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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Had Knee Replacement, Long Hx Of Severe Osteo In Most Upper, Lower Body Joints. Treatment?

Hi Dr. Siegel, I ve had 2 R knee replacements, one in 2008 and the next 4 yrs later in 2012. Immediate excessive bleeding in hosp bed in 1st surgery upon removal of drainage tube by resident; I needed blood transfusions afterward that day. Worse, in 2012, the drainage tube was removed with an almost surprising total lack of bleeding from site on my part. But when I was sent home later that same day I nearly bled to death all over my bedroom & bathrrom floor, was rushed back to hosp and received 3 separate sets of blood products. My hemoglobin & hematocrit levels were perilously low when tested and I d lost consciousness for much of ambulance ride to hospital and beyond. Now 1 year later my knee replacement area continues to look & feel abnormal, looks enlarged sometimes +3 or +4, the frequent pain occurs mostly at night which never really totally resolves, skin around site oft gets dusky and darkend at times, skin gets stretched and develops dark red raised skin rash that itches madly, too at times over prosthesis area. My blood chemistry over past several years shows spikes and valleys of sed rate and CRP values.. Do you think there is a malignacy going on by any chance in there? I looked up bone lucency on ortho sites and it seems to indicate some sort of tumor presence per Xray?? Is that an accurate generalization? Would appreciate an outside overview opinion please. I am 65 yo Cauc.female w/ long Hx of severe osteo in most upper & lower body joints, was born with severe untreated scoliosis lower spine, too, and more recently I was Dx srheumatoid arthritis, I weigh 115 lbs. and no longer able to use my beloved exrcise bike gently to tone up legs and keep those knees workig but stiffness and pain in R knee.precevts bike use. My L knee is in advanced state of OA damage/pan but there s no way I m in a hurry for a replacement on that side, believe me! My main concern today is this new discovery of bone lucency as some potentially dangerous abnormality. Could you please elaborate on this bone lucency finding (further details not yet known to me but I may find out more soon...) Many thanks for your time, Tess D. Pacifica, CA
Mon, 21 Oct 2013
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Orthopaedic Surgeon, Joint Replacement 's  Response
Hi, thanks for writing to HCM.

Your entire description suggests that your Total knee replacement is infected causing you continuous pain along with other symptoms.

The lucency that is seen radiologically is not malignancy or any tumour but it is the result of bone destruction secondary to infection termed as Osteolysis which presents as a lytic & lucent lesion on xrays with bone destruction.

You need a thorough evaluation to diagnose the presence of infection & periprosthetic osteolysis. Generally, the definitive management of either of these conditions is always a revision.

Hope this information is helpful. Good day
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Had Knee Replacement, Long Hx Of Severe Osteo In Most Upper, Lower Body Joints. Treatment?

Hi, thanks for writing to HCM. Your entire description suggests that your Total knee replacement is infected causing you continuous pain along with other symptoms. The lucency that is seen radiologically is not malignancy or any tumour but it is the result of bone destruction secondary to infection termed as Osteolysis which presents as a lytic & lucent lesion on xrays with bone destruction. You need a thorough evaluation to diagnose the presence of infection & periprosthetic osteolysis. Generally, the definitive management of either of these conditions is always a revision. Hope this information is helpful. Good day