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TKR Slow, stiff recovery, PT pain<

Bone shards sounds like sloppy surgery to me. I think he did not clean out your joint properly before closing you up. Remember, they use a saw to cut off pieces of your bone in order to fit the new knee. The knee has to be washed out carefully and inspected to make sure they get all the pieces of loose bone and cement. They have to get everything out or it will cause a lot of trouble. The lucencies I'll bet are bits of bone cement.
 
Sounds painful. So sorry you are going through this. I'm glad you've found an OS for a 2nd opinion. Keep us posted.
 
@Josephine
I am finally getting an audience with my OS so he can explain why his PA told me at my last appt. that the CTScan was fine, no problems, must be scar tissue, surgeon happy to do open lysis (not arthroscopic).Are bone shards common? Could this explain the pain almost 6 mos out? I am using a cane so I don't destroy the other leg with my bad limp. Thank you.
 
raingirl,
Glad you are using another OS to clean out your knee. The OS the did your TKR does not deserve a second chance.
It will be interesting to see what kind of answer he give you about the MRI.
 
@raingirl Yes, bone fragments can happen, but most surgeons clean them out with the lavage tool. I wonder if the surgeon left the clean out duties to his PA.
 
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OS couldn't be more accommodating; spent almost 1/2 hr. with me showing me the "bone shard." Turns out the radiologist in this small hospital has little experience with TKR and knees, in general. It was just a corner of the femur that wasn't perfectly rounded, previously worn from arthritis, nothing loose and floating around my knee. (Would have been nice if the OS had returned my phone calls and not let me go 3 wks. thinking the worst, though.)
Bottom line: i have excessive scar tissue all up and around my knee cap, like a horse shoe shape. He said the only way I could get better flexion numbers is with surgery, open synovectomy. He'd go in through the original scar and take out all the scar tissue; no guarantees, though, that it wouldn't produce again.
Anyone have this problem before??!
 
IMO I would take your MRI disk with you and see the other OS before you agreed to additional surgery. Even though he spent time with you while you were there he left you hanging for 3 weeks waiting for an answer. Is your extension still slowly getting better?
 
I would still see the second OS. He could be just trying to cover himself. Maybe the radiologist is right.
 
Oh, wow, hard to know but yes, by all means go to the new doc. You have nothing to lose.
 
I think @skigirl had experience with removal of adhesions. I agree, I think I'd see another OS before a second surgery.
 
@raingirl was reading your posting about using like a tens machine, you sounded like you found this helpful. I know I have a unit like this in a drawer, does it help promote healing, or help keep the swelling down or exactly what. I would consider getting it out and trying it, I am 7 wks out is it to soon to use this device???
 
raingirl, the swollen, stiff knee is one of the toughest issues to resolve with a tkr. I will give you two stories that I know quite well.

I myself had a lot of pain while riding my bike---I rode 10 miles and was rolling in pain afterwards. I went to see my surgeon who told me that the spacer should have been a little bigger---if he had known how limber I am, he would have chosen a larger size. (Gee, I wonder why he never thought to ask?)

He did an Open Lysis of Adhesions---he opened the knee up along the old scar and removed "extensive scar tissue". I was in pain for maybe three days and then, my surgeon cautioned me to take it slow and easy since if you have had adhesions, doing anything aggressive with the knee will cause them to reform. So, three weeks on the couch with my knee propped up. Did some easy walking with the dogs, but no pt. At three weeks I began very easy PT. My PT agreed with my OS and felt that we should take it easy for 8 weeks. His thinking---if we did this and the adhesions did grow back, at least we had done everything that we could do to prevent them.

So, very boring two months. I did mostly table exercises---clam shells leg lifts. at five weeks, I began easy step ups and hamstring curls--no weight, 10 reps tops. He went overboard to not over stress the knee. My surgeon again stressed that if I made the knee hot and inflamed, I would cause more adhesions to form. So, lots of ice, simple and easy exercise---mostly walking and not too far. At eight weeks we began a more typical pt---but always backing off if the knee became swollen.

The results? Some adhesions did reform--I can hear a crackle when i do a deep knee bend, but there is no pain when I bike or ski. I can ski all day, bike 20 miles and hike 10 miles without any problems.
 
That was getting kind of long, so here is the second story. I have a close friend who is also a ski instructor with me. She had a tkr and her leg was stiff and swollen for three years!! At the end, she had a rom of 50. She went everywhere---had metal testing--she is allergic to metal. Had a lysis of adhesions, also had an arthroscopic removal of adhesions, had a revision---all for naught.

Then she went to my OS---the local knee expert. He agreed to another revision--to a Smith and Nephew Oxinium knee. After the surgery he came to her and told her that he had ordered a 14 day culture of the old implant, instead of the more normal 7 day culture. He discovered that she had an infection called Propionibaterium acnes. She had to have six weeks of IV antibiotics. She and I were shocked when the OS told her that he thought she had had the infection all along since the first implant. This last one was her third implant!!. I will give you the info on the infection----.

The result for my friend? she now has a rom of 115 and is very happy, although she is frustrated that she had to endure three years of pain and stiffness before the solution arrived.

"Propionibacterium acnes: an underestimated pathogen in implant-associated infections.
Portillo ME1, Corvec S, Borens O, Trampuz A.
2013 Nov 6

Abstract
The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants.

The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment.

Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered."


I think you need a consultation with someone who knows about revisions and who knows about arthrofibrosis. I will give you a list of those that I know about, but, I think you need a helpful and open minded surgeon on your side.

Dr. Colin Eakin, Palo Alto Medical Foundation, California
Dr. Steadman, Steadman-Hawkins Clinic, Vail, Colorado
Dr. Peter Millet, Steadman Hawkins, Vail (as of 10/1/05)
Dr. Lonnie Paulos, Salt Lake City
Dr. Frank Noyes, Cincinnati Sports Clinic, Ohio
Dr. Wojitys, Ann Arbor, Michigan
Dr. Jason Folk Steadman-Hawkins Clinic of the Carolinas Greenville, SC
Dr. Shelbourne, Indianapolis, IN
Dr. Flandry, Hughston Clinic, Georgia, Alabama
Dr. Gill Boston Mass. General Hosptial and An asst. Prof at harvard
Dr. Tomas Sculo HSS
Dr. Answorth Allen HSS
Dr. Henry A Finn Weiss Memorial Hospital Chicago
Dr. Charles Bush-Joseph---Rush University Med Center.
Dr. Michael A. Terry Northwestern U Feinberg School of Medicine
Dr. Juan J. Rodrigo Baylor Schott and White Hilcrest Medical Center Waco, TX
Dr. Thomas N Lindenfeld Cincinnati Sportsmedicine and Orthopaedic Center
Dr. Friedrich Boettner HSS New York and the United Kingdom
Dr. Ajai Cadambi Texas Hip and Knee Center Forth Worth, TX
Dr. (Mr) Glyn Evans London Orthopedic clinic
Dr. Simon Tan St. Vincent's Sprotsmed Darlinghurst, Australia
Dr. Philipp Traut Bad Oeynhausen, Germany

If you google Frank Noyes, he has a series of articles on Adhesions. (scar tissue) . Also Peter Millet is one of the men who does not think you should have an open Lysis of adhesions. Steadman treats arthrofibrosis, but they will not treat it after a TKR

Also Dirk Kokmeyer, Pt wrote tutorials on Arthrofibrosis Rehab that I found really useful
 
Final post, I promise!!! The bottom line in all of this, is that I would not rush to believe anything. I think you have gotten good advice to continue with the second OS and see what his opinion will be. If you trust the first OS and feel that you can speak to him, then I would ask him about the infection---he could order a culture for you and I would pursue the question of nickel allergy as well before you have yet another surgery and rehab.

I was sure that I did not have a nickel allergy---but my knee did not have gross swelling. Swelling in itself is a red flag and is not necessarily from adhesions. I hope this helps--be sure to ask any questions---just tag me so that I am sure to see them. Kelly
 
@zzevi
My PT did use on me an electronic device with wires leading to electrodes with medicine on the stickie patches. Medicine she told me was to address pain and break up scar tissue. The electric vibrations felt good while on. The knee felt less stiff, less painful the first 2-3 times, then after that i didn't notice much difference, but then again I'm not your normal patient, don't happen to be healing well. Talk with you PT about if the tens is something for you. I think it can be a useful aid, but not a miracle tool.
 
@skigirl
Thank you for all the wonderful information, beautiful! So good to hear both the stories. Very helpful in teasing through this mystery healing process of mine. I sooo want to be normal again!
I do have a Smith and Nephew replacement now. I did push the OS to run blood tests for infection. He reported that I had no infection, but gave no details of what tests he ran. The results came back fairly quickly so I doubt a 14-day culture was done.
I will read the materials on all the authors you suggested. No plans to make any sudden moves towards surgery again. Will see if this new PT offers any new tricks or the 2nd opinion surgeon offers any new insights......meantime, it's Celebrex, walking, some pool exercises and lots of ice!
Thank you so much for your time!
 
@skigirl
Please forgive me. I was reading back over my post......"wonderful" and "beautiful" were no words to be associated to what you and your friend went through to finally get relief on your knees. I am very sorry.
I was trying to say how good it was to hear that there is a possibility that i can get the same relief. Thank you so very much for sharing.
 
Don't worry about the words you used, I simply wanted to help you wade your way through the morass that is a swollen and stiff knee. You are welcome and feel free to ask any questions.
 
raingirl said:
Are bone shards common?
Click to expand...
No, they are not. I've never seen 'shards' of bone. That would imply serious and unnecessary damage to the bones. There can be fragments though, almost bone meal really, but this is usually dealt with by use of a pulse lavage

raingirl said:
Could this explain the pain almost 6 mos out?
Click to expand...
Not!
 
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