Third attempt to replace knee prosthesis

[sheilatherann]

Had knee replacement surgery two years ago.  XRay taken after complaint of pain  indicated to MD the prostheses was badly placed.  Had second surgery (new Orthopedist) with prosthesis replaced with 18 in long prosthesis.  Now bone scan reveals "Intensely increased rate tracer activity is identified outlining the entire tibial component of the right knee prostheses including the tibial plateau and the stem.  No abnormal rate tracer uptake identified about the patellar and femoral components."  I was informed by his nurse on the phone that I must have a third surgery.  When I asked for a consult, she said that the surgery would be delayed many months if a consult was given.  No explanation was given as to what went wrong or what the (third new surgeon), intends to do to the knee.  No appointment available until near the surgery date. I want to protest being passed to three different doctors in the same medical system.  This last one is a DO, not a MD.  What questions should I ask?  I don't know anyone who has had three surgeries for a simple knee replacement.  Help

[DrNavneetMD]

Hello Dear,

I can understand your problem well.
Total knee arthroplasty is successful in degenerative, arthritic or injured joints.
The reasons for the revisions included polyethylene wear and osteolysis, aseptic loosening and infection.
An inflammatory process at the bone/cement or bone/prosthesis interface leads to a severe osteolysis
What has been the indication for knee replacement?
What has been your complication?
To be specific- has it been any one of these?
The most important long term complication seems to be aseptic loosening.
Although early diagnosis is very important the standard techniques often fail Tibial bone loss is frequently encountered at the time of revision total knee arthroplasty, and the outcome of the revision often depends on the management of this bone deficiency. Structural allograft provides a stable and durable reconstruction of a tibial bone deficiency.
Revision total knee arthroplasty is done to alleviate pain and improve function. Contraindications for revision total knee arthroplasty include persistent infection, poor bone quality, highly limited quadriceps or extensor function, poor skin coverage, and poor vascular status. Results are not as good as with primary total knee arthroplasty; outcomes are better for aseptic loosening than for infections. Failed revisions require a salvage procedure (resection of arthroplasty, arthrodesis, or amputation), with inferior results compared with revision total knee arthroplasty
For further guidance and support you can consult, Dr Engh GA & Dr at Ammeen DJ. Anderson Orthopaedic Research Institute, 2501 Parker's Lane, Suite 200, Alexandria, VA 22306, USA.


Best,
Take care