HerbM: Here We Go Again, Bilateral TKRs for late October/early November

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@HerbM I wondered if it was @Roy Gardiner, I found his thread helpful too! I just clicked on the blue "BTKR" tab and tried to read most of the threads that came up. I think this really helped me prepare for, and know what to expect during recovery.

Best wishes for your BTKR - please let me know if you have any questions. Not that I'm through this whole thing - but being less than 4 weeks post-surgery, whatever I can do to help you, just let me know :)
 
Not sure that I have seen a clean distinction or definitions of these words anywhere here.

Surely you have an article or it would be worth writing one....?

Actually, there is an article that pertains to this subject. If you'll look in the very first post of your hip recovery thread, you posted the list of our basic recovery articles. I'm assuming you read them, but go back and check out the one on Healing: How Long Does Recovery Take? You'll see references in the narrative to "short term healing" and "long term healing." And you'll also find a chart that tells the approximate time for the various parts of the body to heal and for normal body functions to return.
 
Hmm, it depends on why that is. In my case it was firstly a long term injury (I fell over my next door neighbour's dog when playing with him; he wasn't hurt) followed by arthritis. Now there's no restriction - injured knee now in a bin somewhere, arthritic bone spurs removed) but that my tendons have shortened over the years. If it's similar for you, IMO you'll be able to gain full flexion, but I bet it will take a long, dedicated time. The doctors should be able to tell you - although in my experience they tend to be pessimistic.

That is pretty much my deal: early injuries not requiring major intervention, followed by decades of sports, MA, Army etc. and just OA in general (almost every joint is a little bit compromised, neck, back, fingers) but most aren't like the knees (or hips). Knees and hip went bone on bone some years ago.

Lot's of bone spurs to removed. He told me that was a part of the reason for the extra half hour in the OR (long hip neck required him to work 'deep within my body' was the other. He was only working through a 5" hole at the outside. Likely at this been a posterior approach he would have opened more than 12" on me. ARGHHHHH!

He could guess, but already sees more osteophytes on my xray and MRI for the knees.

Despite lots of attempts to stretch and do things like yoga, my knee flexion made little change. I do have short(ened) tendons and my have congenitally show ligaments. I am TIGHT, but not terrible so really.

I CAN get quite a bit of mobility and flexibility if I spend enough time -- at least in other joints.

Once yoga got me to really correct downward dogs (one bend, at the hip, another at the ANKLES and everything else straight with the the feet all the way on the floor. It's actually much easier once you can do that as all the force goes STRAIGHT into your feet and hands with no reason to exert a lot of muscular power.

However, the first surgeon told me they expect to LOSE some ROM on a knee replacement.
 
Actually, there is an article that pertains to this subject. If you'll look in the very first post of your hip recovery thread, you posted the list of our basic recovery articles. I'm assuming you read them, but go back and check out the one on Healing: How Long Does Recovery Take? You'll see references in the narrative to "short term healing" and "long term healing." And you'll also find a chart that tells the approximate time for the various parts of the body to heal and for normal body functions to return.

I figured there would be an article that discussed this so thank it might be worth reading again.

I have read those articles, and that one I believe several times -- each time it occurred to me there were logical inconsistencies or definitional problems in the "short term" vs. "long term" explanation. Part of the reason for specifically remembering that article.

The article is understandable even with those problems, and if it also has a clear explanation relating or distinguishing the terms "essence of healing" with "our views on recovery" which @Josephine indicated I was confusing.

Although the terms SEEM clear enough (just from the English meanings) it is quite possible that I *AM* confusing them or something related so I will go back and find them in that particular article that you recommend.

Thanks. I appreciate that.
 
bingo ..my thoughts exactly..im scheduled for BTRK 12/1/14 i'm going over all my options and I'm loaded with fear how to step up 3 in lip of shower then done 6 in and in return up 6 in and down 3 in to the floor. my bed sits high how to navigate this , do I beg to be sent to rehab facility after my three day stay in hospital my husband works out of town most of the time I know he will try to be home more ...but would that be enough .how long will I be before I can take these small obstacles on my own with only the help of a walker ...questions questions my head is wirling cant sleep if only l knew
 
However, the first surgeon told me they expect to LOSE some ROM on a knee replacement.
Temporarily, yes, but in my case it's now vastly better than before.

I'd be tempted to ask for full clarification of what he means.
He could guess, but already sees more osteophytes on my xray and MRI for the knees.
When I stood up for the first time (arms around two very nice physios but I was a good boy in case they let go...) the way my knees wibble-wobbled (that's the technical term, of course) was disconcerting. It was because the spurs were gone.

Getting up is painful; once up, no pain. Hallelujah!
 
If these things worry you AND you are likely to be alone, it is my opinion you should AT LEAST have a plan to go to rehab until the obstacles aren't really important.

My wife is here, and I am willing to let her run a lot of errands (up to a point) but CANNOT expect her to wrestle me in or out of bed much beyond maybe lifting or holding one leg for me to deal with the rest. If I was desparate, I have an out of town friend who would literally take off from his business and come stay with me (I can't believe how good a friend he's been to me over the years.)

As to the shower, what you describe, I think you just DON'T shower if it is that bad. On the other hand you can't skip the problem of getting in an out of bed or a chair so rehab is likely a good choice.

I don't believe you will need to beg for rehab even though I know MY rehab is difficult to get an admission. As I understand it, Bilateral (knees) is pretty much a qualifier for these programs; talk to your surgeon to find out if that is true or if he can otherwise plead your case. Much easier if he says, "@meowmary must go to rehab" (after they finish asking who meowmary is and laughing :) that is.)

We (you and I) can learn how long it takes MOST people to take those obstacles be we really aren't going to know for sure until we get to that point ourselves.

We don't have to decide NOW about rehab I don't think -- I believe we can just decline at admission time -- so better to arrange a spot and duck out early than have to stand in the doorway begging for a bed. :)

That's my plan anyway. I want OUT of the hospital FAST, into Rehab, and out of there too as soon as my condition warrants it.

By now, everyone will likely admit that I am a bull since as of today, Day #10 Post-Op from my Hip surgery, I have done more* than many do in a month, but this is DIFFERENT.

[*
  • Yesterday morning I did a full hour of water PT.
  • Last night I went to a Systema (Russian Martial Arts Practice) and did about an hour.
    Though I worked VERY LIGHT it include 2 low falls from my knees, and 1 'ceremonial' back roll at the end of class to exit. (I needed the falls to ensure my safety if a fall on concrete etc. should occur.
  • Then I left there (driving myself since Day #4) and went to the Y for a 30 minute whirlpool and more PT exercises while soaking.
And no, I am NOT pushing it too hard or too fast -- this is just how good my Anterior approach surgery and my own body are doing.​
]
Knee Replacement is different, and 2 knees are more different.

My plan for the Hip was Outpatient and we did that, but my PLAN for the BTRK is rehab.

[Maybe I will come home from the BTKR on the day of the surgery or on Day 1 Post-OP but that is too far and to unclear to plan at this point. However, I am going to ask the surgeon if he will release me WHEN my self-sufficiency is demonstrated AND I am ready. I don't want to stay in the hospital/rehab just for someone's rule, as opposed to a real medical reason.]

I don't think we must decide ahead so I advise seeking your surgeon's support and a spot ahead of time.

Also, I intend to VISIT the rehab (probably this Friday) to determine if there is anything there that looks helpful etc. FOR ME.

Please relax and be sure no one will let you go home unless you are ready (and check to make sure that is TRUE.)

:) After all, you do live in Texas and not some 3rd world country or 2nd class state :)

Where in Texas? Carol and I are in Austin.
 
...questions questions my head is wirling cant sleep if only l knew

@meowmary, Please start a thread of your own in this forum. Here is the link that gives you the instructions you need to do this: Starting a new thread and posting

By starting your own thread, you and your questions and concerns will receive the attention they deserve. I look forward to seeing your first post.
 
My OS felt I only needed 2 or 3 nights in the hospital then directly home. My primary care doctor told me he really wanted me to go to rehab for one week. To be honest, I was torn. I was scared to death of my stairs (15 to my room) and pain, and at the same time, wanted to be in charge of my own ice and meds. So, I wasn't sure what to do. I just let it play out - and it worked out fine for me. While rehab is a great option for some, and I'm sure if I went, it would have been fine - but it wasn't needed. My dr was ready to discharge me home after two days but I felt I wasn't ready. So, we decided I would stay one more night. By the next day I felt stronger, safer and easily able to go home. I was so tired of being woken up during the night by staff, that I didn't want to go anywhere but home. I not only made it home without any problems, but I had no issues with all the stairs - even the first night. Was it easy? No, but it was very doable. My first week I only went down the stairs once in the morning and up each afternoon. I felt unsteady with my first shower, but never even used a shower bench - as I felt more comfortable standing. I really think all my pre-surgery exercise and workouts helped me that first week at home. My husband was wonderful - and I needed him to help me with ice, food and other odds and end things. Especially to stand near me on the stairs just so I "felt" safer.

So for me, I kept the rehab option open. I knew which one I would go to (if they had space) and part of me wanted to go there and be cared for.......but again, for me - once I was in the situation and the decision had to be made, it wasn't needed - or even wanted.
 
Temporarily, yes, but in my case it's now vastly better than before.

I'd be tempted to ask for full clarification of what he means. When I stood up for the first time (arms around two very nice physios but I was a good boy in case they let go...) the way my knees wibble-wobbled (that's the technical term, of course) was disconcerting. It was because the spurs were gone.

Getting up is painful; once up, no pain. Hallelujah!

THAT surgeon is no longer part of my team -- he's not a bad guy and is still a very good surgeon in my opinion but I found someone who could do things for me that he didn't offer.

The wibble-wobble is good to know about, as that would have scared the sheep out of me to think that my knees were now 360 degree joints with no "detent". For 50 years, I have actually DEPENDED on my knees being STRONG in such stability to avoid hurting myself or falling unexpectedly.

It would have really freaked me out to think I might be that way forever.

Painful getting up is Ok, I guess -- I am going to have Exparel again so it is foreseeable that there will be little or no pain (in the knee) even.

GOOD INFO, thanks!
 
...To be honest, I was torn.
... I just let it play out - and it worked out fine for me.
...While rehab is a great option for some, and I'm sure if I went, it would have been fine - but it wasn't needed. ...My dr was ready to discharge me home after two days but I felt I wasn't ready.
...next day I felt stronger, safer and easily able to go home.


...So for me, I kept the rehab option open. I knew which one I would go to (if they had space) and part of me wanted to go there and be cared for...
....but again, for me - once I was in the situation and the decision had to be made, it wasn't needed - or even wanted.

That is pretty close to where I stand <pun> too. I am planning to have the rehab in place (right by my house so my wife can commute trivially -- 5 minutes) but if they keep me in the hospital longer or I feel better sooner than maybe I'll just go home.

Better to have it and not need it than the alternative.....

I have no significant steps that must be navigated. 1-2" ledge in through the garage but that's it except for the bathtub and I can wash with baby wipes.
 
To those who are worried about it - it is usual practice not to discharge you from hospital or rehab until you can get into and out of bed and navigate steps by yourself.

@HerbM - and others,

If you want to follow specifically the threads of people who have had bilateral knee replacements, look in the Knee Replacement Recovery Area for the threads that have a little green sign before their title that says "BILATERAL TKRs".
 
Please relax and be sure no one will let you go home unless you are ready (and check to make sure that is TRUE.)

:) After all, you do live in Texas and not some 3rd world country or 2nd class state :)

Where in Texas? Carol and I are in Austin.

I live in ft worth but my surgery will be done in dallas... meowmary is due to a down syndrome brother who affectionately nicknamed me this when he was about 4 all because of a game I would play with him I'm 13 years older than him .. and he calls me this still today but I agree without knowing the story behind the name one would not only laugh but wonder what the heck lol..
 
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@meowmary my grandkids call me HerbO largely because my grandson with Autism does.

Dallas has a LOT of good medical care so I hope you are getting the best. For me it is harder to BREAK OF the hospital than to get them to LET YOU STAY.

You are welcome to post ANYTHING on topic (including about you) in this thread, but do start you own pre-op thread that can focus on YOU.

Remember, in your thread and your recovery it is perfectly FINE to be completely selfish. Each of us my work our on recovery and our job will be taking care of OURSELVES with help from our families, our medical team, AND our friends HERE on BoneSmart.

Herb wrote: (Though I noticed they didn't give me a 100,000 mile warranty with my new hip -- heck, I didn't even get to keep the box it came in or the instruction manual.)

Me2 responded: HaHa! Love it . . . I would love to at least see the box . . . and the instructions -- mayhap with all the advances they will soon sell on Amazon for the do it yourselfers!


[Moved this here so that I wouldn't interfere too much with that other thread belong to someone else.]

I watch a LOT of surgery videos to plan, choose, and prepare for my hip (and eventually knees) and they REALLY DO come with instructions in many cases.

The patient specific instrumentation even has "wall charts". I just hope the same team that writes the IKEA instructions doesn't do the translations.

You know, "You were put locking nut F3 above pin T4 uses to make install nice job."
 
@HerbM and @meowmary When I was still in the hospital, the hospital PT staff showed me how to get myself in and out of bed, so when I came home I could do it myself. Yes it was challenging, but I could do it. They also asked how many stairs did I have and helped me learn to navigate those as well, again before I left the hospital.
Like @ljrfrm I was advised that I had to meet certain goals while in the hospital to be able to go directly home. If I couldn't meet those goals (like getting up by myself to go to the bathroom, and being able to walk with my walker a certain distance). I would have had to got to rehab. I am also fortunate that my husband has been a tremendous help.
@meowmary take heart and know if you set your mind to having BTKR that you can do it. Yes it is very challenging, and very hard some days, but so was being in constant pain from my arthritis. Someone on Bonesmart said that the pain we have now is healing pain, and that does make it a little easier to bear.
Know that you will have good days, and then you will have those days where everything just aches. I have to say that PT has really helped me regain mobility, but also it's been hard work.
Also, what I believe was another helpful factor was doing the prep exercises before my surgery.
Like ljrfrm said, feel free to ask us questions, and peruse the BTKR blogs, so very much information here from some very wise and brave people.
 
Very helpful @Crow22 -- is there a link to specific prep exercises you did? Or ones you personally thing were most useful? (Maybe you cheated and didn't some of them but got the benefit from others.)

I am doing a LOT of exercises for both my hips AND knees so *I* might already be doing most of it but it never hurts to have such good information clearly in mind.

Again, my incredible luck has held: I have ZERO steps to deal with arriving and around the home. Our house is a 2-story but there is nothing upstairs that's needed (office/computer room, sewing room, extra bathroom). The computers are all accessible by wireless from my easy chair, bed, back deck, or anywhere my laptop can go with me. The big TV also has it's own media computer but it's reachable by both wireless and remote keyboard.

There is precisely one almost step on the path (we'll use) in through the garage: A 1-2 inch threshold, very low, no issue. Likely getting in and out of the car will be my greatest challenge for getting home.

The bed likely will be toughest. I have already put a 5.5" toilet seat riser on the bedroom toilet, and my wife likes the contraption so it's going to stay at least through my knee recovery. The other downstairs bathroom has assistance rails without the raised seat; also that is a small bathroom where my long arms can reach to the sink which provides a stable and reliable hand hold to pull myself up.

Getting into my chair won't be much trouble (if I can do the bed.) Part of my prep was to buy a new La-Z-Boy power recliner, very decadent, but I'll be using it for 2+ rehabs and about 10 or 20 years as my all day chair to work from (I work from home, sitting in the recliner most of the time.)

Likely I will do my 2nd hip (should have done them both last week; would have if I'd realized it was a choice) by next year, maybe THIS YEAR if my wife doesn't need surgery first. Oct 21st, will make it tough to get another one in by the end of December but it is POSSIBLE. :) The whole thing is FREE if I do, but then my wife's or mine will cost a little bit next year in any case so it's not an overwhelming consideration.

Had we done both hips the odds are I would be feeling just about the same here on the 11th day. My new hip is in NO WAY my major limitation -- the knees were a bigger problem pretty much from waking after the surgery. (I likely could have SKIPPED down the hospital hallway if the knees were good.) :)

For getting up, the power recliner is pretty good; it will get me back to "normal seated" but I will still need to rise from there. Also it is SLOW when you need to get to the bathroom. I had to set down my laptop computer, wait for the power to restore the chair while pushing away the over-bed table, plus unpack pillows, blankets, ice packs, and reach for the cane.

Planning ahead for the bathroom may be critical with two knees to navigate.

It sounds like you learned to deal CAREFULLY with getting in/out of bed pretty much as soon as you could walk (to bathroom and hall) which would be very good news to me.

So how long (everyone is different) before you felt like getting into or out of bed and a normal chair were not a major engineering projects? If you are there yet.

It sounds like @meowmary has more steps to contend with but feel free to post that here as I will need that advice to get to the YMCA or other places. It does interest me greatly.
 
@HerbM I just joined this forum as I have scheduled a RTKR for mid-November. I read about the technique that you are using and I am interested in learning more about your surgeon. I'm in Georgetown, just up the road from Austin, and would be interested in talking to him/her and comparing to what I was planning to do here.
 
Absolutely, @Rather -- My guy is David Dodgin with offices in Cedar Park and Guadulupe St. Austin (sort of near Central Park.)

Many people make claims for their surgeons but Dodgin is literally one of the top Hip Replacement guys in the world (see my Hip replacement thread in my signature below). Joel Matta, his mentor, is the father of the Modern Anterior Approach in the US, and helped Matta develop the special table and tools that cause all the excitement with the Anterior Approach. He has done more than 1400 Anterior Hips. (Plus as many posterior as were required because a compromised patient can tolerate the longer anesthesia.)

Technically I don't know his knee work directly (scheduled for Oct 21) but from everything I know about him both personally and through research he may be as good (or close) with knees.

I also wanted a PSI approach and he told me straight out (without my mentioning that) that he could do BETTER (not just as good) with PSI (custom instruments) vs. CAS (computer assisted).

This is a toss up in the literature with perhaps the NEW studies starting to give the nod to PSI, but there are other reasons for it such as reduced jig size means he doesn't need as much incision room to get clamp on and make the cuts. Also, it's quicker, and all things being easier most would choose the faster surgery with fewer steps.

I would strongly encourage you to use Dodgin as a 2nd opinion EVEN IF you have NO intentions of changing surgeons. He's a straight shooter.

It really doesn't matter if I have a "nice surgeon" but he also happens to be a friendly guy and to have a great sense of humor.

Long term, CAS may be as good, but it definitely isn't (much) better. So given these reasons, I wanted the Signature MRI and my set of cutting guides and jigs.

Notice however this is NOT a GIANT difference as it is with the Anterior vs. the Posterior Hip.

If you want to talk in person, let me know and I will provide my phone number in a private message.

We know Georgetown well living here in far North Austin.

You are welcome to post anything you wish here in my thread relating to knee replacement.

I wish you the best of luck and enjoy talking about this stuff.
 
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