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Forum Name: Joint surgery

Question: Post TKA Buckling/Give Way and -15 Extension Deficiency


 bcjd - Thu Apr 23, 2009 2:45 pm

At the time of my TKA in December 2006, I was 54 years old woman and otherwise in excellent health. OS recommended TKA after review of x-ray showing bone on bone condition in my right knee (I did not have and had not experienced pain with this problem, but an inability to transfer weight, esp. when climbing/descending stairs).

The TKA resulted in several problems. The immediate problem was ROM on the operated knee -- a -15 measurement of right knee extension. Due to risk factors, I declined the MUA. I used the recommended Dyna-splint for approx. 6 weeks, but there was no improvement with the extension deficiency. At this time, I also had severe and persistent swelling on the operated knee, which persists now, two years post TKA. The prescribed NSAID did not alleviate this problem, even after two months of use. The extension deficiency leaves me with a limp.

In August, 2008, I suffered a "give way" when suddenly I collapsed when the knee buckled after I started to walk after being seated for about 20 minutes. Now, the
buclkling happens frequently, and when I arise after sitting I must stop and permit the prosthesis to fully engage before I can initiate ambulation. I must use a cane for stability to walk properly. My OS does not believe there is instablity in the prosthesis and has recommeded correction via surgery through the posterior capsule with consequent high risk of nerve damage.

How can the -15 degrees of extension be corrected? Does this extension problem cause the buckling? If not, what is the cause and how is it corrected? Any other pertinent medical advice would be appreciated.
 Tom Plamondon PA-C - Mon Apr 27, 2009 8:31 pm

User avatar Hello,
This is a tough case because the most important rehabilitative element post op knee replacement is achieving full extension. It is number one priority.
Without meeting this goal, you run into problems with pain, stiffness, poor gait patterns, weakness.
The giving way of the knee may be from weak quadricep muscles.
Two years post op is too long to expect full extension unless the knee is surgically manipulated back into extension.
As far as the integrity of the knee and the prosthesis, I do not know.
A thorough exam and xrays should help the orthopedist determine treatment options and discuss them with you.

All the best to you.

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