jmelpy

All total knees can be revised later. Its just a matter of how many of the components need to be revised. In a total knee there are 4 components. The femur, the tibia, the tibial insert, and the patella (if the patella is resurfaced, some docs choose not to do it based on the patient.) The tibial insert is the most commonly revised prothesis. It is made of a extremely strong polyethylene, and it basically acts at the "bearing" for the knee. We call revising the insert a "liner exchange." We open up the knee, pop the old poly out, and throw the new one in. Takes about a half hour. Bigger revisions consist of changing out either the tibia or femur. This is a very involved process, and can take a very long time.
Reasons for revisions are usually poor prothesis placement, infection, or fracture. (Peri-prosthetic fracture, aka a fracture 'around' the implants.) ALL total knees can be taken out and have new ones put in their place! There is not a specific kind of knee that can't ever be revised, or a specific kind of knee that is "easier" to revise. It all comes down to what implants need to be exchanged, and why they need to be exchanged. Keep in mind the knee is literally cemented into the femur, tibia, and patella, so its not easy if you have to replace those parts!
This is why its IMPERATIVE that your surgeon has been fellowship trained in joint replacements!!!! I cannot stress that enough!!

nutcase

I will find out more about it after the MRI I guess. In the mean time I've managed to tear some ligaments in my ankle. Now I cant even ride. Not a happy camper.

nutcase

Had the MRI yesterday, and the Doctor is on the fence about the TKR. Say's he will do It but wanted to see How long an injection of Cortisone and lanicaine(sp) would work. I got the injection and the knee feels better. It's sore and a little tight, but no aches. It's not a permanent fix, but I will see how long it lasts. The good part is while I was down in San Francisco I went to have lunch at the Bicycle Café, and came out with a brand new bicycle. Yep, 2010 Jamis commuter 2. It's an up right type bike. Comfy seat 7 speed internal hub, and so much kinder on the wrists and elbows than my Masi Special commuter. So I guess is was worth the 7 month wait. I go back in two months for a follow up.

Coopers_Dad

I tore my ACL MCL playing indoor soccer 3 years ago and only just got around to having the surgery in March of last year. It was the best thing I've ever done for myself, as you adjust to life with the injury you forget what pre injury life was really like. I waited because I couldn't take the time off work I traveled 2-3 weeks a month. All the horrible pain locking up and noises that my knee made are gone. I was walking with crutches within 3 weeks I had full range of motion back a week or two after that and I was back to normal life within 3 months. I'm still working on getting back my previous lateral stability but I'm now not terrified of snow, ice or slippery floors. I had my right knee scoped and cleaned out last November after it started to lock up when I was running. That surgery lead me to spinning classes as part of my recovery and to road riding as a natural progression.

We tried cortisone one on my left knee with little effect and only because the wait time at the hospital for elective surgery was a about 9 week at that point.

Good luck!

nutcase

Thanks. Glad to hear it worked for you. I rode 7 miles today with no pain. Thats the first time in several years.

Peter_C

it's all about putting off the TKR as long as possible. It's a dance between quality of life, pain, meds, etc. If the injection can work for you and last at least 3 months, then that will be the best choice until the shots fail to last. It is really not a case of doing more damage by waiting, but rather, the longer you wait, the less chance of having to go in and replace parts later - that is what the doctors are looking at.

Be careful though, recovering from a TKR takes work, and time - and if you wait until health becomes an issue (like I did) - this will make the recovery that much harder. I respectfully suggest that you take the time with the shots, and use it to increase both health, and general overall body condition. so that when you do have the TKR, it will be that much easier to recover from.

nutcase

^ Thanks for the advise Peter. I think I will use the injections until the Tkr is absolutely necessary. I thought I was doing myself a favor by cycling a lot prior to the TKR to build muscles to help in recovery. Doc told me that my muscles are so large in my leg that it will be even harder to work around them. Ha Ha. I'm still riding, and my new bicycle sure is making it easier. Went shopping on it today. 10 miles round trip, but it was 10 miles of fun.

Peter_C

the new bike, or it didn't really happen ~~

nutcase

^ Ok Peter here it is.

Peter_C

Love the color~! Now you'll need to change your signature too

nutcase

Yes your right. Although the Masi is still in the stable, but I sold it to my oldest boy for college transportation.

lookinUp

Nutcase,
I just had TKN 10 weeks ago - what a difference it's made! I'm very heavy and figured that would affect my recovery time and worried whether the new knee would work. WRONG! I was in the hospital 3 days, walking with a walker for two weeks. Walked with a cane for about two days.

At five weeks, was on the golf course playing two or three holes. At 8 weeks, playing 18 holes of golf (but tired afterward).

BIKING... couldn't wait to get on the bike again - it had been over three years since I could bike. The biggest issue starting to ride again was that I couldn't make an entire pedal revolution. It took several tries on a stationary bike over the course of a week or so to finally get that range of motion.

So... here it is 10 weeks today after TKR - I'm riding 10 miles at a time. The knee is stiff and hurts a bit when I start out, but after a mile or so, the (minor) pain goes away. What a JOY to be back on the bike. I'm slow... because I haven't used the quads for three years, but that will improve with time.

As others have said, I don't know why I waited so long to have it done. With the pain meds you are given, there isn't a LOT of pain. PT is a PITA, however, is necessary. I'm a great believer that having a positive attitude and willingness to work hard at PT is the reason my TKN has been so successfull.

Looking forward to my first 20 mile ride in three years .... in about two weeks!!

zjrog

So update this thread brotherman!!!

nutcase

Here's the update. 3 weeks ago I had the Left TKR. The home health team graduated me yesterday. She said That I had recovered better than any TKR patient that she had ever worked with. Probably trying to make me feel better. I feel better every day. The muscles are always sore from PT. The incision looks really good. I start outpatient PT this coming Monday. I can drive my truck now and run short errands. Takes a load off the rest of the family. I have a long way to go,but I'm pretty sure it will come out good in the end. The hardest thing for me is of course the stretching to get more ROM, and trying to walk normal. Keeping my left foot pointed in is very hard, and feels very strange while doing it.

Peter_C

I had my Left TKR (with recision) in 11/09. Since that time I have ridden 650+ miles on a 2010 Giant Suede DX (comfort bike). I also had shoulder surgery for a torn rotator cuff, and was hospitalized for multiple PEs (second time). Weight loss total is roughly 30lbs (up and down and up) - am on the trainer in the basement daily for at least 30 minutes. If you want the whole (very long story - with jabs, jokes, and whining, you can read The Saga.

I think it's neat that all the folks having TKRs are sharing the same thread now. It gives a nice comparision, and helps folks see what it's all about

zjrog

I just didn't want nutcases' thread to drop out... Good on ya brother for the hard work in therapy. But if you think home health phase hurt, wait till you get the REAL pain!!! JK... Have a good time with it. THIS is the phase that will get you moving. And like I said, my home health PT is still in my head telling me how to walk... And I have NO doubt, she will remind me of everything I do wrong when we go camping and hiking (she is a close personal family friend!).

nutcase

Yea I'm preparing for the real PT. I push hard but I know they push harder. I've got a lot of biking,hiking,hunting,and just being outdoors tp look forward to. It will be great with a new knee. Who knows I might even Get the other one done someday. Wait a minute did I just say that? I think I will probably wait at least a year between knees.

zjrog

If you have digital camera, lets see the scar buddy!!!

nutcase

Yea i've been thinking of doing that. I'll try to get it done this week. It's just 17cm.

nutcase

Went for a walk yesterday. Longest one yet approx 6 blocks. I had pretty good form on the way up, but got ugly on the way back. My toe wouldn't stay in. I was fairly sore as it was an uphill grade to the top of the road and then downhill the other half of the way. Worked the whole leg. Pt starts today.

zjrog

Sweet, you got out to walk... Right as I was ready to walk around more, we got a lot of snow.. THat sucked.

Now is an easy time to overdo things. Not time to push yet, let the PT get you moving some more. First couple week I thought my PT was holding me back. He was keeping me from hurting myself.

Have fun though with PT...

nutcase

PT wasn't to bad. I am still sore from yesterday. I must admit I really am tired of this pain. I mean you never seem to be able to relax pain free. At least thats my experience so far. Unless I'm asleep, I'm either aching,sore,or just squirming around in pain. It's hard to take your mind off of it. I take the pain meds as prescribed,but they wear off so fast,and then I have a couple of hours before I can take the next dose. A couple of days ago I felt better and would have been able to talk myself into doing the other knee. Today I couldn't do that. Does it get better? I sure hope so. In pt yesterday they had me on a regular bicycle trainer(upright) that went well, they did the final stretch while icing, lying on my back with a wedge under my ankle for 10 minutes. That was the most pain I've had yet. Wow!

Peter_C

First, it *does* get better...

I felt like that the entire time I was in Pian MGNT, until I had my TKR.

zjrog

Yes, there are days like that with PT... The wedge under the ankle is working to get you to zero for extension. It is very imortant to keep you from falling. There were a couple days where I had to "disappear" into my "Happy Place" with music and a favorite bike ride. PT is an eye opener. You'll hate it, but then you'll be anxious for the next round. Its weird. *I* must seem to be somewhat masochistic, since I really enjoyed PT. But let them push you, THEY know what you need.

If you want, I can PM you my number if you want to chat about it...

nutcase

Ok as promised