Revision TKR Wberry knee is up<

[Jamie]

I know this is moving frustratingly slow for you, but hang in there. It will work out and you'll see both these doctors for additional opinions.

Jo is going to be the one to interpret your medical records. I'm sure she'll be along soon.

 

[wberry]

I have noted post about not using the same surgeon for a revision that did the knee. I am totally in agreement with that. Is there any concern if the OS that did the knee recommends a revision specialist. Is this a matter of someone they know or they are being honest and recommending someone they know will do a good revision. Would a OS get concerned if he is always referring his patients that need revisions to certain revision specialist. Maybe i am just being paranoid. One of the two OS specialist I will be seeing was recommended by my current OS that did my knee. I just want to make sure i am not casting my lot in the wrong place. Several have commented on him as being very good, that helps.

 

[Jamie]

It all depends on how the recommendation was made. If I recall, your surgeon was indicating that he felt you'd be in better hands for a revision with the doctor he was recommending. That's a good surgeon. What you want to avoid is having a doctor that doesn't recognize (or won't admit to) a problem with your implant but who gives you the name of one of his pals to see. In that second scenario, you're most likely to get the second doctor saying you have no problem.

Your recommendation is not like this at all. Please don't worry.

 

[kneeper]

Yes, I agree that it sounds like he wants you to go to someone who is well versed in revisions so you can get the best treatment.

 

[wberry]

Thanks, these comments make me feel much better. I'm just so worried and don't want this to be a never ending story


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[wberry]

@skigirl I have a spacer question for you? When they did yours, they just replaced the spacer, no need to revision the upper and lower components right? I understand that the initial implants last much longer than a revision when they replace upper and lower components also. That is why I am really seriously wanting only a spacer replacement and nothing more unless they get in there and find the implant loosened at the bone or something really bad going on. Revisions say they last maybe 10 years, gosh i don't want to do this again in 10 years.

Since I am doing this, I wonder if I should consider getting the left knee done at the same time. I relaly wanted to do only the right and then the left after I am fully recovered. But what I have read from Bilaterals like @referee54 it might not be as bad as I think. Should I consider this option and ask the revision specialist what they think?

 

[Josephine]

The Lachman's test is stable with normal engagement of the polyethylene post on the femoral condyle. Anterior and posterior drawer sign is negative

The Lachman test is a clinical test used to diagnose injury of the anterior cruciate ligament. It is recognized as reliable, sensitive and usually superior to the anterior drawer test. The knee is flexed at 20–30 degrees with the patient supine.

In the sitting position the patient does demonstrate positive engagement of the polyethylene on the femoral condyle with active quadriceps testing at 90° of flexion.

So it catches - well, we knew that!

There is also approximately 5-10 mm of opening of the medial collateral ligament in extension as well as in flexion. There appears to be some increase in medial opening in flexion compared to the sitting position which may be suggestive of some midrange instability.

means it's a bit lax

There is 1+ to 2+ effusion present in the right knee.

Means there is some fluid present. As a rule, fluid is only present when something is a miss.

There is some tenderness to palpation of the lateral patella retinaculum. There is also some pain that occurs with the patella lateral retinaculum

The retinaculum is a sheet of fibrous tissue that tethers things together. In this case, the patella to the side of the femur and tibia. It's also what gets cut when they do a lateral release.

Mild lateral tilt is noted on the patella clinically

Something else we knew!

X-rays of the right knee taken on 6/3/2015 reveal evidence of a cemented posterior stabilized total knee arthroplasty

No kidding!

This may be related to tight patellar retinaculum or possibly related to asymmetric cut of the patella which is causing some mild lateral tilt.

He's pondering if perhaps the patellar cut wasn't quite true.

He is a candidate for going in and proceeding with a revision of his patellofemoral articulation. This could be a lateral release. A more aggressive revision would be to proceed with revision of his femoral component

See above about the retinaculum. I personally doubt revising the femoral component would work.

Do all doctors downplay the amount of pain the patient tells them they feel. I gave a scale of 8-9 when the patella pain hits, he put it down as minor, go figure.

I'm afraid they do. Which is why I always exaggerate it a bit! For instance, if I have a pain of 5, I'll tell the doctor it's a 7 because I know he'll downgrade it to a 5! You have to play them at their own game!

 

[RestAssured]

@wberry,

The "what ifs" will drive you crazy if you let them! Find a great revisionist, let him take a look at it and give you his expert opinion. I had a PT tell me tell "you need to have your kneecap removed because it keeps sliding out of place!" Dr. Maale replied, if I removed the kneecap, you would need a walker for the rest of your life! He then told me to tell the PT to get busy strengthening the inside of my knee because i was imbalanced! After that the kneecap stabilized!

 

[referee54]

The "what ifs" will drive you crazy if you let them! Find a great revisionist, let him take a look at it and give you his expert opinion.

Yep!!! Find that special OS who you trust, ask him the questions and the "What if's" and let him give you his expert and knowledgeable ideas about it.

 

[wberry]

All points to ponder for sure. Guess I need to get a list of questions and what ifs ready to ask. @referee54

One thing I don't get, how did the knee cap get out of alignment so badly. I must be grinding the prosthetic across the back of this to cause this much pain. And yes there is a sack of fluids about an inch and a half along the right side of the knee right by the knee cap. If I tense the knee it sticks out very noticeably. @Josephine I thought a new spacer was what I needed, not a reversion of a component. I really hope these other doctors can give me a straight answer and fix this properly. What should I believe is the right thing to do?


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[ceilly]

Hi
Just read your post. Please read and listen! This is a marvelous forum! I have been encouraged and enlightened by reading the various articles and listening to people like Josephine, kneeper, etc. You will feel better both physically and emotionally, I promise. God bless!

 

[referee54]

Guess I need to get a list of questions and what ifs ready to ask.

Yes---write all of your questions down ahead of time---script them, if you wish.

That way, when you walk out of the office after your appointment, all of your questions should be answered and you will not slap your forehard saying, "I forgot to ask him about...)

 

[wberry]

Good point, I will work on those questions. I also want to take the points @Josephine made to heart.


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[Angel1978]

She is great. I am so showing the new doc her findings with me. This is pathetic on my old OS. He is for the money man.

With 9 kids wow I don't think I could handle it. My knee when I move from side to side you can hear it. I have video is awful. Anyways enough about me. Hope your doing well. Hope the new OS can help. As I was told,and I use often. Out with the old in with the new!!! Been thinking and praying for you. I hope all works out for you. Xxx keep chin up no matter results. It will all work out. Xxx


FaithMitchmommy
PKR December.1,2014
TKREV MARCH.2,2015

 

[wberry]

Thanks, I can use all the prayers I can get and support.


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[jfiori54]

I hope your new OS resolves your situation. It is disheartening to be having problems after working so hard & doing so well. Don't you wish we could have these awesome BoneSmart Administrators, moderators & advisors live, in person with you at your OS appointments? Wishing you the best.

 

[wberry]

Now that would be great, I could see people like @Josephine smiling and staring down the OS.
Poor guy would be shaking in his shoes.

Yes, it is very disheartening, and I really tried to do everything right and make this a great recovery. I look back on it all and try to see if I was at fault in any way. The OS says he doesn't know why people loosen up, but a very small percentage do. On the patella issue, I just don't know, but I have my questions after i read Josephines evaluation.

Well nothing to do about it other than to shrug ones shoulders and move forward. For me, I am just living with the pain right now, knee constantly swollen with fluid, and waiting on appointments a month away in one case. I still don't have the second one yet. Don't these OS know people are hurting all this time. And to top it off i am worried i am damaging the patella ev en more every day. Simple things like sitting, just moving my leg at night bring on the sharp pain when the patella passes that area where it catches. I have gone back to using a can to try to lighten the stress on the knee and reduce the patella issues. I continue my quad exercises in hopes of having them as strong as possible when ever surgery does get scheduled.

 

[wberry]

Knee swelling has increased, icing to try to get it down. Pain around knee cap worst. Pain in area where I have no nerves inside now. I'm getting worried.


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[Kansas Teacher]

Hang in there, @wberry . This too shall pass. Do you want me to send an email to Dr. W. and ask him to get things going!

Roxie

 

[Jamie]

Yes, it is very disheartening, and I really tried to do everything right and make this a great recovery. I look back on it all and try to see if I was at fault in any way.

Please don't let yourself go there. You haven't done anything to cause whatever is going on with your knee. You are better off just to do as you suggested and look ahead to options for getting back on track (literally!!). There will be a path for you here real soon. Make your list of questions. That can help settle your mind down and get rid of the "what ifs" as you're waiting.