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Ligament instability after TKR?

Posted by mpirruccel @mpirruccel, May 9, 2023

I had a TKR in august 2021 on left knee due to OA. First 3 months pain was what was expected however it has never gone away, particularly on lateral side of knee. Operating surgeon at 6 months said I was a “slow healer “ and referred me to pain specialist. Pain is worse with stairs, walking. Tolerable when swimming. Cycling is now limited, used to ride 30-50 miles a ride. Icing and massaging every day. Do ROM stretches every day but painful. Have had 2 genicular nerve ablations with no results. Also tried MFR, acupuncture. Taking 75 mg Lyrica at night for sleep. Been to 3 different doctors all with different opinions. Last doc said only solution was a revision as problem is ligament instability. Anyone else gone through this?

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oceanspruce | @oceanspruce | May 11, 2023
In reply to @katrina123 "oceanspruce, I had severe pain in a similar area after TKR and there was an orthopedist..." + (show)
@katrina123

oceanspruce,
I had severe pain in a similar area after TKR and there was an orthopedist who was going to excise my popliteal tendon and he wrote in a patient portal that he had told me that I could be worse off however he had never told me that so I cancelled the surgery. I am glad that I did cancel because I went to another Orthopedic Clinic and they did an ultrasound and saw right away that I had what is called a fabella bone. This is a fairly rare bone that not everyone has and not all doctors are looking out for it. Sometimes after TKR this bone can cause a lot of pain. I could feel a little lump under the skin.
I had surgery to remove this bone and it immediately took the awful pain away.

I thought I should share this with you since your issues sound similar to what I went through. Maybe you could get an ultrasound to see if this is a possibility.
Katrina

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Thanks, Katrina,

I had never heard of the fabella bone before, but I just researched it online and found that it's located in the very same postero-lateral area (outside rear aspect) of the knee joint, precisely where I too have ongoing pain in both knees. I'll look into it further.

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katrina123 | @katrina123 | May 14, 2023
In reply to @mpirruccel "Thanks Katrina for this information! I am scheduled to possibly get a fibular head manipulation by..." + (show)
@mpirruccel

Thanks Katrina for this information! I am scheduled to possibly get a fibular head manipulation by an osteopath later this month although we have to see if that is appropriate. I looked into the popliteal tendon issue and had ultrasound and then cortisone injection into it. Lasted about 3 days so that’s not the problem. I will ask the osteopath about the fabella bone. Did you mean fibula bone?

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No it is Fabella...
( I had never heard of it either and I actually had orthopedists who were not on the lookout for this problem.) I went to several doctors before getting the correct diagnosis.

Fabella Bone
The fabella is a small sesamoid bone found in some mammals embedded in the tendon of the lateral head of the gastrocnemius muscle behind the lateral condyle of the femur. It is an accessory bone.

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1 reply
mpirruccel | @mpirruccel | May 14, 2023
In reply to @katrina123 "No it is Fabella... ( I had never heard of it either and I actually had..." + (show)
@katrina123

No it is Fabella...
( I had never heard of it either and I actually had orthopedists who were not on the lookout for this problem.) I went to several doctors before getting the correct diagnosis.

Fabella Bone
The fabella is a small sesamoid bone found in some mammals embedded in the tendon of the lateral head of the gastrocnemius muscle behind the lateral condyle of the femur. It is an accessory bone.

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Thanks so much for your help! How did they find the bone, X-ray or ultrasound or MRI? I’ve been told that a MRI is useless after a prosthetic is implanted as the metal causes too much scatter. Let me know how they found/diagnosed your pain. Thanks again

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1 reply
katrina123 | @katrina123 | May 15, 2023
In reply to @mpirruccel "Thanks so much for your help! How did they find the bone, X-ray or ultrasound or..." + (show)
@mpirruccel

Thanks so much for your help! How did they find the bone, X-ray or ultrasound or MRI? I’ve been told that a MRI is useless after a prosthetic is implanted as the metal causes too much scatter. Let me know how they found/diagnosed your pain. Thanks again

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They discovered it with an ultrasound. The doctor who identified it was so excited because he had never seen this before. He literally jumped up and down. I was lucky that he was aware of this unusual condition. Orthopedists must have knowledge regarding this in the first place or they would miss it. I went to several orthopedists with my pain and none of them even knew to look for this issue. I am so glad that I didn't give up.

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mpirruccel | @mpirruccel | May 16, 2023

Unfortunately I do not have this bone per the sports medicine doctor I last saw. He said it can be seton an X-ray. Still waiting for fourth consult ☹️

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katrina123 | @katrina123 | May 17, 2023

mpirruccel,
I don't know why but for some reason mine was not identified on an x-ray by several orthopedists.

I hope that they can find out your issue soon. Sorry that you are having such a problem.

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mpirruccel | @mpirruccel | May 17, 2023

Good to know. I will be asking my next consultant to do an ultrasound. Thanks

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apriljoy | @apriljoy | May 20, 2023

Yes- my 2017 TKR has been painful since day one. I’ve done all you’ve done except the pain clinic nerve ablation’s , which 2 Ortho Drs said do not do. It’s so hard to sleep at night and have to take medication. My 2nd knee surgeon who did my other knee, and I’ve had no issues with, has done mri’s, etc. he had me come in and they drained quite a bit of fluid off the knee and I’m finally getting some relief. I’ll try that again in 6 months- which is next month. If this keeps working- I won’t have to have a revision done. I’m hoping this is the solution that I can live with. The X-rays, mri’s showed no red flags. So it was good news. But bad news as we couldn’t find the cause of all my pain. And pain was all day long.

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1 reply
mpirruccel | @mpirruccel | May 20, 2023
In reply to @apriljoy "Yes- my 2017 TKR has been painful since day one. I’ve done all you’ve done except..." + (show)
@apriljoy

Yes- my 2017 TKR has been painful since day one. I’ve done all you’ve done except the pain clinic nerve ablation’s , which 2 Ortho Drs said do not do. It’s so hard to sleep at night and have to take medication. My 2nd knee surgeon who did my other knee, and I’ve had no issues with, has done mri’s, etc. he had me come in and they drained quite a bit of fluid off the knee and I’m finally getting some relief. I’ll try that again in 6 months- which is next month. If this keeps working- I won’t have to have a revision done. I’m hoping this is the solution that I can live with. The X-rays, mri’s showed no red flags. So it was good news. But bad news as we couldn’t find the cause of all my pain. And pain was all day long.

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Hello Apriljoy,
Thanks for your reply! I have been told an MRI was useless because of the scatter from the metal implant. I take 50 mg Lyrica at night for pain, a cbd/melatonin capsule and use cbd cream to help with sleep. I have a referral request for university of San Francisco med center , my fourth consult. Can’t take NSAIDs as they cause my diverticulosis to flare up. Tylenol doesn’t do much. Hope it’s something that can be addressed without a revision as they have less success than the original tkr. Don’t think it’s fluid but could be scar tissue which could be removed but then more scar tissue is formed from that ☹️. X-rays and bone scan all clear which is good but doesn’t take care of the 24/7 pain. No fabella bone per X-ray and not popliteal tendon. Good luck to you! Please post how successful this latest procedure is. Hugs!

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1 reply
apriljoy | @apriljoy | May 20, 2023
In reply to @mpirruccel "Hello Apriljoy, Thanks for your reply! I have been told an MRI was useless because of..." + (show)
@mpirruccel

Hello Apriljoy,
Thanks for your reply! I have been told an MRI was useless because of the scatter from the metal implant. I take 50 mg Lyrica at night for pain, a cbd/melatonin capsule and use cbd cream to help with sleep. I have a referral request for university of San Francisco med center , my fourth consult. Can’t take NSAIDs as they cause my diverticulosis to flare up. Tylenol doesn’t do much. Hope it’s something that can be addressed without a revision as they have less success than the original tkr. Don’t think it’s fluid but could be scar tissue which could be removed but then more scar tissue is formed from that ☹️. X-rays and bone scan all clear which is good but doesn’t take care of the 24/7 pain. No fabella bone per X-ray and not popliteal tendon. Good luck to you! Please post how successful this latest procedure is. Hugs!

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I will and thanks for all your support and information. It really helps reading about other’s journeys. It’s so frustrating not being able to get to the root of the pain. I’ve thought about going to Mayo Clinic for a 4th consultation if this fluid drainage doesn’t help before getting a revision- which I really don’t want to endure.

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