Knee replacement gone bad: Patella & Recovery

Posted by hbaudouin @hbaudouin, Oct 15, 2023

In 2021, I had total knee replacement surgery. I remember feeling an air pocket that would pop while bending my knee during physical therapy. When I told the doctor, he told me it was normal. That whole year, my knee stayed swollen and tight. In 2022, I went for a 2 mile walk around my neighborhood. The following day, I woke up with my patella on the side of my leg. When I contacted the doctor's office, I was told I over did it. I waited another two weeks, and the doctor wanted to see me. They took an x-ray and saw that my patella component had come loose from the cement. That was in April 2022. I had to wait until June 2022, to have revision surgery. This past July, my husband and I went bike riding. Woke up the next day with a swollen and painful knee. I waited two days to contact my primary care doctor. They did not have an appointment and told me I needed to go to urgent care because they thought my knee might be infected. At urgent care, the doctor took an x-ray and told me that my patella has been fractured. I have been in a brace since July. I was able to find another orthopedic doctor. I felt like my first orthopedics surgeon did not listen to me and he never spent more than 5 minutes with me. During my first visit, he suggested that I should return to my surgeon since he knows my knee better. I told him I was not comfortable returning to him. According to doctor’s note: Possibility of displacement of the fracture in the future discussed. The complexity of the problem, which was explained to her in detail given the extensor mechanism injury, the possibility of her having some persistent pain, further loosening of the implant, repeat fracture, displacement of the fracture compromising her ability to stand, walk, etc. discussed in detail. The possibility of instability in the future is also discussed, given the extensor mechanism pathology that she has. She understands that possibility of refracture is there, using a prosthesis risk is also there, need of additional surgical intervention, possible patellectomy, allograft placement in the future etc. discussed. She is aware of all the scenarios. No guarantees expressed. " I have been back to this surgeon three times. Every time I go, all he tells me is to wear the brace for 4-5 more weeks. I feel that he is afraid to do anything because of my complicated case. I am wondering if anyone else out there has had this situation. What was done? How are you feeling? Is there a way to fix this problem? I am 59 years old and in pretty good shape. I am shocked that this has happened to me and that I don't know what my future holds.

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I did not mean to imply that you should try to sue. I am aware that this can be an impossible and also very expensive venture if you DID find a lawyer willing to go forward.
My best advice to you is to find a revision orthopedic knee surgeon that is experienced in fixing surgeries "gone bad." Revision orthopedic surgery is really a subspecialty. They specialize in repairing other surgeons' mistakes.
Best luck to you. I don't know if the surgeon that did all these screw ups is a general orthopedic surgeon with little inexperience but I suspect so. Again, you want a surgeon that only does knees and hips - not shoulders and other body parts also. And that surgeon should do a high volume of procedures every year at a high volume medical center or affiliated hospital.

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@hsminc

Your experience is horrible. It should not have happened. It seems absolutely crazy. I have had two total knee replacements; a hip replacement; and a reverse shoulder replacement. I had excellent surgeons that specialized in just those body parts. I never had any problem - and no pain with either the hip replacement or the shoulder replacement.
Even if I had to use my savings to pay for it, I would go out of town to a large city that has a high volume practice with knee replacement experts that specialize in revision knee surgeries. I would find out what you need to have done to get the problem fixed and then do it. It might involve changing insurance. My understanding is that insurers cannot discriminate against patients for pre-existing conditions. But be sure to verify. Always verify.
I agree. Orthopedic surgeons (and any doctor) are loathe to say anything negative about their brethren in the same city or region. They fear lawsuits if you filed a malpractice claim, etc. . Lawsuits can be very expensive for the physician that tells you what the other doctor did wrong. Lawsuits take up inordinate amounts of time for everyone and that is the major issue.

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I agree that most docs won't say anything about their local counterparts but in my case, the situation was so bad that the second opinion surgeon I saw said the first doc should have never done a partial knee on me as they have such a high level of failures (it failed the first time they got me up after operation. I can say that was a surprise for me. The 2nd surgeon was refaered to me by primary care doc, and when I told him what he said, even he was surprised. My hubby was there and could back it up.
The first surgeon ws nothing but a whole bunch of problems. For the operation I was left under sedation for about an additional hour before surgery because, supposedly, the package the instruments were in had hole it it and had to be presterilized. At least that was what my hubby was told though there is nothing about that in the surgery notes we got later. The surgeon even toldme that at my first check-up but then Hubby brought it up and he affirmed it. Strange.

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Hello @ hbaudouin , I had a similar problem. Unfortunately orthopaedic surgeons are not the greatest listeners. Though I totally respect them for the high degree of skill they have. Just think of the anatomy of the area and having to navigate through it. Anyway i had a TKR 1 year ago. I was told I would I would have 85 percent recovery in three months. Things were going well for the first three months and then it was down hill from there. At nine months I had been reduced to using a cane and very limited walking. In the end I had say to the surgeon, please take me seriously or refer me to another surgeon.. I respect him for jumping into action. Examining me thoroughly and coming to the conclusion that there was a defect in the manufactured prosthesis under the patellar. I trust his abilities .Within a month I was in for surgery ; it was found the plate was loose. . It was causing inflammation and effusion, My quadriceps had wasted . Two weeks after surgery I can say there is marked improvement but still swollen and painful. I have chosen to back off physio for a bit. In a months time I start in a rehab programme tailored for people who have had knee revision. I don’t know if this is the right thing to do. .Anyway I am lucky I have a surgeon who is skilled and I trust. I just needed to amp up my assertiveness to get the situation taken seriously. As a side note read the book “How Doctors Think” . It is very interesting and gives the reader the realization that many doctors don’t listen well and there are many reasons for this including the way insurance structure dictates time spent with patients. But you can break the barrier down by pointing out that you think you are not being listened to. When I finally got my point across. my surgeon did not get defensive at all . He was very professional. He jumped into action. My knee cap was replaced . During surgery he tried a number of sizes and made sure it was tracking well.I have no idea how long my recovery will take but I am going slow and easy. I see him in a month. If the situation has not improved , this time I think he will be timely in his reassessment. Unfortunately no surgery is guaranteed . Things happen and it is awful when it happens to you. I wish us both well.

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@101will

Hello @ hbaudouin , I had a similar problem. Unfortunately orthopaedic surgeons are not the greatest listeners. Though I totally respect them for the high degree of skill they have. Just think of the anatomy of the area and having to navigate through it. Anyway i had a TKR 1 year ago. I was told I would I would have 85 percent recovery in three months. Things were going well for the first three months and then it was down hill from there. At nine months I had been reduced to using a cane and very limited walking. In the end I had say to the surgeon, please take me seriously or refer me to another surgeon.. I respect him for jumping into action. Examining me thoroughly and coming to the conclusion that there was a defect in the manufactured prosthesis under the patellar. I trust his abilities .Within a month I was in for surgery ; it was found the plate was loose. . It was causing inflammation and effusion, My quadriceps had wasted . Two weeks after surgery I can say there is marked improvement but still swollen and painful. I have chosen to back off physio for a bit. In a months time I start in a rehab programme tailored for people who have had knee revision. I don’t know if this is the right thing to do. .Anyway I am lucky I have a surgeon who is skilled and I trust. I just needed to amp up my assertiveness to get the situation taken seriously. As a side note read the book “How Doctors Think” . It is very interesting and gives the reader the realization that many doctors don’t listen well and there are many reasons for this including the way insurance structure dictates time spent with patients. But you can break the barrier down by pointing out that you think you are not being listened to. When I finally got my point across. my surgeon did not get defensive at all . He was very professional. He jumped into action. My knee cap was replaced . During surgery he tried a number of sizes and made sure it was tracking well.I have no idea how long my recovery will take but I am going slow and easy. I see him in a month. If the situation has not improved , this time I think he will be timely in his reassessment. Unfortunately no surgery is guaranteed . Things happen and it is awful when it happens to you. I wish us both well.

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I read your story … I like yourself had revision after 1 year but I know you have to get right in physical therapy …if you don’t move you lose this is so true …. Even now over year out of revision if I take a brake I get more tight ….i am talking I was sick so missed the gym for 5 days I was so tight I hurt …. So now I know gym is less pain so I go 5 days a week …. My revision I had was due to dr putting in knee two sizes to big , so after surgery I mean we all know the first few weeks are a struggle… but after few weeks going actually felt better…. Just my experience you have to keep on moving …. It does get better

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