TKR TKR and Hardware Removal? Advice welcome

Ayse

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Hi all, just trying to see if anyone has any advice or been in this situation before... In Nov 2021 I had an accident from a medial blow to my leg and suffered a lateral tibial plateau depression fracture, some microfractures, a lot of trauma to soft tissues and ligaments, medial and lateral meniscus tears. Initially I was told I didn't need an operation and was non weightbearing for 6 weeks with a brace set at 45 degree flexion. Unfortunately, I wasn't told to do any exercises so my muscles severely atrophied. Following progressive weightbearing after the 6 weeks, I had multiple issues. Pain in the medial side of joint and patella when contracting quads, pain to the medial side of centre in the joint, along with feeling of obstruction (which I assumed was the meniscus tear), instability of the leg when walking where my leg swayed from side to side (which I assumed was the fracture). After 6 weeks of no improvement I saw a surgeon who said the fracture needed an ORIF plate/screws. On 22 Feb 2022 I had a plate and screws with hip bone graft and a stitched repair of lateral meniscus tear. No arthroscopy was done at the time and I was told the medial posterior horn meniscus tear was degenerative and didn't need debridement.

Following the operation I was non weightbearing for 4 weeks. Following progressive weightbearing it became apparent that none of the previous problems I'd had were rectified by the operation, and instead I had more problems. Now, 4 months on from the op and 7 months from the accident I have multiple issues.

The Plate/Screws: I have a big lump, swelling, pain, inflammation at the top of the plate and down the side and front of my leg. It constantly rubs on the soft tissue and I can feel the plate/screws through the skin. The muscles around the scar are solid and some parts seem as if they are stuck on the plate or with scar tissue. The ligaments rub when I move my knee. It's constantly painful resting but worse with any movement that involves the joint like walking or trying to do exercises. I've been advised I need to wait until it's been in for 6 months to get it removed to allow the fracture to heal, but the pain is becoming more unbearable and my leg less functional as the time goes on. It feels like it's doing a lot of damage the longer it is in and I need a balance between the problems it's causing and the pain/swelling.

Functional problems: Since the operation my patella has been unstable. I can't stand properly on the leg because I can't relax my patella when standing because it feels like my knee will collapse. My quad tendon keeps contracting. When I actively try and relax my patella, which only lasts a few seconds, my patella only goes half way down compared to my good knee. The patella feels like it's in the wrong place and twisted and is catching on something, and it sort of pops on and off whatever it's rubbing against. It doesn't glide up and down freely or completely. I don't remember having this problem prior to the operation. I can't put weight on my leg with it in a standing bent knee position because of pain/obstruction in medial side of joint, along with pain behind the kneecap and the patella tendon. I also have bone pain from the femur and tibia either side of the medial joint line.

It's very hard to even walk. There is something painful obstructing the joint just medial side of centre which feels more like bone, not meniscus. My leg doesn't flex and extend in a straight hinge movement anymore. It now goes medially and laterally when I bend my leg so when walking my knee leans inwards then out, causing pain in MCL/LCL area, as if they're being stretched. The pain from the plate is excruciating when walking. I'm using a brace and walking stick. My knee swells more after walking/exercises. I also have increasing pain down the front of my leg.

I also have pain and swelling in the area of the patellofemoral ligament, patellotibial ligament, patellomeniscal ligament, patella tendon, area medial to the patella tendon. No ligament tears have shown up on MRI. I've been advised the LCL/MCL/ACL are loose and wavy. There is also traumatic cartilage damage to the joint surfaces, and the patella, where the medial side of the patella has also completely lost cartilage. There is meniscus degeneration and possible tears, along with calcification of meniscus and loss of joint space.

I've been doing physio exercises for 6 months and although my muscles are stronger than they were, my leg function/pain/instability is not improving. I had trouble with quad exercises because of the pain on the area medial to the side of patella when contracting my vastus medialis or movement of patella. Every time I try to progress to functional exercises like step up/down, wall slides, mini squats, the pain gets worse due to the obstruction in medial side of joint, pain behind patella, instability, the joint not bending and extending in a straight line, and hardware pain. I can't walk up/down a slope or up/down stairs because of these problems.

Prior to this accident I was an active person and it has completely changed my life. I've been trying to get different opinions from other surgeons as I wasn't happy with my original surgeon who has basically said he can't do anything for me because it's too early for TKR. I have multiple problems with the plate, kneecap, and joint. 1 surgeon said he could remove the plate after it's been in there 12 months and arthroscopy to try and clean up the joint but he's not sure how much it will fix but he didn't want to do TKR because I was too young. Another surgeon has said the same or that he can go straight to TKR. Both have said the accident has changed the biomechanics of my kneecap and the plate may be hindering it's position and that there may be scar tissue also contributing but haven't really been forthcoming about whether a TKR would help reposition it. Any advice welcome...
 

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InkedMarie

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I can’t offer anything except support from afar! So very sorry.

Marie
 
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Ayse

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Aww, thanks so much, Marie. Very sweet of you. xx
 

sistersinhim

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On my goodness, you poor thing. You and your knee have been through so much.

You might have to travel some but I believe your best bet would be to find a revision specialist who deals with problem knees. You need one that has no connection with your current doctor. You are not too young for a TKR. We've had some members in their 30s.

I hope you can find someone to help you.

Even though you had your ORIF surgery in February, I'll leave you our recovery articles for a joint replacement. Your recovery will be very similar.


Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax and let it. Don't try and hurry it, don’t worry about any symptoms now; they are almost certainly only temporary.
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when the pain starts!)​
3. Do what you want to do BUT...
a. If it hurts, don't do it, and don't allow anyone to hurt you.
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again for a few weeks.
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep
 
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Ayse

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Thanks so much for all the very useful info. I'll read thoroughly xx
 

Jamie

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@Ayse......thank you so much for providing the images in your post. Are they recent?

Let me echo what has been stated above. You are NOT too young for a knee replacement. We have many members your age and younger who require this surgery. Done properly by a surgeon who does at least 150 knee replacements (not knee surgeries, which would include more than just replacements) each year. Experience counts with joint replacements.

Because you are in Cyprus, we're not going to be of much help for you in a search for a new surgeon. But you definitely need to find one who will recognize that you need your knee replaced as soon as possible in order to regain your functionality.

Although the articles above may help you with your current recovery, I'd like to offer the information we give knee replacement pre-op patients. It contains some additional articles that may be helpful to you as you search for a surgeon.

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:

Score Chart: How bad is my arthritic knee?
Choosing a surgeon and a prosthesis
Longevity of implants and revisions: How long will my new joint last?


If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?


And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

Stories of amazing knee recoveries

In looking at your x-rays, I noticed a couple of things that can be the source of at least some of your pain.

1658641861869.png

The space between your femur and tibia is reduced which indicates problems with the cartilage. The two areas I've marked in red appear to be bone on bone (on the right) or nearly so (on the left). This can result in the type of pain you're describing.

1658642744518.png
1658642982859.png

Your knee is on the left and a "normal" knee is on the right. Notice where the patella is located on your image....it's a bit too high which may indicate some maltracking problems with your knee cap. This also could cause a lot of pain for you.

We cannot actually diagnose what is going on with your knee on the forum, but you obviously have problems that need to be addressed by a surgeon who knows how to deal with a knee that is not functional even after surgery. You'll need to ask a lot of questions of any surgeon you talk to to find out if this is the case. He should be seeing and fixing a lot of problem cases, doing adult reconstruction, or knee replacement revisions.

Please let us know how you get along and we'll do our best to help you through this challenge.
 
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Ayse

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Hi Jamie, thanks SO much, that's really helpful. The X-Rays are from 6 weeks ago. Trying to find the right surgeon is key, which is the hard bit so far! I may have to travel to UK for it so still researching. I'll have a read through all the links. xx
 

Jamie

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If you decide to go to the UK, @Jaycey may be able to guide you to a good surgeon. She’s in the UK.
 

Newbai

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@Ayse Sorry to hear about your accident and all the pain your are going through. I can relate as my situation is/was some what similar to yours.
Here is my background thread about how I got to the point to of needing a TKR… https://bonesmart.org/forum/threads/what-hinged-tkr-did-you-get.70623/
I end up getting a hinged TKR because all of my lateral ligaments were completely torn and my ORIF surgery wasn’t able to set the plateau on my tibia correctly which created a large gap on one side of the knee joint, thus causing my leg to have a large varus angle. He is my TKR recovery thread from my surgery about from 12 days ago.
FYI, I am only 46 yrs old (some OS thought I am too young for TKR while some were saying it’s ok to do TKR at my age). My advice, get as many OS opinion on your situation before you make a decision that will give you the best chance of walking pain free again.
 

benne68

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he didn't want to do TKR because I was too young.

We have quite a few members who have had TKRs in their 40s and 50s.

You might check out @Susie-Q 's recovery story. She had her first TKR at age 42, and had her other knee done last year.
 
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Ayse

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If you decide to go to the UK, @Jaycey may be able to guide you to a good surgeon. She’s in the UK.
@Jaycey if you had any knowledge of surgeons that would be great. I'm trying to find one who deals with all the issues, plate removal, patella problem and instability, and the joint problem. Thanks so much xx
 
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Ayse

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Thanks so much Newbai. Will check out your thread. So sorry you went through this! xx
 

Susie-Q

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I'm so sorry you are dealing with all of this. I hope you are able to find a surgeon to help you. :flwrysmile:
 
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Ayse

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So, I travelled to UK to see a knee specialist and 2 weeks ago had the hardware removed. The plate was actually stitched to the ligaments and tendons, as well as being too big so no wonder that side was causing so much pain and problems! There's some improvement on that side, but now I've not got to wait 3-4 months for the bone to heal before most likely having a complex primary TKR. Not looking forward to having 3 surgeries within 1 year and am totally crapping myself about the surgery!
 

Jaycey

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@Ayse So sorry but I did not get a notification of your tag earlier. Sounds like you did find someone to help you resolve this problem. Actually I think you are through the hard part - hardware removal.

Focus on getting this knee healed in preparation for the final stage. I assume your surgeon is a revision specialist?
 
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Ayse

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@Ayse So sorry but I did not get a notification of your tag earlier. Sounds like you did find someone to help you resolve this problem. Actually I think you are through the hard part - hardware removal.

Focus on getting this knee healed in preparation for the final stage. I assume your surgeon is a revision specialist?
Hi @Jaycey, thanks so much! Yes, it is Sam Rajaratnam. He does revisions and a lot of knee replacements per year. Fingers crossed I will be in good hands!
 

Jaycey

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@Ayse, I just looked at this consultant's numbers in the NJR - very impressive. I would not worry at all about having him do your TKR!
 

Jamie

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I'm glad you were able to find someone to help you with knowledge and experience. That's half the battle! Although you'll have a bunch of surgeries in a short period of time, others have been through this and have done just fine. Here's hoping things go well for you. Please keep us up to date on how you're doing. We're here for support if you need us.
 

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