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Author Topic: Confused with 2nd opinion  (Read 1115 times)

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Offline special one

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Confused with 2nd opinion
« on: July 28, 2006, 03:18:36 PM »
15 weeks after total knee replacement my OS sent me to a colleague for a second opinion"Just in case I am missing something".I have restricted knee flexion and persistent flexion contracture, due to adhesive capsulitus/arthrofibrosis following a haematoma.Walking is abnormal due to quads fatigue. Here are options suggested in second opinion response :-

a)Revise the femoral component by resecting the more distal femur to increase the extension gap, followed by re-shaping the distal femur. This could be combined with posterior cruciate resection and stripping of the posterior capsule, followed by insertion of a posterior stablised femoral component. This will obviously mean also changing the plastic inset but hopefully this can be acheived without interfering with the tibial component.

b) A full scale revision to a linked design, as this is generally more successful in improving motion, because the ligaments  and capsules are not required for stability.

Then he concludes by suggesting either stay non operative, which I cannot accept as a bent knee causes limping and eventually other disformaty, or option a) - having stated that option b) would be more likely to lead to success??

Help !!
 ??? ??? ???

Offline luckygrandma

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Re: Confused with 2nd opinion
« Reply #1 on: July 29, 2006, 10:38:24 PM »
15 weeks after total knee replacement my OS sent me to a colleague for a second opinion"Just in case I am missing something".I have restricted knee flexion and persistent flexion contracture, due to adhesive capsulitus/arthrofibrosis following a haematoma.Walking is abnormal due to quads fatigue. Here are options suggested in second opinion response :-

a)Revise the femoral component by resecting the more distal femur to increase the extension gap, followed by re-shaping the distal femur. This could be combined with posterior cruciate resection and stripping of the posterior capsule, followed by insertion of a posterior stablised femoral component. This will obviously mean also changing the plastic inset but hopefully this can be acheived without interfering with the tibial component.

b) A full scale revision to a linked design, as this is generally more successful in improving motion, because the ligaments  and capsules are not required for stability.

Then he concludes by suggesting either stay non operative, which I cannot accept as a bent knee causes limping and eventually other disformaty, or option a) - having stated that option b) would be more likely to lead to success??

Help !!
 ??? ??? ???
This posting scares me as I am 7 months post op and I still have so much stiffness and pain and trouble bending. Most of the pain seems to be comng from the back of my leg, it just tightenes up when I walk. My gait is terrible and I walk stiff legged.

Offline emphatic

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Re: Confused with 2nd opinion
« Reply #2 on: July 30, 2006, 04:54:03 AM »
Then he concludes by suggesting either stay non operative, which I cannot accept as a bent knee causes limping and eventually other disformaty, or option a) - having stated that option b) would be more likely to lead to success??

This part is a non sequitur. The way it's written is says it suggests not operating but operating would give the best result, and if you do operate, choose this option but the other option is better. As I said -- a non sequitur.

Option A is a surgery where your surgeon would basically adjust the implant you have. Do you need an explanation of what the medial terms mean?

Option B is a total do-over. Put in a totally new implant, but use a different design than what you have now.

What does your original surgeon say? Realistically, it looks like your choices are:

1) do nothing
2) have an "adjustment" surgery
3) have a surgery to re-do the whole thing

You could also ask for a 3rd opinion -- hopefully from someone who can actually form an opinion.  ;)

I doubt this helped much, sorry.

Meg

Offline Kai

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Re: Confused with 2nd opinion
« Reply #3 on: July 30, 2006, 05:26:02 AM »
um.. I may get in trouble again..   but.. it sounds to me like dr. #1 messed up and dr.#2 is trying to say something without coming right out and saying so..   either case...   your results are not satisfactory..  and you need to see someone really really good for opionion #3..   good call emphatic..  really appreciate your ability to cut through medicalese...   you are an asset to the board..
ACLR - (patellar BTB autograft) left knee - May 31, 2006
Partial Lateral Meniscectomy right knee Feb 20, 2008
Partial Lateral Meniscectomy right knee Aug 11, 2008

Offline special one

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Re: Confused with 2nd opinion
« Reply #4 on: July 30, 2006, 05:56:17 PM »
Then he concludes by suggesting either stay non operative, which I cannot accept as a bent knee causes limping and eventually other disformaty, or option a) - having stated that option b) would be more likely to lead to success??

This part is a non sequitur. The way it's written is says it suggests not operating but operating would give the best result, and if you do operate, choose this option but the other option is better. As I said -- a non sequitur.

Option A is a surgery where your surgeon would basically adjust the implant you have. Do you need an explanation of what the medial terms mean?

Option B is a total do-over. Put in a totally new implant, but use a different design than what you have now.

What does your original surgeon say? Realistically, it looks like your choices are:

1) do nothing
2) have an "adjustment" surgery
3) have a surgery to re-do the whole thing

You could also ask for a 3rd opinion -- hopefully from someone who can actually form an opinion.  ;)

I doubt this helped much, sorry.

Meg
Thanks Meg. Do you agree that either option is at the cost of the original surgeon as as either way there is some doubt as to whether the prosethis was fitted correctly. As I said, I feel that ' do nothing' is not an option.
Special One















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