TKR TKR after tibial plateau fracture

Jamie

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Hoping this surgeon can help you. Good luck and will be thinking of you.
 
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Ayse

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Wondered if anyone had had this problem with their implant... since the TKSlA as well as it not fixing multiple existing problems I have got severe pain from knee cap, the tendons and ligaments either side and a big lump and dents in muscles around it. My kbee feels deverely twisted and can't sit with knee bent as it's agony. Feels like femur is tiwsted medially, tibia twosted laterally and a brick or rod in medial side of knee causing pain pressure. Looking at pre op and ppst op xrays the shape of my femur and position of k eecap is very different. I can see when looking at my knee femur is bigger than it was and stretching tendons etc out of orriginal place. Is this something a revision could fix?
 

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Jamie

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It’s possible. With knee replacements, the surgeon’s skill in balancing the ligaments and making sure the patella tracks properly are critical. If a patellar button wasn’t installed, it also can cause some problems post-op.
 
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Ayse

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It’s possible. With knee replacements, the surgeon’s skill in balancing the ligaments and making sure the patella tracks properly are critical. If a patellar button wasn’t installed, it also can cause some problems post-op.
Thanks @Jamie a patellar button was put in. It's like the femeral implant is the opposite of the angle of my original knee so the patella is twisted medially now plus it seems bigger than oroginal bone. I dont understand how this can be normal as it would mean everyone who has an implant would have twisted knees
 
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Jamie

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It appears that the angle of the two x-rays may be slightly different and that can make things difficult to compare. Be sure and raise these questions with the new doctor that you’ll be seeing along with the possible need for a patellar button.
 
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Ayse

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It appears that the angle of the two x-rays may be slightly different and that can make things difficult to compare. Be sure and raise these questions with the new doctor that you’ll be seeing along with the possible need for a patellar button.
Yes it might be but I can really see on my knee thay the femur now sticks out about an inch wider than it was and my kneecap is about an inch over medially to where it used to be. I will definitely be speaking tto the new surheon on tuesday when I see him about this and the many problems. A patellar button has already been put in Thanks @Jamie
 

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Really hope the new surgeon can give you some answers and a plan to improve things. We are all really rooting for you to get better.
 

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Blimey!! You have had a tough go at it and I’m so sorry you are suffering. Constant pain is debilitating, I can totally relate to that. I wish I had some words of reassurance for you. I think you know you’d be better off going to the U.K. for treatment.
I wish you all the best
 
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Ayse

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Just had an update re my ongoing problems. I saw the original surgeon who said everything looks fine on the implant. Looks perfectly aligned and the right size etc. Saw new OS who, looking at the CT scan, says it shows the tibia is roated 40 degrees and he thinks the femeral implant is too big which does fit with some of my problems I'm experiencing. Some things they both said they can't do anything about such as bony deformity below knee that stretches ligaments and soft tissue and scar tissue on fat pad and other places etc. The new OS has suggested revision TKR but he thinks only 60% possibility of improvement which doesn't sound that high. I'm going to get another opinion as well soon.
 

EalingGran

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I think you are wise to get another opinion as your situation is very complex. If you are coming to London I would recommend my surgeon Alex Liddle
as someone I would trust to give a good, sensible opinion on what is possible.
 

Jamie

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I agree that one or more additional opinions would be a good idea. I'm wondering if a good reconstruction surgeon could take a look at your bone deformity and give an option for you. These surgeons can usually do joint revisions as well.
 
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Ayse

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I agree that one or more additional opinions would be a good idea. I'm wondering if a good reconstruction surgeon could take a look at your bone deformity and give an option for you. These surgeons can usually do joint revisions as well.
Yes indeed. Thanks so much @Jamie
 
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Ayse

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The frustrating journey continues! Ive been in UK for a month and seen several surgeons for further opinions.

The surgeon who said the CT scan showed rotstion of the tibia referred me to his colleague who looked at the scan and said the implant isn't rotated so he's referred me tp another colleague who is a lower limb reconstruction expert. There has always been some rotational problem between my knee and foot since the accident and it looks on long leg xrays like my lower tibia was bent in a curve after the accident.

It seems like the medial patellofemerol injury wasn't repaired during the TKR. So that could be causing some of the patella instability. There's also scar tissue benesth my kneecap. But I also saw another surheon who thought the femeral implant looked too big. And he explained that the reason my kneecap is now about 3/4 inch medial than before is because the femerol implant is a completely different shape to my original knee. So that is causing big problems because bending my knee now is agony as it feels really twisted and all the tendons/ligaments are stretched over. If I sit and bend my leg I have to turn my foot inwards to relieve the pain a little. On the tibia because of the bony deformity now the ligaments/tendons on that part have always been stretched into the wrong place too so I've got double that now. He doesn't think there's anything that can be done to improve things and could make things even worse if that's possible but is having a meeting with colleagues and then will see him again.

Then I saw a revision expert who is a colleague of the original TKR surgeon who said everything is OK.

It's looking like I will be stuck like this as the ongoing problems have been there for 19 months and the new problems from the replacement may not be able to be fixed. So I still have a knee that doesnt function properly and can still only stand and walk on a flat surface for a few minutes. Fingers crossed there may be some good news but I'm not very hopeful.
 
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EalingGran

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I am so so sorry to hear that there is no obvious answer for your injuries. I hope the meeting with the surgical colleagues might come up with some solutions to improve matters.
 

Jamie

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So sorry to hear this, and I can only imagine how frustrating this must be for you to have so many radically different opinions. There are so many factors at play here, I do understand how your situation would be difficult to diagnose. But….good for you that you keep seeking answers. I hope you continue with that, as it’s possible that you will find the answers and hopefully a solution that goes beyond ”just live with it.”
 

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