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When to consider 2nd opinion and/or revision of TKR
I had left TKR 9 months ago. I'ma 78 years old male but active.
I had a poor start to PT. Some delay and one poor tech at first.
Now I still have significant pain - particularly going down stairs. Some swelling. A semi-soft "lump" below the joint (a cyst???).
And my left (operative leg) foot is splayed out more than the normal right foot.
Also, my 'knock kneed' previously normal condition was not corrected as promised by my surgeon.
Don't get me wrong. For my previous hip replacements my surgeon did fantastic work on both hips (all of this from arthritis). But I"m obviously disappointed with the knee.
My surgeon has since retired; sadly because he has cancer.
I'm not sure I should continue with his partner and replacement who is well recommended.
So should I wait to see if it improves?
Get a second opinion?
Consider revision now?
This isn't a total show stopper but it does hamper my quality of life.
Thanks for your advice and inputs.
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If it were my knee I believe I would go ahead with a second opinion
Never hurts to have another pair of eyes on something that feels like a problem.
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4 ReactionsI also agree that you should get a second opinion. Revisions are complex so you need a really good revision surgeon to do the opinion. I would do substantial research for the revision surgeon and if I had to travel, I would do so to get the best.
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1 ReactionGood advice. And I have good access to Univ. of Mich hospital. Top notch outfit. Thanks.
@steveinarizona
RE: "I would do substantial research for the revision surgeon"
I'm pre TKR... have been to 3 surgeons and 4th in a couple of weeks... so HOW do YOU research surgeons?
I would definitely get a second opinion from a different orthopedic dr. Your surgeon’s partner would probably continue along the same path as your previous surgeon. I had a right knee replacement at a top Boston hospital and my knee has never been the same. The surgeon said to me “Well, it will never be the knee that God gave you”. What kind of an explanation is that??? Definitely research other orthopedic surgeons in your area and go with someone else. Hope that this helps.
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3 ReactionsGood comments. Good questions.
I will get a 2nd opinion. To find that surgeon I'll:
Use my list of well qualified surgeons at U of Mich first.
Now, based on this thread, I'll ask (new "partner" surgeon and my candidates): 'how many of your TKR's have required revision'?!
I'll see what that turns up.
@robcfl
First, I do research on the procedure (on line) to see how it is done, why, and what alternatives there are and the cost and benefits of each. Doing that I can usually NIH research papers and can start cross referencing what I see there.
Second, locally there is a magazine (Phoenix Magazine) that annual rates doctors based on a survey of doctors, not patients. So I see what they have to say.
Then I start looking for doctors who seem to be using the best methods. I prefer someone doing that but also someone who has done lots of them. So I start looking for that. I see yelp reviews, healgh reviews, etc.
In my case I eventually found a video of my first choice surgeon doing a TKR at an orthopedic conference using the newest subvastus approach with tranexamic acid rather than a touriquet implanting a bicruciate retaining implant. All the best and the video is from 2020.
Further research on my surgeon shows that he has been doing subvastus TKRs since at least 2015 so he vastly experienced, especially in doing a bicruciate retaining implant (which I am hoping to get but is more complex than the traditional method of cutting the ACL).
I would also ask my doctors who they would go to and especially if any of them have had a TKR. I would ask friends but I would then research their recommendations. Someone might say he had a lot of pain from a tourniquet (like my brother) but that is irrelevant if the surgeon is going to use tranexamic acid instead (by the way I found a study that showed this was a fine way to proceed).
Most doctor web sites indicate what type of procedures the surgeon does. So a beginning point would be if the surgeon's own website lists procedures but doesn't include revisions that this is not the surgeon you want for a possible revision.
There are of course great centers of medical excellence (Mayo, Cleveland Clinic, Mass General, Scripps, etc. etc.). They are excellent places to go if you have a complex condition that requires diagnosis and will provide excellent surgical practices. But they are not necessarily the best for what you want to do.
I was researching my brother's surgeon and found a 13 year old debate he was having with a Mayo surgeon who was arguing that old fashioned mechanical alignment was fine and the newer kinematic and Functional alignment were not necessary. 13 years later I went into the Mayo website and, lo and behold, they now argue for a form of functional alignment. Does that mean that Mayo is crap? Absolutely NOT. But for a particular problem or procedure, there might be a better choice out there.
Does this help?
@steveinarizona
John's Hopkins
Stanford
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