Revision TKR Third and final surgery all done

[liam2015]

hi kayow11 ~ just read your post about trying alternating heat and cold. my physiotherapist tried using heat on top and cold underneath one time and it didn't feel good to me at all and my knee felt achey for a few days after. i tried it at home, but only for a couple minutes and i couldn't stand heat on the incision. this was just my experience ~ i'm sure it works for some, not for me. however, i did enjoy using heat on the knee before the surgery.

 

[kayow11]

I tried it one time last week, but I seemed to swell worse afterwards, and took days to recover. It felt o.k. When I did it, though.

 

[Celle]

Applying heat to your knees is a very bad idea. It increases the blood flow which, in turn, increases swelling.

 

[Josephine]

Also, do you think there is any benefit to contrasting with alternating moist heat and cold packs to help reduce swelling? My PT and my chiropractor thought that it might be more beneficial than just cold for me. But I did notice the one time I tried it two days ago, that it seemed like my old knee swelled up more and still hasn't recovered from it.

Well since you've tried it and found it caused swelling - which is my usual reply to this question - then I'd stick with the ice.

 

[sistersinhim]

After one of my kneecap removals I had to go to a pain specialist after about 6 months of healing. He suggested I'd ice for 30 minutes then apply heat for 30 minutes. He said it would confuse the nerves. I was completely healed, so I had no swelling from the heat and it helped a lot. But, the key is, all those soft tissues have to be healed before applying heat to them.

 

[kayow11]

Here is a photo of my legs, as you recommended, full length from waist down, and then from standing and looking down, and the photo is my knees down to my feet. As you can see, the left knee and leg are not lined up right. Please tell me what you think Josephine and whoever else wants to comment on this. This surgery on my left leg was done six weeks ago today. My right leg was done on June 19 and is straight.
My surgeon thinks the apparent misalignment is from access swelling and possibly muscle in balance, that he thinks will resolve as the swelling diminishes.

I do see him tomorrow and will give an update after that.

 

[Jamie]

I'll tag @Josephine to take a look. It would have been better to have your legs bare (wearing shorts so we could see the knees), but she may be able to tell you what is going on.

 

[kayow11]

We can redo the photo if needed. Please advise if you need Bare legs. I thought seeing the angle was all you needed but if you want to see how the knee looks, we can send another.

 

[Celle]

Bare legs (wear shorts) would be best, please. It will be easier for Josephine to see the angles.
Your second photo needs to show your whole leg. It might be easier to have it taken when you're lying down on your back.

 

[Josephine]

I managed!

@kayow11, I make your leg having 10 degrees of valgus

 

[kayow11]

Josephine, what are you saying in your last post? Did you have Valgus like this with your surgery? I am just not sure what you are trying to tell me.

 

[liam2015]

hi @kayow11 ~ i think she means that she managed to diagnose your condition based on the photo you posted. at least that's how i took it. hope you're doing okay.

 

[sistersinhim]

I think she meant she could use your photo as is, also.

 

[kayow11]

Thanks Liam and sistersinhim for explaining what you think Josephine meant.

10 degrees of Valgus is moderate, right? I don't like how this looks, and I can't believe that an angle like this will not eventually affect the hip and ankle/foot alignment either directly or indirectly.

I did see my surgeon today, 6 weeks postop on knee number 2. Another X-ray was done today and it looks a little worse than 4 weeks ago, even with less swelling.
He said he would need to do a CT scan to know more, but his estimate was about 5 degrees.

We asked him how this can happen with all of the complex equipment that makes decisions and lines things up right, but he said he takes full responsibility for this.
He feels that functionally, this should not give me any kind of problem at all. But he knows that he can't predict how it could affect other joints but also that it may not affect them too.

My PT says that the body is amazing in accommodating for problem areas and substitutes as needed.

Since I am still so swollen and painful yet, I am not very active so I can't test out anything to see how it all feels. Right now my gait isn't good anyway. I still have lots of swelling in both legs especially the knees too.

The surgeon explained how he would fix something like this, in great detail with models etc., he spent lots and lots of time with us and thoroughly listened and explained and answered every question I had.

I am going to get a second Opinion soon.

I have been very emotional these last several weeks due to dealing with pain, meds, swelling and inability to do things, limited flexion, etc. But very upset about the look of my leg and what it could potentially cause.

I have no idea what I will end up doing, but right now I just need to heal up from the surgery and get rid of these pain meds. I asked my surgeon to prescribe tramadol and I will take that along with Tylenol. He thought that would be a good idea with trying to wean off The Oxycodone, and to alternate for a week or so first.

I also would like to be more functional and do more normal activities of life.
Two major surgeries in four months is about all I can handle right now. Have any of you out there seen this type of problem and do you have any info about it or other ideas or thoughts for me?

 

[sistersinhim]

It's a really good idea to get a second opinion from an Revision specialist that has no contact with your current OS at all. You don't want them know each other. I wouldn't want my new knee to be stuck like yours is either. Something is certainly not right.

 

[Josephine]

10 degrees of Valgus is moderate, right?

The ideal would be zero valgus.

I don't like how this looks, and I can't believe that an angle like this will not eventually affect the hip and ankle/foot alignment either directly or indirectly.

I don't blame you and neither would I.

We asked him how this can happen with all of the complex equipment that makes decisions and lines things up right, but he said he takes full responsibility for this.

That's no answer! But it's all too easy to imagine that all the tools and stuff remove the responsibility for the alignment but it's not true. Each and every tool requires a man to hold it and apply his own brainpower to see that it is used correctly. Mistakes are all too possible.

He feels that functionally, this should not give me any kind of problem at all.

I'd contest that!

My PT says that the body is amazing in accommodating for problem areas and substitutes as needed.

Another person trying to pacify with incorrect advice!

The surgeon explained how he would fix something like this, in great detail with models etc.

Can you tell me some of them?

 

[kayow11]

Josephine, my surgeon brought a couple knee models in with all of the parts that show how it is assembled and he took some of that apart and described how he would carefully remove the bone cement without damaging the bone. He said he learned how to do this removal of bone cement early on in his career so he feels he can do it well with very little trauma. He then said he would only shave off the amount of bone at the end of the femur that needed it on that one side to create a straighter horizontal angle. He also said he would have both legs uncovered so he could compare both of them together while he was fixing the one. He said he would have the x-ray machine handy to use during surgery to make sure the angle was correct and would put the joint back together temporarily, without cement, just to see how it looked, and to make sure it looked straight, before he added more cement to finalize the project.

He did say that he felt the joint would recover quicker and rehab faster because there would be much less surgical trauma done to the bones and the revision in general. I also assume he would be making sure that the tibial surface was also completely correct before finishing. But I would ask him how he would determine this before hand.

I know I have been advised by some people on this forum to get a revision specialist that doesn't associate with my surgeon. I understand the reasoning behind this. But I want to say something about my surgeon. I am in the medical field and did a lot of searching around to find who I thought would be the best one for me. People come from far away places to see him. He has a great reputation and has done this for 21 years and is very willing to please and says his patients health, well-being, happiness, and satisfaction come first to him.

Is it naïve of me or stupid to think that he couldn't do a good job to correct this? He has a reputation to maintain and I really don't mistrust him.

Now is my time to think about all of this, and gather my information so I can make an informed decision in my future.

Any thoughts on all of this?

 

[sistersinhim]

I'm one of those who agree that you should see a totally different OS, a revisionist. I wouldn't let that doctor touch my knee even if he were the last OS available! He did it wrong the first time. That should never have happened. You now need a doctor that knows how to repair the mistakes that other OSs have made, like yours did! Please reconsider letting your OS operate on you again.

 

[kayow11]

Sistersinhim,
thank you for your response and opinion.
Now is my time to gather information to make the right decision for my future.
How do you know if the surgeon you see, has any association with your former surgeon?
And how do you go about finding a revisionist?
I plan to check into all of this but need some guidance.

 

[Knees4Me]

@kayow - I'm facing a revision too, with the same advice about getting another surgeon to do it. I'm not sure yet that I want my original surgeon to open me up again. She does revisions of other surgeons' knee operation mistakes. But I do at least want to get an second opinion from a knee revision doctor at another hospital who's supposed to be the top guy in town. Please keep posting your news! And all the best with your knee.