Connect
Has anyone dealt with chronic synovitis after TKA and Revision?
This is a long story that I've condensed. I'm hoping someone who may have experienced something similar may be able to provide some insight as to how they dealt with it.
For some perspective, I'm a 53 retired First Responder who has always been healthy and active. Prior to the first TKA, I would ride my 500lb off road adventure motorcycle for hundreds of miles in a day on the back roads of Idaho. I had been regularly mountain biking for over 30 years. I used a rowing machine and lifted weights regularly. I would take long walks with my dogs multiple times a week.
I had an TKA Jan of 2024 which began to swell significantly within two months of the procedure. The surgeon was not responsive to my condition despite repeated draining of red bloody fluid over many months. One draining alone was 130 ml conducted by my primary care physician because the surgeon's office could not get me in to drain it. The fluid tested positive for signs of infection and a year later, just last month, I learned it also tested positive for gout which I had never had before. My primary care provider put me on a course of anti-biotics and sent all the results to the surgeon. The surgeon made no mention of the infection or the gout and eventually opened the knee up 8 months post-TKA, installed a "button" behind the knee cap, removed some of the synovium, then closed me back up. He said all looked fine. Within days the swelling was back and he drained more bloody fluid.
I switched surgeons at that point and upon my first meeting with the new surgeon, who has over 30 years of experience, he immediately recognized the knee as infected. Six days later he had removed it and put in a temporary anti-biotic spacer. He said the "button" behind the knee cap basically fell off when he inspected it, the tibial implant was very loose and easily removed and there was evidence of infection throughout the knee. A PIC line was installed, and I had daily IV antibiotics for the next six weeks. The swelling remained.
In December of 2024, 10 weeks after the spacer was installed, it was removed and a new implant made from what the surgeon claims is the most non-reactive metal known was installed. During recovery post-surgery, something went wrong, and my BP tanked to 50's over 40's, I was in and of consciousness, pumped full of all sorts of stuff to keep my heart going and then given a blood transfusion. I spent a night in ICU and had recovered enough to go home the next day. No one could tell me what happened other than I had what they referred to as a "life threatening event".
Within in days the swelling returned and has remained and is worsening. A month after surgery, the knee was drained and no signs of infection were found. The surgeon calls the swelling Atypical Synovitis. It has precluded me from doing PT because of how significant the swelling is and keeps me in near constant moderate pain which can spike to severe at times. The knee has been unstable for many months but has recently started to partially dislocate at random times. I have been on multiple steroid treatments to include two Medrol Packs and a high dose (starting at 40mg) Prednisone taper, none of which reduced the swelling one bit.
Additionally, all of my joints have become inflamed to the point of near debilitating at times. The surgeon suspects the swelling/inflammation has created an autoimmune response in the rest of my body. Needless to say, I have been unable to do any of the activities that I was used to doing.
My wife and I are convinced that my body is rejecting the knee implant but the surgeon refuses to accept that as a possibility because I have two small titanium screws in my right knee from an ACL repair from 1995 with no reaction. However, I have no plastic anywhere else in my body other than the implant, so we suspect that could be the issue. My knee is huge. When I wear jeans, I looks like I have a knee pad on similar to what a volleyball player would wear.
My surgeon has spoken with others in his field and claimed they are all baffled. He said the advice he was given was to give it a year or two to see how it reacts. That is NOT an option for me nor does he agree with that. I have suggested looking for a second opinion at more specialized Universities or places like the Mayo Clinic but the surgeon hasn't really embraced that as an option. Yesterday I was fitted with a leg brace commonly seen on an NFL lineman's legs. I still felt the instability and the swelling was increased due to how the brace sits of the leg.
If anyone has suggestions, I'm all ears. I'd be interested in recommendations of specialists that may have dealt with this before. Thank you in advance.
Like
Helpful
HugInterested in more discussions like this? Go to the Joint Replacements Support Group.
Connect
rapamycin
Sorry to hear of your knee situation. I too have been battling w my knee Surgeon only to be told each time, X-ray is fine there’s no issue, But I’ve been telling him from not even 6 weeks from my TKR that I was having bad pain. They took out hardware after 10 months because of nickel allergy. It helped but I’ve still got this burning pain. It feels like rubbing against a muscle or I.T Band etc. it feels like raw meat and I’ve been having to walk on this bum leg almost 2 yrs now. After all the PT’s they couldn’t get the swelling down during the 1st TKR. I had begged my Dr to do a CT, Ultrasound or even MRI. Only to be told that the X-ray is only way to see it because images will bounce on other tests. Finally after beginning n nearly crying he agreed to MRI. Tests came back as a small Effusion which I’ve been studying up on for when I go back in couple weeks. I did google if a moderate amount could be causing the burning stretching n pulling pain n sure enough, it says YES. Now I’m having a hard time understanding this. This fluid, water, infection or blood prob needs to be drained n checked. But could this really be the reason for all this pain? I’m having issues straightening out my leg. I had to lift my leg in n out of bed with a slight bend at a weird angle which isn’t that much pain but only way to get n bed. Or even in the car. This is miserable to have to be walking on a bum leg. My Dr I believe may be trying to get rid of me or brushing me off hoping I’ll give it another 6 months to yr to have more healing time. But I can’t go for this. Nearly 2 yrs is too long. I should’ve insisted more details months ago instead of dragging this on. Plus the Drs put Wedges into my Femur n Tibia for support. Now if I get out of bed wrong or step down wrong, I’m screwed for rest of the day. It puts a stress at the shin n very painful. At the femur I have pain also like a Turnakit or belt ties around my leg. It’s busting. So does anyone have much knowledge about what all they can do to help with an Effusion? I’m all for having it drained to check for infection. My Dr when I saw him last must’ve had a bad day, because he did burst out in a Cocky tone, that he didn’t think I had a nickel allergy in the 1st TKR. Even though I had tested positive to nickel for past 30 years. My husband would even hold a heat temp gun over my knee which showed 110 degrees or more. Other knee nice n cool. Some Drs needs to be more patient n listen to their Patients. We know how our Bodies working. We know when something is wrong. I’ve done between the 1st TKR n the Revision 4-6 sets each of PT. I’m good at my exercises. Right now I’m still icing n learning to sew w my left foot. Which takes twice as long. Can anyone Concur with this kind of Issue ? What else is there to try besides draining n check for infection? Which is another thing, I even asked if there could be infection a yr ago. Noooo! Or having another Revision which I’m NOT wanting to do again. Much appreciated. God Bless our Country 🇺🇸 Thanks 🙏
I have never heard of it but after looking it up, I’ll ask my surgeon about it. Thank you.
I’m sorry you’re having these horrible problems. My advice may not help solve the problems, but as an attorney with 30+ years of experience, I’d recommend you consult with a medical malpractice attorney and definitely interview a few new orthopedic surgeons. As for Mayo Clinic being better than anyplace else, I can only say they have not impressed me after my TKR. The level of communication as to possible outcomes and problems was almost nonexistent.
I just feel so bad for you. I wish I could offer some advice, but other than seeking a malpractice attorney, which doesn't help solve the medical issues, I can only encourage you to search for an orthopedic surgeon who specializes in revision complications. That's what I'm doing. I'm three months post op from a partial to a total replacement. A year after my first surgery I was still having pain and swelling and had an arthroscopy which showed synovitis and other findings the surgeon said he didn't expect. He cleaned it up and two years later I had the revision. The heat in the knee is constant and I don't know if it's raging synovitis or an infection. But the pain and constant catching of either the hamstring or other tissue is unbearable. My PT is very aware of it and can feel the catching. I'm waiting to hear if I can get an appt with an ortho who specializes in complicated revisions. Please post how you're doing and what has helped/didn't help.
Thank you. While I’m not sure exactly in what area, my current surgeon feels the Mayo is not what it used to be. Thank you for the advice regarding medical malpractice. That is something I have been pondering.
Thanks for the reply. I feel your pain, literally. 🙂
Thank you. It is very frustrating when a surgeon won’t listen to their patients. Unfortunately, many of them believe only they know best and can never be wrong.