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Old 02-16-06, 01:42 PM   #1
DnvrFox
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Knee Replacement Surgery - Advice sought

My wife (68yo) is facing knee replacement surgery. The X-Rays show no cartillage at all, and the left tibia is angling considerably inwards.

The doc says none of the "alternative" treatments are appropriate at this time. These include the injections of silicone and whatever else they now inject, the cortisone shots, braces and/or PT.

My wife is terrified. She loves to bicycle and hike, among other things. We have seen two orthopods, and both say the same thing.

She is tremensoudly interested in other's experiences with knee replacement, especially any females (wifes or persons on this list, but males will also be ok).

If there is anyone out there who has experienced knee replacement surgery we would love to have you share your experiences.

1. Has anyone done the "minimally invasive surgery?" The doc we saw today says he has given up on MIS due to poor results. Yet, we have some other docs locally who are currently holding seminars on MIS, and specialize in it! ????

2. Success rates and stories and when back to bicycling. etc.?

3. Recovery period?

4. Complications?

5. Any other thoughts?


We went to a doc at Rose Medical Center here in Denver, which is a major regional joint replacement hospital, doing over 1,000 last year. ( I wonder what they do with all of those old joints? )

As usual, your thoughts and feedback are greatly appreciated.

Thanks in advance.

Last edited by DnvrFox; 02-16-06 at 01:53 PM.
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Old 02-16-06, 02:10 PM   #2
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Sorry to hear about the problems, and NO I do have not have kneee surgery experience but know of several that have. Only one rides though and from his experience- once he got over the surgery he started Static bike riding- within a week he was putting pressure on the wheel and in 3 months he could manage a 30 miler. Took him a year before he came offroad with us, but we lost him. He enjoyed riding his road bike so much- He turned to the dark side and became a roadie. Good bit is that we meet up on a few century rides- and we can still beat him over the distance on our MTB's. Mind you- he still gives us a few scares for the first 25miles on the hills.
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Old 02-16-06, 02:14 PM   #3
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Quote:
Originally Posted by DnvrFox
1. Has anyone done the "minimally invasive surgery?" The doc we saw today says he has given up on MIS due to poor results. Yet, we have some other docs locally who are currently holding seminars on MIS, and specialize in it! ????
No experience with MIS, just normal KRS.


Quote:
2. Success rates and stories and when back to bicycling. etc.?
Hummm. Couldn't bike before, can almost bike now with a semibent Giant Revive. I think she could have done it if she had ignored some pain in the post surgery therapy sessions. The problem is bending the knee to get started. I does not sound good to me when she tries to force it, so I don't push it.

Quote:
3. Recovery period?
Not too bad, as I recall about 6 weeks. For about 2-3 weeks needs to stay on a single level.

Quote:
4. Complications?
None really, but I was scared prior to surgery. Oh, wait, at one point in the recovery center the pain shot was not getting into the body as they missed the vessels. A little hysteria/temper tantrum solved that problem.

Quote:
5. Any other thoughts?.
Post surgery therapy is critical. If range of motion is not gained in those important days after surgey, it will not return.
Wife is talking about doing the other knee this year, so she thinks its a good thing. I think you can only do 2 of these on one knee in a life time.
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Old 02-16-06, 02:22 PM   #4
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Both my wife and I have had knee replacements. I've had both with the
wife having one for now. So maybe I can offer real time experence.

Knee surgury has come light years ahead in the last 5 yrs due to all
the baby boomers needing TKR. So a lot of the concerns of the past
are gone or moderated to make them not that important now.

Share with your wife to be clear on the amount of bend her implant
will allow (yes there are different ranges). Share also that rehab is
critcal on the outcome of the surgury. She must understand that
while it will, at first, hurt like hell the rehab will help her get better
everyday she works at it. THE very worst thing she can do is not
do her rehab like her life depended on it.

There is some danger with blood clots as with any surgury but any
good hospital will watch that before releasing her. Ice is your best
friend to keep swelling under control. Do EVERTHING the doctor
tells you without fail.

After your wife is "back on her feet" talk with her doctor at length to
be sure she can ride as a fall with a knee implant is BAD news. If the
doc feels her implant is robust enough to handle a fall then you are good
to go. Just let him decide as he knows the mechanical limit of the joint
he used. Also make sure you have the doc tell you all the things you
should not due anymore because of the implant as from this point on
you are now considered a handicapped person by vertue of the implant.
Yes, I know......I didn't like that part either. But you are no longer a
whole person you are now a 'repaired' person which is way better than
you were.

Trust you doctor. Understand what he's telling you , do your rehab, adjust
your lifestyle accordingly, get back to living. It ain't near as hard as it used
to be.
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Old 02-16-06, 04:44 PM   #5
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Quote:
Originally Posted by Tightwad
Share with your wife to be clear on the amount of bend her implant
will allow (yes there are different ranges). Share also that rehab is
critcal on the outcome of the surgury. She must understand that
while it will, at first, hurt like hell the rehab will help her get better
everyday she works at it. THE very worst thing she can do is not
do her rehab like her life depended on it.
Hurt like hell seems to be an understatement. It's absolutely criticial to work thru the pain in order
to get full range of motion. My wife quite because it hurt too much and is determined
not to make that mistake the next time.

Excellent point about falling and good comments tightwad.
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Old 02-16-06, 06:01 PM   #6
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Quote:
Originally Posted by DnvrFox
2. Success rates and stories and when back to bicycling. etc.?

3. Recovery period?

4. Complications?

5. Any other thoughts?


We went to a doc at Rose Medical Center here in Denver, which is a major regional joint replacement hospital, doing over 1,000 last year. ( I wonder what they do with all of those old joints? )
I had a knee replacement in June 2004 at age 62. Biggest thing I can say is that I should have done it sooner.

I've supplied a photo of my knee before, after and a year later. I went through all of the therapies (steroids, cartilidge injections, lots of PT, etc) and it only got progressively worse.

I rode my bike back and forth to work (3 miles) but that was about all. Two months post-op, I was riding my bike to physical therapy. Last spring I began riding more (Dr said swim or ride) and in June, a year post-op, I bought a new Specialized Crossroads. Between June and Dec I rode just over 4,000 miles including my first century. and my goal for this year is more miles. I now have a Jamis Coda Comp which is sweet and fun. I rode 43 miles today.

If you and your wife don't know about the Knee Guru web siite (http://www.kneeguru.co.uk/) I highly recommend it. Great resource by a U.K. orthoepedic surgeon with lots of input from folks who have had, are having or are thinking about a replacement. Also links to other resources.

Here is what you should know. It takes LOTS OF WORK both pre and post op. Range of motion is more critical than anything else. I spent 8 hours a day in a range of motion gizmo fot three weeks post op until I was at the limit of the machine. I hated the drugs (except for oxycontin and that I liked a lot )

Her bad leg almost certainly has sever muscle antrophy and only exercise will fix that. It takes LOTS OF TIME to recover. Measure progress in week/months. I was on my feet in one day, walking with crutches in two days, walking with a cane in about 3 weeks and walking without any cane in about 3 months. I went back to work in 3 1/2 months, but could have gone back sooner (had a desk job).

My Dr said I was too far gone for MIS and even though he does it and was published papers on it, he is not too keen on recommending it. I had mine done at the Joint replacment unit at George Washington University Hospital. The facility you chose sounds like the right kind of place. You want surgeons, nurses, orderlies, aides, PT and OT people who have done lots of knees.

I've gone on too long. But if you have questions, please done hesitate to post or send me an email.

Good luck,
Tim
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Old 02-16-06, 08:07 PM   #7
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There is one point that I , as well the others, forgot.

Infections.

Once you have a TKR you have to watch all wounds , no
matter how minor, like a hawk to see that you NEVER EVER
get an infection. For some odd reason once you get an infection
they head straight for your knee implants which can be fatal.

Someone got a cold. AVOID them. ETC. Just don't let yourself
get in a bad way with a cold or an infection.

I can't even kiss my grand kids when they get colds and I HATE IT.
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Old 02-16-06, 09:34 PM   #8
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Minor correction here: the dangerous infections are bacterial, not viral. Colds, flu, coughs are 95% to 100% viral and not a risk factor for prostheses. Any prosthesis is a risk for blood borne bacterial infections and one of the more common ways to get in trouble is routine dental cleaning. There are others, post op instructions should discuss antibiotic prophylaxis circumstances. Any joint prosthesis, valve prosthesis or other types of implants, (pacers, pumps, shunts etc) are all at risk. Ones attached to bone are more problematic as bone infections are harder to get control of.
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Old 02-16-06, 09:35 PM   #9
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I have two (2) total knee replacements. My first in May 2000 (age 53) and the second in January 2004 (age 57). I was riding for distance within three (3) months of the first replacement but the second replacement was a different animal. I was able to ride a few blocks within five (5) months but it was about a 1 1/2 years b4 I could ride for distance. The main reason for the difference in time was the Orthropod used a different type of replacement on the second go around. The second operation almost ended my cycling. ( I ride recumbents). I have since went to shorter crank arms (155mm - 165mm) which has allowed me to ride longer distance without much pain.
In regards to the operation and rehab I agree with the previous posters concerning the extra effort given to the rehab. The more you give the more you get out of it. I was lucky because I was able to spend two (2) weeks in a rehab hospital after each operation with three (3) months on an outpatient basis. This really gave me a leg up on others who had their rehab at home. Be careful of infections and work like hell on the rehab and you will be back riding in no time.

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Old 02-16-06, 10:07 PM   #10
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I had my TKR on 2/19/04. I was riding 30 miles a day the previous summer,but couldn't walk very well at all. Make sure the Doc. is going to administer blood thinners after surgery. I had a pulmonary embolism[big trouble ]. Make sure the Doc. writes an order for a CPM machine, and have your wife use it as much as she can stand it. Force her to do it. Make sure she does all her exercises after surgery. She will not be the only one going through this. You MUST help her and nag her every day to do her exercises. Because of the embolism, I went through physical therapy that resembled torture back in the dungeon days. I had very limited ROM[range of motion]. I couldn't get the cranks around on my road. I had to buy a Hase Crank Shortner and install it on my road bike[will not work on a MTN bike]. I no longer need it. I'm riding 20 miles a day. I feel I could ride more but I don't want to be stupid about this. I highly recommend a book; "Total Knee Replacement and Rehabilition" by Dr. Daniel Brugioni. Also, ask your doctor what kind of knee he's planning to install. There's cemented and non-cemented. Because of high level of physical activity, the doctors were concerned that I would wear my new knee out too soon. I have a trabecular non-cemented knee. It's made of titanium and polyethylene. It has tiny micro-scopic swiss-cheese holes in it which the bone grows in,around and through attaching it to the leg. Also, "bite the bullet" and don't let pain-meds control your life after surgery. You'll definitely need them but when it's time to get off them, realize it.
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Old 02-17-06, 07:49 AM   #11
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Thanks all for all the feedback.

I will share your thoughts with my wife.
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Old 02-18-06, 05:15 PM   #12
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I'm a 46-year-old man. I had total knee replacement two years ago.

Before the replacement, I was essentially a cripple. I couldn't walk more than two or three blocks, let alone ride a bike. I walked with the aid of a cane. I'd had years and years of pain, including several surgeries of various kinds, dating back to an accident (non-cycling-related) which smashed up my knee pretty good. That was in 1990.

So my orthopedist recommended knee replacement. I did it. The doctor came and got me on my feet in the hospital the next day. Two days later I was sneaking out of the hospital for a smoke (I know, stupid. I've quit since then). I was home the day after that, and I went back to work one week (literally) after the surgery.

I went to some therapy. Not all that much (cheap insurance company). I devised my own therapy plan.

Now I do anything I want. A couple of months ago I spend nearly a week hiking and rock climbing in Joshua Tree National Park. I ride my bike, for the first time in years, and I expect to complete a century by the end of the summer, if not sooner.

I avoid high-impact activity. I don't run, or do things that are likely to torque my knee (like skiing).

My advice to your wife is to do it. Knee replacement gave me more freedom than I'd had in years. I wish I'd done it years ago.
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