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TKR Wrong Sized Implant?

Hi, @DogTiredKnees , I hope this morning finds your spirits lifted a little, to know that the liner replacement surgery shouldn’t be too bad. Btw, I was looking & reminded that your MUA was mid-December, that’s only 3 months, & my understanding is that procedure can be pretty tough for some, so don’t be too hard on yourself. Keeping fingers & toes crossed ( do you realize how HARD that can be?☺️), and, keeping you in my prayers.

My extension is still not fully there, but, my surgeon reminded me that this can be a 12 month recovery, and, at my first appointment, he told me that my knee might not be Perfect, but it would be Better. I’m fine with that.

Thankfully, you have some wise advice here from folks who have “ been there”, & can share their experiences. So I’m praying for you to make the right decision as to a second opinion. I thought what @Mamie said about the second opinion shedding light on many of her questions was an excellent point. Sometimes it does take a different person to open things up, maybe seeing things freshly, & from a different viewpoint - and there seem to be some good ones in your area.

Meanwhile, try to rest some, & listen to your body. Oh, and you asked about my ID visit. It went well, my blood work looked excellent, and she is having me finish my latest 2-week prescription, then stop. She feels there would be more risk in being on the antibiotic for too long than the risk of an infection on the joint. She’s a good Dr, and I trust her. I’m a little anxious, but also relieved, and thinking positively for a good summer filled with grandson stays, gardening, canning & our beloved Farmers Market ( which begins April 2). And, we can “ sleep in” til 7 or 7:30!

Well it is now a little after 8, so I need to get our breakfast started... traditional Saturday for us - cheesegrits, eggs, bacon & toast/ jam. . You & those cute little dogs of yours have a lovely day
 
Good luck to you, dogtiredknees.
I know from experience that Jamie's advice is one to hear. My knee looked large after my first surgery, and it was the first thing a second opinion surgeon said to me. X-rays or other means such as MRI or Cat Scan for looking at your knees is the only way to prove or disprove a large knee.
I would be requesting X-rays be taken at least every month in the early healing time. It's nuts that they have not taken them but once in five months. You deserve better than that.

Mamie
 
Good afternoon, Catalien45 and Dogtiredknees!

What a relief to read your getting better Catalien45, and looking forward to the Spring and Summer activities. I am praying that the same is true for dogtiredknees and myself. And actually everyone enduring the long journey we are all on. It's difficult to see the small improvements in life while in such a place of fear or worry, but with each tiny "better" its a joyful moment. What a great post Catalien45 with words for visualization of hope. I've learned to be greatful for every blessing of improvement even if difficult to see.
Catalien45 said:
liner replacement surgery shouldn’t be too bad. B
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With what you say to dogtiredknees about the surgery not being so bad, I hope makes her smile some. I'm sure she may feel overwhelmed to have to go through any more at all, but at least it's said to be not like before. Dogtiredkneesyour positive outlook will keep your spirits up but we all need support to take any more. We are all here for you. My prayers are with you too.

I do not know where you live but hopefully it's a place where you can see yourself enjoying the fresh air of Spring with all of the buds about to bloom and the birds chirping you a tune. It's so hard to do at times but I found if I can take my mind and focus on anything but my knee, life seems a little easier to endure the difficult challenges..

Your BoneSmart Friend,
Mamie

​

 
Thanks, @Catalien45 and @Mamie. You are both very kind, and I hope you are both doing well in your recovery.

Extension is now approximately +15.

I received a copy of the surgeon’s letter, in which he says that the probable revision surgery would be to a “posterior stabilised“ knee, and “downsizing the polyethylene” to increase the extension gap.

Can any admin shed light on this please? I am hoping to get a second opinion, and would like to understand what is being proposed more clearly. Thanks
 
I am not knowledgeable about the different implants so I will have our staff discuss it and get back to you. I know that changing out the spacer isn't that unusual and nowhere near as bad as joint replacement surgery. If it is too big it affects the ROM and too small it affects the patient's stability.
 
@DogTiredKnees , A posterior stabilized knee is a prosthetic with additional features to stabilize the knee in the absence of the posterior crucial ligament, which is removed. Removal of the PCL creates more room for scar tissue and in theory allows your knee to cope with scar tissue growth.

I have this kind of prosthesis.

If you don’t already have this kind of prosthesis then installing it is a full revision, not just the change of spacers (I had this done too). From your comments I get the impression that your surgeon is suggesting a full revision.
 
The question I would have is why would he choose to revise to the "posterior stabilized" implant? I don't recall that you indicated instability in your knee joint. The spacer change could help with your extension, though. This is why you need additional opinions. And when you're in the consultation with each surgeon, ask questions until you understand exactly what they are proposing and why. If you find a surgeon won't answer your questions or brushes you off with a little ego, then that's not the right surgeon for you.
 
Jamie said:
This is why you need additional opinions.
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When I was getting my partial I knew nothing, and trusted the first and only surgeon I saw. I figured, he was the surgeon, he must be right. It never occurred to me to get a second opinion before agreeing to the partial replacement. My husband even commented about a year after my surgery that we didn’t even know what questions to ask.

5 years later, with a poor outcome, I know a lot more now. Unless I’m in an emergency situation, I think I will always at least try, to get a second opinion about a proposed surgery. I will “interview” my next surgeon, and decide who to “hire” for the job. :heehee:
Jamie said:
And when you're in the consultation with each surgeon, ask questions until you understand exactly what they are proposing and why.
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This is good to keep in mind, but it can also be difficult sometimes. The appointments are often rushed, and the surgeon talks fast, because he knows what he talking about, and forgets that this information is new to us. Try not to let this happen.
Jamie said:
If you find a surgeon won't answer your questions or brushes you off with a little ego, then that's not the right surgeon for you.
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And then there are the surgeons who take your notes, literally, out of your hand, and place them out of reach and says, just tell me. :hairpulling: My first second opinion did this to me, and he came highly recommended. I was so flustered I could hardly remember what all was on my list. My appointment was rushed and very unsatisfying. And, the ride to his office that should have taken one hour and 40 minutes, actually took. 2.5 hours, and took 3 hours to drive home. My husband and I were not happy and I did not see this surgeon again.

So I understand some of the challenges we go through in doctor appointments.

On the other hand, my second second opinion took his time with me. He actually read my list of concerns before he came into the room, then when he did, he went down the list and addressed each one. Unfortunately for me, he was not able to offer me any help for my issues, but the 2 appointents were like night and day.

So, I would echo Jamie’s advice to get at least one other opinion, and try to be assertive, if you must, to really understand what they are telling you. Not all surgeons are created equal, not all opinions agree.

We wish you the best as you seek answers and help for your situation. Please keep letting us know how things go. :console2:
 
Thanks, @WFD. I have been reading your recovery thread.

Thanks, @Jamie and @Jockette. Yes, I’ve never had any instability in my knee (as in giving way), either before or since surgery. My current surgeon is rather ”old school” and I think that everyone is a little bit scared of him, including me :loll:He doesn’t make it easy to ask questions, but I will certainly be prepared when I manage to get to see another surgeon. Thanks for your advice :)
 
Try not to let any of the surgeons intimidate you. They sometimes have pretty big egos and seem larger than life....it can go with the territory for surgeons. But in the end they are just people like all of us. You have a right to have your questions answered. And you REALLY have a right to be an active participant in your care. Asking questions and understanding what is being proposed is part of that. Hopefully things you've learned here on BoneSmart will help you. Write down some questions to take with you so you don't forget anything you are unsure about.
 
Surgeons still have to put their pants on one leg at a time................... They don't intimidate me-if one of them had snatched my questions out of my hands, I'd have either gotten up, gotten it back, and told him I was using my notes, but more likely I'd have walked out after telling him what I thought of his behavior. Some doctors have a god complex, and I would never put up with one who does. My time is every bit as important as his, as is my life.

My doctor always tells me right away to ask my questions as he knows I always have a ton, and, more importantly, he listens to every single one, takes the time to answer every single one, and then we go from there. Any doctor not willing to give you the time you need, within reason of course, isn't worthy of your time. Any doctor who is dismissive, won't listen, tries to make you feel like you're not worth his time and so on, is not worthy of you as a patient.
 
@DogTiredKnees Here's another perspective on dealing with surgeons and doctors in general. 1- You are their employer. Oh yes they work for a hospital or practice but you are the one wanting to hire them to do what ever surgery (or you need their continued care after a surgery) is needed so YOU have the right and need to know their credentials, experience, approach, etc. Doesn't matter if their pay $$ is coming from insurance or private pay or where ever. YOU are employing them.

2- Appointment timing - All doctors are busy. Surgeons do have a lot of other things to do besides appointments and performing surgeries. So when ever possible schedule your appointment to be first on their list for the day. That way they have a bit more time as they have not had to deal with emergencies yet, have not gotten drawn into office politics or other problems, etc. For me the best time to see my Primary Care Physician is first thing Monday morning - a bit inconvenient for me but he is rested from a weekend off as is his nurse, he's on time as office emergencies have not yet backed up his schedule, and as above other concerns have not yet used up time and attention.

3-Ask your most pressing questions first. And let him/her know you are an informed patient - and you need the information to continue to thrive under their care. You need explanations, and instructions for remedying any and all problems - they are the experts and you are in need of their expert care and guidance.

I've had 3 different surgeons for my joint replacements - the shoulder folks were both lovely people and very easy to work with - willing to take time to fully answer questions, very clear in the info they gave, etc. The hip guy, on the other hand, was not of that mind set and it took a bit of persuasion on my part to convince him I was not questioning his expertise but was seeking answers for myself and that I was reasonably knowledgeable about the general process of surgery and recuperation. IMO he had not taken med school class Bedside Manner 101 very seriously. Once we had that established he did warm up a bit and we got along better.
 
Howdy Dogtiredknees
I’m with everyone here. You are the surgeons boss. I’ve learned the hard way what to do and that’s too late once the wrong surgeon is on board. Ask for a few patients to see what their experiences have been. Ask how many of these procedures has he done. What is his percentage for both infections and successful surgeries. These are all fair questions. Visit the hospital floor you will be going to and talk to the nurses. If they will, no one could know the answers than they would. Be the best advocate for yourself as you can be. After all, you deserve only the best. You will be in my prayers. I was so disparate to find a qualified surgeon I trusted those answers to be truth and discovering later was too late. Good luck.
 
It’s been some time since my last update, but I have been too dispirited to post here.

My left TKR was October 2021, followed by an MUA in December 2021. Stiffness and lack of range of movement did not improve and the original surgeon suggested that a revision may be necessary. I felt that there was an implication that I hadn’t worked hard enough and that it was somehow my fault.

I sought a second opinion in May 2022 and then a third in August 2022.

Two of the surgeons suggested a partial revision. The implant is a Stryker Triathlon cruciate retaining keen replacement, with a size 4 femoral component and an 11mm polyethylene insert. They planned to revise the femoral component to a posterior stabilised femur and change the bearing to a thinner posterior stabilised bearing.

The third surgeon does not use Triathlon replacements, (can’t remember what he uses instead) but would prefer to revise both major components and ensure that the flexion and extension gaps are equal and matched before revising both components. The implication is that the original replacement was too big.

My range of movement is approximately 15 to 18 degrees extension and 90 degrees flexion on a good day.

Last week I had a joint aspiration and Synovasure test to check for infection. The Synovasure was an immediate negative, still waiting for the other result, but the surgeon thinks an infection is extremely unlikely, but I’m still glad that he is being thorough.

I am on the waiting list for a full knee revision, still no date, but I hope it will be in the next few months.

My question is, is it common for a knee replacement to be deemed too big? I am fairly small framed and have lost a lot of weight since the original surgery due to problems with medication, but surely the components are carefully measured beforehand to ensure the best chance of a successful recovery?

I would be grateful for your thoughts.
 
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Hi @DogTiredKnees and welcome back. I'm so sorry to read that you are still struggling. It's absolutely understandable that you are feeling dispirited.

I don't have any direct experience with wrong-sized implants, I do recall reading that other members have had revisions for a wrong-sized implant. You can find them by using the Search tool on the far right of the blue menu bar.

I'm glad to read that you don't have an infection, and hope you will get a surgery date soon and that it will give you relief/
 
Thanks, @benne68 :)

I‘ll take a look and see what I can find. Please can you change my thread heading to wrong size implant. Thanks!
 
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