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Author Topic: Hinged Prosthesis (UPDATE)  (Read 2101 times)

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Offline luckygrandma6

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Hinged Prosthesis (UPDATE)
« on: September 02, 2008, 12:54:39 PM »
Can anyone lead me to information for a Hinged Prosthesis to replace a failed TKR. The doctor has mentioned this as a way to solve my problem, but I would like to learn more about it so I can be sure he is not just playing another guessing game. Has anyone had this type of prosthesis and can you overextend the knee with it.
I would appreciate any advice you could give. It bothers me when a Doctor recommends something that I cannot find any research on. He also suggested an arthrodesis for my knee but can find no information for an arthreodsis for a knee, only for wrists, ankles. Please help. Is there such a thing or is he inventing
« Last Edit: October 17, 2008, 11:20:56 PM by luckygrandma6 »
Right knee (arthroscopy) 2004
Right knee (PKR)) April 5, 2005
Right elbow (Bursectomy)1998
TRKR 2006 Failed)
Left knee (arthroscopy)
Left knee (arthroscopy)
THR 1992
2 back surgeries (Feb 2007 & March 2007
Right knee spacer exchange (Failed) 2008
TRK (Hinged Prosthesis) Jan 2009

Offline missmyknee

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Re: Hinged Prosthesis (Please Help)
« Reply #1 on: September 02, 2008, 11:49:21 PM »
Hi

A hinged prothesis is usually used where there is bone loss or severe instability from damaged ligaments . You retain your collateral ligaments and some retain their PCL. This prothesis has a hinge in the middle and long stems on both the femoral and tibial component. The hinge takes over the job of the ligaments. Hinged prothesis has been around a long time but improvements have been made that allow for rotational ability.

Here are some links

http://www.orthosupersite.com/view.asp?rID=18390

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=15581766&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&log$=relatedarticles&logdbfrom=pubmed


I think Teresa S a poster on the forum has one, but I could be wrong.

This prothesis has been mentioned by my OS ....I've suffered a couple of severe ligament injuries to my TKR but he has done a great job salvaging my knee and not having to go down this road yet.

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 over it

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Re: Hinged Prosthesis (Please Help)
« Reply #2 on: September 03, 2008, 12:50:45 PM »
My mom has a hinged prothesis.  This was her only option to saving her leg from bone cancer in the tibia.  She had a regular prothesis placed 20 years ago but it failed when the tumor ate away the tibia bone surrounding the prothestic stem.  She also had to have alot of reconstructive surgery for the ligaments and tendons in that knee to make sure all the cancer was removed.  To stand, she has to hyperextend the knee inorder to get it to lock.  I don't know if this is the case with all hinged prothetics. 

Offline luckygrandma6

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Re: Hinged Prosthesis For Overextension
« Reply #3 on: October 02, 2008, 03:06:52 PM »
Thank you very much for this information. My OS mentoned this and then got nasty and said I would wear out anything they put in. If I keep overextending my knee I will, but I can't control it. From what I read it sounds like exactly what I need. I need to stop the overextension and it is felt that it is caused by stretched out ligaments.
Since I have left that OS and went to my GP and he is referring me to an OS who's specialty is knees. They are still waiting to get all the op notes form the two OS who did my last 4 surgeries. I've only had one revision from a PKR to a TKR and I wasn't having this problem with the PKR.  This OS just did not believe in PKR and so he did it over.  He did a spacer exchange when he could have done the Hinged Prosthesis at that time. It would not have made a differecne as he had to open my knee back up anyway and I can't imagine it hurting anymore by doing the TKR over again.
Anyway I'll see if this new OS mentioned the Hinged Prosthesis and if he doesn;t I'll bring it up.
« Last Edit: October 02, 2008, 03:34:50 PM by luckygrandma6 »
Right knee (arthroscopy) 2004
Right knee (PKR)) April 5, 2005
Right elbow (Bursectomy)1998
TRKR 2006 Failed)
Left knee (arthroscopy)
Left knee (arthroscopy)
THR 1992
2 back surgeries (Feb 2007 & March 2007
Right knee spacer exchange (Failed) 2008
TRK (Hinged Prosthesis) Jan 2009

Offline Doc79316

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Re: Hinged Prosthesis (Please Help)
« Reply #4 on: October 02, 2008, 06:52:53 PM »
Hi Becky,

When is your appointment with your new OS? Wasn't your last OS a specialist in knee surgery? I think it's worth you arming yourself with a whole heap of questions and a notepasd & pen so you can make a note of the answers you're given.

Then you don't have to try to think about what you were told, it's all there written down for you. Also, if you're not happy and get another opinion, you will be able to compare answers from the surgeons.

Chat soon (on Messenger).

Laura xx
Left knee surgery
08/06/02 - L/Release
13/08/03 - Fulkerson TTT
05/06/05 - Stabilisation & Medialisation/Tendon Transfer
13/01/06 - Proximal Hamstring Superior Stabilisation
06/03/06 - RSD/CRPS diagnosed
20/07/06 + 03/04/07- Excision of scar tissue
30/07/07 - PKR suggested by OS (no date yet)

Offline luckygrandma6

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Re: Hinged Prosthesis (Please Help)
« Reply #5 on: October 04, 2008, 10:18:40 PM »
Hi Laura, Having a heck of a time castching you on IM.
This new OS I'm going to is a specialist in knee replacements. He basically deals in knees. My other OS was a General OS who did all kinds of replacements but if anything goes wrong he is stumpted. I have an appointment with my new OS October 15th. After reading about the Hinged Prosthesias I have hope once again that everything was not done for me that could have been. My present OS mentioned the Hinged Prosthesis and then snottily said "you'll wear out anything we put in" I'm had my THR for 15 years and because he did something wrong which I'm sure of, he is making excuses. I'm not the first person to ever have a failed knee replacement and I have to wonder why he is so stumpted. What I should have asked is what his experience was in knee revisions. I think revising my knee from a PKR to a TKR just because he didn't believe in PKR is where he screwed up. If he doesn't believe in PKR then how could he have experience in revising them. If I could turn back the clock I would do things so different. The six surgeries would have been two at the most.
Right knee (arthroscopy) 2004
Right knee (PKR)) April 5, 2005
Right elbow (Bursectomy)1998
TRKR 2006 Failed)
Left knee (arthroscopy)
Left knee (arthroscopy)
THR 1992
2 back surgeries (Feb 2007 & March 2007
Right knee spacer exchange (Failed) 2008
TRK (Hinged Prosthesis) Jan 2009

Offline Patty0513

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Re: Hinged Prosthesis (Please Help)
« Reply #6 on: October 04, 2008, 10:34:44 PM »
Just wondering why a posterior-stabilized TKR wouldn't stop the hyperextension problem??

Offline luckygrandma6

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Re: Hinged Prosthesis (Please Help)
« Reply #7 on: October 06, 2008, 12:20:29 AM »
Hi Patty, I'm not quite sure what you mean and maybe someone else can answer your question better. In my case I had a PKR first and a revision to a TKR done by two different Os's. I was told the knee replacement was a Zimmer. For the first three months due to pain in the back of my leg which in time led to back surgery, as it was a pinched nerve from Spinal Stenosis. I had this pain through the first three knee surgeries but couldn't get the doctors to listen to me. For the first three months due to this pain I was unable to rotate all the way around on a stationary bike at therapy. I couldn't straighten my leg either as bending and straitening was so painful. Every time I went back for a Dr's appointment after that I kept getting PA who just kept telling me my x-rays look good. Finally I insisted on seeing my OS when I came for my appoinmtent as I was having problems. I almost got up to 100 degrees of ROM and then the day before I was to see my OS I had a set back and could only bend to 85 degrees. He decided to do a manipulation. He made a remark that it was good I had full extention as the manipulation won't help that. After the manipulation I was sent straight to his therapy department from the hospital where I underwent extensive therapy for the next five days.  The man therapist I had was very aggressive and I was screaming and crying so hard I actually swore at him. I also felt something pop in my leg. This pain was worse then the actual surgery. A doctor came in to see me and pain management and that is when they set me up with a Passive Motion Machine. I should have had this from the beginning but my OS doesn't belieive in them but it was recommended for me. It was after all this that the overextension started and has gotten worse to the point I have no control over it. My knee literally goes backwards. It is sick to look at. My OS has been stumpted and did a spacer exchange and it did absolutely no good. I've had this knee cut open three times to no avail. He should have done a new knee replacement at that time but once again tried to take a short cut.   Then he put a cast on my leg. He wanted me to walk and so did not cover my foot and put it from my ankle to thigh. The cast slipped down and landed on my foot before the ended and I once again went back to his office with a swollen sore foot now. I didn't see my Os this time and saw a PA. He put another cast on my leg that covered the foot and went to the thigh. This cast was so big and awkward I could not walk in it so they ordered me a wheelchair. Now if this isn't going backwards I don't know what is. The cast was hurting my back because of my back surgery because it was so heavy so a couple days later I went back and had it removed. My OS is getting frustrated and so am I. Finally to end it all my OS suggestd a arthrodesis. I am not even close to being a candidate for an arthrodesis and this sickened me to no end and he brought it up more then once.  He just wanted to do a permanent fix on me. I've had it so I decided to see my GP who has made arrangements for me to see an other OS who just specializes in knees and I will be seiing him on Oct 15, and I so hope this nightmare will come to an end. My OS also tried to blame my problem on nerve damage from my back and so I saw three different Neurologist and a Neurosurgeon who said NO.  Knee replacements are supposed to add to your quality of life and I have lost my quality of life as a result of what these doctors have done to me. I don't beleive I ever needed a knee replacement but I did need back surgery and I don't understand why they couldn't figure this out from the pain I was describing. Both OS's knew about my back but I swear they have some kind of a contest going to see who can do the most knee replacements in a year. The moral of this story is: Ask a lot of questions before you get a TKR, if I could turn back the clock I would have done things differently.
« Last Edit: October 17, 2008, 11:24:37 PM by luckygrandma6 »
Right knee (arthroscopy) 2004
Right knee (PKR)) April 5, 2005
Right elbow (Bursectomy)1998
TRKR 2006 Failed)
Left knee (arthroscopy)
Left knee (arthroscopy)
THR 1992
2 back surgeries (Feb 2007 & March 2007
Right knee spacer exchange (Failed) 2008
TRK (Hinged Prosthesis) Jan 2009

Offline Doc79316

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Re: Hinged Prosthesis (Please Help)
« Reply #8 on: October 07, 2008, 03:21:50 AM »
Hi,

The posterior-stabilised TKR is something I've heard of but if the OS responsible for the surgery makes a mistake or for whatever reason the sugery is unsucceswsful, then fom what I've been told, it would mean oly one more surgerywhich would solve the hyper-extension problem for sure.

Becky, you've had a rough ride with your OSs. Your new OS should be able to help and make sure that on 15th. you go to your appointment armed with a whole heap of questions.

My next appointmentwith my OS is on 27th. October and I haven't seen him since February (don't know why I'm going to be honest!). I have a list of 32 questions so far and every time I think of something to do with my knee, I write down the quesion. This time I will NOT be leaving my appointment without full answers to each and every question I've written down. I think you should do the same.

You cannot live like this anymore. You'r ein pain 24/7 and it's your quality of life that's been messed up. You deserve better. Your OS should endeavour to correct anything that has been done incorrectly, or even if there are no real mistakes as such by your previous OS, your next doctor should certainly attempt to resolve the problems you have.

Take care,

Laura xx


NB - I've not been on the PC much recently as I've been writing my statements for the full hearing in Court with Bernard on 16th. December. Oscar has been playing his "Dragons & Fairies" games on the PC after school most days for a short while so maybe I'm showing as being oline when it's actually Oscar.
I'll try to make it should that I'm not at this desk if it's Oscar using the PC.

Left knee surgery
08/06/02 - L/Release
13/08/03 - Fulkerson TTT
05/06/05 - Stabilisation & Medialisation/Tendon Transfer
13/01/06 - Proximal Hamstring Superior Stabilisation
06/03/06 - RSD/CRPS diagnosed
20/07/06 + 03/04/07- Excision of scar tissue
30/07/07 - PKR suggested by OS (no date yet)

Offline Beda

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Re: Hinged Prosthesis (Please Help)
« Reply #9 on: October 07, 2008, 09:08:18 AM »
Hi G. Well, I have read through what you have written, and from what weve talked about along the way, theres no new surprizes!! I have had a hinged protese put in, posterier stabilizing, and if it hadnt worked itself loose, probably would have been my saving. But unfortunatly EVERYTHING they put in me works itself loose. As youve had a THR and had it for 20 years, theres nothing to suggest that you will have the problem of either looseness or wearing it out. As you are so unstable in the posterior of your knee, it would suggest that a hinged prothese would be the answer for you. Now that your going to a new OS who deals ONLY with knees, I think you will find his attitude is completely different to the first OS who was clearly out of his depth.
As Laura suggests, a good notebook filled with questions ought to be part of yur armour when you go to see the new OS. Last time I had an OS appt. I think I had a list of 29 questions!!!I found that because the OS was so nice and easy to talk with, he answered most of my questions as i taked with him. I was in there with him for a whole hour, my mom was with me, and he took me VERY seriously. He actually said to me they aim to put new implants in where and if at ALL POSSIBLE before they start down the road of an arthrodesis. To me it sounds like not all has been tried on you yet, and that old OS was only suggesting to you to do what HE COULD do, because he COULDNT do the hinged joint successfully because he was not competent enough. My old OS, the one I had before this failure specialist wanted to try to put a 7th prothese in, but in the same mouthfull he said it wouldnt work!! he just didnt want to loose face. Unfortunatly I have been sleeping on the school bench, because I kept going back to the same OS for a period of 15 years. Oh, he SOUNDED competant, but why did everything he EVER did on me fail???
 My New OS said to me, why hadnt I been referred to him for ages ago, but to be honest I didnt realise that the other stuff the old OS was doing was wrong. Another thing the new OS said to me after looking at my x-rays, he said that the prothese I had in my knee was NOT of the size he would have chosen for my height and build. This is very important when they do revisions, they need to measure you up to work out the correct size implant they are having to use. This is all based on the lenght of your leg, the density and  size of your bones, and of course the condition of the boney tissue you have already. Maybe they wont use cement in you, maybe they will set it with bone chips. This is chips of freshly crushed boney material that comes from a cadaver and is put in to fill out the spaces the old prothese has made, and acts as a glue by growing itself around the new implant and holding it in position. They also may chose to use 50/50. 50% bone chips and 50% cement. But by seeing all of what youve had done before, you have no problems of implants working loose, so there shouldnt be a problem. But I am NOT a doctor, I have and can just speak from my all too long experience. When I had my first PKR and subsequent TKR's there wasnt anything that was called Internet, and I had to blindly trust that what the doctor said goes, and what he says is the only best for me. But now, after doing a LOT of research on the internet, I have found out that I have been grossly misused by the doctors through lack of competance. Lucky for ALL of us we are in an 'information age' whereby we can go on the internet and find information about just about anything you want to find out about, and we no longer have to buy the cat -in -the -bag solution. But on the other hand, the bad doctors can, with no difficulty at all print out their own diplomas etc. so I wouldnt be impressed by the ammount of diplomas a doctor has on his wall in his office. Diplomas do not  make any impression on me.
Well, it wont be long now before you have your appt. and I wish you all the luck in the world with that. We'll speak again soon,
Love Beda xx
'79 trauma v.knee
'81surgery patella lux.
'84 osteochondritis dissecans
'86 osteotomy
until now 16 knee surgerys ink. 6 failed tkr. pretty much exhausted all areas and types of surgical proceedures for knees
all TKR's loosened & failed
2008 wait for Final arthrodesis
constant pain

Offline luckygrandma6

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Re: Hinged Prosthesis (Please Help)
« Reply #10 on: October 09, 2008, 12:06:50 AM »
I want to thank everyone who has responded to my post. You have given me a lot of hope when I thought I had run out of it. I don't understand why my prevous OS didn't do the Hinged Prosthesis instead of the Spacer Exchange when he had my knee opened again. I swear it could not have been more painful if I had the TKR done over again. I think he was looking for a simple fix. My knee had been unstable since about the third month after my TKR. It's been almost three years that I have been struggling with this and the longer it goes on the weaker I get. I worry that No matter what they do I will never remember how to walk normally as I've been walking this way for so long. Do you thank if I get the knee fixed right that walking will come normally again or do I have to be trained like when I was first learning to walk at a year.
Right knee (arthroscopy) 2004
Right knee (PKR)) April 5, 2005
Right elbow (Bursectomy)1998
TRKR 2006 Failed)
Left knee (arthroscopy)
Left knee (arthroscopy)
THR 1992
2 back surgeries (Feb 2007 & March 2007
Right knee spacer exchange (Failed) 2008
TRK (Hinged Prosthesis) Jan 2009

Offline Beda

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Re: Hinged Prosthesis (Please Help)
« Reply #11 on: October 09, 2008, 01:32:33 PM »
Dear G. If you get a hinged prothese, it cant go out posteriorly, because it is basically hinged, and the hinge stops at 0 degrees. You should get a good ROM and I hope I'm right in saying this, but it should automatically stop your leg from bending the wrong way. Please i stand corrected if this is not so, But I think maybe your muscles will have to undergo a 'retraining' cos, as you said you have beenwalking so strangely for so long. Your muscles must be stretched to their maximum by now in the wrong direction, but muscles and tendons are like elastics, specially tendons, and if they arnt stretched, they dont give. Imagine an elastic band. You cand bend that any way you want, but when you dont pull on it it resumes it start-position and form. It may take a while, But I'm sure its something that can be remydied with the help of PT. And maybe if your muscles have been stretched out of shape, they can be surgically corrected. I've had that done on my L. knee to stop the patella from luxating. They moved one muscle and heafted it over to the other side of my knee over the patella to stop it from being loose. G, I think you have every reason to be positive about this upcoming surgeon, I realy really hope it works for you, you deserve a break, really!!
Love Beda xx
'79 trauma v.knee
'81surgery patella lux.
'84 osteochondritis dissecans
'86 osteotomy
until now 16 knee surgerys ink. 6 failed tkr. pretty much exhausted all areas and types of surgical proceedures for knees
all TKR's loosened & failed
2008 wait for Final arthrodesis
constant pain

Offline luckygrandma6

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Re: Hinged Prosthesis (Please Help)
« Reply #12 on: October 10, 2008, 12:44:31 PM »
Could anyone give me suggestions as to what kind of questions I should be asking this next OS. Right now my mind is blank as I asked question after question with my last OS and he got disgusted with me. What kind of questions are you asking him Laura.
Boy, beda after all you have been through you could do my surgery. Care to take a crack at it. You know my situation better then most Docs.

Only a few days away now and I'm getting nervous as I'm depending a lot on this. If anyone would like to check out the Orthopedic Specialist I'm going to here is the web address. It's very interesting and cetainly not like where I have been.
www.sosbones.com

Very catchy address and original don't you think.

Hey Laura, if you thinking arthrodesis as a fix if this doesn't work. That will never happen. I'l live this way first. At least I can drive a car and sit at a table without kicking anyone.
« Last Edit: October 10, 2008, 12:46:17 PM by luckygrandma6 »
Right knee (arthroscopy) 2004
Right knee (PKR)) April 5, 2005
Right elbow (Bursectomy)1998
TRKR 2006 Failed)
Left knee (arthroscopy)
Left knee (arthroscopy)
THR 1992
2 back surgeries (Feb 2007 & March 2007
Right knee spacer exchange (Failed) 2008
TRK (Hinged Prosthesis) Jan 2009

Offline luckygrandma6

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Hinged Prosthesis (UPDATE)
« Reply #13 on: October 16, 2008, 11:29:43 PM »
I have an update on my situation. I saw the Knee Specialist yesterday and what a  turn of events, He said I clearly have a balance problem caused by many things that were not done properly in my knee replacement.
First of all the new OS is having a spacer and prothesis custom made for me. He said when the PKR was taken out and the TKR done that the bone should have been built up as the present prosthesis could not handle it.  So he will be building up the bone also. He said it will be a very long and difficult surgery but believes it will fix my problem. The surgery could last all day. he said I was not even close to considering arthrodesis and he said if I was in my 70's or 80's he wouldn't even offer me this surgery.  He will putting in a hinged prosthesis to stop the over extention and lower the tibia as he said it is too high.
Let this be a lesson. Don't give up and if you are not happy with your OS seek other opinions. My last OS wanted to even do more harm by telling me I needed arthrodesis.  My new OS said that thought would never cross his mind at this stage of my situation.
« Last Edit: October 17, 2008, 11:19:13 PM by luckygrandma6 »
Right knee (arthroscopy) 2004
Right knee (PKR)) April 5, 2005
Right elbow (Bursectomy)1998
TRKR 2006 Failed)
Left knee (arthroscopy)
Left knee (arthroscopy)
THR 1992
2 back surgeries (Feb 2007 & March 2007
Right knee spacer exchange (Failed) 2008
TRK (Hinged Prosthesis) Jan 2009