Well, I went to my OS today to have him check out my knee.
He said that there were no outward signs of infection, such as excessive swelling, redness and fever. He said that the amount of effusion in the knee was not excessive for this stage in recovery. Nevertheless, he ordered a blood lab to be done to check for any other indicators of infection. Based on those results, he may decide to take a culture of fluid from the knee. He mentioned that he would not do a bone scan, since he considers them unreliable and generally unnecessary. He took X-Rays of the knee, and said that there was no apparent loosening of the components. Everything looked good.
Regarding the pain: He said that the knee cap was tracking properly along the femoral component. He mentioned that during the surgery, he had to do quite a bit of debridement around the MCL, due to all the joint fluid that had leaked out from the arthritis. He said that may explain why the medial area is a little painful and tender. The pain I am having is level 2, so he did not prescribe any painkillers. I'll use OTC for now.
Regarding the looseness and clunking: He said that there was a fair amount of medial-lateral (sideways) movement. He did not consider it to be excessive, and he explained that the the movement may have increased as the swelling in the knee has gone down. He doesn't think I have any scar tissue, and my ROM measured good at 125. He looked at my surgery report, and said that he was able to get 130 ROM on the operating table, so I'm not too far off that mark. He said that the clunking is normal, and is a result of the femoral component contacting the surface of the plastic spacer, and it's stem (the knee is a posterior stabilized).
I asked him about the size of the spacer he used, and if it might be too thin ( That kind of caught him off guard
). He said he used a 10 mm spacer, and that the thickness of the spacer is only determined by the size of the metal components, and the amount of bone that has to be removed for placement. He said it has nothing to do with age (there is a common notion that thinner spacers are used on younger patients to allow for more ROM). He said that the clunking may get better with time, as the effusion in the knee slowly goes away. But, he said if I am really not happy, that he could do a revision to put in a thicker 12 mm spacer. He said it would have less lateral-medial movement, but that it would still clunk to some extent, and that I might lose a little ROM. It's entirely up to me to decide this.
Regarding the dental issues: He said that what is done is done, and there doesn't seem to be any signs of infection in the knee. He said I can go ahead and get the dental implants done whenever I want, but that I should take a 1 week course of antibiotics afterwards, as well as the usual 2000 mg pre-dose.
So, it looks like perhaps a "wait & see" approach is in order. We'll see what the lab work reveals, and take it from there. I'm thinking that if the lab work comes up clean, then I'll go ahead and have the dental implants put in. My reasoning is that I'd rather get the dental work over & done with, and if any infection occurs as a result of it, then I will go ahead an get the revision anyway. The dental work has to be done, no matter what. But the knee revision doesn't.
I'd really like to hear people's comments, and also whether you think I should go see a revision specialist for a 2nd opinion. Thanks!
Roger
United States
