Surgery a Second Time
The Problems with Revision Surgery
Not all surgery goes well. That is a fact. Some operations fail. Sometimes we know why and sometimes we do not. When we do not patients sometimes think information is being hidden from them. I assume this does occur. But sometimes we just don't know why.
I perform a large amount of revision joint replacement surgery. Like most joint replacement specialists I actually do not revise many of my own. A joint surgeon's failure rate is generally quite low. I do a lot of revisions because I was trained in specifically doing them and many surgeons choose not to take these complex cases on. I am now well into my second decade of revision joint replacement surgery here are some pieces of advice I can share from experience.
If you are having a problem with a joint replacement it is extremely important to know exactly why. In other words- what is the cause of the failure? Is it infection? Is there a fracture? Did the metal crack? Did the plastic wear? Making a diagnosis is the most important step. This may include a series of many tests. Do them. Get a diagnosis.
What are your options? This is the next is to understand all the options- surgical and non-surgical. While I rarely recommend non-surgical treatment for a joint replacement failure, there have been occasion for this. A good example is a failure of a hip replacement in a bed-ridden patient. Another example is a patient with a severe medical history that will put them at grave danger in any operating room.
Who will do your surgery? Revision joint replacement surgery is not for the untrained, uninitiated, or general Orthopaedic Surgeon. There are a range of skills, techniques, and tools that are the domain of the specialist in this.
What result can you expect? In general, here is the bad news. Everything is worse after a revision. There is a higher infection rate, a higher limp rate, a higher limb length discrepancy rate, and so one. This does not mean that you will not get an extremely satisfying revision joint, it just means your risk of a worse result are higher.
I hope this helps some of the questions posted on my Arthritis message board with regard to this topic.
Dr. K.
Related Topics: Illnesses Hamper Joint Replacement Recovery, Is Less Invasive Hip Replacement Surgery Best For You?
Another interesting arthritis blog
Not all surgery goes well. That is a fact. Some operations fail. Sometimes we know why and sometimes we do not. When we do not patients sometimes think information is being hidden from them. I assume this does occur. But sometimes we just don't know why.
I perform a large amount of revision joint replacement surgery. Like most joint replacement specialists I actually do not revise many of my own. A joint surgeon's failure rate is generally quite low. I do a lot of revisions because I was trained in specifically doing them and many surgeons choose not to take these complex cases on. I am now well into my second decade of revision joint replacement surgery here are some pieces of advice I can share from experience.
If you are having a problem with a joint replacement it is extremely important to know exactly why. In other words- what is the cause of the failure? Is it infection? Is there a fracture? Did the metal crack? Did the plastic wear? Making a diagnosis is the most important step. This may include a series of many tests. Do them. Get a diagnosis.
What are your options? This is the next is to understand all the options- surgical and non-surgical. While I rarely recommend non-surgical treatment for a joint replacement failure, there have been occasion for this. A good example is a failure of a hip replacement in a bed-ridden patient. Another example is a patient with a severe medical history that will put them at grave danger in any operating room.
Who will do your surgery? Revision joint replacement surgery is not for the untrained, uninitiated, or general Orthopaedic Surgeon. There are a range of skills, techniques, and tools that are the domain of the specialist in this.
What result can you expect? In general, here is the bad news. Everything is worse after a revision. There is a higher infection rate, a higher limp rate, a higher limb length discrepancy rate, and so one. This does not mean that you will not get an extremely satisfying revision joint, it just means your risk of a worse result are higher.
I hope this helps some of the questions posted on my Arthritis message board with regard to this topic.
Dr. K.
Related Topics: Illnesses Hamper Joint Replacement Recovery, Is Less Invasive Hip Replacement Surgery Best For You?
Another interesting arthritis blog
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37 Comments:
Dr. K.,
I had partial left hip replacement 13 mo. ago, due to a fall. Everything was replaced except the socket. Now I am having groin pain, and my O.S. thinks it might be the socket. He wants to do an injection of anesthesia to that area to determine if it is the socket. Then a total hip replacement. I dont feel comfortable going back in for another hip replacement. I have not fully recovered. I limp, have to use a cane, have some discomfort in the thigh area both in front and along side, plus when I bend over, I have pain under the buttocks area. Also it would seem that I have more discomfort when I drive a stick shift instead of an automatic.
What do you think?
Sherry in Arizona
The Question is:
Why did you have a partial hip in the first place?
As I noted in the blog entry- making a diagnosis is key- there are so many more questions needed to be asked in your case.
Dr. K.
Dr.K
I had a revision of a TEA last Augest. I still have swelling in my arn, from about 4 inches above my wrist to above my elbow. I went to the doctor who did the surgery and he drew enough fluid to do a culture, which was neg.Also my little finger and ring finger is numb. I think the numbness is from the swelling but I can live with it. I know nerve damage is sometimes a result of replacement surgery. I just don't understand the swelling and the sergeon won't talk to me about it. He just tells me how good my range of motion is. And it is very good. Is there any thing that can be done about the swelling????? Does the swelling have anything to do with the numbnes??? Any help you can give me about this I think you for.
Polly
gmap@ev1.net
Dr. K
About 25 years ago I crushed my right shoulder to the point that the Glenoid bone was totally gone. After 6 operations attempting to fuse the arm and shoulder into one, it was decided there was nothing else to do. There are 4 screws, all of which have broken, and scar tissue is all that is holding the arm and shoulder bones together.
At the time, I was seen by UCLA, the Mayo Clinic, Cleveland Clinic and by over 150 surgeons. They all said nothing more could be done and that when the time came, everything would just let loose and the arm would have to be removed which is what they wanted to do back then.
I live with a great deal of pain and I am lucky to have a Doctor that understands what I am going through. My wife and I have wondered if there have been any new things that might help.
The last ortho I saw about it was about 3 years ago and he said there was nothing more to do.
One problem I have failed to mention is the fact that while the screws have broken in 2 and 3 places, I have another problem. My body is dissolving the screws. I know this sounds crazy but even me teeth that have caps on them, if there is a stainless steel post, my body has dissolved them. This has not given me much to really lean on when all of the shoulders I have seen have stainless steel.
Any ideas.
Mean while I take voltrex and when it comes for time for my kidney shut down from the mecidine then will I be able to get my knees replaced I am 46 I am cripples half the time but I dont need surgery said the md what the heck do they know about pain pain can drive you insane i know
o Ppolly:
Your surgeon is too good to talk to you....
The swelling is probably putting pressure on the ulna nerve- ergo the numbness. Elboe repalcements are poor operations and revisions worse. If you get good ROM it is a good start. The swelling is probably due to chronic instability. Try resting it in a sling for 4-6 hours a day to start. Consider a hinged elbow brace.
Dr. K.
Dr K,
I had TKR and had pain ans swelling for 4 years. My ortho would not listen just gave pain meds. Went to new Ortho and was determined I was allergic to nicklel. TKR had to be redone. I have had quite a few health issues since this first TKR. How would long term exposure (4 years) to the nickel effect my body? I am very concerned. My 1st Ortho did not do any allergy testing. The new Ortho said when he took the 1st knee out it was a nasty mess inside my knee. How is this going to effect my health and what should I do?
please respond to balphin@bellsouth.net
I had a TKR 1 year ago and was recently told I would have to have this replaced - appears it is loose? Bone scan was done. I have been seeing the same ortho surgeon should I see somebody else, do I need a second opinion. I don't blame the physician - I guess I don't really know why it didn't hold. Is this something that can be told now or not till after the surgery? You stated that the surgery is more difficult - he told me the surgery and recovery will be more difficult. I was off work 4 months the first time and I can't afford to loose this job, he said I could come back in 3 weeks with a cane. Is this realistic? I am a nurse in a home health agency - no actual patient care - I supervise staff. Do you have any information on femoral block for pain control. I was told he now uses this and I am very nervous - I had good pain control with IV meds and Vicodin last time. Don't I have the right to refuse the femoral block? Thanks for any help you can give me.
I had a TKR on 10-07-03 and a partial revision on 10-08-04 as the safety screw backed out and after a couple of weeks got stuck in the spacer. The spacer was replaced and vast adhesions removed. The physical therapists all say they have never seen a knee like mine, and that until the knee mechanics are right they can't help. The leg swells from the upper thigh to the ankle, it is very painful and I can barely walk in the morning or after riding in a car. My other knee has been bone on bone for over 4 years and taken such a brunt of force and pressure it hurts almost as badly. I cannot find anybody who even does revisions as I live in a small midwest town. Ideas?
I had a tnr and a rework. What can cause the knee to knock.
I had TKA 5 weeks ago and the pain is so bad during the night i wind up sleeping in the recliner. i keep ice on it. what medicine can i take to relieve this? why does it still pain so bad?
Dr K,
I had knee surgery in Jan. of 2003. Recently I have been having a lot of pain in that knee. I am a student and I don't have health insurance, but I made an appointment at the student health center (an Orthopedic surgeon volunteers his time to see student's there once a month). I have a large screw holding my knee cap in place, and he said that the pain could be a result of scar tissue that built up aound it and that is what may be causing the problem, because it could be pushing the screw out. I can feel the screw when I lightly run my thumb over the area. Is this normal, is it cause for another surgery? The Doctor that I spoke with, said that one of my options would be to have surgery again to remove the screw. However, I am confused as to what that would mean, wouldn't that completely disregard the reason I had surgery in the first place?
I would really appreciate any information and advice you could give.
Thank you,
Stephanie in New Mexico
Is it "normal" to need a blood transfusion 2-3 days following a total hip replacement? I recently had the surgery, did not require a transfusion during or immediately following the surgey and then was told (3 days later - while still an inpatient) that I immediately needed a transfusion. Thank you. I am just concerned that something else may have been causing the low blood count and low blood pressure - 66/55
Dr. K.,
2003 had TKR, 6 mo. later constant swelling & pain, surgeon reentered to find knee cap & platform deteriorated & replaced both. Next day he shared with me that a large amount(about 14 oz.)of thick "strange" fluid had been sent to the lab...no ID made! Pain & swelling persists. Long ago, I had artificial toe joints that literally disappeared...
diagnosed as Giant cell reaction to the material. My search for a non allergy type of material has led me to creamic joints...do you or someone you could recommend do replacement of the platform or knee cap with ceramics? Other knee is desperate for replacement but haven't been able to proceed...affecting the hip now too! Lee in AZ leeswpromo@msn.com
I had a TKA a little over a year ago. The recovery was difficult and I am a very active 59 year old female. I started having medial knee pain a month ago and it has gotten worse. I just had a bone scan and it is apparently loose. Should I get a second opinion before pursuing a revision?
Dr. K,
I am a VERY healthy 40 year old that has never been happy with the appearance of her feet. I saw a Board Certified Podiatrist that said the lumps I had near my pinky toes were Taylor Bunions. He shaved down the bones and now, 7 mos later, I have developed an infection on my left foot. After having an MRI I was just told that the infection is down to the bone. I'm doing as much research as I possibly can and was wondering if you had any information to share with me regarding removal of a portion foot bone. Thank you.
I had THR 4 yrs ago and have had A LOT of pain the last 2 yrs. Now my OS says the joint may be loose so I have to have a bone scan. What r my options? does anyone have a similar situation? I really don't want to go through another surgery. I am only 38 yrs old.
Dr. K.,
I had a TKR 18 months ago and required a complete revision. I had a lot of pain and the test results showed a "shifting". When they went in, it was infected and they removed it and put in a spacer. After 12 weeks, the infection appeared to be gone and they proceeded with the revision. It has been only 3 months, but I have been sick ever since. The knee pain is a bit more than what I expected after the first one, but manageable; but after long term antibotic use, my stomach and bowels are terrible. I have lost over 30 pounds since the second surgery and my appetite is gone. My doctor told me that could be expected for up to a year. Why is that and isn't there anything I can do? I stopped all PM because I thought it might be part of the problem.
SEF
Last year, my husband had his left
knee replaced (total replacement). Everything was ok for a while, with great reduction in pain, and
he regained quite a bit of mobility. However, without warning, his knee started swelling up with what we thought was fluid. He went to Dr. had a full blood screening and then a bone scan - all came back normal, no sign of infection or other issues. Dr. prescribed Celebrex. The knee was better for a little while, then it started swelling up again.The doctor drained the knee and the fluid was just blood - no other fluids.
My husband had surgery again week before last to find out what is the problem and the doctor couldn't find anything wrong with the knee. Dr. did a bit of cleaning but nothing is out of place, no cracks on bone or the
implant. Knee improved for about 6 days, then the swelling and pain
returned. My husband went to see Dr. but his only suggestion is
to go back in and smooth out the patella which is a little rough but nothing out of the ordinary, according to the doctor.
The swelling on the knee is to the point where my husband cannot bend it enough to go down the stairs. Whenever the swelling comes back, he will ice it but that doesn't help much. The swelling goes down on its own and can return without warning. When the knee is swollen, it is warm to the touch.
We are now at a complete loss about what we should do. My husband is working on getting an appointment for a second opinion, but in the mean time, we are trying to find out if anyone has any info on this problem.
Thanks!
my active 76 year old husband had both knees replaced in 1990. they
have served him well. earlier this year he has had increased pain in both knees and the right knee is making a scraping sound. we went back to the doctor and after x-rays he told us that he thinks that my husband has worn out the lining of the replacement.
my husband wants to have surgery to replace the linings since the pain is severe. can you please tell me what is involved in a "lining replacement" or direct me to a web site to learn more about this? thanks !!!
y name is Valerie and my doctor doesn’t know what's wrong with my foot and don't know what to do. He wants me to see another doctor....because he has no idea what's going on with me.
It started 2 years ago with a bunion, I had the surgery around 11/05. My foot wouldn't heal and stayed swollen and painful. My doctor thought I was having a reaction to the screws and wire that was in my foot after the surgery, so he removed them. I still kept having the same problems (swelling & pain) we did a blood clot test & that came back neg.,durring this time I also had a touch of staff infection & was on medication for it. Still having all the same problems, we had an MRI done, a week after that I went for a sent me for a bone scan...because both test were contradicting each other I went in for a bone biopsy. The came back that the bone now had died in my right foot, right side. So, my doctor sent me in for a pick line to have iv antibiotics and I went in for my 4th surgery to have bone removed from my hip to replace the dead bone in my foot, I also have a plate & six screws to hold it in place. At the same time I had the bone shortened on my second toe due to that bone was also dieing. This surgery was 11/06. I have also had a "chunk" of bone taken out on my right foot, right side, due to it never healing as well.
After this last surgery I had another touch of staff and was on medication again. And the swelling & pain is still there. Even my doctor said something is causing the swelling and that it should be like that...it's been almost 8 months since the last surgery. My doctor & I just want to know what's wrong with me & how can it be fixed....it's been 2 years now that I've been in pain & my foot been swollen..I really don't want to just "live with it".
This is a quick version, would you have any idea what could be the cause of my swelling & pain. It's in my foot, ankle & calf.
Thank you,
Valerie
valerie0424
valerie0424:
To ask questions about your specific situation, please visit our message boards
Thank you.
I had a total knee replacement on my left knee five months ago. I was in the hospital for eleven days, due to a high fever and infection. I went through two complete rounds of out-patient therapy. I have good range of motion, but my knee keeps filling up with fluid and therefore tightening up on me, it is also warm to the touch. The last time my doctor drained the knee, he sent the fluid for analyzation - the results were normal (no problem with white or red blood cells and no "crystals"). Whenever I ask my doctor what is going on, he says he doesn't know. He has told me that sometimes the swelling goes on for 1-2 years - this doesn't seem right. What do you suggest?
i dont know if this is your field or not, but i do have a couple of questions. i have an "acl" cadavar replacement, put in with plastic dissolveable screws. how long does this take? can a body be "allergic" to them,and what are they made of? can it make a person ill?
I AM IN THE MILITARY AND WAS TOLD I HAVE A LEG LENGTH DESCREPENCY. I WAS GIVEN INSERTS FOR MU SHOES BUT IT STILL HURTS.....
I had total right hip replacemnt March 2007. My right leg is approx 1 inch longer than left. I walk with a limp but most of all I have thigh pain when walking and climbing stairs. Went to another surgeon he has requested bone scan and xrays for he feels I need a revision. I am 62 in fairly good health, are there any other solutions other than revision
I'm 56 and both hips have been replaced. Original problem was at birth. The second hip (done in '96) grinds and slips out of the socket. I also am looking at a knee replacement in same leg. Pain and lack of stability are major problems but doctors can't seem to find a problem. I've had bone scans and fluid drawn from hip. Tests are negative. Now I'm reading revisions are not "all that" either. Not sure what to do. Unable to work but would love to. Please help!
Dr K. I had a total knee replacement in 2004 and the pain is much more than before. They say nothing is wrong with it. They say it is Fibromyalgia but I feel that isnt the case . I cry every night to sleep i am in so much pain. They pain meds dont even help ....
Doctor- In July I had a screw placed in my right thumb because of a ruptured ulnar collateral ligament. The area is swollen and sore when I pinch with my thumb. My recent xray showed nothing wrong with the screw so my doctor feels that for some reason I just did not heal.
I am in excellent general health.
She wants to go back in , "clean out the area" , and replace the screw.
Any thoughts?
Betsy
my knee swelled up over night and is very warm to the touch, i did not hurt it just a small cut what should i do...
My 60 year mother, who has severe RA and Fibromyalgia fell and broke her hip in seven places. She had a hip fracture surgery that resulted in 3 screws and a section of her hip "glued" back together. She is experiencing severe groin pain. She went back to the surgeon who did X-rays and CT scan. The surgeon feels that the groin muscle has not positioned itself properly and his recommendation is to wait and see what happens. If the condition does not correct itself then he may recommend corrective surgery. He indicated that this is extremely painful and due to her other medical conditions does not want to do anything unless necessary. He indicated that the muscles/tendons, etc. have already attached to the hardware and surgery would involve disconnecting and reattaching the muscles/tendons, etc. In the meantime, my mother is in extreme pain. She is off of her Humira due to risk of post-surgical infection and is also off of her methotrexate. None of her doctors are adequately treating her pain management. Her orthopedic surgeon feels that her pain is RA/fibromylagia related. Her RA doctors won't deal with pain management because she is under the care of the surgeon and her GP is throwing his hands up saying there is nothing to be done. She has visited a pain clinic at a hospital and because she is disabled and has no plans to return to work she doesn't qualify for their pain management clinic services. There are no other pain management specialists in the area. Any thoughts on how I can get her doctors to 1) deal with the hip and 2) deal with pain management issues.
Dr. K. I had my ACL relplaced in my left knee 10 years ago. I was 17 at the time and they decided you use my patella tendon as the graft. Well now I am 27 and I have torn my ACL again. The doctor that I am seeing made a suggestion of not replacing the ACL again. He said that he would if I wanted him too but it was not necessary. He is talking about going in to repair the cartlidge and clean up the trauma but not replacing the ACL. What do you think about this?
Jessica in Columbia, SC
I had 3 torn ligaments repaired 6 weeks ago, I put no weight on it at all for the 6 weeks, when I started walking I have really bad swelling in my foot. My ankle, top of my foot, even my toes swell. My Doctor said this was tissue damage from the surgery, what does foot swelling have to do with knee surgery??
My father who is 82 years old was in an accident about 50 yrs ago. They wanted to take the leg off but he refused. Now a bone ulcer has opened up on the ankle and he has burning pain and it is hard to walk on this leg. The doctor put him on a sulfer drug and said he would have to stay on this for the rest of his life. The thing about this it doesn't seem to be getting better and it's painful. any suggestions
His Daughter
i had a infection had to have my total knee removed.They then installed a spacer until they where sure infection was gone this went ok at first wt to have the 2nd knee installed and lost my insurance.Was told sorry when you can afford to do this come back see me the doctor said that was 3 years ago the spacer has come lose hurts very bad and i am wondering what my chances are of being able to have this fixed?
DR K.,
I HAD LEFT HIP REPLACEMENT IN DEC 2002, AND MY SOCKET IS NATURAL ALSO. I HAVE PAIN IN THE JOINT LIKE SHERRY BUT IT IS TOLERABLE. I DO HAVE A QUESTION FOR YOU. I AM HAVING SEVERE PAINS, SHOOTING PAINS, IN MY LEFT LEG. THE BEST WAY TO DESCRIBE THIS IS IT FEELS LIKE A HYPEREXTENSION, BUT THE PAIN IS IN THE FEMUR BONE. COULD THIS BE THE METAL JOINT LOOSENING IN THE BONE, AND SHOULD I MAKE AN APPOINTMENT WITH MY DOC? I KNOW THE JOINT IS WEARING OUT AND WILL HAVE TO BE REPLACED SOON, BUT THIS PAIN IS NEW, ABOUT TWO WEEKS NOW, AND IT HURTS TO STAND, TIGHTEN THE LEG MUSCLE, AND PIVOTING CAUSES IT TO FEEL LIKE MY LEG IS GOING TO COLLAPSE. ANY HELP WOULD BE APPRECIATED, THANKS CHRIS FROM BELL, FLORIDA.( I AM 41 YEAR OLD MALE)
hello my name is diane and i had surgery two months ago to repair a broken femur from a gunshot wound. what i'd like to know is how long will it take for this injury to heal because i've talked to the o.s. and he hasn't really given me any answers and i've started having problems with my knee like there's a screw loose from the rod that was placed on top of my thigh bone.i also have some nerve damage with numbness and i just want to know if the feeling is ever going to return and if their going to have to remove the rod from my leg.
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