Total Knee Replacement, Anyone?

[muted reborn]

Wow that’s brutal. Good luck. I hope you have the hipaa waiver so the doc is allowed to talk to you directly. It’s an easy form, but she’ll have to sign it

I do have it already, thankfully.

Thanks everyone for the advice and confirming that this is probably gonna suck for everyone.

[Shredhead]

Just being put under at 90+ is a huge risk.

My dad was a surgeon. People would always shop for the best surgeon, but didn't even research the anesthesiologist.
Who's going to be the one that kills you.

[PB]

This is the worst of all possible situations. I can sympathize with her at least a little - in essence she's saying her life is not worth living as it currently is, and she's willing to gamble on the surgery. It sounds like she probably thinks if she doesn't survive the surgery/anesthesia, she's fine with that - solves the primary problem. Unfortunately if she does survive it, the next 6-12 months could be far worse than her pre-surgery condition. I recommend talking to the surgeon and anesthesiologist, one on one, maybe even backing them into a corner. Also get second opinions from Docs that don't have their professional reputations directly on the line.

[Bunion 2020]

Many of Americans like McHatton deal with chronic knee pain. The culprit nearly always is injured cartilage — the elastic, almost Jell-O-like substance that protects the joints and bones of the human body. More than 30 million Americans suffer from osteoarthritis, a wear-and-tear condition that occurs when cartilage withers away, a defect especially prevalent in the knee. The last-resort treatment for those with bum knees is replacement surgery. According to the Academy of Orthopaedic Surgeons, more than 600,000 Americans get new knees made of metal every year. Indeed, total knee replacement is now the most common inpatient surgery for people over 45.

https://wapo.st/3MOkr0E

[MagnificentUnicorn]

First, the surgeon wants to do her surgery because that’s what he does. Orthopedic surgeons are surgery happy, especially joint replacement surgeons. When you have a hammer…

Second, the surgeon doesn’t care about her general health, he only cares that she has osteoarthritis and that she complains of pain.

Third, the anesthesiologist isn’t going to kill her. She’ll likely get a spinal and nerve block. No one that I work with would give a general anesthetic to someone that age and condition for what is an entirely elective surgery.

Muted, is your mother’s primary complaint with her knee pain? She really needs to use a walker or cane. If she does have surgery it’s not the surgery or anesthesia that will kill her, it’s the inactivity after surgery with her congestive heart failure. There will probably be no quality of life change after surgery other than less pain, maybe.

I would suggest that you strongly discourage your mother from going through with surgery.


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[bodywhomper]

My grandmother had tkr in her early 90’s. She was fairly immobile and in a lot of pain. Surgery intent was to reduce pain. She didn’t have comorbidities and did not have plans for significant rehab. The surgery was successful and helped her with the pain. She retained her minimal mobility, but without pain and lived to be 99 with minimal medical intervention, which was early compare to her older siblings.

[mcski]

Wow that’s pretty amazing/lucky, but I think your grandma is an outlier

My dad had his second bka 10plus years after the first when he was 87. He was really good about exercise and rehab for both, but age made recovery from the second much more difficult. He got through it, but he was an outlier a bit as well. He got a couple good years out of it but in retrospect, I’m not sure I’d have had him do it again

[bodywhomper]

Yes. Her lack of other health issues with no intent of gaining full mobility back made her a good candidate.

My father never really had a chance to recover from his tkr last winter. His spiral started with DVT likely as a result of the surgery. He was 78 and spent months prehabbing.

[muted reborn]

Despite my concerns and all your concerns (thank you for the advice) my Mom is having a TKR tomorrow morning. Her good leg now has edema since I posted, it is extremely swollen and 2-3 times the size of her bad leg. But all the doctors she has seen has given her the green light, including her surgeon (who I don't like) and her primary care doc who is beyond compassionate with my Mom when she visits. It's confusing.

Thanks Bunion for that link - I asked the surgeon about those alt options and he said he's never heard of any of them. He just does one thing and one thing only and doesn't care about alternatives - the fucker.

MagUni, you are right she is getting a spinal block - now as I read a couple pages back on this thread I'm realizing that means she will be awake the whole surgery?? How did this not register with me weeks ago...damn it.

[rod9301]

Yeah, i would never want to be awake during a surgery like this, hear the bone saw?

I understand that for me, general anesthesia might be more dangerous, but the way i look at it, they put me to sleep, and if i don't wake up, I'll never know.

This is my opinion for me, not implying anything for your mother.

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[plugboots]

I was going to suggest steroid injection(s), but oh well, good luck.

[teledave]

Despite my concerns and all your concerns (thank you for the advice) my Mom is having a TKR tomorrow morning.
......
MagUni, you are right she is getting a spinal block - now as I read a couple pages back on this thread I'm realizing that means she will be awake the whole surgery?? How did this not register with me weeks ago...damn it.

Spinal block and deep sedation (twilight) is pretty much the go to these days. They say it's not general anesthesia, but I have absolutely no recollection of between IV administration and recovery. Hopefully that will be the same for her.

Best of luck.

[old goat]

What teledave says--she'll get a sedative, often Versed, that will keep her from being aware or remembering any of it.
Swelling in one leg is a concern--I assume a blood clott has been ruled out?

[muted reborn]

I was going to suggest steroid injection(s), but oh well, good luck.

Steroids stopped temporarily solving the problem more than a year ago. They worked well at first.

Spinal block and deep sedation (twilight) is pretty much the go to these days. They say it's not general anesthesia, but I have absolutely no recollection of between IV administration and recovery. Hopefully that will be the same for her.

Best of luck.

You were right, and thank god. Thanks.

What teledave says--she'll get a sedative, often Versed, that will keep her from being aware or remembering any of it.
Swelling in one leg is a concern--I assume a blood clott has been ruled out?

It was checked and ruled out twice just to be sure.

Overall today went well so I'm slightly slightly optimistic now. She is a tough old bird.

[teledave]

Overall today went well so I'm slightly slightly optimistic now. She is a tough old bird.

All the best. In some ways the apprehension is the worst. Now you have tangible issues to overcome, but the known is generally easier than the unknown.

[Iowagriz]

I've been milking bone-on-bone in the Left knee for several years. 18mos ago, saw a ortho and got an injection of Cortisone (which seemed to help, probably due to inflammation reduction). 2 more injections since that time. Most recently discussion was me asking/confirming that they said "I'd know when I need a TKR". Her answer was "oh, you're ready". This actually surprised me, but probably drove home the fact that it is time. 59yr old, would like to be able to enjoy my 60s before life starts to slow down.

So, what questions do you ask to ensure your surgeon is the correct choice? # of procedures a yr and total, rejection rate. What else? Is there a web site that I can get those stats? I trust his PA (the one I had the conversation with), is a competitive cyclist and understands where I come from (as an aged former competitive cyclist). But trust doesn't mean they are the right ones for the job. I initially found them via referrals and because they are the Ortho for the local college team.

It sure sounds like I'm due for TKR, so to me, the next choice is ensuring I have the right team in place to perform it. Any help on that decision is helpful. Thanks
(In Missoula if someone knows docs here)

[Iowagriz]

delete - dup post

[ticketchecker]

Similar age and knee boat here trying to decide when to get the upgrade. I have an appt in Feb with the doc I would use here in Maine, made the appt in June and Feb was first available for a new patient. Figured I’d best get on the books with an initial consult with him so I can decide when to pull the trigger and not have to wait another six - seven months just to meet the guy.


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[The Iron Horse]

I have a TKR sheduled for my right knee on March 11th.

Tore my ACL last March, and the doc who did a great job scoping my left knee convinced me the ACL was the way to go, even though I was assured that eventually both knees would need replacing. I asked him to just do the TKR, but he said he wanted to get me 10 more years (I'm 52). I trusted him, and while I believe he did a good job with the ACL, I'm in a ton of pain. Went to get a second opinion from a recommended surgeon, and he told me that he would do the TKR now since there is extensive medial narrowing and my pain level. He made the case that age should not be a factor, but quality of life. Well, my QoL sucks at the moment.

This will be a MAKO Robot assisted, and from what I can tell the surgeon is very good. Admittedly, however, it's not easy to find info.

[garyfromterrace]

Intently following this thread. Thinking within 5 yrs I'll be getting at least one done, but will put off until my knee guys says it's time.

[ticketchecker]

but will put off until my knee guys says it's time.

What I'm finding here in Southern Maine is I'm not going to hear the doc say it's time, they want the patient to make the call. I'll confirm that theory when I have my consult in Feb.

Sidenote of less than awesome, took a digger last Tuesday on a groomer and pretty sure I strained my PCL on the knee that is a TKR candidate. Been on crutches since then, full RICE protocol. Had my first ACL repair on that knee in '83, it's since had multiple scopes and a second reconstruction. Other knee has had two ACL recons.

Fuck me

[muted reborn]

Despite my concerns and all your concerns (thank you for the advice) my Mom is having a TKR tomorrow morning. Her good leg now has edema since I posted, it is extremely swollen and 2-3 times the size of her bad leg. But all the doctors she has seen has given her the green light, including her surgeon (who I don't like) and her primary care doc who is beyond compassionate with my Mom when she visits. It's confusing.

Follow up - my 91 year old Mom is a month out of replacement and she is doing great. She was in a rehab home for 3 weeks and is now at home alone with a walker moving fine. As long as she avoids a home fall during her recovery I'm going to call this a complete success. I'm surprised and impressed.

[Dantheman]

Great news! So happy to hear that.

[ticketchecker]

Great news muted!


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[bodywhomper]

Great news muted!!

What I'm finding here in Southern Maine is I'm not going to hear the doc say it's time, they want the patient to make the call. I'll confirm that theory when I have my consult in Feb.

Sidenote of less than awesome, took a digger last Tuesday on a groomer and pretty sure I strained my PCL on the knee that is a TKR candidate. Been on crutches since then, full RICE protocol. Had my first ACL repair on that knee in '83, it's since had multiple scopes and a second reconstruction. Other knee has had two ACL recons.

Fuck me

My donjoy custom brace stabilizes my knee a lot. I’m in uniform sometimes hotlapping all day with a torn meniscus, possibly still torn mcl, and no acl. I also wear it when hiking, swimming, etc. They can stabilize pcl’s, too. It was super fast to get: I contacted the company, was given the contact info for the local rep, met the rep for measurements and to sign some paperwork, and got the brace 2 weeks later. My high deductible insurance covered the brace (expensive year!!), but it would have been fairly inexpensive if I paid out of pocket. Maybe worth considering while you’re waiting for the big surgery.