TKR/Debridement/Steriod injections

[diana9559]

I had a TKR on my right knee 5/2007, and they removed scar tissue 3/2008.  I have had to use a lot of steriods since the last surgery in order to keep my ROM.  I started with oral steriods, then when side effects started becoming an issue we moved to injections.  These injections into the joint seem to work well for me if I get them every 60 days or so, although there is still some pain and stiffness at times.  Is this a common treatment?  I have read where there are concerns of infection doing any kind of injection into an artificial knee.  Also, should I still be having pain and stiffness after all this time?  I know that a lot of people on here have suffered for many years - but my dr. doesn't see any problems with the joint itself and I can't seem to get an intelligent response from either the DR, PA or PT about why I keep reverting to pain and stiffness after progressing to 120 flex and -2 extension.  Even at those ranges I still have pain when climbing stairs.  I'm 49 y/o and wonder if I'm ever going to feel normal again.  I know several people who have had this surgery and within a few weeks have been climbing stairs and think this surgery was the best thing they ever did in their life!  I don't know whether I should look for a 2nd opinion or what?  The Dr who did my TKR is supposedly the best n town.  Am I just one of the unlucky ones who is going to have problems the rest of my life?  I would truly appreciate any advice you could give me.

I just found a post about iliotibial band syndrome - this sounds like it could be part of my problem!  I thought this was just still numbness resulting from TKR, but maybe not.  I have a dr appt. tomorrow and I will definitely ask him about this!

[Roma]

It seems like every OS has a different opinion on things.  I asked my OS if we could try steriods and he said that he wouldn't even consider putting shots into my knees with all of the problems that I have had after my TKRs because of the danger of infection.  He also said that alot of the things they are trying have not been tested for long enough to know if they really do work.  When I went to see Dr. Steadman, he had another specialist come in and look at my knees.  They decided that part of my problem could be that I had severe tendonitis from all the scar tissue and the trauma of repeated surgeries.  They did put shots into to the tendons on either side of my knees which did relieve some pain.  However, because I had so much scar tissue, the prothesis popped loose shortly after that.  Sometimes I feel like I would be willing to have them experiment on me if I could help one other person from suffering the pain I have suffered.

Roma

[Janet]

My OS also won't do an injection into the joint. When I had continuing problems with tendons/soft tissue, he did do a cortisone injection around the biceps femoris tendon. That had a short-term good effect, so I had an ultrasound guided cortisone injection in another area around the tendon that was too close to the nerve to do in his office. Again, a short-term good effect. I also wore a brace which prohibited full extension (to relieve the stress on the tendon) and had additional PT...which didn't help at all. The next step was a tendon needling procedure right into the tendon which completely eliminated the pain for about a month. Since then, the discomfort in that area is minimal and I haven't needed any more treatments in that area. I continue to have soft tissue discomfort around the knee and use lidocaine patches as needed.

Even after two years, my knee gets stiff (although it doesn't sound as bad as yours). Every day I ride my recumbent bike for 10 minutes, which helps to keep it moving. I have about 110 flexion as long as I keep it bending. If I don't keep working on it, it will go back to 90 flexion really quickly.

I was also 49 when I had my TKR (followed by a MUA), so I understand when you say the surgery hasn't given you the knee you expected. While I have gradually progressed to being very happy with my new knee, it still gives me enough trouble that a 20 minute walk makes me limp. However, I'm not in daily pain anymore and truly do feel like I have my life back. If you are unhappy with the (non)answers you are getting from your medical team, I think a second opinion is always in order. Although your OS might be "the best in town," a new pair of eyes may see something that he is missing. Try to find a surgeon who only does replacements and sees patients with "failed" TKRs. If you don't know where to start, a university teaching hospital is a good place. Or go to kneesociety.org and search for an OS in your state. This is a select group of replacement surgeons who are studying and researching.

Good luck,
Janet

[Roma]

Janet,

Thankyou for your comments.  I feel that you have given me some valid information.  I truly feel that besides having scar tissue that there is alot of inflamatiion in the tendons around my knees and it seems like that is where so much of the pain is coming from.  Some days my whole leg gets riled up and I think that is why I have so much pain when I walk.  I also am being treated for IT band syndrome and just this past two weeks I have developed bursitis in both hips.  I finally went to my family doctor yesterday and asked him to give me something for the bursitis just to see if I can get my legs calmed down.  I would be very happy if I could just get the pain reduced.  I have always said I could live with the stiffness i f I could walk without pain and not have so much discomfort after I do the simplest things.  I am going to look up the knee society.  When they put the shots in my tendons at Steadman Hawkins it did help for awhile.  After 5 TKR's you might think that my legs are totally stressed and just have not had enough time to recover in between surgeries.

Roma