TKR revision surgery and problems

Posted by szqyoung @szqyoung, Jan 17, 2019

I fell and hurt my knee in March 2017. MRI showed meniscus damage. DR did surgery to repair meniscus in June of 2017 - removed most of left meniscus and removed affected area of right meniscus. Knee continued to swell and was very painful. Tried more PT, cortisone shot = no improvement. Had a TKR on 9/26/17. Right after surgery my knee would buckle while still in the hospital. DR said PT would take care of it. Knee continued to swell and buckle and be painful. In December of 2017 I returned to DR and he ordered more PT. Unsuccessful in correcting buckling, swelling and pain. DR did revision surgery on 2/19/18 - replaced 4mm liner with 10mm liner. Buckling greatly improved, however, I still have pain, kneecap pain, swelling and stiffness. Returned to DR and he said that recovery can take a year and to continue to elevate and ice my knee as needed. I’m now 11 months out from the revision surgery and am no better off. My regular Dr did X-rays and bone looks good. 2 years of limping has caused tendon issues in my hip (hip MRI done in Dec). Before the original injury I walked 3 miles every day. I’m now lucky to walk 1 mile without stiffness, pain and swelling. Consequently I’ve put on a lot of weight. I’m 69 years old, frustrated, fat and wondering what, if anything can be done. My yellow lab is also frustrated with my lack of mobility:-)

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@doodles418

@contentandwell I had bilateral Jan 2019. MUA Feb 2019. Active, healthy, 125lbs, 61 yr old. No health issues at all other than bad knees. Should have been an excellent candidate for surgery. After the manipulation things never got better. I was diligent with PT at home and I still go once a week at 6 months post op. By April I felt frustrated and so did my PT's with the little progress I was making. The pain was unbearable, still is. I still can't walk very well, people tell me it's painful to watch me walk. I can't stand for more than 10 minutes due to pain. At 5 months my surgeon said "just part of recovery". My PT's didn't agree and suggested a second opinion. It was with a top surgeon who specializes in failed implants and revisions. He said they appear to be too big for me, along with knee caps that were not placed back properly. I have 3 different sizes ranging from 3-5 in the surgical notes. 2 nd opinion Dr. suggested revision on right femur that is a size 5, tibia size 4, he could shave the plate and use the tibia implant. On my left knee I have a 4 femur and 3 tibia, so not as big nor as painful, but still not the right fit. He said to revise right and if I was pleased with the outcome I could consider the left or just live with it. I asked about custom fitting before surgery and was told no one in the area did that, would have to travel out state. I'm trying to decide how long to wait, Dr said within 18 months (which would be 24 months post op). The pain and rehab are still pretty fresh with me, so I want to know if those that had revisions were satisfied with outcomes.

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@doodles418 It sounds as though you are on track now. I’m happy that you found a good surgeon who was able to diagnose your problem. I know a woman who spent two years in pain until she finally found a surgeon who knew what to do. It was also a size problem, but in her case I think it was the stem.

The doctor sounds very confident and thorough, I would say, “go for it”. The only other possible thing would be to get a second opinion if that would make you more comfortable. My husband had an ankle problem when we were first married. Four different doctors said four different things but two were fairly similar so my husband consulted with the doctor I had back then, a dean at Harvard Medical, the doctor said that both were going into the ankle so then it would be very apparent what the problem was. My husband chose one of the doctors and he was the one who had diagnosed the problem correctly. The surgery was successful and my husband is 100% most of the time. Occasionally the ankle does bother him.

It sounds as if you will be getting relief soon. Keep us up on your progress and surgery.
JK

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<p>Problem 2 1/2 years post tkr</p><p>After I was ok 2 1/2 years post surgery, I awoke one morning unable to put weight on my leg. There was significant swelling. In the 6 months since this developed, I have had about 8 flare ups, which only occur during the night, while I am sleeping. I need to use a cane for several days after a flare up. During the other times I am able to resume my other activities, though with caution. Nothing showed in x-rays and original surgeon isn't sure what is the cause. His assessment is for revision surgery is to consider putting a thicker poly in verses changing the tibial component and using constrained poly. Infection has been ruled out. Possibility of allergy to metal or cement, though I've been told that allergy testing has many false positive results. I am doing PT to strengthen the muscles around my knee, using an exercise bike. Second opinion by another surgeon: possibility of some early reaction to the polyethylene debris. It has not gone on to loosening but these episodes of effusions could be in response to the plastic. Both surgeons have conferred and are encouraging me to wait until more flare ups before having a revision replacement. I'd welcome any input from others, particularly in regard to why the problem develops only while I am sleeping.</p>

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@rsroseco

<p>Problem 2 1/2 years post tkr</p><p>After I was ok 2 1/2 years post surgery, I awoke one morning unable to put weight on my leg. There was significant swelling. In the 6 months since this developed, I have had about 8 flare ups, which only occur during the night, while I am sleeping. I need to use a cane for several days after a flare up. During the other times I am able to resume my other activities, though with caution. Nothing showed in x-rays and original surgeon isn't sure what is the cause. His assessment is for revision surgery is to consider putting a thicker poly in verses changing the tibial component and using constrained poly. Infection has been ruled out. Possibility of allergy to metal or cement, though I've been told that allergy testing has many false positive results. I am doing PT to strengthen the muscles around my knee, using an exercise bike. Second opinion by another surgeon: possibility of some early reaction to the polyethylene debris. It has not gone on to loosening but these episodes of effusions could be in response to the plastic. Both surgeons have conferred and are encouraging me to wait until more flare ups before having a revision replacement. I'd welcome any input from others, particularly in regard to why the problem develops only while I am sleeping.</p>

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Your situation has many similarities to mine. I am almost five years post- op after 5 surgeries on the same hip. After considerable research I am not rushing into any more. I am allergic to nickel, chromium and cobalt all of which were put in my body in the first Surgeries. I tested positive with blood tests from Melisa testing in the US. Unexplained pain will not be a reason for surgery for me at this point. I do know their is some lucency tho but still doing my research. Am investigating neuropathy now. Happy to connect any time.

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@rsroseco

<p>Problem 2 1/2 years post tkr</p><p>After I was ok 2 1/2 years post surgery, I awoke one morning unable to put weight on my leg. There was significant swelling. In the 6 months since this developed, I have had about 8 flare ups, which only occur during the night, while I am sleeping. I need to use a cane for several days after a flare up. During the other times I am able to resume my other activities, though with caution. Nothing showed in x-rays and original surgeon isn't sure what is the cause. His assessment is for revision surgery is to consider putting a thicker poly in verses changing the tibial component and using constrained poly. Infection has been ruled out. Possibility of allergy to metal or cement, though I've been told that allergy testing has many false positive results. I am doing PT to strengthen the muscles around my knee, using an exercise bike. Second opinion by another surgeon: possibility of some early reaction to the polyethylene debris. It has not gone on to loosening but these episodes of effusions could be in response to the plastic. Both surgeons have conferred and are encouraging me to wait until more flare ups before having a revision replacement. I'd welcome any input from others, particularly in regard to why the problem develops only while I am sleeping.</p>

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@rsroseco Welcome to Mayo Clinic Connect, a place to give and get support.

To have swelling suddenly 2.5 years after surgery and continuation since this is obviously concerning and you are looking for answers and support.

I moved your question to an existing discussion where members like @doodles418 @cobweb @amberpep @contentandwell @debbraw have previously discussed this topic.

A revision is a major surgery, especially since you are unsure of the problem. You said that you met with 2 surgeons. May I ask if either of these surgeons were at a specialty or teaching hospital system? If not, have you considered getting a third opinion from a specialist?

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@erikas

@rsroseco Welcome to Mayo Clinic Connect, a place to give and get support.

To have swelling suddenly 2.5 years after surgery and continuation since this is obviously concerning and you are looking for answers and support.

I moved your question to an existing discussion where members like @doodles418 @cobweb @amberpep @contentandwell @debbraw have previously discussed this topic.

A revision is a major surgery, especially since you are unsure of the problem. You said that you met with 2 surgeons. May I ask if either of these surgeons were at a specialty or teaching hospital system? If not, have you considered getting a third opinion from a specialist?

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Thanks, Erika. By moving my question, is there anything I need to do to access the existing discussion that you referenced?
Both surgeons are with Kaiser Permanente. Even though they have much experience with knee revisions, I appreciate your suggestion about a specialty or teaching hospital system. I will explore that option in and near Denver.

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@ladyelaine

Your situation has many similarities to mine. I am almost five years post- op after 5 surgeries on the same hip. After considerable research I am not rushing into any more. I am allergic to nickel, chromium and cobalt all of which were put in my body in the first Surgeries. I tested positive with blood tests from Melisa testing in the US. Unexplained pain will not be a reason for surgery for me at this point. I do know their is some lucency tho but still doing my research. Am investigating neuropathy now. Happy to connect any time.

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Thank you. After 5 surgeries, you must be very frustrated. It sounds like you are trying to figure a way to deal with the pain. Hopefully you will find some options.

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Wife was diagnosed with metal allergy to replacement knee joint which was then removed and replaced with a Smith & Nephew alloy unit which didn't solve the problem. Doctor is now recommending another replacement. We are wondering if treatment by an allergist could lessen her bodies reaction to titanium?

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@wa34937

Wife was diagnosed with metal allergy to replacement knee joint which was then removed and replaced with a Smith & Nephew alloy unit which didn't solve the problem. Doctor is now recommending another replacement. We are wondering if treatment by an allergist could lessen her bodies reaction to titanium?

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@wa34937 I'm sorry to hear about your wife's surgeries. With it being a third surgery, this is a big decision.

I moved your question to an existing discussion where members are already discussing this topic. You may wish to scroll through the previous posts.

What kind of knee would the surgeon use next time and how do they know that she won't be allergic to that one as well?

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@rsroseco

<p>Problem 2 1/2 years post tkr</p><p>After I was ok 2 1/2 years post surgery, I awoke one morning unable to put weight on my leg. There was significant swelling. In the 6 months since this developed, I have had about 8 flare ups, which only occur during the night, while I am sleeping. I need to use a cane for several days after a flare up. During the other times I am able to resume my other activities, though with caution. Nothing showed in x-rays and original surgeon isn't sure what is the cause. His assessment is for revision surgery is to consider putting a thicker poly in verses changing the tibial component and using constrained poly. Infection has been ruled out. Possibility of allergy to metal or cement, though I've been told that allergy testing has many false positive results. I am doing PT to strengthen the muscles around my knee, using an exercise bike. Second opinion by another surgeon: possibility of some early reaction to the polyethylene debris. It has not gone on to loosening but these episodes of effusions could be in response to the plastic. Both surgeons have conferred and are encouraging me to wait until more flare ups before having a revision replacement. I'd welcome any input from others, particularly in regard to why the problem develops only while I am sleeping.</p>

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Hi, @rsroseco Welcome to Connect.

I definitley agree with @erikas, revision is basically like another TKR I think, so pretty major. I would want to be darned sure that was the only option before going forward with it. I agree also, that generally teaching hospitals have some of the best and most knowledgeable doctors, primarily because they see more problems than other doctors. I went ahead and checked US News hospital ratings in Orthopedics. I think US News is pretty much the gold standard in these, and UCHealth University of Colorado Hospital is rated #39 in the country, #1 in CO.

I presume you have searched your brain to figure if you have done anything specific preceding each of these flare-ups and come up with no answers.

My husband had a problem a long time ago and he consulted with at least 3 orthopedic doctors (this was not a knee problem) to try to determine his problem. Then he conferred with our primary doctor who was a dean at Harvard Medical, chose one of the doctors, and finally got relief with surgery. Some problems are very tricky and can be very difficult to diagnose, and with a 2.5 year post-TKR problem that really is strange.

I do hope you can find the answer. A third consultation would hopefully shed a bit more light on things and help you to get that knee back in better shape. If the exercise bike doesn't bother you more, it really is a great exercise. My orthopedic surgeon positively loves exercise bikes for pre and post TKRs.

I wish I could be more helpful but it definitely is a mystery.
JK

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@wa34937

Wife was diagnosed with metal allergy to replacement knee joint which was then removed and replaced with a Smith & Nephew alloy unit which didn't solve the problem. Doctor is now recommending another replacement. We are wondering if treatment by an allergist could lessen her bodies reaction to titanium?

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@wa34937 Hello there. I'm so sorry for your wife. I suffer from certain allergies myself, & I need TKR surgery ASAP but live on 5th flr walk-up & it's insanity for my overall health issue's.
I understand suffering all too well & am no stranger to surgeries.
All that aside for now. I would like to know how does the Dr's Orthopedic Surgeon check you to see if your body will tolerate that type of metal or alloy or plastic replacement? I don't know what the procedures entail before full knee replacement surgery & if they do any kind of tests prior to TKR surgery?
Have you seen a Neurosurgeon about this issue?
I'm sorry for your wife & I hope you both hang in there. Life is not easy, especially when you have severe Allergies & chronic pain issue's make life living misery.

I hope she feels better too.

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