Revision TKR TKR Revisions 24 months after Original TKR

[Cherey]

Have finished with one consult. His recommendation is RFA and no revision. Going to get more and try the RFA

 

[Cherey]

Have sought a second and third opinion neither of which think a total revision is the answer one stating that there is an increase risk of infection and revisions do not last as long. The second said it was a 50:50 chance of success with a total revision. Going to see if radiofrequency ablation (RFA) is possible. Both doctors are at HSS so I am comfortable with their knowledge and it seems that the implant is fine. It just does not bend and becomes excruciatingly painful when the weather changes. If RFA does not work I am going to pay $500 and have the “Reconstructive Joint Group which are 12 orthopedist at HSS who review and decide amongst them what can be done and who will do it. There are two Dr. Sculco at HSS and both seem to be recommended for arthrofibrosis. Anyone have personal experience?

 

[Cherey]

Here is he diagnosis and update. HSS has determined that I do have fibrosis and pain of unknown origin. It is considered a complex knee but are recommending against a revision due to risk and only a 50% chance of success. An attempt will be made to control the pain doing a genicular RFA with no guarantee of success. If not successful then I will need to consider long term opioids I know that the risks of a revision is to great at this stage of the original to undergo one. I am signing off for now

 

[Cherey]

Starting to feel like I am talking with my self. But maybe someone will respond. The trial block in preparation for the RFA worked as it did after the RFA. Over the weekend we have had weather change and I have been in excruciating pain. I contacted the Pain Management specialist at HSS and he feels that if I am still having this much pain that the RFA did not work. In preparation for if it did not work I made an appointment with a local pain management specialist who was baffled with me traveling as much as I have. He seem reluctant to work with me but when I got a call several days later to set up a follow up I assume that he will. He is talking about Oxycotin or similar medication. I am not really happy about all of this since I seem to loose a little bit of myself when I have to take oxycodone on multiple days. I have called HSS and left messages for both of the doctors I have seen in hopes they will call back. Just want to cry

 

[Pumpkin]

@Cherey ,
Moving right on to Oxycotin seems like a choice that should be reserved only when all options are over. IMO: I would stick with HHS for now.
Has anyone spoken with you about Therapeutic Neuroscience education? It can in addition to every thing else you are doing it can help you better cope with your situation and begin to get your life back.
Places you can start are the Curablehealth.com, Retrainpain.org, and the Pain Reframed Podcasts on iTunes.

 

[Jamie]

@Cherey, I know comments from your fellow BoneSmarties have been rather scarce lately and I'm sorry about that. You are going through such a difficult time and I know it would help to have support and some validation for your decisions. But, I'm sure you know that your situation is quite unusual and that makes it difficult for us to provide specific advice. We're as dependent as you are on what the specialists are telling you.

I certainly hate to see you having to go the route of long term opioid medication. I hope you can get back to one or more of your HSS surgeons to see if there are any other options for you.

Forgive me if you've already answered this, but have you had a metal allergy blood test? The particular test I'm talking about costs around $550 and there is only one lab that does it. Usually it's not covered by insurance. If you haven't, I do suggest you get that test done to rule out the problem of any metal sensitivity.

Please don't give up. We do care about you and want to know how things are going for you.

 

[maryo52]

I agree with Jamie. Do the Orthopedic Analysis test, and you'll have that information for the 12 doctors when they brainstorm. It may explain a few things.

 

[Jockette]

I agree about the blood test, I would gladly pay for it myself to see if it could solve and prevent a problem.

 

[Celle]

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 (or any lab) can do the blood draw and send it in for testing.

 

[skigirl]

My husband ended up with long term opiod use after his back surgery failed to fuse. I have to say that he was miserable much of the time. He had constant constipation and so took a variety of laxatives which were draining. He was sort of sleepy much of the time and dizzy too. Also, the pain meds had to be increased at times because he became habituated to them. Oxycontin is the strongest and most addictive of the pain relievers, I am amazed that someone would jump to it first. After my surgery, I took it for 10 days---my doc would not prescribe it for more days because it was so addictive. It happily worked for the first few days after surgery, I ended it after the 8th day.

 

[Josephine]

You might like to know this about oxycotin vs oxycodone: Oxycodone is an opiate agonist that is the active ingredient in a number of narcotic pain medications, including Percocet, Percodan, and OxyContin.
OxyContin is a specific brand name for a pain medication in the opioid class (narcotic drugs) that contains the extended-release version of oxycodone.

 

[Cherey]

Yes I am aware of the difference. The doctor specifically said Oxycotin was his preferred choice since it is long duration. I keep thinking the problem is the arthrofibrosis and if that was corrected everything will be okay but so far no one at HSS is interesting in trying to save the prosthetic. The original surgeon was to revise and HSS does not give good odds if it is done. Thinking of paying the $500 for the group opinion or seeing another surgeon at HSS who is listed as specializes in arthrofibrosis Sculco

 

[Cherey]

Weather has been changing constantly which is driving the knee and me crazy. The RFA did not work since it has been over three weeks ago. It was thermal and I have read that cooled makes a larger lesion and have started looking for someone who does it. Still taking oxycodone and am thinking I will go that way until I can get the cold RFA done. The HSS doctor who did the RFA has talked about a nerve stimulator implant but the thought of it makes me sick

 

[Cherey]

Went to HSS and met with the Chief of Surgery Emeritus. He is listed in the arthrofibrosis doctors. He said that the posterior cruciate sparing prosthetic that I have has a history of causing inflammation and subsequently recurring scar tissue. He is going to do an arthroscopic break down of the scar tissue followed by a MUA which is the opposite sequence of what was done the last time as well as remove the posterior cruciate. He did not use any superlatives instead he said this is what he has done in the past and prefers to try it before doing the more invasive procedure of a revision.

I have been on a roller coaster and lots of opioids to manage my pain along with having to turn down a position in Great Falls MT which I really wanted to take but my knee was in the way. I figure once the doctor works on me I am then officially under the care of the #1 orthopedic hospital in the country and if anyone can get my knee right my best odds is with them.

It has taken a while but if this does not work then I can accept the idea that I have to have a revision. I do not like loosing the posterior cruciate but I have one of the best in the USA and one of the best in the world saying this is the answer and he is the only one that has been insight full enough to give me a sound reason for everything. Surgery is July 26th.

 

[sistersinhim]

I hope you can finally find success in this new journey. It sounds like you have done lots of research and it's paying off.

 

[maryo52]

This sounds like a good plan to me, having had some of these issues. Unfortunately, the outcome is hard to predict. We are so different, and often everyone's best thinking is only an educated guess. I did have the arthroscopic removal of scar tissue. It saved the day, so to speak, although that TKR really was never good and I'm glad it's gone and I have a new one.

 

[Josephine]

He said that the posterior cruciate sparing prosthetic that I have has a history of causing inflammation and subsequently recurring scar tissue.

I wouldn't agree with this as according to the NJR stats, the majority of knees are done with PCL sparing implants.

The difference between what you have and what he is referring to is this

I've never heard or read that PCL sparing cause more scar tissue (adhesions) than others. That's news to me.

 

[Cherey]

Thank you all. I had another opinion regarding the approach. I guess it is not unheard of. The doctor who will be doing it is the founder of the HSS complex joint reconstruction unit. They do a lot research so I give credit to them. A cousin who graduated from Cornell Medical School said I ought to get someone who is not so research oriented but since I am looking for an alternative to the revision and this is the only offered I am going for it. There as an alternative which I asked about which uses amniotic membrane which one of the doctors is trying for arthrofibrosis but the results are all over the place

 

[mainegirl1]

My husband lacks a PCL. He was having knee lock up problems and XRays showed a migrating object. He had several x rays and this thing never stayed put
He had it arthroscopically removed and it was a segment of PCL calcified
The docs asked him when he ran into a wall or had a severe accident
He had to think back to when he was 14
At the time of discovery he was 66 and hiking a lot
He continues to do so minus little PCL

 

[Cherey]

I went through my physical Wednesday and have been pronounced good to go. Ready to get off the opiods. Having some pain with the lower back and am concerned it will affect how much I get on the CPM