Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
133 Doctors are Online

Fibromyalgia, recurrent knee surgeries - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: TMJ
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2477 Questions
User :   Query: Hi doctor: I am a 68 year old male. This is going to seem like a long narrative, but I think everything following is all related, so necessary for you to know. After having 3 orthroscopic attempts to repair my right knee I had to have a TKA in January of 2006. During this same time period I continued to walk and use my right leg as normally as possible. This had a detrimental affect on my right ankle and my left knee because of the severe limping I was having to do. When I had the TKA the doctor indicated that he felt I should have a TKA of the left knee as soon as I was able to manage. During the summer of 2007 my right knee became better than I remember it ever being. But, by the end of summer my right ankle became completely worn out and it was decided I had to repair it first. I had this surgery in Nov. of 2007 where they attempted to fuse my right ankle. My own leg bone was used. Shortly after the surgery, while still in the cast, one of the two screws broke in the ankle. We used an external bone stimulator during the rest of the year until November of 2008. At that time it was determined that the fusion had not occurred. The surgery was repeated in November of 2008; the screws were removed; a larger amount of bone from my hip was used; and the screws were replaced by large staples. Again during the rest of the year the bone stimulator was used and once again the ankle did not fuse. The staples had pulled out of the bone, and the staples were removed during surgery yesterday. Now here's my real dilemma. 1) Since the surgeries began on my ankle my foot, ankle, and lower leg to the knee have been continuously swollen to a very large extent. My surgeon doesn't know what's causing the swelling. We've had various tests done, I've seen 3-4 doctors in other fields of study, but no one seems to know the answers to the problems. And 2) The
User :   surgeon doesn't think it would be a good idea to attempt a third surgery to fuse the ankle, nor does he feel that surgery should be done to my left knee until the right ankle problems have been resolved. I can understand his thinking, but I'm reaching the point that I can barely walk on either leg do to the pain. What are your thoughts? Why hasn't the ankle fusion been successful? What's causing the severe adema in my right leg? Do you think it would be inadvisable to have my left knee replaced before rectifying the right leg problems? I really need to be able to walk with at least one good leg. What would you do if my legs were yours? Thank you for your consideration.
Doctor :   Hi'
Doctor :  
Let me read the paragraph..
Doctor :  
May i know why these surgeries what was the need for TKA
User :   The knee was replaced because the miniscus was torn beyond repair and arthritis has gotten really bad. 'There was no cartilage left in the knee.
Doctor :   Have any Xrays been done to know the cause for the swelling?
User :   They've taken many sets of Xrays, an MRI, and a CT. They also did two vascular ultrasounds, but could reach no conclusions as to the cause of the swelling.
Doctor :  
Do you have the reports of the recent X rays or the MRI with you and may i know the reports of these?
Doctor :  
I would like to go through those before giving a conclusion.
User :   I personally do not have these reports. Is it possible to have them sent to you?
Doctor :  
It would be better if i can see those reports before conclussion.
Doctor :   for fusion to occur the bones have to be healthy.
Doctor :  
Fractures during the time of healing or an infective process during the time after the fusion can impain the healing procedure and can result in non fusion.
Doctor :   Since you did have fractures during the procedure it might have resulted in the non healing.
Doctor :   Have you followed?
User :   Could the adema be causing the bone to be unhealthy? Is this a catch 22 situation? One causing the other and vice versa?
Doctor :  
Yes, the odema can also play a role on the healing procedure.
User :   My surgeon just doesn't have any idea of what's causing what.
Doctor :  
If the odema had been there during the time of healing it could have resulted in the jusion, not otherwise.
Doctor :  
Have you followed.
Doctor :  
And regarding the cause for the swelling i need few more details on the swelling to know the cause for it.
User :   I don't understand your last statement.
Doctor :  
can i proceed?
User :   Proceed in what way? What do you need me to do?
Doctor :  
I meant if the swelling had developed immediately after the surgery during the time of the healing procedure then it might have contributed to the non fusion.
Doctor :  
I meant can i ask few more details ?
Doctor :  
Have you followed?
User :   Yes, by all means. The swelling came immediately after the surgery.
Doctor :  
Yes then it might have contributed to the non fusion.
User :   I'll answer anything you ask.
Doctor :  
may i know if the swelling is localised only over the knee and the ankles or is it generalised swelling of the limb?
User :   The swelling is my toes, ankle, calf, and leg up to the knee.
Doctor :  
Do you have pain due to the swelling or is it painless?
User :   A lot of pain to walk. Shooting pains across the ankle. Shooting pains up from the ankle into the calf.
Doctor :  
Do you have noticed any similar swellings on the other limb too?
User :   On occasion there is some swelling below the left knee. Sometimes extending down TO the ankle, but usually only when I've twisted the knee severly while limping on my right leg.
Doctor :   Ok.
Doctor :  
do the swelling increase or decreases in size when there is a change of postures?
User :   There is no change in the swelling, even when I've lain all night with my leg propped up above my heart level. It does get more swollen some days when I've walked too long on hard floors.
Doctor :   Ok.
User :   But for the most part, no change.
Doctor :  
Do you have any other medical problems?
User :   I have fibromyalgia. Was diagnosed back in 1995. I had stents placed in my heart January 2009.
Doctor :  
Ok.
Doctor :  
I can give you a gross picture of the cause based on your history.
User :   Of course!
Doctor :  
The cause for the swelling might be of a vascular cause.
Doctor :  
if the x rays did not reveal the swelling arising from the bones.
Doctor :  
The exact cause can however be established after going through the reports of the MRI and xray.
User :   Would a vascular cause not have shown up in the ultrasounds I've had?
Doctor :  
A doppler study if done might have picked those.
Doctor :   If there were any.
User :   OK. So, what do I need to do for you now. Can I have tests, etc. sent to you?
Doctor :   can you send us the scanned reports of the scans both the ultrasound, xrays, and the MRI scans to us
User :   Yes. I'll get a disk with all that information and send it to you Monday or Tuesday.
Doctor :   You can send us those to the following id.
Doctor :  
It would be YYYY@YYYY
User :   OK. Attention anyone specific?
Doctor :   No.
Doctor :  
Just mail to us. one of the doctor have access to it and will let me know immediately when those reports come.
Doctor :  
Have you followed?
User :   OK. I'll get it done. One final question: What sort of vascular person should I see?
Doctor :   If you haven't been evaluated by a vascular surgeon you can get the evaluation done by a vascular surgeon too to rule out the possibility of a vascular cause.
Doctor :   Have you followed?
User :   Yes! Will talk with you soon, I hope. Thank you very much for your time and assistance.
Doctor :   We shall return to you as soon as we your mail.
Doctor :  
Do you have any other query?
User :   No. Not at this time. Thank you. Goodbye.
Doctor :  
And we would be getting back to you through your mail.
Doctor :  
so please confirm your email id..
Doctor :  
YYYY@YYYY .. is it the same?
User :   My E-mail is YYYY@YYYY
Doctor :  
We shall get back to you through the same.
Doctor :  
Please fill the feed back form too.
Doctor :  
Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
User :   Form was completed.
Doctor :   Thanks and bye for now. please refer our service to your friends and family if you had liked it.. bye for now.
Doctor :   Hi.
Doctor :  
Are you there?

Question is related to
Medical Procedures
© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor