Second TKA in 9 months due to metal allergy

[Firefighter57]

I will try to keep my post short and simple to understand.
My injury was back in May of 2011, continued to work with PT until Oct 2012. At that time something needed to change. This is when it all began with 2 different surgeons , 2 Occ. Med. Doc's, and 3 different types of therapy including the Bowen Technique.
I had a scope completed in March 2013 by the Sac Kings doctor that released me to full duty without ever evaluating my progress, I changed doctor's and had a second scope June 2014 and at that time he requested a TKA due to the fact that the MRI does not show everything.
TkA completed in Nov 2014 with the standard Cobalt-chromium Alloys, this was the beginning of my 9 months of living HELL due to the latter diagnosed nickel allergy!
On the positive side, I just had it removed and replaced with a Titanium Alloys on Sept 4, 2015. So far so good.
I would like to share my experience with others that have or feel that they too may have an allergy. There is a lot to share so if there is anyone that would like to chat, feel free to ask me anything. In retrospect there were many tell-tale signs that were missed, as both Doctors and the Physical Therapists had never seen a patient with a metal allergy before.

 

[Josephine]

Hi and welcome to BoneSmart! Do please share all you have right here. The more information we can acquire on this troublesome topic the better. I'm only sorry you had to go through all this and share your hopes that this time around will be a much better experience.

Can you provide us with your dates of surgery? It#s so helpful to know the time lines.

You might also find this stuff of interest

Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- 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

 

[Celle]

Hi @Firefighter57
to BoneSmart.

i'm sorry you've had such a bad time so far. We do have a few people on here who have been tested for metal allergy, so i'm sure your posts will be welcome. It's good of you to be sharing your experience.

I hope your revised knee is doing well.

To make it easier for us to see at a glance what knee surgeries you have had, please will you make a signature? here's how to do it:
How to create a signature
Tell us which knee and put something like this:
Revision TKR 4 Sept 2015
TKR Day/ Nov 2014
Arthroscopies March 2013, June 2014.

Thank you.

 

[Firefighter57]

Here are the dates:
Revision TKR 4 Sept 2015
TKA 20 Nov 2014
Arthroscopies March 2013, June 2014.

 

[Celle]

Thank you firefighter. Can you put the full dates in your signature for us please (and the arthroscopies)? And add whether it was your left or your right knee. Thank you.

It's so much easier if all that information is in your signature and then we don't have to keep referring back to one of your earlier posts.

 

[mytrose43]

Can you please tell me what the symptoms are . I hope all continues well for you in your recovery.

Sent from my XT1080 using Tapatalk

 

[Celle]

We have an article in the BoneSmart library about metal allergy:
Metallosis: what is it?

 

[skigirl]

I have a friend who just had the same surgery. She had her stryker triathlon removed and got a Smith and Nephew Oxiunium knee. She is also better already at 2 weeks.

 

[Widget1]

Firefighter57, I'm so sorry that you have suffered so much in the last year, and hopefully your titanium knee will be the first step for a great recovery for you.

It's puzzling to me that we have such defined standards for metal disclosure on jewelry that's worn outside/on the body, yet items inserted inside the body for a lifetime aren't covered. For jewelry, the US FTC (Code of Federal Regulations Title 16, Chapter 1, Subchapter B, Part 23) has stringent requirements for truthful disclosure of all metal alloys used in jewelry, and specific criteria for hypoallergenic metals. If companies lie, they can be shut down and sued. If one wants to sell jewelry online (ex: Amazon), part of the contract has strict requirements for truthful disclosure of all metals used in each and every piece of jewelry the seller plans to list for sale. These requirements wouldn't exist if only a handful of people had allergies to these metal alloys.

Nickel or cobalt allergies may be present in a small portion of the population, but even if it's the 5% that I read about, why isn't testing done? I've had numerous allergy tests performed and gone through about 3 years of immunotherapy treatment, and allergy tests are quick. Why couldn't a skin test for nickel and cobalt allergy be done routinely as part of the pre-op process? If the allergy is present, then the OS team could decide what type of joint to use instead of the one(s) that the patient would not be able to tolerate.

 

[Firefighter57]

After the first implant, I had a very hard time in rehab. I went to pool therapy twice a week for 3 months, clinical therapy twice a week for 6 months, working on the left knee in therapy 4 days a week. I had constant pain 24/7 stopped taking Norco on a regular basis after a couple of months, swelling never went down. Two months post op, I had 2 large golf ball size areas swell up over night. One on the top of knee and one on the side. Both Doctors and therapist stated that they have never seen this before and the Doc ordered topical (Voltaren Gel) with I used 3 times a day for 1 month, no change.

I had very severe stiffness throughout the nine months. I reach 100 degrees after 6 months of therapy, not well. The therapist tried every time that they could think of, no changes. I bought a stationary bike and it took me 5 months to finally do a rotation, pain was so strong. Each time I went to therapy or rode the bike I never gain anymore movement from the last time, it was like my knee had a muscle memory. This time around I started on the bike day 13 post op, 20 minutes twice a day with full rotation.

Squatting was impossible, had to lay on my side to do anything close to the ground. Pain would shoot up to a 10 when I would accidently stub my foot on something. Kneeling on it was also impossible.

After 7 months my Surgeon could not explain what was going on and he suggested we do a metal allergy test. Sure enough that so far seems to be the dominating factor of my 9 months of hell. My Surgeon once called me his poster child for how much therapy I was doing, after the allergy test he now calls me his problem child.

About me: professional fighter, 178 lbs. 5’10 prior to the TKA I was running 3 miles every other day and doing my workout the balance. I have gone into all 4 surgeries in pretty decent condition.

 

[Firefighter57]

Widget to answer your question on testing, I was told by my Surgeon that does over 300 knees a year, that he had never seen it, just heard about the allergy. The insurance companies will roll the dice before having everyone tested. It's just that rare. The blood work had to be drawn before noon and over nighted to a single company in Chicago where they had to run 4 vials of blood for a numbers of days to get the results. The test only was over 400.00, so you see now where the insurance co. stands.

 

[Celle]

Thank you for doing the signature so promptly, Firefighter.

 

[Widget1]

Firefighter -

It's really tough when dealing with the insurance companies. Because yours involved a prosthesis that had been implanted inside your body for months they probably chose the test that would provide conclusive results to the theory that you had a nickel allergy.

Maybe an alternative would be for them to purchase the cheap jewelry (7 cents for a "sterling silver" bracelet) that is nothing but nickel, and give the patient a bracelet to wear for a couple of days. With allergic contact dermatitis symptoms would start appearing within 12 - 48 hours. Another lower cost option would be to have a dermatologist do the "patch test" and have the patient come back in a couple of days when the patch would be removed. If there's eczema or a rash under the patch there's an allergic reaction. I looked back at my last patch test documents from 5 years ago and nickel was one of the 107 things I was tested for (negative response).

If a woman has ever worn cheap jewelry and had a reaction, she should make sure that her doctor has that information as part of her record. Women have had reactions more than men because in past times only women wore pierced earrings, etc.

I'm thankful that you finally had an answer to what happened to your knee, and that you now have a titanium prosthesis. May your recovery be great this time around.

 

[sdgrandma]

@Firefighter57 -- So sorry you had to go through so much pain. My doctor never asked about metal allergies, either, but I was reading online about two weeks before my surgery date and saw a warning about nickel allergies and the cobalt/chromium implant. I can't wear earring posts that aren't either gold or silver--my earlobes swell, get red, and have a discharge. My wrist also got a rash when I wore a cheap watch. So I called the surgeon and he just decided to go with a titanium implant and didn't bother to do testing. If anyone contemplating surgery has trouble with earrings, please let your doctor know so he can decide if a metal allergy needs to be considered.

@Widget1 -- I think you have a cheap solution to testing!

 

[Widget1]

@sdgrandma - I'm so glad that you were able to be proactive prior to your TKR and that your surgeon used a titanium implant!

Your suggestion for anyone with trouble with jewelry to inform their doctor prior to surgery is very important! Thank you for posting that.

 

[Firefighter57]

I was put on a Vacutherm device for the first 5 months. The OS told me no ice only heat. The PT told me no heat only ice, so I did both with this device.
My symptoms were: Depression, pain, fatigue, swelling, stiffness, and decreased ROM. And of course thinking all along that it was me not doing enough, this was a full time job for me.

 

[Firefighter57]

Sounds good, but the concern is that skin testing may not accurately reflect the internal reaction to an implanted prosthesis. Your body may react differently, keep that in mind.

 

[Lovestoread]

I hope your recovery goes smoothly this time! You've really been through the wringer! I have nickel allergies and told my surgeon on my first visit. I don't know what kind of implants I was given (never thought to ask, but I will in December when I go for a check-up!) but I haven't had any problems, so I assume it's titanium.


Sent from my iPad using BoneSmart®

 

[Firefighter57]

So how did you discover your nickel allergy? I never had a clue that there was such a thing going into this.

 

[sdgrandma]

@Firefighter57 -- I found out about my allergy when my earlobes reacted to cheap earrings. I never had an issue if the posts or wires were gold, but if I bought a cheap pair the earlobes were angry. Now I only wear gold or other hypoallergenic jewelry.