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Total knee replacement

Started by pep, May 25, 2015, 07:20:44 AM

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pabst79

doctorb,

I completely agree with your comments, in my opinion everyone repeats the story about the guy who got burned up in a car because of a belt, but never consider or talk about the tens of thousands that die because of ejection or bouncing around like a pinball. A 2 ton bucket truck pulled out in front of my Dad and I, we were going about 65 and Dad had no time to hit the brakes. He was wearing a seatbelt, I was not, the airbag saved my life. He had bruised ribs, I had a broken hip, femur and cracked ribs. I tell the story as often as I can to the anti seatbelt crowd. Its so easy to wear them, why risk it!

I would like your opinion on the cortisone shots or steroids? I'm supposed to be going to a pain management clinic, but haven't had time to get in. I have been on 200-300mg of Tramadol for 4 years and use Voltaren gel and they seem to help enough that I can still work, but not sure how long they will continue to be effective? I have heard that sometimes the shots can do more harm then good? Again I appreciate your advice.
Not sure which came first, but I have chickens and eggs.

doctorb

Cortisone injections are a mainstay of reducing the inflammation and pain of arthritic joints.  Usually given 4 X / year maximum, most often only twice.  They really help some people and I would not hesitate to use them.  Given too often then can have a deleterious effect on joint cartilage, but your doc should keep you away from that.  I think the risks are very, very low compared to the benefit, especially if you are running out of meds to try. It may not work, but usually they do.  The unanswerable question is for how long.
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."

Brucer

No point in repeating doctorb's advice -- he's the expert on the medical side. Here's some advice from the patient side (patient's spouse, actually). EDIT: I added a few comments in blue after I first posted this.

Barb had her second knee replacement 8 years ago, and the first one 6 months before. She really didn't want surgery and did everything she could to avoid it. Finally her GP told her it was the only option left -- she had advanced arthritis in both knees (no cartilage left).

At that point she had trouble getting up and down the basement stairs, trouble walking up and down hills, trouble getting in and out of the car. I was doing a lot of fetching and carrying so's she could avoid all those difficult places.

When she finally decided to go with the surgery, there was no fooling around. It was going to happen. As it turned out, her GP recommended one particular surgeon and he had a 6 month waiting list. Fine. In the meantime, I started researching on-line. Here's what I learned.

Your new knee will never be as mobile as your original (when you were healthy). The longer you can put off getting a replacement, the more satisfied you will be with the result.

This is not a "plug and play" scenario. When your new knee is in place, it only has the potential to be better than your worn out one. You have to make it better. It's a lot of hard work and no one can do it for you.

Prepare yourself physically. When your knees are that bad, you may not be able to do a lot for weight loss. Doesn't matter. Go to the gym and work on your upper body, your core muscle strength, and your aerobic fitness. Get some advice from an experienced trainer. You will find it a lot easier and safer to move around if you can take a lot of the load off your legs. Good cardiovascular condition will reduce possible complications. If you're a smoker, quit now. Three months in the gym just before surgery is a good target. Longer is better.

Prepare your house. If you think you might need handrails in the bathroom, get them installed. You might need to raise your bed. You can check some of these things out ahead of time by trying to move about with your bad knee straight and putting almost no weight on that leg. You don't want to find out that your bed is too low to get out of easily when you have to go the bathroom urgently.

You'll want a chair you can get in and out of easily, and you will want to be able to keep your leg raised for a good deal of the time. At the same time, you will want to move about as much as you can. That means in and out of the chair a lot.

Plan for all the things you will need to do if there is no one there to help you. You won't be able to kneel on your new knee for a very long time, and you won't be able to flex it enough to kneel on the other knee. Is there anything stored in low cupboards that you won't be able to reach? Be sure to have a wireless phone (or cell phone).

You will probably need a walker for a week or so. You might need crutches as well. Barb used a cane for a month or so after surgery (she bought one with molded handles and adjustable length).

Have people you can call in an emergency. Rethink your ideas about what an emergency is -- small, simple stuff can become much more important if you aren't mobile. What happens if you slip and fall? How are you going to get back up (even if you don't hurt your knee in the process)?

Your spouse/partner will have to be prepared to do a lot more work around the house for a couple of months. If there's no one living with you, arrange for someone to come in and help out.

You won't be able to drive for several weeks. Make sure you'll be able to get to appointments after the surgery. You will need a lot of physiotherapy -- 2 or three times a week. You may need to see a chiropractor.

You will need medication -- meds for pain, and blood thinners (blood clots are a big concern after surgery). Someone will have to fill those prescriptions for you. Someone will have to inject those blood thinners if you aren't able to do it yourself.

The biggest thing that will lead to a satisfactory outcome is knee joint flexibility. You will need to work hard on this (that's why the physio) and it will hurt (that's why the pain killers). You need professional advice so you pace yourself properly, but you also need someone to keep pushing you.

Barb discovered one of the greatest things for working on flexibility at home was a recumbent exercise bicycle. We got a cheap one that was adjustable for leg length and resistance. Barb was able to keep adjusting it so she was always pushing herself just a little. After both knees were good (about 1 year after surgery) we gave the bike away to someone else who was having knee surgery.

Finally, the outcome. Two years after her second surgery, with both knees in good working order, Barb and I became grandparents. When I watch her playing with the grandkids, taking them for walks in the woods, hiking through the snow, scrambling up and down hills, I think of what it would be like for her if she hadn't had her knees replaced. She thinks about it too.
Bruce    LT40HDG28 bandsaw
"Complex problems have simple, easy to understand wrong answers."

LeeB

Excellent post Bruce. A lot of good food for thought.
'98 LT40HDD/Lombardini, Case 580L, Cat D4C, JD 3032 tractor, JD 5410 tractor, Husky 346, 372 and 562XP's. Stihl MS180 and MS361, 1998 and 2006 3/4 Ton 5.9 Cummins 4x4's, 1989 Dodge D100 w/ 318, and a 1966 Chevy C60 w/ dump bed.

doctorb

Brucer's post should be a must read for any patient considering knee replacement.  Excellent.
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."

Brucer

I added a couple of comments to my previous post (in blue). Good cardiovascular fitness will reduce potential complications during and after surgery. Smokers should try really hard to quit as part of preparing for surgery. I know that's hard -- try to convince yourself that it will make your new knee(s) even better. Remind yourself that once you're past the surgery you can always take it up again (but maybe you won't want to by then :)).
Bruce    LT40HDG28 bandsaw
"Complex problems have simple, easy to understand wrong answers."

Gary_C

After being in the dairy business, I have been around many people that have had knee replacement surgery and I can say you can expect results to vary widely depending on many factors. The obvious factors are the skill of the surgeon and hospital in making the right cuts and avoiding infection.

Quote from: Brucer on May 30, 2015, 01:54:23 AM

This is not a "plug and play" scenario. When your new knee is in place, it only has the potential to be better than your worn out one. You have to make it better. It's a lot of hard work and no one can do it for you.


What Brucer said is an extremely important point. The best outcomes are with the people that can push thru the pain during the immediate post-op period and beyond. You must get that new knee in motion right away or there will be unwanted scar tissue that develops and will make your rehab more difficult and the final outcome not as good. During that immediate post-op time, it truly is as the saying goes "no pain, no gain."
Never take life seriously. Nobody gets out alive anyway.

petefrom bearswamp

My experience.
My knees were hurting for  the past several years.
i heard about a new partial compartmental replacement called MAKO plasty and researced it further .
Had both knees done last June 9th.
the recovery was slow and I am an impatient sort so quizzed the last surgeon I consulted with in October.
He said I tell my patients that a bilateral is not twice as slow, but about 5 times as slow recovery.
Almost a year now and at 77 yrs the knees are great.
No problems
I just finished marking about 70 acres of timber some on a very steep slope with no problems.
worked at the mill alone today carrying heavy slabs, planks and boards with no discomfort.
My unprofessional advice is to look into this procedure.


Kubota 8540 tractor, FEL bucket and forks, Farmi winch
Kubota 900 RTV
Polaris 570 Sportsman ATV
3 Huskies 1 gas Echo 1 cordless Echo vintage Homelite super xl12
57 acres of woodland

Brucer

You need to get a diagnosis on your condition before you do too much research. A partial replacement would not have worked for Barb -- her knees were too far gone. For other people in other situations, a partial would be an excellent choice.

Barb's first meeting with the surgeon was interesting. His first comment (before looking at her file) was, "You're awfully young for a knee replacement." She told him she'd been diagnosed with "advanced arthritis" (which is a technical definition, not a generic description). He pulled out her X-rays, took one look, and said, "Right, new knees."
Bruce    LT40HDG28 bandsaw
"Complex problems have simple, easy to understand wrong answers."

petefrom bearswamp

Brucer, glad all went well for your wife.
I appreciate everyones comments especially Docs medical insights and brucers advice regarding post op.
I did do a consult with xrays and cat scan with the surgeon before doing my extensive research over several weeks.
I also looked into blood platelet enrichment injection which is touted as very non invasive and will supposedly rebuild cartilage.
This is not covered by any insurance and would have required a trip to NJ or CAL and was very expensive for out of pocket for a fairly new and somewhat unproven procedure.
regarding Mako, I found a 45 minute utube by a surgeon in Clearwater FL who claims to have done more than 500 of these.
Very interesting and set my mind at ease.
At 77 I doubt that i will wear the knees out, but i am too stubborn to stop working.
As an aside, I ruptured  my left ACL in 95 and had it replaced with a piece of patellar tendon.
The surgeon wasnt sure he could save this repair but thankfully he did.
Also have had a total on my left hip in 99 and a dry revision in 2006.
thank goodness the prosthesis is modular.

Kubota 8540 tractor, FEL bucket and forks, Farmi winch
Kubota 900 RTV
Polaris 570 Sportsman ATV
3 Huskies 1 gas Echo 1 cordless Echo vintage Homelite super xl12
57 acres of woodland

doctorb

Platelet rich plasma (PRP) injections have been touted for a whole lot of conditions.  Tendonitis, arthritis, bursitis, fracture healing, nonunion repair, meniscal repair, assisting total joints in adhering to the bone.....Yep, it's a hot topic right now with very little science behind it.  Sure, they can see that the high amount of growth factors and cells in these concentrates, but we are not sure how they identify what your specific problem is and how they focus in to repair it.  In the future, we hope to be able to give you a specific cocktail of cells and growth factors to stimulate the repair that you need.  We are not there yet.  So, while PRP is big business, and very much a sexy medical topic, I'd wait a bit before climbing on that bandwagon.  I had a friend of mine get 6 different PRP injections over a 9-12 month period for patellar tendonitis.  Heck, the darn thing would have healed by itself in that amount of time!
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."

Gary_C

Doctorb, what's you opinion on this computer guided surfacing to get the precise angles needed for best positioning of knee joints? Is this just another fad or is it going to be the new standard?
Never take life seriously. Nobody gets out alive anyway.

doctorb

At this point, my joint surgeons have tried it and no longer use it.  It's currently more of a marketing tool, in their opinions, than something that improves your outcome.  Here are the controversies.....

1.  It takes a long time to set up, slowing the procedure significantly.

2.  Dependent upon placement of markers and calibration, it can be no more accurate than what is currently done.  Most surgeons currently use guides within the bone to align the femoral and tibial components, not computers.

3.  Everything is experience dependent.  An experienced surgeon places these components within the acceptable range of position the vast, vast majority of the time.  A younger surgeon with a computer is not necessarily better, and could be a lot worse, than an experienced arthroplasty surgeon .

4.  What we have found is that we are all built a little differently.  There is no one perfect position of the components for all patients.  So the allure of the computer assisted guides is that machines are more accurate than humans, but the computer does not necessarily make the adjustments required for your specific anatomy.

There are lots of computer guided surgeries being done.  Many involve brain surgery.  I don't think these techniques are a fad.   I think that they need to be refined and tested.  Further, I think we need to prove that these computer assisted techniques improve long term outcomes in joint replacement.  For the majority of knee replacements performed, the critical factor in their longevity has not been shown to be an absolute requirement of position, as long as the components are close to the acceptable range.
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."

petefrom bearswamp

So doc,
Am I understanding you?
Replacement and other ortho surgery is not an exact science?
I imagine that the surgeon in any case is an artist and I can relate to that as I have had a lot of ortho done.
both knees as stated above, both rotator cuffs and they are acting up again, my fault.
Both bicep long tendons blown no surgery at the insistence of my surgeon again my fault.
Left hip, duputrons on both hands the left one twice, Carpal tunnel both wrists,
Maybe brain surgery to correct my late life accident proneness is in order.
Kubota 8540 tractor, FEL bucket and forks, Farmi winch
Kubota 900 RTV
Polaris 570 Sportsman ATV
3 Huskies 1 gas Echo 1 cordless Echo vintage Homelite super xl12
57 acres of woodland

Gary_C

Thanks for the update Doc. Around the Twin Cities the smaller medical facilities are always sending out a news release touting some "new and better" medical procedure, mostly to compete for patients with the Mayo Clinic. Since Mayo never participates in the hype of the "new and better" it's sometimes difficult to know what is a better way. Your insights are exactly what is needed by those who are facing a decision on knee surgery and it seems like it still more important to find an experienced surgeon than someone touting a new method.
Never take life seriously. Nobody gets out alive anyway.

Brucer

You can draw an analogy between sawing a log and replacing a joint. Each one you do is a new adventure -- you never know for sure what you're going to find.

A lot of the time things work out pretty much as you expected. Sometimes you run into a problem but you've got the experience to deal with it. And once in a while you get a surprise. Sometimes it's a pleasant surprise and sometimes it's a nasty surprise.
Bruce    LT40HDG28 bandsaw
"Complex problems have simple, easy to understand wrong answers."

doctorb

Quote from: Gary_C on June 02, 2015, 01:16:37 AMit seems like it still more important to find an experienced surgeon than someone touting a new method.

Well said Gary.  IMO, there is no more important factor in deciding WHAT needs to be done than factoring in the Experience of WHO is going to do it.  I would rather have a tried and true procedure done by someone who's done thousands of them than have a young hotshot (who may turn out to be absolutely great) perform a newer procedure that they've only done a dozen times.  Just my perspective, and I think it applies to life in general beyond medicine.
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."

Magicman

And well said by you Sir. 
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It's Weird being the Same Age as Old People

Never allow your "need" to make money to exceed your "desire" to provide quality service.....The Magicman

cbla

Interesting thread with some great info. thanks doctorb for sharing your knowledge. I messed up my ACL in my left knee 7 years ago and the plan from the Surgeon was to scope it , but I decided to wait ( 35 years old at the time) and do 6 months rehab.

Still have issues with the Knee, but I am managing. For Work I have to have a medical every 3 years with the last being last year. The Doctor told me at that app there is about 20mm of play in the knee and it will have to be scoped at some point.

blackfoot griz

Thanks for the feedback Doc.

My late mother was the queen of surgery. She had 4 full hip replacements (two replacing hardware that had worn out) a full knee replacement and shoulder (rotator cuff). The last surgery she had was back surgery.
Her take was that hips were the "easiest" followed by the knee ("not bad") the shoulder operation for her was a pain because it had a much longer recovery/healing time. She never recovered from the back surgery (blood clot).
Her house was a 2 story so we installed a heavy-duty handrail and had a walker for each level of the house. After each surgery, she was "allowed" to go downstairs only when she had proven to the PT that she could do so on her own safely.
After her last hip surgery, I talked with her briefly afterwards asking her how she felt and she said "Fine, but I'm not ready to kick a soccer ball yet".  I went to a sporting good store and bought a soccer ball and had all of her friends sign it--it was her get well card and she loved it. I found that damned ball the other day and it brought both a tear and smile!

doctorb

Excellent personal story.  thanks.
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."

drobertson

I've only know three older gents to have had it done,  they are golfing to this day, and very happy, this said the process to the greens was a tedious task. But they are golfing, laughing and enjoying life.  So, it is a hard call, but one that needs to be made and the surgeon and team (hospital) has to have a good history for such a thing.  Sincerely wish you all the best, fighting pain and inactivity is a difficult matter.
only have a few chain saws I'm not suppose to use, but will at times, one dog Dolly, pretty good dog, just not sure what for yet,  working on getting the gardening back in order, and kinda thinking on maybe a small bbq bizz,  thinking about it,

fat olde elf

Chuck White just sent me a personal message. His wife Sheila had knee replacement surgery this morning.  All is well and she is up and walking today !! My wife Bonnie has had both knees done . Both of us have had hip replacements. Before her hip I conferred with the Forum's orthopedic surgeon about a new procedure. He suggested staying with the tried and true deal.  All went well and both of us are blessed with good mobility at 78 and 79.  PTL   Paul E. Randolph
Cook's MP-32 saw, MF-35, Several Husky Saws, Too Many Woodworking Tools, 4 PU's, Kind Wife.

doctorb

For those who want to know, my recollection of the substance of our discussion was whether to have an "anterior" total hip replacement, or have one through one of the other, more traditional, surgical approaches.  My remembrance was that the surgeon performing the anterior hip was younger, having been recently trained in this newer approach.  Given that the long-term results of these two different approaches are considered to be the same, I suggested going with the tried and true (both in surgeon and the surgical approach).  I have two hip replacements myself, so, given my arthritis and my profession, I think I had my facts straight . :D

Glad to hear you're doing well, elf.  Still hang your Christmas ornament on the tree each year.
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."

Chuck White

As of last night, Sheila said that she has had no pain, just a little discomfort!

She's been up and walking several times now, the first time was only a couple of hours after surgery!

She's doing great, says she wouldn't be surprised she'll spend 2 overnights in the hospital instead of 3 or 4!

I just reminded her that there is a healing process that goes along with the feeling process!
~Chuck~  Cooks Cat Claw sharpener and single tooth setter.  2018 Chevy Silverado and 2021 Subaru Ascent.
With basic mechanical skills and the ability to read you can maintain a Woodmizer  LT40!

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