Revision TKR Two year plus odyssey - no end in sight yet<

[kneeper]

When I got the tendonitis, brought on by PT having me do too much too soon, it lingered for quite a while. The only thing to do was to do very little exercise for quite a while and then gradually add minutes. I know you're afraid of "becoming a lump," but better to do what you feel is virtually "nothing" right now in order to let this issue heal and then be able to go forward later with your exercise program.

 

[ottothedog]

Good morning, Josephine, Runnergirl, Jordan6, and all -

Sorry that I took a break from knee and other orthopedic discussions for a couple of days. I appreciate the encouragement, sympathy, etc... as well as suggestions to "do what Josephine did" with a fresh and otherwise non-problematic TKR and recovery - her "how I used a lack of exercise to ensure my recovery". I am pleased for everyone who had different (better) results - I wouldn't wish mine on anyone (not even my original surgeon).

In answer to latest questions - I do also walk some... about a mile'ish on level ground usually every other day. Did I previously mention that I have some left hip issues which are generally aggravated more by walking than by recumbent bike exercise ? Yes, I wish I had (1) simple to solve problem, but instead several.

I have never been sedentary - and am not comfortable with that, but just FYI - have taken it easy for the last few days and honestly notice not much difference in pain or stiffness. If it's going to "hurt about the same" when I try to "use" these things mostly normally (or don't), then... I'm going to continue using these things... until I can't.

I recognize that most people don't have "serious" problems with these TKRs, but am aware of several people (local) that I have talked to personally... that do. Most of these have given up on getting any better and "just deal with what they have". I'm not ready to do that yet. I am appalled (generally) that so many individuals having these are treated like fast-food hamburger preparation in that (mostly) these are performed about the same, with follow-up PT and etc. prescriptions (mostly of an aggressive nature) also about the same (regardless of knee appearance and patient response to this). I had to change PT providers because they were literally unable to acknowledge that what they were doing was not working or that there were at least some uniquely problematic issues with the knee that more intensive PT and time alone would not solve.

My problem (other than ongoing with the function and pain of my own 2nd partial TKR - as a repair of the 1st) is that there does not appear to be "a Plan B" (in other words - when things don't go as well as expected)... even those these surgeons are well-aware there actually are significant number of these. More than one has told me they were frustrated by this... but that's not the same understanding that they actively working on solutions (versus just continuing to perform more of these same intensely profitable surgeries).

So... I've described what I've had done, when, and by whom - and included what was tried subsequent to these surgeries and procedures. What I continue to experience is a somewhat higher level of function and decreased pain early in the day - which deteriorates to increased swelling, stiffness, and pain (and we know for a fact that 20-22cc's of fluid is collecting in the joint daily - and is mostly absorbed back into the tissues overnight). We know that replaced knee joint is stable and within a limited range of flexion (although it has never straightened completely) seems to work ok (nothing like before surgery, but ok).

I would be interested in doctor referrals in the Pacific Northwest Area who specifically deal with problematic TKR results - or other suggestions specific (or at least generally similar) to my own 2+ year surgery and (lacks of) recovery experience. Yes, I recognize that "recovery" may be considered by some akin to "spiritual growth" - and therefore a lifetime journey. I do not share that opinion, but welcome any useful suggestions.

Thanks for your continuing kind thoughts, patience, and who knows that maybe I will yet receive a referral or suggestion than can help set me on a path toward "getting better", I sure hope we all find that !

John

 

[sistersinhim]

I am so sorry you are going through all this. I will tag @Jamie to see if she can get you a referral.

You can make your posts as long as you want to. We are here to listen and to try and help.

 

[Jamie]

I suggest you contact this surgeon for a consultation:

broken link removed: https://www.pamf.org/dr-colin-l-eakin.html, Palo Alto Medical Foundation, California

He works with patients who have problems with arthrofibrosis and it's possible that is at least part of your problem.

My other suggestion would be that you ask to have a complete metal allergy test done. It's about $550 and not usually covered by insurance, but we are finding that sometimes people have an undiagnosed sensitivity to certain metals that can result in problems with recovery.

 

[ottothedog]

Thanks, Jamie and "Sister" (and Josephine as well) -

Jamie - Yes, I do have an allergy test on the horizon (as part of an appointment with a rheumatologist - if I can ever get this scheduled).

I also have an appointment with a Dr. Borus - who comes highly recommended to me (located in Vancouver, Wa.). He believes that the joint is loose/has loosened and I had a bones scan which may show a slight additional uptake in the l. Personally... I do question this as the source of the continuing irritation/inflammation... and do have serious concerns at his suggestion - which I understand to be a 3rd surgical revision.

Josephine - I did read your "exercise-less" recovery... as well as an interesting discourse (forum style) where several people commented in favor of at least a very limited exercise with PT recovery... versus the kind I had (and apparently so many others). I eventually did change PT providers, but in retrospect strongly suspect the PT I originally received contributed to the MUA... and to increasing pain and decreasing function generally.

I highly recommend this article to all (and thanks, Josephine for your contributions)
ttps://sbfphc.wordpress.com/2013/08/21/ceasing-aggressive-physical-therapy-after-total-knee-replacement/

So...

Here's how it went:
A) A TKR which included an oversized (femoral) portion of the joint
B) PT which was completely over the top 4X a week to the point you couldn't walk on it

(at all) the following day - and no amount of pain meds would suffice​

C) An MUA
D) More of the same PT - followed by more of the same effect...
E) New slightly less aggressive PT provider - who still believed in some forcing to get a little higher degree of flexion (that you couldn't get on your own)
F) A replacement of the upper portion of the the previous TKR to the next size smaller including removal of the meniscus.
G) More PT - less aggressive, but still aggressive to the point that we stopped makingprogress and started going backward.
H) Dr. Desai with his cortisone, dextrose, and then PRP injections (after the previous surgeon tired of the lack of progress and persistent pain complaints)... including a suggestion for "neurotransmitter" to drown out the pain signal... including that he also suggested the daily fluid, swelling response might be neuropathic alone (if you didn't perceive the pain - maybe you wouldn't have the swelling/fluid response) ???
I) And now... Dr. Borus and his suggestion that maybe a thin "line" on an xray couldindicate a loosened joint - and THAT could be the genesis of the daily swelling and pain ? And let's do surgery and change out the joint... again...?
J) And now a suggestion for a surgeon in Palo Alto and I'm guessing he will probablyrecommend (drum roll) surgery ?

So... thanks for everyone's attempts to help... and my apologies where I've tried (or continuing trying) people's patience. Sorry that I can't be a more positive story. trust me that nothing would suit me better.

Suggestions (referrals within a thousand miles, etc) welcome...

Thanks and best to all,

John

 

[sistersinhim]

Do give Jamie's recommendation a call. It's time for you to have a knee that's right!

 

[ottothedog]

Dear Sister - Thanks for your encouragement (and for Jamie's previous recommendation).
I completely agree that I am way past time for a positive surgical experience. However unless I actually sell everything I own and move to Palo Alto to see a surgeon that does not accept my insurance (Providence - what else ?)... then I guess I could figure out some way to completely liquidate my retirement (to pay for the surgery - which insurance will not cover... remember, this is the US of A we're talking about)... and then maybe do my recovery 1000 miles remote from the person who did the surgery ? - not that all the surgeons I've had so far might as well have been thousands of miles distant (for how completely uninvolved they chose to be after the surgery was performed... and not much interested in my recovery, period).

Sorry to be a little negative on that referral... except that it's not really a feasible option... except in the sense that liquidating everything we have both worked 40+ years for and putting it all on either "red" or "black" and then "spinning that wheel" would also be considered a feasible option.

I'm thinking (hoping) that there must be at least one more capable, caring, surgeon - but maybe in the Pacific NW - or maybe this is not in bonesmart's collective experience ?

Sister, Josephine, Celle, and all - I really do appreciate your "listening" and suggestions so far, but I really do hope to receive one that I can actually "try". I am glad for you all - that you were able to find solutions, relief, and etc. (I don't at all resent your collective success - I wish to share in this also).

Just so you are all aware - I have (because of illness or other infirmity) had to "rest" the knee for periods up to a week and more... and have notice not much difference in the pain and no discernible improvement in the function. I am confused in suggestions to "take it easy so things will or can heal". That has never happened (and you have to remember we are about 2½ years since the first surgery and nearly 1½ years since the last. So are you saying that now in a situation where we can not "go back in time and un-do the aggressive physical therapy that followed both surgeries... we can "rest" or "baby" the knee long enough (maybe for years ?) that it finally starts to heal ? C'mon... that does
not seem reasonable, but let's say it is. So... specifically how long ? when do we get results ? and what are these expected results ? Sorry - but I do have to ask (since this suggestion continues as a reoccurring theme).

Anyway... I will continue to look for updates and am hopeful of more useful suggestions... maybe a trip to Lourdes, right ?

Thanks all,

John

PS - Included R. Knee bonescan which to my layman's eyes appears inconclusive, but probably not inconclusive it could not serve as the rational for a new surgery by someone being well paid to perform just that... Anyway... now you (all) have this as well

 

[Josephine]

Excuse my ignorance, but do I need any special software to send you a digital copy? I am assuming that you are interested in the most recent xray which showed a slight "line" between the femur and the replaced joint

If you scan it on to your computer you can upload it just like you did your bone scan report.

And his basic message was "that's all I can do - some knees just don't get better... we don't know why

This certainly is a sad fact.

As "grown-ups" we have to admit generally that patients
are oversold on the "statistically more likely" benefits and undersold on darker (but still real) possibilities.
Patients are "sold" on having these surgeries - primarily for financial incentives.

I'm not a US citizen but we certainly never have this in the UK. Not ever.

It's an unfortunate fact that generally most surgeons I have met believe all "real" medical solutions... are surgical.

And I don't agree with this either. I know that around 60% of new patients surgeons see just need some simple advice and reassurance.

including explanations to "Ok.. if I have this additional
surgery will it solve these problems (of continuing pain and stiffness)? Or might I end up the exactly the
same or worse?

I don't know of any surgeon who would guarantee that. They would be more likely to say 'might'. Their legal and insurance vendors wouldn't be at all impressed if any were known to be guaranteeing outcomes like that. Just isn't done!

What I don't see or hear... is much recognition that there are a statistically significant number of problems with these surgeries

Surely when you signed your consent form, there was a list of possible complications which would have included such cautions as

infection
failure of wound healing
loosening
continuation of pain
blood clots
death​

If you didn't get this list, either written or verbal, then your hospital/surgeon was at fault of obtaining consent without proper cautions.

I would not care to live in a chair or bed only nor where I would not "do anything" for fear of causing myself additional pain. So less strenuous gym work, but please, what in the way of suggestions and recommendations?

Nobody is asking you to do nothing and you shouldn't. But the activities of daily living are quite sufficient and those are my recommendations.

Yes I had also thought about amputation which I agree - is nuts, but then I see people getting around better than I am and when talking to them about it they are in less pain.

But it's often the case that amputation doesn't resolve the pain because it's in the entire leg, possibly even going up to the hip, and certainly in the nerves. If you have the leg amputated at midthigh level, there is s till an awful lot of nerve left which is giving problems.

My problem (other than ongoing with the function and pain of my own 2nd partial TKR - as a repair of the 1st) is that there does not appear to be "a Plan B". More than one has told me they were frustrated by this... but that's not the same understanding that they actively working on solutions

I think you're expecting quite a lot of your surgeons. They are not research scientists moling away in a laboratory trying to work out or create these problem solving things. They KNOW what they have to work with and they can draw on that knowledge at any given time. So if they cannot come up with a ready answer they either don't have that experience (which means seeking out another surgeon) or it doesn't exist in the first place. These things are not an exact science!

I highly recommend this article to all (and thanks, Josephine for your contributions)
ttps://sbfphc.wordpress.com/2013/08/21/ceasing-aggressive-physical-therapy-after-total-knee-replacement/

John, that link doesn't work. You can see it hasn't gone blue.

 

[ottothedog]

Dear Sister, Josephine, Celle, and all -

Thanks all for your continued comments, suggestions, etc.

Josephine - sorry that you are unable to reference that extended conversation (which is actually one of your own). May I suggest that you cut and paste it to your browser (which is what I did - not being especially or at all - "tech savvy").

I am tending toward believing/accepting Dr. Borus's attempt at a diagnosis - that being that the lower portion of the joint has loosened - this being demonstrated by the uptake of blood in that tibular "head" right where it joins the replaced joint.

The analysis of this bone scan doesn't tell me (maybe it does others) much - but the actual scan (which I don't have a copy of) - shows what seems a pretty dramatic difference - compared to the upper portion of the joint (and the other non-replaced knee joint). I accept that he can not "guarantee" this as "the solution", but the most reasonable explanation I've had yet - which makes sense to me with the following:
A) If it was really an allergy to either the metal or the cement - then it wouldn't settle down overnight and wouldn't be so related to weight bearing (which it absolutely is).
B) It's getting worse - not better... and by that I mean the knee becomes irritated, swollen, etc. more quickly and is generally more - not less painful. Yes, more use and more stress makes it even more painful, but my exercises keep getting dialed down to less weight and less reps (and is generally not less painful - only more painful when I try to do more. For instance... I walked at the mall and went to the gym at opposite ends of the day... and was so painful the following day that I couldn't go to the gym. 5-6 months ago... I was regularly walking in the morning and going to the gym... six and sometimes seven days a week (and it was a harder workout at the gym - and I was less painful generally).
C) I'm getting more noise out of the joint - not all the time, but some of the time and I have a little bit of a sense of things seeming a little looser generally (and I originally thought - well, this is because the upper part is smaller and you don’t have the MCL anymore - but now I'm not so sure that's the reason).
D) When I talked to Dr. Ballard about bone loss concerns when he replaced the fibular portion (which I expected), he commented that there really wasn't any to speak of - and that he was actually surprised at "how easy it came loose" (and that was why no real bone loss). At the time, I was thinking - "that's good, but now, I'm wondering if neither part was properly secured in the first place. The original follow-up xray done by Dr. Borus (before the Dr. Ballard surgery) showed no slight line between the lower portion and the leg bone... and then my year after meeting with Dr. Borus xray did - which is why he wanted the bone scan done.
E) If this is correct – then any subsequent x-ray (taken a few months later) should show a more pronounced (apparent) “line” and also any subsequent bone scans should just show (further) increased levels of “uptake” (as you would expect this to “loosen further” as more time passes). It shouldn’t “get better” – it should “get worse” (like all things mechanical - with a defect).

So... I'm planning on having my right shoulder joint replacement "done" and then to re-evaluate the knee - after the recovery of all that... with the accumulation of time and use allowing me to further confirm the above diagnosis on the knee. 'Best laid plans again... perhaps ? Your thoughts ??

Two further questions:

A) Does anyone out there have any information, ideas, suggestions on how to avoid creating/forming so much scar tissue (which I understand as the body's reaction to injury/surgery). Maybe my body tends to "over-react" in this respect - and I'd like to "lessen" or at least "somewhat manage" that response for my upcoming shoulder surgery. Ideas ?? Suggestions ?? Including - Can this even be managed ??

B) Neurologists (and others) are anxious to recommend an implanted "neuro-transmitter" - which comes with a "trial" to determine it's effectiveness in your particular case. In my minimal reading, I see this was actually developed for back pain - but has also been used for management of "other pain"... in some cases more successfully than others. This is also known as "SCS" (spinal cord stimulation").

Your collective thoughts on this for TKR related pain ? Is there any successful experience (or otherwise) on this out there (as it relates to TKR pain) ? Once again (not to be negative), but I've also read that this is a new "cash-cow" for the pain-related field and is being aggressively marketed. It requires next to no effort or time on the part of the doctor - usually an in-house day-surgery of about half an hour and carries about a $60K payday (for the permanent install - after a trial) .... so there is of course that...

This is the "neuro-stimulator" two different doctors have recommended: file:///C:/Users/susan/Downloads/burst-patient-brochure.pdf
Once again - cut and paste this into google or other browser or type in "pain interrupted-life transformed" which is sort of their "sales tag-line"...geniuses of marketing that they are and who wouldn't want that ?

One further article I will recommend (furnished to me by an extra good friend) on nuclear imaging as it relates to failed/loosened replacement joints - interesting !

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4109096/pdf/WJR-6-446.pdf

Anyway - that's my thoughts for now and would appreciate yours when you get a chance.

Thank you (and my further appreciation) all - I still believe I'm going to get through this,

Ottothedog aka John

 

[Josephine]

I am tending toward believing/accepting Dr. Borus's attempt at a diagnosis - that being that the lower portion of the joint has loosened

I diagnosed that from your first post!

If it was really an allergy to either the metal or the cement - then it wouldn't settle down overnight

Quite so

I walked at the mall and went to the gym at opposite ends of the day... and was so painful the following day

That's a very good indicator of a loose prosthesis.

when he replaced the fibular portion

I think you mean tibial. The fibular goes nowhere near the joint!

he was actually surprised at "how easy it came loose"

Well they do if they're not secured properly!

but now, I'm wondering if neither part was properly secured in the first place.

Of course it wasn't!

then any subsequent x-ray (taken a few months later) should show a more pronounced (apparent) “line” - you would expect this to “loosen further” as more time passes)

Not necessarily

I'm planning on having my right shoulder joint replacement "done" and then to re-evaluate the knee

I'd get the knee done first. It's loose!

Does anyone out there have any information, ideas, suggestions on how to avoid creating/forming so much scar tissue (which I understand as the body's reaction to injury/surgery)

There is no knowledge about this. Nobody understands it.

Neurologists (and others) are anxious to recommend an implanted "neuro-transmitter"

That's a typical "Don't know what to do so let's try this" response. Their tendency is that they don't work for this kind of situation. Don't waste your money.

Once again - cut and paste this into google or other browser

That's all I could do with the first one as well! If it had been a proper URL, then it would go blue when you posted it. They both come up "no page! errors.

 

[Angiebabe]

On tendency to form scar tissue - I too have this and it is evident in my eye surgeries as well as my knees. The eye guys don't know why but do have tactics to delay or avoid over zealous healing by using various eye meds. I can't remember which of the many I had did this but it may have been steroid based.

Not much help with the knee I'm afraid.

 

[ottothedog]

Good Morning (here) All -

I would not wish my continuing experience on anyone (here or otherwise), BUT... maybe the important thing for us all (me, included) - is to "learn" from the experiences of others... and hopefully benefit by not having to go through the same steps (in other words - not take the longest road possible to the eventual solution... as I have done).

The history (for those unfamiliar). TKR (right) 12/10/15, followed by MUA, followed by arthroscopy, followed by partial Rev. TRK (upper/femoral portion "downsized' and meniscus removed)... all this I believe properly dated in my profile (thanks, Josephine). Nothing "worked" or worked for long.

I still have the persistent inflammation, stiffness, pain - and etc. After the last surgeon, I was referred to a pain/injection clinic where i was injected with cortisone (my replaced knee and both shoulders), dextrose (same) and PRP (same - boy, was that painful !) - all these with no lasting therapeutic result.

Then it was suggested by that doctor that I try stem cell injections... which on further questioning, I chose not to do when it was admitted that this was VERY unlikely to help (just as the PRP), but "who knew" what might happen? (although he had never seen this work before on a replaced knee joint). BUT... what I did learn (other than increased skepticism) was that I regularly (daily) was accumulating about 20-22cc of fluid on the replaced knee - which confirmed my daily experience.

From that doctor I was recommended to a neurologist who recommended either "burning" the nerve responsible for most pain - or implanting a sort of "neuro-stimulator" which creates "electrical noise" - which in theory would "drown-out" the pain, if it could be demonstrated to be "mostly neural" in origin... Finally abandoned this course of action maybe determining that it "wasn't mostly neural"... despite neurologist determining that "he could probably get insurance to pay for this" (seen by me - as his primary emphasis).

So... back to a highly recommended local surgeon (Dr. Borus - who I'd seen before as a 2nd opinion prior to the partial rev. TKR) ... who compared the original xray (before revision) to one taken that day (post revision) - noticed a slight line which he felt might indicate "joint loosening", which he further confirmed with a bone scan (showing dramatic "uptake" in that area). BUT... he also noticed that I'd had nothing but a history of all this inflammation and wondered if there might be something else involved as a root cause. He asked if I had ever had a metals allergy test... and suggested that I get one.

So... then I researched the testing and learned that "skin patch testing" was more common, but considered as much less reliable than blood (serum) testing - and that the most highly regarded of these was the MELISA test (of course - no test lab in the United States... and the closest place to have blood samples drawn (an authorized location) nearly 1000 miles away. On contacting MELISA (in Twickingham, UK), I discovered they would send me the test kit and I could have the blood drawn at any doctor's office... and then... up to me to get it air-freighted to arrive at their lab (within 48 hours from West coast USA to Neuss, Germany), but we did get it done. Thanks to the MELISA folks (they are very nice), Julia and Linda especially.

For my testing (including freight) less than $550.00 USD. I give this organization and its people my highest recommendation.

Yes, I DID end up being diagnosed with a metals allergy. The "CURE" ? Replace that entire joint with a new hypo-allergenic one... and I am probably leaning towards ceramic. Anyone out there with experience of this - your further thoughts ???

Now my further thoughts: US surgeons regard the problems of "metals allergies" as statistically minor... and not likely to pose a problem for most patients. What is sure - is that it will not cause any problems for orthopedic surgeons (and that when it occurs - mostly results in extra surgical procedures... in a way, "rewarding them"). The actual numbers tell a very concerning story. It is known that about 12-15% of the US population has an allergy to chromium/nickel (the most common elements in joint prosthesis construction)... and then there are other metals involved as part of these alloys, such as manganese and molybdenum (which is what I'm allergic to). If it was just 10% (and we know it's more), that's over 65,000 people a year in the US alone... most of whom have never been tested... and many of which have gotten the "Well, I'm sorry - there's not much more I can do... sometimes these things just have persistent problems we can't solve... and we're really not sure why... and at some point you need to just accept this... etc." speech (that I've already had a couple of times). It's a little hard to accept (as a patient) that there are so many studies and articles on this subject that I can be aware of - and somehow all of these orthopedic surgeons are not. Frankly... this is likely just another case of "None so blind..." (as those who refuse to see). If doctors say this is an insignificant problem - then to them it is, despite what any numbers or volumes of articles show. It is a self-fulfilling prophesy, period. And that's why US doctors mostly never test for this before surgery.

Now... I know there are many of you out there who are nurses and other medical professionals. My wife is also a recently retired (40yr+) RN. Initially... she had problems accepting this "rest of the story"... but I guess I would say (just like in boxing) "protect yourself at all times" and you'd better depend on yourself for your own due diligence (otherwise... it may be a long time coming).

In the National Institute of Health study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726476/), it is confirmed that one in five (roughly 20%) do have problems and are unsatisfied with their TKRs. The most common problem is persistent inflammation, stiffness, pain, etc. This can lead to "joint loosening." A VERY high percentage of those with "loosened joints" were found in this NIH study to also have a metals allergy. You can draw your own conclusions on that speech about "sometimes these things don't get better - we don't know why... etc" (which do not include a metals allergy test). But sometimes... when it walks like a duck... and quacks like a duck... it is actually... a duck !

Bottom line: If you are having continuing problems of inflammation, stiffness, pain, etc. that remain as undiagnosed problems... and have not been tested for a metals allergy... PLEASE do yourself a favor and get tested (before you go through years of just getting worse and not knowing). Yes, it's terrible to know you have to have a surgical replacement... but better to at least finally know why you can't seem to "get better". Trust me - you are not alone.

My best to you all (and by that I mean a much BETTER experience) - I hope there is at least one other person out there who can be helped by what I now know.

John

 

[SusieShoes]

Hi @ottothedog and thanks for the update! Metal allergy is a serious matter and something people are wise to test for. You give a good argument for that! Have you scheduled a date for replacing your implant?

 

[ottothedog]

Thanks for reading my post (and you probably deserve a medal for that), Susie !

More medals to come here (and that'll teach you to respond), but hopefully entertaining...
I hope you had time for reading that attached NIH article (one of many on that subject)

No... I haven't scheduled the new right TKR surgery yet... ironic that I was originally at
the first TKR (in 12/10/15) surgeon for my right shoulder (which was bad then - worse now) and was "talked into be proactive and replacing the right knee first" (and then it never healed). It was only from Dr. Borus that the question of a metals allergy was raised and then made more urgent by an impending shoulder replacement surgery.

I really do hope at least SOMEONE ELSE... can benefit (and not have to go through all this). A whole lot of all this pain, suffering, and expense - is completely unnecessary (a a good part of it simply from lacks of proper surgical due diligence in behalf of the patient).

We depend... on these doctors, these surgeons, their medical oversight (medical boards and other organizations... AMA and etc.) to "guard" against worst practices and to protect us from things which could negatively impact our health. On who else will we depend ?

As a corollary, the Roman Senate was informed at the creation of the Centurions (the first police force for the city of Rome) that these men would "guard" the lives and property of the citizens. One of the senators (a poet - Juvenal) laughed and asked "Quis custodiet ipsos custodes?"

"And who will guard... these guards ?"

And that's the real story - for me (and lots of others)

And of course my best !

John

 

[jboles]

@ottothedog I'm so sorry you're finding out after the fact about your metal allergies. I was one of the unlucky or lucky in my case, people who requested and paid for out of pocket for the metal allergy test. I had to change surgeons and delay my surgery by 3 months in order to find another OS who was willing to research the joint that would work for me. I'm allergic to almost all metals, including titanium, which only a very small percentage of the population is allergic to titanium, lucky me. I have a Smith & Nephew ceramic femoral component with an all polyethylene tibial component. The OS wasn't able to use the base plate for the tibial component, because it's titanium. My LTKR is 8 months old and my RTKR is 2 months old, so far, no problems, but there's still that worry in the back of my mind. I hope you are able find a replacement that will work for you.

 

[lovetocookandsew]

Because I have gone through almost an identical process, and have since had the metal allergy testing, which was positive, I am about to have a revision to a non-reactive implant. I have wondered why they don't fix this problem before it starts. I've thought it'd just be easier and better long term, if they all just switched to ceramic knees for everyone. But barring that, every pre-surgery protocol should include at least the question about a patient's past metal reactions, if not actual testing.

If that question had been asked of me anywhere before the original surgery, I'd have told them about my nickel reactions all my life, which would have clued them in to a possible problem and it could have, and should have, been addressed prior to the TKR. If more labs around the country offered the testing, not only would it likely bring down the cost (my insurance covered it, but I would have paid for it myself if necessary), but maybe it would get us to the place where it would be a normal part of the blood work they do before this surgery; as it should be. The test is a heck of a lot cheaper than all the surgeries, etc, they have to do for those who have problems after, not to mention the pain and hassle of several more surgeries for the patient!

I do plan to bring this up to my OS next week at my pre-op and ask him if he can, or already has begun to, do anything about it for others in the future since he's is the chief of ortho at my hospital.

I would imagine that doing the test, at least for those who reply in the positive to a question of metal reactions, is cheaper to do for many patients than the extra surgeries, doctor visits, tests, etc, after a TKR for one single patient with an allergy. And, if it became a common test, it would save a ton of money in the long run, even if only for a small % of the population needing TKRs. Hopefully, as time goes on, this problem will be logically addressed and handled pre-surgery for everyone.

 

[sistersinhim]

I would imagine that doing the test, at least for those who reply in the positive to a question of metal reactions, is cheaper to do for many patients than the extra surgeries, doctor visits, tests, etc, after a TKR for one single patient with an allergy. And, if it became a common test, it would save a ton of money in the long run, even if only for a small % of the population needing TKRs.

Boy, do I agree with that! I asked my doctor before my surgery and he said it was such a small problem that he didn't do it. I will tell you all my experience on my own thread.

 

[Jaycey]

@ottothedog you will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just give a shout.

 

[Josephine]

I am probably leaning towards ceramic. Anyone out there with experience of this - your further thoughts ???

Certainly. There are several devices on the market specifically designed for use in cases of metal allergy. Two of them are mentioned in this article Metal allergies and knee replacements

 

[Jamie]

the most highly regarded of these was the MELISA test (of course - no test lab in the United States... and the closest place to have blood samples drawn (an authorized location) nearly 1000 miles away. On contacting MELISA (in Twickingham, UK),

This resource you quoted is the one people who are in the UK would use. The one resource available in the USA is Orthopedic Analysis. Sorry you didn't ask or we would have let you know that you didn't have to work with someone outside the USA. Fortunately for you the cost seems to be about the same for both companies.

I certainly understand your frustration with surgeons who either don't test for metal allergies prior to surgery or at least consider it when a patient reports problems afterwards. As you noted with the study you cited, opinions on this are slowly changing in the medical community. But the change will take time and it's important for patients to be aware of this potential and talk about their concerns with their doctors. That is certainly what we recommend here on BoneSmart.