Revision TKR Would like advice please, I think knee has moved

[busylizzie]

Hi I'm new to this forum. I've had a left TKR Nov 2011 and revision Aug 2012. Still having problems and would like to find a new surgeon for a second opinion before a further revision surgery. I live in the North West of England

Many Thanks

 

[maryo52]

Josephine would be the one to answer your question.

 

[Josephine]

It would be good to know what kind of problems you are having and where and by whom you had your two surgeries.

 

[busylizzie]

Thanks Josephine

Had left total knee replacement for grade 4 oestearthritis in November 2011
Salford Royal Hospital Manchester surgeon Mr W Kim

I have had uncontrolled pain from day 1
Limited bend
Swelling and warmth
Oxinium knee used due to cobalt and chromium allergies

Antihistamines and antibiotics both lower the pain and swelling but do not eliminate it.
Blood tests all OK

Second opinion from colleague Mr Wilkes obtained about June 2012 confirmed arthroscopy and biopsy to be undertaken. Both do not think infection present

August 2012 went in for day case arthroscopy. This was carried out by Mr Kim and his registrar. Had 5 minutes to agree to change to revision surgery to change knee button. Mr Kim thought that there was a metal ring on button that could be causing the problem. No metal ring found in theatre. Synovectomy performed and biopsies taken. Results negative. Skin swabs taken a few days after surgery negative.

Following revision bend greatly improved. Swelling, pain and warmth still present. Antihistamines and antibiotics still improve symptoms

February 2013 signed off by surgeon

March 2013 visit rheumatologist at Salford Royal. He is concerned and orders LUCA scan. Comes back positive. Negative ESR and CRP.

Referred by rheumatologist to Mr Wilkes. He orders aspiration to be done in theatre. Negative result. X Ray shows some lucency

On rheumatologist's suggestion have been taking body temperature regularly. Temperature rises when weight bearing bending knee but not when using crutches. When on antibiotics temperature is lower. Glands have been swollen intermitedlly since original surgery in 2011. Been on antibiotics roughly every 6 weeks for the last 6 months. ( I have a stomach problem that requires antibiotics when I have a flare up) I'm having pain above and below knee now as well as knee pain. I have trouble sleeping due to pain, worse when I turn over in bed.

Mr Wilkes has decided to do a two stage revision in the hope knee will improve.

I would like an independent 2nd opinion before undergoing a further 2 major surgeries but don't know the best place to go

Thanks again

 

[Josephine]

Mr Kim thought that there was a metal ring on button that could be causing the problem. No metal ring found in theatre.

He could have seen that in the xray!
I am amazed that you went to Salford with Wrightington so close by. I suggest you see one of the following surgeons at the Wrightington Hospital
Peter Kay
Robert Smith

 

[busylizzie]

Thanks again,

I would have thought so too. Xrayed me in theatre. I was fully awake for both surgeries as had spinal so heard all conversations. He was amazed that there was no ring!

I had 2 previous arthroscopies done by Mr Aslam Mohammed. Last one November 2010 on NHS but at private hospital. I was due to have TKR at same hospital but at last minute he decided not to do it there but transfer me to the local NHS hospital without discussing it with me. When asked he said it was because he wanted a high dependency bed available. I didn't want it done there and asked about Wrightington but was told I couldn't have it done there by him.

I decided to change surgeons. Mr Kim at Salford was suggested, that is why I went there.

I have appointment with GP next week so I will ask about your suggestions. I had been thinking about Martyn Porter but thought he was mainly hips.

 

[Josephine]

Porter is a hip man, that's why I never included him. And Winston Kim is a hip man too. Last year he did less than 5 knee revisions and he only did 56 primary knees as well! Most likely a good surgeon and a nice chap but not one I would choose were I in your situation.

Overall, Salford Hospital is a very low performing hospital as far as any joint replacements are concerned. You are having a revision which requires a specialist in the subject to get the job done properly. The two men I mentioned are specialists ... please go to one of them.

 

[busylizzie]

Thanks for the information. I'm definitely going to try and get a second opinion from Wrightington. It is Mr Wilkes that is down to do the revision at Salford not Mr Kim. There is a 3 month waiting list at Salford so I should have time to go to Wrightington first. Will they have to repeat all the tests?

Next job is to get GP to refer me to Wrightington

 

[Josephine]

Richard Wilkes has the following stats for last year: primary TKR 57, revisions less than 5.
Not what you might call a high throughput surgeon!

 

[speccybecky]

Josephine, where can we find the stats for number of ops performed by uk surgeons please

 

[bottomshollow]

speccybecky, Nancy here's the link that's in the Library: http://njrsurgeonhospitalprofile.org.uk/

 

[speccybecky]

Thank you

 

[speccybecky]

Judy, it only seems to cover England and not Scotland?

 

[bottomshollow]

I really didn't know that---I thought it was for the whole UK---you'll have to ask Jo.

 

[busylizzie]

I have seen GP this morning and asked to be referred to Peter Kay at Wrightington for a second opinion. Now I have to wait .............

 

[maryo52]

I hope you get a good second opinion. I underwent a bunch of the same stuff: rheumatology workup, tests for infection, etc. Mine ultimately was ruled "nonspecific synovitis."

I take it that you were tested for things like Lyme disease? Lyme is becoming epidemic here. My husband and several friends have been diagnosed.

I know that there is debate about the existence of low grade infections, which can be hard to diagnose.

I hope you get some answers soon. The waiting is hard . . . But at least you're scheduled to see a recommended surgeon.

Here in the US, the only tests that get repeated are, for instance, xrays. Each surgeon seems to want to do their own xrays, and I've heard of specialists repeating MRIs done elsewhere because apparently they differ in quality as well.

 

[busylizzie]

Hi maryo52,

Thanks for your posts. I don't know if I've been tested for Lyme Disease. I'll ask my rheumy when I next see him at the beginning of August. He is taking care of me and it was him that did all the blood tests and ordered the scan and referred me back to the ortho after they signed me off. He wants to see me regularly to keep an eye on the inflammation. The inflammation is on the upper outer knee. It's 2 degrees centigrade higher in temperature than the inside of the same knee.

The Lyme Disease symptoms are interesting as I have Fibromyalgia and Neuropathic problems. I'm allergic to some insect bites and was bitten again this weekend - bugs in strawberry patch in the garden. The GP gave me some more antibiotics this morning as she didn't like the look of my leg. Fortunately it is my right leg and the TKR is my left one. I've only had 2 doses of the antibiotic and the inflammation of my TKR knee is beginning to go down - as always. No effect yet on right leg still very swollen and itchy

Can you tell me a little more about your "nonspecific synovitis" please I'm interested? What type of symptoms? The only test that has come back positive for me is the LUCA scan plus there is some lucency on the tib plate.

I often have low grade infections. My temperature tends to go up and down. It goes up if I weight bear on my left leg and bend my knee a lot. I have been using crutches outdoors for over 3 years and have recently bought a mobility scooter. I haven't had a MRI since the TKR but the rheumy mentioned one last time I saw him.

 

[maryo52]

My, aren't our bodies interesting . . . mystifying . . . and frustrating!

My nonspecific synovitis means I have chronic inflammation and thickening of the synovium for no apparent reason! I've had synovectomies but synovium grows back. Plus it produces that wonderful fluid that lubricates the knee, but in excess. My joint capsule has always felt stiff except immediatey post-MUA and post-arthroscopy. I am pretty sure your issue is different; it does so sound like infection, though courses of antibiotics just cannot reach the bacteria on the prostheses. I hope you stay in the loop here because your story is one I am hoping has a happy ending in the foreseeable future.

BTW was is a LUCA scan? It sounds like a bone scan, which I know shows bone density. The fact that there's some changes near your tibial prosthetic is not great news, is it? I'll tag another member here who has been through just about every TKR trial and tribulation. RestAssured

 

[RestAssured]

Hello busylizzie!

Wow, you have been through a lot! Can you tell me how you feel? Do you have headaches, uncontrolled mood swings, crying one moment, laughing the next? Does it hurt to stand on the leg? Are you tired all the time and can't find the energy to care about much of anything? That described me when MRSA would hit each time! I hated MRSA and found a revisionist who is a specialist and does a one stage knee replacement. He helped invent the new type of hinged knee and it has been wonderful! I am so grateful for all he has done for me! I wish you lived in TX! We would get you fixed up right away!

 

[busylizzie]

RestAssured

I don't think I have MRSA. Everytime I go into hospital new swabs are taken and they have all been negative.

It does hurt to stand on my left leg also bending it especially weight bearing. It aches at rest quite alot of the time even when resting. Turning over in bed quite often causes pain and wakes me up, I think it is the twisting movement. I'm now getting pain above and below my knee, especially at the back of my knee. I don't have many headaches. The fibromyalgia means my all body hurts, I tire very easily and don't have much energy especially during flare ups. It does get me down at times. I have just finished a 'Mindfulness' course and this has helped.

maryo52

It is interesting what you say about chronic inflammation. I have chronic inflammation and fibrosis inside my peritonium. I have/had endometriosis. I am full of adhesions causing me major problems with my large colon. They have been surgically removed twice but they keep coming back and they will not operate on them again. Next operation will be a stoma!

When I had my knee aspiration they removed quite a lot of fluid but it came back within a couple of hours. The relief was noticeable straight after the aspiration, pity it didn't last. My knee is stiff. The surgeon did a synovectomy at the revision. It sounds like you!

LUCA scan is a nuclear medicine procedure which shows up white blood cell concentrations (leukocytes). It is an indication of areas of infection.