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The verdict is in - I need BTKR :-(

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Thanks all.

Judy - it is a bit of a waiting game if you have to go on the NHS. The irony is that I actually have private health insurance, but because my knee problems are caused by my rheumatoid arthritis which was a pre-existing medical condition, I'm not covered. :headbang:. I would probably have it all done my now if could use the private insurance.

Becky - your knee is looking good!

Tim - the patience I'm practising on :). I have been busy watching re-runs of Kung Fu (I think you usually post that picture from the show?), so I'm "in the zone" :SUNsmile:. I used to watch it all the time first time round and can't believe that after all these years it should finally be back on TV at just the right time. Must be fate :heehee:.
 
Just catching up on your thread and saw the nickel fiasco stuff. I'm so sorry you had to go through all that anxiety. Good to hear you are finding Kung Fu helpful. :wink: As I recall he was pretty tranquil.
 
The worst part was getting through the weekend after being told of the cancellation, luckily I got to see the surgeon on the Monday. I have now had a call on Thursday from one of the nurses from the orthopaedic ward who told me she was getting the paperwork ready for the nickel free implant. Apparently the implant needs to be sized from the X-rays. So it's nearly made to measure :). As soon as it ready, I will get the next available surgery date. She couldn't give me a time frame - but I am hoping for a date in July. Would be good to get at least on knee sorted during the summer....

There was an option to use an "off the shelf" nickel free implant, but they don't normally use that manufacurer's implants at my hospital, and as it's a different cut and the surgeon has not used it before that was not an option I want to take.

By the looks of it things are moving along now. A case of third time lucky perhaps?
 
Phoenixx29 said:
Tim - the patience I'm practising on :). I have been busy watching re-runs of Kung Fu (I think you usually post that picture from the show?), so I'm "in the zone" :SUNsmile:. I used to watch it all the time first time round and can't believe that after all these years it should finally be back on TV at just the right time. Must be fate :heehee:.
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I never thought, as I watched it way back when, that I would find it in any way therapeutic-----oh, the irony!
 
Phoenixx29 said:
There was an option to use an "off the shelf" nickel free implant, but they don't normally use that manufacturer's implants at my hospital, and as it's a different cut and the surgeon has not used it before that was not an option I want to take.

By the looks of it things are moving along now. A case of third time lucky perhaps?
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That is a very wise and great of your surgeon---he is thinking of you---since he is not familiar with the brand or type, he is hesitant to use it. Surgeons use a brand that they are familiar with and fit the specs to the patient. Your surgeon, while delaying your procedure, was looking out for your best interest by waiting to get the one personally fitted to you.
 
Phoenixx29 said:
I have now had a call on Thursday from one of the nurses from the orthopaedic ward who told me she was getting the paperwork ready for the nickel free implant. Apparently the implant needs to be sized from the X-rays. So it's nearly made to measure :). As soon as it ready, I will get the next available surgery date. She couldn't give me a time frame - but I am hoping for a date in July. Would be good to get at least on knee sorted during the summer....

There was an option to use an "off the shelf" nickel free implant, but they don't normally use that manufacurer's implants at my hospital, and as it's a different cut and the surgeon has not used it before that was not an option I want to take.By the looks of it things are moving along now. A case of third time lucky perhaps?
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Hi Phoenix
Size and fit of the implant might be an important topic on your list of questions to discuss directly with your surgeon. Unless you have a custom made implant, which would be well into six figures $$$, they are all "off the shelf". It would be a rare implant that is custom made.

I asked my OS the question regarding the fit and size of the implant. My OS explained that he uses the x-rays, and in my case, computer aided navigation, plus his skill as the surgeon to determine the size and precise fit. Preliminary sizing was pre-surgery but final determination of the size and its precise fit was done in the operating room by him.

I signed additional paperwork allowing for the manufacturer representative to be present during surgery. He was in the operating room with all of the various sized sterile implants and once the OS determined the size needed, the manufacturer representative provided it. They have a large variety of sizes, including gender specific sizes, and my OS was very exact on the size needed but as I mentioned, his final determination was done in the operating room.

I have only heard of two manufacturers of nickel free implants. The major manufacturer used by OS doing nickel free implants is Smith and Nephew.
 
It sounds like you do have an excellent surgeon working on your behalf. That's always comforting. Now if he could just find a decent secretary!!! You're taking this well and in the end, you'll be just fine!

Sometimes customized jigs are made for individual patients and this may be what your surgeon is referring to.
 
Thanks all - the reference to it being "nearly made to measure" was a bit tongue in cheek. It won't be one of those 3D modelled type, custom made knees - I doubt the NHS would pick up the bill for one of those (and I need two....)! It will be made by using the X-rays for sizing, and they needed my weight so they can get the right implant - I think it probably is what Jamie referring to as "customized jig".

I'm sure all will be fine. I'm just hoping they will come up with a date soon. All this waiting is no fun....
 
Phoenixx29 said:
There was an option to use an "off the shelf" nickel free implant, but they don't normally use that manufacurer's implants at my hospital, and as it's a different cut and the surgeon has not used it before that was not an option I want to take.
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Even with a customized cutting jig, it sounds like he won’t be implanting a nickel free implant as he has not used that type of implant before. If nickel free is your requirement, I’d ask if it will be nickel free and how many he has implanted of that specific nickel free model.
 
Hi, Just catching up on your thread after my own BTKR three weeks ago. What frustration, all the postponements and mis-communications! Glad it seems sorted out, and it sounds like it will have been worth the wait, even though some of the wait could have been avoided if someone had paid better attention to the nickel allergy up front. Hope you get a new date soon! I am absolutely thrilled that I had both of mine done at the same time!!
 
Holy Toledo!!! LOL

This is the last time I will say this cuz I really hate repeating myself - I am so glad I found this forum!

Phoenixx29 - Hang in there! After reading this complete thread, I salute you! I thought my surgeon made me nuts by postponing me twice, once by 4 days and then by 7. I can't imagine being in your shoes!

A couple of comments.

Re: surgeons bedside manner vs. technical expertise. I think they are inversely proportional! My first two surgeons (PKR and then conversion to TKR) I ADORED! They were sweet and kind and took time to answer my questions. Never seemed to be in a rush, sat and listened to me cry. One was even a real gorgeous piece of eye candy. But, in retrospect, I am concerned about their skills. In reviewing my medical records I have found some things that are worrisome and also some downright false information. I even had both surgeons tell me, to my face, outright lies.

My current OS is in a teaching hospital, which I have always avoided like the plague because I don't want to be a guinea pig. But from all of my research, which I neglected to do the first time around, it seems that his skills are very highly rated. I also happen to personally know two of his previous patients who have nothing but good to say about their outcomes. And my mother is a retired nurse and she worked in the same hospital with him for 10+ years and she agrees with his top skill rating. But - 100% of the people I have talked to, including myself, agree that his bedside manner reeks. He hardly even makes eye contact with me much less answers, or even asks, questions. No matter, I route my questions through the nurses and the residents, who are very pleasant and easy to talk to.

I guess if I had to choose - I would prefer skill over bedside manner. I mean, do I really have to like my auto mechanic? If he loves my car and keeps it purring like a kitten, I could care less how he treats me!

Re: customized implants.
If I am correct, and after reading this thread I will certainly be on the phone in the morning to clarify, I am getting a custom-made implant. I had to have a CT scan from the waist down to my toes. I was told that the implant would be manufactured specifically to my measurements. That was the reason I was given for a 6 week wait after the CT scan - because it takes that long to build the implant.

I am in the U.S. and this is a teaching hospital. I have Medicare so I am not using a top notch private insurance.

Thoughts, anybody?
 
Elisea, at my hospital they are using the Depuy model (the nurse let that slip), and the nickel free version is a special order. The "off the shelf" one is by a different manufacturer, and that is the one my surgeon has hasn't used before. The surgeon himself suggested that he would prefer to stick to the model which they normally use at this hospital, even though it would mean a slightly (?) longer wait. And I'm with him on that. What's another few weeks, when I haven't been walking properly for around 8 years or so.

Wanda, yes, it has been a bit of a roller coaster ride. I expected postponements from the beginning; now I know the next date will be it - so it will be time for major nerves to kick in when the date comes through!

With regards to the surgeon - the one I'm seeing now, is actually very nice, takes his time and listens, and the nurses speak very highly of him. So fingers crossed, all will be well.
 
I am sorry that you need to have a BTKR, but it sounds like you are all ready to move forward and have crossed your T's and dotted your I's. Good for you!
 
How goes your surgery?
Did you have it yet?
 
As for surgeons' bedside manner vs skill, I think mine had pretty good bedside manner but leaves most of the patient interaction to his PA and spends most of his time in the OR. I would think surgeons become surgeons because they want the hands on work more than the patient interaction. But I do know he cares b/c when I had that glitch with the femoral block I could tell he was angry that that had happened. I think someone probably got a piece chewed out of her...
 
I haven't been posting much on my thread as I'm still not making much progress.....Have been back to the hospital for more X-rays, then got a letter last week with a date for an alllergy test, which I didn't realise they were going to do, although it does make sense. That's on the 3rd of August. So - at least I will know for sure about the nickel issue.....I know that I will get the first available date after all is sorted. In a way I'm glad it's all done properly - but the waiting is starting to get to me a bit now. The cortisone shot I had my knee in March is starting to wear off, and I could be in real trouble with that knee....So I'm a bit worried about that at the moment, as I know the surgeon won't want me to have another one. I don't really want to start taking too many painkillers at this stage as I don't want them to become ineffective after the surgery.

If I'm lucky, I will get a date in August for the first knee, although I'm beginning to think that it might be September. Oh well, I will just have to take it as it comes.
 
Phoenixx29 said:
I haven't been posting much on my thread as I'm still not making much progress.....Have been back to the hospital for more X-rays, then got a letter last week with a date for an alllergy test, which I didn't realise they were going to do, although it does make sense. That's on the 3rd of August. So - at least I will know for sure about the nickel issue.....I know that I will get the first available date after all is sorted. In a way I'm glad it's all done properly - but the waiting is starting to get to me a bit now. The cortisone shot I had my knee in March is starting to wear off, and I could be in real trouble with that knee....So I'm a bit worried about that at the moment, as I know the surgeon won't want me to have another one. I don't really want to start taking too many painkillers at this stage as I don't want them to become ineffective after the surgery. If I'm lucky, I will get a date in August for the first knee, although I'm beginning to think that it might be September. Oh well, I will just have to take it as it comes.
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Well, good to hear from you! Sounds like things are progressing. I thought you already had the testing and that's how you knew about the nickel. They must be testing for something other than a nickel sensitivity if you are already receiving an implant that is nickel free.

The test is the LTT (lymphocyte transformation test) if you are not familiar with it. It is a blood test not a skin type test; big difference between the two types. A skin test doesn't measure the body's immune cell reaction to implanted materials which the LTT test does. LTT measure various metal sensitivities / allergic reactions to the implant materials like to nickel, chromium, iron, and more.

After they draw the blood, depending what metals are tested, about 4-5 vials, they send it overnight to one of the several labs around the country that does the testing, culture it and results are about ........... if I remember 10 days later. Hope that gives you a timeline! Do keep in touch!
 
Thanks Elisea - I too thought they were making the nickel free implants. It was presented to me as though that was definitely going ahead. With regards to the allergy - I have never actually been tested. I do get a reaction though if I wear earrings which contain nickel (within a couple of hours, I get inflammation, a discharge and blisters) which is why I was so concerned about the implant, as I was reading up on the subject and the recommendation was to make the surgeon aware.

You're probably right that they'll do the blood test - I would actually prefer as this should be more comprehensive than the skin test, but if those results do take 10 days to come back - I suppose I will be looking at a date in September for the first knee now.....
 
Wow Phoenixx I just caught your thread and I can't even fathom how frayed your nerves must be!:console2: You are one strong cookie for not giving everyone a peice of your mind! I know the saying goes "what doesn't kill you, makes you stronger", but must they put you through the test?! I hope you jump to the top of the "surgery" list after the blood work and all else gets sorted out. Stay strong and stay well my friend!:friends: I look forward to reading your post-op story soon!
 
It's not all bad - just the waiting is becoming a nuisance now. And I'm a teeny weensy bit envious of all of you who have managed to go through it all and are well on your way through recovery now. I should be waiting to have my second knee done by now! Don't get me wrong, I am pleased for you all and I am amazed at the progress you all have made. I just hope now the allergy test proves what I have been saying all along. Wouldn't it be ironic if it came back negative! At least they are doing things properly, and I have been given assurances that I will get the first available date once it's all sorted. The annoying thing is I had to get a lot of stuff ready at work, I have told all my regular customers (I work in customer services/sales) that they will have a temporary contact etc and now everyone's asking what I'm still doing there. I'm like a broken record having to explain it all. I'm looking forward to the day when I won't have to discuss my knees any more :heehee:.

And considering that I was going to spend my recovery time in my garden, and we haven't had a summer yet, I haven't actually missed out on that much!
 
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