Josephine
NURSE DIRECTOR EMERITA
United KingdomYou actually don't need such a 'specialist', even if there was such a person. So far as surgery is concerned, AVN is not that dissimilar to osteoarthritis and the treatment is exactly the same - a TKR
TKR Replace or not replace, that is the question
- Thread starter simryg
- Start date
Jo's right. Frankly, I don't think you necessarily need a revision specialist to look at your left TKR. You just need an experienced surgeon to deal with your bad right knee. AVN can bring a tremendous amount of pain and disability. My feeling is that you have been pushing to take care of your family when you probably should have just gone ahead and had your right TKR. I think your body trying to compensate for the pain in that knee is what is causing your discomfort in the left one.
That said, I can give you the following names for New York City revision specialists. They obviously can do a primary TKR too, so if that makes you feel more comfortable to talk to someone about your left knee at the same time you are scheduling your right TKR, then go for it.
Dr. Scott Marwin
761 Merrick Avenue
Westbury, New York 11590
(516) 357-8777
New York City Office
333 E. 38th Street
New York, New York
(646) 501-7300
Edwin P. Su - Primary TKRs, works with hand held navigation for better implant placement and balancing of knee ligaments. Hospital for Special Surgery, New York City
Hospital for Special Surgery
535 East 70th Street
New York, NY 10021
212-606-1000
https://www.hss.edu/physicians_su-edwin.asp
Revision surgeons at Hospital for Special Surgery, New York City (in order of their work with revisions both hip and knee):
Dr. Goeffrey Westrich
Dr. Russell Windsor
Dr. Seth Jerabek
Dr. Michael Cross
Dr. Michael Parks
That said, I can give you the following names for New York City revision specialists. They obviously can do a primary TKR too, so if that makes you feel more comfortable to talk to someone about your left knee at the same time you are scheduling your right TKR, then go for it.
Dr. Scott Marwin
761 Merrick Avenue
Westbury, New York 11590
(516) 357-8777
New York City Office
333 E. 38th Street
New York, New York
(646) 501-7300
Edwin P. Su - Primary TKRs, works with hand held navigation for better implant placement and balancing of knee ligaments. Hospital for Special Surgery, New York City
Hospital for Special Surgery
535 East 70th Street
New York, NY 10021
212-606-1000
https://www.hss.edu/physicians_su-edwin.asp
Revision surgeons at Hospital for Special Surgery, New York City (in order of their work with revisions both hip and knee):
Dr. Goeffrey Westrich
Dr. Russell Windsor
Dr. Seth Jerabek
Dr. Michael Cross
Dr. Michael Parks
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simryg
member
Thank you @Josephine, why I asked for someone specializing in AVN is because prior to my left TKR, the surgeons I saw in NY did not want to attempt operating on me because my AVN involves multiple areas in the knee and it is widespread. My surgery was over 7hrs, as the knee collapsed and the bone was too soft to get the prosthesis to be secure. Had to be redone three times, ended up needing long stem both components.
@Jamie, thank you for the recommendations
Any that come more highly recommended that the others?
I will try to research which dr I should set up appointment with.
@Jamie, thank you for the recommendations
Any that come more highly recommended that the others?
I will try to research which dr I should set up appointment with.
Josephine
NURSE DIRECTOR EMERITA
That's not uncommon with AVN.
Well he should have planned to do a long stem knee from from the get go. I think he probably didn't really know what he was doing.
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simryg
member
@Josephine , what is the test that helps determine if there is loosening of any of the replacement components? Bone scan? Want to know what test to request
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simryg
member
@Josephine, @Jamie
I was seen by Dr Michael Cross (thank you @Jamie for referral) finally had mri done. This is the report
“The patient is status post left total knee arthroplasty. There is no periprosthetic fracture. Sequelae of prior medullary infarction are again seen, preferentially involving the left distal femoral metaphysis. There is prominent fibrous membrane formation along the flat portion of the patellar component, and to a lesser extent along the pegs; however given residual cement fill about the pegs, component loosening is not suspected.
Incomplete small areas of fibrous membrane formation are present at the lateral aspect of the tibial tray, without evidence of loosening. Minimal incomplete fibrous membrane is seen involving the anterior flange of the femoral component without findings to suggest loosening.
There is slight edema along the medial aspect of the proximal tibia, possibly slight stress reaction. There is minimal nonspecific synovitis without MR imaging features to suggest aggressive infection. Focal edema is present at the quadriceps fat pad. Mild focal scar is noted in the peripatellar region, without globalized Fibrosis.Scar remodeling of the collateral ligaments is present without disruption. Mild fatty infiltration of the popliteus and distal thigh muscles is present.
There is no extruded polyethylene fragment or evidence of direct neurovascular impingement. Extensor mechanism is scar remodeled but remains otherwise intact”
I was seen by Dr Michael Cross (thank you @Jamie for referral) finally had mri done. This is the report
“The patient is status post left total knee arthroplasty. There is no periprosthetic fracture. Sequelae of prior medullary infarction are again seen, preferentially involving the left distal femoral metaphysis. There is prominent fibrous membrane formation along the flat portion of the patellar component, and to a lesser extent along the pegs; however given residual cement fill about the pegs, component loosening is not suspected.
Incomplete small areas of fibrous membrane formation are present at the lateral aspect of the tibial tray, without evidence of loosening. Minimal incomplete fibrous membrane is seen involving the anterior flange of the femoral component without findings to suggest loosening.
There is slight edema along the medial aspect of the proximal tibia, possibly slight stress reaction. There is minimal nonspecific synovitis without MR imaging features to suggest aggressive infection. Focal edema is present at the quadriceps fat pad. Mild focal scar is noted in the peripatellar region, without globalized Fibrosis.Scar remodeling of the collateral ligaments is present without disruption. Mild fatty infiltration of the popliteus and distal thigh muscles is present.
There is no extruded polyethylene fragment or evidence of direct neurovascular impingement. Extensor mechanism is scar remodeled but remains otherwise intact”
SusieShoes
Former BoneSmart staff member
I'm tagging @Josephine to give an informed opinion about this report. Glad to hear you got to see Dr. Cross and have some answers now!
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simryg
member
@Josephine
Does anything in the mri report seem informative at all and can explain the pain I am in?
I am having low grade fevers of 100-101.5
We are waiting to do another knee aspiration in 2weeks as I was on antibiotics post root canal.
He wants to compare to the one I had in December
Does anything in the mri report seem informative at all and can explain the pain I am in?
I am having low grade fevers of 100-101.5
We are waiting to do another knee aspiration in 2weeks as I was on antibiotics post root canal.
He wants to compare to the one I had in December
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simryg
member
I will try to figure out how to post picture of X-rays
@SusieShoes we don’t have answers yet, we are at the stage of trying to ask the right questions
While it's always great to have the actual report, my question is what does the doctor have to say about your knee and what does he plan to help you improve your pain situation? It would be good if you could post xrays for Jo. You should be able to get copies of any images taken from your surgeon's office. They will usually drop them down on a CD-ROM for you. Some ask for payment for this, but not all do. Then you would upload them to the forum just like you do any photo or image.
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simryg
member
Thank you @Jamie l will go through my file tomorrow to find the disc of X-rays needed. His concern is if there is chronic infection present. Upon physical exam he did feel bit loosening of one of the components was hoping for clearer pic through mri. My dr emailed me after I let him know how unbearable the pain is now plus the fevers I am having. His plan is to aspirate the knee again to see how high the wbc is and to see if any cultures will grow as they did not in December
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simryg
member
Josephine
NURSE DIRECTOR EMERITA
Well, yes and no. It's a rather poor image in terms of resolution - the xray not your picture. So Even though I enlarged it considerably, the resolution just got worse and I was unable to discern anything with any certainty. But there did appear to be some space around the stem in the tibia. How significant that is I really couldn't say.
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simryg
member
@Josephine it might be the cement surrounding the stem. If there is indeed space, it might be what is causing instability and hence the pain
Josephine
NURSE DIRECTOR EMERITA
In my experience, loosing with cement is almost always in the bone-cement interface. Very rarely the cement-metal interface.
