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
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.
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 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
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!
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!
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
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.
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.
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
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.
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?
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.
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.
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.
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.
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.
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.
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?
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.
Lee-
Here's a little Q&A I go through with my patients. If you want to skip it, the take-home message is that while exercise can help you lose weight, you don't need to turn into a gym rat to do so.
"How many calories in one pound of fat?" Answer: "I have no idea"
The answer is that there are about 9 cal/gram of fat....and there are 454 grams in a pound. Roughly speaking, that's about 4000 calories in a single pound of my spare tire (I usually grab it now to make the point.)
"How many calories do you burn if you run a mile?" Answer: "I have no idea."
The answer about 100 calories. And it doesn't matter whether you run a mile or walk it, it's still about 100 calories. The calories burned seem to correlate with distance, not speed.
"How far is Washington DC from Baltimore?" Answer: "I have no idea."
The answer is about 40 miles. So I show them that walking from my office to the Washington Monument would burn about 4000 calories.....only one pound of fat! (40 miles X 100 calories / mile = 4000 calories.) They are shocked to realize that a 40 mile walk only burns one pound off their weight.
Now, let's look at exercise....If you walked 5 miles/day, How many calories would you burn? Answer: 500 (5 miles X 100 calories / mile.)
If you walked 5 miles every day for a week, How many calories would you burn?
Answer: 3500 (7 days X 500 calories / day)
Doesn't that figure sound pretty close to the 4000 calories stored in a single pound of fat? So....ideally:
If you could eat 500 calories less than you burn up every day (and that figure varies for each of us), you would be at minus (-) 3500 calories for the week. If, in addition, you could walk 5 miles /day, you would be at an additional minus (-) 500 calories for the week. Total those two methods and you would be at minus (-) 7000 calories for the week, and, using the 4000 calories per pound estimate, you would lose between 1.5 and 2 pounds per week.
The point is that you don't have to exercise to lose weight. Many of my patients have injuries and disabilities that will not permit them to walk 5 miles per day. But through a change in dietary intake, we can make a steady dent in our universal problem of being overweight. But exercise does increase the amount of calories you burn, and exercise has tremendous other health benifits besides burning fat. Many patients tell me they can not lose weight because they can not exercise. That's when they get this little lecture and hopefully they benefit.
Thanks doc. I know a change in my dietary intake is the biggest factor in losing weight. It's hard to change a lifetime of bad habits. I also know I have to get some kind of exercise since my job is now pretty much administrative now and I spend about 12 hours a day behind a desk. Got to keep the ticker going and keep down the edema somehow. So, with cardio health in mind, is a bicycle any easier on the knees than walking/running? This getting old is not easy, but I like the idea better than not getting old.
doctorb,
I appreciate your advice, and yes I could stand too lose 30lbs, I got down to 175 a few years after my accident and surgeries by walking 3 miles daily and cutting out carbs. I now have too much pain and swelling to do that much walking and I'm trying to keep a better diet. I had the accident in 03' so I've made it okay but recent xrays show bone spurs and moderate arthritis in both my hip and knee, my hip was also broke so there are what look like deck screws holding it together, besides the nail which travels the length of my femur. I had the screws in my knee removed in 05', I assume all the hardware will have to come out at some point?
P.S If I had been wearing my seatbelt like my father was, I wouldn't be having these issues. I won't even ride in a parking lot without my belt on now. smiley_sidelightbulb
Lee-
Exercises that load the knee in flexion are hardest on the patella / femur joint, and not the weight bearing surfaces of the femur / tibia portion of the knee. It may depend how hard you push when you pedal a bike whether your arthritis flares or not. In general, smoother, non-impact loading exercises like a stationary bike or an elliptical are better for knees than running.
"This getting old is not easy, but I like the idea better than not getting old." Amen, Lee. Amen.
Pabst - without seeing you x-rays, I would bet that most, if not all, the hardware will need to be removed if further reconstructive procedures need to be done in the future.
There's an old thread around here about seat belt use. I have pretty strong opinions, backed up by a ton of scientific investigations, that seat belts save lives and lessen injuries. Some still stick to the "I have a right to do what I want to do..." philosophy. It always sounds like the motorcycle helmet debate to me. Others state that "Thank God I didn't have my seat belt on in that crash, or I would have been trapped." While that may be true in selected and very rare instances, the number of drivers and passengers that get ejected from vehicles is astronomically higher without seat belt use. If you want to see the vehicular death rate climb, get thrown from a vehicle during a crash. Ejection of an occupant is much, much, much more common that the depicted "trapped by your seat belt" scenario. Finally, I hear, "The paramedics told me I would have died if I had my seat belt on." That is absolute horse hockey, IMO. I've known hundreds of paramedics and had them describe thousands of vehicular accidents to me, and I've never heard one say that. So I tire of the justifications to not wear them. Click them every time. I am glad you learned your lesson and are here to tell the tale. Sorry about the rant that has nothing to do with the topic!
It would have to be on the exercise bike here at work. Not much place to ride a real bicycle here on the rig. :D I get a little exercise when I'm at home, just not too much when I'm on the rig.
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.
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.
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.
Excellent post Bruce. A lot of good food for thought.
Brucer's post should be a must read for any patient considering knee replacement. Excellent.
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 :)).
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."
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.
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."
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.
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!
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?
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.
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.
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.
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.
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.
And well said by you Sir.
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.
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!
Excellent personal story. thanks.
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.
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
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.
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!
Sheila is scheduled to be released from the hospital tomorrow around Noon.
She is really getting bored.
Here, she'll have a person from the Physical Therapy department come to the house 2-3 times a week.
She still says she wants to bowl on the ladies league that starts in September.
We'll see!
Her Doc says to aim for a high goal, but don't be too disappointed if you don't quite make it!
Well, she's home and kicked back in the recliner with the "Ice Water circulation gizzmo" hooked up and she's comfortable.
Even though she can't really do anything around the house for a while, it's wonderful to have her home. smiley_love
She goes back to the surgeon for a checkup in 2 weeks!
Also, gives me a break from sawing! ;)
Good to hear that. smiley_thumbsup
Well, she toughed it through the first week and is into the second!
She says it's getting easier and I can see that there's less swelling and black&blue and greater movement in the knee each day!
A lot less discomfort as each day goes by!
But she's not quite ready to nail that 7 - 10 split, is she? :D ;D
Nope...... But she talks about it a lot! ;D
Chuck, it's good to hear about Shelia's progress, and it's also good to hear that you are being a good nurse.
Hopefully the Pig Roast will be in next year's plan. ;D
It's been getting discussed quite a bit here lately, Lynn!
Good morning Chuck,
my very best to Sheila on a quick and full recovery,
be well,
DGDrls
Well, she's making lots of progress.
She's graduated from a walker to a cane, she gets around in the house without the cane though!
She's done with in-home physical therapy, and Monday will start outpatient pt at the hospital.
She only has 5 Lovanox (sp) shots to go, I've been giving them to her here at home.
She says she wants to start driving again, home nurse said "ask the surgeon" and your "regular doctor"!
Thanks for the good report Chuck.
Thanks to all for the well-wishes!
Just wanted to give you an update on Sheila's knee surgery.
Well, it's not doin' so well now, the tendon behind the knee (I think it's called the ham-string) is too tight. Thinking there are adhesions preventing the movement.
She can't straighten the leg as much as it should be so, on Tuesday (the 8th) she'll go back to the hospital and they'll put her under anesthesia and physically with brute muscle strength, bend the leg as far as it's supposed to bend and straighten the leg as straight as it's supposed to be.
The doc says she'll be a "sore puppy" for a few days afterwards then all will be good!
Praying things go well.
I'll keep you 2 informed!
It's called a manipulation under anesthesia, or MUA. Not a brute strength thing. Gentle, constant pressure. The last few degrees of straightening, called knee extension, rate as important if not more so than gaining excessive flexion (bending). To walk well, you need to get your knee straight. These last few degrees are the toughest to obtain for any patient. Do not underestimate the need for full knee extension - a straight knee.
Thanks for the clarification Doc, MUA sounds a lot better too.
I'm sure she would also agree.
Thanks for jumping in so many times on this thread!
Well, Sheila went in for the procedure at 12:00 and was back in the room at 12:10.
DONE!!!!!!!!!! :o
The doc said she's doing fine and with time and more physical therapy she'll be good as new!
She has a lot more "range of motion" now, and walks a little straighter.
This is the time, despite pain, to maintain as much of the motion gained through the manipulation as possible. It's time to put up with the discomfort and push yourself.
And she has! ;)
Thanks Doc
On her visit to the surgeons office last week, her knee flex was measured!
She has all of the "bend" back, and she still lacks 6° to be fully straightened!
She is walking "most times" without any sign of a limp!
So, overall, she's doing great!
Thanks for sharing the good report Chuck. :)
Excellent. I told you that the last few degrees of extension were tough. Put her foot up on your coffee table and gently push down on her knee. Every commercial.
Thanks Doc, she still goes to PT, twice a week!
Likely she'll be done with PT within the month, it's already been discussed.
She said the toughest thing at PT was slowly walking backwards on the treadmill, but it seems to be what helps the extension the most!
SWMBO had the minimally invasive total knee replacement on 10/28 and seems to be ahead of the curve in recovery. Her range of motion is currently from 0° to 95° and we should be switching from in home physical therapy to the local PT clinic next week. 8) We're fortunate to have a couple of the MDs who 'wrote the book' on the technique in our back yard.
I am facing a knee replacement soon. Hope all mentioned are doing better.
Good luck to you fishpharmer & SWMBO.
The PT seems to be everything.
Sheila says the best thing she's noticed is "all the pain she had before surgery is gone"
SWMBO says the same thing. All the deep pain is gone and right now its just weakened sore muscles and the incision site.
My wife had knee replacement surgery yesterday afternoon, is already home, and I just caught her walking without her walker! Women are definitely tougher than men (at least this man). PT guy told her to try and do 5 reps with her exercises so she did 20. I'm praying that she continues to do this well.
Y'all have a great Thanksgiving.
Sounds like she will do fine.
Just remember, PT is everything!
Good Luck.
8) :o both knees both hips compleatly replaced i can get down and crawl across the floor of course you might have to help me get up :D :D
Well finally had the total replacement Jan. 5th. The surgeon wouldn't discharge me till Saturday. Supposed to get out Friday but I had a fever and my knee extension wasn't at 90 degrees. So Saturday I had to suck up the pain until the PT said I had 90 degrees. It was the most excruciating pain I've ever experienced. My wife who is a PT is doing her part inflicting some pain,lol, like Chuck said PT is everything. Go back to the Surgeon for removal of staples on the 20th. They say knees are a lot more painful than hips. Also the anesthetist did a spinal rather than a general. Much better and gives longer pain relief than a general. Hoping to rent a cpm tomorrow to help with the extension exercises, much easier and less painful. Happy New Year and Cheers to all
Pep
Hoping you heal quickly.
Had both knees done compartmentally (MAKO plasty) 1-1/2 years ago .
Both are about 98 percent now.
Hang in there
Thanks Pete. Been having a hard time managing the pain.
I have had trouble with my right knee for years but lately its been getting worse with it popping out for no reason just walking and picking the weight off my foot will pop it out how long is the recovery is it a simple or major surgery or am i asking for apples in a peanut patch
My take on this, from Barb's experience, is that you are far too young to be needing knee replacement surgery.
Hopefully Doctor B will weigh in on this.
It sounds more like some broken cartilage fragments which can be cleaned out and dressed up with arthroscopic surgery.
Sheila's doing fine with her total knee replacement last July!
When she first gets up, the joint is a little stiff for a few minutes!
Years ago if I remember right, she tore an ACL and over time (many years) it lead to the knee replacement!
She was 48 when she had the replacement done!
While every case is unique some doctors are doing replacements on younger people than what was done before. Like in any surgery if you don't absolutely trust the advice of your doctor ask around for recommendations and get a second opinion.
One thing I've heard time and again (and from Barb's surgeon as well) is that if you get a knee replacement too soon, you may not be happy with the results. The new knee will never be as good as the original (when it was in good shape). People who delay the replacement surgery are generally happy with the new knee because it's way better than just before the surgery.
Your first step should be to see an orthopedic specialist and find out exactly what is wrong. From what you say, it might be just some kind of knee brace would would be called for to stop the knee from "popping out."
It doesn't sound like you are ready for knee replacement yet.
pictures, pictures, pictures, Then if they cannot determine have arthroscopy.
Had mine done for some minor issue which could not be seen on film.
took about 4 weeks to get back to 75% then about 2 more months to where I trusted
it enough to go back to"regular stuff".
Get an inexpensive brace for now and get in soon,
FWIW do not side load or twist load it,
Best
Dan
Sorry - don't know how I missed this thread.
When you have a joint problem, the diagnosis is key. Don't listen to anyone who suggests ANY treatment (Brace, pills, PT, scope, injection, total joint) until you've had the appropriate tests to diagnose the problem. Certainly, this requires a visit to a doc, followed by whatever imaging is necessary to follow the trail 'til you reach your diagnosis. Then, and only then, do you start to discuss treatment options.
"Popping out" is a very non-specific term. It could be a subluxating (sliding) patella (knee cap), It could be a meniscus (cartilage) tear. It could be a loose body (small chunk of stuff floating around in your joint). It could be bursitis (Irritated sliding of tissues). It could be arthritis. I suggest you get over to your primary care or, if possible, an orthopaedic surgeon, and have them examine you.
Not a surgeon, but have gone through two, and still am with at least one,, the right one,, left knee had a torn ACL, went several years with it, before getting with a surgeon that knew what to do, it did(pop out) if this is right, at least that's what it feels like,,pretty much go down, but it only did this with a twisting or turning motion.. the right knee was a clean up as described,,it hurts to this day,, snagging and debris that twists the knee is painful, at some point I need to get back and see like you, I feel your pain,,
Had a total replacement on da left one a few years ago. I couldn't be happier with the results, (other than if they had used a little lighter grease for this cold weather). :D
Going in for the right knee replacement this fall. When I asked da doc at Mayo Clinic if it was time, he laughed and said it was probably time a couple of years ago. I guess my tree climbing days are over. :-\
It's been a couple weeks now since I got my new right knee. Knee is coming along great. But I did quit all da pain drugs after da first 5 days, except Tylenol. This time around they were really messing me up, even after I stopped it was a miserable few days.
Missing out on Deer Camp with my sons ain't helpin' neither. :(
Are you doing physical therapy now?
Bump.
Since @Magicman (http://forestryforum.com/board/index.php?action=profile;u=10011) is about to have a knee replacement, I thought it would be a good time to bring this topic back to life.
The first page has a lot of information from @doctorb (http://forestryforum.com/board/index.php?action=profile;u=10176) about the surgery itself.
In post #27 I list a lot of things you can/should do to prepare yourself (and your spouse, and your home) for the surgery.
Thank You Bruce for bumping this back up because I had completely forgotten about it. I read the entire topic and probably will go back and do more reading/research. My old knee popped out yesterday further confirming that my upcoming procedure is necessary. :-X
MM-
Just a question....
Your symptoms are not typical of patients with arthritis who are candidates for a total knee replacement. They have arthritis, with its accompanying stiffness (especially after being still for a while like watching a movie), morning stiffness, swelling, and late-in-the-day pain after use or overuse. This "popping out" you described sounds more like a mechanical symptom associated with a torn cartilage or a loose body floating around in your joint. Just because you have postratumatic arthritis from an old injury does not mean you need a TKR NOW. If you have locking of the knee joint, or sudden giving way, those symptoms might be from something that can be taken care of with an arthroscopy.
Not to get your hopes up, but the science is that performing an arthroscopic clean out for arthritis is NOT a long term fix. If, however, you have a meniscal tear or loose body causing these mechanical symptoms, a scope might help you out quite a bit.
Thanks doctorb. I fairly well described my woes in the topic that I started: Knee Replacement in Health and Safety (http://forestryforum.com/board/index.php?topic=108030.0)
I do not have pain and the other knee has plenty of cartilage with no signs of wear. I have had cleanup arthroscopic surgery removing fragments, etc. that had my knee locked. I have ACL damage that I should have had repaired but stubbornness kept me from getting it done. Even wearing a Dr. prescribed knee brace with hinged supports, it still "pops out" or rather "gives way" at times and I can not trust it to allow me to do much of anything.
An ACL deficient knee can certainly act like that. Knees that are "too loose" after injury have that kind of sYmptomatology. The abnormal slipping and sliding within the knee wears the cartilage out.
I appreciate the professional information in this thread! (FWIW, I bought a table saw from a guy in MD just before the holidays, Temple Hill, MD. He was a guy on a heart pump and recently the transplant list-lucky me!
My knees never bothered me through much sports activity, 10+ yrs military and hard labors of various kinds-industry & agricultural.
The bad part kicked in when my step stool sank in the FL sand on one side last winter while loading our mtn bikes over my head on the rack. I compensated and tore outside meniscus on left knee. It self healed nicely while we were there, honestly it "liked" bicycle riding immediately after and self healed as had my diagnosed torn meniscus in my rt knee many years back around age 50-55.
Then I tripped in the woods on a hidden limb under a bunch of leaves, then I strained it and went to the doc, got a cortisone and all was well after each of the 3 shots, 3 months apart. I'm due my 4th on 1/13 and it won't come soon enough! I was moving some very large rocks using FEL forks to widen our main private road and strained the knee and PA said I had shredded the meniscus on the inside this time. Originally the doc said I was a great candidate for a cleanup endoscopic procedure, then the xrays/MRI showed osteo and all that was off the table. I don't know if it was osteo alone or a combo of my age and Medicare rules? Pa suggested I need the doc this Jan visit as I might just be near a new knee. My knee has definitely loosened and become more prone to trickyness since the first shot. I wear an elastic sleeve which aids stairs and kneeling which has become hard to do. Swelling comes after a day on my feet.
Web info lays out the parameters of PT and so on but I've seen some PT a knee pretty quick and others who bitched and moaned and refuse to get their 2nd knee done.
At 76 I am fortunate to have an active life style, mtn bikes, hiking, farm stuff, sawmilling, lifetime woodworker and motorcycle rider, and more. It was only in late May that I did a hike up and down a 7K mtn in NC with a son, so this knee thing has snowballed on me!
It was suggested by my doc to look into plasma treatments- the Tony Delk Center offers them in that same city. I think its ~ $1,800 now, out of pocket. Mike
My knees are starting to bother me. Not overweight at all, in fact very slim and trim, but the signs of trouble are undeniable. I have no idea what it is but something is going south in both knees. I'm an active sort of person so I immediately suspect osteoarthritis....but I ain't sure of it. Because it is early days, I have not seen a medical person for this issue yet. But I have the strong feeling I will need to do something. I can have pains, but I don't get stiffness so far.
Tell me this though....if/when knees are replaced..and since I don't even know what's wrong with mine, for the sake of this discussion, let's just say I would need total knee replacement. So....doing one knee at a time (I assume-again, no idea how this goes), how laid up are you? Are you just in a chair? How long before you're half-way back to normal activities? It is this recovery period...and its attendant lack of exercise, that really concerns me about getting these operations done.
doctorb, one additional question if you see this; I once heard that walking backwards was good for the knee and its troubles. Do you support this idea? I do lots of personal PT on steps, including much backward stairs-climbing. It really pumps the legs. I do wonder if it is also supportive of the knee joints, as I was once told. Thanks
Read Knee Repacement (https://forestryforum.com/board/index.php?topic=108030.0) to see how a super-human recovers in record time! ;)
Thanks ljohnsaw..and yes, I do read bits of that thread. I note our friend is still struggling. I'm scared to death of what this is going to do to upend my physical regimen. A lot of time being laid up, sitting on me butt...is not something I relish.
This life is a trap; Be inactive and become weak and overweight....be active and have your parts wear out! I'm in the later group. Then, as you get those parts replaced, you are forced into inactivity which sets up the next injury.
I may just try to tough it out for as long as I can. It's the kind of stuff where you start to feel pains when climbing and going down stairs, etc....but
I do a ton of that purposely as exercise. As I'm not diagnosed at this time, I'm not sure I can make a valid comparison with MM's situation.
First step is to tell your family doctor/general practitioner and let them advise you, treating yourself when you don't know what's wrong may do more harm than help. Good luck!
No doctor/Surgeon is going to do anything that has not been confirmed by a X Ray, an MRI or a CT scan. Any procedure including the test will have to be approved by your insurance before anything will be done.
Some surgeons will do both knees (at the same time), and some will not. I personally know 3 people that have done both with no regrets.
Thanks fellas. It's early days with me but it does not please me to see this on the horizon. I go to the doc and all that stuff. Just a new-ish situation developing.
I'm bumping this up for personal reasons. I read it all a few years ago and again today, I'm finally getting to the point it will be needed. A few years ago I was told someday, 3 days ago I had new x-rays and got cortisone shots in both and told I'm ready but insurance wants/requires several rounds of shots before they'll pay for the surgerys. Looking for maybe next Jan/Feb if possible, big question is one at a time or do them both at once? I've read pros and cons and will discuss with New Doc in 3 months when I see him again.
I've had both knees done at different times. There is no way I would consider doing both at once. After a few days I could get around enough to do stuff with one done. Personally, being totally laid up with both done at once I would have gone nuts.
There is definitely a psychological issue that must be dealt with.
For me it was the idea a laying on a table and having my leg cut off with a saw. I never hesitated to the point of not having it done, but I did reach the point of telling Pat & Marty that I could get back into the car and go back home.
I have never regretted for a second about having mine done, but I would still be hesitant about having both done at the same time although I personally know 3 people that did and they all 3 recommend both. It's just a mind thing.
You can find my comments on TKR in post #27. Just a couple of things to add. Barb had her first knee done 17 years ago and the second one 6 months later. They're still going strong. She also says she'd never want to have both done at the same time.
Both my TKR are doing good. Don't even think about them anymore.
My Dad had his replacements replaced at the same time. He said that was better than one at a time. I dunno, just hope I don't wear these out and have to do it again.
When I googled the pros and cons of doing both together I first read the pros and thought that's the way to go but then I read the cons which left me more confused than normal and that's bad :uhoh: . A lot will depend on what the doc says but they often want you to decide such things.
If both knees are replaced it is my understanding that it will be done by two Doctors and surgical teams working simultaneously.
I suspect that I will have a bit of swelling in my knee tonight because of the many times I am up and down replacing my porch decking. I have full strength in that knee and there will not be any pain, just tightness when I completely bend it.
My knee was not replaced because of age related wear, but due to the lasting effects of a motorcycle accident back when I was old enough to know better but too foolish to understand.
Michelle's total is just about back to "normal". Her gait is improving, she has 120+ degrees of motion which is good. The partial that preceeded it lasted about 2 years. It was doing fine, she forgot and hopped out of the back of the truck "The doc had said "no jumping". Removing and replacing that partial slowed down this total replacement, that ended up being worse than just a waste of money IMO.