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TKR Sailor's Recovery Thread

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Hi @Roger Nice that your wife is having an easier time and things are improving for her. Hard to believe how much has happened in less then a year. My surgery date was April 26 and yours May 8 so many things in short while and must be very strong to have handled it all. Today it minus 19 celcius here very cold but the sun is out snow plows trying to catch up after the heavy snow falls . I keep remembering that last April when I had my surgery the weather stayed warm and wore shorts so when I get feeling like spring is a long way off I remember that April is not that far away. Hope you find a really good dentist and all goes well for your recovery and hoping that this new year is a great one. Holly
 
The blood test results came back today. They are inconclusive for indication of infection of the knee replacement. My OS wants to draw a sample of joint fluid for testing. I agreed, so I will have that done tomorrow.
The fun just never stops !
 
What does "inconclusive" mean? Usually they draw blood for a C reactive protein. Was it normal? I remember having fluid drawn for culture. A part of me wanted it to be positive so I would have answers, but most of me hoped not (which was the case). Ultimately they decided it was "recurrent synovitis of nonspecific origin."
 
Mary,
WBC was slightly elevated (13), but it has been that way for the last 3 years, long before my TKR. I think it is related to low level infection of my teeth. The uppers have been extracted, but the lowers remain, and they will need to go soon.
CRP was high, but I'm not sure how high. I have inflammation in my lower back (bulging discs). Maybe that's the reason.
I'm OK with having more tests done than what is needed.
 
Good luck tomorrow, Roger! I hope things are good. Are you feeling any better or are you the same?
 
Thanks, all, for the good wishes. My gut feel is that the knee is not infected. I think it just has excessive laxity. We shall see.
The knee is pretty tired after being back to work. I've got aches around the MCL and the kneecap. As far as the other symptoms, like excessive looseness feeling and severe clunking, it is no better.
 
Your knee sounds like my knee. I cannot remember . . . have you ever gotten a second opionion? My OS never physically checked my knee after surgery, so I don't know whether he knew about the laxity or not. But I had two second opinions and they both said the knee was lax, and I forwarded their notes to my OS who said outright that he didn't disagree. I do believe, from others' experiences, that the laxity results in synovitis and scar tissue. My brace makes the knee OK. Clunking is not necessarily a sign of anything except that you have a TKR. Mine rarely clunks now. I guess you really won't know until more time has passed (unfortunately) where your knee is ending up. The improvement toward the end of the first year and beyond can be surprising.
 
Roger,
I think it is time for a second opinion. Once you confirm there is no infection, you can take your time deciding what to do. The second opinion (s), will give you peace of mind.
I hope you have your teeth taken care of soon, there are so many choices other than dentures. We are lucky to live in a time where we do not have to just live with arthritis, and dentures.
 
@maryo52 , @Pumpkln ,
Thanks for the replies.
The fact is, my knee has gotten worse over the last couple of months, since the swelling has gone down.
I realize that clunking and clicking is normal after a TKR. But I'm talking about an excessive amount of clunking. It is literally bone jarring. I can feel the huge vibration right up to my hip bone, with every step I take (2 times per step), and it affects my gait. This has gotten worse, not better. Nobody seems to believe me when I say how bad the clunking is.
I think the knee is loose, due to either an improperly sized spacer, an alignment problem, or improper balancing of the ligaments.
I have a posterior stabilized knee replacement. The plastic spacer component has a tibial post that substitutes for the PCL. I've done quite a bit of research, and have read some papers that discuss how critical it is to have proper balance and laxity on a posterior stabilized knee. If not done properly, the tibial post can eventually be fractured and sheared off by the excessive forces from the femoral component. I read one paper that referenced a case involving an elderly fellow who had a problem similar to mine. He went to 9 doctors, and nobody believed him. His family finally had him committed to an institution for OCD. While he was in the institution, the tibial post of his knee was fractured. They did a revision, and of course found the fractured component. They believed him after that....
I'm going to get a second opinion soon, after I get the results from the knee aspiration.
 
I had an OS appointment today. He decided not to take a sample of joint fluid. We revisited the blood test results, and he is positive that the knee is not infected. What I failed to mention earlier is that the Sedimentation Rate (ESR) was almost 0. He said that he has never seen a knee infection that did not have an elevated ESR. The WBC and CRP are only slightly elevated, and are probably due to my teeth and back issues, as I had mentioned earlier. Oh, and I had a cold when the blood test was done.

He did say that the knee has more medial-lateral laxity than most knees that he has seen at this stage, and he admitted that the only way to correct this is to install a thicker spacer. He also checked the lateral side of the knee, and he thinks there may be some scar tissue that is rubbing against the side of the femoral component. I agree, because when the clunking occurs, there is a moderate pulling sensation in the lateral area. He says this tissue could be cleaned out at the same time the spacer is exchanged.
He advised against doing a revision until I have had both arches of my teeth restored and they are free of infection.

So, I'm pretty satisfied with this opinion. The knee is good enough for me to sail and go on business trips, for now, as long as I take it easy. I am now going to focus on getting my dental implants installed. If I do decide to have the knee revision done, it will be about one year out, providing all goes well.
I'm also going to try to do some exercises to build up strength in the quads and hamstring. I know that I can't tighten the ligaments with exercise, but maybe strengthening the muscles will help.
 
Hi @Roger I am sorry to hear that your knee and teeth are giving you so much stress. It seems that there is always something to handle and just when you get one thing settled the other things take their place. I am finding that my knee is less of a concern now it still is probably around the 90 degree range but feels ok. I find that sometimes when I am walking it seems to bend more but now some say maybe it is not as strong as I think it is. I always tell myself that when it drops a little it is trying to bend more not sure why this happens. I am finding that my left knee is getting a little more uncomfortable and in the spring April when I go for x-rays and then to see my surgeon I think I may agree to having this surgery done worried that this knee will break if not looked after.with a replacement. My left knee is very sore especially when sitting but my operated knee is doing ok. I hope that you have a good doctor taking care of you and that the difficulties with your teeth can be handled for you so that things get easier. So many things have hqppened to us in less then a year but you have a great outlook and will make it through all of this. Wishing for the very best news for you and that you are being well cared for. Holly:console2:
 
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@lavender ,
Thanks, Holly! Now that I know what the problem is with my knee (laxity), I am more at ease. My goal is to try to not obsess about it too much, and to get on with having my teeth restored. I'm in the airport now, taking off on a business trip, and the knee is feeling OK. I wear a knee brace, and it helps a lot with the laxity.

I'm so glad to hear that your operated knee feels good! That is great news! It's great that you are considering having the other knee done. It will improve your life, for sure.

Take care,
Roger
 
Hi, all,
It's not knee related, but I wanted to post an update on my dental issue. I did a TON of research, and I've finally found an implant specialist in the USA whose price is very good, and whose doctors and services are high quality. I don't have to travel internationally, but I will have to travel to Indiana. I'll be getting an "All-On-4" fixed bridge, with 4 - 6 implants. The bridge will be non-removable and is made of Zirconia, and not the cheaper acrylic which wears out after time and needs to be replaced. This is the state of the art in restorative prothodontics. I'll be getting the work done beginning in March. I fly out in Feb for a consultation.
I'm really happy about this, and glad I found a solution at reasonable cost!!
 
:)Hi Roger Nice to hear from you and hope you are doing well. I am happy that you have found a way for your teeth to be replaced and I hope it does not cause you much pain and that it will make thing easier for you. One more thing off the list and helping you to feel comfortable. Hoping your are having a nice week and wishing for spring here minus 19 celcuis today and so bitter cold but the sun is out and hopefully will melt some of these monster piles of snow. Spring is now far away maybe 3 more months but will be well worth the wait. Holly
 
@lavender ,
Hi, Holly,
Thanks for the reply. Well, we never did have winter so far here in CA! We need rain badly. There is fire danger, and the governor has declared a drought emergency. We are supposed to get a few showers in the next few days, but probably not enough to make a dent in the situation. So we would gladly trade our weather for yours. More snowpack in the Sierra Nevada mountains would certainly help our water problems. On the plus side, the sailing in SF Bay has been very good :)
 
Roger, I agree that getting your teeth fixed is important---the knee can wait. It sounds like you are moving forward there too. I recently had $9,000 worth of dental work done---I share your pain!!!

I had a spacer replaced due to laxity and also an adhesions clean out. Two years after the surgery. The knee is now much more stable and I did have to take it easy during recovery. My doc stressed that exercising on a hot, swollen knee would cause more adhesions to form. So, I had pain for about four days and then I was bored for another two months until finally, I could work on my musclces!!
 
@skigirl ,
Thanks for the reply!
Yes, dental work, especially implants, is way too expensive. I'm saving 50% by traveling to Indiana, and it's still going to cost me a bundle. But you're right, I need to get it fixed.
After much prodding, my OS finally did admit that he could have used a thicker spacer in my knee. My knee laxity doesn't bother me much if I wear a knee brace. I'm talking about the $10 Futuro type brace that they have in CVS. Now that I am 9 months out from TKR, and the swelling is down, I'm going to step up my exercises a bit, in an effort to build up the quads and supporting muscles. This may help take some of the load off the ligaments, and may help the laxity. Based on the symptoms that you, Maryo52 and Pumpkin have described, it sounds like my laxity may not be as bad. Maybe, just maybe, I can get by without a revision. It will be well past the 1 year mark before I make any decision, though.

Roger
 
Sailor.
My girlfriend ironically is a dental assistant. She has the most beautiful teethers I have ever seen . Be sure to bundle up when you go to Indiana. You Dont want to wear standard California clothing. Thanks for that PM. As my big day is 12 days away. Again hoping you all the best.
 
Hey Roger,

Glad to hear that you found someone to take care of your teeth at a reasonable price for what you are having done. You are right, if the brace is doing the job for now, the knee can wait and possibly be taken care of by strengthening the quads and surrounding muscles.

Take care!
 
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