Lounge Doctor

Revision TKR TKR Revisions 24 months after Original TKR

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
39,955
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Don't worry about the CPM. They don't make any difference to your eventual ROM anyway.
 
OP
OP
C

Cherey

junior member
Joined
Feb 28, 2016
Messages
47
Age
58
Location
Pennsylvania
Gender
Male
Country
United States United States
My surgery was done on Friday July 26, 2019. The doctor unlike last time did not do a MUA followed by the arthroscopic lysis. Instead he did just lysis. The PCL was shot so he did not remove it instead he worked till he got 115 degree flexion and at that point he stopped applied pressure and got 120 degrees. I pretty much am happy so far. I understand how not pushing it avoids a lot of swelling and the possibility of scar tissue and fibrosis accompanying it. Interestingly I am on aspirin twice a day for 42 days. I am pretty much off crutches and just hanging out taking my drugs (hydrocodone) and doing the CPM machine 4 hours a day. I know the CPM machine is controversial but since what is being done is out of the ordinary and the doctor is cited as specializing in arthrofibrosis I feel that if he wants it who am I to go against it since what he is prescribing is not all that difficult to do for now and avoiding a revision is the goal. Besides I think the game here is for the surgical incisions to heal withe least amount of scar tissue forming.
 
Last edited:
OP
OP
C

Cherey

junior member
Joined
Feb 28, 2016
Messages
47
Age
58
Location
Pennsylvania
Gender
Male
Country
United States United States
A person earlier in this post wished for me to track my progress. I met with the surgeon for my first follow up. We discussed the procedure. Unlike the primary surgeon he did not do a MUA. Instead he electro cauterized the scar by using it to peel away the scar tissue. He released me to 115 degrees and then with a little help pushed it to 120 degrees. He ordered four (4) hours a day of CPM along with five (5) days a week outpatient PT from the time of surgery till the first follow up. I was able to flex to 110 for him on the day of follow up prior to surgery I was 95 degrees. He has now backed me down to one (1) hour CPM and PT three (3) times a week. PT has experience with arthrofibrosis so they are not pushing it. I am being very cautious about getting my hopes up until six (6) months out but it does seem possible that I will have a functional knee. The surgeon feels that even if I go backwards he will not need to do a revision but maybe catch it early and do a MUA at six (6) months instead of waiting a year as the primary surgeon did. It is obvious to me that the surgeon is very good in handling complex joints. I found him using the arthrofibrosis list here on the web site
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
18,324
Age
64
Location
Delaware
Gender
Female
Country
United States United States
How do you feel recovering from this procedure as compared to when you had the MUA?

And, I know you were concerned about your back and using the CPM, I would have the same concern. How is that going?
 

tabbykit

member
Joined
Apr 19, 2019
Messages
141
Age
63
Location
Scotland
Gender
Female
Country
United Kingdom United Kingdom
@Cherey, just read your thread and sending good wishes for your recovery. You have been very thorough in choosing your OS, quite rightly of course. From my own experience and from reading about others on here, it seems there are many surgeons who shouldn't be doing TKRs, let alone the more complicated revision/problem cases.
 
OP
OP
C

Cherey

junior member
Joined
Feb 28, 2016
Messages
47
Age
58
Location
Pennsylvania
Gender
Male
Country
United States United States
I am recovering quicker than the previous two attempts to treat the arthrofibrosis. My back is holding up with no major issues. Certainly I have a more experienced surgeon and physical therapists
 
OP
OP
C

Cherey

junior member
Joined
Feb 28, 2016
Messages
47
Age
58
Location
Pennsylvania
Gender
Male
Country
United States United States
Yesterday I went for PT. On a whim I asked to be measured actively and I flexed 118 plus a little what ever that is. The CPM died this morning and doctor has let me off the hook from it. Went down the stairs at the house and was pain free on one descent. That is the good. The bad is that we have been having weather changes like a revolving door. They have been EXTREMELY painful. The doctor and the PT team say to give it a couple more weeks before panicking which is hard to do since the neuropathy is one of the primary reasons for the surgery. At least the flexion is good
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
18,324
Age
64
Location
Delaware
Gender
Female
Country
United States United States
Weather bothers my replaced knee a lot! Never did before surgery. It’s still happening 2.5 years after surgery.
 
OP
OP
C

Cherey

junior member
Joined
Feb 28, 2016
Messages
47
Age
58
Location
Pennsylvania
Gender
Male
Country
United States United States
My surgeon feels it comes from the scar tissue he removed. He is listed among the arthrofibrosis doctors so i guess I will go with his opinion for now
 
OP
OP
C

Cherey

junior member
Joined
Feb 28, 2016
Messages
47
Age
58
Location
Pennsylvania
Gender
Male
Country
United States United States
So acupuncture helped but not enough to relieve the pain enough so I can get off hydrocodon. Genicular block was 100% successful but the follow up RFA was less than 50% successful. I have been told that phenol ablation is the next effort to try but have a doctor in the family who is concerned about side effects. Does anyone have had it performed and what does the group know?
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
32,335
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
@Cherey I am not sure any of our members have had phenol ablation. My colleague @Jamie has been here a bit longer so I have tagged her to see if she remembers any members.

Are you to be part of a study or does your doctor do this routinely? What side effects is your family member worried about?
 
OP
OP
C

Cherey

junior member
Joined
Feb 28, 2016
Messages
47
Age
58
Location
Pennsylvania
Gender
Male
Country
United States United States
Jacey. My situation is unique and therefore a learning opportunity. The forum will not share my educational background so I will leave it at that. There is a phenol trial going on at Northwestern but you have to be no more than 12 months post surgery. Currently I am under the care of a doctor at Hospital for Special Surgery and not planning on changing that unless I move with regards as far as the mechanics of the prosthetic. However their pain management has not been successful in treating the pain And therefore I have sought for treatment outside HSS. I come from a medical family and one of them who is head of all anesthesia for the VA system heard my history and pulled in her head of pain management who has been a Navy surgeon of 30 years. I have had genicular RFA twice at HSS and they have been less than 50% successful and still am on hydrocodone. For the record Genicular RFA or any ablation post TKR is at best 65% successful. The kicker is the lidocaine diagnostic block that was performed prio to the RFA was 100% successful so I have hope. The Navy surgeon said to find some one who performs the procedure under ultrasound guidanc. The previous two attempts where under fluoroscopic guidance. RFA for osteo is approximately 80% successful but the difference appears to be due to the nerves rerouting themselves after TKR and therefore fluoroscopic guidance is basically a guess. The lidocaine was successful but lidocaine spreads over a broad area which in theory what phenol will do. However phenol is not something you want spread over an area greater than what you intend for it since there is a chance of unwanted necrosis which is what Dr. my cousin and her surgeon is concerned about. As the doctor who I am currently having discussion with said I am atypical case. Although HSS has said there is nothing wrong with the prosthetic the current pain management doctor and I agree that it might be a good idea to get a bone scan to rule out loosening even though HSS says it has not loosened based upon MRI, blood test, and radiographs. Decision day will come post bone scan and after a successful diagnostic block which will be followed by ultrasound guided RFA probably if the RFA fails I will pay for the phenol out of pocket. Just need to get off the hydrocodone
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
32,335
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
Thanks for the details @Cherey !
However phenol is not something you want spread over an area greater than what you intend for it since there is a chance of unwanted necrosis which is what Dr. my cousin and her surgeon is concerned about.
You certainly don't want more potential for necrosis.

I think the bone scan is the way to go. And sounds like you have a tentative plan to move forward. Please keep us updated! I wish you all the best in getting this resolved.
 

Macknit

graduate
Joined
Jun 2, 2019
Messages
510
Age
67
Location
Oregon
Gender
Female
Country
United States United States
Hi @Cherey I just popped into your thread and see we have some similarities. I have had neuropathy issues since around 2008. Mostly for leg and foot pain. Mine seem to stem from spinal issues, however, not the genicular nerve.

I will be following your updates on your tentative plan to see about the phenol ablation. I'm guessing from your post, that this procedure is done on the genicular nerve also?

I wish you the best of luck in all of your treatments.
 

rustic

member
Joined
Dec 3, 2018
Messages
160
Age
61
Gender
Male
Country
United States United States
Thanks for continuing to report. I've been following for a while. I'm 16 months post op, with pain that my OS has recommended RFA for. I'm delaying, giving me time to learn all that I can before deciding. Tech literature, as well as seeing how it works out for others.
Your situation seems complicated and difficult in many ways. I hope that things start working out better for you soon.
 

Top Bottom