My Chronic Knee Pain After Replacement caused by Wrong Size Implant

Posted by cyd @cyd, Aug 5, 2020

Hello, I have seen a lot of people with similar stories of chronic pain in their knee after surgery. My experience: I had a total knee replacement although I worked very diligently with Physical Therapists and followed their instructions of what exercises to do at home, I still had extreme pain every single day.Upon the advice of my Ortho, I had a manipulation procedure. Skipping on past months, nothing I could do would relieve the pain short of sitting doing absolutely nothing but elevation and ice therapy. My pain management Dr. performed a Genicular Nerve Block. Nope, that didn't help either. Skipping on past months more, injections and water retention aspirations didn't help either. Then my Ortho decided the only thing to do was to go back in for a little clean up (knee scope). That proved to be not of any use. It's now two years after my replacement. Things are going downhill at a faster pace. I finally convinced another Dr. to take a look at me because you know the other Orthos don't like to take on someone else's patient. Anyhow, he immediately started ruling out causes. Tested for metal allergies, blood tests for infections, Nuclear Bone Scans for hard to detect hiding infections. You name it, he did it. I had mentioned to the original Dr. and now to this new Dr. that I had had such a hard recovery from the surgery that something right from the start must not have been right. My original Dr. thought it was laughable when I asked him a few times if perhaps the wrong sized implant was used . My new Dr. took that question much more seriously. The findings from all the tests showed loosing of the parts of the initial implant. My new Dr. also confirmed with imaging that the femoral part of my implant WAS too large for me causing the slow painful loosening of the whole knee implant. I was very wary but hey what could I do ? I couldn't live like that any more. Yes, I agreed to the revision and oh my gosh ! from the very first day I could tell a big difference in the way I felt. My pain and swelling was hugely less, my progress with Physical Therapy was 100 % more successful. My recovery time was amazing much easier. If there seems to be no explanation from your Ortho about very chronic pain my suggestion would be to find an Ortho to take your question of if you have the correct sized parts for your body implanted into you. You know how it is, when you go to your follow up appointments, you're always told that there's no problem everything looks like it's lined up just fine. I found out the hard way that this is a more common problem than you think. I couldn't believe it myself ! And yes, as some of you have stated my original Ortho Doc was as mad as a hornet that I had gotten another opinion. THAT'S YOUR RIGHT AND THEIR EGO PROBLEM. Hope my story might help someone else out their with unexplained seriously painful chronic pain on a daily basis.

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Profile picture for cathymw @cathymw

I ended up getting an MUA (Manipulation under anesthesia) after 11 weeks post-op based on a second opinion. I feel like this has helped immensely but I still have to warm up the knee every day, and it still feels warm after a day of moving, always feels tight (going on 13 weeks since MUA).
I'm glad I did it as its added so much more mobility to my joint. I'm going on 6 months since my surgery. I hope that someday I can forget about it all. It can hike and bicycle... just that damn tight feeling all the time.

Every day I have to stretch, exercise, and get it moving, oiling the exterior up as well so it feels better.

I too agree that there is no consensus on the physical therapy/surgeon coordination of rehabilitation. Does it really benefit a patient to be hurt and pressed down by 2 PT's just to get a number that doesn't last? I am still concerned about developing further scar tissue, so I keep working always. Should I be resting? Ibuprofen still, 200mg every 6 hours, sometimes Tylenol still. Geez... never used to take hardly anything. I still use my ice machine at night sometimes.

Meanwhile, my other knee hurts badly... don't know if I can go forward. Not much follow-up from surgery team.

I love bannisters, I love railings in bathrooms and tall toilets. Different perspective for sure these days!

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@cathymw
Would you please tell me how much pain there was after waking up from your MUA? I might be having one after about 21 weeks post TKR, because plateauing at 90 degrees for several months. If post MUA pain is as brutal as my post TKR pain was, I'll need to know ahead of time, to arrange a family member to live with me for a while.

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Profile picture for tonilynn @tonilynn

@cathymw Was the pain level following your MUA as high as the post TKR pain level? (I'll need to arrange at home help for after my possible upcoming MUA, as I needed for the ten days after TKR if pain level is high.)

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@tonilynn My pain levels were always very well controlled by my healthcare team from the get go. After surgery I kept a spreadsheet and kept track of when I took my pain meds. I always took 5mg oxycodone an hour before physical therapy. When 2 PT staff would press down on my knee to straighten me or to bend me, that pain was terrible. After about 6 weeks of going no where with that, this is when I sought a second surgical opinion, leading to the MUA.

After theMUA, I had more oxycodone prescribed, which I took for the 4 hour trip home and for a good night’s sleep. I really didn’t need it except I would take it before physical therapy at first. PT would ice me too. I was pretty swollen initially. But I healed pretty quickly and the swelling went down.

Maybe help just to drive you to therapy if you take a pain meds?

I loved my ice machine for pain control and comfort as well.

You will be glad you will get your knee working!!
Best wishes.

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How was wrong size implant diagnosed? Did the cement give away?

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Profile picture for melcpa86 @melcpa86

How did you find out it was the wrong size implant? I see Dr. #14 on Monday to try and confirm that my knee was installed incorrectly. Its been 2 1/2 years, 2 other surgeries, lots of pain and lots of guesses.

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Thank you for your story. My experience is somewhat like yours with eight years of multi-doctors, revisions, PT, and bogus diagnosis. My last Ortho (only this week) stated I have a loose implant. I couldn't see what he saw when reviewing the bone-scan and needless to say, with all the past bogus diagnosis I'm reluctant to undergo another revision.

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Profile picture for ouch89 @ouch89

Thank you for your story. My experience is somewhat like yours with eight years of multi-doctors, revisions, PT, and bogus diagnosis. My last Ortho (only this week) stated I have a loose implant. I couldn't see what he saw when reviewing the bone-scan and needless to say, with all the past bogus diagnosis I'm reluctant to undergo another revision.

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@ouch89 is surgery recommended or physical therapy for loosening implant?

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Profile picture for babette @babette

@cyd - Welcome to my world. First surgeon screwed up. He used a DuPuy Attune implant, known to have problems, and an implant with years of litigation behind it. In fact, there are entire law firms that do ONLY DuPuy lawsuits. I knew something was wrong from the very beginning. Long story I had over a year of incredible pain, suffering, immobility, trouble with ADLs, no social life, no mobility due to pain. Second surgeon - brilliant - did the revision and, like you, I knew it was good.

I'm now interviewing attorneys and will be during DuPuy and/or my first surgeon.

Best of luck with your recovery!

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@babette - Like you, I had a Depuy Attune implant used for my first total knee replacement in 2018. I too knew something was wrong from the beginning. Original surgeon downplayed my issues, insisted everything looked good. Fast forward- it took me 4 years to find an ortho surgeon to do testing and discover the implant was not only loose due to cement not adhering to it, but it was also the wrong size! Am doing very well after revision by new doctor. Am wondering if you had any luck with any legal action against makers of the implant? I have not.

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Good for you! You must be your own advocate as exhausting as it may be.
This is one reason I am a proponent of custom made implantable joints!!
I had s bilateral replacement years back using that method and if I ever need a new knee or etc that is the route I will seek from a MD who utilizes that technique!

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