Spacer replacement 4 years after TKR

Hi wallygator. Thank you for keeping us posted. Your last note said you were going to have a 2nd opinion. Did he agree the revision was necessary and if so did the 2nd opinion surgeon do it or did you go back to your original TKR surgeon. It's so great to hear that you can already tell you have improved. Would you mind describing your symptoms, particularly the clunking you were having...was during flexion or extension and was it with every step.. was it at a particular area and would you describe the clunking as painful or just super uncomfortable and unnatural feeling?

@wallygator
So relieved to learn that you are doing well after the spacer replacement surgery. Mine is now 12 hours away
Hoping all goes well though 3 surgeons confirmed the requirement but I am still very apprehensive hope the clicking and instability will go away but my OS did say that my knee will feel more tight
My ROM is very good hope will be able to re achieve it
Will keep you updated!

@ggji I’m lifting you up in prayer this morning. May you have excellent results from the surgery and a smooth and speedy recovery.

Thank you @wallygator
My spacer replacement went off uneventful yesterday and I was back home in the evening
When the OS came to visit I was already walking with a walker along with the PT
Though I couldn’t sleep bc of the discomfort of reclining but I was totally pain free didn’t need oxy but I am taking it now as my OS said it helps in overall recovery
After 3 surgeons opinion /observation I had to insist on it with my OS bc he appeared disinclined
And wow What was discovered both the
implants were nice and study and healed well only the spacer which was 11 mm had to be replaced by 15mm
This was done now at 18 months after LeftTKR though I was raising my concerns just after 2 months after surgery that my knee rattles as if it was a kids box of marbles. There was weight and feeling of stress and discomfort on the left side below the knee, there was instability and all the while for 16 months time I was feeling as if someone has stuck my knee ahead of my leg
Within 24 hours all seems to have gone my Rom is already straightening 0 to little over 90 at bending even though there is still the thigh ace bandage wrap around leg and ice machine flaps
Hope this will help and motivate others similarly placed
If it is needed do it do not wait indefinitely and get your independence back
Cheers to all

@ggji
Very frustrating when they don’t seem to believe the patient complaint is valid🙄
I know someone who had a TKR twice same surgeon, same knee. Still no pain relief and affected his ability to do so many things!
He and his nurse wife got online and after much research and discussion with a surgeon in another state (nice that XRays, scans like CT/MRIs can be shared via computer!), had the third replacement and has been fine ever since!
You just have to be your own advocate these days.
I had similar issues years back and it took me awhile but once I found the right surgeon - relief!

@wisco50
True I agree that you have to advocate for yourself
See my insistence for revision of TKR with higher number on the spacer. It’s 2 days and I am already relieved of my complaints
It happened once earlier with a dentist who kept giving me antibiotics for 6 months for shreds coming from my mouth
I got frustrated with her as I had a surgery coming up. I researched the internet and looked at the information given by the most reputed Medical schools and hospitals
And lo and behold it was just an allergic reaction to one of the ingredients in the various reputed toothpastes that we all use
I did not use that toothpaste that night and by morning I was relieved of my symptoms
Imagine a dentist could not even suggest that I change my toothpaste and see
I could not even sue her for a malpractice as the attorneys told me that it could have been pursued if it had killed me
Unbelievable state of medical practices
So for any issue bothering one must research and get aware of the options and solutions

@bionicwoman hi can i ask you a question I just had total knee replacement in march just past now they telling me I need revision surgery the spacer I kept telling the doctor I was in pain with knee clicking and popping he did nuttin about it send me to see another doctor now I need revision surgery how long is the recovery time think you how is the procedure done

@odess13
I had a spacer replacement (increased size) about 4 years after an initial TKR which never seemed to work: bend was never great (about 90), PT didn’t seem to do much aside from cause pain though I kept at it, and always that unspoken charge that the knee was fine, the problems were my fault. I ended up with a pain Dr. and finally a different orthopod at a major university. This Dr. said my knee was unstable and suggested sx. So I had an open partial revision at which he switched up my spacer and cleaned out some scar tissue. Knee was bent to 125 while under anesthesia. The op report sounded pretty uncomplicated. LOTS. of pain immediately post op, PT was very painful but eventually things settled down and I was fairly pain free (off pain meds) for about 2 years after which the pain has returned, pretty much to original level. So now my bend is about 90, my pain is about 6, I go to the gym 3xweek for a gentle workout but my operative knee is pretty useless. I am profoundly affected by the weather. Was the spacer replacement worth it? Probably not.

@ggji

Whether one is needing a TKR or a revision, I believe that surgeon selection is critically important. A TKR is a very invasive procedure and I think one needs to understand it and the various options that a doctor may use (intentionally or not). Then the potential recipient can start trying to find a surgeon to do the surgery successfully in the manner you have selected.

So my criteria were choose the method (for me subvastus or mini midvastus), the type of implant and the accompanying process (for me a bicruciate retaining implant -- Journey II XR process), the type of alignment (not mechanical. Kinematic, inverse kinematic or Functional I wanted and got Functional).

Having chosen the method, I then search to see if there is a surgeon who can meet all of these requirements. These are Extensive successful experience doing that exact procedure, great hands and great mind.

Finding a surgeon who meets all of these is difficult because there is no database of surgeons who meet these criteria. I would do research such as surgeon descriptions, reviews, websites, publications, etc. Narrow it down to a few and one can then ask about any remaining questions. I was fortunate that I had gone through a similar process three years ago to find a hip replacement surgeon and it turns out that he is also a knee surgeon who met all of my criteria.

There is an element of luck but I was fortunate in that I had zero post surgery pain after my hip replacement and after my knee replacement 8 weeks ago. I attribute 5% of the credit to my research, 90% to Dr. Chow's skill, and the remaining 5% to good fortune.

It would be nice if all hip/knee surgeons were equally great. But that is not the case with joint replacements nor with most professional skills. Peyton Manning and Ryan Leaf were drafted one two. Leaf failed miserably and Manning went on to what will be a hall of fame career. The same is true of surgeons. I want the Peyton Manning of surgery, not the Ryan Leafs. Well, actually, I don't want the Peyton Manning of surgery either. I want the Tom Brady of surgery. I want the GOAT.

@ggji

I absolutely agree. Surgery is no different from any other professional activity. Some performers are great, most are in the middle and some are at the wrong end. It is essentially a bell curve.

If you can research for yourself you are then in a position to advocate for yourself. And if you do your research for both the process and surgeon, you can then advocate for the best possible result.

Surgeons are not mind readers. You need to tell him what you want and need and if she is good, she will respond and not blow you off.