Spacer replacement 4 years after TKR

So you are having revision surgery on the same revision you just had less than 3 months ago?

Unfortunately yes. The initial revision was because the bone cement on the upper part didn’t hold. A new upper metal piece was put in the femur. I have had significant popping, clunking and intermittent pain throughout my days. So I’m having another revision less than 4 months out from the last revision to replace the polymer spacer. It’s a bit disappointing, but if this revision works, Hallelujah!

Did they give you a reason for not changing the spacer at the time of your femur prosthetic replacement at the time of your first replacement? I've been having deep hard clunkig for 15 months..since day 1 after TKR. Had arthroscopy cuz of what my doc thought was patellar clunk syndrome and actually had quite a bit of scar tissue removed. Unfortunately it did nothing to help the clunking. Now he's saying it's likely mechanical clunking from some instability or the patella not tracking perfectly. I'm so discouraged. You are brave and I hope this next surgery helps and I would love to hear from you after for an update. Thank you so much for responding.

Hi wallygator. I wrote to you yesterday about my TKR results and asked why they did not evaluate (for instability) and replace the spacer at the time of your initial revision 4 months ago? I am shocked they would suggest doing another major surgery so soon on you as opposed to waiting to see if "things settle down" after an appropriate amount of time for swelling to subside and healing to take place. Also, I wanted to ask if your ROM was ever an issue for you?

I believe that the polymer spacer was changed, but possibly the wrong thickness. I’m having a second opinion today with an orthopedic surgeon in a different city not associated with my dr.
Assuming that he confirms the need to replace the polymer spacer, then 10/6 surgery again.

Oh. I see. It's just that you said only the femur part was replaced cuz it came loose. The spacer is inserted thru the tibial plate. I know you must have a copy of your operative report to take with you to your 2nd opinion. Right? It describes exactly what was done to include the size and brand of any parts you had replaced. You can get it right from your surgeon's ofc. You can just tell him you want it for your own file at home if you don't want him to know you are going for a 2nd opinion. Or get it from medical records from the hospital. But very important to have it with you at the time of your appt for him to read prior to seeing you. Just curious what city or town you live in. Also, is the guy who did your revision the same guy who did your TKR 4 years ago? If so, you should also get a copy of the operative report from that surgery. Jist sayin'. 👍🏼

I am SO glad I found this site. Here's my story. PKR 2.5 years ago. I'm a female, 56 (was 54 when I had the surgery). I injured my knee originally in martial arts class when someone "swept the leg" and I went down. Likely tore my MCL but had no health insurance at the time, so didn't do anything. Developed arthritis in the knee. Wore custom braces forever while still doing martial arts. Finally decided to get the surgery. Surgery was done and was considered successful. I was his first patient to walk to his office (he's half mile down the road from me) in ten days with only my cane. PT guy told me I was remarkable in my progress. I told my doctor my goal was to return to martial arts. He said the partial would allow me to.

I've had no issues at all with the PKR other than an infection after the first surgery and some blood leaking from the sutures which was from the infection. After a year of allowing it to heal and only bike riding, I joined a gym and began lifting weights. I'm also a breast cancer survivor and on estrogen blockers so I had to start lifting in order to try to keep my muscles from deteriorating which can happen with menopause and while on these hormone blockers. I didn't lift too much weight, just started slowly and gradually have built up. Everything was going well. Took ONE class at a martial arts studio about two months ago and when I went to do a round house kick while balancing on my left knee (the bionic one) I felt a lot of pain when I pivoted and something just felt off. I rested the knee for a few days, then went back to weight lifting/bike riding but not Martial Arts.

On the 18 of September, I was at the gym and decided to go to the ballerina bar to do some light stretching. I did one where I stand on my left knee and swing my right leg in front of me and then pivot to bring it behind me like a spinning hook kick. Something snapped and the pain shot up my leg and I went down immediately. I was rushed to the ER where they took xrays and said all looked fine and I was probably just experiencing a strain or ligament tear. However, the Xrays CLEARLY showed a piece of something just floating in my knee that was not on the OG xrays after my surgery. At the ER, they sent me home with an immobilizer brace and some Norco and Ibuprofen and told me to contact my surgeon. The pain was unbearable but better in the morning. Tried calling my surgeon the next morning starting at 7am. No one answered, including the usual doctor's exchange that you might get after hours. Finally someone answered in the office at 9:30 am. I told them I was having an emergency and needed to been seen immediately. I was told my doctor was off until the 30th. I asked to see the other doc that he shares the practice with only to be told that he, too was off for two weeks. I asked if there was a doctor in the area that they could recommend and was met with crickets. Hung up, called the ER to ask if they could refer me. They sent me some options.

Called the number that the ER recommended and told them that I thought something had broken in my hardware. They made an appointment for me but it wasn't for 4 days. In the meantime, my knee pain had subsided except for when I would sometimes be walking with my cane and it would lock up causing me horrific pain for a few seconds, then it would subside. Something was also clicking. I went about my normal life because there wasn't much I could do until I saw the doctor.

I went to the doctor that the ER recommended only to be greeted by a radiologist telling me he would take me to get xrays of my ankle. WTF? Turns out, the hospital had referred me to a foot and ankle specialist and not a knee specialist. I was livid. Foot doctor still looked at my xrays from the hospital and told me it looked like the spacer had dislodged and was moving around my knee cap. Told me to keep my brace on and that I could walk on it until I saw my surgeon. Thanks for that $60 co pay bullshit.

Saw my surgeon on the 30th. He took morce xrays and confirmed that the spacer had dislodged completely and was now floating around my leg, in a different position than it was when I went to the ER. He scheduled me for surgery the following day. I was told that in his 14 years practicing surgery, he had only seen this happen one other time and that he wouldn't know until he went in if I would simply need a new, larger spacer or if I would need a complete redo of the partial OR a full knee replacement. I was TERRIFIED. Had surgery last Wednesday and thankfully, he was able to just put a new, larger spacer in. Everything else looked perfect, he said. So I'm 4 days out from my surgery. The first two days felt the pain was exactly like the pain from the first time. However, day 3 I was blown away by how much better I felt. I can bend my knee, put full weight on it and can even lift my leg unassisted onto the pillows to elevate at night which I could not do for weeks after the first surgery. I just woke up a few hours ago on day 4 and it feels even better. I can already tell that it will be a fast recovery. I'm on Welbutrin but Oxy is working for me for the pain, I just hate taking it.

I'll keep you posted here how the recovery goes but I'm hopeful. American health system is messed up. If you have been told your spacer needs replacing, just know that there is a chance that it can dislodge and you will have pain like you've never felt when it does. I'm hoping that this is the end of this journey for me and my knee but time will tell. Good luck to all of you, my fellow warriors and amazon queens.

I should add that the doctor gave me the spacer to take home as a souvenir and I cannot believe how big it is and how it was just floating around my knee. I'm not sure if I have a malpractice suit here to the manufacturer of the part. I don't think my surgeon did anything wrong. He said my ligaments and MCL had stretched causing it to come loose. I've also lost over 100 lbs in the past 3 years so maybe that could have been a factor or even my estrogen blockers.

@xenawp
I wish you luck
I am now 18 months out of left TKR but just after 2 months reported to my OS that though I have good ROM and no pain I have lot of shifting discomfort on walking lot of clicking and feeling as if my knee is giving way kept telling me to do icing PT etc but no relief did mention once that we need to change spacer still kept avoiding surgery not happy with him took 2 opinion he said for immediate change of spacer assured recovery within 2 weeks and NO PT needed
Didn’t think that PT not required was correct so again went to my OS and now that it is 18 months after TKR has scheduled for 10/8 for revision of Spacer replacement and full PT thereafter
I am really scared and apprehensive of the revision surgery
And just while this was going on my other knee which is 8 months out of TKR which recovered so well started feeling stiff and painful a week back when I was breaking vegetables in the backyard
And it also feels as if something is stretching when I bend my knee went to OS he was out but his PA attended but didn’t do any X-rays
I am just very scared as to what’s going on and what I should do please tell

I wish you luck, as well.

I had the surgery 5 days ago and my pain is truly not terrible. I know I will need PT as my doctor already mentioned it however, he didn't want me to start it immediately like we did after the first replacement. I see him on Thursday and I'm sure he will have me schedule it...and I will start to do the exercises I was doing after the first time.

One thing I learned from this is to really elevate your knee. You have to place at least 4 pillows under your calf and ankle and sleep like that. I didn't do this the first time...just put it on one pillow. But it almost needs to be at a 90 degree angle. It's really helped with the pain and swelling.

Just took my first shower tonight and finally starting to feel like a human again. Prepare yourself for two days of feeling very similar to how it felt the first time as far as pain...but each day gets better and I can already tell my recovery will be quicker. Trust me, you do NOT want the spacer to pop out on you. That was the most painful feeling I've had in my life. My doctor gave me the spacer he removed as a souvenir and I cannot believe it was just floating around inside my knee for two weeks. If you are prepared and know that you are facing only two days of intense pain but that the meds will help you sleep through it, you can do it. I wish I could have been prepared but we had no idea that this was going to happen. It was freaky.

@ggji I ended up getting my spacer changed yesterday. The nerve block is worn off so elevation, ice and an occasional med is keeping things at bay. I’m barely 24 hours post-op, but the pain is surely less than the original TKR surgery. I’m walking around the house with a walker mainly for balance. Of course there is swelling, but I feel that the knee feels tighter without the significant shifting and clunking I was having. I’m crossing my fingers that I will have a great recovery and a functional knee.