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Bilateral TKR Superior and Inferior Patellar Enthesophytes

I am approaching my two year bilateral knee anniversary. I have spent the last couple of weeks getting specialized X-rays and a CT Scan of my knees. Both are still somewhat painful on the medial side, both to the touch and just achy, with the left knee still "catching" at times causing a great deal of sharp pain. This happens at times when rising from a chair, going up and down stairs, getting out of the car, etc.

I belong to Kaiser Permanente In Northern California. Two years ago, knee and hip surgeries were only being done at their Vacaville facility. I live about 30 mikes away in Vallejo. After being basically "blown off" by the OS at my one-year check up, I tried on three separate occasions to connect with his office for a follow up of my continuing problems. My calls were never returned. At my regular check up with my GP, I asked her for a referral to Ortho in Vallejo. She told me that I had to return to the OS in Vacaville, and she would have her medical assistant contact his medical assistant about an appointment.

The OS finally took me seriously, and listened to what I was telling him. He then admitted to me that I am his first patient to have problems after he operated. He said he spends a great deal of time "fixing" surgeries of patients operated on by other surgeons. Sounds like his ego got in the way of my evaluation. Yesterday, he suggested that arthroscopic surgery be performed to clean out suspected scar tissue that is probably causing the "catching." He ordered an ESR test and a C-Reactive test, and more hip X-rays. He also had his MA book me today for a second opinion with another surgeon.

Today, the ESR came back at 38 with a normal range of 0-30. The C-Reactive test came back at 1.6 with a normal range of equal to, or less than 0.5. The new surgeon says these results are slightly elevated, and infection needs to be ruled out. He feels that I may have multiple possible issues going on: catching, knee cap not tracking properly, referred pain from the hip, and infection. He is strongly pushing me towards a hip replacement, but wants to proceed cautiously. I am scheduled for a hip arthrogram next month during which he will inject a steroid into my hip, and remove some fluid from my knee to test for infection. At my follow up appointment two weeks later, if I have no pain in my knee, he says that shows the pain is actually being caused by my hip; hence, the replacement. If infection is found in the knee, he will discuss his recommendation for me at the follow-up.

I did not see any of this coming. It is a bit overwhelming to consider a possible knee revision and hip replacement. YIKES! My husband, using his humor to try to help me keep to the lighter side, said that at least it would only be one knee this time. LOL

It is interesting that after my bilateral knee replacement, Kaiser in my area no longer performs bilateral surgeries. They also have changed their protocols for knee and hip replacements to an "out patient" same-day surgery. After my horrible experience in Vacaville two years ago, I am more than okay with going home. Maybe this time I will actually have my pain managed instead of having to rely on Extra Strength Tylenol and ice. Hoping that the new year brings no infection, and only arthroscopic surgery.




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I hope there's no infection, too, and that your knee pain is coming from your hip. You know that's bad anyway and needs replacing, so to have it cause your knee pain would be a blessing!
 
After two years of being “blown off” by my OS, he finally examined my knee and admitted that he could feel the left knee catching. After extensive diagnostic x-rays and a CT Scan, he told me that nothing showed up as being the cause. He said that his recommendation was arthroscopic surgery that he stated had a 50/50 chance of success. First, however, he told me that he had consulted with a colleague doctor, who specializes in hip replacements, and he felt that I have referred pain from the hip. He also wanted to have a knee aspiration performed to rule out infection.

I underwent a hip arthrogram on January 10, with results to follow on January 18. I have never had pain in my left hip, but was willing to go through the process to try to get this issue diagnosed. I do have significant pain in my knee upon extension (level 10), and the intensity has increased significantly since the arthrogram, and my right knee now has a swollen area on the right side of the kneecap the size of half a tennis ball.

The doctor performing the arthrogram asked me my pain levels before and after the procedure. He told me to message him four hours after the procedure. The one change was that the surface pain when touching the left knee, had disappeared, the right knee remained unchanged, but the right knee was not ncluded in the procedure. Bupivacaine was injected into the hip. I messaged the doctor that the original knee pain was now extremely intense, and icing and Tylenol are of little help. I am still waiting to hear from him. I am at a loss as to why both of my knees are now worse off because of a hip procedure.
 
Oh my, what a shame that you are having extreme pain now. I will tag someone that knows more about your medical procedures than I do. @Jamie, @Celle.
 
GratefulNana,
I noticed your most recent thread related to what you had posted in your original thread and have merged the two threads, so we have a clearer picture of your challenges.
For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
 
I think you need Jo's expertise for your questions. She is away from the forum until this coming Saturday, but she should see her tag and respond to you next weekend. Sorry you must wait!!! But she really is the best person to address your situation. Please let us know any additional information you get from your doctors.

It is true that a person can have referred pain in the knee from a hip problem. I'm curious....did anyone do an xray of your hip to see how the joint looked? That should have been the first order of business for a diagnosis. If you have that xray, it would be helpful for Jo to see it if you could post it here.
 
My regular doctor ran x-rays just before I finally got an appointment with the OS. The OS followed up by ordering more in-depth x-rays of the hips and a CT Scan. The diagnosis that both doctors told me was mild arthritis. Kaiser does not routinely give the patient copies of x-rays, so I do not have copies. The OS told me that the doctor he was referring me to would inject my hip with a steroid and while my leg was numb, He would do the knee aspiration to check for an infection. I was told by the OS that my knee pain would be re-evaluated two weeks after the arthrogram.

When I saw the referral doctor, he informed me that I needed a hip replacement. I asked the doctor how I could need a hip replacement when I only have mild arthritis and no hip pain. He dismissed my question. We spoke about the injection and aspiration, but he never once mentioned the word arthrogram. I had to ask the surgery scheduler if there was a name for the procedure I was going to have, and she told me.

After the procedure, I asked the doctor if he had injected a steroid into my hip joint. He said no that it was just a test. I need to add here that there was no knee aspiration written on my consent form. They had to hold up taking me in for the procedure until the doctor authorized it and new paperwork prepared.

There are two problems that I see going on here. These doctors are typical surgeons with no bedside manner. I am okay with them not being overly friendly as long as I feel confident in their ability. The OS told me that he spends his time fixing other doctor’s mistakes. I am supposedly his first dissatisfied patient. My position is that, while he is considered a very good surgeon, he ignored my knee problems and resulting knee pain. Maybe his ego got in the way. I have no knowledge of the doctor to whom he referred me. I did not care for this doctor, and the fact that he had to be reminded to perform the knee aspiration, and no steroid was injected, as I was told by my OS, concerns me.

I do not have a “warm, fuzzy feeling” about these doctors. The OS has never addressed my pain issues from surgery to current date. The other doctor just seems to be focused on replacing my hip. My position at this time is that the OS didn’t get my knee right from the beginning, why should I trust him to do more surgery. I have no intention of having my hips replaced.

I asked my regular physician to give me a referral to another Kaiser facility, but she refused saying that I had to go back to the OS for follow up. I will keep my upcoming appointments with the referral doctor; however, I am prepared to go to member services to try to be evaluated elsewhere.
 
I agree with Jamie that you need Josephine's expertise on this.
 
GratefulNana said:
I am prepared to go to member services to try to be evaluated elsewhere.
Click to expand...
I agree with following up with member services to find an OS who can independently evaluate your knees and hips and give you a straight answer to your symptoms.

You may want to call some OS offices outside of Kaiser for a consult. Call the offices and find out how much they charge for cash pay.
Recommend you obtain a copy of all your x rays, MRI's, labs, surgery report etc. to take with you to any appointments.

GratefulNana said:
I only have mild arthritis and no hip pain
Click to expand...
X-rays do not always show the extent of the damage, surgeons often get into a joint with "mild" arthritis, and find severe arthritis. Hips can refer pain to the knee, sending us on wild goose chases.
 
Last edited:
They need to explain to patients better. If they were just testing to try to determine what was causing the pain that may be why they didn't inject a steroid. Maybe that would interfere with the results? Just guessing here.
I hope they give you a good explanation of the results at your next appointment.
 
kneeper said:
They need to explain to patients better. If they were just testing to try to determine what was causing the pain that may be why they didn't inject a steroid. Maybe that would interfere with the results? Just guessing here.
I hope they give you a good explanation of the results at your next appointment.
Click to expand...

Thanks everyone. This has been a very frustrating journey, especially when it takes so long to get someone to take you seriously. I may be what the medical profession deems elderly and on my way out, but I am going kicking and screaming (Laughing) I am a very active person. I have a very large two-story home that I alone clean. I cook almost daily, and my husband and I put in a very large vegetable garden at our daughter’s home every year, which also has numerous fruit trees. I also spend the summer months into fall canning. My husband and I also love to visit the National Parks, and do short hikes to the various sites within the parks. My knee surgery and the resulting catching/pain issues has all but stopped our travels.

I did get a phone call from the doctor today who I was referred to that did the arthrogram. He told me that there was no infection found. (Great sigh of relief!) He also found no reason that the hip could be causing my pain. He is going to schedule me for arthroscopic surgery to try to find the source of the catching. While I don’t look forward to another surgery, at least this one is not major surgery and, hopefully, may resolve the problem. One thing I am going to insist on is that my pain be managed through this next procedure. Both of the doctors ignored me after the arthrogram. I went through bilateral knee surgery recovery with ice, Tylenol, and one Mobic daily. I had breathing problems after surgery that the hospital doctors deemed caused from the Percocet and Trammadol, which I had never taken before. I accidentally discovered that my hemoglobin was 5 when I was released. No one informed me of this, I discovered it when I logged onto the Kaiser site to look at my discharge orders, and discovered my hospital chart had been accidentally uploaded. Interesting, that these numbers do not readily appear in my test results area. I have to search for them by date. Oh, well. That is history now.

It is a new year, and hopefully I will have a pain free knee. (Smile)
 
I received a survey in the mail a few days ago requesting feedback on my arthrogram procedure. It is interesting that the questions centered around how well the procedure was explained and how well my pain was taken into consideration. I have decided to wait until after my arthroscopic surgery, if I decide to continue with it, to reply.

I received a phone call from a Nurse Practioner in the Perioperative Department two days ago. We went over my health history. She then asked me if there was any swelling in my knees, as she noticed my c-reactive tests results were high. I explained to her that my knees have been consistently swollen since surgery, even with continued icing. She asked me if the surgeon had seen the swelling, and I told her that he had, and he said to ice them. She asked me about the pain in my left knee, and how it was being managed. I told her that the surgeon said it was tendinitis and to ice and take Tylenol, which did nothing to alleviate the pain and swelling overall.

The Nurse was not happy with my case management and was very apologetic. I told her that I appreciated her concern, but she had no control over what happened. What is good, is that she has access to the messages between me and the doctors, and she could see that what I told her was accurate. She told me that my surgery was scheduled for Monday, February 12 at 8 a.m. Two hours later, the surgery scheduler called me to say that my surgery was being changed to February 13, no time yet. Interesting...

I also find it interesting that the OS is not going to perform my arthroscopic surgery. The doctor to whom I was referred by him for the arthrogram will be doing it. I asked why, and the new doctor said that the OS only did big cases. The new doctor also has impeccable credentials, but this seems like a strange move. I will keep my appointment with the new doctor on February 6; however, if I am not happy with his responses to my questions as to what he will be looking for and trying to fix, and pain management, I am going to cancel the surgery, after all he too, ignored my pain levels before and after the arthrogram. I even asked the Nurse Practioner if my chart was flagged for some reason regarding pain meds, as the only prescriptions that I have had in many years was for the Percocet 100 tabs, Trammadol 50 tabs, after BTKR, and three days following surgery when they were discontinued, an advice doctor wrote for Tylenol with Codeine 40 tabs. That was over two years ago. She replied that she didn’t see any reason for withholding pain medications. I worked in a hospital pharmacy for 25 years, and I know that our bodies can get used to pain medication. I, therefore, decided that I would only take the Schedule III drugs after surgery. Until the BTKR, I had never taken a Schedule II drug, and I was quickly taken off of it.

I went into having the BTKR with a very positive attitude. I was very fortunate to have been one of the lucky ones with being able to be more mobile than most very early and having great results with my range of motion despite the swelling. It was the most difficult thing I have ever done to go through this process without adequate pain control. I now wonder if that has helped to create the situation that I find myself in. I have mixed feelings about the upcoming surgery. In retrospect, I am worse off now than before the BTKR. I don’t want to spend weeks going through another recovery with no positive results. The OS said that this is a 50/50 surgery.
 
Wow. I just read through your recovery thread and am appalled at how you were 'cared' for. Having had Kaiser for 41 years now, I know that not every facility is as good as the one I use. I had a horrible experience for a different surgery years ago at a Kaiser that I don't normally go to. The surgeon, surgery and his follow-up were great, it was the nursing floor that was horrible. That doctor made sure I wrote a detailed letter to the management as he was also appalled at everything I went through there and I received many calls from different department heads after as a result. As a result, I stay at the Kaiser I love, and will never go back to the other one, although I have heard they have made some major changes for the better there. Anyway, I wanted to ask you if you have considered a different Kaiser facility and surgeon, and if you are willing to travel a little bit? If so, please send me a private message and I'll tell you which facility and the OS I use (and love!) there. The nurse who said you have to go back to your OS is wrong-I know from experience how Kaiser works and you can see another doctor if they are taking new patients. I am pretty sure mine is right now as he just saw my husband for the first time for his shoulder, but I can't guarantee that. But there is another one there I also really like, so you could check out both of them.
 
Thanks @lovetcookandsew. I received a phone call from a Vacaville Surgery Scheduler a couple of hours ago. My surgery date has been moved up to February 8. Third date this week. My head is spinning from all the calls and changes this week in the ancillary appointments that go along with surgery. My fridge calendar looks like a war zone. I am actually going to receive my anesthesia consult when I show up the day of surgery.

My surgery has also been moved to Vallejo, where I live. Good for me and my family. The scheduler said that the Ortho doc’s schedule was changed, and he no longer does surgery in Vacaville on Tuesdays. I asked why my OS was not doing my surgery. She told me that he doesn’t do arthroscopic surgeries. I was cheeky and remarked that he messes up my legs and someone else tries to fix the problem. I was surprised that she answered back, “pretty much.” If I had known this was the protocol, I never would have had him operate on me. He has no vested interest in my outcome. He is elevated to the “prima Dona” surgeon status, who has no patients, just operates. Factory work. I am not a happy camper. I will ask the new doc what happens to me in the event of an unsuccessful surgery. I am really hedging on not going through with this now.

I need to get myself centered at this point and make a list of the pros and cons of having the surgery. Can you tell that I used to program computers in a previous life? lol I always resort to logic, my safety zone. I think I will start by having my husband take me for a long ride up the coast on Sunday. Ocean air is good for the soul.
 
@GratefulNana I am appalled at what you have had to do to get proper care. My father and my late mother had (Dad still does) Kaiser and they tried for so long to treat Mom. After awhile they just started throwing pills at her and there seemed to be no follow up on all the meds so she just kept refilling the scrips and taking everything.

It seems with Kaiser you have to be especially strong in advocating your health care. The strength you have shown is incredible. I’m sure you will make the best decision about the surgery based on what is best for you.

Best of luck and tons of good wishes

Sherrie
 
@SherrieT Thank you for your kind words. I am so sorry about your Mom. I worked at a Kaiser hospital pharmacy for 25 years. I often helped prepare the discharge medications when the staff was swamped. It always amazed me that some patients would be discharged with 15 to 20 medications. These were not individuals on transplant medications. Drugs are prescribed to offset the side effects of other drugs. I recently read a medical journal that actually addressed this issue. It looks like medical science is actually starting to sit up and take notice. My observations of this type of prescribing behavior, and seeing the resulting quality of life issues,
has made me even more aware of how helpful, and dangerous, these meds we take for granted can be. That is why I take as little medication as possible. My goal is to take none.
 
@GratefulNana at 70 they still had her on estrogen even though she had a hysterectomy 45 years before. When she got worse mentally she was only taking a few things and her physical condition was not effected a bit. She even had a little overnight case that that she carried all her pills in.
 
@SherrieT That is so sad and very hard to hear. My husband, a 31 year survivor of non-Hodgkin Lymphoma who was initially given six months to live at age 40, likes to say that Kaiser doctors are lousy at troubleshooting, but once they figure it out, you can usually get proper treatment. What I have noticed lately, is that the doctors are always typing into the computer as they talk to you, unless you are seeing a specialist. While multitasking is a great skill to have, it is not, in my opinion, conducive to building a good doctor-patient relationship. I do not believe they are “hearing” what is actually being said. Unfortunately, they probably have too many patients and not enough time to spend with them. My GP knows that I do my own research.
 
I know my one doctor will talk to me and look at me but then has to spend a few minutes typing. He apologized for having to do that but "they make us do this now." Back in the day they would dictate their notes...
 
Back when we had actual charts for our records, doctors spent time during appointments writing in those charts. They were, and are, able to listen as they enter info into our charts, whether on the computer or back when they used physical charts. There are pros and cons to today's technology. For instance, last time I was in with my OS, one of my many questions was about something I had heard about the new implant he was going to use. He wasn't sure of the answer as he hadn't heard what I was asking about, so whipped out his phone and texted the rep, who responded right back and answered my question. In the past, getting that question answered would have taken longer and I may not have gotten the info for a while.

Having access to all my doctors by e-mail, having all my history instantly available to them, being able to have the doctor look at the computer and see the exact date of something, etc, is a good thing. In the past, patients had charts for doctor visits, separate charts for hospital visits, separate charts for a different facility, etc, and if you wanted info from a different chart, it had to be ordered, then searched through until the answer was found. Today, it takes a few seconds to locate any past info needed. Last time I was there we also both wanted to see how long it took after each surgery before I started having bad reactions to the oral pain meds. He went over to the computer and had the answer right away, plus how many times I had to go to the ER after each surgery and the different reactions I had. That info would have been impossible to get during my appointment in the past, and very difficult to get at all. It was important to know in order to help plan the pain relief course for my upcoming surgery. So, yes some doctors sometimes spend time making notes on the computer these days, but it's not really that different from when they made notes in our charts back in the "old days".
 
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