unexpected pain 22 weeks post PKR

[suetara]

Hi, my name is Sue, I'm 57 and about 23 weeks post medial, unilaterial knee replacement with the Conformis iuni. There has been no pain since July and though I have never acheived flexion past 14 or bending past 117 at least I was limping along.

On Aug. 9th I suddenly couldn't put weight on the knee at all due to severe pain at the site of the implant. The OS took x-rays and it showed a small space between the bone and the implant he said maybe the implant moved or there was a small fracture, he prescribed crutches tor 3 weeks. I faithfully did the crutches and went back in 3 weeks. It was great to walk again and felt much better. He refused to take another xray though saying now that the space was a normal occurance. He prescribed excersize. Well the pain is back, sometimes so severe I can't put any weight on it. This will usually last only a day then I can walk carefully again. I can't determine what triggers the severe pain and never know when it will occur so I take the crutches with me. I have an appointment in November with another OS to get his opinion.
Can anyone comment if this is a normal situation for my surgery? It feels wrong to me. Thank you very much for listening.
Sue

 

[Josephine]

Hi Sue and welcome to BoneSmart!

Sometimes partial knee replacements work really well and sometimes they don't! Generally speaking it's a bit of a lottery. In your case, it does sound as if the implant is irretrievably loose and needs attending to. Did you have your knee cemented into place? Either way, these implants don't generally reattach themselves to the bone once loose so I cannot imagine why he would be suggesting that they do! And I certainly wouldn't permit that surgeon operate on my knee again!

Anyway, my strong recommendation to you is to get another opinion or two (or three!). Preferably from a surgeon who specialises in doing revision knee arthroplasty. Sadly this means some hard work on your part.

Up the top of the page is a Clinic Locator (recently upgraded and all surgeons or clinics listed have websites! Find yourself a list of places/names and look at the profiles of the surgeons. Look for ones that are interested in revision knee arthroplasty and who does a goodly number of knees a year, around 500 is a good place to start. Personally, I'd say the more the better!

Then you need to contact the surgeons, email them a short explanation of your situation and ask if they would be willing to advise you. Then make an appointment and interview them! Truly!

Until you've had some other opinions, I really wouldn't do much in the way of exercise. You'll likely risk making a bad situation worse.

 

[suetara]

Thank you for the reply. Yes it was cemented in place. I will check into the clinic sites you suggest and see if there is something in my area. I do see another OS Nov. 2 hopefully, he will take x-rays and be able to diagnose the problem. From other posts it suggests that a loose implant should hurt all the time which isn't my case.

Thank You,
Sue

 

[Jamie]

Hi, Sue....welcome to BoneSmart. Sorry you are having problems, but I'm glad to hear you're going to seek some additional opinions. Is the surgeon you are seeing in November a revision specialist? If not, I would suggest that you find one or more in your area and see them also.

Jo is in Great Britain and under their National Health Care program it is possible to email surgeons. Sadly, that is rarely the case here in the US and you may find that you must actually make an appointment and talk with them in person. You can probably get answers over the phone from the clinic staff for questions like ... does the surgeon specialize in revision cases and how many procedures are done each year.

 

[Josephine]

I have seen so many US surgeons' websites with email addresses on them, I thought it was common practice. It's most likely the email goes to their secretaries anyway, not directly to them.

We certainly can't email surgeons in the UK, maybe email or phone their secretaries. Sorry for the confusion.

Also, I'm not so sure about loose implants being painful all the time. Sporadic pain is just as common. It all depends what you're doing or how you're putting weight on it. If you put weight on it in such a way that it presses the implant back where it should be, then it's not going to hurt as much or at all.

If you would care to get copies of your xrays and post them here, I could look at them for you.

 

[cotton1958]

I wish they did allow for emails. I am sure they would be getting a lot of them! From me too! : )

They pretty much steer you to the Doctor initially. Then later calls usually get steered to the nurse. Then he/she tells you, that you need to come in. Or that's where you can get a refill. Sometimes I try to get the PA, but usually it's the nurse, and they've always done an excellent job calling back.

I am supposing emails would slow down their days, and they probably don't want responses in writing, and want you in the office for business sake. Saying this as a generality here in US, not specifically all Doctors I am sure.

 

[suetara]

Thank you all for the good information. I'll ask my doctor for a copy of the xrays (not too sure how he'll feel about me going to another doctor) the new OS wants to see them too. I don't know much about this new doctor except he has excellant ratings on web sites and was highly reccamended by my GYN, I will inquire about his "revision" experiance if that turns out to be the soloution (man I sure hope not). It's really helpful of you all offering good advice and relating experiances I truly appreciate it.
Sue

 

[Jamie]

Sue, your doctor should be okay with you getting a second opinion. After all, it is YOUR body! That happens frequently and it's just part of the business. Actually, you can request a copy of the xrays from the clinic's administrative staff and the doctor probably won't even be aware you have done that.

 

[suetara]

Hi all, well I got my second opinion yesterday. He said the implant was loose. He also said that an extreme amount of bone was removed which will make revision and TKR very difficult because there is about a 20cm space to be filled. He didn't think the prognosis was very good for good use of the knee. He wasn't impressed with the job my OS did (duh). I'm searching for a really good surgeon who accepts my insurance one possibility is James Huddleston at Stanford CA anyone heard of him? I am attaching a copy of the x-ray comments appreciated.

Sue

 

[Jamie]

Sue, I am going to tag our forum nurse, Josephine so that she will see your latest post as soon as she comes back online from her vacation. @Josephine:

Based on what your second opinion doctor has said, it is going to be even more important for you to locate a surgeon with lots of revision experience....someone who is used to fixing problems caused by other surgeons. They are out there, but you may have to search a little. You'll find one.

So sorry this has happened to you, but don't give up hope just yet. Please let us know how things go.

 

[suetara]

Thank you Jamie, I'll keep you all posted.
Sue

 

[suetara]

Another question please: How would you suggest I find out true information on Doctors, what resources ar available?
Sue

 

[Jamie]

It depends on what kind of true information you are looking for. If it's whether or not they are revision specialists, you can sometimes get that information on the phone by talking with their staff. The staff may also be able to provide you other statistics such as the number of surgeries like yours performed in a year and infection rates. If not, then you will have to personally interview the surgeons yourself and make your decision based on those meetings.

Unfortunately there is nothing like a national database that provides informaiton like this. You will see companies that claim to on the internet. You must pay for their evaluations. But the ratings are done by patients and it is somewhat unreliable. People tend to respond when they are unhappy and the successful patients just go on with their lives.

It is challenging to find a good surgeon, but I think you'll be fine once you start talking to people.

Of course, if you know anyone in the medical field (or your primary doctor), you can ask for referrals. That sometimes can provide someone to interview, but the decision still needs to be based on your meeting with the doctor himself.

 

[RestAssured]

Hi Sue,

I found my revisionist by going back to my original OS that had taken care of me for 4 years but did not do knee replacements. He knew of one to send me to that was tops in his field. Good luck to you!:D
Let me know if I can be of any help!

 

[Josephine]

I would say that the tibial implant is almost certainly loose. There is a significant shadow around the medial side of the tibial implant (red arrow) which is also set very deeply - too deeply for good function, imo. I am very much afraid it needs a revision and from the looks of it, a total will be the only recourse as he has taken so much bone off the tibia.

PS - Just what your 2nd surgeon said as I now see! (was too busy copying the xray to read previous posts! :hehe

 

[suetara]

Thank you very much Josephine I truly appreciate you insight. Last Wed. I sent an email to Conformis, the company who made the implant, I told them the story and what the second opinion was. I asked them if they had instances of loose implants before and if they specified to the Doctor how much bone to remove. Well I got a call on Thursday from my doctors office, seems he was in Boston for a Conformis siminar so they showed him the email and they discussed my case. My Dr had my xrays sent to the Confrmis doctors to review. My Dr denied removing excessive bone and said he didn't think a TKR would be good for me due to my active lifestyle, he wants me to come in to discuss alternatives this Wed. by then we should have the report from Conformis, I will let you know what he comes up with, whatever it is I will seek at least one other opinion. Stand By.

Sue

 

[Jamie]

Sue, that doesn't make any sense at all. We have MANY BoneSmart members who have TKRs and go back to very active lifestyles. Your doctor does not leave me with much confidence in his abilities!! But I agree that you should at least meet with him and see what he has to say. At least now he knows he's on the hot seat. Boy, I would have loved to been in that meeting between him and the implant reps.....

 

[Josephine]

Perhaps you should print off this article and give it to him Knee Replacements Not Harmed by Most Sports :hehe:

 

[Jamie]

:thmb::thmb:

 

[suetara]

Well I saw my OS on the 10th, he finally admits the implant is loose (since the Conformis company confirmed it). He still denies taking off too much bone though, he says he was well within the protocol for the Conformis implant (I'm still waiting to hear from Conformis on that one). He said revision TKR is usually the only fix but offered to replace the tibal implant that is loose for free. I asked if he had done this before? "no", did he know any Dr's that had? "no", has he ever heard of it being done? "no" my answer was "no". We took new x-rays there is now looseness on the other end of the implant so it's getting worse and causing bone damage. I have an appointment with Dr Huddelston at Stanford Hosp. Calif. on the 23rd to see what he can do for me. I'll keep you all posted.
All the Best to Everyone,
Sue