time. I does sound like your implant may be loose. However the only way to confirm is via your consultant and an x-ray or MRI.

I would call your surgeon's office and see if you can get a consultation. It may be a challenge as wait lists for orthopaedics are huge these days. But if you can even get a phone consultation and get referred for diagnostics at least you are moving forward.
 
Thank you Jaycey,
Apologies for causing you any inconvenience!

I will attempt to start the process of further investigation!
 
@Scouseman No apology needed. You have discussed this problem several times on this thread. Having all your history here helps us advise you.

I really hope you can get this addressed. Our NHS is in a dire mess these days. But I have heard surgeons discuss ring fencing areas for orthopaedics.

Let us know how you get on.
 
Thank you Jaycey!
Of course, I will publish any updates to this forum, which has been invaluable to me!
 
I hope you get answers, and a solution!
 
Do you think the prospect of a loosening is realistic, given my age and short period of time post the TKR? I was 56 at the time of the procedure, two years ago.

Perhaps the following may be of relevance?

My procedure was not straightforward. I have been informed that my surgeon was not happy with the initial fit of the new prosthesis, to such a degree that he actually removed it and repositioned it once again.

I am imagining that this process might be a contributing factor, or perhaps not?

I welcome any opinions, as always!
 
It‘s so easy to speculate on what is wrong, when we have problems, but without an xray and extensive exam by a knowledgeable revision specialist, we don’t know for sure. And sometimes a surgeon just has to go inside the knee to know for sure.

When I was one year post op I had symptoms of a loosened implant, and I guess technically I still do, at almost 4 years now. I’ve had 2 second opinions, but neither surgeon looked past my X-ray to find a cause of my discomfort. The second surgeon really did study the new X-ray he took that day, and described what we would see on it, if it was loose, and showed us that nothing showed loosening. But other than simple bloodwork, he was sorry for my discomfort, and didn’t offer any further testing.

Since then I’ve come up with several theories as to what is wrong with my knee, but I may never know. What I have is fairly uncomfortable, but not actually painful, but after 2 unhelpful second opinions, I’m just living as best I can with what I have. It’s manageable, and for that I am thankful. I’m not in any hurry for any further surgery on this knee, especially in this covid and lack of appropriate pain medication days we live in right now.

I hope you can find an answer to the pain you have.
 
Hi Jockette,
Thank you for taking the time to provide such an informative and helpful response.

It would appear that a general X Ray is sufficient to provide a surgeon with the necessary evidence to confirm or rule out loosening of the prosthesis. Why the radiographers advised otherwise is a tad confusing.

I, like you, would not wish to rush into further surgery if a loosening was confirmed and such an option was deemed appropriate.

However, I must admit to not being enthused by the prospect of having to endure, for the rest of the lifetime of the prosthesis, such symptoms.

Or maybe I need to resign myself to this being the trade off for total elimination of the arthritic pain?
 
Scouseman said:
My procedure was not straightforward. I have been informed that my surgeon was not happy with the initial fit of the new prosthesis, to such a degree that he actually removed it and repositioned it once again.
Click to expand...
This isn't unusual. There is a lot of measuring and assessing the implant positioning during the procedure.

Let us know how your phone consultation goes.
 
Thanks Jacey,
Perhaps I presented a degree of inaccuracy? The repositioning/resiting of the joint was presented to me as an aspect of a procedure that normally takes my surgeon 50 minutes taking just short of two hours.

The surgeon further explained the importance of total completion within two hours for release of the tournoquet.

All in all, it was not a straightforward procedure. I may not have all of the details as to why, but just trying to establish cause of my worsening symptoms.

My GP will have at his disposal the Radiographer's report of my knee X Ray taken in September.

I shall discuss the contents with him during our telephone consult on Thursday. If the X Ray report is not positive for any loosening, given Jockette's experience, I might decide to leave it at that.

Of course, I will update the forum with the outcome of the telephone consult.
 
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