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Dr. Raj is indeed right on on this in that we are still learning a lot about this issue. I suspect you are aware the the ASR socket has been recalled. The American Association of Hip and Knee Surgeons is continuously working on recommendations about how to best manage patients with metal on metal devices. If your serum cobalt and chromium levels are indeed elevated there are several options at this point. Cross sectional imaging like an MRI can be used to look for any abnormal fluid collections or abnomamlities to the soft tissues. If you are asymptomatic your surgeon may elect to repeat the levels in 3-6 months to see if the are continuing to trend up. We have an extensive experience with metal on metal total hips at our institition and while most patients have done well we have identified some patients that have had trouble. You need to make sure that your surgeon follows you closely going forward to make sure that any sins of failure are not missed and caught early.View Thread

Every patient is indeed different. It sounds like you actually have achieved above average knee flexion and that is great. I tend to tell patients that it can take out to about a year to reach maximum benefit. It sometimes takes longer. I think it is always important to look back and ask if you are improving week to week. If you can say that you are then you are probably going to be just fine. It certainly seems that things like pain, stiffness, knee swelling, warmth about the knee and fatigue can continue to improve well past the third month in some patients. Keep working hard and make sure you share your concerns with your surgeon.View Thread

I guess the real question here is did you have a cortisone shot in the knee that underwent the replacement? It would be helpful to know what was going on that led you to require the shot in the "replaced" knee. Assumably the knee was giving you some trouble? In general, when someone is having pain after a knee replacement it is important to rule out possible early causes of failure like infection or loosening of the implants. The history you give of initialy doing well and then starting to have trouble could be indicative of either of these failure modes. It sounds like your surgeon is trying to figure this out as the fluid that was drawn from your knee was likely analyzed for infection. I would make sure to discuss these concerns with your surgeon. It may be that all of the tests to help identify these failure modes have already been done. It is good that your doctor is trying to identify other causes of knee pain (your hip and back). Keep an open dialogue with your surgeon about your concerns as it sounds like the right things are being done to get to the bottom of this.View Thread

I just realized that Dr. Raj already responded as well. As you can see from his excellent response that the surgical options are not very predictable and that is why conservative treatment is felt to be so critical. I still would also pursue further work-up of the hip joint and even your back given the lack of success you have had with the treatments so far.View Thread

Sorry to hear about the trouble you are having. It sounds like you are having trochanteric bursitis and also IT band syndrome? The trochanteric bursitis usually hurts up at the hip and the IT band syndrome can actually affect people as far down as the knee. Conservative therapy like PT and injections are indeed the first line of treatment. It is very important that you have also had a work up for some other causes lateral (outside) hip pain and leg pain. There times where pathology in the lumbar spine and hip socket can cause some of the symptoms you describe. There are times when operations are performed to try to address IT band syndrome and even trochanteric bursitis but this is something that we generally try to avoid if at all possible. I would recommend that all diagnostic measures are exhausted before moving on to more aggressive interventions. This may include further imaging studies of the hip and the lumbar spine. I hope this info helps.View Thread


Very sorry to hear about your troubles. Though TKA is usually a very predictable and effective surgery there are certainly early failures and patients that persist with pain after surgery. When patients are painful following TKA it is critical that the patient is worked up for infection, implant loosening, and some other problems including possible metal allergy. I think all patients are entitled to a second opinion following this surgery if pain persists. I have had patients from my own practice seek a second opinion if I am unable to identify a mode of failure just in case I may be overlooking something. I tend to have them see a surgeon that does a high volume of surgery like we do at our instituion as it is likely that surgeon has evaluated a lot of patients with painful TKA's and will likely have some good insight.View Thread


You definitely had a pretty severe injury and I am glad to hear that you have been able to do triathlons with a history of a patellar tendon repair. The certainly could be some scar tisse in an around the area where the tendon was repaired. I would definitely consider being evaluated by an orthopaedic surgeon. I would think about seeing some one with a background in Sports Medicine.
Mike B.View Thread

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