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[REVISION TKR] TKR Revisions 24 months after Original TKR

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Cherey

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Thank you for your comments. I live 4 hrs from Hospital for Special Surgery in NYC. They have 12 surgeons who classify themselves in being qualified to do to revisions. For the primary I followed the Medicare surgeon scorecard and went with the highest rated who was listed on Conformis web site. Fortunately during a post op visit his nurse said he does not do revision. So when he said he does I became suspicious. The administrator has suggested one at HSS to consider and I have an appointment with him soon. I say all this but still it all going to take time to select a surgeon build up sick leave etc. The pain from my back and other joints keep getting worse and my opioid use is increasing
 
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Celle

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Yes, it will take time to find the right surgeon to do your revision, but I think it will be time well spent.
You'll need someone who specializes in doing revisions. Don't get hung up on Conformis - as a vet, you know that it's the skill of the surgeon, not the hardware, that is the critical factor.

I wonder if @Jamie could recommend a revision surgeon for you, at either HSS or Special Surgery in NYC?
 

Jamie

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Celle, HSS and "Special Surgery" are the same place. I don't really have a favorite revisionist there and think he will be in good hands with any of the surgeons with that specialty. But I'll be interested to find out who you see and how the appointment goes, @Cherey!
 
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Cherey

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I am looking at two individuals. One has done Conformis, I am looking at him just in case it is possible to salvage the current implant, his name is McLawhorn. The second is Delle Valle, who someone mentioned to me as someone who is known to BoneSmart. I am thinking of a third as well but want to get past these two first and then go from there.

Still with the pain and the current opiod scare it is tough going. My back is currently aching and I do not know if it is related to my knee on that side or to my hip. The pain is similar to what I had prior to my THR on my left side.
 

Jamie

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Sorry, I should have spelled out the acronym for you - Hospital for Special Surgery (HSS) in New York City....one of the premium hospitals in the US for joint replacement surgery.

I will appreciate everyone watching out for me as I tend to mis-type the acronym as HHS. This comes from 30 years with the Federal Government and my fingers keep thinking Health and Human Services (HHS)! :heehee: If you see me make this boo-boo, push that REPORT button and straighten me out!
 

Jamie

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Be sure and let Dr. Della Valle know you're a BoneSmartie. He is very familiar with us. Hope you have a good experience with them and it makes your choice easier.
 
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Cherey

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So I have been reading about reasons for premature revisions. The top of the list shows to be a low grade infection. Anyone know different. The allergy test was negative
 

Josephine

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You didn't read that on here! Infection is not the commonest cause of revisions. Other reasons are dislocation (hip), malalignment, poor choice of implant size - all in fairly equal measure.
 
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Cherey

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Will do. With this being a knee I don't think dislocation is likely. Because I had a great response to the flushing I am suspecting it is a low grade infection
 
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maryo52

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@Cherey I just wanted to mention that I interviewed Dr. Alejandro Gonzalez Della Valle at HSS. He was a lovely man and wanted to schedule me for revision, but because of logistics of spending two weeks in New York (which is what they do for people who live far away), I chose a surgeon in Boston (I was able to make the 6 hour drive home two days after surgery). Otherwise, I would've gone with Dr. Della Valle. He has his own website https://www.agdvmd.com which I still visit because it is such a fount of information. So who at HSS are you going to see? Oh, another thing. Dr. Della Valle asked how I heard about him, and I said it was "Jamie" from the Bonesmart website. He phoned Jaime that same day to thank her. Another thing I want to share with you is that I knew someone day I would need a revision because of my lousy first TKR, which had a miserable recovery. I assumed all TKR recoveries were miserable. I had Dr. Freiberg at Mass. General do my surgery and I haven't taken more than 5 oxycodone tablets in two weeks (and never more than 1/2 tab). The first surgery I was on 1.5 percocet every 4 hours at this juncture. My revision was made necessary by aseptic loosening, which I've read is one of the most common reasons for revision.
 

maryo52

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BTW My PCP agreed to put in an order for the Orthopedic Analysis test. Mine came back "highly sensitive" to nickel. My revision has the Zimmer Biomet titanium stemmed implant. The surgeon I chose is not a believer in the sensitivity tests but was willing to do this. I too had a never ending effusion and I spent 8 years on and off looking for answers. Ultimately I ended up with polyethylene wear induced osteolysis causing component loosening. That in itself causes effusion but it doesn't explain the early years of effusion. So your frustration is familiar to me.
 
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Cherey

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Right now I am scheduled to see Dr. McLawhorn. I am looking atDr. Della Valle as well. Dr. Cross is on the list on the list as well. I am going to meet with all three and see who I am comfortable with and go from there. I am suspecting a diagnosis of low grade infection. As I have read there are several approaches to the problem and am anxious to see what they have for a treatment plan. The sensitivity test being negative and the fact that all of HSS have asked for further diagnostics is giving me some comfort but I am still concerned about the possibility of a two stage revision. I really can not afford the time of from work for recovery
 
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maryo52

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Right. You probably already know this, but anyone considering a revision is going to draw fluid and culture it. My fluid analysis looked normal but my CRP and ESR were elevated (just had the pneumococcal vaccine). I did hold my breath a bit until hearing back about the 14 day culture as I too became convinced at times I had an infection.
 
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Cherey

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Well I went to my first consult. The doctor reviewed everything and drew joint flood for culture. He felt that the fluid good and showed no sign of infection but submitted it anyway. He did not have any reason for why I am having pain however. He did recommend a revision since they typically have a higher risk of infection and that they do not last as long. Since it is a Conformis he said as far as he knew he could not help with a 5 degree lateral movement by changing the polyethylene spacer. I have another consult with a doctor whose office said he was one of the designers of the Conformis so perhaps he knows more about what can be done. He also is more experienced surgeon. I am scheduled to meet with Dr. Della Valle the week following. Does anybody know who the specialist is for treating arthrofibrosis at Hospital for Special Surgery. They have 42 surgeons that do TKR and 12 who are listed for revisions but do not show who might specialize in arthrofibrosis treatment
 

maryo52

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I had arthrofibrosis with my first TKR and it was an experience that drove my already active curiosity to explore every person, treatment, research, etc. about the topic. There seem to be no answers. My former surgeon said that if the topic came up at a joint replacement conference, people would scatter.

Now having had a different surgeon (who believes that arthrofibrosis is linked to surgical technique), and a fairly painless recovery, I am inclined to agree within. Something my first surgeon did left my knee so inflamed and painful that adhesions proliferated.

I did find that the Steadman Clinic in Colorado had some expertise in arthrofibrosis (they do a lot of ACL surgery which classically is prone to adhesions forming).

You'll find Dr. Della Valle easy to talk to. I know he will want to see the results of your synovial fluid analysis.
 
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Cherey

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Just started looking at surgeons who are listed for arthrofibrosis. I have 3 more to meet over the next month or so. I know it is coming but after talking to McLawhorn I do not think a revision is the right way of approaching my problem. I think I know the reasons for my problems but I won’t share them until I a, asked. Somewhere there is going to be someone who makes some sense
 

maryo52

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Your determination is an inspiration. At some point it would be great if you wrote down in your thread how you approach these appointments. Lots of people struggle to make sense of what doctors tell them. Keep us posted!
 
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Cherey

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My visit with McLawhorn was very concerning with regards to the Conformis. He felt because it was custom nothing can be done such as changing the polyethylene spacer. He was going to ask the rep. I know that when the prosthetic was made the primary surgeon had three sizes to select from according to a phone conversation I had with Conformis earlier. I will be meeting with Dr Jose Rodriguez in 10 days. Dr Rodriguez according to his office one of the developers of the Conformis. It is my opinion that because of the looseness of the implant that the body is laying down scar tissue to stabilize the joint. After the MUA with arthroscopic lysing the joint was very loose and that supports my theory
 
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