Revision is my future!

[Judy.judy.judy]

Hey Smarties, I went in for a second appointment with new OS today who was orignally going to just resurface knee caps. Bad news... the possibilities today look like I need total revisions. As he examined my knees again today, (he did the last exam in April) he said they are extremely unstable. They hyper-extend so the spacers are too thin and the play on the side to side movement is getting so bad they move around when I walk.
A bone scan will decide exactly what has to be done, but he said today total knee replacements instead of just a resurface my be in my future!:shk:
If you guys remember I had my Bi-lats screwed in with no cement, so scan will be helpful to know what is making them move side to side so much. I do not exactly understand what causes them to move side to side? My husband was with me at the appointment, and I think we just stopped listening completely when he said totally new TKR'S Any ideas? I am a basket case right now! Another year recovery!

 

[Jamie]

Judy, I'm sure this is very frustrating for you! Is there any way you can post your xrays or CT scan here so Jo could look at it?

 

[Max Wallace]

Sorry to hear you are having trouble, we are here for support.

 

[ship4]

Judy,
Will the new OS be using bone cement this time rather than trying to make a peri-menopausal woman or a menopausal woman try to grow bone? It is really difficult. I know a woman who had one knee done without cement and the prognosis was for the bone to grow in around the replacement over 18 months..... That is WAY to long IMO. Hopefully you will have a much better recovery.
I was 58 and now 2 years out I rarely think about my knees. I do wish the same result for you after this revision with this new OS.
Positive thoughts are heading in your direction. How soon will it be, before the revision?

 

[RestAssured]

Hi Judy,

I know all about revisions but for a different reason. I went in to see my doctor and was in the OR 2 hours later!:shk: No time for decision making at that point. If you need to talk, I am always available.:cnsl:

 

[Josephine]

Was there a reason you had uncemented knees? Please remind me.

I've not come across a knee replacement with screws before. Sounds odd. But having cemented redo seems the way to go.

Uncemented knees are always more risky because, unlike hips where the prostheses are impacted into the bone by weight bearing, the nature of the implants in a knee is largely to be sat atop the tibia and femur. Thus there is a lot of shearing forces applied as once walks around. This will have an effect upon the bone ingrowth into the surface of the implants and so the risk of loosening is somewhat higher. Even with screws its higher. Screws aren't often equal to those shearing forces which can be pretty powerful. And moving side to side is what loose knee replacements do!

I hope you're not going to let the same surgeon do these revisions? When he's already fluffed it once. If it were me, I'd sooner find a surgeon who makes a practice of doing revisions. There's a skill in diagnosis and treatment that is somewhat different to doing primary TKRs.

Crystal, it's nothing to do with age per se but rather osteoporosis which will lessen the quality of bone growth, though it doesn't really happen all that often probably because so few uncemented knees are done. When you think about it, the vast majority of TKRs are done in menopausal or post-menopausal women! Can't think why your friend was given a time frame of 18 months. :skp: If bone ingrowth hasn't happened within about 6 months then it's not going to.

 

[cotton1958]

I think Judi said she has a new OS. I hope you get this taken care of soon, and I sure am sorry you have to go through TKR's again. I have high hopes of your surgery going well this time. If these are considered revisions, it does seem peeps on here have had super success with them. Anyway, glad you got another opinion.

 

[Judy.judy.judy]

Jo, I did not know I was getting cementless TKR'S! :shk:The first time I saw them was at my first appointment with my OS AFTER I had the surgery. I will admit that I did not know that much about the actual TKR process until I found this site after my surgery. When you start having trouble or something doesn't seem right that is when you start searching for answers.
Anyway, I "interviewed" three revision specialists from three different hospitals, and unlike I thought, I got three of the SAME opinions, patellas need resurfaced and all three said they have never seen TKR'S put in this way. All three suggested that I wait for a while because things might get better or I could feel I could deal with the pain enough to not have to go through surgery again. So my husband and I picked the OS we felt best about in April. We went in yesterday, our second time seeing him, he said they are getting worse not better, a complete redo MAY be in the future! I have to say I knew they were getting worse, I have been unstable and pain was getting bad. I have a bone scan scheduled in October to pin point exact failure. If it is the tibia plate that is not holding right, he said he can't mix and match replacement parts, as he said he would not use the kind that are currently inside my knee.
I have some x-rays on a disc, I just can't figure out how to post them! I am really slow in the technology dept!
Crystal, I have terrific bone mass I had a DEXA scan a few mos. before TKR's, although I know I am "peri".

 

[Leftoutknitter]

I'm in the same ship. Met new OS yesterday. "Total TKA failure" options, a knee brace all the time or revision. He also said it was because one of the components was too thing, he explained wonderfully how the thin component allows for the loose/side to side shifting and how I feel clunking and instability. He showed me films, showed me the cement and how it was actually well healed. As I had a bad bout with infection, he also laid out how HE deals with infection and how it differs from what I had experienced in the past. I sincerely hope this experience is faster than the last. I know now that it will be the WORST pain of my life and that I will be frustrated and have to work HARD, but I believe I can get through this easier if I can avoid the complications of last time. Surgery scheduled for October 25th. My choice. I have some things I want to do before surgery, things with family and some big obligations I have. OS is ordering a Donjoy brace to help stabilize knee until surgery as it is going to be months.

 

[Judy.judy.judy]

Hey leftout, Thanks so much for replying to my thread! I now know someone is in my situation and we can do it together! My surgery is scheduled for Nov. 2. I fortunately did not have infection, but the slipping and the thunking and clunking have made life miserable and painful! I have such good ROM (of course now I know why) that is the only positive thing about this TKR. Now I am afraid of other things including infection, as I get ready for the re-do. I have bi lats so I will have to do the second knee too as it has more slippage but less pain.
I wish you the best, lets keep in touch.

Hey Jo and Jamie (and anyone out there), Are there more complications when going in the second time. OS said you cut in the exact same scar, is there more scar tissue after?. What happens to all those nerves that are cut again? Another tourniquet, so more varicose veins for me?

 

[Jamie]

A revision surgery is actually a little less difficult for the patient because the major bone cuts are already done. There still is a lot of work for the surgeon, but your recovery will be no worse (and possibly a little easier) than your original TKR.

 

[RestAssured]

The revision was the worst part for me! It hurt like heck, a lot more than the TKR. I believe the reason mine hurt so bad though was because I had MRSA and it is one of the most painful infections that you can get. Your TKR will most likely give you a lot of relief since you don't have any infection. I think it is the answer to your prayers!:D

 

[Leftoutknitter]

I really think my complications (constant seizures and the MRSA) are what made my recovery so long and drawn out and eventually got me where I am. I am cautiously optomistic that Judy Judy Judy and I can get through this as buddies. I am hopefull there won't be a lot of bone loss.

 

[Josephine]

I will be frustrated and have to work HARD

Actually this is a myth. Recovery depends as much upon giving the body a chance to heal with rest, elevation, ice and pain meds as with aggressive exercises, especially in the first 4-6 weeks.

Judy, I shouldn't think you'd want any of that stuff left in, would you? Much better to have it all replaced with better stuff and start from scratch.

 

[Leftoutknitter]

I don't remember, but my mom came and stayed for quite a while after. She says I elevated and iced and took pills as prescribed, but I still had a very hard time. It was super frustrating for me not to be able to walk. Not getting the knee to bend, the dependence on other people are equally hard for me. I am fond of control and strength.

 

[RestAssured]

Judy and Leftout, I will keep both of you in my prayers! Leftout, are you having the same knee replaced that had MRSA before? Do you have the infection again? Judy, I truly hope you find the relief you are seeking. It isn't any fun being in pain all of the time.

 

[Leftoutknitter]

yes, same knee that had the TKA. No MSRA at this time, though I do notice it is hot to the touch frequently, the incision is closed and I have no fever. I have been staph-free for many months. I have a new OS and he knows of my previous infection. I have a note to ask him if he is going to start prophylactic vancomyacin.

 

[skigirl]

Dear Judy and Left Out---what bad news!!! It must be so difficult to hear that!! But, I have to say that my second tkr was much easier than the first--and I hope that you will experience the same thing.

Left out do you have an infectious disease specialist who will assist with the surgery? I think I would like an expert around with MRSA in the picture, just for peace of mind.

Judy, I am so sorry that you will have to go through this again--but hope that this time is smoother for you. The right implant does make a difference. Kelly

 

[Leftoutknitter]

I'll call my old infectious disease doctor and ask if they want to be around and at least make them aware of my surgery date/location. Good idea!