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Revision TKR Wberry knee is up<

I agree with Josephine. I was honest last time. But only cause I was in agony. And needed a knee fix know. But big mistake on me. Don't make same mistake I did. Xxx to you.


FaithMitchmommy
PKR December.1,2014
TKREV MARCH.2,2015
 
@Josephine Ok, but the pain in the front and I the side is on the hard area wear the bone is and the bottom plate. But from what you describe are you saying it's an IT band or tendentious or both.

I agree with your suggestion. I asked the PT and she was very honest also and said he was the type of surgeon who would not take it well. So I am using the VA excuse to get my records.

Finding someone to fix my problem is a big issue. Hopefully someone in @Jamie group will work


Sent from my iPhone using BoneSmart Forum
 
@wberry , I'm still holding out hope that it's going to be a simpler fix than you are anticipating. Hang in there,my Kansas friend.

Roxie
 
Me to!!!:fingersx:.
@Jamie and @Josephine, thank you so much for your responses. I was so worried i had not only the patella issue but also a loosening implant. I have started icing the lower area and will treat it like tendentious. Guess I have an IT band related issue also now @Kansas Teacher .
Now I just need to get past Mondays appointment, I have the bad feeling he is gonna recommend doing something and it may push me to tell him I want to get a second opinion. Like I mentioned before, even my PT says he would not take it well. Professionalism comes with a chip on the shoulder for some surgeons I guess. He's a nice guy, he has worked on me for years, but I just have failing confidence that he can fix this issue, especially after he has disregarded it each time i have mentioned it as i need to strengthen my quads. Well I am getting some nice big quads from all the working out and instead of things changing they have actually gotten a little wrist. Thanks for everyone that is pulling for me on this issue.:yahoo:
 
Me to. It's rough. Just call be honest say I need some help asap. I am in same boat as you. My hub is upset as we trusted this previous doc. A new knee should be functional as old. It's a nightmare. Keep trying find some one. Will be with it. Xx

Prayers for you.


FaithMitchmommy
PKR December.1,2014
TKREV MARCH.2,2015
 
Something weird I just noticed. On my non operative knee, when I tighten and tense my knee cap, it just moves a little. On my operative knee it drops down in place like one inch and this thick band of something puffs out on both sides. It's like an inch and a half wide and goes around the knee cap especially on the right side. And it is really stiff and firm. The knee cap looked like it drops down into a hole with a tight band on the outside. Is this normal??


Sent from my iPhone using BoneSmart Forum
 
@Josephine is Hoffa syndrome the same as PATELLOFEMORAL DISORDERS? The explanation reads very similar. They say the pain is often found at the lower and outer margins of the kneecap - underneath the patella and at the outside of the knee. It is from this article: https://www.hss.edu/conditions_patellofemoral-disorders-overview.asp
They also talk about a lateral release as treatment if PT, stopping stairs, icing, and muscle strengthening fail.
And they say the lateral release should be done in conjunction with: "Lateral release can be helpful in conjunction with a larger surgery such as a tibial tubercle osteotomy or a medial patellofemoral ligament (MPLF) reconstruction as part of the overall soft tissue balancing,” .
Also quoted from the same article.


Sent from my iPhone using BoneSmart Forum
 
Interesting observation about your knee although I have no idea what it means. Hopefully someone else will.

Roxie
 
That's another question for @Josephine.

I definitely agree with Jo that you stay mum about your effort to get another opinion. There is no reason at all to share that with your current surgeon and especially not if you feel it would damage the relationship you now have with him.
 
Yes, I agree. The release was mentioned by my OS before he put me on PT for another 6 weeks.
 
wberry said:
is Hoffa syndrome the same as PATELLOFEMORAL DISORDERS?
Click to expand...
No, the patella is not involved here. Hoffa's is also known as a fat pad impingement
wberry said:
They also talk about a lateral release as treatment if PT, stopping stairs, icing, and muscle strengthening fail.
Click to expand...
That article is not referring to a post TKR knee. However, if your surgeon thinks a lateral release might help then you can lose nothing by trying it. It's done arthroscopically

[Bonesmart.org] Wberry knee is up<
 
Tomorrow's the OS appointment, isn't it? I'll be thinking of you and pulling for you! We Kansans have to stick together.

Roxie
 
[Bonesmart.org] Wberry knee is up<


OS Report!!

Well today was the big day, I will make everyone have to wait for the final outcome until I go over what happen.

First, okay someone replaced my OS with someone else. Why do I say that? Because he didn't act or say anything like what I expected at all. I was expecting the "its metal and plastic and that's how it is and you need more PT". Instead he spent 30 minutes examining, manipulating, looking at xrays, and after all that he started talking. He asked me a couple questions:
1. Has there been any improvement, my answer: NO, things are worst
2. Is the pain on every step, my answer: YES
3. Does it feel looser or like it catches, my answer: YES
Discussion comments by him:
1. I reviewed the operation notes and after your exam your degree of looseness is far greater than it should be, you started at 2mm, now your way beyond that. I don't know what that is, some people loosen up over time, but your only 4 months out and you shouldn't be this loose.
2. Looking at the xrays, you knee cap is defiantly off center to the right and it is probably catching on this corner because it is off centered to the right. The image above shows this, and everytime he moved the knee it caught. I also mentioned to him that it does a funny jig to the right as it bends up.
3. He also said it is pulled down so far and something would have to be done to shift it over and realign the knee cap.

He recommended the following:
1. arthroscopic procedure to do a release and hopefully realign the knee cap.
2. Because there is to much looseness, instead of just the alignment only, he want s to go in and put in a new spacer.
3. (Surprize) I want you to go get a second opinion and he recommended a specialist in Wichita, KS (Paul Pappademos at Advanced Orthopedic Associates) There is also the possibility that a upper tibia reversion may need to be done to get the alignment right.

He figures if I have to do the realignment and the significant looseness is there we should fix it at the same time. As for the second opinion, he said after you talk to the other surgeon you can see if he agrees with me. He is more specialized and does mostly TKN and revisions. From that point if you decide you feel more comfortable with him doing the work you can, or I can do it.

Bottom line: I am going to have to get some level of surgery to fix this.
Minimum: scope to do release and trim off knee cap in hopes of re-centering it.
Marginal: realign and release and spacer update
Max: realign, release, spacer, tibia revision

:blackcloud:so my parade has been rained on.
I have to go through this again:gaah:

He said that your recovery has gone well, you got all your ROM back, but this issue is not going to resolve itself and I have done all I can do conservative wise to try and fix it.

So I have so request from a few folks:
@Kansas Teacher do you know this OS in Wichita, KS
@Josephine what is your take on all of this?
@Jamie Since your in Kansas also, you know anything on this OS

Anyone is welcome to chime in.

:dead:All my hopes have hit a dead end
 
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I'm sorry this isn't the news you wanted. I'm glad your OS laid it out so clearly, that he wants you to get a second opinion, and that he wants you to go with the surgeon you are most comfortable working with. What he says, in my layman's mind, makes sense and does seem to explain the problems you have been having. I'm not so confident arthroscopic surgery will work for a spacer replacement, but that would be awesome if it did. I think, in your gut, you knew it would be something like this. Keep us posted.
 
The only scope option is for the lateral release, but he says the looseness is such that a new spacer is needed, that requires going back in through my original incision. So I start over with surgery like before. The only case for a revision is possibly of the top femur if the surgeon does not believe the alignment is going to work. I hate those gut feelings. I will get this done once I get a second opinion, I prefer sooner to later, this knee is sore to walk on with the problems that have developed.
 
@wberry , I'm so sorry you got the news you did today but it sounds like the change in OS may have been a blessing in disguise. He took you seriously, did a careful investigation and felt a second opinion was in order.

I have definitely heard of Dr. Pappademos and have heard all good things about him. I have had at least two friends who used him for tkr's and spoke highly of him, as well as had very positive experiences. Had I stayed in Wichita for my surgery, he was one of two surgeons I was considering. I think you would be happy with him.

Glad you at least have a partial answer now.

Roxie
 
Thank you, this is encouraging. I talked to my wife, she thinks it's a good idea to have someone else do the next phase.

The OS felt the swelling was still not what it should be. He felt it was additional evidence of issues with the knee cap and the catching and subsequent inflammation.

I wonder if he somehow got word that I had the release of medical records sent to me to complete. What do we think the chances of that are.

For some reason I feel tired. Not sure why, this has been a long day.



Sent from my iPhone using BoneSmart Forum
 
@wberry I have been following all of your issues lately and I am happy you got some answers today. I am sure you are exhausted from the stress of your appointment today. Good look with your new OS, and I hope you get an appointment soon. I hope you get a good nights rest and then you will be able to tackle tomorrow and whatever comes up. Much luck to you and I will definetly keep you in my prayers.
Sharon
:sleep::prayer:
 
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