Knee Replacement questions

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Knee Replacement questions

Post by Brewman »

I hope this is not viewed as asking medical advice since that is not my intent.

DW is in her early 50's and definitely needs to have a full knee replacement. She has undergone other treatments to prolong the inevitable such as having it scoped twice, pretty much constantly wearing a brace, and for the past 2+ years has been having the lubrication injection procedure every 6 months. She is now bone on bone and the quality of life is being impacted. Both surgeons we have seen have agreed that it needs to be done. She agrees she needs it and plans to with in the next 12 months or less but is nervous.

Have any Boggleheads (or family) had a knee replacement and how did you make your decision as to where to have it done? What questions should we be asking of the doctors to help us decide who and where? What if anything should we be doing pre and post op to make things go smoothly to help her get back on her feet pain free as quickly as possible? If you have had one done, what would you do differently if you could?

We are looking for some feedback to help us make a good evaluation of where to go and what to prepare for. We do know that we are looking at 8-12 weeks of a rough haul and maybe 6- 8 months before she really feels herself again.

I apologize to the moderators if this is viewed as medical advice I mean it to be more of information gathering to help us make an informed decision and not about whether it should be done.
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Re: Knee Replacement questions

Post by greenspam »

This is not medical advice, i am not a dr,

But i know others who have gone thru this and i would recommend:

1) lose weight before the procedure (if at all overweight) because every xtra lb adds even more load to the joint;

2) choose a surgeon who preferably works in a teaching hospital/medical school and who has performed many of these procedures.

3) check on his/her surgical infection rate as well, and/or that of the facility, if possible... infection of a total knee implant almost always requires removal of the hardware.

4) discuss the various total knee replacement options, there are several....

5) comply with all post-op rehab/etc; patient noncompliance is a major source of failure or delayed healing...

Good luck !
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Re: Knee Replacement questions

Post by livesoft »

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Re: Knee Replacement questions

Post by midareff »

About 16 years ago I had a well known orthopedic surgeon advise I needed a total knee replacement which did not look that way from the x-ray he was pointing at. I still exercise walk 4 times or more a week on that surgically untouched knee. OTOH, I have had several hip replacements, the last being August 4th of this year and can tell you things have changed dramatically since my first replacement almost 25 years ago.

My thoughts.. use an experienced well regarded surgeon. One who restricts their practice to knees or knees and hips. This is not generalist work, at least not on me. Find out about the different hospitals the surgeon may practice at and why they prefer one or the other. Separate wards at the hospital is very important.... orthopedic ward for orthopedic patients should not be mixed with pneumonia or respiratory patients and the availability of a private room is important. Be in the best shape possible for the surgery.. if carrying excess weight lose it, if the patient has been sedentary for an extended period get as much exercise as possible to rebuild muscle circulation and flexibility before surgery... it will help with recovery times. Find out what particular device the surgeon uses and why they prefer it over other devices. Investigate any changes you may need to make to your home (furniture arrangement or such) during your recovery period. Find out about post surgical support.. visiting nurse, visiting physical therapist, etc. Where physical therapy may be done outside the home and any transportation arrangements needed.

Good luck.....
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Re: Knee Replacement questions

Post by t3chiman »

Brewman wrote:... help us make a good evaluation of where to go and what to prepare for. ....
Problem is, it is very difficult for a patient, or prospective patient, to know what information is relevant, what questions to ask, or to evaluate the information and answers once gotten. Everybody in the profession, it seems, has some sort of agenda, and you are at a great disadvantage when it comes to countering the sometimes hidden conflicts. I have had a couple of joint replacements (hip), so I am more aware than most of the level anxiety that comes with the universal ignorance of the surgical details. Best advice I can give: ask your primary care physician for a prescription for physical therapy for the knee issues. Then call around to the various PT shops in the area. They are normally happy to have a new customer, usually offering some kind of "first visit free" special. As the visit progresses, casually chat up the PT regarding the amazing progress of joint replacement surgery these days, preferably with some anecdote about some distant relative in a big city who got same-day service from some celebrity orthopedic surgeon. Then, ask outright, who the PT would go to if his/her knees deteriorated. After a couple of these conversations, you should have a good idea of who to go to. You might end up going to the big city; those celebrity docs really do work wonders.
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Re: Knee Replacement questions

Post by btenny »

I have about 6-8 friends who have had knee replacements and several others who have had various kinds of knee surgeries. We are all snow skiers so bad knees are sort of a routine injury. All but one has had good luck and all were totally back to running and skiing and so forth in weeks. Yes they all had big pain for a few days but then things got very good fast. All did a few weeks of rehab. One lady has not done as well but she is a extreme case and has had like 8 surgeries and several bad outcomes previously. She took almost a year to get totally well but now she is doing good. And finally another friend has had a half knee replaced and she is doing great as well.

Finally are you sure you need a full knee replacement? There are 2 types of knee fixes, a full replacement and a half replacement where they do a special fix that only does half the knee. A surgeon in NAPA does this fix. It is easier and less risky. The full knee fix is where they put in a total new knee of steel on both sides. And finally the latest technology is some stem cell treatments that regrows cartilage. PM me if you need Doctors names and details.

Hope this helps. Good Luck.
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Re: Knee Replacement questions

Post by staythecourse »

I'm a doc and my mom will be needing one soon. Knee replacement are not overly complicated and usually go smooth. I would say the bigger issues I see are folks who don't do adequate rehab AFTER the procedure so they still end up with a restricted range of movement despite a great looking artificial knee on xray.

Pick a doc. from friends who have had good experiences (not with his personality) but with the end outcome. That usually means he/ she has done a good job coordinating the care postop with well respected rehab therapists. You will not need to see the doc again postop UNLESS there is a problem so the system they have of moving folks through the preop, intraop, postop, and post discharge (rehab) is important. You will follow up with their PA, but the doc is not that important once the cutting is done.

Good luck.
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Re: Knee Replacement questions

Post by Dan999 »

My wife had a full knee replacement this spring and is getting the other one done in a few weeks.
Choose a doctor and facility that does a lot of these. Practice makes perfect.
Exercise the knee muscles before surgery.
Follow directions to the letter.
Rehab is vital to get full range of motion. Both at home and at outside rehab facilities with the right equipment.
She will most likely be going home after 24 hours.
Be sure to take rx and exercise properly. Especially those to prevent blood clots.
You will need to get a dental clearance a couple of weeks before surgery. Be sure all dental work is done before this check. If you have cavities, they will not clear you.
Pets will need to be removed from the home, or be away from the patient. (At least this was what they told us to do.) Infections..
She will be going to rehab for about 5 weeks +/-. It is very painful, but pain killer helps somewhat.
It was all worth it, since she is now getting the other one done. Both were/are bone on bone.
Try to get off narcotics as soon as possible and try to phase down to one just before rehab.
My wife took too many thru the 5 weeks, then weaned off over a few days. Once she was off she had a terrible time sleeping for a couple of weeks.
The leg , and foot will swell, and turn purple and look awful. We will use more icing this time to see if it helps.
It is well worth it but it is not a piece of cake.
Good luck.
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Re: Knee Replacement questions

Post by BolderBoy »

midareff wrote:My thoughts.. use an experienced well regarded surgeon. One who restricts their practice to knees or knees and hips.
Agree with this. PM me if you want more info.
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Re: Knee Replacement questions

Post by philpill »

Fifteen years ago I was told I needed knee replacement. I changed orthopedists and relied on Advil, shots etc. It maintained me until three year ago when the pain increased and palliatives were devoid of effect.

Last year, at the age of 87 on dec. 12 I had total knee replacement. One day later I was walking, with a walker, and felt ache but no pain. Now I can go on hard six mile hikes with lots of uphill gain and the cat came back!
Procedure works for most people. I believe there are two factors: you, the surgeon.

Prior to surgery you must strengthen your leg muscles by doing physical therapy and exercise. The muscles support the knee.
After surgery every day you must spend 5 to 10 minutes doing exercises. I can now bend my repaired knee at a greater angle than my unrepaired knee.

Next is the surgeon. Make sure the orthopedist does many many knees a year.
if he/she does ten a year, this is insufficient. If they perform 100 or more a year, this is good.
I have no pain, had no pain. Prior to surgery life was a torment.

The procedure usually is successful but only if you are a good candidate and have a proficient surgeon.

I am not a physician and my advice is merely relating my own experience in an effort to assist you in future plans.
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Re: Knee Replacement questions

Post by Dan999 »

Oh, and another thing, she must walk a lot every day, increasing the time and distance. Walking is the best thing for the knee, in addition to the daily exercise and therapy. She should graduate from walker to cane very quickly.
Back and forth down the hall many times until you can get out and walk the streets or the mall.
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Re: Knee Replacement questions

Post by LadyGeek »

This thread has run its course and is locked (medical advice). The reasons medical advice is not permitted in this forum:

1. This is an anonymous internet forum. It is not possible to verify anyone's identity (nor do we want to). Credentials also imply accurate advice, which may not always be the case.
2. There can be disagreement among experts, which can be harmful if someone is basing a medical decision on the advice.
3. A member's description may be incomplete.
4. Readers will misinterpret the member's description.
5. Readers will misinterpret the given advice.

Since real harm can be done, we do not permit medical advice and is the reason for the first sentence in: Medical Issues
Questions on medical issues are beyond the scope of the forum. If you are looking for medical information online, I'd like to suggest you start with the Medical Library Association's User's Guide to Finding and Evaluating Health Information on the Web which, in addition to providing guidance on evaluating health information, includes lists of their top recommended sites in the following categories: consumer health, cancer, diabetes and heart disease. They also provide a larger, but less frequently updated, list called Top 100 List: Health Websites You Can Trust.
The OP did not intend the discussion to go in this direction, but the trend is now discussing medical advice. Several posts have answered the OP's question.
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