1. Community
  2. Bones, joints and muscles
  3. Knee Problems

Is a TKR normally the same size as the other knee?

Posted , 7 users are following.

francis24843
francis24843

I had a TKR in August of 2014.

The new joint is 10 mm in diameter wider than the original knee and than the other knee.  This means it always looks swollen - although it often is anyway.

I am 1.84 m tall and have thin legs.

Are TKRs usually the same size as the original knee, or are they one size fits all?

 

0 likes, 18 replies

18 Replies

Next
  • ken25066
    ken25066 francis24843

    Posted

    Total knees usually come in six or more graduated sizes. That is a big discrepancy. Apparently your anatomy is a bit unusual. The sizing is done interoperatively and is adjusted first by the femoral condyles the ends of the thigh bone. Most manufacturers allow for a discrepancy of one size up or down for the other side. In your case the promimal tibia must have been larger than the norm. These sizes are made to fit most but certainly not all.

    This should have been caught preoperatively on X-ray. At 25mm to the inch 10mm is quite a large discrepancy and could lead to irritation of the collateral ligaments. I would see another orthopedic surgeon for consultation. This might have been avoidable or maybe not. It would be good to know which.

  • sueisobel
    sueisobel francis24843

    Posted

    Have you spoken to the surgeon, or your consultant.  It could also be fluid that hasn't flushed through your system because of some irritant or other
  • francis24843
    francis24843

    Posted

    Thank you Ken and Surisobel for your quick and helpful replies. The extra width is not due to fluid.

    Pre-op I was not examined by the surgeon in order to determine whether I needed a TKR - all done via an X-ray and an examination by the arthroplasty nurse. Spoke to the surgeon for less than 1 minute the morning of the op in the waiting room at the Royal Inf, Edinburgh, with all other patients and relatives also present. Prior to that my total contact with an orthopaedic surgeon had been for c. 5 minutes to sign my consent form. I asked whether my previous pes anserinus transfer (1977) would affect the TKR and was assured it would not.

    Post op I have not seen the consultant who carried out the op and only seen a registrar for about 2 minutes in the ward.

    Since discharge I have not seen any of the orthopaedic surgeons at all - only the arthroplasty nurses. I cannot walk on rough ground without severe pain on the outside of the operated knee.

    What I would really like now is for them to give me the arthritis in my knee back and chuck the TKR in the recycling bin. 

    • veronica91735
      veronica91735 francis24843

      Posted

       That is exactly how I fee. Mine is only 6mm oversized (malaligned to the right), & I am booked in for a complete revision a week on Tuesday. Don't give up - ask your GP to arrange a 2nd opinion (with a consultant who cares). I have had a year of pain, swelling, stairs are a no-no. It hurts all the time. Sleep is hit & miss, walking is out so I have put weight on. Depression began to really hit hard & the amount of times I have wished I could turn the clock back & walk out of the pre-op tests (which is what I wanted to do, but the consultant persuaded me it was urgently needed (I have a new consultant now). Hopefully my new surgeon will improve things but he has warned it may never be right. If only we had a crystal ball eh? - Veronica
    • ken25066
      ken25066 francis24843

      Posted

      I am not surprised that you are in GB. Sadly. Your experience confirms all of the terrible stories we in the Us fear we are headed for.

      Being in a socialized medicine system. You probably received a low cost implant that lacked the features that would have allowed the surgeon to give you a proper fit. Not his fault nor yours. It the result of the system that GB has settled for.

      Without a doubt your previous surgery complicated this surgery and they were completely unprepared for it during your procedure.

      I wish I could offer something helpful. I ho

    • sueisobel
      sueisobel ken25066

      Posted

      What on earth are you talking about? What is a socialized medicine system apart from being an Americanism (careful, I am part US).  There has been a lot of effort put into the health care over here, both private and National Health.  At the end of the day it IS down to the operating surgeon, they have a duty of care. It is they who measure the patient to the replacement.  Nothing to do with legislation. To tell someone they have received a low cost impalnt is stupid + it does nothing for a persons self confidence in being able to find out what really is going on!
    • sueisobel
      sueisobel francis24843

      Posted

      I know how you feel, but you must not give up.  Go to a different consultant, be a pain in the backside.  You are not expected to be in pain, especially when mistakes have been made.  Registrars are not as experienced as the consultants.  Get your doctor to write a letter to another hospital.  What the consultants look at is how the joint has settled, if it is smooth, then it is a success, no matter how much pain y ou are in.  Yours has not settled because it is ill fitting, that is negligence.  Please do not give up.  I have learnt to live with my pain, there is nothing wrong with the replacements.  (a whole different issue).  The last thing you what is to settle into depression.  Go kick some butts.  If it was a part for your car or washing machine or ....you wouldn't stand for the poor service!!!  Wishing you the very best of luck.
    • sueisobel
      sueisobel veronica91735

      Posted

      Keep on at them. Try to stay positive.  You have a new guy, pin him down, ask the awkward questions.  You know a lot more now than you did before.
    • ken25066
      ken25066 sueisobel

      Posted

      To defend socialized medicine is defend a system where politicians make medical decisions. In this case the surgeon was obliged to implant the manufacturer who bid the lowest. This system was a stripped down system designed to fit most people.

      She said that she saw the surgeon for five minutes and that's probably all the surgeon got too. He is supposed to show up to work and perform his scheduled surgeries with the implants at hand. When he encounters a situation that falls outside the norm, he cannot order in another system and complete the surgery the next day. He has to do the best he can with what he has. In this case what he had was insufficient.

      Who is to blame? The surgeon or the guy who accepted the low bid from the manufacturer? Neither! They were both doing there jobs within the framework of the laws of the land.

      THAT'S what is wrong with socialized medicine. It takes individual incentive out of the picture. Nobody did the wrong thing but the poor patient didn't get the RIGHT thing.

    • sueisobel
      sueisobel francis24843

      Posted

      If you read this properly, you will see, that whilst there is NOT a one fit all policy, there can be a situation where the replacement does not fit)QUOTE:Knee implant for women launched A knee implant designed specifically to fit women is now available in the UK. Surgeons believe it could help reduce the pain suffered by some women after the operation, and improve mobility.

      They say the pain in women is probably due to ill-fitting knee replacements caused because women having narrower femurs, or thigh bones, than men.

      The design is based on findings presented at the Computer Methods in Biomechanics and Biomedical Engineering Conference last year.“ For a lot or women, the replacement doesn't quite match the end of the femur ”

        But some surgeons have warned that the changes in the new design might be too subtle to have a significant effect on patients.

      In the study, the differences between male and female knees were mapped, and it was found that women's femurs had a different shape.

      During knee replacement operations, the femur must be coated by a metal plate, and typically surgeons choose the best-fitting implant from a range of designs and sizes.

      It is important that the replacement knees fit as perfectly as possible to maximise comfort and mobility for patients.

      'Phenomenal success'

      The new knee cap, called Gender Solutions, replaces the thighbone portion of the knee, and is designed specifically to match the shape of women's femurs.

      Nick London, a knee surgeon who has been using the new design, said: "Knee replacements have become a phenomenal success, but surgeons have noticed in the last few years that men and women are behaving differently after the operations.

      "For a lot or women, the replacement doesn't quite match the end of the femur, and in the last few years that has made a difference to their pain."

      He said although he believed the new knee implants would make a significant difference to the success of the implants in women, it would be some years before these effects would be confirmed by studies.

      Oliver Schindler, a specialist knee surgeon at the Droitwich Knee Clinic, said there were differences between the knee caps of men and women, and that increasing the variety of implants available was a good thing.

      However, he warned that the small design adjustments made to these implants might not be enough to have a significant clinical impact. UNQUOTE

    • veronica91735
      veronica91735 sueisobel

      Posted

      Now THAT is very interesting. My lower bone still bruises after a year, & if I gently press, is still very, very tender. Wish I'd been fitted with a "female" one!
    • sueisobel
      sueisobel veronica91735

      Posted

      As does mine.  Both my joints are a perfect fit.  If you look at the where the bruises are; they are not necessarily near the joint.  If the "line" round the joint is painful, that could be where the nerves have been damaged/cut. Still does not explain the bruises though does it??
    • francis24843
      francis24843 veronica91735

      Posted

      I am male but with thin legs, so I wish I had been fitted with a 'female' one as well. My lower bone is also still tender, but probably not as much as yours. My wife also noticed the slight misalignment of the operated knee - crucial according to an engineering don in Oxford who specialises in the load-bearing structures of leg and hip implants.

      The whole joint also starts to ache if I lie on my back for more than 5 minutes - preferred the arthritis! 

      I have a feeling that Ken's point about cost has a bearing on the decision on which implant to fit.

    • veronica91735
      veronica91735 francis24843

      Posted

      I am worried, as I know they have to "drill" the old(new) bits out of the bones to do the revision. I'll mention the tender bits to him, it's a week on Tuesday & I have been feeling ill all day - probably nerves, but I know they won't do it if you are ill with a temperature (as I have today).
  • janice60986
    janice60986 francis24843

    Posted

    Hi Francis, 10mm sounds quite good to me as my operated knee us 25mm bigger than the other.  Had op 2 July and boers doing exercises religiously and just hope that the bruised swollen appearance if the bigger knee will go in time.
Back to top
Next

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.