Still in pain 1 yr post surgery

[TCHarp]

Hello All,

I sure wish I would have found you all earlier but better late than never.

Still being in considerable pain 1 year out finally prompted my surgeon to do a bone scan and we have discovered that that the ingrowth type of tibia crown used is apparently not growing in. Mirco-movement was the term he used today. The tibia crown was very hot on the scan but not so hot that infection was suspected. The suggestion was that it should be replaced with a cemented prosthesis.

The surgeon further stated that he really didn't think there was much chance for improvement or continued healing after a year and that it would most likely only get worse.

This last year has truly been a nightmare of pain but even so I find myself somewhat reluctant to endure the process once again.

Am I letting my experience with this failed prosthesis get in the way of success if we cement a new one in there? Has anyone had any experience where healing actually continued past the 1 year time frame?

I surely appreciate whatever thoughts you might have,
Thank you,
-TC

 

[Josephine]

Hello, TC and welcome to BoneSmart. Sorry to hear about your troubles.

I would say with some certainty that the likelihood of any improvement is highly unlikely after so much time. Bone healing takes place for about 10-14 weeks and thereafter what's done is done. The surfaces of the cut (or broken) bone get a layer of fibrous material laid down which effectively brings any further bone growth to a standstill. We see this often in cases where fractures fail to heal and the only remedy is to go in and debride (remove all the unwanted 'scar' tissue) and get nice, fresh bone that will start the healing process again.

Of course, in this case, the only answer is to redo the tibial component and since your bone has already demonstrated a reluctance to cooperate by growing into the implant, it makes sense to avoid that issue by using a cemented prosthesis.

Cemented prostheses are very commonly used and so there is no need for you to worry on that score. I'm sure you will be delighted and relieved with the result.

 

[susan1228]

TC,
Maybe since you have already seen the doctor and he has said you need to have this redone what I have to say may not apply but I am seven months out of having both knees replaced and I still have pain and am still in physical therapy. My surgeon says sometimes it can take a year that everyone heals differently and sometimes even longer. I had shoulder surgery and it was arthorscopic and I know I spelled that wrong and not even extensive and it was a year before I was totally out of pain so for me I am hoping this will be that result too. I have only run into one person in here that still has pain this long out so for me it can get depressing. Good luck Susan

 

[ship4]

TC,
Glad you have found this forum. Welcome! Sorry you have not had success with the uncemented replacement. I had BTKR in June 08, at 58, and have cemented replacements. I do think it will be a much easier recovery with the cemented version as you can get right up on them and not have to wait for the bone growth. We do have to wait for the healing of the cut ends of the bone, but won't it definitely be worth not being in pain forever by doing something about it?
The first 3 weeks are the hardest, and then every day it gets better.
I vote you choose to have the cemented version put in and eventually be pain free. JMO
Best,
Crystal

 

[TCHarp]

Thank you all for the welcome.

I was up on this ingrown pros immediately as it is also screwed into place.

I'm thinking I'll get a second opinion as a matter of course, but I don't think it will be much different than what I have already heard.

Yes Josephine, my doctor has also told me that it wouldn't make much sense to attempt another ingrown type of tibia crown for exactly those reasons.

I guess the most interesting thing about all of this is that the femur section has no apparent problems.

Well, it looks like I'm headed back to the OR then.

-TC

 

[Josephine]

Well, one out of two is better than zero out of two!

But all joking aside, this is often the case; one prosthesis will be solid as a rock but the other will become loose and the one that most often becomes loose is the tibial component. That's because it's only sat atop the tibia (post and screws notwithstanding) whereas the femoral component is cupped snugly around the femoral condyles and therefore has a lot more purchase and security.

Plus, the weight bearing is ON the tibial component whilst the femoral component is merely a distributor of the weight. See the difference? IOW it presses onto the tibial part and creates a shearing force on it. This is the micro-movement your surgeon mentioned. It takes only a few days or even hours of this movement to destroy the minute spicules of bone that have tried to grow into the implant. Once they are destroyed, then the fibrous material starts being laid down instead as it is flexible and can cope in the environment of movement.

 

[TCHarp]

Thank you Josephine, that's very informative. Of course the doctor didn't explain any of that to me.

-TC

 

[Josephine]

Guess not - I think it's a nurse thing to be able to explain the fine detail!

 

[Rowdy66]

Sorry for your problems and certainly for the pain after so long a time. Good luck with the new prosthesis, I will keep you in my thoughts and prayers. Rowdy PS One good thing you found this forum.

 

[TCHarp]

One good thing you found this forum.

It's true. I will be a regular visitor for some time. I'm am an avid participant in my amputee forum as well. I have found over the years that these types of forums can be a wealth of information. This one is certainly no exception to that rule.

I'm going into this second opinion guy armed with much more knowledge than I had on Friday.

-TC