Recovery from debilitating symptoms including chronic fatigue, depression and eczema after revision from nickel to titanium knee replacement.
In January 2008 aged 43 years I was working a 60 hour week as a personal trainer. I was very healthy playing tennis and running regularly up to marathon distance. I slept well and had generally very good health with no need for days off sick since qualifying as a trainer. I had some minor health issues, like mild depression which responded well to medication, mild eczema, which again responded well to weak steroid creams and extensive osteoarthritis in my left knee. After various surgical interventions, it was decided that I was a good candidate for a knee replacement. This took place in February 2008, and a nickel containing implant was used (although I was not informed of this at the time).
February 2008 – April 2012
Almost immediately post-op I was exhausted, irritable, depressed and in severe pain. I was unable to walk even with crutches with a massively swollen knee joint and swelling extending down to my foot.
Within 6 weeks my life had changed completely. At first I was constantly exhausted cutting back to working 12 hours a week and suffering from Chronic Fatigue Syndrome. By late 2011 I was registered disabled; receiving the highest rate of disability allowance. I now needed assistance in all tasks around the home. My pre-existing depression no longer responded to the highest doses of anti-depressant medication and was classed as severe. Eczema on my hands flared so severely that the knuckles would split and bleed, strong steroids would suppress the eczema but it returned as soon as I stopped applying the creams that were thinning my skin. I developed Pompholyx (primary cause listed as over-exposure to nickel when allergic), again my fingertips were often split and bleeding and too sore to perform everyday tasks. I suffered from insomnia and was generally susceptible to any and all infections.
Local symptoms around my knee were also severe; I had unexplained pain around joint, knee, calf, and thigh: requiring strong pain medication and attendance at pain clinic. At the worst time I was taking a total of 320 mg MST daily, in addition I took Oramorph, NSAID and high dose paracetemol and there was still no respite from the constant pain. The knee area was swollen, hot and inflamed throughout this entire period, and I experienced a loss of movement so severe that I was unable to have a bath during this 4-year period, due to lack of knee bend, I was unable to walk up and down stairs normally. The scar hadn’t healed properly and excess scar tissue meant further surgery to remove adhesions. I had to crawl up the stairs and come down on my bottom. I suffered from inflammatory conditions throughout my body, particularly joint and soft-tissue areas. As at 29th March 2012 in the following locations: acute synovitis in left dorsal foot between navicular and cuneiform bones; acute tenosynovitis in left flexor pollicis longus; acute medial epicontylitis (right elbow); acute synovitis in dorsal aspect of right wrist. All these were unexplained, and had no impact on inflammatory markers in blood tests.
Metal allergy/toxicity was suspected and confirmed by patch testing, which showed a positive reaction to nickel, palladium and a weak reaction to gold. MELISA testing backed up the patch testing results and showed a strong positive reaction to nickel, a strong reaction to palladium and again a weak positive reaction to gold. MELISA testing to titanium was negative. A revision of the knee replacement to specially designed titanium prosthesis was recommended by my orthopaedic surgeon, this was not carried out for 18 months.
After replacement of nickel knee joint prosthesis in April 2012
Here’s my diary of the health improvements after the knee revision:
• Within 3 days post-op: Eczema had gone completely without steroid treatment.
• Within 7 days: The pompholyx had gone and my fingers had completely recovered.
• Within 7 days: Peri-oral dermatitis has cleared up, facial skin has improved and able to stop antibiotic treatment.
• Within 7 days: Significant improvement in mental health, with positive thoughts, better concentration, better attention span, clear-headed feeling, no further need for anti-depressant medication
• Within 10 days: Surgical site completely healed and stitches removed. Thin scar line rather than excess scar tissue development.
• Within 14 days: Able to flex to 90o and extend to within 10o of full extension.
• Within 14 days: Sleeping better. Although still some disturbance due to post-op discomfort, generally sleeping for longer periods of time (4-5 hours at a time).
• Within 3 weeks: Able to return to work on limited basis (2 hours per day, 4 days per week).
• Within 4 weeks: Fatigue is gone completely.
• Within 4 weeks: I have stopped the Oramorph, which was prescribed post-op, and stopped the Oramorph I had pre-op as well. I am continuing with anti-inflammatories due to the localised swelling at the knee joint.
• Within 4 weeks: Able to fully extend knee and able to flex to 100o. Able to participate in Pilates classes and demonstrate several exercises with ease.
• Within 4 weeks: Lost ½ stone in weight without any change of diet.
• Within 5 weeks: More energy than I have had in 4 years.
• Within 5 weeks: Able to return to private Pilates clients and existing private PT clients.
• Within 5 weeks: All the lymphoedema in the left leg has disappeared and I am already able to wear normal shoes. High daytime temperatures and being on my feet all day do not have any impact, or cause any sign of the lymphoedema previously suffered.
I still have widespread osteoarthritis and have had to undergo 10 further operations to my knee – several due to the extensive scar tissue and others due to the damage to the bones caused by the nickel being left in-situ for too long.
However with my new titanium knee, for the first time in years, I feel well. There is still some residual heat, swelling, and effusion within the knee joint and I need to wear a compression stocking for work. But in general for the first time in over 4 years I feel well, I have energy, I feel positive about my future, my skin is healthy and I’m sleeping well.
Gaynor Mitchell 2015