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

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@chereb,

Hello!

I have a Smith and Nephew HK revision and I am out living life again! My replacement had popped loose from the fibula, but mine was due to infection. My leg started going backwards, and it wasn't stable any longer! I was put in a brace for awhile, and then I had the revision. I was 46 at the time. I am now doing things I never dreamed I would be able to do. :yes!:

Life has taken on new meaning and my life is going great! A revision isn't the end of the world; it can be the start of a wonderful life! I am living proof!:happydance:
 
@RestAssured did you find you lost rom or extention after the hinged knee went in? Im just scared that i do this and then it goes wrong again. The osteotomy was not straight forward. To explain i had a distal femoral osteotomy with a hip graft. After 12 weeks nwb i was cleared to put weight on it. I started physio and tge person said that he wasnt sure the rehab for osteotomy but assumed it was similar to TKR and would rehab me that way. Now i felt overworked and very painful. I discussed this and was told its ok. I knew nothing so accepted and did whatever was asked to stair stepping and lots of full weight bearing. I am sure thats where my problem started. The leg got more painful to the point i was in tears almost daily. Still was made to feel like i was a "moaner". So i carried on and my tibia went banana shape. Was sent back to os 9 months after the surgery. 6 months fwb by then and tortured by pain. I was booked in immediately as the femur had cracked completely causing the medial knee joint to collapse. The following week the osteotomy was revised and the femur was moved again and plated again. This time i healed fine but the medial side was now constantly in pain along with the kneecap. Waited another few years before i then had the tkr. I honestly thought that would be the end. I have said from early it wasnt right (just like the first osteotomy) He said the side to side movement will worsen as everytime it comes out it further damages the tissues ect which explains the pain up behind the knee. Im having trouble driving now. Even just moving my foot from accelerator to brake and back is very painful. Sorry its lomg but just want to explain the history. I also had the plate removed pre tkr for the same pain im having so wondering if the ligament problem has been there since the original osteotomy failed.
 
chereb said:
@RestAssured did you find you lost rom or extention after the hinged knee went in? Im just scared that i do this and then it goes wrong again. The osteotomy was not straight forward. To explain i had a distal femoral osteotomy with a hip graft. After 12 weeks nwb i was cleared to put weight on it. I started physio and tge person said that he wasnt sure the rehab for osteotomy but assumed it was similar to TKR and would rehab me that way. Now i felt overworked and very painful. .
Click to expand...

My HK knee is giving me 135-145 ROM now. My replacement knee is the same. When I sit back in yoga my rear end almost touches my heels, so that's good enough for me! :heehee: Extension is 0 so that is great also! One thing I want to tell you, my revision (and most revisions) take longer to come back from so it is a longer process. The Smith and Nephew HK is a rotating hinge knee so it is closer to the function of an original knee as explained by my OS, one of the inventors. I wish both of my knees were the HKs simply because it does feel more natural. (No, I am not looking to having the left one revised until it wears out though!):snork:

I had infection down in the bone during the time that we waited to put in a revision. They took care of the infection, but Dr. Maale had to take out pieces of bone that were affected in the fibula and a little portion in the tibia. I don't have long stems like I see with a lot of HK's, mine are medium.

Cherub, this is how I look at life. If what you have is painful and isn't working, take that leap of faith, put trust in your OS, he is a revisionist isn't he?, and Go For It! :)

I sat on the sidelines waaaaayy too long! Now I'm back in the game! @Josephine, can you help out with the revisionist to help Chereb feel more secure?

By the way, if a physio is hurting you, tell them to stop! It is your knee and your life.:console2:
 
@chereb How are you getting along seeing this other chap?

Would you be prepared to travel to see a really good surgeon?
 
Still playing the nhs wait game. The other guy said the stems where medium not long and does a lot of revisions in there. He works only with knees. The os who done the ops does hips/knees and a few others. He was very frank with me and laid it out along with risks in plain sight. He said that there is no 100% guarantee in any tkr primary or revision but he was confident that my age and general health would see me through it. He done a thorough exam of the knee and checked me walking/sitting ect. He had long line xray/and the angled ones and talked me through every mark on my femur ect from previous surgery. Anyone who knows the nhs here you get a 15 min time slot. He was with me for well over an hour. The original surgeon wanted me to have the second opinion and then meet with both to discuss. The one i just seen said he doesnt see it as nescessary as the problem is clearly the ligament and he would do the surgery with his own team. Its just all so overwhelming. I have never got past 115 rom and have worked like a dog fo get it and bo matter what i do i just keep hurting.

Now i need to wait on my gp until i can get an apoointment to discuss further.i have even been considering a private consult but would probably be way out of my budget.
 
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It sounds like the one who does revisions only clearly knows his stuff! Give his name to Josephine. She is the expert on this forum! She knows practically every revisionist in the UK, or maybe it just seems that way. She has connections that I don't have though, so please chat with her and put your mind at ease. No surgery is ever guaranteed; but I like what I am hearing from your revisionist! Ok, I reread your post. Which surgeon is which? Did you see the one who only does knees 2nd?

There are no guarantees in life. We take chances everyday!

I guess my moment of clarity came about when I weighed 435 pounds, had braces on both legs, and shuffled w a 4 wheeled walker while trying to teach 7 th grade. The OS said, since you have had 6 previous rounds of MRSA, you have a 50/50 chance of getting it in your knee replacements. The question becomes, "Do you want to live a life of quality, or merely quantity?" That sealed the deal for me, and although my journey has been longer than most, I am so glad I took that leap of faith!
 
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The original os done the osteotimy, osteotomy revision and the TKR. He mentioned the ligament 12 weeks post TKR but said he thought it would tighten in time. I went back again and he said ligament was a problem and maybe the kneecap and he wanted me to to see the second os for a second opinion. The second os is the one who said it was definitely the ligament and said to revise the joint. Hope that makes sense.
 
Ok, so the other guy is the one who only does knees? He is the one who spent an hour with you and said he had a specialized team of his own?

If that is the case, he sounds a lot like my OS. Very assured that he can do what is needed to get you back to living again, and he isn't afraid to have others opinions on his team.

Dr. Maale is like that; each patient is unique and he has a "round table" of experts that meet about each case. He doesn't do the same exact procedure on anyone; there are always variables that makes it necessary to bring in different surgeons and other doctors. My "team" consisted of an ID or infectious Dieases doctor, a Cardiologist, because of Atrial Fibrilliation, a Neurologist because of my MS, a GP because of my BMI and other health issues, and he had his Anesthesologist attend because of the atrial fib, and sleep apnea! Dr. Maale also sent me for extensive testing on my heart, got a CT and MRI plus 3 phase bone scan of the knee to make sure he knew what he was dealing with before surgery! :wowspring:

Did all of that scare me? No, it showed me a doctor who was looking at every angle to make sure that my revision would be a complete success! :loveshwr:

I didn't know it at the time, because I had already been given some "happy juice" :)through my iv, but the hospital had a power "blink" before the generators kicked in. Dr. Maale halted my surgery for 3 hours because he has a specialized operating room only he uses, and it is pressurized. It takes 2 1/2 hours to re pressurize the room, so until Dr. Maale was happy that EVERYTHING was in order, surgery was put on hold.

I have not had any recurrence of infection, (except for a staple that buried itself deep in my skin. ). Dr. Maale did what no one else could do and that was stop the onslaught of 8 rounds of MRSA that kept making me sicker! :groan:

So, I would be delighted if I were you, especially if you tell us the name of your revisionist. Josephine has been our forum leader for many years and a orthopedic nurse for over 50. She travels and meets a lot of the OS's and has worked with quite a few. :idea:

If Josephine gives you the green light, you have a great revisionist, or she will check him out for you! That's how much we care on this forum! We want everyone to make an informed decision, knowing that they have lots of support every step of the way!:console2:

I will be here for you with any questions that you have. Although we have been down a different road that leads to a revision, a revision is different from a replacement. Some people see it as a failure.... I see it as a second chance at living my life to the fullest!:happydance:
 
Went down to theatre at 11. Had sedation, femoral block and sciatic nerve block. Kept on recovery for 30 mins and now back on ward. Operation took longer than expected as there were complications. No idea what they were yet until i see the consultant. My pain level isnt too bad as im numb haha. Can feel the incision painful though but cant feel my butt!! The aneathasist wanted to femoral block me for 2 days but meant i couldnt get up. So we compromised and aimed for tomorrow morning. Still on oxygen as my sats were a bit low. Feel awake though :-)


Sent from my iPhone using BoneSmart Forum
 
Glad you are on the recovery side. Glad they are not going to do the femoral block and let you get up and walk.
Here are the recovery articles, always good to read them again.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds as prescribed
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
 
Seen the consultant who said everything is good in the knee now. He said it was unstable but all changed now and he said its solid as a rock. Surgery took 4 hours. I am surprised at how awake i am. Cant remember a thing about the surgery except them tournequing the leg which was strange as i never even noticed them move it and putting some kind of warm blanket.Butt feels like a marshmallow and bladder area seems numb. The blocks should wear off by morning allowing me to get up and moving.


Sent from my iPhone using BoneSmart Forum
 
So glad you're out of surgery and recovering!

Gosh, 4 hours - that's a really long surgery. Hope you get some detailed notes about what went on there. Maybe it's just me, I'd be super curious!

I was in recovery forever - as they wouldn't let me go to my room until I could feel something at my waist. That femoral block worked really well for me, as I had no feeling from about my chest down - it was super weird. I just remember being SO cold. They kept piling warm blankets on me, but nothing seemed to help. I was so miserable that I kinda lied and told them I could feel it when they poked me at my waist for about the 10th time, hah! Truth is, I felt a little, but probably not as much as they wanted - but I just couldn't stand that cold room anymore. :)
 
lunula said:
So glad you're out of surgery and recovering!

Gosh, 4 hours - that's a really long surgery. Hope you get some detailed notes about what went on there. Maybe it's just me, I'd be super curious!

I was in recovery forever - as they wouldn't let me go to my room until I could feel something at my waist. That femoral block worked really well for me, as I had no feeling from about my chest down - it was super weird. I just remember being SO cold. They kept piling warm blankets on me, but nothing seemed to help. I was so miserable that I kinda lied and told them I could feel it when they poked me at my waist for about the 10th time, hah! Truth is, I felt a little, but probably not as much as they wanted - but I just couldn't stand that cold room anymore. :)
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Lol its a horrible feeling the block. So glad i fought for today only being with a block. Consultant said i can go home possibly Thursday. I feel so good just now. Im sure once it wears off i wont be so chirpy haha


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Hi @chereb

Congratulations on your revision. I had mine done towards the end of September. I'm so glad I had it done. I'm suffering a minor setback at the moment. The front door was being hammered, I panicked, got out the chair too quick and I have upset the soft tissues and joints. So back to elevation, ice and rest for me, with non weight bearing exercises for a little while until they settle.

My revision took around three hours but I never found out why. I didn't care to be honest, I was just so grateful to have a knee that I could straighten at long last xxx

Good luck with your recovery. I prefer spinal too x

Keep posting about your progress, as that's what it will be. Remember the recovery for this procedure is the same as for TKR. I didn't realise until one of the moderators on this site put me right!!! X

Take care chereb
Love Nana moon 27 xxx
 
So i had a lot of bone loss diring surgery especially the femur. Something about augments? No idea what that is. Numbness is wearing off and im surprised that i can lift my leg off the bed as last time it took me weeks.


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Hi @chereb

You will be amazed at what you can do after revision. Don't make the mistake I made. Mine felt so good I overdid it straight away. Not worth it. Lovely to hear from you.

Love Nana moon 27 xxx
 
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