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Revision TKR Right Knee Take Two

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celynda

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Thanks, @Josephine, for your comments. Since you’re not a fan of the surgery to remove the scar tissue, what would you recommend instead?
 
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celynda

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Now I’m really confused. The external scar looks good. I have excellent extension and acceptable ROM. Not sure of the exact numbers. What’s causing my pain is the Crepitus inside the knee which I hear and feel when getting up from a seated position. Walking is very painful and after a few minutes of standing, my hip on that side starts to ache and very painful.

If the scar tissue/adhesions or on the inside near where the thigh bone connects to the quad tendon, don’t I need an internal operation to remove it? I didn’t think plastics worked under the skin.

Latest OS Note:

Progress Notes
Subjective:
The patient returns to clinic today for further evaluation right knee. She reports that she has fallen 3 times, not due to knee instability. She reports pain mainly around her patella. This is worse when attempting to rise from a seated position.
Objective:
The patient walks with a mildly antalgic gait. She does have crepitus with knee flexion and extension. The knee is very stable to varus and valgus as well as anterior and posterior drawer.
Imaging:
Radiographs reviewed these demonstrate the components in acceptable position. There is no evidence of loosening.
Impression/plan:
#1 Status post revision right total knee arthroplasty
I discussed with the patient believe she does have some scar formation behind her quadricep tendon causing a patellar clunk type symptom. I would like her to see 1 of my sports medicine colleagues for possible arthroscopic debridement of this. I placed a consult for her today. We will otherwise plan to see her back in 1 year for routine follow-up.
 
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celynda

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Finally heard from scheduling and have appointment on January 29 with referral OS to see about debriding the scar tissue.

Keeping my fingers crossed.
 
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celynda

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:tantrum2:
:tantrum2:I wish I could say things are going well. Heck, it would be nice if things were going ok. I am so tired of being in pain. My revised knee hurts when I get up from sitting. The other knee just hurts in general. According to the Xray, the L (non-operated) knee has plenty of cartilage so not really ready for a TKR on it yet.

I think I’ve mentioned I also have cerebral palsy. The CP has made the left leg smaller and weaker so I limp and toe in when I walk in the best of conditions. With a painful artificial knee on the right, I am an unsteady mess. If I walk too much, my hips/low back ache and I just want to relax into an opioid fueled haze.

I know this isn’t good so I resist and try distraction, ice, and knitting. I’m really hoping the appointment with the new OS offers a solution to the crunchies/scar tissue I feel and hear when I flex/extend my knee with weight on it.

OK, rant over - back to the knitting.:censored:
 

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Rant any time you want. I’m sorry you have something to rant about. :console2:
 
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celynda

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I saw the “scope expert” in my OS practice today to see about having the scar tissue removed. Isn’t it amazing how medicos know just where to press to find the spot that hurts. Anyway, the OS says I have tendinitis where the quad tendons attach to bone.

He thinks the tendinitis is the bigger problem and wants to treat it before doing any surgery. Since I was getting better up until my traveling for work kicked in starting in September and the two falls since; it makes it less likely scar tissue is the major problem.

So, I got a steroid shot (see circle in image) CE136B9D-D55C-4BDA-BAAA-494DBA76F469.jpeg , a script for PT, Mobic, and Tramadol for acute pain. The OS seems to think strengthening the quads and gluteus will break up scar tissue thereby reducing the pain and crepitis. I know walking is the best exercise, I guess I’ll try doing more while the pain is marked by the steroid. Maybe I’ll be able to walk around the block without feeling like I need an Uber to get back home.

Or, since my problem is tendinitis and not the revised knee, maybe I do need to follow the no pain, no gain rehab plan.

I am so confused. :beg::bawl:
 

Jockette

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I hope things will settle down for you. What a long haul you’ve had.

I’m sure you know what option I would choose!
 

sistersinhim

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I'm fighting tendonitis, too. My PA said to try ultrasound, so I'll try it to see if it helps.
 

kneeper

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Or, since my problem is tendinitis and not the revised knee, maybe I do need to follow the no pain, no gain rehab plan.

I am so con:bawl:fused. :beg:
Based on my experience I'd say take the exercise really slow. Tendinitis is easily aggravated.
 
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celynda

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An update from my previous post on the visit to the 2nd OS:

While he told me it was “tendinitis,” it was actually “pes anserine bursitis” in addition to the potential scar tissue. He also prescribed PT to strengthen the quad and glut muscles. Supposedly the if the muscles are stronger, it will change the way the knee rubs and maybe break up the scar tissue. Okay, I am willing to give it a shot.

This isn’t the first time I’ve had pes anserine bursitis in this knee. The first episode started last May after I had been trying to get into shape after my pre-diabetes scare. The “getting in shape” routine ended in my revision as the paid never went away. And now it’s back! I can’t win for losing...

The OS said to give PT three months and “if the patellofemoral symptoms continue to bother her, we will consider arthroscopic debridement but I did tell her that this does not always take with the symptoms.

He did not tell me the following: “She does have slight patella baja now related to the necessary elevation of the joint line which I have explained her can sometimes lead to continued patellofemoral symptoms.”

@Josephine, should I care about the “patella Baja?” Is there anything I should know, do or not do?
 
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celynda

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This Baja thing doesn’t sound good. Should I go back to original OS and ask why he didn’t mention it and how is he/we gonna fix it? Or, should I seek out another unrelated doc?

@Jamie, anyone on your magic list of great doctors in Florida? Within 300 miles of 32806.
 

Josephine

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While he told me it was “tendinitis,” it was actually “pes anserine bursitis” in addition to the potential scar tissue. This isn’t the first time I’ve had pes anserine bursitis
Don't like the "potential scar tissue" bit. Why do US surgeons and PTs always fall back on that old chestnut because it's so rarely true and very much so in your case! If you were going to get adhesions, they would have developed long ere this!
He also prescribed PT to strengthen the quad and glut muscles. Supposedly the if the muscles are stronger, it will change the way the knee rubs and maybe break up the scar tissue.
Another old chestnut! Anything that they can't explain will always fall back on PT!
@Josephine, should I care about the “patella Baja?” Is there anything I should know, do or not do?
Jockette gave you the link to our article. That's about all I know, I'm afraid.
 
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celynda

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Thanks, Josephine. I will call the OS tomorrow and see if I can get some clarification.

In the meantime, the new NSAID isn’t helping and with my current pain levels, I am not keen on starting PT. I think I may just try walking in the pool or in my neighborhood while it’s cool.

Yesterday, I walked .26 miles in about 10 minutes with the dog. It wasn’t excruciating; although I did ice for about 45 minutes afterwards.
 
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celynda

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@Jamie, do you have any recommendations for surgeons in Florida? My ZIP 32806 and I’m willing to drive uptown 250 miles.
 

Jamie

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Here are a couple of surgeons I have for Florida. You might try the one in Orlando first since that's close to you. He was recommended by a surgeon I know and trust in Daytona Beach as a great guy to "problem solve."

Orlando, Florida

Dr. George Haidukewych, MD
* Recommended by Brian (Orthodoc) for difficult revisions and infections knees and hips
Orlando, Florida He does one and two stage revisions. Good with infections.

Orlando Health
1222 S. Orange AVE
5th Floor, MP 43
Orlando, FL 32806
Phone: (407) 649-6878

Internationally recognized for joint replacement surgery and trauma, George J. Haidukewych, MD, serves as director of orthopedic trauma, chief of complex joint replacement, academic chairman for the Orthopedic Faculty Practice and professor at the University of Central Florida College of Medicine. He trained at the prestigious Mayo Clinic in Rochester, Minn.

Dr. Haidukewych specializes in total hip and total knee replacements as well as orthopedic trauma. He brings extensive experience in the management of failed and infected total hip and total knee replacements and in reconstruction of the joints after trauma.


Jacksonville, Florida

Dr. Kurt Blasser
Mayo Clinic in Jacksonville, Florida
Primary and revision hip and knee
 

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