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[REVISION TKR] TKR Revisions 24 months after Original TKR

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Cherey

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Hi Gang. It has been awhile but I thought in light of my past couple of visits to my surgeon I need to hear from you.

My knee replacement was done back in Sept 2016. At my 30 day follow up things looked good. Flexion was okay but not what I had hoped. At my one year it was poor though not terrible but around 90 degree and had troubled with swelling and instability with the popping when I shook the leg. The surgeon said no problem we will do an manipulation and go from there.

We did the manipulation in 2017. In January of this year I had another follow up and the knee continued to be warm (not hot) with icing help with pain and overall comfort and flexion was poor again and hovered around 90 degrees. The decision was made to repeat the manipulation but also the surgeon went with the arthroscope and debrided the scar tissue. Unfortunately at follow up we found that he had not removed all of the scar tissue and there is a pop from the knee going over the scar tissue and therefore the knee is constantly irritated especially if I cycle for more than 30 minutes. The surgeon and I agree that my quality of life is suffering and possibly this all may result in effect on its quantity.

The surgeon is now recommending a revision and removing all of the scar tissue through a full arthrotomy and adjusting the polyurethane and by inserting a thicker one. My question is how many revisions can a person have. I am 56 and I expect I will have to have one to two more revisions since the average TKR is 15-20 years before a revision is necessary.

I used the Medicare score card to find my surgeon. If you do use it and are young keep in mind that it is based upon an older group of patients so may not be applicable to a more active person
 
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NavyGunns

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@Cherey,

I’m not a medical expert, so I’m tagging @Josephine who will be better able to answer your specific medical related questions. However, I think you will find that your info regarding the life of implants may be a bit dated. From what I’ve been told, when done properly and if no issues during recovery, TKR and PKR can last 20 yrs or more. My OS told me my PKR May be all I’ll ever need as long as I don’t develop other issues elsewhere and I’m only 58 and very active!
 

Pumpkln

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@Cherey
You'll notice that I have merged your newest thread with your original recovery thread. I noticed that your past history with ROM and MUA are relevant to your present challenges. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
 

Pumpkln

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Sorry to hear you continue to struggle with your knee.
You can have more than one revision or more if you require additional surgeries.
Skigirl had arthrofibrosis and left you her story in post #20 in this thread, you may want to go back and re read it.

Please post the surgery date of your latest MUA and debreidment, having the exact date will help us advise you properly. A moderator will add it to your signature for you.
Thanks!
 

Josephine

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My question is how many revisions can a person have.
These procedures - open lysis, arthroscopy and MUA - are not revisions so they don't count.
I am 56 and I expect I will have to have one to two more revisions since the average TKR is 15-20 years before a revision is necessary.
This is very old information! Modern knee replacements are now projected to last around 30 years and even longer. So it's more than likely that you will outlive your present device!

I'm also concerned how much intervention your surgeon is planning to carry out on your knee. Much of what you have described is unlikely to be resolved by surgery, did you know that?

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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Cherey

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I am totally at a loss for words. We tried manipulation at 9 months, manipulation and arthroscopy at 18 months and now he is saying total revision at 27 months. When the weather changes and on active days I am taking opioids for pain. Swelling has never really left the knee
 

Cjackso21

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I have had several revisions, the first was a total cemented knee after the cementless TKR did not “stick”. After several more and after finally spending $600 because the test for allergies they discovered I was allergic to Nickel. Took a year to get the new top component and by the time they did the revision it was completely loosened. Do not understand why this blood allergy test is not covered but you might look into this. Good luck.
 

Jaycey

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@Cherey I would recommend you seek a second opinion from a surgeon who has no connections to your current surgeon. If this surgeon has not been able to help you all along perhaps a revision specialist would be a better choice.
 

Jamie

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@Cherey .... you'll notice that I've merged your latest thread into your original recovery thread. Since you've had so much trouble with this knee, we really need to keep all the information about what's happened in one place for easy reference when we need to provide advice for you. So please continue to post updates and questions in this thread. If at any time you would like a different thread title (perhaps to draw attention to a specific issue), just post what you'd like it to be here and we'll get it changed for you.

I completely agree with Jaycey that you need to get at least one opinion (two would be better) from a good revision surgeon....someone who sees and fixes a lot of problem knees. Your current surgeon may or may not have the expertise needed to deal with a complex problem like revision. I also agree with Cjackso21 that it would be a good idea to have the full metal allergy test that can only be obtained from one source here in the USA. A link to their website is:

https://www.orthopedicanalysis.com/

Since you've had continuing problems, allergic reaction is one thing you want to rule out. You may find insurance will not cover this test and it is expensive at almost $600. But if this happens to be the problem, you will think it's well worth it.

If you'd like some help locating a surgeon, please tag me and provide your city and how far you would be willing to drive for additional opinions. I can help you find some options for surgeons.
 
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Cherey

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Well feeling a lot of frustration and sadness knowing that I have long ways to go before I can stop the pain. First need determine why - allergy, infection, or something else. Then a surgeon, then if needed a new custom built prosthetic. Looking at another 3-12 months of suffering from the pain
 
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Celle

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@Cherey - I support the suggestion to get a second opinion, from a surgeon who specialises in problem knees. These surgeons see problem knees every working day and they can often spot a problem or a solution that has escaped the original surgeon.

You'll need to consult someone who has no connection, either professional or social, with your current surgeon - so that he/she can look at your knee with new eyes, uninfluenced by the opinions of your current surgeon. You may have to travel outside your area to get this independent opinion.

Meanwhile, you could have the blood test, to make sure that you aren't allergic to any of the components in your knee.
You can get the test done in the USA by ordering the test kit from https://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP/PCP (or any lab) can do the blood draw and send it in for testing.

If you should need a revision, it may not be possible to have a custom-built prosthesis. That doesn't matter, as it's the quality of the surgeon that is paramount, not the type of hardware used.
 

sistersinhim

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Meanwhile, you could have the blood test, to make sure that you aren't allergic to any of the components in your knee.
You have to have a doctor order for this test to be done. I ordered the kit and before sending back a sample, I would have had to include a doctor's order. I sent the kit back and they refunded me. Make sure you have a doctor that will order this lab to do your metal test.
 
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Cherey

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I am scheduled for the blood draw on 12/26/2018. Hospital for Special Surgery has received my records and are awaiting the x-rays. HSS has according to their web site 12 surgeons who do revisions. I have two in mind and awaiting one to call and set up an appointment
 

Jamie

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Is the blood draw you're having done at HSS for the blood allergy analysis Celle and I recommended? I hope so! That is the best test available to see if you have any sensitivity to metals.
 
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Cherey

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Got it covered I think. A friend is a MD and will be sending a prescription with it. I will double though thanks for the reminder
 
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Cherey

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i am doing the blood draw prior to the appointment hopefully HSS will accept it
 
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Cherey

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Has anybody have had a revision following a Conformis implant
 

Celle

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I am totally at a loss for words. We tried manipulation at 9 months, manipulation and arthroscopy at 18 months and now he is saying total revision at 27 months.
@Cherey - Quite honestly, I think your surgeon has had more than enough attempts to get your knee right and it isn't right yet.
I do hope you're seeking a second opinion - or even two or three - from surgeons who specialise in problem knees.
 

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