The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: fischbein on December 16, 2010, 05:18:54 PM

Title: failed t.k.a. 10 years ago, chronic pain, 12 knee surgeries, revision set
Post by: fischbein on December 16, 2010, 05:18:54 PM
I am 65 years old, and have been in chronic pain on morphine for 5 years.  I have had 12 surgeries on Rt. knee including relpacement 10 years ago.  Now on 300 mg morphine a day and pain can still be out of control.  Sent to the Anderson Orthopedic Clinic, where a so called super specialist suggested a total revision, saying that even though tests do not show infection, it cannot be ruled out, and that there are many radioluscent lines on tibial platform of artificial knee.  I have read that the outcomes of revision surgery for non specific chronic pain post t.k.a. is not very good but the doctor says it is the only chance I have to get better, he seems honest saying he cannot guarantee success but unless we remove everything and rule out infection and start new there is NO chance for the pain to mstop, but it could end up worse.  Has anyone been in this situation.  I am sceheduled for revision on Jan. 25 2011, and will try almost anything, any options I have not thought about.
Charles.  Pain out of control even with 300 mg morphine daily.
Title: Re: failed t.k.a. 10 years ago, chronic pain, 12 knee surgeries, revision set
Post by: yaesumofo on December 23, 2010, 03:50:38 PM
I read that when infection is present they remove all parts and replace them with a plastic insert with antibiotics to treat the area and insure all infection is gone.
WTF "they cant rule out infection?
Has he pulled fluid for testing?
If it were me I would find the best guy I could. somebody who specializes in only knee replacements and has been for at least 20 years.

There are tests which are very good at determining if there is infection.
Have they done a bone scan?
Maybe it is a simple case of your body wanting to reject the plastic? I have had a TKR for about 10 years and it has always run on the warm side. My body does not like the plastic...
TKR was a great thing for me though. Sorry to hear of your pain.
Have you been to a Pain mgt specialist? They have new techniques developed in the iraq wars.
300 mg Morphine is  ALOT and is a dangerous amount. Have you tried other main meds? IMHO Morphine is more about dulling the mind than killing pain. better for dental work than otho pain.
You have likely developed a monster tolerance requiring larger doses without even getting the same amount of pain relief. You might want to look into a LONGER ACTING medication like Methadone. What ever you do make sure that any medication change is closely monitored removing the Morphine after 5 years would be a BAD thing leading to a terrible withdrawal.
good luck.

Long acting Pain meds may make you feel better but determining the root cause should be NO1 priorty.

Title: Re: failed t.k.a. 10 years ago, chronic pain, 12 knee surgeries, revision set
Post by: fischbein on December 24, 2010, 06:59:23 PM
Thank's for your idea's.  I have tried methadone as well as oxycontin, and the morphine does the best job.  after 11 surgeries on my knee I have been sent to the Anderson Orthopedic Clinic, it is a research center outside of Washington D.C.  They specialize in knee and hip REVISIONS.  The doctor I am seeing who has scheduled me for surgery has designed several prosthetic knees for varis manufacturers.  They bhave asperated my knee and done a bone scan but I have been told there are a great number of false negative results, and since I had a major infection 5 years ago with three weeks on antibiotics in hospital they feel I may have a bone infection that is deep and would only show up during the surgery.  My x-rays show a large number of radioloucent lines which suggest a loose tibial prosthesis, but if it is from the cement breaking down or infection even the people at the Anderson Clinic cannot be sure.  My delima is that the Doctor there seems very honest, and has told me that while he will remove everything, send samples of bone and tissue to the lab, he cannot guarantee it would make a difference, in fact he said it could turn out worse, and he has done many hundreds of revisions.
I do not see how it could get worse, as the pain has been so bad in past few months even with pain management on high levels of morphine I cannot get out of bed three out of five day's and must use a power wheelchair to get around the house.  I have read that even though you end up with a stiff leg athrodesis does almost always releive the pain, I am willing to pay that price and told the Doctor that if he finds major problems he has my ppermission to do an athrodis. Does anyone have any thoughts on athrodisis?