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

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Pumpkln

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Sorry you are feeling like you are going downhill at the moment, I hope the PT can help your foot tomorrow.
I am still puzzled by what is rotating back and forth in you leg????? Guess the OS's are too.
 

Homeport

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I am sorry your news is not good and I wish you were near enough to try the guy I had he is rated high


20/01/2015
 
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busylizzie

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@Homeport,

Thanks, the way I am feeling just now, I would go anywhere in the UK that is feasible if they could fix me.
 
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busylizzie

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@Pumpkln, yes it is a mystery. My patella is tracking sideways to the lateral side, not up and down as it should. It was poked and prodded a lot on Monday and is hurting even more. The pain I feel in my shin when my knee hyperextends he thinks is from the end of the long stem.
 
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busylizzie

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@Orthodoc, @Josephine

Please can you comment on the following

CT scan result Dec 2014

True rotational variance between femur and tibia 15 degrees to medial border of tibial tuberosity, 30 degrees to medial third of the tibial tuberosity. In both measurements , tibia is externally rotated with respect to the femur.

Is this something that I should be able to live with?

There are other measurements quoted in the report.
 
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Pumpkln

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Busylizzie,
What a conundrum with your knee. If your tibia is externally rotated relative to your femur, the attachment of your quads would be lateral to where it should be? Could explain some of the lateral pull on your patella, just a thought.
Wishing you all the best, as always,
 
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busylizzie

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I don't know if it is relevant but it also says that prosthesis is rotated posteriorly.
 

Orthodoc

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True rotational variance between femur and tibia 15 degrees to medial border of tibial tuberosity, 30 degrees to medial third of the tibial tuberosity. In both measurements , tibia is externally rotated with respect to the femur.
This is not a complete report. I also have not reviewed the images and this opinion is informational only and may not be totally applicable to your situation. I can provide some thoughts, however. It states the the tibia is externally rotated with respect to the femur. This usually happens when the tibial baseplate is cemented (or screwed) in an internal rotated position. The ideal placement of the tibial baseplate is for the very front of the baseplate to be inline with the medial 1/3 of the tibial tubercle (that is the reason that they mention that landmark in the report). If the baseplate is placed internally rotated then when the knee is put back in place to meet with the femoral component, the tibial needs to rotate externally to align itself with the femur. This will make the entire tibia/ankle/foot rotate externally.

If the tibia rotates externally, then the patella tendon (attached to the tibial tubercle) will be pulling the patella (knee cap) toward the outside (lateral) part of the knee replacement, rather than in a straight line in the middle of the posthesis. This will created an increased contact force on the outside portion of the knee cap and make the patella more prone to dislocation/pain.

There are several of factors that are important to consider.

1 - If the prosthesis is a rotating platform design then this mismatch will be much less noticeable because the poly can spin (somewhat) to help re-align the leg in a more functional position.
2 - If the knee cap was resurfaced (usually done in the U.S.) then the new patella button may have been medialized, which can reduce the abnormal forces from this mal-alignment from rotation.
3 - If a lateral release was done (cut the tissue on the outside of the knee cap) during surgery, this will also reduce some of the stress on the knee cap from this mal-alignment from rotation.

You can test your tibial rotation by bending the knee 90 degrees and by keeping the ankle and heel directly below the knee (thus keeping the hip in neutral rotation as well). You should not be able to see the ankle or heel because the knee is blocking it from view. Then look straight down to see if the toes are pointed forward. If the tibial is rotated externally then the the toes will point outward. This relationship is dependent on you not having any other lower extremity deformities such as a flat foot, hip arthritis, bunions, etc...

I hope this helps.

Orthodoc
 
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busylizzie

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I have been to the physio again this morning. She has taped my knee and it is feeling better. I'll have to order some more tape. We did an allergy test with it last week, so I will have to stick to the same brand.
 
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busylizzie

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@Nana moon 27,

I am struggling at the moment, my sciatica has reared its ugly head again. As if I haven't got enough pain to deal with, it is down my good leg.
 

Nana moon 27

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Oh @busylizzie I'm so sorry to hear that. You've enough to contend with, without that my eldest daughters suffers for. It and I want to cry when I see how it debilitates her. To imagine that with your other problems is so awful.
Sending you positive thoughts and (((big hugs))) xxxx
 

Legin

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Ouch lizzbizz, it is difficult we know what we are doing may cause problems but stuck as its the only way to move.

Legin THR Sep 14
 

Legin

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Hey Lizz bizz ty for popping into my thread how are you. I hope the weather has been as good as ours. I have a toasted head,

Legin THR Sep 14
 
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busylizzie

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Thanks @Legin. My sciatica has settled down at last. I have managed to potter in the garden a little but the good weather has triggered my hayfever. Thank goodness for antihistamine tablets, they take the edge off it. The longer brighter days do lift my spirit. Still having problems with my left leg.
 
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