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Any Kind of Surgery can be Hazardous to Your Health!

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Logo Copyright@2018, Adah F. Kennon, Ph.D.

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I wake-up every morning around 3 am hearing my husband moan in pain. Why? He is in chronic (constant) pain due to back, neck and knee surgeries. We have found nothing to successfully manage this pain.

Worst of all is the pain in his knee area, which causes the most concern. He has had three knee replacement surgeries (total knee arthroplasty) since 2000, each performed on the same knee by three different orthopedic specialists.

The first replacement came apart within 6 months. The second insert worked fine, until my husband was involved in a car accident. His car was rear-ended by another car, which caused trauma to his leg and resulted in the second insert having to be replaced.

A third specialist removed the second insert, replacing it with the one that my husband currently has. The important thing is that each specialist removed the hardware placed by the preceding doctor and installed a different insert. Each specialist claimed “bragging-rights,” proclaiming that his attempt was successful.

Despite the anticipated scar-tissue, no one understands why the chronic pain continues.  My husband wears a TENS (transcutaneous electrical nerve stimulation) unit on his leg, applies ice, gets physical therapy (including massages), takes pain killers, and uses a variety of creams and lotions. Nothing gives more than slight relief, and only for a few hours.

Out of desperation, we recently had another meeting with a fourth orthopedic specialist. He reviewed up-dated X-rays and MRI’s, and assured us that nothing was wrong with the position of the knee insert.  As we talked, new information surfaced.

The second specialist used a “ceramic” insert, which the third specialist removed and replaced with one containing “nickel.” Now, why is that important? Because, the cause of the chronic pain in his knee area might be due to an allergic reaction to “nickel.”

Apparently, there is nothing in a ceramic insert that causes allergic reactions. We asked him why the third specialist would remove the ceramic insert and not replace it with another ceramic insert. His response was that he didn’t know. But, maybe it was because this is what he always used. We asked him why we were not told that the composition of the third insert might cause an allergic reaction. His response was that he didn’t know. But, he did inform us that, while rare, some patients exhibit what’s known as “metal hypersensitivity” after a total knee replacement, and that pre-operative screening (a skin-patch test) could have been done to indicate this sensitivity. A positive reaction to this screening would have proved invaluable in treatment planning, alerting the third specialist not to use any “metal-containing prosthetic device,” especially an insert containing “nickel.” Had this screening been done, the third specialist could have used a ceramic prosthetic device. The result – no pain. Unfortunately, another replacement surgery is out-of-the-question. My husband will have to live with his current insert due to his advanced age.

The take-away:

* If you need any kind of surgery (i.e.,  knee, hip, shoulder, …) involving a prosthetic device (i.e., nickel, palladium, cobalt, gold, …), ask for a pre-operative screening to see if you have an allergy.

* If you find that you do have an allergy, explore options that do not contain the problematic metal.

* While most insurance companies pay for pre/post-operative skin patch testing for patients with a history of certain conditions where symptoms are obvious (i.e., contact dermatitis – rash, itch), determine if your health insurance company will pay for a  pre-operative screening (a skin-patch test) for metal hypersensitivity.

*If your health insurance company will not pay for this pre-operative screening (usually costs between $250  – $500), consider giving yourself a gift and pay for it out-of-pocket. You (and those who care for you) will thank yourself for making this very wise choice.

Copyright@2018, Adah F. Kennon, Ph.D.

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