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Revision with loose cement (at age 42)

PinckneyJ

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Hi everyone- I'm so glad to find this forum! I'm 42 and have had around 58 knee surgeries- scopes and replacements since age 12 due to presumed RA. I'm scheduled for a re and final revision on my right knee 09/24/19 here in NC. I've had a right knee arthrosurface in 2013, total knee 2015, prosthetic joint infection in 2016 with spacer, revision placed 01/17. Left knee has a total knee (05/18)with a partial revision of a thicker liner in 12/18 with persistent stiffness. Also have a right hip replacement due to avascular necrosis.

unfortunately, my cement is loose in the right knee and my knee is buckling like crazy for the last 8 months. I've had a few falls. They're trying to figure out if infection has caused the loosening or another cause. I've been on 3 antibiotics twice daily for the last 3 years for my knee. We have seen multiple surgeons over the course of my knees and have recently switched to a large medical center and really like the surgeon. Surgeon said after this the right knee would have to be fused or amputated. Ive had a bone scan and he will aspirate soon with my being off antibiotics before he operates. Wondering if anyone else has had this situation with a revision being loose after only 2 years? Thanks so much-
 

Jamie

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Hi, PinckneyJ and welcome to BoneSmart. My goodness you've been through the mill with surgeries!

Of course we do see people here on BoneSmart who have revisions because of loosening and sometimes it happens relatively soon after the first surgery. You can read the recovery threads of those individuals by going to the Knee Recovery index page that lists all of the threads available in that forum. Once there, find a thread with either REVISION TKR or INFECTION as the prefix and click on that prefix. That will give you an index file of all threads with that prefix.

I'm glad you are happy with your current surgeon and hope he will be able to get your knee stable and strong. If for some reason that should not happen and you still have problems, please don't leap into fusion or amputation. We have at least one surgeon who has done some very good work with infections and joint issues and he might be good to at least talk with.

Please know that we're here to help and support you in whatever way we can. Don't hesitate to ask questions or voice any concerns you might have. We'll be here for you.
 

Celle

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@PinckneyJ - I'm sorry your joints have caused you so much anguish.
Have you had the same surgeon for all these operations?

It's unusual to have so many surgeries for RA. I assume you had juvenile arthritis?
 

ArmyVet

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I can chime in here. My loosening resulted from a bone tumor. I had my total knee on 4/30/2018, and my revision on 6/19/2019... So just over a year from original replacement to revision. Surgeon said when he opened my knee, they found a bone tumor where my implant was loose. I'm hoping another one won't show up ...
 
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Jamie

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@PinckneyJ ... I do have a couple of questions for you. I'm confused by your comment about "presumed RA." Are you under the care of a rheumatologist who has given you a diagnosis of this problem? Also, you mention having problems with avascular necrosis (AVN). Have you taken steroid treatments in the past that would have made you more likely to have this problem?
 

Celle

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I can chime in here. My loosening resulted from a bone tumor. I had my total knee on 4/30/2018, and my revision on 6/19/2019... So just over a year from original replacement to revision. Surgeon said when he opened my knee, they found a bone tumor where my implant was loose. I'm hoping another one won't show up ...
A tumour would be one of the most unusual causes of loosening. In my 8 years on BoneSmart, ArmyVet is the first person I've read of who had this.
 
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PinckneyJ

PinckneyJ

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Thanks so much to Celle, Jamie, and ArmyVet. Sorry I'm slow in responding. I've been to a lot of preop visits that have worn me out. To answer your questions, I was a serious gymnast growing up and started having surgery at age 12 due to dislocating patellas. I probably had juvenile RA. I was diagnosed with RA at age 30. My rheumatologist recently retired. I've seen several new rheumatologists and they have agreed I have RA due to my physical exam and labs although the first one I saw said I didn't have it. However, my surgeon sent me to another rheumatologist as he felt strongly that my hip going back without previous surgery was worrisome for RA. The AVN (avascular necrosis) they felt was due to steroid use intermittently for the RA. They're trying to figure out what's making the cement loose as the cement is starting to loosen in my other knee that's only been in for a little over a year. I did have to get a larger liner due to instability. I have a pretty significant extension lag in my right knee that's getting ready to be operated on. PT is worried about that and feels the revision and infection in this knee contributed to the quad weakness. I go back to my surgeon Monday Sept 9 to have the knee aspirated before surgery to make sure infection is not causing the loosening. Yesterday they told me this surgeon, who is new to me, likes spinal anesthesia which I've never had. I've always had general. I'm curious what people 's experience is. I'll search the threads for information. I'm worried about being awake. I've been through a lot and I don't want to know anything! I'm now so very glad to have found all of you and thank you for answering my questions again.!
 

kneeper

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Generally with a spinal they also give you something to make you sleep. I had a spinal and what we jokingly call "happy juice" with both my tkrs. I simply woke up feeling like I'd had a good nap.
 
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PinckneyJ

PinckneyJ

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Thanks again for everyone’s information. My surgery was bumped to oct 1 due to an emergency patient. Hoping for a successful surgery.
 

Jockette

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I requested general anesthesia because I didn’t want a spinal and they didn’t argue with me at all. I got the GA. If that’s what you prefer, tell them.
 

Celle

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Thank you for letting us know the change of date for your revision. I've changed it in your signature and asked for you to be added to the October Feisties list, instead of the September Sapphires.
 
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PinckneyJ

PinckneyJ

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Thanks so much Celle! Can I start a thread in the pre op area for my surgery and progress etc or stay on this thread? Thanks again
 

Celle

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@PinckneyJ
You keep posting here until you have your surgery.
After surgery, you need to start a recovery thread here, in the Knee Replacement Recovery Area

Some people start their recovery thread the day before surgery, which isn't a bad idea, as you're clear-headed at that time. After surgery, you'll have several days when your thinking is dulled.
 

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