bi-lateral TKR pre-surgery prep

[Matto]

Dear Fellow Bloggers,

I'm about to ask for bi-lateral TKR (complete - not partial for either knee) and wanted to get feedback re: pre-surgery preparation. Exercises and so on to better prepare for post-op rehab. Any feedback re: post op PT is welcomed, too!

Also, how critical is spinal tap anesthesia vs. general for shorter recovery time? And how fussy need I be in discussing the different choices of manufactured parts or materials with the surgeon? (Is one company's stuff much better than another's?)

Thanks! Matto

 

[Josephine]

Hi there Matto. Delighted to have you with us!

As far as pre-op prep is concerned, I am sure that many other members will concur, the more fit your muscles are beforehand, the easier you will find the exercise regime afterwards. Your commitment to exercise afterwards will be crucial in the rate and completeness of your end result. Read around the threads in the Recovery Discussions. Lots of excellent advice and detail in there.

As for the anaesthetic, go for the spinal every time. Less drugs in your system to take ages getting over, it's safer and provides you with several hours pain control afterwards so less morphine. I think you will find that most anesthetists prefer to give a spinal for a bilateral as it a general will be very hard on you.

Choice of prosthesis is an American curiosity I have yet to come to terms with. Being a Brit and thus somewhat constrained by the NHS system, we don't get much of a say in which prosthesis is used. But you are in the US and that is the protocol over there so I just have this to say; the majority of prosthses have a good track record. Differences are invariably of design detail rather than overall performance. As I have said numerous times before, my choice would hinge upon the surgeon rather than the implant. Pertinent questions I would ask are

1. why do you use the prosthesis you do? What recommends it above other implants?
2. how many have you performed over what period of time? (not less than 500 per year unless there was some really good reason for it being less)
3. what is you infection rate? (anything under 1% would be good - Charnley always claimed his was around 0.04% which seemed little short of miraculous!)
4. what is your rate of unacceptable outcomes, both short term and long term? (these being dislocations, loosenings and other mechanical problems)


I wish you well - keep us posted on your progress.

 

[Doug]

Matto,
I had my tkr nine days ago.
I've worked out with weights for most of my life and exercised in support of whatever sport or martial art I was involved in.
Work your whole body out!!!! I went less with a bench press type exercise and more of a dip motion. That will help with pushing yourself up from a chair.
As for legs go for strength not just endurance. The one I liked most was a leg extension flutter. Rather than doing complete lowering and extension of the machine, use a light weight, fully extend the leg, lower it 6-8 in. and then extend. I would do sets of 25.
As much as I have to struggle with my post op exercises, I can't imagine how hard it must me for those who could do nothing to prepare.
Either way, even with the discomfort I'm going through now, I know I made the correct decision to get it replaced.

 

[Matto]

Doug,

Thanks for the advice on the leg extension flutters, dips, etc. I'll add those to my weights and exercise regimen, and dump the bench presses. I also ride a stationary recumbent bike at the gym for 30-35 mn. 4-5 days/week.

I'm also shedding some extra weight - have dropped from 225# to 208# since Jan. 1; and want to get to about 195# by the operation date (March or early April). I'm 55 yrs. old, 6'2" and larger boned & mostly muscular, but have cleaned up my diet and eating habits big time these past weeks and it feels good.

Anything else you might suggest will be welcome! I hope your recovery continues well, and thanks again for responding!

Matto

 

[Matto]

Thanks, Josephine!

I appreciate all of your feedback. I'll go with the spinal, and ask the appropriate questions of the would-be surgeon(s). I am amazed, however, that such folks can do - or DO do - upwards of 500 of these per year? That's more than one per day - how is this possible? Just curious!

Matto

 

[Matto]

Dear Josephine,

I appreciate your expertise and specific information! I'm just curious about that number: 500. You mean to tell me that a typical TKR surgeon does at least 500 of these procedures each year? I'm stupified!

Matto

 

[Josephine]

A typical primary knee replacement takes around 1½ hrs, maybe 2. In the UK an operating session is 4 hrs allowing around 2 or even 3 knees per session. Typically, joint replacement surgeons have all day sessions which means they would probably manage 5! He may have 4 operating days in a week and even put in extra all day sessions at the weekend.

Taking 8 weeks off the year for leave and study, that is 44 weeks which could work out at around 880 replacements per year.

Some eager young surgeons do 1,000 a year or even more but it's not my experience they can keep that up for too long as physically, the operation is a very demanding procedure!

Thing is, there are an awful lot of people out there in need and if a surgeon has any compassion, they will work themselves to a standstill to meet that need. I know in the US there's a financial aspect as well but nevertheless, most of the surgeons I know have their hearts very firmly in the right place. So I would certainly not want to receive surgery from a surgeon who does less than 500 a year as, in my opinion, he would just be dabbling in it!

 

[Matto]

Dear Josephine,

Thanks for the mind-blowing clarification! This is unbelievable pacing - WOW! (I have trouble grinding my flax seed each morning for atop my porridge - thanks!) I'll follow your gracious advice as I procure an apt surgeon1

Sincerely,
Matto

 

[referee54]

Matto--I had a bi-lateral on November 8th. I spent nine days in the hospital and then came home with a walker---moved quickly to crutches and, for a brief while, a cane. I am now back at school teaching, but my left knee (actually the muscle) and the IT band is tight. Get as strong as you can, but you will be amazed at how quickly you lose almost all of your strength. I am in PT now--my regimin is this---i ride a bike for 10 minutes---then I go to the leg press machines--do both for 3X10 and then do singles 3X10. Then to leg extensions/curls---the same. Then I go to another machine and do lunges and hip-flexors (3X10 each side ). After that--balancing and such on a half -ball . I crouch on the half-ball and throw a medicine ball at a bounce back---i have to catch it. I do it straight on 30X's---then from the left and the right 30X's each. Some days I am attached to a tether and I half to wlak over hurdles---forward and sideways---left and right.

On days that i do not go to the PT, I go to a gym, ride a bikefor 23-5 minutes and use rubberbands to flex, stretch, and strengthen the muscles.

I then ice my legsfor about 20 minutes.

It has been a long haul, but it is worth it!

Tim C.

 

[referee54]

BTW---I am not sure how many TKR's my MD does in a year---but that is all he does. He does them four days a week and has office hours on Friday and early Monday AM. I would imagine that he does at least three a day some days. Sort of like a Lube-Stop place---just line 'em up and gettem' done!

Tim C.

BTW---you will also lose weight doto the pain meds. DOn't worry about getting too strong---you will be amazed at how much stregth you lose just in the hospital!