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.

Interested in more discussions like this? Go to the Joint Replacements Support Group.

@wildebjef

Tell your Orthopedic Dr You want Tramadol. I have been taking it for 3 years!!!

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Thank you.

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@cyd

Thank you.

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Tramadol is now classified as an opioid. I too have been on them 3 years. They are like taking an aspirin. Next Monday I am getting my knee replacement, Tramadol won’t touch the pain, I hope they have something stronger for my post operation pain.

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@housing1st

You shouldn't have this type of pain. Perhaps an appointment at Mayo?

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Tramadol did nothing for my pain. Like taking nothing. If you have light pain it may work but sure doesn't touch. Only thing that help my pain is Hydrocodone 10/325. I've tried evrything in the book. Doctors don't want to give it out as there spooked about losing their license.

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@sweede536

Tramadol did nothing for my pain. Like taking nothing. If you have light pain it may work but sure doesn't touch. Only thing that help my pain is Hydrocodone 10/325. I've tried evrything in the book. Doctors don't want to give it out as there spooked about losing their license.

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I live alone. Will this be a problem?

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@cyd

Omg, you've been through so much. It feels good when you find a doctor that really listens to you. Before my revision my flexion was only 70 no matter how hard I tried. I wish you all the best. My revision was Oct. 2019, just saw the Ortho and he tells me my maximum improvement will take about a year.

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Hello
It gets confusing who I’m replying to. What hospital and Surgeon did your revision take place at?
I am facing the same thing after the Covid wanes ha ha whenever that might be

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Has anyone had trouble with or had a spacer replaced? If so what symptoms did you have. Thank you

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At my 6 week post-op follow-up, my surgeon was not pleased with my lack of extension. He mentioned there had been discussion in the surgery about moving down a half size, but he didn't go down a half size(doesn't the rep have supplies ready in the room in anticipation; isn't this stuff planned based on our images???). He said the larger size maybe contributing to my stiffness and that he could fix it while I was under for my second replacement scheduled almost 2 months out. The other components are smaller sizes. I didn't understand this when I was there.

Since then I have been reading about MUA (manipulation under anesthesia) and the huge amount of starting all over again with daily PT, aggressively after MUA. Plus I have learned this does not work for oversized components. And I have learned if there is MUA, it should be done early on for it to be effective, and it does statistically lead to increased need for revision surgeries!

Everything is on pause currently as I seek out another opinion. The Dr. has walked back his comments spoken in front of myself and 2 others, saying the component overhangs slightly only and he did not state it was too large. My Physical therapist had mentioned early on that it was unusual for me to have both flexion and extension issues, as she has only observed one or the other in her TKA patients. She also noted that my anterior pain that I state when walking lines up with this issue.

I currently am working very hard with PT 3x/wk, and at home daily often. I still need my 5mg oxycodone prior to PT so they can "crank" my knee to the ROM (122* and 0* yesterday!). I use Tylenol and Motrin to keep moving the rest of the time. My ROM 3s are improving. Every day I wake up soooo stiff, and feel like I am starting all over again. Prior to my post-op appointment, I thought this was part of the slow normal recovery process. Now I am not so sure. Highly acclaimed joint replacement center, really great care from the get go.

My walking has been very hard, pain starts about 2 blocks in.

Anyone going through any of this?

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@babette

Yes, the second surgery was at The New England Baptist. I wouldn't to anywhere else for orthopedics. In fact, I'm getting ready to have shoulder surgery next!

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I'm not sure if we can disclose actual names, but if you're comfortable sharing, I'd love to know the name of the surgeon you had so much success with at New England Baptist! Thanks so much.

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@contentandwell

Hi @cyd Welcome to Connect.
I am so glad you were finally able to find a cause and get relief from your pain. Your story sounds remarkably similar to a woman I know.

I have been very fortunate, two TKRs, and no problems. The second TKR was a Conformis which is custom made to basically mimic your original knee so there is never a problem with it not being the right size. That's why I chose to have that one and go to a doctor who did Conformis replacements. I was fortunate in living in southern NH so I have easy access to Boston hospitals and doctors because the originator of the Conformis was the doctor who I had do my knee. He is based at Brigham and Women's Hospital in Boston.

I hope you are enjoying life more fully now and that all of those problems are behind you.
JK

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I live in New York and after 3 years I continue to have pain and stiffness in the knee tha doctor who did it gave me then brush off and since then I have seen 3 other doctors 2seem to think the pain in referred from my back I think no one cares I can’t find a doctor to help me. X-rays it s and mri are normal I have not been tested for allergy or infection. I’ve given up. Quality of life diminished

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@cathymw

At my 6 week post-op follow-up, my surgeon was not pleased with my lack of extension. He mentioned there had been discussion in the surgery about moving down a half size, but he didn't go down a half size(doesn't the rep have supplies ready in the room in anticipation; isn't this stuff planned based on our images???). He said the larger size maybe contributing to my stiffness and that he could fix it while I was under for my second replacement scheduled almost 2 months out. The other components are smaller sizes. I didn't understand this when I was there.

Since then I have been reading about MUA (manipulation under anesthesia) and the huge amount of starting all over again with daily PT, aggressively after MUA. Plus I have learned this does not work for oversized components. And I have learned if there is MUA, it should be done early on for it to be effective, and it does statistically lead to increased need for revision surgeries!

Everything is on pause currently as I seek out another opinion. The Dr. has walked back his comments spoken in front of myself and 2 others, saying the component overhangs slightly only and he did not state it was too large. My Physical therapist had mentioned early on that it was unusual for me to have both flexion and extension issues, as she has only observed one or the other in her TKA patients. She also noted that my anterior pain that I state when walking lines up with this issue.

I currently am working very hard with PT 3x/wk, and at home daily often. I still need my 5mg oxycodone prior to PT so they can "crank" my knee to the ROM (122* and 0* yesterday!). I use Tylenol and Motrin to keep moving the rest of the time. My ROM 3s are improving. Every day I wake up soooo stiff, and feel like I am starting all over again. Prior to my post-op appointment, I thought this was part of the slow normal recovery process. Now I am not so sure. Highly acclaimed joint replacement center, really great care from the get go.

My walking has been very hard, pain starts about 2 blocks in.

Anyone going through any of this?

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Please refer to my comments about synovitis or "angry knee syndrome because your symptoms sound just like mine. My newer PT told me that cranking your knee to full extension is old school and that method is coming under scrutiny. My swelling most of the time is much better but unfortunately my bend still sucks and this after TKR 19 months ago. I am grateful for what I can do but stairs without a bannister is a nightmare and stability is poor. Best of luck on your journey.

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