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Author Topic: Total knee replacement  (Read 9368 times)

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Offline pep

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Total knee replacement
« on: May 25, 2015, 07:20:44 am »
Well it looks like I need one sooner than later.  Had the back surgery last summer so don't want to have the knee done till Nov. or Dec.  Sawed one log last year and none so far this year.  Been working on tables, bar tops for my nephews restaurant in North Bay since the fall.  My knee pain has been getting worse and worse.  Hoping I can get through the summer.  Can't even cut the grass.  Been cutting and splitting firewood for the last month, hopefully will get to the cedar logs soon.
Any other members have knee replacements, I know the recovery is 3 months. Had the knee scoped in the 90's and the surgeon told me I need a new knee, but was too active to give me one.  Saw the surgeon in January and he said, Ya your ready.  Said to call him when I'm ready and he'll save me a spot.  Not looking forward to it.

Cheers
Pep
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Offline Chuck White

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Re: Total knee replacement
« Reply #1 on: May 25, 2015, 09:51:08 am »
I have a couple of cousins that ended up having both knees replaced a few years back and their comments (from both of them) were "wish I had done it years ago", so, they are happy.

My wife is scheduled for left knee replacement in July.

They've already taken the cat-scan so they can make the artificial knee ahead of the surgery, then if they have a cancellation, maybe she can have the replacement done earlier than scheduled.

All I know is she has endured lots of knee pain and more to come before the surgery.
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Offline Chet

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Re: Total knee replacement
« Reply #2 on: May 25, 2015, 10:18:09 am »
Go for it. I totally agree with the statement "wish I had done it years ago".  8)   I've never regretted mine one single day.
I am a true TREE HUGGER, if I didnt I would fall out!  chet the arborist

Offline Bruno of NH

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Re: Total knee replacement
« Reply #3 on: May 25, 2015, 01:50:26 pm »
i need a double knee replacement .
I'm scared im only 49 years old had knee problems my whole life being a carpenter spent lots of time on ladders .
Being self employed and out of work for 3 months not good .
Jim/Bruno
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Offline ljohnsaw

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Re: Total knee replacement
« Reply #4 on: May 25, 2015, 02:19:16 pm »
The estimate of 3 months is just that, and estimate.  A friend (about 65) had her right knee replaced on Christmas eve.  She is still icing it after 5 months.  Age might be an issue but not her physical condition.  She was a runner (before knee problems) but has stayed an active cyclist doing long rides (several hundred miles across the top of NY state last summer).

So, I would not count on being 100% at the end of 3 months.  But she does not have the pain as before!
John

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Offline MikeZ

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Re: Total knee replacement
« Reply #5 on: May 25, 2015, 10:33:33 pm »
pep:Had total left knee repl 7 yrs ago. One of the better surgerys I had done. So glad I did it. Took 6 weeks till was sure I did the right thing. My recover time was right at about one year before was comfortable with it. It definately is different sort of pain but just knowing it will get better helps. My home rehab was with ice machine and power flexer every 4 hours for 30 days. My ortho surgeon worked on Notre Dame athletes. I even had to stay the 4th day in hosp because of pain. Good Luck,things do get better!
MikeZ  Homemade  Mill

Offline pep

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Re: Total knee replacement
« Reply #6 on: May 26, 2015, 06:09:07 am »
Thanks for the reply's guy's.  I'm hoping I can make it through the summer and fall.  I do work with a gen II brace on and am on cellabrex daily.  Doesn't it suck to get old.

Cheers
Pep
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Offline thecfarm

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Re: Total knee replacement
« Reply #7 on: May 26, 2015, 07:47:22 am »
My Father was in his late 60's when he had it done. I use to cut wood with him. It worked for him. He was the type that did not go to Doctors. But a man can only put up with so much pain for so long. He was glad he did it.
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Offline doctorb

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Re: Total knee replacement
« Reply #8 on: May 26, 2015, 08:10:48 am »
Sorry, was away for the holiday weekend.

pep-

If you have any specific questions regarding the procedure, I am sure I can answer them.  Your recovery estimate of three months is a bit short, IMO.  Yes, at the 3 month mark you should be walking and have a good range of motion of the knee, but it is not like the knee is "back to normal".  You will get some swelling if you overdo, and it takes awhile to regain strength in a recently operated limb that's been painful for a long time.  Total hips are easier to rehab than total knees.

Some of my partners say that the good to excellent results that are routine in total knee patients happen in about 90% of those receiving them.  The other 10% are not as happy with their result, usually from residual pain and stiffness.
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Offline pabst79

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Re: Total knee replacement
« Reply #9 on: May 26, 2015, 08:30:46 pm »
 What I would like to know is, are there really "new" types of artificial joint replacements? Do they work and last longer? I have seen a model at the Ortho that looks like they only cut out half of your knee joint, supposed to offer a faster recovery?  I will be 36 in August, I need a new hip and knee, the problem I have is that my femur has a titanium rod that go's from my hip down into my knee and I don't know how or if I can recieve a artifical joint. My Doc say's I need to wait as long as possible, I wear a kneebrace and use Tramadol and Volteren to get by. So I'm very interested to hear how other people deal with joint issues. Pep, I wish you luck and hope all goes well.

Josh

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Offline doctorb

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Re: Total knee replacement
« Reply #10 on: May 26, 2015, 10:08:03 pm »
pabst-

First - you will need that intramedullary nail removed before you get a total hip or total knee replacement as the surgeon places an aiming jig down the inside of your bone (in the intramedullary canal where the nail currently resides) to line up the joint correctly (knee) or to place the stem of the total hip.  Either way it's coming out as it's directly in the way.  Not a big deal to remove in most cases.  Often not done at the same time as the false joint.

There are newer knee replacements that only replace a portion of the knee joint.  These are called partial knee replacements and should be thought of as long term temporary fixes.  Often, the remainder of the knee wears out over time and the partial replacement gets converted to a total knee.   The reason the partial replacement rehabs faster is that it's much less surgery.  If your entire joint is arthritic, you are not a candidate for the partial replacement.

Total knees are generally thought to last about 20 years.  The science of their longevity lags behind as the joints that were inserted 20 years ago have changed.  So the current "best" and newest model doesn't have a 20 year track record yet.  A common dilemma when really long term follow up is required.

You are VERY young for a knee replacement and I agree with your doc.  Wait as long as possible.  If you are overweight, make dieting a number one priority.  Your knee will feel much better with less weight to carry around so it will be easier to make it to the ripe old age of 50 with the knee you've got.  The younger the patient, the more active they usually are.  Couple that with increased weight and being a male by gender, and the likelihood that a total knee inserted in you at age 36 lasting the hoped for 20 years is pretty slim. 
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Offline ljohnsaw

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Re: Total knee replacement
« Reply #11 on: May 26, 2015, 10:28:34 pm »
doctorb,

Just for my own general knowledge - my knees are fine but my wife was looking at the prospect before cancer got her.  I've heard two stories:  When your replacement knee(s) wear out, 1) they can replace them one more time with a longer version or 2), you loose your leg(s).  Are either true?
John

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Offline doctorb

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Re: Total knee replacement
« Reply #12 on: May 27, 2015, 09:00:36 am »
Both of those answers are incorrect overstatements.

If a total knee "wears out", that can mean two entirely different things.  The most common is that the plastic liner has worn, creating some particulate debris and inflaming the knee.  This results in swelling and pain.  Newer forms of the plastic are demonstrating much less of this effect.  The treatment here is to exchange the polyethylene plastic tray and leave the metal components (what's actually attached to you), in place.  This is a relatively easy operation.

The other form of "wearing out" is when a component becomes loose.  This causes pain and requires a revision surgery with the insertion of a new component.  With each revision surgery, a little more bone is removed to permit a good fit of the new component to your bone.  If a significant amount of bone is eventually removed, the type of total knee required is more like a hinge.  These "constrained" knees do not last as long as a well done virgin knee replacement, which is more of a resurfacing of the damaged joint.  If an infection arises, then things can get really dicey.

You are not necessarily looking at an amputation after multiple total knee replacements.  The salvage operation is a knee fusion (also called an arthrodesis), which gives you a shorter leg with no knee at all, as the tibia bone gets fused to the femur, leaving you with a permanently straight leg.  This is an operation that is not too common, because most total knees last a long time, but it is one I have performed when necessary.  While that straight leg sounds awful, many patients are quite happy to put up with that over an amputation.  Amputation after total knee replacement usually only follows failed revisions for infected total knees.
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Offline ljohnsaw

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Re: Total knee replacement
« Reply #13 on: May 27, 2015, 11:03:51 am »
Dr. B,
Thanks for the info.  My wife was looking at (wanting) a replacement was back in the mid-90's when she was in her mid-30's.  She was told she was too young and wouldn't be able to have a new set in her 50's when the first wore out.  Granted when your 35 that is young, but when you can't walk more than a few feet, your quality of life suffers.  Have things changed that much in 20 years or was it just the health plan not wanting to spend the money?  She had complete cartilage degeneration as viewed by arthroscopic surgery.
John

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Offline doctorb

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Re: Total knee replacement
« Reply #14 on: May 27, 2015, 02:22:17 pm »
Cartilage lost to that degree at that young age is unusual.  Sometimes its due to malalignment, what we call varus or valgus alignment (you would call it bow legs or knock knees).  If your anatomic alignment is way outside the norm, then an osteotomy (breaking of the bone) is often performed.  This realignment of the leg unloads the diseased portion of the knee and often gives years of relief.  In a young patient, I would first look to see if an osteotomy could decrease pain as well as provide a number of years longevity before possibly needing to resort to a total knee.

I do not hold the opinion that it was the insurance company just keeping their money in your wife's example.  Doing a total knee in a 35 y.o. is a very serious decision, and everything needs to be done to postpone that decision, as the rate of requiring a revision surgery in the future is very high.   Anti-inflamatories, steroid injections, injections of "cartilage" builders, osteotomy, and certainly weigh loss need to be considered for quite a while before agreeing to do a total knee at that young age.  things have not changed regarding that decision in the last 20 years.  It's possible someone might suggest a partial knee replacement, dependent upon the specifics of her arthritis, to try and milk her through for another 10-15 years.
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Offline Chuck White

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Re: Total knee replacement
« Reply #15 on: May 27, 2015, 03:00:11 pm »
Doc;  My wife is following this thread and is scheduled for July left knee total replacement and wants me to ask you this question.

When she has the knee replaced, if she follows the suggested/required physical therapy, would she possibly be able to return to her once-a-week bowling at 3 games per week, 6 weeks after the surgery?

Thanks.
~Chuck~
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Offline doctorb

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Re: Total knee replacement
« Reply #16 on: May 27, 2015, 03:32:10 pm »
Some patients could, but some may not yet be ready.  Even with those that would be able to bowl 6 weeks out, it might not be as graceful as it will be further into the future.  She should shoot for it, but not be disappointed if she feels she's not up to it, 6 weeks postop.  A good aggressive goal is a great target.  Talk to her doc after the surgery.  There are things that must be individualized with every surgery, including TKR.  He may say that she's a go, or he may ask for a slower, less aggressive rehab.  Depends on the knee and how the surgery went.
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Offline BradMarks

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Re: Total knee replacement
« Reply #17 on: May 27, 2015, 04:14:19 pm »
Chuck:  I have a teammate who had knee replacement last Sept, right after league started. He was not comfortable coming back until late Jan/early Feb, about 4 months worth. After a few weeks of soreness-not necessarily his knee!, he started scoring better. Until his other knee made him miserable...... which will be replaced. Already informed me he will not bowl this next year.  His first one was the slide leg.   As to "complete" recovery, surgeries I've had generally take a year or so to regain close to full strength.   

Online LeeB

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Re: Total knee replacement
« Reply #18 on: May 27, 2015, 09:26:58 pm »
This topic is of much interest to me because my knees trouble me a lot. I know for sure that I need to loose weight and get more exercise. Running or just a lot of walking makes my knees really hurt. Is riding an Exercycle any better?
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Offline trapper

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Re: Total knee replacement
« Reply #19 on: May 27, 2015, 11:08:32 pm »
Was thinking I needed a knee  replacement.  Lost 30 lbs since easter and almost all my knee pain went away.  This is a knee without a knee cap due to an accident.  Not saying it would work for anyone else but sure helped me.  Half way to my goal.
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