Scar tissue after knee replacement

Can I ask where did you find a revision orthopedic surgeon at I live in erie pa and can nit find one

@gutthookd My last TKR was done with a custom made knee. They do an MRI of your knee and make one that fits exactly the same. I chose that because it has the reputation of having a quicker recovery, plus one of the designers of the knee is in Boston and I had him do the TKR. He offers other knees, I presume he must have to, to not have a "conflict of interest" but of course I chose his, the Conformis, and it has worked out great. I am very surprised more people do not opt for custom made knees. I think, not sure, that there are others besides the Conformis.
My first TKR was a regular knee, I am not sure of the brand, but despite having minor pain after a lot of exercise, and not having quite the ROM I would like, I really cannot complain.
JK

Good afternoon contentandwell (and all) - Yes, I am aware that there are such things as "custom made knee prosthetics", but these are
very much the exception rather than the rule. I didn't have that option with my insurance (and most people - don't). I'm glad that you had
a mostly good experience with both your knees (even if one was somewhat - or maybe a lot - better). It isn't as if I am not aware that people
don't have good experiences - I wish everyone did (including me). One other thing that a whole lot of TKR (shoulder, hip, etc) patients are
NOT aware of... is that with many of these prosthetic manufacturers (of all types), there is a "little something exgtra" in the way of a financial
incentive to exclusively use one brand versus another. No... I'm not kidding. This information used to be considered "private" and was not
easily available. But... just as some doctors are kind of "additionally comped" for prescribing for instance a "name brand" drug vs the generic
(even though this usually costs much more), surgeons are also "taken care of" by medical device manufactures - and sent on lavish trips plus
paid well additionally to recommend these same devices to other surgeons (because who can "maket" a surgeon better - than another surgeon...
and of course he can get paid some additional dollars, too). Years ago Pro Publica won a series of lawsuits which require that this is now "public
information". Nothing "against" the surgeons, but I think nearly anyone can understand that in certain cases this could definitely cause a conflict
of interest. Anyway... if you are interested in finding out who is "getting paid additionally" (or not - all you have to do is type their name in:
https://projects.propublica.org/docdollars/
No, I do not "have anything against" doctors in general or orthopedic surgeins in particular (although I am a WHOLE lot more skeptical now
regarding what I am told by doctors - especially where it seems in conflict with what I believe might be true or actual). By that I mean - when
you have a knee that is nearly double the size of the other and quite warm to the touch... I am skeptical when the surgeon tells me "how good
the knee looks". I don't distrust him because "he's a doctor", but because of the objective circumstances. The medical field is not (by a long shot),
the only specialized field which will occasionally mischaracterize something - based on their assumption that the person they are talking to "doesn't
know any better" and will tend to "go with" and trust... nearly anything they are told. Most people (my age 60+... especially) will tend to make strong
assumptions that any doctor or surgeon would always give them "the straight scoop" and would primarily be interested in the patient's health. I would
agree that there are definitely doctors who "are still - like that", but I do wonder occasionally if these are becomming less common. I hate to think that,
but in my own case - have had things told to me (both before - and after surgery) that just simply were not true and tended to support the surgoen's point
of view on the matter being discussed. THAT in conjunction with other doctors and surgeons privately commenting in strong terms on the honesty and
reasoning of other doctors/surgeons but then failing to publically (or where a written opinion is required) confront what they themselves consider (or have
privately said they did) unsafe, illogical, or "strictly for the money" behavior.... does concern me (because it potentially puts us all at risk when these people
are essentially "left in place" to continue practicing medicine in these same ways - because of other medical professionals being unwilling to confront these
types of behaviors). It's just another case (and there are many) where the persons most capable of "seeing and understanding that these problems exist"
choose NOT to personally involve themselves. I don't know if anyone out there other than me remembers the sad case of Kitty Genoveeese, but a sort of
"watershed" event for that time period... on the subject of "getting personally involved" vs avoiding this... and that there are consequences.

Anyway... please understand that I am not by nature "a negative person", but have had an expensive education (and quite a bit of this learned - "the hard way"). I really do wish everyone else out there a better experience, but wouldn't agree that sticking our heads in the sand regarding problems and conflicts
that do exist... would be the best way to avoid these. The more you can know about your surgeon and the surgery you are considering before you have surgery - the better. Had I known more then, I believe I would be in a different situation now (and if I can cause one person to avoid a similar experience -
just by asking these questions earlier than I did... then I'll consider I have accomplished something worthwhile).

My best to you - and everyone out there,

John

Dear kneeproblem, win sturgeon, (and all) -

Kneeproblem 1st - I'm in Oregon (Oregon City, actually)... but it shouldn't be that different in Erie, PA. At any point you can
schedule an appointment with another orthopedic surgeon for a 2nd opinion. Yes... sometimes it's tough to get a 2nd opinion
if you go to another orthopedic surgeon in the same clinic (or maybe even in the same town - surgeons tend to stick together).
If... you have either been released from continuing care by the original surgeon (or have "fired" him or her), then typically any
other surgeon will consider you "fair game" - and frankly... then you have to be careful on the answers you get regarding if a
revision surgery is needed or NOT. It is in the economic interest of any surgeon - to do another surgery. You may think I'm
"nuts", but most orthopedic surgeons believe that the best solution to an orthopedic problem... is surgery (done by them). This
is how they get paid. If I were you (and I'm not), I get two completely unrelated (different clinic, different area of town - maybe
different town) surgical opinions... and don't be in a hurry to make a decision. Originally... I sort of :"figured" that if the 1st surgery
was "a problem" that the next surgery could "fix it" (figuring - no big deal... sure the 1st one had a problem, but these guys know
what they're doing and they'll get it right the next time). That isn't necessarily true. I hope it will end up finally "being true" in my
case, but really what I've found out... is that there is a lot they DON'T completely understand (and you could potentially be put
into a bad health situation by surgery that is NOT healed or fixed by subsequent surgey). I know that's not very encouraging,
but that's the truth of my situation (which doesn't mean it will be for you - and I hope not). When surgeon's are "selling you"
on the idea of having the surgery... they do sort of make it "sound that way", but like Humpty-Dumpty... not everything that
is broken can be "fixed - good as new" and I've found myself ready to accept less and less. One thing is for sure (at least
for now)... after 3 surgeries (2 complete TKR's and 1 partial revision), I will not be having another TKR unless or until they
can give me a good reason to assume I will have a different outcome (because I don't have that now).

win sturgeon: Good question re "And where is the FBI or the FDA ?" The only way I know how to answer that - is to ask
you how many people you know of who were actually put in jail for all the financial fraud that clearly went on during that
little "mortgage crisis" and resultant near-depression that will end up costing trillions ? Just like with campaign financing
laws (that were put in place after that minor misunderstanding we know as "Watergate"), the actual laws with actual teeth
regarding medical misrepresentation or medical malpractice are so watered down that it is nearly impossible to get any
kind of case in front of a jury - for anything other than actually amputating the wrong leg (which is one of the reasons they
do make sure they are damn positive on that). The conversation between surgeons and their patients is private and "nuanced"
in favor of making it sound like problems "nearly never" happen. If you think about it (as far as after a TKR recovery has become
a problem - and then what all these various specialists who are typically NOT covered by your insurance will suggest), we are not
in a much different situation than we were (as patients/consumers) before there ever was an FDA. Yes, there have been significant
advances (medically and otherwise), but this is still mostly about making a ton of money and the customer is nearly desperate and
ready to believe (or pay) nearly anything. I don't know if most of you are aware of this, but the medical device industry (prosthetics
and etc.) is regulated a whole lot less - even than Big Pharma and depending on whose numbers you believe... it may be a bigger
market. So... who is really "out there" protecting the health, safety, and interests of the patient/consumers ? Not many people... and
at times it seems like nearly no one (and I am talking about both political parties - who both take a ton of money from these industries).
The industries who give so much money to politicians are not making a "donation" - they're making an "investment" (and this is an
investment that pays off for them). That's just the reality of that situation (and has been for some time).

My best all,

John

John - Thank you for posting the link to propublica. I was able to look up surgeon 1, who did my R knee. He received a total of 40.00! Now, more interestingly, I went to see a surgeon in Boston for a second opinion on knee number 1 and to consider having him replace my L knee. He received well over 2M! However, he is either the creator or one of the creators of the Conformis custom knee. What do you make of his earnings?

@gutthookd I am very aware that the doctors do get comped by drug companies, and I presume by device manufacturers. Our local newspaper printed the names of all of the local doctors and how much each received from drug companies a few years ago. It was eye-opening. I wish they would do that again. I realize too well that drug companies are making way more money than they should be by charging exorbitant prices for necessary drugs. Of course, they are entitled to make a profit but the profit they make is unconscionable, particularly when they take a drug off the market that is helping a small segment of people but they are not making enough profit for them.
Medicare and my supplemental paid for my knee, I paid virtually nothing. I think I would have paid some extra though to get the knee I have. I did do quite a bit of research before I chose my surgeon and knee. Knowing what I know now, I believe that is essential, particularly with something like a TKR that has such a high dissatisfaction ratio.
I truly hope that you can get some more positive results with your knee. You have gone through much more than you ever should have had to.
JK

@babette That is my knee, and I presume the doctor who did my TKR. The large amount he made is of course profits from other doctors using that knee, not being paid by Conformis for using it himself.
It is refreshing to see doctors whose profits from drug companies and device companies are under $100. They have their patient's best interest at heart, not their wallets.
JK

Good Morning, Babette (and all) -

Yes... this is interesting stuff (and if you're like me - a little surprising that people who are so well compensated...
figure endless ways of "getting a little more"). This is now very common. I guess I don't draw a whole lot of
conclusions from his vs other surgeon's "additional earnings". My questions for any surgeon would be - how
involved will YOU be during my recovery and is there a coordinated care plan (ideally there would be a nearly
seamless hand-off to physical therapists who would stay in contact with the surgeon and fully report on your
progress). If he (or she) waffles on answering these questions, personally - I'd say find someone else despite
their qualifications. The potential problems are not generally caused by their lack of skill as a surgeon, but more
by a lack of willingness (or in some cases - a determination to not under any circumstances) to involve themselves
in anything OTHER than just the surgery (and the healing of the surgical incision - which generally includes making
sure there is no infection concern related to the surgery).

Based on what I think I have learned (personally - and in conversations with others)... where there are inflammation
problems (which are common) during initial stages of recovery - the race to make gains before enough scar tissue
results to halt the progress can be lost by the patient because of generall failures in communication (regarding that
there is a serious problem emerging) between the patient, physical therapist, and surgeon (sometimes also the PCP
where he has stayed a little involved and is aware of the situation). All the medical professionals in this situation defer
to the surgeon - and no one of these wants to make too much noise about patient concerns (although they all are
completely aware this is a time loaded situation). Unfortunately, maintaining these "professional relationships" seems
more highly regarded than patient concerns/distress and it is common that these are discouraged or explained away
as "normal progress".

When I read about that X10 machine and how it came to be developed (by an orthopedic surgeon - a Dr. Halley)
because of him seeing so many problems with his own patients and because of NOT seeing better results with
use of a CPM immediately after the TKR surgery. While this is no kind of "magic" - it is at least an attempt by a
surgeon to help patients recover in response to what he was seeing, rather than just standing back and letting
"this" continue to happen.

I think I'm going to try to do a little further research on what "other countries" (other than the US) are doing so far
as how they are avoiding or helping patients progress through more problematic recoveries. I think we (as US
citizens) tend to think that WE know best regarding how we handle heathcare (and maybe everything else). The
statistical numbers (how much we spend as a percentage of GNP for healthcare - and what our outcomes are)
just don't "add up" favorably for what we are doing. Generally we spend (a lot) more - and get (a whole lot) less.
Even though this is an older program, I recommend Frontline's "Sick Around the World" (which basically looks at
8-9 democratic market economies... some with "public" care and some with "private" care, but single payer through
taxes (and by the way - not higher taxes than what we already pay). What all these other countries have in common
is that they lack a medical insurance industry...period. I think "the way" we receive health care in this country skews
the motivations of those providing it - and in some cases (I think) puts surgical patients at greater risk. Anyway...
this is all interesting stuff (please draw your own conclusions). I think we might all agree... we can do better.
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
My best to you (Babette - and all),

John

Good morning, registerednurse (and all) -

Infection in the joint capsule after a TKR is a big deal (typically). I hope the antibiotics "work"
and i am crossing my fingers for you. My own situation is so inflammation sensitive that my
previous surgery arthroscopy essentially ended up being like bailing water from a seriously
leaky boat (we regained the scar tissue to the same degree - almost immediately). I'm glad
to hear your exerience has been better (or sounds as if it has - and I hope that continues).

Yes (JK), those gym hot tubs (and swimming pools) do have bacteria in them of all types
(regardless of the amount of clorine put in them). If I had immune suppression issues, I would
share that same concern. Counter-intuitively (at least based on what I think I understand now),
my inflammation problems are driven by too much of an immune system response (some
inflammation being "the normal response"). That's part of "why" a steroid injection "works" to
reduce inflammation - it does this by partially suppressing that same immune system response.
It would make a lot of sense to me - that they would consider "bathing" the joint capsule with
steroids during the TKR surgery (particularly where this is a revision - with a well-understood
history of inflammation causing previous problems), but it's my understanding they generally
will not do this.

More "grist for the mill"

Best to all (and good luck JK),

John

All pools have bacteria in them. I went in a hydropool 36 hours post arthroscopic arthrolysis and debridment of left knee, no problems it was highly chlorinated.
I paid 12K for a knee replacement in the UK, only to get me back to work ASAP....it didn't work due to scar tissue. I still don't have knee flexion to what some people get 96 degrees....