Another doc on causes and treatment of TKA problems

[Dewy]

This one is more technical and less assessable than some others. However it is recent and quite comprehensive, so still may be useful to people having problems and having to seek specialist advice.

http://www.sgotssot.ch/support_documents/070111-180328_doc_fr.pdf

 

[referee54]

Very interesting reading; I thank you for the very informative post and article. It is quite technical, but i did agree with this:

but: satisfaction with TKA determined by
patient’s expectation and not their absolute
level of knee function

This makes sense to me!

From what I have read, though, on the forum I have to disagree with this:

we must learn to refuse
surgery (obesity)

Many TKR patients have reported that they are overweight...

 

[Dewy]

Yes, I also thought that was far too strong a conclusion!

It was reasonable to point out that obese people have significantly more complications etc etc. A more reasonable conclusion might have been that obese patients should be told of these additional complications and should advised to try to lose some weight before surgery if possible (or something like that).

 

[Josephine]

a) I wouldn't be inclined to take this PP presentation without the commentary that goes with it.

b) there is no date on it

c) I spoke in a post just the other day about the inconsistency of figure retrieved from Joint Registries.

It should be noted that statistics obtained from Joint Registries can be very misleading. At a conference recently, it was shown that in three different countries, UK, Sweden and Australia, two knee replacements (let's call them product A and product B) had very different results.

In the good results ratings, in the UK, A was rated the top product and B was about halfway down the list. In Sweden, B was in the middle and A in the lowest grading. In Australia, B was top and A was the lowest. It was figured that the only variable that could be responsible was the surgeon's skills! Go figure!

 

[Dewy]

Jo,

You are right that it lacks a date - powerpoint presentations should always have one. It must be 2010 or later as one of the references is 2010.

I don't think we should ignore Joint Replacement Registry data just because different countries are not consistent. Even with other (non-registry) datasets, different studies use different data and therefore sometimes show different results. This is not unusual with observational data. One can only draw definition conclusions about cause and effect from randomised trials, and these are relatively rare with joint replacement (although a few exist).

Your point about the lack of commentary is a very valid one - I wouldn't be unhappy if you prefer to the delete this. (I'll concentrate on journal papers in future.)

 

[Josephine]

I think I might lift the text off the PP and make an article of it. It might be easier for members to interpret!
And I rarely delete things that people have taken the trouble to post! :wink1:

 

[RestAssured]

Hi Dewy!

I found this powerpoint to be very interesting in some respects because it still makes assumptions about people in general.

I am sorry but I disagree with their findings about obese people needing to avoid surgery! I am one of them, and I am a lot smaller than I was before I got my first TKR!

If I had listened to a doctor that would report something like this, I would still be in horrible pain with BOTH knees. My OS said "it would be nice if you could lose more weight before surgery, but your knees are in such terrible shape, that I don't see waiting any longer!"

I have lost 72 pounds so far, and I am becoming more physically active than I have in years!

I am ready to get back to living again, and if I had believed an article like that, or a doctor like that for that matter, I would still "be looking at life from the sidelines!"

 

[Dewy]

Sonja,

As mentioned in an earlier post, I didn't agree with what appeared to be an inflexible position on this.

Patients are individuals, whereas papers and presentations are trying to draw out general conclusions. And cases such as yours are exactly the reason why a flexible approach is needed - I'm so glad your surgeon was sensible! Your story is an example to us all.

I need to lose weight but haven't managed it yet.......

 

[RestAssured]

Dewy,

I am glad that you posted this powerpoint! I am not upset with you by any means!:biggrin:

I just wanted to prove the point that "doctor's" can put together all the stats they want, it is up to each individual to succeed!

 

[Truivia]

As a person who has battled obesity for about 28 yrs now - with a high weight of 267.5 and currently at 219 I will say that to lose that weight with my knees so bad was very very hard.

I am hoping my new knees allow me to lose the rest a bit easier.

Do I find my weight an issue while healing? Yes & No.

In the beginning when I had to get in and out of bed alone it was very very hard. I honestly think it would have been a little easier with less weight.
BUT truthfully I think most of my difficulties with this was I have "weak" arms. Being as I had both my knees replaced, my legs were useless to me and I had to use my arms a lot.
I have told several people, if they can to lose weight and build up arm muscles IF they can.

I feel comfortable saying that in general I think anyone would find any surgery easier to heal from being a healthy weight.

My .2 cents :wink1: