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Knee Replacement Imbalance

Joint Replacements | Last Active: Apr 17 2:57pm | Replies (7)

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@steveinarizona

I've been back to my original surgical team many times with pain, swelling and with 3 dislocations. All they would ever tell me is that my knee is "unstable" and would never explain why. Not knowing why, bothered me a great deal, so I got a second opinion from another surgeon (at another hospital). He is the one who diagnosed my problem as a “flexure/extension gap imbalance”. You are correct, during my original surgery both my PCL and ACL were cut, but my Medial and Lateral Collateral Ligaments were left intact. It is these ligaments that second surgeon claimed get loose as I flex my knee. He explained, to maintain stability with my type of knee replacement that it is crucial that the gap between the Tibia and Femur remain constant as the knee is flexed and straightened. He did an examination that proved that the gap narrows as I bend my knee and the more the gap narrows the looser my Medial and Lateral Collateral Ligaments actually get. They get so loose that my knee becomes sloppy and unstable when flexed. The surgeon demonstrated this by having me sit in a chair and bend my knee just past 90 degrees. Then he took hold of my leg just below my knee and with very little effort he was able to move my lower leg all over the place. He went on further to explain that this excessive movement explains why my knee gets more unstable the more I flex my knee, He also said this why my knee is always swollen and painful. Unfortunately, he refused to speculate on how or why my knee got this way. I’d like to know how this happened, so I can move forward.

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Replies to "@steveinarizona I've been back to my original surgical team many times with pain, swelling and with..."

@skybig

Very good explanation of issues relating to gap imbalance which is the cause of my mid flexion instability and severe lateral pain due to soft tissue impingement.

It took 4 opinions regarding my severe lateral side pain post TKR 12/23 to have my current surgeon explain gap imbalance as well as possible rotational problems with my implant.

I had a partial TKR 7/25 to attempt to correct this by replacing the insert only with a semiconstrained insert. I knew that this was a 50-50 chance and I wanted to avoid a full revision. It did not work.

I am having a full revision in 10 days on 4/28. The plan is to change the femoral component only if this will resolve the gap imbalance to the satisfaction of the surgeon. If that will not work he will install a DePuy hinged implant. I asked about using a less constrained CCK implant but his opinion is that at this point the hinged is best. Hopefully this resolves the severe pain for the last 28 months.

As to comments about the competence of the original surgeon, I believe that mine did not perform the TKR properly. I have posed that question to several surgeons who have examined me. They will not comment or throw one of their own under the bus.
I fired that guy and moved on.