Revision TKR Wberry knee is up<

[wberry]

I am keeping my fingers crossed that a spacer up-sizing and cleanup and realignment of scar tissue around the patella will fix all this. I need to read @skigirl thread to see what the spacer change out and recovery was like for her. I am taking the time to read her entire diary of the revision she had, it is great reading, very informative. I appreciate all her detail and information in her post here, I would still like to know more how the post op and recovery was. I am wondering if I have adhesion's also like her, and if it is causing the patella to be off like it is and colliding with the prosthetic, thus the clunk and jarring i feel all the time. Sounds like fixing the adhesion's could not be done with a scope, is it normal to open the knee up all the way in these cases. Since you got the spacer upsize, has there been any more loosening at all, it seems like you have non from what I read.

Also, what should I be doing to prep, or should I wait to see what the OS second opinions say before i do anything at all. I have backed off on exercises until I see them, I don't want to do anything to make anything worst. What does everyone think?

 

[Angel1978]

I'm right with ya on waiting. Takes for ever to know. But will be worth it in end. Prayers for you!!! Hope you get in and get some answers soon. Xx


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

 

[Angel1978]

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

 

[skigirl]

I continued with anything that did not hurt. Biking hurt, lifting heavy weights hurt. I did a lot of walking, stretching and exercises with a big ball. I did a lot of upper body and abs stuff too.

The knee is very stable and strong right now. I had a lot of adhesions under my patella and that is why my patella hurt so much when I was biking. I went on a 20 mile ride right before the surgery and i was in agony for the last 10 miles. I actually considered hitch hiking!!!

After surgery, I have no patella pain at all. If the patella is moving and "clunking"---have you read about "Patella clunk syndrome"? My patella is slight lower than it should be---patella baja syndrome, but it does not bother me, so i plan to leave it alone.

 

[Jamie]

I was curious about the comment the receptionist gave about they review the records first to determine if they want to take on my case. Of course this might be a standard line, I was talking to a receptionist not the doctor.

This may be a routine practice, but probably even more so since you are not yet a year out from your surgery. Many surgeons don't accept patients who are so fresh from surgery, but I doubt if that will be an issue in your case. Please don't worry about it.

A co-worker is having his redone and he spoke to me about the head or orthopedics at KU medical Hospital in KC. I checked him out and he was mostly a upper extremities and hand specialist.

You're right.....you don't want a surgeon who is not a knee revision specialist!

I am trying to shift gears to be more positive, like I am finally going to get this fixed instead of, here we go again.
A positive attitude can help create a positive outcome.

Good plan!! Positive is always better. And I too believe this effort will get you back on track again. You'll feel better once you have a solid plan to go forward.

So @Jamie am i supposed to start a new pre op thread?

I think it's better just to continue with this thread so your entire journey with this knee is in one place. We can change the prefix when/if you require a revision.

If this is a cement issue, do I need a re-gluing?

Bone cement isn't really what you think of when you think "glue." It doesn't "stick" the implant to the bone. The cement is forced into small cavities in both the bone and the implant surface just prior to it hardening up from the chemical mixing reaction. Once it hardens, it's there for good. It doesn't get redone. The problem comes if it is not properly applied so that it gets into all these little cavities. It's a technical skill and one of the reasons why we advise people to use experienced surgeons.

My loosening seems to be more along the line of ligaments i think, in other words the amount of play in the joint is increasing beyond what he felt it should be to a significant degree. So my question is, does that translate into a revision or just a new spacer?

This is really going to be a question for your new surgeon. I don't think anyone here can answer that for you.

The idea of taking the entire thing out worries me. Is there some way they can tell through xrays or and MRI or CT scan if the cement is loose?

Both these revision surgeons should be able to tell you from an xray if the implant itself is loose. It doesn't sound like that from the comments you reported that your current surgeon had. It sounds more like a ligament issue. Please try not to worry about a complete revision. Even if that needs to be done (and I'm certainly not suggesting that is the answer!), a good revisionist has the knowledge and skill to get this done correctly for you.

 

[skigirl]

The worst thing to tell someone is to just wait and see---I know, I would bristle if someone said that to me too!! But for right now, you will just have to wait until you have all the info.

If the ligaments are loose, they can sometimes tighten them---sometimes they will recommend a hinged knee and sometimes it will be a spacer exchange---you see---none of us can tell you which one it will be--or even maybe half of each.

I would try to find something that I have wanted to do and let yourself have some fun. have lunch with some friends, do anything to get beyond this obsessive questioning phase. (I know all about how that feels!!)

I was a mess when I had to have the spacer exchange--Jamie and Jo were great to me during that time, so I owe the universe some patience in your case!!! But, really, you need more info before you can start worrying---so, now is the time to watch some movies, drink some beer and try to have faith in both your surgeons and your self. You will get through this and the outcome will probably be great. I am so glad that I did it--although I felt like canceling the night before. I am so glad that I did not do that.

Oh yes, before you start worrying about a hinged knee---@RestAssured has one and so does @LaPaz and they feel just like any knee to them. There is nothing horrible in your future--I know oh so well that feeling that i just wanted it to be over!!!!

 

[Kansas Teacher]

It's going to work out @wberry . I am not as well versed in things as Jo, Jamie and Kelly are but I do have a strong gut feeling that all will be well. And remember, you've got a friend in Wichita.

Roxie

 

[wberry]

I feel so good right now! All of your are showering me with encouragement, wonderful advise and great support. I am so glad to find this forum. Thank you and Bless each of you. I am confident everything is going to work out. The sooner I get the appointments the better I will feel. I think I will call and see how long it will take to get my records so I can get the appointment in Kansas City.

I need to read @Jamie and @skigirl post again. There is so much good stuff in there.

Yes @skigirl I have the clunking loose patella. Also there is a large area surrounding it filled with fluid. So it is very irritated and inflamed. What I read about that syndrome it sounds like mine. I posted an X-ray of the knee and patella. Mine is tilted out and actually is catching and tuning against the implant on the lower right underside. The OS said it is pulled over badly maybe due to scar tissue, fat pad or ligaments. Getting it rebalanced and turned back flat is the only solution there. I did not expect the looseness, but when he manipulated my knee he couldn't believe how loose it had gotten.

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[Angel1978]

I believe it will all work out for the best. You will if you have to why it done. Be glad you did it. And then you can do start living the life these knees robbed from you.


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

 

[wberry]

I have started to notice some things with my knee. First the clunking continues and seems to have a new secondary catch clunk to it. When i bring the knee forward instead of the usual clunk and secondaries, the knee now cocks sideways at the joint and then back strait producing the secondary clunk and catch. If I lay on my side and raise my right leg up off the bed, the knee drops down with an audible clunk. When I put it down it moves back the other way with a clunk. Maybe this is the looseness the doctor mentioned during the exam. I read @skigirl comments about the patella clunk syndrome and read some articles on it. Fortunately most say the issue was resolved with a scope. But with me having this looseness issue on top of things, a scope will probably not work for me. I am going to continue my quad exercises and the others that do not hurt. If I have to have a second operation I want my legs nice and strong before hand. Wondering if i should continue to work on improving my ROM, at about 123/0 now. Puffy area on right side of knee that the OS says is fluid has gotten larger. Icing the area daily hoping to hold it at bay. Gonna have to cancel my planned trip to Florida, need to save the time for leave for the surgery and recovery, hopefully it will be shorter than before and i can get back to work sooner. I just want to get my life back completely.

 

[Kansas Teacher]

Darn. Your saga just keeps going on. Hopefully you'll hear something about appointments today.

Roxie

 

[wberry]

Tell me about it .
Maybe I wasn't paying attention to it that much.

 

[Josephine]

@Josephine, yes, the caps look the same, but in my case the operative one is actually grinding across the upper prosthetic on the side, so much so, it is catching on each step.

Exactly!

 

[Angel1978]

I am so sorry on your problems. I am so with you. I can't do anything with out knee moving and poping. It's a mess. I hope you get it all sorted... Xxx


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

 

[Blendab1]

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.

I recommend based on the surgeons suggestion that you get the looseness fixed. I work for an orthopedic firm and see a few cases where the patient has to go back in and have a larger insert done to correct the looseness. At this point if you're going to fix it might as well address the looseness and then the patella can get aligned at the same time. It's a major setback but I'm sure you want the knee done correctly as that was your initial goal when you first had this done. Good luck surgery buddy!


Brenda

 

[wberry]

Yes, this is what I understand. I will see what the other doctors say. Hopefully the spacer and the re alignment is all I need.


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[RestAssured]

Hello! As Skigirl said, I have a hinged knee and am out living life to the fullest! If you need one, don't worry about it! I am getting excellent ROM with both replaced knees!


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[wberry]

@RestAssured So you don't get any funny motion or anything. I thought this limited your movement? Why did the decide to do a hing on you?

Ok, just started reading your thread, wow. Haven't found the answer to my question above, but you have faced a lot.


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[wberry]

Spent some time reading and reviewing my online medical records. I see a couple of critical points in what I read.

1. Any obvious malalignment, tilting, fracture or lucency of the patella, thus the finding of maltracking of the patella. This seems to be the cause of the clunk, catch and subsequent pain. I am concerned that the prosthetic has dug a gouge out of the back of the patella as a result.
2. http://www.medscape.org/viewarticle/413058_4 "Patellofemoral complications are not uncommon in TKA. There are multiple reasons for patellofemoral instability, each of which should be carefully evaluated at primary surgery and, in case of patellofemoral instability, after surgery. These reasons include the following: residual valgus alignment increasing the Q angle; internal rotation of the femoral or tibial component; medialization of the tibial or femoral component; increased height of the patellofemoral joint (excess patellar thickness or inadequate anterior femoral resection); asymmetric patellar bone preparation; and soft tissue considerations (medial capsular dehiscence or failure to perform a lateral release when indicated)."
In this case the tried a lateral release, but it wasn't sufficient, ended up removing and changing the mount of the femoral: "The tibial tray was in proper rotation, so a lateral release was performed. However, this did not fully resolve subluxation of the patella. The femoral component, though well fixed, was removed and repositioned at 5° of external rotation to parallel the tibial axis. The vastus medialis oblique was also advanced to ensure stability. The patient currently has 110° of motion and no patellar crepitation at 6 months after surgery."

This was mentioned by my OS as one of the possibility if a release and alignment are not sufficient. Sounds like a revision of the top half to me. I hope release will be what I need and just the spacer. I get the feeling they will tell me, until they get in there they will not no for sure. There seems to be a lot to consider in alignment and such with a TKR. I will have to ask @Josephine to decipher the language up above.

So how does that work, do they keep a stock of knee implants on hand in case they need to do a revision, or do they order a revision implant just in case prior to the surgery.

I did not find a lot on the loosening of the ligaments, and since the xrays I have are from prior to starting my last 6 week PT, there might have been changes. I am hoping the @Josephine comments on the IT band are all the pain on the side and below the knee are and not loosening of the implant.

Called about my records, they said 5-7 working days, I will get paper and xrays on a disc.
I will probably scan the paper and combined the images on the disc and just send a disc to Kansas City. Then I continue to wait for an appointment, since I need two, also in Wichita, I can see this going into next month at this rate. Have to find something to do with myself while I wait. I will continue my quad exercises ans strengthening. Don't know if there is any danger to the patella as it continues to get gouged from below. Would had to fracture it do to over use or exercise. Any recommendations from anyone on this concern?

 

[wberry]

What are the indications of an infection?