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    Partial knee replacement - post surgery pain (18 mos)
    Maveric2020 posted:
    My name is Jim and I am a 44 year old male. I have very painful, post-surgical knee pain in my left knee that I would appreciate some feedback on to assist in my appeal to get another opinion.
    As far back as I can remember I've had left knee pain (no problems with the right knee). Current diagnosis is DJD (degenerative joint disease). As an adolescent I had Osgood-Schlatter Disease but that was the only thing affecting both knees. In 1984 and 1988 I had two arthroscopic knee surgeries. The first helped a little but the second, where they drilled into the bone and I had to keep weight off of it for 6 weeks in order to build back pseudo-cartilage (whatever you call this scar tissue) really helped. This lasted for 22 years. I still had osteoarthritis all this time but it was tolerable. In 9/2010 the arthritis was too much so I had another arthroscopic knee surgery. Again, they drilled into the bone hoping to achieve the same results of the previous surgery but the arthritis pain in my medial compartment wasn't much better.
    In 4/2011 I had a robot-assisted unicompartmental knee replacement (medial). After recovery I noticed the arthritis was a lot better but now I have painful clicking with the lateral joint compartment (possibly knee cap - not 100% sure) and the lateral muscle on the upper outside of the knee feels painful/fatigued all the time. In fact, when I walk it feels like the knee is going in and out of joint — a bone passing bone feeling which causes me to limp. I went back to my surgeon and they did an x-ray, CT scan and MRI but the surgeon said they didn't show anything abnormal. At least, the artificial component has not moved or loosened. All the surgeon could say was, "the scans look fine" and there's nothing else they can do.
    After a year of pain and having trouble walking I finally convinced them to refer me to the pain clinic. At my first appointment my doctor, an Anesthesiologist, pushes on my knee (something the surgeon never did which I find surprising) and recommends a medial unloader knee brace. This really helps. I am able to walk further with less pain but it's still not great. I still have a lot of pain even when I am at rest - located at the top of the medial compartment and where that lateral fatigued muscle attaches to the bone. I can point right to these specific places but, as I said, the surgeon claims nothing is wrong.
    My surgeon says I am too young for them to consider a total knee replacement at this time. My options are either arthroscopy or arthrotomy (unsure for what purpose; as far as I know there was no talk about implanting any cartilage cells or anything). I asked for a second opinion but it was within the same department and the surgeon they set me up with didn't do this type of surgery (only performed arthroscopic surgeries; no replacements). They could only offer the possibility of another arthroscopic surgery to look around. I then requested a third opinion, this time "out of network" but my insurance company denied it. I am in the process of writing an appeal now. There is no infection that I'm aware of. I am on Meloxicam (NSAID) for the inflammation and some medicine for the pain. In all honesty I don't want more pills to cover up the pain. I want to fix this so I can get my life back. It's now been 18 months of pain!
    I understand there can be complications with any surgery but it feels to me like my surgeon knows something is wrong but isn't willing to admit it. Why wouldn't he push on the joint or suggest the brace? Can you offer any suggestions to the cause of my problem or possible solution? I personally believe the joint is not lined up properly and a total knee replacement would be my best option at this point. Thanks in advance for any advice or opinions you can provide.
    KevinHilton responded:
    You do a great job of describing your symptoms, however there could be plenty of things right or wrong with your knee. I assume your surgeon ruled out an underlying infection, so I'll assume your knee isn't infected. I'm curious by your description "feels like the knee is going in and out of the joint" and your response to a medial unloader brace. These two results seem to point to some type of instability you may in your knee. I'm going to guess this instability is localized to your medial compartment but it could be from other causes as well. I think you are the right track about seeking a second opinion -- or third in this case. Between a good set of xrays, an appropriate physical exam, and review of your lab work, a reasonable differential diagnosis should be formulated. I would advise against "exploratory" surgery -- such as looking around with an arthroscope, until some reasonable diagnoses have been ruled in or out. Good luck

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