Revision TKR Zimmer Rotating Hinge Knee Prosthesis

[grannyweasel]

I was just wondering if anyone else has been fitted with an RH prosthesis and if their recovery was smooth.

When I had the first replacement in my right knee in 2000, it was a standard unconstrained prosthesis but unfortunately I found it was very unstable and I kept on falling over. In 2003 it was replaced with a semi-constrained prosthesis but because of a thick spacer, I couldn't straighten my leg - it had a 25 deg bend - so it was playing hell on my back.

My surgeon found that my MCL had "given up the ghost" so on March 28 this year, he put a rotating hinge knee prosthesis in.

I was bending my knee to 96 deg within 2 days of the operation and was on crutches within 3 days, finding it quite easy to move around. Everyone was very pleased with my progress and I got out of hospital in 6 days instead of the original 14 days my surgeon said I'd be in.

However since coming home, I'm finding it hard to walk with just one crutch. It feels like I have something heavy strapped to my knee and I seem to be clumping awkwardly instead of moving smoothly.

I was just wondering if this is something to be expected and if it will correct itself with time. I have always recuperated quickly after operations but this one seems to be taking longer than usual.

I would love to hear stories of other people who might have had this type of prosthesis to know how they fared during the post-op recovery period

This is the X-ray of my prosthesis ...

 

[Bumpa]

Grannyweasel, thanks for sharing your story - I always thought that hinge knee replacements were serious stuff and the receivers expectations had to be modified - best if they are painfree and stable. When I was first involved in the early 1960's the McKee, Shiers, and Waldius knee replacements were hinge type - they then went out of fashion. Are they now coming back. Please let us know how you get on?

 

[wanna]

Didn't have the Zimmer hinged prosthesis but had the German Link Hinged joint.
They often fit them to people who have had big trauma and also ligament damage.

My X Rays look pretty similar to yours - I also notice you have the long stems inserted (wish I had a coin for every time an X Ray person refused to believe how long the stems were)

I'm certainly no expert on hinged joints but mine took a while to get used to. I actually felt more secure going in a straight line, although I needed 100% confidence in it, although it has never given way or let me down.

I had a little trouble trying to twist or turn as it didn't like this. I understand what you say about it being heavy and clumping.
Mine was like this, and I ended up doing what I could to increase the strength of my leg muscles to carry it easier (have to be careful what I say here, as there are many on this board that think you just sit back and the Gods come and increase your strength and ROM!)

Now the prosthesis is fine and I find it remarkably stable ( I have other problems but nothing to do with the prosthesis)

When mine was first put in after a number of soft tissue and ligament problems, I asked about why a hinged joint and was told that many Consultants in Germany prefer these prosthesis and believe they are much more stable and reliable than ones used more frequently in the UK and the US.

Not sure this helps much :DOH: but I would persevere with it and it's still early days for you getting used to it

 

[bottomshollow]

I had a little trouble trying to twist or turn as it didn't like this. I understand what you say about it being heavy and clumping.
Mine was like this, and I ended up doing what I could to increase the strength of my leg muscles to carry it easier (have to be careful what I say here, as there are many on this board that think you just sit back and the Gods come and increase your strength and ROM!)

No, no, no, wanna, we don't advocate sitting back and letting the gods come and increase strength. (althought it would be nice if they did). What we advocate is allowing the knee to heal properly with reasonable, basically pain free physical therapy. The idea here is not to aggravate the knee for the first few months after surgery and prolong the healing process.

After the knee heals, a person can do all the strength training they want to do. Some of us have no reason to do such strength training, but those who do certainly are not being told not to after the knee heals.

Hope this clarifies the BoneSmart position on this. Take care.

 

[Josephine]

Thank you, Judy. There are some enthusiasts of aggressive PT that totally misunderstand our stance on that.

Granny, I think hinged devices do take quite a bit of getting used to. You are only just three weeks out from this surgery and cannot possibly expect to have any positive results yet a while. Try to be patient. It could be a couple of months more before you start getting really good movement.

In the mean time, you could help yourself by reading these articles
The first set is essential reading, the second is useful and the third just good information but you will need it all
The importance of managing pain after a TKR and the pain chart
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice
Swollen and stiff knee: what causes it?

Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

 

[grannyweasel]

Thank you so much for all your responses. I really appreciate your views and it has given me hope that I'll be able to walk normally with time!

I'll definitely read all those links you gave me, Josephine so thanks for that!

Bumpa - yes, I believe the old fashioned hinged prostheses were hopeless since they didn't rotate at all therefore became loose, causing more problems! Thankfully they improved the design so that they worked more like a normal knee

 

[Josephine]

They did indeed work loose! And patients couldn't kneel because the implants would only go to 90 degrees of flexion. One needs at least 110 to be able to kneel. The Shiers and the Stanmore were actually designed to do that! The Sheehan was the forerunner of today's style of replacement. He was an Irishman and well ahead of his time.



I still have these upstairs in my "archive" box!

Shiers knee 1970

Stanmore knee 1975

Sheehan knee 1975

 

[Janet2012]

It seems like that was such a short time ago! Makes you wonder what they will have developed in another 30 years.

 

[GrandyGirl]

Hopefully by then someone will have come up with a cure for arthritis and knee replacement will be a thing of the past.

Dori
aka GrandyGirl

 

[wanna]

I think it's truly amazing how fast medical science is progressing.

I have only had 8 years of (massive!) problems but the protocol, technology ,prosthesis and attitudes have changed rapidly in those days.

Even the use of anaesthetic type and Pre Op Assessment tests are hardly recognisable from the start to end of that period.

I suppose it reflects life in general where IT and development is king.

 

[Josephine]

Absolutely!

 

[RestAssured]

Now they are back to the hinged knee for revisions in some cases! Dr. Maale has worked with doctors around the world to perfect the next generation of hinged knee. It will bend past 120 which will be fine in my opinion.:wink1:

 

[grannyweasel]

Josephine, thanks so much for posting those pictures of the old fashioned hinged joints. Boy, they look pretty brutal, don't they? Certainly not ergonomically designed :th_heehee:

I had to laugh when you said "And patients couldn't kneel because the implants would only go to 90 degrees of flexion." I have never thought of ever being able to kneel on either knee and God forbid if I fell down ... I'd need a forklift to get me up again - LOL!

I'm still finding it hard to walk without 2 crutches and now, every time I do my quad exercises, I can hear the joint squeaking Makes me feel like the Tin Man - do I need to find that can of oil to dribble into the prosthesis, hmmmm?

Wanna - does your German linked hinge joint squeak at all? Just curious if it's something to be expected or not.

I had a very bad valgus problem prior to my operation so will put that in the pre-op section as It'd be good to compare notes with someone who has been through the same sort of thing.

 

[Bumpa]

The German prosthesis mentioned above is the Waldemar Link of Hamburg. The Swiss also did one under the Sulzer lable called the GSB name. (Waldemar do not now list a hinge prosthesis in their product range).

 

[wanna]

hi All

Think my prosthesies is this;

http://www.linkhh.de/english/english/index.html

Think the hinge joint is down the bottom of this page under B)

Note to 'grannyweasel' - my hinge joint is silent & certainly doesn't squeak!!

Doesn't really feel any different to other joints, although it does feel slightly more stable, but not sure if this is in my head.

I have never got bend anywhere near 120 because of my Carbon Fibre problems never mind the type of prosthesis, I would be happy to get to 90 at the moment with my past problems.

Interesting to hear about the developments of a new hinge joint 'rest assured'. Will be too late for me unfortunately but maybe an option when I get older. Any online references?

 

[Josephine]

That link doesn't take you anywhere, wanna.

But you're right - hinged joints don't squeak. Wrong kind of dynamics!

 

[grannyweasel]

Sorry ... I should have explained the statement I made better.

It doesn't make a noise which we can hear but if I or my husband put a hand over the knee, you can *feel* it squeaking. I promise you it's not my imagination :-D

Does that make sense?

If,like you said Josephine, the dynamics are wrong then I shouldn't even *feel* it, should I? Oh well, am seeing my surgeon on May 2 so hopefully he'll have some answers ;D

 

[wanna]

That link doesn't take you anywhere, wanna.

But you're right - hinged joints don't squeak. Wrong kind of dynamics!

Yep apologies for that. It did yesterday when I cut and paste the link - now it just takes you to the link site.

Good job nobody I work with is on here, they would laugh at my IT skills!

ps just tried again and failed. They have one of those non specific links that means the link is only assigned to the main site. Think it's there to stop idiots like me posting on sites like this!

If anyone has a burning desire to see the prosthesis -
Follow the link in my post above - click the 'Medical Professionals' tab - Click 'Knee' - Click 'Total +Hinge' - then scroll down to 'Total Hinge'

 

[grannyweasel]

Bad valgus after liner changed in December

I was just wondering if anyone else developed a bad valgus bend and had a Rotating Hinged Knee replacement to fix it and if so, how their recovery went.

It's a long story but my right knee has been the bane of my existence since my first TKA in 2000. It was unstable afterwards, despite 2 allografts (tendons attached to try and stabilise my MCL) which failed.

In 2003 I had a TKR and a semi-constrained knee was put it. For 9 years I've been unable to straighten my right leg fully and when in bed, needed a pillow under the knee.

My present surgeon said that this was affecting my back pain so he recommended replacing the present prosthesis so that I could fully straighten my leg. However just before the operation, he called me in to say that my prosthesis had a very thick spacer (18mm) so he would replace it with a normal sized one and if my knee straightened, he'd leave it at that and not put in a new prosthesis.

As it happened, that's what he ended up doing, he just changed the liner, and for the 1st 2 weeks, everything was great. Then my leg started to bend to the right and every day my husband noticed it was getting worse.

We went back to my surgeon who informed me that my MCL had "given up the ghost" so I needed a rotating hinged knee prosthesis put in.

I've posted a photo of how my knee looked just prior to my surgery and I was just wondering if the "damage" caused by the bad valgus 'bend' would affect my recovery now that I have my RH joint.

I've had 6 major surgeries on my right knee but never had any difficulty with getting over it, despite getting DVTs and needing to have a manipulation of the knee under anaesthetic in 2001.

However this time I'm finding it almost impossible to raise my right leg straight up while doing my quad exercises and it's so difficult to try and walk with just one crutch.

I was wondering if this was to be expected after the ligament damage caused by the valgus?

(PS - I have multiple problems throughout my body and have had 18 (orthopaedic) operations since 2000.)

Thank you for your time in reading this

 

[Josephine]

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