symptoms of wrong size knee replacement

It’s interesting that you were improving over the first six months and then began to decline. I have been told by several people that the left leg is not straight. Joint infection is often a difficult diagnosis to make. It is a difficult and extensive procedure, one that almost no surgeons have extensive experience performing, and unfortunately one associated with a lot of complications. please do you have any suggestion. I wish you a full recovery. It’s possible that a revision or re-do surgery will be necessary. It aches badly. A knee replacement can fail for several reasons. Your description of the symptoms worsening rather than improving with time and “feeling like something is in the wrong place” further supports my concern. As an update to this article I have written a blog article for those who are specifically concerned about symptoms of a wrong size knee. Call 954-489-4575 or visit to schedule a consultation. This site uses cookies. I do suspect you will need further revision surgery. Now I’m needing the other one done but keep putting it off because I’m not happy with the one I had replaced. My R is perfect, no complaints but my L has increasingly become more painful. The Synovasure test has really helped me to clarify if an infection is present or not, even with negative cultures. “Bone on bone” pain is one of the main reasons why arthritic knees are painful and a major trigger for patients deciding it’s time to choose knee replacement. Fort Lauderdale, FL 33334 The most common symptoms of a failed knee implant are pain, instability, swelling and stiffness across the entire knee (generalized) or in a small section (localized). Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. I suggest you discuss these concerns with your surgeon who will have specific recommendations. If the femoral component is under sized, it often results in a loose flexion gap. i am in a brace. I went a month with no redness and now it’s back last week. When a patient is not happy with the result after surgery, it is very important that we understand why. Fort Lauderdale, FL 33334 I would suggest you return to your surgeon and discuss your concerns and complaints and look for his or her advice. Click to enable/disable essential site cookies. Is it because of my weight or am I due for a replacement? This may be a clue to the underlying problem. You can also change some of your preferences. An orthopedic surgery expert witness opines on a case happened in New Mexico where an orthopedic surgeon carried out bilateral knee replacement surgery and fit the patient with the wrong size prosthesis. I can straighten and bend my leg well when it’s not swollen. If too small a tibial component is implanted and does not rest on the hard peripheral bone of the tibia, then there is an increased chance that the tibial tray will not remain stable and will subside. I think it’s always reasonable to get other opinions from different knee surgeons who may have a different perspective or experience. I found a new ortho and they did a bone scan and it showed loosening. In short, I seem to be no better off now than I was before the operation…which is really, really frustrating – especially when all I ever get from the surgeon is “Everything looks good – there’s nothing left to do.” I have a feeling I’m a victim of “soft tissue” complications, with something just rubbing the wrong way against the components. Some patients have subtler complaints such as the “new” knee simply is not comfortable or “doesn’t feel natural.” If they’re experiencing pain, is the pain only with activity such as walking, or is it present all the time, even at rest? If this is what is going on, then diagnosing and correcting the problem can lead to a good result. Chances are, it is high time that you undergo knee replacement surgery before things get from bad to worse. I was faithful to my therapy. Now my Dr. says maybe I should have a patella put in / 3 months in a cast, straight leg with no guarantee that will solve the problem. Had a TKR in March 2016. This site uses cookies. A prosthesis that is extending beyond the peripheral margin of bone can also potentially irritate overlying tissue. In special circumstances a CT is ordered to help better understand component positioning. Is the kneecap tracking or does it slide off to the side during flexion? I wish you a full and satisfactory recovery. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at In addition to the swelling that can occur, another symptom of a failing prosthesis can include noticeable warmth of the joint. Op rpt is only 1 page long & very inarticulate. i dont know what to do. If your treating surgeon has not been able to identify the problem, I also would recommend you find a specialist who can. If other causes such as loosening or gross mal-alignment are not apparent, in my practice I’ve had great success diagnosing subtler problems by using the VERASENSE OrthoSensor, which provides quantifiable data for analysis and then directs correction. My knee is getting deformed (bow legged) and it causes a lot of pain. Other reasons for anterior knee pain and a patient feeling like their knee is not stable is the patella not tracking centrally down the front groove of the femoral component called the trochlea. What is the main complaint? If that is the case, the operation your surgeon is recommending may be your best chance for success. No other surgeon will touch me for at least a year post op. If there is a mechanical problem or soft tissue instability underlying your recurrent problem, then that needs to be corrected in order to ultimately resolve your condition. Have had major complications with pain & instability. This case involves a seventy-eight-year-old male patient with a past medical history of osteoarthritis and hypertension. Along with pain, you are likely to experience swelling, a reduction in the range of motion … Otherwise you will be prompted again when opening a new browser window or new a tab. It feels like a tendon or ligament ended up in the wrong place, upon flexion/extension in get a popping feeling that causes pain, & a ice pick pain in the knee itself along with increasing stiffness the longer I’m on the knee which is all day & sometimes pain while sedentary. You are free to opt out any time or opt in for other cookies to get a better experience. Ultimately, if the situation is to be rectified and the problem corrected, then the specific etiology must be clearly delineated. Can’t get back to normal life or enjoy anything. You can read about our cookies and privacy settings in detail on our Privacy Policy Page. Can you guide me to someone in NY who can help? You can check these in your browser security settings. Soft-tissue balance and restoration of the joint line? General comments will be answered in as timely a manner as possible. First, I think other diagnoses that may be causing your problem should be considered and ruled out. I live in South Georgia. My surgeon wants to operate and take out the liner, clean and irrigate and take a tissue sample. My surgeon initially tried to say it was all in my head. This surgery can be very debilitating physically n mentally. If this individual is not able to help you, I would recommend you seek out other opinions from orthopedic surgeons with a special interest and expertise in TKR and revisions to help you solve your problem. Many reasons can cause your symptoms. Hi He does not return calls. I wish you a full recovery. My advice is to discuss fully with you surgeon your concerns about having more surgery and what he or she thinks is really going on. I think a second opinion may also be appropriate. it just feels like I have a block of wood in there and experience severe pain when PT pushes it to 107. I did great with it. Typically, I would expect your symptoms to be improving or at least stabilizing at that point. All of these should be assessed and compared to the well-functioning TKR. any suggestons. I have had success treating in a number of patients using kinematic sensor technology to help me pin point the mechanical problem(s) and then address surgically to correct. By sandees3 June 7, 2010 - 5:35pm. Surgery must address the underlying problem and correct it. A new test has recently become available called the Synovasure™ test. This just came on in the past week or so and although very active, I cannot recall a specific event that may have caused this. If in the interim your results are worsening (that is, you are losing ground with less ROM and more pain) then look for solutions or other opinions sooner. I would recommend that you discuss your concerns with your doctor. Infection always must be considered. What to Do if You Suspect Knee Implant Failure: Don’t hesitate to contact your surgeon immediately. I had 3 months of vigorous therapy and they can’t do any more. Other aspects of you knee also must be evaluated including alignment, component sizing and position, as well as stability. Many times bone spurs or osteophytes develop behind the femur and tibia in an arthritic knee. If you’re this uncomfortable and dissatisfied one year after your surgery, I would encourage you to continue to pursue further diagnosis and treatment. It appears that with time, your symptoms have become worse. My balance seems good the moment after I have them and walk with a better stride. It is unusual for someone as young as you to already have undergone a TKR. Most likely, it will be surgical. At surgery the patient’s bone had to be sculptured so as to fit the available sizes of implants. Does the patella appear to be tracking centrally or is it pulled to one side? Get Directions, Phone: 954-489-4575 Ohhh please tell me what’s going on with this thing. This is a much more predictable surgery with a lot of benefits. Do I need revisions? The supportive soft tissues that support the knee are not balanced and / or the components not optimally related to each other (congruency) in some individuals who have undergone TKR will present similar symptoms. My skin is very sensitive; I cannot kneel on that knee at all. The majority of patients who undergo knee replacement surgery experience successful outcomes, with long-lasting improvements in pain, mobility, and knee function. It has been cultured twice in the last three months and has come back negative. When too little patella bone is resected, the total thickness of the reconstructed patella is increased and can result in abnormally high forces created between the patella and the femur when the knee is flexed. Today I still do my exercises. Average . Here are some of the symptoms you need to be on the lookout for, the cause you will need to avoid and treatment option available in case of a blood clot. I’m doin all I can. Unfortunately 20 to 30 percent of those who undergo TKR are not satisfied with their results. The Physical therapist just threw up his hands and said that I was not going to get better than this. Some patients develop nodules of fibrous tissue on the undersurface of their extensor mechanism, most typically where the quad tendon inserts into the patella. In February 2015, I underwent bilateral arthroscopies with resection of scar tissue. Partial knee replacement surgery is not always a successful method of pain relief. I am scared to death of more surgery. Based on my history do you have any opinion as to what might be wrong? Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. Though knee-replacement implants are indeed built to last, unusual amounts of friction and use can lead to bone less and cause the implant to either wear out or loosen. She had the surgery 12-01-09. the doctor told her decided to go with the smith and nephew complete knee replacement. Infection, though unlikely, also needs to be ruled out. This is often associated with lumbar degenerative arthritis which can result in spinal stenosis and elicit the kind of symptoms you report in you right upper outer and inner thigh. In May of this year my Sciatica flared up and my right hip is elevated. Many people have knee replacements (also called knee arthroplasty) because they have osteoarthritis. Correct Knee, Wrong Implant. I call these “the surgeon’s goals” which is what I try to achieve during an operation and, when accomplished, helps assure a stable, pain-free knee with which the patient is happy. By continuing to browse the site, you are agreeing to our use of cookies. Hi. This past week I’ve had some pretty significant pain behind the knee cap area at certain points of flexion when walking. Click to enable/disable Google reCaptcha. Yes for about an hour. I wish you a full recovery. I keep saying something is not right, I have discussed this with the surgeon and the xrays for both knees look different. Fortunately, you live in a part of the world where there are many capable orthopedic surgeons. Dr. William Leone. Inquire if there is another way to learn if the knee really is infected short of exploring, debriding and changing the plastic. So years later when a TKR is done, an attempt is made to balance the surrounding supportive soft tissue sleeve. If the exact reason for you poor result can be defined, then it can be addressed. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. If your surgeon is concerned there is underlying infection, in spite of you reporting two prior negative cultures, then I agree with his determination to rule out infection above all else. Pain is the most common warning signal that will alarm you. Fax: 954-489-4584 While it is possible that you have developed a CRPS (Complex Regional Pain Syndrome), which is characterized as a dysregulation of the central and autonomic nervous system, I would consider this a diagnosis of exclusion. Pain that comes on with activity and limits what you can do is a clear signal to seek help. It’s interesting that you were improving over the first six months and then began to decline. It’s normal for patients to experience some degree of pain up to six months after surgery. Sometimes, we can start to experience aches and pains in our hips and knees, the body’s largest joints. My wife range of motion in her knee is not quite 90 degree. Can they do something that improves or relieves the pain such as assuming a particular position with the leg, using ice or pain meds, etc.? i have had 2 tkr on LT knee in less than 2 years. It is impossible to simply “walk through it”, as the body instinctively recoils, and I end up limping. In fact, certain patients can continue to experience chronic knee pain symptoms after surgery, MedlinePlus reports. Knee pain may be constant or can occur intermittently after increased physical activity. After TKR, which would have corrected your alignment, it’s possible that more stress was placed on the tendon resulting in a tear. Thank you for taking the time to address everyone’s issues. In past blogs, I described the conditions that need to occur for an optimal result after partial or total knee replacement. If you remain this disabled, then I would recommend that you seek further opinions from orthopedic surgeons who specialize in TKR and revision. What I have outline is one possible reason. I also am getting atrophy in the calve of my leg. Was the same manufacturer and prosthetic knee used for both reconstructions or were they different? This helps for about 3 days. My wife is 5' tall. I am now needing surgery again. It remains my policy not to recommend specific surgeons or institutes in this format. Please be aware that this might heavily reduce the functionality and appearance of our site. If infection and other etiologies are ruled out and your physicians do think you’ve developed a CRPS, direction of care from your pain management physician will be very important. The condition more typically develops in those patients who achieve high degrees of flexion after a knee replacement (>120 degrees), is more common with certain knee designs like posterior stabilize (PS) > cruciate retaining (CR), when a patient has patella baja (when the patella is low riding or more distal relative to the joint line than normal), or when the femoral component is excessively prominent or flexed, and occasionally when the total knee reconstruction required correction of significant angular deformity. I am 68 yr. old female, 5’1 and 107lbs. While it is possible that you have developed a CRPS (Complex Regional Pain Syndrome), which is characterized as a dysregulation of the central and autonomic nervous system, I would consider this a diagnosis of exclusion. Being active is the norm for many of us who live at the beach. I am very unhappy with the limitations of my knees, especially since I worked very hard on my rehab following the original surgery. Total knee replacement surgery. You describe postop medical complications as well as weakness, pain and deformity associated with your TKR. Although knee replacements normally perform well for at least 15-20 years in more than 95 percent of patients, Dr. Ranawat says there are five primary reasons why a knee implant fails: Wear and loosening: Friction … This is actually not uncommon and I often refer to this group of patients as “looks good but feels bad” because their X-rays often look acceptable, their incision healed nicely, they can walk a short distance without a limp but are miserable with continued activity. Thank u for any information. Some studies estimate 20% or more fall into this category. Seven weeks is a very short time after TKR surgery and certainly your knees are not fully rehabilitated. During extension, this normal rotation or pivot reverses and the tibia externally rotates. Even optimal sizing of the patella (knee cap) component is critical. I’m going thru simular situation. I (male, age 58) had a left-knee TKR in December 2014, after 4 separate arthroscopic procedures over the prior 30 years had finally left me with consistent bone-on-bone pain. I’m a 66 year old male who had ligament surgery on my left knee at age 23. The new Dr. did a very through exam ( including reviewing all X-rays) and ordered a bone scan which was inconclusive. Some total knees retain the PCL (posterior cruciate … I had sedation and manipulation and left right from the surgical recovery to PT. My advice is to return to you surgeon and share your frustrations and symptoms. Symptoms Of Knee-Replacement Failure. I wish you a full recovery. for Orthopedic Care Artificial knee replacement surgery is a major surgery. I had a tkr ,manipulation , patella put back on,adhesions removed and another tkr in august. I actually returned to sports (slow pitch competitive softball) in August without any issue. I had TKR & am 3 mo. I live in Houston. Sometimes this is referred to as “over stuffing.”. We need 2 cookies to store this setting. Mark, there are many reasons why your knee may hurt. We thank you for your readership. I had a partial knew replace Dec 2014. Don’t know what to do worse pain since hip replacement loss job of 21 years and was told hip was put in at wrong angle and now leg length discrepancy. Depending on your answers to many of these questions, the risks of repeat revision must be weighed against the benefits. Dr. William Leone Not olny that but it is swollen. What I have outline is one possible reason. He now wants me to do a white cell progressive test to check for infection. He never says too much, about ” where do we go from here”? Well it’s been a year and 4 months. The patella component is a plastic dome with pegs that is cemented into the bone of the patella. What can I do,I am very discouraged and frustrated and my surgeon now says he really does not know what his next step will be. Particular bands or types may have known problems and a poorer track record than others. I didn’t sign up for these results. We may request cookies to be set on your device. I recognize that when people go on line and search ‘symptoms of wrong size knee replacements”, they are looking for answers. Retired after the surgery; I couldn’t stand anymore. Pain may be the most common complication following knee replacement. Symptoms to your ipsilateral knee need to be ruled out. For many who fall into this category, it is secondary to subtle soft-tissue imbalance, component malposition or limb mal-alignment. I have fallen several times, my leg just gives out on me; just not steady. Several products are on the market to suit knee replacement candidates of all walks of life. He also examined my mri before surgery and said I did not need a tkr,as I wasn’t bone on bone.But,he also said,he wouldn’t do the surgery. I had my TKR done on October 1 2015 and a manipulation done 5 weeks later due to declining results in flex and extension numbers. General comments will be answered in as timely a manner as possible, I had my Tkr done March 14 2016. You are free to opt out any time or opt in for other cookies to get a better experience. If more surgery is recommended, then either your surgeon will feel comfortable doing it or not. It is very concerning that your knee is developing progressive genu varus (bowleg) deformity and that it is causing pain. Here I am six months later and now,my shoulder has a rotator cuff tear,have back and right foot pain and feel as if this surgery has DISABLED me and afraid I will end up in a wheelchair. It is reported that 20% or more of individuals who have a TKR are not satisfied. Knee Replacement Surgery has helped millions of patients to restore knee function and mobility. Does the discomfort awaken them from sleep? We also use different external services like Google Webfonts, Google Maps, and external Video providers. The underlying reason that required you to have TKR in the first place needs to be understood, i.e., rheumatoid, tumor resection, trauma, etc. I am 7 weeks post op on my left knee it has great flex also but it hurts more every day and it is from standing and walking. Some goals simply are not reasonable, such as long distance running or team soccer, particularly if the new joint is to enjoy longevity. Now it is still numb and it feels as if it’s going to go through my skin. It is important to test for stability with the knee in extension and various degrees of flexion. I’m very frustrated. Is knee alignment acceptable? The supportive soft tissues that support the knee are not balanced and / or the components not optimally related to each other (congruency) in some individuals who have undergone TKR will present similar symptoms. I would suggest discussing your concerns and frustrations with your surgeon and look for his or her advice. And it’s critical that the components implanted match that patient’s own anatomy and are fixed rigidly to their skeleton. Because these cookies are strictly necessary to deliver the website, refuseing them will have impact how our site functions. Since these providers may collect personal data like your IP address we allow you to block them here. I have trouble getting dressed, can’t make it all the way through grocery shopping. My advice is to discuss fully with you surgeon your concerns about having more surgery and what he or she thinks is really going on. It is typically performed using an allograft, which is tissue from someone who has died. Mrs S suffered bilateral anteromedial osteoarthritis and required replacement surgery to both knees. Small degrees of component malrotation and/or soft-tissue imbalance can lead to compromised results and pain. Patients can have a variety of symptoms if their knee replacement is loose, often including pain and mobility issues. If your knee replacement fails or wears out your doctor may recommend that you have a second surgery called revision total knee replacement. Click on the different category headings to find out more. Hip arthritis can also cause these symptoms. When a knee replacement fails whether its shortly after surgery, or many years later it may require a revision, or re-do, knee replacement surgery. During both total knee and partial knee, we replace the end of the femur bone with a component that must match the natural femur’s boney dimensions before significant arthritis or deformity develops. Swollen to ankle walking or laying for months, now only walking. Therefore, I suggest you return to you surgeon and share your concerns. Is the knee tender? Does the knee fully extend? Chest CT clear & bilateral LE Doppler clear. The Synovasure test has greatly improved our ability to diagnose infection and helps differentiate inflammation and other causes of knee pain from infection. I’m concerned that you knee is getting worse with time not better. I had a TKR in June 2013. Every year, more than a half-million Americans opt for the procedure. My TKR is about 15-20 degrees out of alignment. We thank you for your readership. Similarly, a review of the X-rays that were taken prior to TKR also gives clues regarding the knee’s pre-operative deformity, appearance and underlying anatomy.

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