TKR Problems after TKR

ClaireL

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Hi, this is my first post here after occasionally lurking and being impressed. I had a TKR last June and have followed through with PT. However, a couple of things seem to be going wrong. X-ray shows that my kneecap has moved laterally. This doesn't cause any pain, but it concerns me because I have Ehlers Danlos syndrome (a connective tissue disorder) that required previous surgery to correct dislocating kneecaps. That surgery caused severe osteoarthritis and had to be undone in order to replace the knee. So I am concerned that my connective tissue isn't strong enough to keep the kneecap in place. The other problem is that when I move my knee while it is not flexed, there is an audible clunking sound. My PT heard it and was alarmed. This, also, does not hurt.

From what I can gather online, some of this might be correctible with PT--however, that hasn't worked. Obviously, a conversation with my orthopedist is planned, but in the meantime I just wondered if anyone has more information about either of these two problems and what can be done about them. At this point I think I'm hoping for revision surgery before trying the same thing again with the other knee--scheduled for May. Any information is welcome!
 
Hi Clairel. You have come to the right place for answers. An advisor will be along shortly to give you the info you have requested. Stay strong. Jcx
 
Hi @ClaireL and :welome: (officially) to the forum.
I'm afraid I don't have any advice or can think off-hand of any knee folks who currently could respond to your questions.

Here’s a list of links our Nurse Emeritus put together for EDS patients facing joint replacement. https://bonesmart.org/forum/threads/ehlers-danlos-hypermobility-syndrome.35912/

If you do a search of the forum (search box at top of page) for Ehlers Danlos Syndrome you will find other threads where this topic is discussed and where patients with it have had joint replacement. It comes up every so often. I wish I knew more so I could help you.
 
Thank you! I sort of figured this would have to wait for my doctor, just exploring all avenues. I'll check out those links--thanks again!
 
ClaireL,
The clunking you are experiencing is normal, Clicking/clunking knee joint after surgery. Usually it clears up as your leg strengthens.
It is also not uncommon for people to have a problem with a kneecap moving laterally after TKR, usually a
Lateral release in a knee is performed, but in your case this may not be appropriate.

Because of ligament instability your surgeon is the best source for answers.

Please post your surgery date, a moderator will add it to your signature for you. Having the exact date will help us properly advise you. Thanks!

Keep us posted on how you are doing.
 
Thank you. My surgery date for the second TKR--unless another procedure on the first leg interferes--is May 3.

I know some noise is normal. I should have added that the reason for my physical therapist's concern about this noise is that she was testing my knee, having me move it with her hands on it, and actually felt an abnormal movement along with the loud clunk. I've asked her to put in words what she felt, and will edit it into this post when I hear back. It was something like one bone overshooting the other, but that's a very crude rephrasing. Hope to be able to clarify soon. Again, thanks for the information.

Okay, just heard from my physical therapist: "You have anterior laxity of your knee causing a clunk with an anterior shift or anterior drawer test. It allows your tibia to translate too far anteriorly creating an instability and a clunk."
 
Last edited:
Thanks for your upcoming surgery date. Please give us your surgery date for June 2021, and which knee.
Apologies for not making that clear.

Curious if you have a hinged knee? I damaged my ligaments and had a revision with a hinged knee. It stabilizes all the ligaments, and allows full knee flexion and extension. My ROM is 0 to 125, and my knee is very stable.
 
Oh, I see. Last year's surgery (right knee) was June 1. This year's surgery (left knee) is May 3. The current problems are with the right knee.

Vocab, as my son would say--no idea what a hinged knee is, or ROM. Computers? Oh, that's RAM. I am dummy.
 
A hinged knee is stabilized by a pin, I am going on 7 years, no problem.
rotating hinge 2.jpg


Here is some information about ROM (range of motion) information

You will have to ask your son about RAM.
 
Oh, got it. My physical therapist measures me that way. It's the one thing I excel at--bending! (Because of EDS.) I have no idea what kind of joint my orthopedist used, will have to ask. The problem with my ligaments (and tendons, and other stuff) is that they are just way too lax and stretchy, and also not all that strong--one snapped in the middle of the street once, and I had to hop to the curb and cling to a lamp post till some nice man assisted me back to my office. So, whatever is done in the future, it will have to correct for that laxity and weakness, or somehow bypass it. I may just be a poor candidate for this kind of surgery. But end-stage osteoarthritis demanded it.
 
Posting this here again to make sure it's seen. My physical therapist says, about the clunking, "You have anterior laxity of your knee causing a clunk with an anterior shift or anterior drawer test. It allows your tibia to translate too far anteriorly creating an instability and a clunk."
 
ClaireL,
The anterior drawer sign is for a lax or torn ACL. You should not have that much play in your joint. Your PT should report that finding in her regular reports to your surgeon.

I am going to leave you our post op reading, even though it is 9 months from your surgery, you will find the articles informative and helpful for your upcoming surgery.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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 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.

 
Just thinking out loud here, I'm really wondering if your ED isn't causing this issue. I have an acquaintance whom has AD so I know about a thimble full about it. Have you discussed this with your ED physician? That might also be in order here. How is your walking? A steady gait? Just trying to help you figure this out.

Let us know what you find out.
 
Thanks, both of you. I'm sure EDS is involved. I don't have an EDS-specific physician and don't know how to find one. Searches just turn up general rheumatologists. I live near Boston, so there should be someone. My surgeon does know I have EDS. I also think that the shifted kneecap is probably EDS-related. This is why I'm particularly concerned. I don't think rest and ice will do it if it's my own lax tissues that are the problem. It hasn't improved after weeks of rest and elevation and ice. In fact, the tibia stuff began immediately after surgery and has only gotten worse. I now question having the second TKR, but my arthritis is end-stage. I feel like no options are good at this point. The frustrating thing is that before having the surgery, I raised the question to my surgeon whether it would be a good idea given my general laxity and specifically because it would require undoing a previous surgery that corrected dislocations, and he reassured me that many of their patients had EDS.

But to get back to the advice, yes. I'm waiting to hear back from my orthopedist and in the meantime searching for an EDS specialist. Thank you.
 
Hello, I just wanted to ask if you found any answers? Did your right knee get better with just PT, or did you have a revision, or are you in the middle of still trying to figure it out? How did your left TKR go? Wishing you a good recovery for knee #2.
 
Just now saw this post. I am Claire, re-registered as Violet because I have a shoulder replacement coming up. No, the problems did not subside. They are worse now, as I described in another post. Just as I predicted when the surgeon said they would be undoing previous surgery to prevent dislocations, it seems my tendons and ligaments are not holding my kneecap in place. A new orthopedist is alarmed, and I may have to have revision surgery. Right knee functions fine but apparently is unstable; left wants to subluxate, and does, a few times a week. No pain, just fear of dislocation.
 

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