Revision TKR Revision RTKR due to laxity in ligament 3rd March 2015

[skigirl]

I think you will be fine with this thread--it is a year after your tkr and you have a different problem now, so don't worry.

I have described my own surgery to remove scar tissue (adhesions)below, but first I want to tell you that you should try to see a revisionist for a second opinion before you do anything else. A revisionist is simply a surgeon who has done a lot of revisions and is able to look at the knee and assess it for you. I am going to tag @dgwrigh for you as you both seem to be in the same boat!! Also, I will tag @Josephine for you. I f you will let us know the hospital where you had your surgery and your surgeon, Jo, who lives in the UK should be able to help you with a name for a second opinion.

Scar tissue (adhesions) is removed by two methods--Open or Arthroscopic. the Open method involves an incisions while the second method uses "scopes" to enter the knee. I have had an "Open Lysis of Adhesions" and it was about a 2 week recovery for the surgery although the rehab had to be slow and was therefore about 4 months.

 

[chereb]

Not posted in a while as no change really. Still getting the anterior pain ect. Had an appointment and the swelling in front is not fluid but scar tissue. They are saying that they think its either impingement of scar tissue within the joint and/or a gliding problem in the kneecap which may need resurfaced. Back for xrays in 10 days to see the kneecap and discuss what the outcome is.


Osteotomy January 2009
Osteotomy revision September 2009
TKR 1st November 2013

 

[Josephine]

Any updates yet, @chereb ?

 

[chereb]

Not yet @Josephine i go back Monday morning for the xray although im not sure impingement would show on an xray?

 

[Josephine]

You never know!

 

[chereb]

@Josephine xray was clear he said knee looks good. No infection. After examining the knee he said the ligament is loose and also thinks my kneecap needs replacing. He wants me to have a second opinion then consult afterwards.

 

[Coachie]

Was your kneecap not resurfaced in your original tkr?

 

[chereb]

No the kneecap was left intact. I have no idea what all this means :-(

 

[Josephine]

What it means is that your surgeon is most likely thinking of going in again and applying a patellar button.

 

[chereb]

He said he has also never had to repair a loose ligament after TKR. Does anyone know anything about loose ligaments?

 

[chereb]

Surprised at the speed of second opinion appointment. Thursday is the day. Nervous!

 

[skigirl]

Several people here had dealt with loose ligamens---usually the surgeon would take care of that with the first surgery. Most folks in the US get a patella button as a standard thing---but you are younger and maybe your patella was in better shape than mine. Good luck with the second opinion

 

[Phil75070]

Balancing ligaments would seem to me to be totally related to a surgeon's skill. Cutting guides, computer aids and other tools that come along with the prosthesis would seem to me to standardize those results but are there tools that can actually measure how loose or tight ligaments are during the procedure or is that just one of those "feel" things?


Sent from my iPhone using BoneSmart Forum

 

[chereb]

I have no idea. He said ligament was loose at around 3 months and it would tighten by itself. Obviously it hasnt. I had computer navigated surgery. The reason given for the kneecap being untouched was that its not standard practice here. I am 43 so this knee is supposed to last me a few years i would hope. I have insisted since 3 months that it is not right. Too painful/swollen and rom issues. I was told it would settle which it never has. I have had 6 years of surgeries on this knee so far. An osteotomy which failed and the femur ended up splitting fully and was only held together at the other side with the plate, that caused the knee joint to collapse. My leg went banana shaped and i was in tremendous pain. It took 6 months of saying something was wrong. The plate was too big for my leg also and caused other pain and stuck out of my leg. I was told it was healing and pain expected. This was more than that and as discovered i spent 6 months doing intensive physio and walking on a broken femur and collapsed joint. I was taken in within the week (9 months after the op) the osteotomy was revised and the bone knitted that time.then the next plate had to be removed due to pain and then the knee was debrided after that. Then i had the tkr. I really thought that would be the end of it.


Osteotomy January 2009
Osteotomy revision September 2009
TKR 1st November 2013

 

[chereb]

Hi guys back from my consult. Other surgeon agrees with loose ligaments and said he wants to take out the whole knee and replace it with a hinged knee. My head is swirling at the minute. He said that the knee alignment is perfect but where its been bent for perfect alignment its possibly made it over corrected causing the loose ligament. He said the instability will get worse and pain will continue if its not revised.
@skigirl @Josephine why cant the ligament just be fixed? Just thought of this after.

 

[Josephine]

is that just one of those "feel" things?

Pretty much, yes it is. Ligament balance is nothing to do with the actual replacement any more than balancing wheels on a car is to do with the engine. Rough simile but you get what I mean!

@chereb can you tell me which hospital and surgeon you are going to? I think it's time you had a second opinion.

 

[chereb]

@Josephine i have pm you details

 

[skigirl]

Good idea, JO!!! I think that sounds a little drastic and a second opinion is needed. It does not even make sense to talk about the knee being "bent for perfect alignment".

 

[chereb]

Sorry perhaps worded that wrongly regarding bend. The femur was moved at an angle to straighten up the leg. Previously the femur had been broken during osteotomy. Im not an expert in the words used lol. i didn't even realise that it was unstable. I had during walking ect episodes where it feels as if it goes out to the side and back. He said this is the prosthesis slipping out of the joint due to the laxity of the ligament. This was only happening now and again so i never thought about it much. It is however happening multiple times a day now which is why i brought it up. Whilst walking it feels as if it swings inwards. Having never had a knee before i assumed it was an artifical knee thing.

 

[skigirl]

Wow, you have been through the wringer with this knee and femur. I am so sorry that you have had this pain and problems. I think the ligament is loose because the femur was moved at an angle. That is a tough one. I know that Sonja @RestAssured and Abby @RunA42K both have hinged knees and are doing quite well with them, so I don't think you need to fear the hinged knee.