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Author Topic: Posterior capsule surgery -- to correct hyperextended post TKR knee??  (Read 2151 times)

Offline joyday

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   TKR beset with problems, and now need info/advice/recommendation on posterior capsule route to knee
prosthesis to correct a -15 degree deficiency on operated right knee.
    At time of surgery in Dec '06, I was 54 yrs old and otherwise in excellent health.  I did not have knee pain,
but I could not negotiate stairs due to inability to transfer weight to the problem knee.  X-ray showed bone on
bone condition, and OS urged TKR as only remedy. 
    After bandages off and near end of 5 weeks of PT, OS measured operated leg and found  -15 degree of
extension of operated leg in addition to persistent swelling.  I declined OS suggested MUA, but used Dyna-splint
with no improvement in ROM.  So proper ROM cannot be reached due to extension problem and NSAID did not
reduce the swelling, and it persists.
   I have a pronounced limp, and ambulation is difficult, especially after being seated.
   If this isn't bad enough, I began to experience "give way" or buckling of the operated knee last August.  The
OS advises that the correction of the extenion is through the posterior capsule, but this would put nerves in the
knee at severe risk.  I've read on this site about the adverse impact that can result from nerve damage -- even
the potential need for amputation.
    Can anyone give me some insight, offer suggestions, shine some light on all this darkness?  I can't see myself
living with this monstrosity for another 17 1/2 yrs (OS bragged prior to surgery that the prosthesis  would endure
for 20 years w/no problems).  Please feel free to share your thoughts or experiences, and this is a thank you in
advance.
 

Offline Janet

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Sorry you find yourself in this situation. While your subject says "hyperextended knee," my answer assumes you mean that you are lacking 15 degrees of extension.

Since you missed the window of opportunity for the MUA, now surgery is your only option. After all this time, no amount of stretching will resolve your problem. I haven't had this exact problem, but there are several people on the board who have. You might try posting the arthrofibrosis section to find people with problems with excessive scar tissue.

You can also start educating yourself by reading through the arthrofibrosis tutorials on the information hub:

http://www.kneeguru.co.uk/KNEEnotes/node/632

Good luck solving this difficult problem.

Janet
« Last Edit: May 01, 2009, 04:35:17 PM by Janet »
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline missmyknee

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  • From the Land of OZ
Hi

The posterior capsule is a very tricky place to work because of the nerves and many ligaments.. You want to make sure your OS is very experienced doing this. As Janet suggested, read all you can on the Arthrofibrosis section in the Hub. You might seek an opinion from one of the arthrofibrosis /AF experts listed in the HUB. Just make sure they have experience with AF after a TKR. These are doctors who know this condition very well and know the correct surgical, post surgical , and rehab techniques for AF.

I had to go thru an open surgery to remove scar tissue in the posterolateral capsule and several other procedures. It was done by one of the experts

Reading everything on AF will give you knowledge and to make you proactive in your treatment

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline joyday

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Janet and Pam:
    Thank you for your replies concerning my knee issue.  My post was spurred by my day before visit to my OS.
After hearing about my buckling continuing and severe stiffness, he examined the knee and diagnosed patellar clunk.
He recommended some arthroscopic procedure to allow a view and removal of the clunk; I've not since raised the issue of
posterior release since he last mentioned it last January.
    At this point, I have lost any belief I had in the medical care system.  If I had the wisdom I've found dispensed
on this Board concerning the complications of TKR, I probably would have avoided, or at least, delayed this procedure. It
has only caused probelms from post surgery day 1.  After OS advised of extension problem, I went online to find more
info and I discovered KNEE GURU.  I found and studied Dr. Noyes' tutorials on AF and I found and studied original research as well.  Most of this AF review and discussion revealed that most medical, post TKR procedures are deemed "salvage"
procedures due to the nature of knee replacement itself.  Correction is a mighty difficult undertaking, and the risks are
usually immense, and more than I care to undertake.  I'll find, somehow, a way to live with this, as I don't want constant
pain and further deterioration in the quality of my life. 
    Again, I appreciate your concern.

Tx,
Elizabeth