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TKR Three years with new knee and new questions

juniper

juniper

senior
Joined
Feb 6, 2012
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313
Age
74
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Wyncote, Pennsylvania United States
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It's Juniper. I've been visiting bonesmart intermittently this year. Still teaching, now half time, and finally went to a new surgeon, closer to home, just to see what he thought about my knee...still very sore after I've been on my feet for any length of time. He took a look, said it was swollen and it shouldn't be at this point. Took a big vial of fluid out and told me something was wrong. Sent me for blood work and convinced me a bone scan would help identify if there was a fracture. Also had allergy tests. Bone scan was fine, blood work too. I did find that I am allergic to nickel. Turns out the stryker prosthesis I was given does have nickel. He thinks the allergy may be the reason for pain and inflammation, but he is not encouraging me to have a revision. He said that the statistics for improvement after this kind of reaction is about 66%, that 33% of revisions due to allergy show no improvement. We worried because it is a tough surgery...the bone grows around the prosthesis and it's a hard job to dig it out. I am so discouraged. Without shaping my life around caring for my knee...just the right balance of sitting, walking, icing, exercising, rest...I'm in pain. It's daily discomfort, and frequent pain and swelling. Before the replacement, it was infrequent excruciating pain when my knee locked, but there were stretches when I was pretty much pain free. Anyone else have a revision and new knee due to allergic reaction. I just want to see if your stories coincide with what this doctor has seen and read about.
 
@1ELISEA , can help you with information about metal allergies.

Good to hear from you even if it is not in the best of circumstances.
Sorry to hear you are having problems with your TKR two years out.
Recommend you see a surgeon who specializes in revisions about your metal allergies and other options you may have.
 
Juniper, I am so sorry to read of this situation---what a blow. I am glad that Pumpkin tagged Elisea because she has a lot of info about metal allergies and knees. I guess if I were you I would consider a revisionist---I assume he saw no loosening in the bone scans. A tough call and I think you need more expert help before you can make that decision.
 
Pumpkin, Skigirl and RedRider, thanks for your responses. It's good to know there are some people out there who may have information. The new doctor I saw does revisions but it's clear he is conservative. Understands that surgery is invasive, hard on the body, doesn't always have the desired outcome. He was doing minimally invasive surgeries before anyone (including the doc who did my TKR) called them this. He worked with five other surgeons to pioneer and study a shift in TKR procedures. He's incredibly busy. Maybe too busy? But I really like how thoughtful and thorough he is. I definitely want to research the success of revisions after allergic reaction as well as what I can do to make my life better while I'm figuring this out. Physical Therapy did make a difference two summers ago.
 
I know that @1ELISEA has information on one of the few labs that does a blood test for metal allergies. I agree that a conservative approach is best toward revision. Let's see if you used the same lab that Elisea recommends.
 
Thanks, Skigirl. I didn't have blood work. I had a patch test. The doctor thinks that is probably the cause of the pain and swelling/fluid in my knee. He also said the test isn't completely reliable but thinks the amount of fluid I have in my knee indicates something is wrong. I did see that blood tests are somewhat more reliable.
 
Jane! So sorry to hear this news, I'd thought you were on the mend!
Strikes me that maybe these allergy tests should be done for allergies before any op is done?
I'm back to hospital in the new tear as other knee is playing up...not sure I can face this journey again esp when another son us getting married next year!
 
I thought so too. Two summers ago, I had great PT and felt like I made progress. I began teaching part time and kept up the exercises and walking, but there were days that even part time work, standing as much as I did, ;eft me in pain. Summers are easier because I have more control over the balance of exercise and rest. Many people have encouraged me to see another doctor...especially if they see me limping out of school. So I did...and he was surprised my knee was so swollen...it's always that way at the end of the day...said he wanted to aspirate the fluid and test it for infection. He got an entire vial and told me something is definitely wrong. The first doc kept saying it was in my head. It was numbness, not pain I was feeling. Don't you love it? So now, I don't know what to do. More research, perhaps another opinion.

Good luck to you with your next new knee. You know you can get through it...and for you it's a better option than doing nothing. My knee has never been as pain free as it was at times before the surgery. Enjoy the next wedding! Both of my sons got married last year. One trip to California after the other. Both weddings were wonderful and both boys wanted me to be involved in their ceremony.
 
:wave:Hi Juniper--sorry you're back b/c of problems. I have no info on revisions or allergies but want to wish you luck.
 
juniper said:
It's good to know there are some people out there who may have information.
Click to expand...

Hi
Thanks for the tag @Pumpkln and @skigirl
I've been out Christmas shopping; an activity I can now do after my TKR. :yes:

@juniper you mentioned they did not do a blood allergy test? That would be my suggestion; much different than a skin test. To read about it:
Click Here for Lab 1
Click Here for Lab 2

After my test confirmed metal sensitivity (aka allergy) to several metals in the usual implants, I chose a surgeon who was the creme de la creme in his field; teacher of other surgeons, inventor, and did a mega amount of TKRs a year. And he implanted a nickel free implant, the Oxinium Smith and Nephew knee. CLICK HERE

Also, have you been working with a Rheumatologist? That is another suggestion. They have training and knowledge in how the body reacts to conditions involving joints, soft tissues, vascular systems and allergy type conditions.

When you have a blood test for metal allergies, work with the Rheumatologist to review it and decide upon a plan of action. I have an Allergist who sat with me and reviewed the test in great detail, and together we decided a new knee was needed and to give it a try. To date, I have one TKR even though the other knee is in bad shape; I wanted to wait several years to ensure that I did not react negatively to the current nickel free implant.

I am sad that you are not able to fully enjoy post TKR life. Hopefully, this information is helpful and do let me know if you have questions.

Also, I'm tagging @Orthodoc for advice he might give to you.
 
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juniper said:
It's Juniper. ..finally went to a new surgeon, closer to home, just to see what he thought about my knee...still very sore after I've been on my feet for any length of time. He took a look, said it was swollen and it shouldn't be at this point. Took a big vial of fluid out and told me something was wrong. Sent me for blood work and convinced me a bone scan would help identify if there was a fracture. Also had allergy tests. Bone scan was fine, blood work too. I did find that I am allergic to nickel. Turns out the stryker prosthesis I was given does have nickel. He thinks the allergy may be the reason for pain and inflammation, but he is not encouraging me to have a revision. He said that the statistics for improvement after this kind of reaction is about 66%, that 33% of revisions due to allergy show no improvement. We worried because it is a tough surgery...the bone grows around the prosthesis and it's a hard job to dig it out. I am so discouraged. Without shaping my life around caring for my knee.....I'm in pain. It's daily discomfort, and frequent pain and swelling. Before the replacement, it was infrequent excruciating pain when my knee locked, but there were stretches when I was pretty much pain free.
Click to expand...

Hi @Orthodoc
I've quoted from most of @juniper 's initial post from this week (her first post in this thread). She had a RTKR in January 2012. Is there a next step she might take?
 
Last edited by a moderator:
This is a very difficult problem. We have discussed metal allergies many times here on the forum and unfortunately, there has not been significant progress with this issue recently.

It is most important to make sure that the swelling does not indicate infection. One option for treatment would be an arthroscopy (scope) prior to revision to make sure there is no soft tissue impingement. Has a scope been considered?

Orthodoc
 
Orthodoc, thanks for responding. I have had blood tests that indicate there is no infection. Also had a bone scan. I'm not sure what soft tissue impingement means. I called the doctor who did the knee replacement and he thinks that it is rarely an allergic reaction. He doesn't believe that skin tests or blood tests can be trusted. His take on this...that my right quad is much weaker than the other quad and that this can cause swelling and pain. He thinks I need PT. That would be great. The surgeon I have seen recently, who is much closer to me (in the same state), pretty much said, "it's probably an allergic reaction but I don't advise a revision. They are rarely successful. Come back in a year." WHAT?? I'm not sure why I went through blood tests, allergy tests and a bone scan if there isn't really anything to do. I'm discouraged, but am happy to do more PT, and to meet with a nutritionist to get on an anti-inflammatory diet. (That's what my GP suggested). Really I just want to do something.
 
One of the problems is that you have differing opinions without knowing which one is correct. Perhaps a third opinion will help (perhaps not). Considering revision must never be taken lightly and there is no good clear cut answer for you.

Soft tissue impingement is when there is tissue (scar tissue or synovial tissue) that is getting caught between the plastic and the metal parts of the replacement. This can cause recurrent swelling and or recurrent bleeding into the knee joint after knee replacement. It is not common, but still part of the "differential."

Orthodoc
 
Well, orthodoc, I wish you were nearby to be my third opinion. Thank you for responding to my questions. I keep trying to be positive. It's possible that PT might help...or an anti-inflammatory diet. The bone scan didn't show anything horrible. The nurse who tried to convince me to get it assured me that sometimes people discovered they had cancer and were able to begin treatment (oh, joy). That could have happened. It didn't. Good to know that there are several possibilities and I just need help in figuring out which it is. I'll keep trying.

I sort of lost it when reading your response. You have no investment in being part of this Bonesmart site, except like Josephine, and all the moderators, you want to be helpful, and have expertise. This moved me enormously. Thank you. I will pursue a possible answer, and ask whether a scope might be indicated. Thank you so much. And thank you, Elise A, and Pumpkin and Skigirl for sending my questions to orthodoc.
 
Juniper,
Deciding what direction is hard to do, you know what you have and there are no gurantees if you have a revision that it will be better. I agree with Orthodoc, you should get a third opinion.
Wishing you all the best this Holiday Season.
Merry Christmas and Happy New Year,
 
I agree too, seek out another OS with experience in revision. If you can get two opinions to agree that will be a big step. And thanks for the kind words---all of us here enjoy helping others. We wish we could have magic wands, but all we can do is sympathize, advise and listen. I know it is hard to think of a third opinion, but it is probably the next logical step.

I wonder if you could send your records and images to someone at the University of PA/ or a big hospital in Philly. with computers now it is easier to get an opinion via images and records.
 
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