Arthritis and A Total Knee Replacement 101 (I just found out that a Garrett pin pointer can detect metals in the body)

Garrett pin pointer can detect metal in your body

We do a lot of metal detecting and I have a Garrett pin pointer that I use. There have been many times I have set it off, I forget that I have it on and it starts sounding off, I had it next to my knee replacement.

One day I got curious and took it up and down my leg to find out how far the stem went, it goes further than I thought.

I then decided to see if it would pick up the metal in my neck from a previous surgery and it did.

What a handy little device it great for metal detecting and has other purposes.

TKR Update After 6 years Going Strong Out Of Nowhere I Get a Severe Knee Infection

November 18, 2013 I had to have my knee replaced again because of an infection. The doctor has no clue how I got it, I haven't been sick, no cuts that were infected, no bad teeth, he told me less than 2% of people get and infection like I had for no reason. This makes the 4 th replacement, first 2 done wrong the 3rd was going well, 6 years go by and I get an infection.

I had no warning, my husband and I were out metal detecting and it was windy, so I thought my knee was getting sore because of over doing it. We stopped at a restaurant afterwards and ate. I got out of the car and my knee was hurting worse. While eating I started to get chilled and thought oh great getting the flu. I then get up to use the restroom and almost couldn't walk. Within three hours I was unable to walk on that knee. The next day I went to the emergency room and they did a blood test and it came back that sed rates elevated. I was told to go to my doctor and then he set up surgery.

I was on vancomycin from November 19 till December 26th and had home health coming to my house. My knee is doing better and I know from experience that it will take time for my knee to get back to where it was.

I have a very good orthopedic surgeon, the first surgeon is no longer in Illinois, but from what we hear he is still practicing. The last we heard he is in Mississippi.

There are many good orthopedic surgeons in Peoria Illinois things would have been so much easier if I had known this in the beginning.

Three time TKR Total Knee Replacement Survivor

You may have come to a point in life that your doctor has told you that your only option left is to get a total knee replacement. This is a decision not to make lightly.

I'm not a doctor or an expert, but I do know from experience about a TKR, since I've had it done three times on the same knee.

Your doctor will do ever thing possible to relieve your pain, before doing surgery.

Surgery will be your you last resort.

Doctors may prescribe anti-inflammatory drugs, to relieve inflammation, such as Celebrex, Ibuprofen, Naproxen, etc. They may also prescribe medication to go along with the anti-inflammatory drug. I was prescribed each one of the drugs above, trying to find one that would work for me. I was not able to get much relief out of any of these drugs.

My left knee was worse than my right knee. Going up or down any kind of stairs was getting quite difficult. I could hear my knees make popping noises with ever step. I could feel the grinding, from just rocking in a rocking chair.

Cortisone Shot

My doctor said another option was to take cortisone shots. You can only get these shots ever three months. So I took him up on the ideal and got the cortisone shot. When I first started the shots, they seemed to give some relief. But as the arthritis progressed, the pain was worse and the shots would only last a couple of days.

Since the cortisone shots were no longer giving any kind of relief, my doctor said arthroscopic surgery could be done. He said this is a way of cleaning up the arthritis, making a smoother surface for the knee to glide better. I was told I had a 50/50 chance this working. Since nothing previous was working for me any more I went ahead with the surgery on Nov 18, 2004. This procedure was done as an outpatient.

Right Knee Left Knee Arthroscopy

Operative Report

11/18/2004

Preoperative Diagnosis:

Internal derangement right knee.

Internal derangement left knee.

Postoperative Diagnosis:

Right Knee chondromalacia patella, right knee tear lateral menisus.

Left knee chondromalacia patella with condylar defect medial condyle and tear lateral menicus.

Procedure Performed:

Right knee arthroscopy, arthroscopic partial lateral meniscectomy and chondroplastic shaving patella.

Left Knee arthroscopy, arthroscopic chondropic shaving patella, partial lateral meniscectomy and chondroplastic shaving medial femoral condyle.

Indication: Patient has significant pain in both knees for prolonged period of time. She failed outpatient care including Cortisone injections. She is admitted for diagnostic bilateral arthroscopy. Her x-rays show some mild subluxation patella but otherwise normal.

Right Knee Arthroscopy

Patient was taken to the Operating Room and adequate anesthesia obtained. Attention was focused on the right knee. The right knee was then prepped and draped in the usual manner. At this time a lateral parapatellar tendon stab was made and the arthroscope was inserted. A medial parapetellar tendon stab was made and the nerve hook was inserted. The knee was inspected. The medial joint showed some softening at the epicondyle but no frank abrasion. The medial meniscus was intact. Attention was focused laterally. The lateral meniscus showed some tearing of the anterior horn at the anterior third. The torn portion was explored. It appeared to be a degenerative type tear. At this time using combination of hand and power instruments, the torn portion was removed. There was some softening of the epicondyle cartilage of the lateral compartment with no frank abrasion. The anterior horn was inspected and found to be stable. I should mention that the reaming portion of the lateral meniscus and the entire medial meniscus was probed and found to be stable and the patellofemoral joint. There was chondromalacia patella. This was mostly at the lateral facet involved the bulk lateral facet. This was mostly Grade III. At this time using the axillary portal, this was shaved until smooth. After this was accomplished, both gutters were inspected along with the superior patellar pouch and this was within normal limits. The knee was then thoroughly irrigated. The portal was closed with staples. A sterile dressing was applied after the knee was injected with Depo-Medrol.

Left Knee Arthroscopy

Attention was focused on the left knee. The left knee was then prepped and draped in the usual manner. Same portals were utilized. Inspection was done and found some softening of the articular cartilage medially diffusely. There was a condylar fracture of the articular cartilage on the posterior medials aspect. This was approximately 5 mm x 7 mm. The loose piece of articular cartilage was then removed. The medial meniscus itself was intact. Attention was focused on the intercondylar notch. The anterior cruciate ligament was intact. There was noted to be an indentical tear of the anterior lateral meniscus as the right knee. This is shaved until smooth. The remaing portion of the lateral meniscus is within normal limits. Again there was softening or the articular cartilage laterally, but no frank abrasion. Attention was focused to the femoral joint. There was significant chondromalacia patella. There were two areas exposed subchondral bone approximately 1 cm x 1 cm in size. At this time the loose pieces of the articular cartilage was then shaved until smooth. The medial facet showed softening but no frank abrasion. Both gutters were inspected along with superior patellar pouch and this was within normal limits. The knee was then thoroughly irrigated. The portals were closed with staples. Sterile dressing was applied. Patient went to the Recovery Room in good condition.

Right Knee Arthroscopic Success

The surgery was a success on the right knee.

Left Knee Arthroscopic Failure

The left knee was said to be bone on bone. A few months after the arthroscopic surgery, my left knee was getting much worse, than before.

Synovics

So my doctor wanted me to try synovics to see if I could get some kind of relief. Synovics is supposed to be like grease. The relief did not lasted for about 2 months and you can only get this shot every 6 months.

TKR replacement needed

My doctor told me since nothing tried, was working, that I would need a TKR. I've talked to People who have had a TKR and most of them are very happy with their results. Some were saying they were walking great in just a couple of days. I even had one person say they went dancing the next week.

So on July 29, 2005 I was scheduled for a total knee replacement.

This was my first TKR picture

TKR Operative Report:

7/29/2005

Preoperative Diagnosis: Degenerative Joint Disease, Left knee.

Postoperative Diagnosis: Degenerative Joint Disease, Left Knee.

Operation: Left Total Knee Replacement, Zimmer Type.

Anesthesia: Attempted Epidural, General..

Indication: The patient had pain in her left knee. Previous arthroscopy showed degenerative joint disease. The patient has failed conservative management including the arthroscopy, therapy, cortisone, and Synvisc injections. She is admitted for total knee replacement. The risks, benefits, and alternatives have been discussed including the fact that given her age prosthesis would probably not last lifetime.

Procedure: The patient was taken to the operating room and placed in the supine position. After an adequate level of general anesthesia was obtained, the left leg was then prepped and draped in the usual manner. There was noted to be about 10- to 15- degree flexion contracture. At this time, a medial arthrotomy was carried out. The patella subluxed laterally, it was osteotomized. Attention was focused to the distal femur. The femur was entered; it was then osteotomized in 6 degrees of valgus. Attention focused to the tibia. The tibia was not osteotomized. Attention focused back to the femur. The femur was measured for size and a size D femoral component gave the best fit. In the appropriate rotation, the anterior and posterior condyles were chamfered and then removed. The notch for the patella and the focused back to the tibia.. Utilizing the instruments for the MIS tibial guide, the tibia was measured and a #3 tibial baseplate gave the best fit. In the appropriate rotation, the central peg holes were created and a canal for the 45 - mm stem

At this time, the trials were inserted including the 45 - mm stem. With the 10 - mm polyethylene, the knee had a range of motion from 0 to 155 degrees. With gravity alone, the knee flexed to 130 degrees. The knee was stable in all planes. At this time, the patella was re-osteotomized. It was measured for size and a 35 -mm patellar button gave the best fit. The patellar button was inserted. The patella tracked well using the no-hands technique. At this time, the trials were removed. Mutiple drill holes were placed in the femur and tibia. The entire wound was copiously irrigated with a Water Pik and dried. All remaining osteophytes were removed. At this time, the above-mentioned components were cemented into place. The wound was then irrigated and dried. Utilizing a #3 tibial baseplate, a size D femoral component and a 35 - mm patellar button. Again a 45 - mm stem was utilized on the MIS tibial baseplate. After the cement was appropriately cured, excess cement was removed. Hemostatsis was achieved using the platelet gel. The tourniquet was released. At this time, trials were again done. With the 10 - mm polyethylene insert, the knee had a range of motion from 0 to 150 degrees. The knee was stable in all planes. The patella tracked well using no-hands technique. The knee was stable in all planes. At this time, the trials were removed. The wound was again irrigated. All remaining cement and osteophytes were removed. A 10 - mm polyethylene was then inserted in the tibial baseplate and secured using the Zimmer locking mechanism. Range of motion and stability were again tested and were identical with the trials. The patella tracked well using the no-hands technique. Final hemostasis was achieved. The wound was again irrigated. The remaing portion of the platelet gel was utilized. The wound was then closed utilizing interrupted #1 Vicryl for the fascia, interrupted 3-0 Vicryl for the subcutaneous tissue, 4-0 Monocryl for the skin along with Steri-Strips and Dermabond. The patient tolerated it well and went to recovery room in good condition. Estimated blood loss was 400 ml.

Epidural Failed

The type of anesthesia that my doctor wanted me to have was an epidural with a nerve block. This did not work for me; I could still feel everything they were doing to my leg. So they up the meds in the epidural, they would stick me in the leg to see if the epidural was working. The epidural failed, so they put me to sleep. They put the Foley in while they were prepping me.

Morphine

The first day after surgery I was not allowed out of bed. For the first two days I was on Morphine for pain control.

Vicodin

Third day I was then given Vicodin to control the pain. Do not let your pain get out of control, before asking for pain medicines. Take your pain meds on schedule, you will avoid much unneeded pain.

Therapy Starts the Morning after Surgery

The morning after surgery a physical therapist came in to my room. I was then gotten out of bed, with the aid of the therapist and a walker. I then walked from the bed to a chair that was next to the bed. I was told I needed to sit in the chair for as long as I could handle it. This was a glider type chair. The therapist said the rocking motion would be a good therapy for my knee. I was told it would also help strengthen my knee, later that day I walked from the bed to the door. When I got back in bed, I was showed other exercises that I was supposed to do. The third day I was walked down the hall with a walker. My therapist then took me to where they had stairs to show me how to use the walker on stairs. I had therapy 3x a day.

Occupational Therapy

I then had an occupational therapist come into my room. She was there to educate and to show ways of bathing and dressing. I only saw the occupational therapist twice.

Release from Hospital after TKR

I could not be released from the hospital until my knee was bending to a certain point, and I was walking to my doctor's satisfaction. On August 2, 2005 I was released from the hospital. A walker was brought up to my room for me to take home. I was given instructions on how to care for my knee, I was told to keep my leg elevated and to keep ice on my knee. I was told not to put a pillow behind the knee because this could cause blood clots. I was given a prescription to for pain medication. Therapy was set up for 3x a week.

Allergic Reaction to Derma Bond

Everything was going great; except one minor thing, my knee developed a rash and started itching real bad. It turns out that I was allergic to the derma bond glue they used to close my knee during surgery.

Knee Replacement coming loose

Therapy was going great, two weeks after surgery I was walking without the aid of a walker. I was now using crutches.

Then the end of August 2005 my problems began. I had all kinds of problems, increased pain, and instability; swelling, redness; heat and I couldn't straighten my leg. I could not trust my knee at all, I would be walking and all of a sudden it would give out o

Dynasplint

Then in September my doctor then had me fitted with a device called a dynasplint. Which is to be worn at night while sleeping. This is supposed to straighten my leg. I wore this device every night till January with no luck.

Estim

In January my doctor had me wear a device called an Estim, which produced electrical current into the knee. This was supposed to help relieve the pain. This did not work.

Not pleased with Doctor

February I was still on crutches and my knee was getting worse; my knee had so much swelling and heat that my doctor thought that I had an infection. My doctor ordered test to see if my knee was infected, it was not.

He x-rayed my knee constantly to make sure everything was in place. Each time I would be told things are fine; nothing is out of place, your knee is stable and in a well fixed position.

I was told that when my year is up that he would like to do a bone scan. He said that if he did a bone scan now that it would give a false reading.

Finally in May he set up a bone scan. The bone scan showed that my knee replacement had come lose.

I was told that my knee had come loose, and that I would need to have a revision done.

So August 25, 2006 a TKR revision is done. The revision seemed to be going great for the first few weeks.

This replacement only lasted 3 weeks.

This doctor would not listen to me. I told him that something was wrong with this replacement. My therapist was even concerned. She had called him on more than one occasion with concerns.

My knee had so much swelling that my therapist thought I had a bad infection. The doctor drew fluid to check it for infection. As before there was no infection.

I asked my doctor could you do a bone scan to see if it is lose again. His reply was as before. It is to soon for a bone scan, if we did one now it would give a false reading.

I was getting really irritated with this doctor.

Second Opinion

So I started looking for a different doctor, to get a second opinion. I was told I had to stay with this doctor for at least 6 months past surgery. I could not get anybody to take my case, each place I was told the same thing.

In March after enough complaining my doctor decided to do a bone scan. As soon as I could I got a copy of the bone scan and read it. I compared it to the first scan that I had done. It said the same thing. When I went back for the results of the bone scan, my doctor told me everything is fine. He had lied to me; my knee had come lose again.

After many calls I finally found a doctor who will see me. On May 25, 2007 I see the doctor. This doctor was not at all happy with the doctor who had done my first two surgeries. I was told that my knee was lose, malrotated, misaligned, there was missing bone he had used extra cement to fill in the gap, he cracked my tibia, stretched my ligaments, the list goes on. This doctor that I'm seeing now said the first doctor knew he had made a mistake and tried to cover it up. I was told I needed to have my knee revised again.

Third Opinion

I got a third opinion to make sure I was being told the truth. The third doctor said the same thing the second doctor said.

I already had an appointment with the first doctor for June. I hadn't cancelled it yet. So I had a thought, I'll see if this doctor will tell me some more lies. Sure enough he did, he said my knee was doing just fine, that there is nothing wrong with it.

Third TKR

On July 17, 2007 I had my knee done for the third time. Believe me I was leery about the outcome. I was prepared for it to go bad again. I did have some problems, but nothing compared to the first two times. My doctor kept reassuring me things are going just fine. I was told the ligaments might never be the same. I was told that since there was so much damage done to my knee that it will take along time for it to heal. This doctor had one heck of a mess to clean up after the first doctor and did a remarkable job.

This an actual picture of my 3rd TKR

Operative Report

7/17/2007

Pre-Procedure Diagnosis: Painful, Malaligned, Unstable Left Total Knee Arthroplasty.

Post-Procedure Diagnosis: Painful, Malaligned, Unstable Left Total Knee Arthroplasty.

Procedure: Revision, Left Total Knee Arthroplast.

Anesthesia: General endotracheal.

Blood Loss: Less than 10 cc.

Drains: Orthopat and Foley catheter

Fluid Replacement: 2100 cc crystalloid.

Tourniquet Time: 114 minutes at 300 mmHg

Implants: CCK left size D femur with a straight 12 by 145 femoral stem. The size 3 tibial base plate with a straight 10 mm, 145 tibial stem. A size 17 LCCK polyethylene liner.

Specimens: Cultures and fluid for culture.

Description of Procedure: The patient was taken to the operation room, given a general anesthetic, intravenous antibiotic, a Foley catheter, and tourniquet on the left proximal thigh. All bony prominences and superficial nerves were well-padded and protected. The left lower extremity was thoroughly prepped and draped in the usual sterile fashion. Her previous midline inferior knee incision was again utilized for expose. Scar tissue was encountered consistent with previous revision surgery. I continued my dissection until the extensor mechanism and a medial parapatellar arthrotomy was performed. Some clear fluid was seen and this was aspirated and cultured. Intraoperative results would show not white blood cells or bacteria on the gram stain. Clinically, it appeared to be an aseptic

source of failure. Dissection then allowed us to further expose the knee joint. We removed an abundant amount of scar cartilage intra-articularly. Examination of the tibia grossly revealed that there was an anterior medial tibial defect with a significant amount of bone loss. The bone loss was near the tubercle region and so care was taken throughout the procedure to protect avulsion of the extensor mechanism. We initially removed the existing polyethylene liner is it entirety. We then went ahead and flexed the knee. We then in an atraumatic fashion removed the distal femoral component, preserving maximal bone stock. Any remaining cement was also removed. We then went ahead and exposed the tibia. The cemented tibial stem extension was removed in an atraumatic fashion. We removed the tibial component in its entirety along with a significant amount of cement that remained in the proximal femur. There was cement that was noted throughout the knee and it was removed carefully with mostly a bur technique to prevent injury to the bone. There was significant bony deficiency posteriorly as well. After the cement and all components were removed, we copiously irrigated all bony surfaces, removing any excess debris and derided any membranous tissue. I then went ahead and assessed my flexion and extension gaps. We initially cut the proximal tibia with a 2 mm reference with an extramedullary guide, simply to establish a proximal working surface. The bone was removed and it sized at a 3. Reaming of the tibial canal for the press-fit stem extender was then carried out. We reamed to about 11 to 12 mm range, which would allow for a press-fit 10 mm stem. We then went ahead and did a trial reduction with the tibia. When proper rotation and position was established, a nice fit was noted. I did then go ahead and work on the femoral component. Intramedullary reaming to 12 mm was carried out. Intramedullary reaming to 12 mm was then allowed to place the stem and then a fresh up cut at 5 degrees valgus made with the intramedullary alignment guide. The component was sized for a D. Rotation cut made for the CCK femur. Trial was assembled and then placed. We then did a series of trial reductions with a variety of inserts, and it was noted that the 17 gave full extension, flexion, and a nice stability throughout the range of motion. A significant amount of scar tissue was noted around the patella, and this was debrided. The patella was not damaged. It was well fixed and then left in place. Final preparations were made for the tibial and femoral components and then trials removed. Copious irrigation, cleaning, and drying of all bony surfaces was followed by mixing of three bags of cement with antibiotic and a vacuum. Components were selected, assembled, and then inserted with the cement and given adequate time for hardening and pressurization while removing any excess cement. We then irrigated one final time when the cement was hard. We selected the final polyethylene line, locked it securely into the

tibial base plate and set the screw and torqued it. I then went ahead and assessed motion and tracking which was excellent. We placed a deep drain. We closed the wound with #1 Vicryl, Inverted 2-0 Vicryl, staples for skin and a bulky bandage. All counts were correct by the nursing staff at the end of the case. She appeared to have tolerated her procedure well and was transferred to the recovery room in stable condition. Tourniquet was deflated 114 minutes and good blood flow was established distally.

Third TKR a Success

My knee is getting better with each day. I still have problems with it going out on me, because of the ligament damage. The pain is also getting better. I was told it could take up to a year, for my knee to be up to par. But since I had so many problems and surgeries that it will take longer.

The first thing I would do in preparing for a total knee replacement is:

I would make sure that it is absolutely necessary to have it done. If you don't feel comfortable with what a doctor has told you. Get a second opinion, or do research to make sure you are doing the right thing.

Research your Doctor

Do a thorough research on the doctor you are seeing or are about to see. Make sure all information you have on your doctor is accurate I thought I had a qualified surgeon and as it turns out he has had a very poor outcome of many surgeries preformed by him. If I had known everything I needed to know about this doctor. I never would have let him do surgery on me. Being in the dark as I was, I allowed this doctor to perform a total knee replacement twice on the same knee. The first came lose, because he used the wrong replacement. The second, was malrotated, misaligned, missing bone, cracked tibia, stretched ligaments, the list goes on. The third surgery was finally done correct by a different doctor. The first doctor kept telling me nothing was wrong, even though he knew different.

Malpractice

We later found out he has multiple lawsuits pending, not allowed to do surgery in 3 hospitals. I was told if I wanted to sue him to wait in line. I wished I had known then what I know now. This would have saved me thousands of dollars, and much heartache.

Information

This is a site that I found some very good information. Some of which I have related below along with my own experiences, and knowledge.



http://www.kneereplacement.com/DePuy/docs/Knee/Replacement/DuringSurgery/knee_surgery.html

Home Preparation

You will want to prepare you home before having your surgery so it will be comfortable and safe when you come home from the hospital. After all you wouldn't want to catch your walker, or crutch on a rug or cord and fall.

Choose a spot in your home that you feel comfortable, because you are going to be spending most of your time there. A great place would be the couch or a recliner. A TV tray, or table would be great to have near your couch or chair. There are many things you are going to want to have near you.

It's possible you may need to set a bed or cot in another area of your house. You may not be able to sleep in your bed. I have a waterbed, and there was no way that I was going to be able to sleep in it. I spent many weeks on the couch.

I myself used a nightstand that had a drawer, which I kept my brush and comb. I also kept the instructions from my doctor along with important phone numbers in this drawer. Under the stand I kept a garbage can.

Your doctor is not going to let you take a bath or a shower for a while. So you are going to want to have something set up to take care of your grooming needs.

I also had a pan that came from the hospital under this table, in this pan I kept the no rinse foam that I got from the hospital, along with my toothpaste and toothbrush. The no rinse foam that I had could also be used to clean my hair. There was no way I was going to be able to wash my hair in the shower or bath, for a while. I also kept a container of baby wipes for freshening up.

On top of this stand I kept a bottle of water, and my prescriptions, in doing this I was able to take my pain medication as needed. I also kept the TV remote and the phone on this stand. As you know the phone always likes to ring, when you are alone, and it's in another room. You might also want to have some reading material near you. After all it gets quite boring watching the same thing on TV, time after time.

Your flexibility and mobility are going to be limited after surgery. It took a while before I could bend my leg far enough to get it over the tub to take a shower. Grab bars are really handy to have next to the toilet or in the shower. Your knee is going to be unstable for a time, and it is nice to have something to hold onto, so you don't fall. I also had a shower brush and a long handled sponge. I couldn't bend my leg up far enough to wash my feet.

You might want to go shopping before your replacement. I bought a lot of simple foods to fix. My husband does not know how to cook. So I had to purchase foods that he could fix. There are so many things you may find that you are going to need after your surgery.

Something else I found to be quite handy, I had a basket attached to the front of my walker, for carrying things. This enabled me to do things for myself. I didn't have to ask my husband to carry from room to room for me. With my crutches I had a bag strapped to it to put things in. You learn real fast, what it is like to be handicap.

Preoperative Testing

Before you have your surgery, your doctor may order tests and may have you get a physical by your family physician to make sure you are healthy enough for the operation.

My surgeon wanted me to have a physical, blood test, EKG, and chest X-ray. Your doctor may want you to donate blood before your surgery in case you need a transfusion for surgery. As soon as you have the clearance of good health, you can then move forward with surgery.

Anesthesia

Prior to your knee replacement, your anesthesiologist will review you medical chart and discuss the appropriate type of anesthesia for you. There are two common types of anesthesia used during knee replacement surgery: General anesthesia, where you are asleep, and regional anesthesia, where you are numbed below the waist, typically with an epidural. The type of anesthesia will depend on your surgeon, your situation, and your anesthesiologists' recommendations.

Find out which type of anesthesia is going to be used. If you are feeling uncomfortable about the type of anesthesia that is going to be used, discuss it with your doctor. I had a bad experience when the doctor tried to use the epidural the first replacement. I told my doctor I was not comfortable using that type of anesthesia, my doctor then decided to use another method of anesthesia, such as general.

Knee Replacement Surgery

This is what happens during knee replacement surgery. A special instrument is used, to remove the worn surfaces at the end of the thighbone. The bone is the shaped for preparation of the new covering that is most commonly made out of metal.

The top of the shinbone is done in a similar way. The worn surface is removed, and a new metal tray is then placed on top of the remaining bone. This tray contains a hard plastic spacer that will become the new shock absorber between the smooth metal coverings. Some surgeons may replace the back of the kneecap with a new plastic surface.

Near the end of your surgery, your surgeon will attach the new metal and plastic coverings to the ends of the bones and the back of the kneecap. This can be done with bone cement where the new knee is essentially glued to the bones. This can be done without cement with certain knee replacement implants that can be press-fitted tightly into the bones and affix to them naturally. Either way, your doctor wants to secure the new knee so you can get back on your feet as soon as possible. When the implant is in position and all the supporting muscles and ligaments are working well, your surgeon closes the incision with stitches, staples or dermabond glue.

When your surgery is over, you will be taken to the recovery room. A nurse will care for you and monitor your condition as your anesthesia wears off. You may experience some symptoms during this time such as blurry vision, dry mouth, nausea, chills, and perhaps some pain. If you do, let the nurse know so that they can provide you with medication to help ease your symptoms if appropriate. After recovering from the anesthesia, you will be asked to do some simple breathing and moving activities. These activities help to prevent possible post-surgical complications, such as developing blood clots in your legs.

Generally, you can expect to be moving your regular room within one to three hours after surgery.

There are different designs for knee replacements. My first knee replacement was a nex-gen flex design. The reason for failure was the stem was to short. Below is a picture of the replacement.

The picture below is from my last replacement. The replacement is called a Zimmer. There is a website that you can go to get information on this type of replacement

www.Zimmer.com

Third Knee Revision

My third knee revision was a different design.

This replacement was done because of

complications of the second replacement.

You should receive a card to carry with you, a short time after surgery. This is what it says on the back of my card: Antibiotics required before dental or medical procedures. Implant may activate metal detectors, x-rays replica shown.

Before I have any procedure now, I'm required to have a coarse of antibiotics, to prevent any kind of infection. You can find more information on this on different websites, or ask your doctor.

 

Hospitals

Hospitals are no different than doctor. Find a quality hospital, research their reputation, and ask around, so you have a much quicker and smoother recovery. I had my knee replacements done in two different hospitals. The first hospital was great and second not so great. Even though I had a very good surgeon the third time, I was not overly fond of the hospital. The staff was not friendly at all and the care was not up to par. I had some nurses that were very rude. One of my nurses waited two hours before me a pain pill. Since you are going to be in the hospital for a few days, you'll want it to be as pleasant as possible. After all you are at the mercy of your caregiver for those first few days.

Therapist

You will also want to find a good therapist, because you are going to need one. Therapists are not all the same either, they have there own methods of doing therapy.

Aftercare Knee Replacement

Make sure you have somebody lined up to help you at home. If not, you will need to find a good skill care unit to go to.

Good Surgeon and Research

Not all people go through what I went through. If I would have had a good surgeon in the first place, I do not think I would have had all the problems that I had encountered. Learn from my mistakes, do your homework before having any kind of surgery.

Recovering and Know Your Body and Get a second opinion

My knee is still recovering, and doing so much better. Be persistent, if you think something is wrong. Don't take their word for it, you know your body, and if you think something is wrong, have it checked out. If you don't get the answers you need, get a second opinion.

Here are websites and searches I found helpful:

http://www.americanarthritis.org/portal/loader.php?seite=practical_tips_for_artificial_knee_joints

Practical Tips for Artificial Knee Joints. Today many orthopedic surgeons perform even more knee replacements than hip replacements. Although some surgeons still advise a certain amount of caution, most experts are convinced that artificial knees are at least as successful as artificial hips, or possibly even more so. The following tips offer some important recommendations. For more information, we would also like to refer you to the tips in the two previous issues of ARTHRITIS INFO.


http://www.medscape.com/viewarticle/421337_2

You will need to join their site in order to view most information. But this is a great site.

Primary Knee Replacement: Management and Alternatives

From Medscape Orthopaedics & Sports Medicine have some really good information

Great information on pain and surgery


http://www.zimmer.com/en-US/pcg.jspx;jsessionid=E5133E04339600D177DB0EEE057AD6E9.zim-prodws2-01



Experiencing PainConsidering SurgeryScheduling SurgeryBeginning Recovery

The only knee replacement inspired

By a woman's shape and size

No one has to tell you that women and men are different. But did you know that even our knees are different? It's true, and you might also not be aware that most knee replacements don't account for the differences between a woman's and a man's knee. Only the Zimmer® Gender SolutionsTM Knee matches your shape and size and has 3 distinct differences from other knee replacements-for a better fit, higher flexion, and more natural movement

Custom Total Knee Replacement

Here is some information I came across recently. It sounds great but scary at the same time. The part that scares me is what if your surgeon messes up like my first surgeon and take out to much bone. What would their solution be for this kind of a problem.

Updated 2/7/2013

2/7/2013

The left knee which was replaced is still going strong. It still gives me fits but educating myself, and knowing what is going on with that knee has help me a lot. Knowing those ligaments are not going to heal completely, let's me know, I will need to adapt, to that sloppy knee. It has a mind of it's own, but so do I. You learn real quick to pay more attention to your surroundings such as gravel. Also be more cautious when walking. A pebble on the sidewalk can send you to the ground so pay attention, so that pebble be on the ground, and not you.

Update 1/27/2013

1/27/2013

It has been a little over five years since

I had my knee replaced 3 times. July 2007

was my last knee replacement. It has been a long road to recovery since the first Doctor did the surgery wrong twice. The Doctor who cleaned up the first Doctors mess did a great job.

I still have some small problems with this knee. But only because the first surgeon did so much damage. He stretched the ligaments in my knee, which will never heal completely. I have adapted and learned to control it so well I don't even notice it anymore. Amazing how our bodies adapt to overcome a handicap.

Some ask would you recommend having a knee replacement? My answer is if I would have had to live with the first two surgeries, the answer would be no. But with the surgery that was done right, yes.

My husband needs his knee replaced, but refuses to have it done. He is afraid it will go wrong like mine did.

I'm still researching options and trying to keep myself updated on new procedures.For when the day comes and he decides to finally have his surgery.

I tell people don't let my experience scare you and keep you from having this done. I just had a bad surgeon. There are many great doctors out there that know what they are doing.

Comments 16 comments

Paul Felix 8 years ago

Hi sstar81 I hope things are well you know I never seen someone put so much into a hub I think it shows how much you've been through I dont want too take the focus off of you but Im 41 years old Ive been roofing for 20 years and I have degenerative arthritis well I need total knee replacement in both my knees my right is my worst I've been living and roofing in pain for the last 5 tears I loved my job so much finally I had my 2nd back surgery ruptured disk and I cant work anymore with my back and knees the way they are my first back surgery back in 2003 I felt so good I went back roofing this time I still have a lot of pain and its been since jan. of this year they gave me steroid shots in the back since then and nothing has worked these doctors dont seem to want to go aganst there fellow doctors when your trying to get help from another one Im impressed that you actually got help from another one.but I've been really scared of the knee surgery he told me I inly have a 65 percent chance of it working because of my age my wieght and I have a desiese of the liner in the knee you were so brave well good luck to ya ~cool~ cya


sstar81 profile image

sstar81 8 years ago from Central Illinois Author

Hi Paul

Hope things go better for you. A persons job can make a difference in the quality of life in later years. Make sure you have a good doctor before having anything done. I had a quack the first time.

I also have degenerative arthritis of the spine. I had a disc removed from my neck and had surgery done on my lower back. My husband had piece and quite for awhile after I had the neck surgery, couldn't hardly talk for 2 months. Ha! Ha!

My husband has worked jobs to that were rough on the knees. He worked as a machinest and some of the factories he worked in were not so pleasant on the knees. He had arthroscopic surgery to help with his knee problems in 2005, thinking he was going to buy a few more years before needing a knee replacement. The down fall of it is he got a severe infection from the doctor that did his knee surgery. The infection was from somebody not washing their hands. This was the same doctor that did my surgery. He now needs a knee replacement. He's afraid to have his done since I had so many problems with mine.

My husband was told he could hold off of knee surgery until he is bow legged.


Karen 7 years ago

I just had my TKR done a month ago. I knew as soon as I woke up from surgery that it was wrong. It's twisted and my thigh is numb, when I bear weight on the knee the peroneal nerve starts pins/needles and tingling down to the bottom of my foot. Of course the surgeon said nothings wrong, he wouldn't even do an x-ray. Now I can't find a surgeon who will touch me and I'm looking for a laywer and a new surgeon. At least a three laywers have talked to me one is reviewing the case now. My biggest concern is finding a good doc to replace the knee, and I'm scared. Tell me how did you find reliable info on docs and hospitals. I have not found anything by googling and spent the better part of a couple days now.

thank you

Karen T


Wanda G 6 years ago

Karen: I had my TKR FEb 2009. Like you I knew something was wrong when I woke up and could not feel my foot on the operated leg. They turned the epidural off and the feeling did not return to the bottom of my foot. I had and still have stabbing pain, stabbing hot pains, numbness, pins and needles, hyper sensativity all in my foot. It feels cold to me but if you touch it it is warm, I feel like I am standing on a block of ice that is 4 inches thick, so you can understand, it feels like I have on a high heel shoe and a flat. It makes it hard to walk, I can not get good ROM and my extension is not good, I have had PT from 3xs a week to 5xs a week to 2xs a week and I have had 3 manipulations and he wanted to do another. I have since found another OS that said I could use another knee because the one I have is boxy and I should have one that is a little more rounded. Every time I tried to speak to the OS about my problem he basically put me off on other doctors, he kept saying everything is ok on his end. I have had 3 EMG's and was told that I have tibila neuropathy which stems from the tourniquet being to tight or on too long.


Angela 6 years ago

I am 45 and my knees are very bad with arthritis they creak i hope they last out i enjoyed reading about you. And your so brave and have gone through such a lot I wish you well hope you are keeping ok arthritis is a cruel thing i have it in my spine,knees,toe joints, and a prolapsed disc also ,It would have to be the last resort before i would get a TKR as you have been through a lot

Good Luck

Angela


Lori 6 years ago

I had a TKR in June 2009. I've had RA since I was a young child. I didn't see a Dr. from the age of 12 until 44. I started out having right ankle pain, and the X-Rays said "floating bone spurs". I was refered to an Ortho and he said my knee was "bone on bone". He encouraged me to have a TKR so I did. What a mistake. I was in the hospital for 6 days. In and out of a fog. I don't even remember the first couple of days I was home. My problem is, from my knee down my "shin" (tibia) "cocks" out to the right at a funny angle and I can't walk right. My ROM is crap, but I have to admit it wasn't that great before surgery. My leg looks disfugured, it hurts all the time. I walk on my right tip toes because I still have the same ankle problem I originally went to the Dr.for!!! What could have gone wrong? Both of my legs were perfectly straight before surgery. Lori


Maxine 6 years ago

Wow! I felt like I was reading my own story. I have had three knee replacements on my left knee. It started out like yours had all treatments, therapy etc. First knee was done in Oct. 07 he put in a wrong size knee,to big and it was 16 degrees crooked. After much looking I found a doctor that did revisions and learned I needed to have the knee removed and my tibia cut to straighten my leg. A year later still in pain, heat, can't straighten or bend more than 20 degrees. Third surgery cut my bone some more, also replaced knee cap and screwed bones together. I am approaching 1 year out from the third one. I still have a lot of pain and 20 degrees from being able to straighten and only have 105 bend. Basically a stiff knee. Still have a lot of heat in the knee. Hard time sleeping hard time living. I hope you are doing much better. You have to live this to understand it. I believe I will always have pain.


Dexter 5 years ago

I had the knee operated on in 2005 they did the first microscopic immediately after they said this is not going to work you need a knee replacement. This was a second openion Doctor.

5 months later I had knee replacement. Something was wrong I knew right away. The Dr. kept saying nothing was wrong. I would wake up at night hollering the pain was so bad. 2 months later they put me to sleep to rebreak my knee loose.. It was terrible. I woke up screaming.

It still swelled was red and hurt terrible. Dr. tested for infection and said no infection . Even tho I had a place swelled up the size of a tennis ball on the side of my knee. The fluid he took out was green, yellow and (red) blood. No infection he said. In January 2006 He said I needed to have the knee replacement taken out. All set for this. after surgery he said he replaced a small part and nothing was wrong with my knee. NO INFECTION. The day I was supposed to go home he came back in and said a new infection was growing. I had to go back to surgery and take the replacement out.The infection specialist came in and said NO THIS IS AN INFECTION WE CAN CONTROL WITH MEDS.. I WENT THRU THE INTERVANOUS FOR 6 WEEKS. WAS GOOD FOR ABOUT 2 WEEKS. THEN TERRIBLE PAIN AGAIN.The Doctor said that was normal.My knee was red and swollen and he kept giving me oxydodone prescriptions (2 1/2 years of this meds. He finally dropped me and said he did not know what else to do. our family Doctor knew something was wrong and she talked to 5-6 surgeons before one agreed to just look at me. He sat across from me without touching me and said you have a very bad infection in that knee. He agreed to take me as a patient since the other Doctor had dropped me. He ordered a nuclear bone scan. I had infection in the bone 3/4 up my thigh and over half way down my leg. 4 weeks later they took the knee replacement out and treated me with antibotics in my knee , also 6 weeks of intervanous antibiotics and pills also to take. 4-1/2 months later they put a replacement back in. The Doctor said it was the worst knee they had ever seen. I had surgery so many times they had a hard time pulling the skin back together.

I still have pain if I am on my legs very much. it still swells. I feel like my leg is very weak and It gives out on me and I almost fall.

I tried to sue the first Doctor and I was not able to. I spoke to probably 10 attorneys. Since I didn't lose my leg or die they could not do anything for me. HOW SAD THESE DOCTORS ARE NOT HELD ACCOUNTABLE...


Zimmer NexGen Recall 5 years ago

@Dexter - you had a bad story.. I feel sorry for what happen to you'. the doctor is accountable of what happened to you and you just gather all the evidence needed for that case. Or the product used in your knee surgery is also accountable on it.


Sharon Tidmarsh 4 years ago

My husband had half Knee op 2008 was in a lot of pain kept going to A&E orphdepics said go home and rest 6 weeks later they decided to xray the whole knee had collapsed breaking the Tiba and Fiba 6 operations infections ostomialitas Sept last year they could do know more and amputated his leg. A surgeon has looked at the first xray and said the half knee replacement was put in the wrong place causing the bones to fracture and the whole knee to collapse.


sstar81 profile image

sstar81 3 years ago from Central Illinois Author

Hi everyone. My knee is doing great now. The ligaments are still loose but I was told they would never heal completely. I have learned to control that knee in order to keep from falling. It will catch me off guard every once in awhile. It took a long time for my knee to heal. If the first surgeon would have done the surgery right I would have avoided years of pain and recovery.

After hearing everything I heard about this doctor. I decided to check him out to see if he had any malpractice suits against him. I found nothing, but not because people didn't try. I tried to put one against him and failed. My doctor would not sign a letter against this doctor. He knew about this doctors track record. Because he had cleaned up a few of his messes and knew of other doctors who had done the same. I don't know if this is true or not, but I've heard they can lose their malpractice insurance if they go against another doctor. What really makes me mad is I still had to pay the first doctor for his mistake.

It took alot of searching to find a good doctor and alot of asking questions. It's not right when they can get away with sloppy surgery or wrong surgery.


Karen T 3 years ago

Hi all,

I have had 3 knee replacements on the same leg in 3 1/2 years. Sounds like everyone here knows that if it goes bad, you know it pretty much right away. This second revision I just had three weeks ago is more malrotated than the first two put together. I live in the Vancouver Pdx area and this dr that did the surgery was the only one I could find in 2 years of looking from Portland to Seattle. Because of the potential of malprctice issues and because the surgeries get harder to do and more chance of amputation, no one wants to touch patient like us with a 10 foot pole. Well, now this doctor, whether he screwed up because of incompetence or just shoddy work has made me even worse off, I can't walk, bend the knee past 40 degrees or so and because it is mechanically constrained by malposition I am quite sure it never will. Bottom line I m looking for someone to take me on as a patient that is highly skilled in revision knee surgeries and the kahunas (akaBalls) to fix the mess that I'm left with since I know I will probably take months or more of looking, I am starting now . Please let me know if you have any suggestions for docs locted in the pacific northwest or near to the Pacific northwest.

Thank you.....


sstar81 profile image

sstar81 3 years ago from Central Illinois Author

Hi I'm not familiar with that area. I would ask the nurses if they know of any good doctors. You can also ask the hospitals and they sometimes will refer someone. Physical Therapist would know about the doctors. Also look on the internet in your area, once you find someone ask around about their work.

I live in Illinois and it is next to impossible to sue a doctor. This doctor got away with what he did to my knee and I still had to pay him and pay for some one to clean up his mess. There are alot of orthopedic surgeons in my area so I was lucky on that issue. I was also lucky to find a great surgeon. I did go to three different doctors before choosing the one I thought was best.

I had doctors tell me I had to wait so many months before they would do anything. It seemed like time was standing still. I couldn't wait for it to be time to get that knee fixed. I knew something was wrong. It was so bad I could take my foot and turn it backwards and have it upside the other one and stand. You know it's loose when you can do that, my physical therapist kept calling my doctor and telling him there was a problem. I think he knew there was a problem and he was not going to take care of it. He no longer practices in Illinois. He is in Mississippi now.

Good luck and keep us informed if you find a good doctor.


JayeWisdom profile image

JayeWisdom 3 years ago from Deep South, USA

My knee replacement was a total failure, and I actually have more pain in that knee than in the other one, which also has osteoarthritis. If we could only know the results of surgery BEFORE it is performed, there would not be nearly as many surgeons working--at least, not in this country! The "pre-education" in this area is definitely lacking, and my own surgeon pronounced himself quite satisfied with the results after six months--even though (1) my knee was still hot as though with fever,

2) I had very limited range of motion, and (3) the pain was worse than it was prior to surgery. He never did tell me I should have an antibiotic prior to dental work to prevent infection in blood from migrating to the knee and causing infection there.

Sorry you've had such a rough time, and I hope the final "version" of your knee works much better for you.

I can't have a TKR revision because (since my original surgery) I've been diagnosed with a blood disorder that creates a tendency toward blood clots. I've been told I can't have surgery unless it is a life-or-death matter and, even then, must be monitored very carefully.


Pat 2 years ago

Finally stories similar to my own. Tried the shots had the knee cleaned up had a replacement then a revision it has never been right.

I thought of suing but thought oh who can go against the white wall of no doctor going against another. I believe what one poster said they wouldn't be able to get malpractice insurance if you did that. Finally I have a reason -it's for their own self preservation with no thought about whatever pathetic way we have been left to try and survive. What a system where we can be charged 100,000 for something that doesn't work right and there is nothing to be done about it.

In same states there are time limitations which bars tou suing of a certain amount of time has went by. I believe thats why they say wait...and wait some more. Time and our lives stand still while they protect themselves.

I am now going to have the old tkr and revision taken out and to start all over. I have been told my ligaments are streches and willl never get shorter. I will have to have a constrictor knee put in. Thank you for sharing your story so that I may have some hope. What is done is done. See if you can quickly and move on from the crummy surgeon. I have no odea how to research surgeons and if anyone has any ideas I sure would like to hear them.


sstar81 profile image

sstar81 2 years ago from Central Illinois Author

November 18, 2013 I had to have my knee replaced again because of an infection. The doctor has no clue how I got it, I haven't been sick, no cuts that were infected, no bad teeth, he told me less than 2% of people get and infection like I had for no reason. This makes the 4 th replacement, first 2 done wrong the 3rd was going well, 6 years go by and I get an infection.

I had no warning, my husband and I were out metal detecting and it was windy, so I thought my knee was getting sore because of over doing it. We stopped at a restaurant afterwards and ate. I got out of the car and my knee was hurting worse. While eating I started to get chilled and thought oh great getting the flu. I then get up to use the restroom and almost couldn't walk. Within three hours I was unable to walk on that knee. The next day I went to the emergency room and they did a blood test and it came back that sed rates elevated. I was told to go to my doctor and then he set up surgery.

I was on vancomycin from November 19 till December 26th and had home health coming to my house. My knee is doing better and I know from experience that it will take time for my knee to get back to where it was.

I have a very good orthopedic surgeon, the first surgeon is no longer in Illinois, but from what we hear he is still practicing. The last we heard he is in Mississippi.

There are many good orthopedic surgeons in Peoria Illinois things would have been so much easier if I had known this in the beginning.

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