For most people a knee replacement can predictably eliminate pain and restore function. This is not to say that the operation is not without complications. I think that we as physicians do a good job of presenting these complications to the patient pre-operatively but I am not sure that we are always great at preparing our patients for the recovery after knee replacment. The first couple of weeks can often be very challenging and the patient is truly doing a lot of work in physical therapy. They likely are requiring pain meds, anti-inflammation medications and icing in between and around the therapy sessions. We often generalize and tell patients they are about 75 percent recovered at 6-8 weeks and that they will continue to make some improvement often out to at least one year. All patients are different and this schedule does not apply to all. Unfortunately, there are some patients (some research has suggested approximately 1 in 5) that may have some pain in there knee after the surgery and when the recovery is complete. Most of these patients are better than they were pre-operatively but still not 100 percent pain free.View Thread
Recovery is extremely variable. We have people that make the bulk of their revcovery in two weeks and a lot that feel like they are not fully recovered till one year out. I think you have to be reasonable about what you take on in the first 6 weeks after the procedure. Your young age and likely good health can be a benefit but there is some research that indicates that younger patients can have more pain. I never restrict people from returning to their work if they feel like they are up for it but I ask them to be honest with themselves.View Thread
If you get to a full year out from surgery and you still have sever pain in your thigh you need to have a work up for loosening of the implant (femoral). If that work-up is negative then your back needs to be evaluated thoroughly. it is certainly not uncommon for back and hip problems to co-exist.I am sorry you are having trouble and wish you the best with the hip.View Thread
Coach G Sorry for the delay in response. I think it is most important to figure out what the next intervention should be. If you have had two manipulations and are still stiff then you should not have any more manipulations. The scar can removed with an arthroscopic procedure or with an open procedure. It is critical to make sure that the implants are all in ideal position and that all are appropriately sized before having an isolated scar excision. The scar removal procedures are not lkely to work if revision of the implants is needed. It is hard to make firm recs without an examination and radiographs. You need to seek out a physician that has a lot of experience in revision ("re-do") knee procedures if your surgeon has suggested that there is no more that can be done. I have to say that there are times we see patient for a second opinion that have implants that are placed perfectly that become stiff. I wish you the best and would suggest you look at the surgeons at the larger academic centers like Rush University and Northwestern for a second opinion. I should point out that there are likely surgeons outside of these centers that have enough experience to help you out.
Jo-Anna, Some of the symptoms you describe are concerning for possible loosening of the femoral component. This is the part of the hip replacement that is in your thigh (or femur) bone. You need to make sure you are communicating all of these symptoms to your surgeon. When I am concerned about this possible mode of failure I will get serial radiographs over time and look changes in the implant position that might suggest it is not well fixed. Once a patient is over a year out from the surgery I will sometimes get a bone scan to see if there is any suggestion that the femoral component is loose. You also have to make sure that some of these symptoms are not coming from your back. You would not be the first patient that had a hip replacement go well and then have some persistent pain related to a lumbar spine condition that would not have been addressed with the hip surgery. It is not uncommon for hip and back problems to co-exist. Hope this helps.The main thing again is to keep the lines of communication open with your surgeon.View Thread
It sounds like you had a hematoma (or blood collection) after the surgery that required you to have to go back to the operating room to have the hematoma removed or washed out. Hopefully the blood removed was analyzed for infection. Any time somone persists with pain after the surgery and is not improving it is important to make sure there is infection present. When I see a patient in your situation I often will draw some labs that can be suggestive of infection and if they are abnomal we often have some fluid taken off the hip with a needle and have it examined for infection. You need to keep an open converstation with your surgeon and make sure you find out what the plan is going foward. There is always the chance that this is just a slow recovery secondary to the fact that you had to have a re-operation shortly after the first operation. Hopefully your surgeon is seeing you more frequently than normal given the tough time you appear to be having.View Thread
Greels1, Sounds like your hip really bad off. I think that it is normal for patients to be apprehensive and nervous. I suspect you will actually be very happy that you went through with the operation shortly after it is over. I am in no way trying to trivialize the operation. Most of our patients stay 2-3 nights in the hospital but there are many patients that can go home after one night. It varies how much physical therapy different physicians require of their patients. I tell people that they should be about 75% recovered at 6 weeks. I hope at that point they are not requiring any assistive aids for walking and most have been off pain meds for some time by then. You will hopefully be encouraged to hear that one of the well known medical journals recently idenitified total hip arthroplasty as the "operation of the century" becasue of the excellent results associated with the procedure. Best of luck to you!View Thread
onmiland, I have not had the procedure but I have colleagues that perform the operation. As you likely know the reverse prostheses are often used after regular shoulder prostheses have failed or when a patient has a rotator cuff tear that can not be repaired and bad shoulder arthritis. The recovery from the operation is likely like the recovery from a regular shoulder replacement and may take a full year to reach maximum recovery. There will be physical therapy afterwards and it is likely critical to be compliant with the PT to optimize your outcome. I do a lot of knee and hip replacment procedures but have many patients that have had shoulder replacements as well. Most indicate that the recovery from shoulder is harder than hip and more like the recovery from a knee replacement. Hope that helps and good luck!View Thread
Activity restrictions following TKA varies from surgeon to surgeon. In general most surgeons advise agains high impact activity that requires running and jumping. This is not to say that we do not want patients to be active. The concern is centered around excessive stress on the implant. We really do not have great data that confirms what activities create the greatest stress on the implants. You need to ask your surgeon what activities he or she will restrict you from before the procedure. I tend to tell people that I am OK with walking, hiking, elliptical trainer, treadmill (walking), stairmaster, doubles tennis, biking, golf and downhill skiing (no moguls). If there is a specific activity that someone wants to do outside of this list I make a decision based on how "high impact" the activity is.View Thread
bziegler, I am sorry to hear what you have gone through. The occurrence of peri-prosthetic infection is rare but it does occur. The key to the managment of the infection is early recognition and surgical intervention when indicated. The surgical history you describe is extensive and a lot for anyone to go through over six months but that can often be the course in the face of infection. If you are still having a lot of pain you need to be worked up for persistent infection versus implant failure or loosening. You should discuss your concerns with your surgeon given that you are over a year out from your last procedure and still not doing well. If you do not feel that you are getting answers then you certainly could consider a second opinion. I wish you the best.View Thread
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