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Lindy gets a new knee today

Started by LeeB, July 25, 2022, 01:16:13 PM

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LeeB

Lindy will get a tkr today on her right knee. We're hoping she can rehab enough to get the other one done before the end of the year so we don't have to eat the deductible again. The right is bone on bone. She's been trying to get it done for over two years but insurance kept denying her because she was 40 lb over thier  weight criteria.
'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.

LeeB

'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.

B.C.C. Lapp

Hope all goes well for Lindy and a quick rehab.  
You know, we pay for our insurance, we pay for our supplemental insurance, we pay our deductibles, and we STILL get the run around and pay through the nose whenever we need serious medical care.   Makes me wonder how much longer this system can work.  Not thats its working so good now.

I just saw Lees second post so now I can ad I'm glad it went well.    8) 
Listen, or your tongue will make you deaf.

thecfarm

Model 6020-20hp Manual Thomas bandsaw,TC40A 4wd 40 hp New Holland tractor, 450 Norse Winch, Heatmor 400 OWB,YCC 1978-79

Magicman

All done before I read the OP.  Good deal.  I have absolutely no regrets on having my knee done. 

I will probably be looking at a hip job fairly soon.  :-X
Knothole Sawmill, LLC     '98 Wood-Mizer LT40SuperHydraulic   WM Million BF Club Member   WM Pro Sawyer Network

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

Peter Drouin

A&P saw Mill LLC.
45' of Wood Mizer, cutting since 1987.
License NH softwood grader.

Larry

Take good care of her and hoping for a speedy recovery.
Larry, making useful and beautiful things out of the most environmental friendly material on the planet.

We need to insure our customers understand the importance of our craft.

Ed_K

 I hope she makes a full recovery. The lady at the house below me didn't do her excerises right and now she has a limp in that knee which made her other knee bad.
Ed K

LeeB

She's very motivated and started her exercises yesterday right after surgery. Brought her home today. Only vehicles we have are 3/4 ton trucks. Was pretty rough getting here in there and 8 miles of dirt road to boot but she is doing well now that she had some rest.
'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

As long as healing of the incision goes well, push for motion of that knee.  Best of luck to you both.
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."

kantuckid

My "hip doc" is also my "knee doc"-that's all he does and he's very good!
 My hips were done anterior which is frontal entry and about twice as fast to heal & PT as posterior. Not all docs do them nor do all hospitals or surgery centers have the table used for anterior. Compared to my shoulder PT, the hips were a piece of cake! ;D Both in time & effort.
I'm told my knee is close-the pad is a mere pencil line in the current xrays. My plan, or hope, is to put it off until winter kicks in. 
I'm also told the doc will decide if the replacement is partial or whole, mines said likely to be whole. I asked how they accommodate the fact that my inner meniscus is mostly destroyed, and was told that the doc adjusts the geometry of the replacement joint to assist that issue. 

I wish your wife a speedy recovery! 8) Shes young and will up and at it soon! 
Kan=Kansas;tuck=Kentucky;kid=what I'm not

Raider Bill

With a tkr I think the take the meniscus out. At least they did mine.
I found the best therapy is to ride a stationary bike.
Got to keep moving it.
The First 70 years of childhood is always the hardest.

kantuckid

The words I was told were "we clean up your damaged meniscus" and " the doctor will orient the geometry of you replacement joints parts to move knee forces away from the damaged area". Meniscus doesn't get the ACL grafting fix so I've heard and read, thus why I asked them that question.
My other (sort of) good knee, I tore the menicus in my 40's and it self-healed.
Kan=Kansas;tuck=Kentucky;kid=what I'm not

Raider Bill

My left knee had a torn meniscus which is why I went to the Ortho. He said at my age they didn't repair them but replaced the knee.
Hind site, I think my ortho is a used car salesman with a Dr in front of his name. lol
The First 70 years of childhood is always the hardest.

doctorb

Seems like there may be some misconceptions here....

1. Total knee replacements remove all menisci.  Period.  They also remove the upper portion of the tibia on which they sit.  The plastic tray which is part of the tibial component in a TKR is concave (slightly cupped) to help provide stability after meniscus removal.  There is no"cleaning up" of the meniscus with a TKR.  It's going in the bucket.
2.  Partial knee replacements remove one meniscus.  The other is left untouched as the surgeon is only replacing half (medial or lateral half) of the knee.
3.  Arthroscopic repair or partial removal of meniscal tears is contraindicated in the vast, vast majority of cases in patients over 65.  This is because studies have shown that arthroscopy does not provide predictable longevity of the joint once arthritis has set in and is the dominant pathology. So if your an older guy and have arthritis, which usually comes with Meniscal wear and tear in this age group, the answer is not going to be a scope.  Just because an MRI has, as part of its findings, a tear of a meniscus, if you have significant arthritis as well, the treatment is TKR.  
4.  There are TKR's that spare both crucial ligaments (ACL / PCL), spare just the PCL, and many that remove both the ACL and the PCL. This very much depends upon your anatomy.

Bill- your surgeon may have sold used cars in the past, but even those guys get it right sometimes.
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."

Raider Bill

He said that was his job during his undergrad summers. lol
The First 70 years of childhood is always the hardest.

LeeB

Lindy is continuing to improve but having some issues dealing with the pain. She doesn't like to take the pain meds because they tend to make her a little short of breath so she does only a minimum. She is walking better (with the walker) and is taking continuous steps instead of shuffling one step at a time. Still doing well at the exercises but not managing to do more than a degree or two increases of angle on the knee bender machine. Her back is bothering her due to having to sleep on her back all the time. I try to help her do things but I apparently have a very rough touch and cause more pain.
'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.

Raider Bill

I found the best way to sleep was a recliner.
We have several 12x18 ice packs that got rotated all day.
The First 70 years of childhood is always the hardest.

Don P

I'd rather take a 2x4 than watch her in pain, I know that is not fun. We did the same thing rotating lots of ice packs, Michelle doesn't do well on meds either. The used car guys also sold me an ice pack with a pump in the cooler to a wrap for the joint. That was the most effective but you gotta watch it, I think you could make ice cream with it as well  :D. And yup the stationary bike is downstairs, motion is the lotion. It looks like they'll have to go into her hip again, but I'm doing my part to knock the deductible down.

doctorb

LeeB

She's only on post op day #4.  The issue with pain postop while rehabbing a TKR is that the discomfort persists as you increase the Range of Motion (ROM).  The tissues around the knee have to do a lot of sliding with knee bending, so you're asking newly operated upon soft tissue and the sutured surgical approach to move, but not scream at you that it's upset about doing so.  This is a back and forth battle.  So gaining the first 45 degrees can be hard, and gaining the next 45 degrees can be harder.  When does she start PT? It's important to try and improve ROM daily.  
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."

LeeB

DocB,

She has had a good day today. Hasn't need any pain meds so far but will take some before bedtime. She does some stretching exercises in addition to the CPM. She does the CPM twice daily for two hours at a time and sometimes more than twice. She says the CPM actually makes here knee feel better. Right now she is at 64° and is increasing it 2-3° each time she uses it. Not sure exactly what day she will start PT. She sees her Ortho Tuesday and I'm sure she will find out then. SHe was going to call the PT place today but I didn't think to remind her. She is already walking better using the walker. Actually walking instead of shuffling. The doctor has her on blood thinners to prevent any clotting. He gave her an extensive list of things not to do because of this so I expect that may have something to do with when she will start PT.
'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.

LeeB

Lindy is doing well with here new knee. Still some pain but more from over doing it in PT than anything else. She has done so well that the ortho is going to do the other one on Oct 17.
'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.

Ed_K

Ed K

Raider Bill

All the cool people get them! smiley_big_grin3
The First 70 years of childhood is always the hardest.

Gary_C

Never take life seriously. Nobody gets out alive anyway.

doctorb

Has she reached 90 degrees of flexion yet?  Does her knee go perfectly straight?  Glad to hear she's progressing nicely.  PT is supposed to push her, so coming home sore is normal.
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."

LeeB

Yep. Full lock out and at 126° when they stopped measuring. She drove the truck yesterday for the first time in a long while. Did great. I'm rather proud of her.
'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.

kantuckid


How far out is she from the surgery now? I've seen some fast knee joint recoveries when in PT for my own purposes. Seems the lighter weight people do it faster.   

 I hope to put my own knee replacement off as long as I have outside work weather still around.  
I called my knee doc this week (I have my 13th shot in several weeks) to signal him that my "good knee" is tiring from carrying the water for the bad one and that I now want both to get a shot in both.
 I also raised the question as to if my knees might benefit from a gel injection vs. the cortisone I've been getting. His nurse called me back to say "we'd talk about that soon".
 My neighbor (who will never allow a joint replacement he badly needs) says he's getting switched to gel his next shot from cortisone. Google says my current shots of which I've had a dozen to date, are for osteo arthritis. Given my joint pads gone in bad knee, it now seems the gel makes sense but I'm sure no doc.  ;D
Question: How does the doc choose the best knee shot "juice"? Google confuses me on that.
Kan=Kansas;tuck=Kentucky;kid=what I'm not

doctorb

Very, very nice range of motion.  By my calculations she's about 5-6 weeks post-op.  That's an excellent result. Way to go, Lindy.

One of the misconceptions that patients generally have is that a joint replacement gives everybody a "new" joint, like you were 20 years old again.  Not so, and docs who perform these operations usually make a point of warning patients about this misconception.  What uncomplicated joint replacements accomplish, first and foremost, is pain relief.  The most accurate predictor of eventual range of motion of a joint following replacement is the degree of motion that was present prior to the surgery.  Some people's arthritis affects the range of motion more than others.  So if you have bad arthritis and only 90 degrees of flexion of your knee preop, don't expect 135 degrees of flexion post op.
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."

doctorb

Shots:  3 types
1) steroids:  widely accepted and used.  Usually given with some numbing novacaine to provide quick relief.  They sorta "reset" the inflammation thermostat within the joint, leading often to months of relief.  Usually not given more than 2-4 per year, and patients say their effectiveness decreases with sucsucessive injections.
2) "gel" injections:  these shots are made up of a variety of substances, and were widely marketed to provide the "building blocks" of cartilage to encourage repair of arthritic joints.  That has not been shown to be true, and the hyaluronic acid it now more thought of as a lubricant of the joint, rather than affecting cartilage repair.  Some patients, and some docs, swear by them.  Most studies demonstrate a limited effectiveness.  They are expensive and often not covered by insurance.  The office often makes the patient buy these upfront prior to injection.  Here's what the Orthopaedic Academy says about these viscoelastic injections:

Another treatment option is a procedure called viscosupplementation. If you have tried all other nonsurgical treatment methods and your pain continues to limit your activities, viscosupplementation may be an option.
In this procedure, a gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints. The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain.
The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.

3) "regenerative medicine" injections:  these reportedly use your own stem cells or growth factors to promote healing. They involve taking a blood sample or a suctioning off subcutaneous fat, and then concentrating the cells and growth factors for injection back into the arthritic joint.  These stem cells and proteins supposedly instruct your arthritic joint in self-repair.  Lots of hype here.  Many of you may have heard of PRP (platelet rich protein) shots for tendinitis.  This is the same idea but for joints.  Docs make a lot of $ (thousands of dollars per shot) doing these preparations and injections. Their effectiveness has not been shown to match the hype or the price, but some patients swear that they are cured of arthritis.  I would do your homework and leave your checkbook at home before seeing a doc about these treatments.  They are definitely not covered by insurance.

Remember that all these treatments are mostly a delaying tactic.  Patients are often not ready to upend their lives and rush to a total joint.  Joint injections are beneficial in this regard, but do not stop this progressive, wear-and-tear disease.
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."

kantuckid

Quote from: doctorb on September 03, 2022, 10:16:44 AM
Very, very nice range of motion.  By my calculations she's about 5-6 weeks post-op.  That's an excellent result. Way to go, Lindy.

One of the misconceptions that patients generally have is that a joint replacement gives everybody a "new" joint, like you were 20 years old again.  Not so, and docs who perform these operations usually make a point of warning patients about this misconception.  What uncomplicated joint replacements accomplish, first and foremost, is pain relief.  The most accurate predictor of eventual range of motion of a joint following replacement is the degree of motion that was present prior to the surgery.  Some people's arthritis affects the range of motion more than others.  So if you have bad arthritis and only 90 degrees of flexion of your knee preop, don't expect 135 degrees of flexion post op.
My left knee issues are threefold: badly torn inside meniscus thus poor lateral stability; osteo arthritis that causes enough pain to be noteworthy; joint pads reduced to a "thin pencil line" in current x-rays. My ortho docs PA, who has 25+ years in osteo work says my doc may opt for a partial, may not. When I asked him last visit how the total or partial joint replacement works well minus the meniscus support, he said the geometry the doc shoots for is designed to help the new knee situ be more stable.
My in a few weeks visit I get new x-rays. I have full range of motion but loose joints both sides and wear elastic supports always when I work. I'm close to using the More substantial knee support they tried me with a few months back. It's similar, but lighter weight, to what football players wear.
Osteo is what got both my hips replaced FWIW. I pay zero attention to my repaired hips, exception is adjusting my seated position now and then in my tractor seat or when down in a floor position such as working underneath something I get a cramp like pinch and stretch my legs.
Maybe this winter I'll get a knee job? Based on pain I'm OK w/o it for now.    
All 12 of my left knee shots have been Triamcinolone Acetonide so far and covered by Medicare & Supplemental-my share is 71 cents :D
I've had three right shoulder shots (same stuff) from a sports medicine shoulder specialist doc in another U of KY clinic. They carry me about the same as the left knee, about 2 of the three months interval between shots. That shoulder has osteo plus a somewhat loose joint, even though I did a PT re-hab on it last winter and been working ever since. 
Lexington, KY has one of the stem replacement clinics owned by former UK & NBA player Tony Delk. I doubt I'll ever try that one. I also doubt I'll push for a switch away from what knee shots I've had so far. I suspect with my neighbor's knee situation; his doc realizes he's never going with a joint job so maybe a try anything next approach to use the gel? 
Kan=Kansas;tuck=Kentucky;kid=what I'm not

doctorb

The meniscus has nothing to do with support or stability after a total knee.  Don't try and extend the function of the meniscus after a total knee.  It isn't there.  And if your xrays show bone on bone arthritis, your meniscus isn't really there right now either.  It gets ground up, flattened and extruded out of the joint space.  The stability of a total knee can be dependent upon the laxity of the remaining ligaments, and there are different types of total knee replacements to deal with different degrees of ligamentous stability.  Your doc makes that decision both before and during the procedure.

FWIW, partial knee replacements are most often indicated in younger patients.  The issue is that, because they only replace part of the knee, arthritis continues on in the virgin parts of the knee and another surgery is often needed within 10 years.  Most patients your age who have arthritis severe enough to warrant surgery receive a total knee and not a partial.  i would be surprised if you are offered that, especially with the ligamentous laxity you described.  keep us posted.
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."

kantuckid

Thanks for a valued "other opinion"!
 The doc who repaired my shoulder mentioned a partial hip (I was early 70's then in 2014) and I read the same thing as what you say on google back then. I do believe my highly active lifestyle prompted him to be caught with him "thinking out loud" with me around to hear it. ;D 

My knee & hip doc is the U of KY Chair for Orthopedics, who keeps his main office at a hospital UK bought a few years back (Good Samaritan) which doesn't allow the residents to operate, only observe, so you get him in any surgery there where mine have all taken place.
 When he's at the main hospital or with a VA patient you will often get a resident with him observing. All too say he's a top-notch doc and actually a really nice guy as well. I'm lucky to have his services as he was the 5th hip doc I tried to be seen by and heard lots of your OK stories, when I was sure not OK. My shoulder ortho doc has done a bunch of high-profile Tommy John work on UK & MLB players along with old farts like me & lots of HS athletes. 
My knee docs PA said he adjusts the new joints geometry at the install to stabilize the knee lacking the meniscus- as I recall.
I tore the meniscus in my good knee when coaching baseball ~late 1980's and it self-healed and never an issue lately, where the osteo and some looseness has shown up. It's been asked to carry the water" for my much worse other knee such that I began wearing a sleeve on both knees  and asked for a shot in both for the first time this week fort late Sept shot. My good knee tricked out getting down off my tractor last week and scared me someas it's been there for several years of bad knee/good knee action.  

I hope this discussion serves others well as they age out and lead active lifestyles here in the FF Forum. Thanks for listening and apologies for adopting Lindy's thread. ;)   

 
  
   
Kan=Kansas;tuck=Kentucky;kid=what I'm not

LeeB

Lindy goes in tomorrow morning to get the other knee done. She super well on the first one. 
'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.

thecfarm

Model 6020-20hp Manual Thomas bandsaw,TC40A 4wd 40 hp New Holland tractor, 450 Norse Winch, Heatmor 400 OWB,YCC 1978-79

LeeB

The surgery went very well and she is doing good. She was up and walked down the hallway an hour and a half after the recovery room. She was already bending the new knee better than I have seen that leg move in years.
I'm very proud of her. Plans are for her to come home tomorrow. The ride home will be tough due to the 8 miles of dirt road to get to the house.There is a closer way home but it has just as much dirt road that's in even worse shape. We learned a little on the last one and I'll bring a pillow to put under her foot and another to go under her on the seat. We don't have a car so getting her in the truck is fun but again, we learned on the last knee so it will be much better this time. 
'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.

Magicman

I wish the best for Lindy.  You are a good caregiver Lee, keep it up.  8)
Knothole Sawmill, LLC     '98 Wood-Mizer LT40SuperHydraulic   WM Million BF Club Member   WM Pro Sawyer Network

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

LeeB

And you too for Mz Pat. Guess we're both doing house duty.
'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.

Peter Drouin

I would say determination is key, Good luck 
A&P saw Mill LLC.
45' of Wood Mizer, cutting since 1987.
License NH softwood grader.

LeeB

 She is up and dressed, sitting in a chair ready to go. The doc just came by and has cleared her for release at noon today 
'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.

kantuckid

LeeB, yer home place location sounds like "my kid of spot"! Ilike AR anyway, came close to moving there years ago...
When I got my hips  done, I made sock puteroner's, pickup stick gizmos, etc's to facilitate my independence as my wife was still in 24/7, 150 mile RT caregiver mode for her Mom back then-me here alone. Hope she's up and about real soon. 
Kan=Kansas;tuck=Kentucky;kid=what I'm not

Ed_K

 I hope Lindy is doing great  ;). And all is good with you too  :).
Ed K

LeeB

She is doing well. A week out and she had her first PT today. Goes to the ortho tomorrow for her post op check up. Much less swelling this time and less pain overall after the first two days.
'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.

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