TKR YYZ Back To YYC!

[mendogal]

Echoing what's been said: BoneSmart staff and members alike do find that there's a lot of potential for soft tissue issues (muscle or tendon) that don't start to resolve until some combo of professionals (orthopedist, podiatrist, PT, experienced body worker, etc) analyze our pain pattern, gait, and structure - feet to hips, on both sides of the body.

 

[2chains]

Thanks for the kind words folks!

I've been researching clinics to get the other knee done. One of the clinics I found in Quebec has a surgeon who has worked at a teaching hospital and follows patient recovery closely. He theorizes that there is a maximum degree of rotation you can do to have a successful replacement before one runs into post surgery issues ie. if one has certain degree of bowleggedness. Also he does not use a tourniquet and uses stitches/glue not staples. Reports are he has good recovery numbers.

 

[2chains]

Would appreciate someone who can comment on whether MRI would provide some insight? I would have to private pay over $1000 CDN so would like input.

GP says can't go in the MRI machine with metal implant but I believe Ive read others here have a different experience?

 

[benne68]

Yes, it is possible, @2chains. Just be aware that not every hospital has the equipment to do this. The metal in the implant can interfere with the quality of the images in older MRI scanning equipment.

 

[Jamie]

An MRI can be done by by a radiologist who knows how to do one for a person who has metal implants. So you need to ask about that. But, if you’re going to have to pay that much money, I’m not sure it’s worth it since you know you are out of balance with another bad knee that you’re trying to walk on. Depending on how bad your other knee is (is it bowed?) this may be your problem. If it takes a while to get your second knee done, it might be better to try and find a good therapist to help you.

I did noticed a clip from your second surgeon’s notes that indicated a possible lack of in-growth. This is a bit confusing because most knee replacements are cemented in place and bone growth into the prosthesis is not an issue. Do you know if your knee is cemented or uncemented? Also, if it’s possible to post any x-rays, that would also be helpful.

 

[2chains]

@Jamie yes 'good' knee/leg is bowed!

Also thanks for mentioning the lack of in-growth! I'll be bringing it to attention of the other orthopaedic surgeon on May 7th consult(he would be the one doing any surgery). Can't wait for this appointment and get answers or maybe more questions, lol.

I've un-cemented implants. I don't have access to X-rays I'd be curious to know if the lack of in-growth shows up on them.

 

[Jamie]

If you have uncemented implants and there is poor bone in-growth, that could be an issue. Also, if your “good” leg is bowed that will definitely impact your gait and could be contributing to your pain.

Be sure and write down all your concerns and questions so you don’t leave anything out when you see your surgeon. Good luck!

 

[EalingGran]

One of the clinics I found in Quebec has a surgeon who has worked at a teaching hospital and follows patient recovery closely. He theorizes that there is a maximum degree of rotation you can do to have a successful replacement before one runs into post surgery issues ie. if one has certain degree of bowleggedness. Also he does not use a tourniquet and uses stitches/glue not staples

This all sounds very encouraging for your new surgeon. A paper I read a little while ago suggested that rotational errors are a not infrequent cause of dissatisfaction with knee implants.
My knee was just glued and the incision recovered really well.

 

[EalingGran]

Internal rotational error of the tibial component is a major cause of pain after total knee replacement
D Nicoll et al. J Bone Joint Surg Br. 2010 Sep.
Free article

 

[EalingGran]

There are metal sparing MRI technologies that can be used after a TKR but as @Jamie says it really may not be worth it if you have known issues.

 

[2chains]

Thank you all for the encouragement!

 

[2chains]

Went to my appointment today with the orthopaedic surgeon. Just want to write everything down so it's fresh.

He indicated none of the tests showed an infection was present. (Unable to get an aspiration due to no fluid in the knee.) Good
The X-ray looked "good". Typical
The bone scan indicated possible infection or loosening but he indicated the bone scan could give false positives. Uugh

I asked about lack of the ingrowth theory by the referring doc and he said won't necessarily be visible on X-ray.

I stated I had ongoing medial pain, very limited walking/standing tolerance having pain after 20-30 mins or more especially walking on concrete surfaces. I then asked if my knee is reopened if he could visibly see what is rubbing/impacting in the medial side of my knee...he said no.
I was surprised by that as I could see during the bone scan there is enhanced activity and something going on on the medial side of the knee. That is where I'm getting most of the pain.

He indicated there are circumstances where they open up the knee and see nothing wrong. OMG!

He initially suggested to get a knee brace. After spending $28K Canadian on the initial joint replacement I just about blew a gasket at this suggestion! Not about to spend $3K on a brace if I can help it.

I told him I'd rather do the revision and he agreed to do it. He indicated it will be in about 6 months but he wants to see me again in 3 months to see if there are improvements.

 

[EalingGran]

stated I had ongoing medial pain, very limited walking/standing tolerance having pain after 20-30 mins or more especially walking on concrete surfaces. I then asked if my knee is reopened if he could visibly see what is rubbing/impacting in the medial side of my knee...he said no.

I am so sorry you are still struggling to get answers and a revision looks likely.
In the meantime I wonder if it is worth trying to strengthen the medial quads to see if that has any impact on the medial pain?
I still have some medial pain on stairs if I don't do my regular pilates for a few days.
This is because my MCL ( medial collateral ligament) is chronically overstretched and needs really good muscle tone to support it. My MCL was overstretched by years of my leg getting more and more bent by my lateral arthritis. I remember you saying your good leg is bowed and I wonder if that is overstretching some of your knee ligaments?
The medial quads ( vastus medialis) are particularly hard to exercise as they only fire properly in the last ten degrees of extension. You have to lie on the floor with the leg well propped up. Then straight leg raise, turn the foot outwards and bring it across the midline. You should then feel the medial quad tightening.

 

[2chains]

Nice! I don't have the last 3 degrees of extension yet even after 12 months leg lifts, leg drops and leg extensions. I have PT friday and will follow up.