Doctors Lounge - Orthopedics Answers
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Forum Name: Joint surgery
|dirt digger - Wed Jan 21, 2009 4:46 pm||
I am a 50 year old female that has had a partial knee replacement in March 2007, and then a TKR in November 2007. The partial failed as a result of the glue coming loose, bone wearing away and micro fractures of the tibia. There is speculation that it all happened within the first month. The pain was pretty bad throughout the whole ordeal, but I was told that was part of the healing process. In August 2007, my doc said all looked good and he would see me in six months. In Oct. 2007, pain at night would wake me up from sleeping. Called doc, he ordered a bone scan, and it showed the damage. Scheduled total knee replacement for Nov, 2007. I reminded doc about allergies to metal. (I always have reactions to 'cheap' jewelry and cannot wear SS or gold overnight) Doc chose the knee made from oxinium, which is supposed to be for folks who have metal allergies. Surgery went ok...took forever to do spinal. I had no feeling in my leg from my knee sown for 3 days. Thought to be from spinal. Had to have blood tansfusion. There was alot of bleeding. Doc had me on some major antibioctics. He said that there appeared to be an 'icky' spot and he wanted to be sure that no infection would grow. Nothing grew in the lab, either. So, I go home. Jane. 2008 had to have manipulation. Doc put me out, did manipulation, tore quad muscle.Ithought my leg was broken. It took four weeks for that to feel somewhat better which in turn put me behind on PT. Feb. 14, 2008, had another manipulation under anesthesia. I had a brace type thing that was made that you can adjust to bring your leg back to create more range of motion. Did that for 8 weeks. In the meantime, a rash would appear on my knee. And no where else. It would start as a few bumps, and itch like the dickens. The more that I scratched it, the worse it would get. Only on my knee. It would not spread anywhere else. I still get the rash. About May 2008, my calf would get really swollen, to the point it would look like it was going to explode. Checked for blood clots. Nothing. At the end of May, doc sent me for MRI of lower leg. MRI showed "mild central marrow edema" (which, by the way, my doc never mentioned this to me...is it something that I should be concerned about?) Part of the report reads, "Mild central marrow signal changes of the tibia, which is thought to be postsurgical or related to the marrow conversion." What does that mean? (My doc never shared this info at the time of the MRI. It was mailed to me last week.) So, life goes on. I have seen this same doc eleven times in the past twelve months. He keeps me supplied with vicodin. In Nov. 2008, doc sent me for blood work. (he did this earlier in the year, also) The results from Nov. were also sent to me last week. My next question would be...How abnormal do blood test results have to be to be brought to someones attention? There are two things pertaining to the red blood cells that are flagged as high, not within the normal range. And there were two things pertaining to white cells that came back low, again not within the stated noraml range. But all of the tests pertaining to the white count were on the low normal side. The doc also told me that the tendon connecting the knee cap to the shin bone is shortening and that he could not do another manipulation. My range of motion is maybe 60 degrees. I cannot do steps normally, can't kneel, can't get down on the floor. Doc also said that there is no fluid around the knee cap. My knee cap doesn't move. I have made an appointment with another doc at a very well known hospital. I don't know what to do...Please, any insight to this whole process is welcomed and thoughts are graciously accepted.
|Tom Plamondon PA-C - Mon Jan 26, 2009 12:41 pm||
I am sorry to hear that you have had so much trouble with this knee.
Regarding the marrow edema and conversion, the marrow edema can be caused by either inflammation or infection. The conversion: with trauma, the characteristics of the marrow may change from fatty marrow to hematopoietic marrow which basically means that the marrow is not resting anymore, it is producing cells to heal the traumatized part.
So the question is whether the knee or leg bones are infected. Your orthopedist can order other nuclear medicine test which can tag WBC and see if the marrow takes it up - an indication of infection.
Without seeing the CBC numbers, it is hard to tell the meaning.
Another question is: Are you allergic to the metal in the knee? Since your other metal allergies appear on your skin, you may test a sample of the knee replacement material and "wear it" on the skin for several days to see if there's a reaction. You would need to contact the manufacturer for a sample of course.
Hope this helps some.
Keep us posted and take care.
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