2goldens
new member
Hi Josephine, I'mmmmm baaaack!
You'll remember I'm now 10 months from a Zimmer TKR (December 18, 2007); had manual manipulation on January 31, 2008. The OS reported that he achieved 125 degrees of flexion in the manipulation and that he was able to break adhesions (but perhaps not all). Had two arthoscopies prior to the TKR. I "enjoy" psoriatic arthritis; being treated with Remicade and MTX. My extension is 0-1 (I'm thrilled), but flexion (cold) is 103, and depending on how the PT measures, flexion after PT session can be 117 (and, as recently as June was as much as 129 (owing to different PT's, and the nature of the assistance at the time of measurement)).
Knee itself really is without pain, but I have a feeling like there's something in the prosthesis that won't let the femur end of the prosthesis roll on the tray like it's illustrated on the various vendors' websites; so, I'm not getting the range of motion that I believe I should expect.
Early on, OS said that I should expect cold flexion of 120, and I did get to 115 before backsliding in the last 4-6 weeks to 100-103. OS has now indicated that he may have made the tibia cut a little high and has suggested, first, that he would undertake a revision in the next 6 weeks to lower the tibia component marginally, or alternatively, I could wait 2-3 months (when I'll be 12-13 months out), we'll see if I find the flexion acceptable and if not, he'll do the surgery then (that's a long-winded way of saying that he'll do the surgery now but he prefers that I wait a few more months to see if the result is acceptable). Second opinion from outside the city is prosthesis looks very good, but the OS is not a fan of revisions, period (having done 7-8 in his department during his career [respected former chair of a noted orthopedics department]); he doesn't like the 4x complication rate for revisions, and feels that revision surgery is very challenging and prone to problems (but, that's why you find someone who's done hundreds and knows what he's doing) [as an aside, I discovered after my return that the original OS actually trained under the second OS!!]. His view was that I was inflamming tissue by so much exercise (5x a week, some of which has been intense when focusing on flexion). Recommendation was that I back off the intense flexion physical therapy (including the outpatient PT) and baby the flexion, focusing on one set of less strenuous exercises 5x day to try to increase flexion gradually. Four weeks later that doesn't seem to be working. I'm also icing my knee 20 minutes, 3x a day.
Second second opinion is from the OS recommended by my rheumatologist as the best in the city for revisions (sufficiently experienced to have done hundreds of revisions that have failed because of the age of components). He feels that the knee is sufficiently tight, but not too tight; he would not do a revision, but feels that the knee can be "tweaked" by replacing the spacer with one that doesn't have a lip on the back side. In other words, my physique (weight proportional and phsically active) is such that I don't need the protection of the lip on the back side [Zimmer doesn't make a thinner spacer, but apparently a custom spacer can be ordered without the lip]. My sense also is that with 120 degrees of flexion, he doens't have a concern about the femur component rolling off the back side of the spacer. He too feels that I should wait (4-6 months), which, if the tweaking gets me an additional 15 degrees, is acceptable.
So, basically, the original OS says probably a revision of the tibia component + excise scar tissue(indicating that he would also have available a standby set of additional components in case the femur component also indicates a need to be changedi; .e., going through the entire ordeal again), one second opinion doesn't like revisions period and that excising scar tissue won't work,, and a second second opinion says tweak the spacer. The only common thread is that there's a sense that I should wait -- I'm happy to do that to humor the OS's, but the tissue is going to have to cooperate and flexion increase in the final stage of maximum medical improvement, as I'm not going to be happy if flexion doesn't get to 115-120.
I know this is part science and part art, but the art part is going to drive me to the looney bin. Any pearls of wisdom?
You'll remember I'm now 10 months from a Zimmer TKR (December 18, 2007); had manual manipulation on January 31, 2008. The OS reported that he achieved 125 degrees of flexion in the manipulation and that he was able to break adhesions (but perhaps not all). Had two arthoscopies prior to the TKR. I "enjoy" psoriatic arthritis; being treated with Remicade and MTX. My extension is 0-1 (I'm thrilled), but flexion (cold) is 103, and depending on how the PT measures, flexion after PT session can be 117 (and, as recently as June was as much as 129 (owing to different PT's, and the nature of the assistance at the time of measurement)).
Knee itself really is without pain, but I have a feeling like there's something in the prosthesis that won't let the femur end of the prosthesis roll on the tray like it's illustrated on the various vendors' websites; so, I'm not getting the range of motion that I believe I should expect.
Early on, OS said that I should expect cold flexion of 120, and I did get to 115 before backsliding in the last 4-6 weeks to 100-103. OS has now indicated that he may have made the tibia cut a little high and has suggested, first, that he would undertake a revision in the next 6 weeks to lower the tibia component marginally, or alternatively, I could wait 2-3 months (when I'll be 12-13 months out), we'll see if I find the flexion acceptable and if not, he'll do the surgery then (that's a long-winded way of saying that he'll do the surgery now but he prefers that I wait a few more months to see if the result is acceptable). Second opinion from outside the city is prosthesis looks very good, but the OS is not a fan of revisions, period (having done 7-8 in his department during his career [respected former chair of a noted orthopedics department]); he doesn't like the 4x complication rate for revisions, and feels that revision surgery is very challenging and prone to problems (but, that's why you find someone who's done hundreds and knows what he's doing) [as an aside, I discovered after my return that the original OS actually trained under the second OS!!]. His view was that I was inflamming tissue by so much exercise (5x a week, some of which has been intense when focusing on flexion). Recommendation was that I back off the intense flexion physical therapy (including the outpatient PT) and baby the flexion, focusing on one set of less strenuous exercises 5x day to try to increase flexion gradually. Four weeks later that doesn't seem to be working. I'm also icing my knee 20 minutes, 3x a day.
Second second opinion is from the OS recommended by my rheumatologist as the best in the city for revisions (sufficiently experienced to have done hundreds of revisions that have failed because of the age of components). He feels that the knee is sufficiently tight, but not too tight; he would not do a revision, but feels that the knee can be "tweaked" by replacing the spacer with one that doesn't have a lip on the back side. In other words, my physique (weight proportional and phsically active) is such that I don't need the protection of the lip on the back side [Zimmer doesn't make a thinner spacer, but apparently a custom spacer can be ordered without the lip]. My sense also is that with 120 degrees of flexion, he doens't have a concern about the femur component rolling off the back side of the spacer. He too feels that I should wait (4-6 months), which, if the tweaking gets me an additional 15 degrees, is acceptable.
So, basically, the original OS says probably a revision of the tibia component + excise scar tissue(indicating that he would also have available a standby set of additional components in case the femur component also indicates a need to be changedi; .e., going through the entire ordeal again), one second opinion doesn't like revisions period and that excising scar tissue won't work,, and a second second opinion says tweak the spacer. The only common thread is that there's a sense that I should wait -- I'm happy to do that to humor the OS's, but the tissue is going to have to cooperate and flexion increase in the final stage of maximum medical improvement, as I'm not going to be happy if flexion doesn't get to 115-120.
I know this is part science and part art, but the art part is going to drive me to the looney bin. Any pearls of wisdom?