PKR Reoccurrence of pain after Episealer implant surgery.

[Celina]

I've had 5 years of an OCD (cartilage and bone) lesion in my medial femoral condyle with different failed surgeries. Now in May 2022 I had the Episealer plug and after initial recovery everything seemed to go very well. At 4,5 months I was pain-free, 6 months I finished PT, 5 months I started my new hobby wall climbing (great for strength, mobility and endurance for my legs). I was pain-free for about 3,5 months and then suddenly without a warning I had sharp stings in my medial femoral condyle (implant side) while walking the stairs. The sharp pain lasted a few days but then decreased, I think mostly due to movement and activity modification. Instead I got a very annoying pressure inside my knee that is hard to get rid of (actually only ice seem to work long enough to fall asleep). I first thought about overuse so I took relative rest (no climbing and limit knee strenghtening exercises) for 6 weeks. I recently been to my OS and physical exam and x-rays are fine. He said my knee still needs to adjust to the implant and with 2 more months of relative rest it should heal. I really hope he is right but I am doubting it since I can't find any similar story on the internet and I think with the 6 weeks of rest I have already taken it should get better not worse. Since about a week my knee turns warm again after inactivity, this happened before surgery as well. I am back to icing, brace, cycling on my hometrainer and limiting activities but still my keeps me awake a lot. I really thought I would be passed this physical knee stage.
Has anybody experienced the same? Or any great advice what I should do or what it can be?

 

[EalingGran]

I am sure a staff member will be along soon with lots of good advice.
I had never heard of an Episealer plug but I just looked it up. It seems to be a custom made mini partial implant for younger people with very focal damage- is this correct?
I had a lateral partial almost 5 months ago- so am very interested in partial knee surgery. It must be a worry having pain after being pain free- especially if it is near where the implant is. Does your surgeon think there is some soft tissue injury/ strain to explain the new pain if he says the implant is ok?
I still have some residual medial pain ( mainly on stairs ) which my surgeon says is due to my MCL having been chronically overstretched by valgus forces pre-op. It is resolving but is very slow. I wonder if your pain could be something like MCL pain?
I know MRIs may not be possible with some implants but I think some people do have them post implants. An MRI would show soft tissue issues that wouldn't show up on an X ray. I would be wanting an answer to explain things if I were in your place.
So sorry you are in such pain.

 

[EalingGran]

Just did a search on the site and can't see anyone else who has had an Episealer plug implant.
But wonder if any of the staff @Jockette
@Layla or @Jamie might have more information on this type of implant?

 

[Jaycey]

@Celina Welcome to BoneSmart! So sorry you are still in pain so far out from surgery. Unfortunately I don't remember any other members having the implant you were given.

If your original surgeon is not willing to investigate this, do you have the option to get a second opinion? This could be a soft tissue injury. But the fact that your knee is warm regularly is a bit concerning.

What was the date of your surgery and which knee? We will put the information in your signature for you.

 

[Celina]

Thanks for your kind messages and effort @EalingGran . Episealer is indeed what you describe. I was already in a hard place mentally from the past 5 years of pain, despair, limitations, ups & especially downs. At the moment it is not really painful but more like annoying pressure and irritation which is just worse enough to bother me through the whole day and prevent me from sleeping. Just all the thoughts that come with it: is it starting all over, when am I able to do normal things, will it get worse again. I was just getting used to being able to lead a normal 33 y old live.

I have asked my question on 3 different fora but only here I did get a reply. I tried to search for keywords but that is really complicated. Beside that, I also send a message to Episurf (the company behind the Episealer) hoping that they can give me an explanation.

In the past week I have done a lot of (scientific) research and attempts to try to find just one person who experienced the same. Because focal articular resurfacing implants are rare and Episealer is even rarer I extended my search to all PKR and TKR but even while reading about survival, revision, adverse events, complications from that I couldn't find a similar story (painfree and back in pain). The things related to the implant that I can't rule out are a hairline fracture and metal allergy.

Maybe it is a good thing that I can't find it because that might mean it is something with my soft tissue either related of unrelated to the implant. I don't think it is an MCL strain because that pain more to the side of the knee and I had no problems with the wall climbing in the past 2 months. My pain is left under the kneecap (medial femoral condyle). Most soft tissue injuries require (relative) rest, ice, strong and loose muscles and time. So that is what I have been doing for the past 8 weeks. I do some exercises at PT once a week with with one quad and one hamstring strengthening exercise and some hamstring stretch (left knee is most tight because of all the right elevation).

Thanks for your reply @Jaycey my surgery was May 11, 2022. I had an Episealer femoral twin implant inserted in my right knee (medial femoral condyle). Just because it might be interesting I send my damage report from the Episealer MRI and two x-rays from the day after surgery. The "double-round" is the Episealer implant. Feel free to ask any questions! The strangest thing is I was completely pain-free for 3 months and then without warning I had these sharp stinging and since then rest didn't decrease my symptoms but it actually got worse. My symptoms also become more similar to my pre-surgery symptoms. For a year I couldn't sleep a full night without my ice macine. I do have trust in this hospital and their doctors. They are specialised in cartilage damage of the knee. My pre-surgical MRI (6 months before surgery) showed no soft tissue damage (although this Episealer damage report says medial meniscus is damaged my doctor disagrees).

I might refrase my question to: did you or do you know anybody who had an implant, was pain-free after a couple of months to a year and then after a few months was having pain again? Thank you

 

[sistersinhim]

@Celina, I am going to edit your title and add the Episealer implant to it. That might help someone who has knowledge of that to speak up. If you would like it to say something else, please let me know and I'll be glad to change it for you.

 

[EalingGran]

Really interesting pictures and report.
Is it possible that the Episealer report was right and there was a small medial meniscus tear which has got worse and is causing the pain?
If you were pain free then there has to be something that has happened.

 

[Jaycey]

I might rephrase my question to: did you or do you know anybody who had an implant, was pain-free after a couple of months to a year and then after a few months was having pain again?

Yes, we see members who have had partial TKR go to full TKR after a number of years. The reasons are a long list. Sometimes the implant is loose for various reasons. Infection or an allergic reaction to the implant are also issues we see here. Here's a link to a list of threads about members who have had Revised PKR to TKR.

 

[Jamie]

@Celina ... I'm sorry that we don't have anyone on BoneSmart who has experience with this particular implant. I think you are doing the best thing by following your surgeon's advice and slowing down your activity and exercise. It is possible that things will settle down in a few months. But it's also possible that something else is going on, so please don't hesitate to continue communication with your surgeon if it continues to bother you or if the pain worsens. I know it's difficult to put your life on hold for an extended length of time like this, but if it's just a matter of your body adjusting to the implant, your patience will pay off.

Please continue to let us know how you're doing. We'll be here to support you!

 

[Celina]

@sistersinhim thanks for changing the name. I think it will be more convinient if somebody will search for this specific implant. Although the search function is really great here on BoneSmart. I actually didn't know about all the filters so thanks for showing me @Jaycey . I still haven't found a similar story but my knee is so complicated anyway. I saw there are also some hemicap and unicap stories which are near similar devices (not patient-specific)

I probably panicked a bit too much after so many sleep deprived nights, I am a bit calmer now but still worried. Must say the last couple of days my knee behaved better than expected (that doesn't mean good but less heat and less irritation) wondering if it is due to healing or all my adjustments.

After finding the recovery chart from here I Googled a bit and I found this interesting website: evolveflg.com/articles/tissue-healing

Main messages:
- No pain doesn't mean that it is healed.
- pain can feel more severe in a tissue / joint that has previously been hurt (papercut-pain).
- There are other (influencable) factors that can contribute to proper healing.

I did 5 months of PT and waited 6 months to start wall climbing (with approval of my very knowledgable pt). This pain is still confusing to me and it started mostly as a meniscus injury (sharp pain rotating and inner knee pressure). @EalingGran I got some pictures from the MRI in my Episealer damage report. I did a 2 minute crashcourse of learning to read an MRI for meniscus injury and I can't find anything on it. Also all MRI's are checked by a radiologist as well and he only reported some scaring on the hoffa fat pad (which according to my surgeon shouldn't by symptomatic).

I wasn't expecting a reply and especially not so quick from Episurf but they replied to my message with the request for my emailadres so it is really kind of them to take time to address this

All the support from everybody is really making me feel better. So thank you! Lets end with a quote from my surgeon in my medical records: "is still happy with the surgery because preoperatively it was a mess.

 

[EalingGran]

Glad you are feeling better.
That is an interesting and reassuring website. It makes sense what they are saying about pain and tissue healing.

 

[sistersinhim]

@Celina, I noticed that the site you recommend doesn't list the after-surgery healing time, though healing from surgery is the toughest injury there is. Each area was listed as having up to 12 months to heal. Some are even finding that healing from a joint replacement takes over a year for them. This is an individual thing and not a set schedule. No one should expect it to be the same as someone else's.

 

[Celina]

My psychologist adviced me to not try to look too much for a solution on the internet but to have trust in my doctors. I got a new appointment next Thursday because it still is (slowly) getting worse. I am back to sleeping with the ice machine because I couldn't sleep a full night without it anymore. I am so glad such device exists! I am also icing more during the day.

@sistersinhim Episealer got a really short recovery timeline except for muscle strength. I think I was on track until this happened. With that website I meant that my pain can feel more severe because my knee has been bothering me for 5+ years now with 4 surgeries and several injections.

I actually received feedback from the Episurf company. We had a call yesterday and they discussed my situation in their team and they don't think it has anything to do with the implant which would be great news. They expect it to be the meniscus and adviced me to ask for a CT-arthrogram (CT with contrast fluid) because the implant wouldn't interfere with the imaging and it should show all the structures. So I will ask for that on Thursday.

 

[EalingGran]

Good luck with your appointment. Hope that the appointment and a scan gets to the bottom of your issue.

 

[Celina]

We decided to go for an MRI with MARS protocol (metal artifact reduction sequence). The CT arthrogram would give an, although small, risk of infection. My doctor was positively suprised that I contacted Episurf. I really hope this MRI will happen soon and will show what is wrong .

​

 

[Jaycey]

Well done on advocating for yourself! It can be daunting trying to direct the medical profession in another direction. Hope you get that MRI soon.

Please keep us updated!

 

[EalingGran]

Glad you have some progress. Really hope it gives you the answer. It is useful to learn about the kinds of investigations that are possible after knee implant surgery.

 

[WFD]

We decided to go for an MRI with MARS protocol (metal artifact reduction sequence).

If you were willing to post an image of the MRI result I would be very interested to see how well the MARS protocol works, and I'm sure other people would too. I'm still struggling with issues and it would be good to know if I can ask for this from my surgeon and know that it would work.

 

[Celina]

I got my date for the MRI. It is on May 8th. Unfortunatly I need to wait till the 1st of June for the result due to a Dutch holiday and my doctor's vacation. I will try to get a picture. I usually don't get the imaging but I will ask for it and share it.

I (re)started with aquajogging last week. It is a good non-loaded activity and in the water my knee barely hurts. Unfortunatly my knee will react afterwards and be sore/hurts the rest of the day but it just feels so good mentally to do something special .

 

[Jaycey]

Unfortunatly my knee will react afterwards and be sore/hurts the rest of the day

Ice is your friend! Ice for 45 - 60 minutes several times per day.