Bi-lateral vs two surgeries and MUAs

[vinny]

If there are concerns over health issues and the risk associated with a bilateral, which is slightly greater than a single, that is a real reason....what set me off was the discussion with someone who would know regarding separate surgeries for double bills....also wonder what percentage of people who need a bilateral never go back for the second due to recovery associated from the first.

Vinny

 

[SeptemberZen]

I can certainly understand the hesitation! But I will definitely go back next year. My arthritic knees were mirror images of each other and my thigh bones had started to bow slightly. Even now, my left knee has been complaining loudly because I've had to put a little more weight on it occasionally.

My motivation? My right knee is swollen, achy, stiff and is frustrating the hell out of me -- but there will come a time where the only difference between that knee and other people's will be a scar and occasional clunking! My left knee won't get better on its own and if I don't do it, I'll never get off the cane.

 

[TexasTee]

Thanks for the clarification Vinny - I wasn't offended, just curious.

 

[Phil75070]

I guess there are minor risks anytime one is put under anesthesia but do those risks increase the longer one is under? Same for the risk of infection. Is it better to be exposed twice for shorter periods of time than one, longer session? I also assume that doing two at once increases the amount of blood loss during the procedure compared to the body having a chance to recover between two separate procedures? I know my OS said the risk of needing a blood transfusion increases with a bi-lateral and I know another surgeon who, as part of his pre-surgical process has patients come in to donate their own blood.....just in case. I am not a doctor nor a medical professional of any kind so I haven't a clue if any of these are realistic considerations.

 

[vinny]

Phil I asked all of those questions...my OS has not asked anyone to donate blood for a couple of years. ...he indicated that a spinal with mild sedation decreases blood loss and it is not a problem being sedated for the 3 hour procedure or longer..much easier on the body than General Anesthesia and studies indicate quicker recovery..regarding infection I went to Hospital Friday morning and Left Monday morning and would probably have had the same stay for a single as my bilateral. He indicated 3 infections out of 900 TKR which is less than the norm and infections can occur anywhere in the hospital so the less time spent there the better.....they say cardiac risk is greater for a bilat which is why pre ops question health issues. I also believe the health and condition of the OS dictates preferred procedures for some due to increased time in them OR .lots of variables but in the end it seems to patient physician relationship and preference..

Vinny

 

[Josephine]

should the OS be pushing MUA's if someone is not in need

Definitely not! This is supposed to be a collaborative thing, not an autocratic declaration! I note many people are very scared of the idea yet when the surgeon 'suggests' it, they don't offer any protest or debate but just accept it because he is the 'expert' and must know best. (Not you, TexasTee!!) The truth of it is, if a person's flexion is not quite up to par at 6 weeks, there is still heaps of time for it to improve before this needs to be done. However, if the flexion is about 70-80 at 10 weeks or more and/or there is a clear stop in the flexion which may indicate adhesions, then yes, it should be done.

does the physician have a responsibility to use caution as there is anesthesia involved

Of course! But it's a responsibility he shares with the anaesthetist who is, after all, the expert in the subject. But it's this concern and responsibility that calls for rigorous pre-op screening.

Also had a discussion recently over the difference between OS who do bilaterals versus one at a time....the person I was talking to felt that some OS want two bites of the apple so to speak and can charge for each operation and also some did it because the patients insurance would only pay for one surgery

Well I can tell you the inside story why some surgeons will do bilaterals and some won't - it's damned hard work! One TKR or THR is hard work but do a bilat and you're stuck in theatre for about 4 hours without a break. You see, it's not just the surgery - the patient has to be positioned on the table, prepped, draped and then operated on. Once you start, you can't take a 'comfort' break or anything else! Very few other jobs are like that. Then the wound has to be sutured, a dressing applied and the patient seen off the table into recovery and the surgeon has to be part of all that because it's his job. When they do a bilat, both legs are prepped and draped one leg is done and finished and then the other. Some surgeons like to treat each leg as a completely separate operation with a new trolley of instruments and everything. This change over adds about 20-30 minutes to the whole procedure. It's worth pointing out that those who will do bilats tend to be quite a bit younger than those who prefer not to!

I don't think bilateral ops are so common over here

Don't you believe it! My surgeon does heaps as do his colleagues. and I can remember doing bilats way back in the 70s as well!

I guess there are minor risks any time one is put under anesthesia but do those risks increase the longer one is under? Same for the risk of infection. Is it better to be exposed twice for shorter periods of time than one, longer session?

Well yes, they do but if the patient is fit and healthy it's not too much of a risk. The wounds aren't open longer! The surgeon will do one, close and dress it, before he starts on the other one. However, if he has a colleague to do the other knee, they can work in concert so each knee is only open the usual amount of time.

Hope that clears things up a bit!

 

[vinny]

I thought the fitness of the surgeon had something to do with bilaterals ....My OS 40ish triathlete I went into the OR at 8am and out at 11am and he opened and closed when I woke up he was putting TEDs on me and said 42 minutes for your left leg and 50 for your right....I asked if I was going to ICU he said no you are doing great I will let you rest today and we are going for a walk tomorrow....he did another TKR after lunch...

Vinny

 

[Maggie94]

Mine is also young and fit...plus has a wicked sense of humor

 

[kneeper]

Interesting topic. I know my surgeon sometimes does bilaterals but views them on a case by case basis. For me, although both knees were bad, the first was practically an "emergency" due to instability. The other was declining but not as bad. And with my RA I agreed it would make sense to wait for knee #2. The good news on that was that I had some time to get some muscle strength and my 2nd recovery was easier.
With the success of knee #1, I never considered not going back for "lefty."

I think it is important to have good communication with the surgeon and to educate yourself on the pros and cons in general and for your circumstances in particular.

 

[Spencieca]

so very glad that I saw this thread, how did I miss it for this long..hehhe...I asked my surgeon to do the bi-lateral but he said he wouldn't. He also said he wouldn't do a TKR because I was only 46..he told me that I still had a very small amount of space left in the medial part of the right knee and it wasn't totally bone on bone yet, so I should wait til I was 50...UMM...NO...why must one wait until they CANT walk in order to have relief? My right knee is covered under the military, I am a 20% disabled Vet so I pretty much have to listen to what the military docs say..Finally when I said I had enough the doc agreed to do a partial..but couldn't get me in until June of 2015 so he referred me out to another facility..that doc said that my knee was in too bad of shape for a partial and he suggested a TKR..he also told me that my original doc had a strong liking to only doing partials..so I guess it is mostly up to the docs...I have to have my left one done but am debating if I should wait to see if the VA will do it and or go and do it under my private insurance..just not sure how much it will cost..thinking maybe the care will be different if I get to choose my surgeon, hopefully worth the money I may have to pay...I can also see why people don't want to go back for the other knee...it is a brutal surgery and recovery...and Im still on the fence on the MUA..I have to be put under because I cannot do a spinal or anything of the sort...and I have a compromised immune system so I have to take all of these things into account..the OS is not familiar with patients with AIDS so I have to "update and educate" him a bit on the subject..not everything is black and white.!

 

[Maggie94]

Interesting insight @Spencieca. Get Groot sorted then research the alternatives and decide. Maggie x

Maggie via Tapatalk

 

[vinny]

@Spencieca ..so Laura you have both issues to deal with ,insurance and choice of OS...both are important and your decision may be guided by how your recovery is going...my OS does not do partials as he feels they are more of a band aid and does bilaterals if both are needed and considers if insurance only covers one operation.... not sure how many VA OS do TKRs' but it would be worth a second opinion non VA...does your primary doctor have am opinion....you are right there is no black and white..

Vinny

 

[referee54]

Interesting topic. I know my surgeon sometimes does bilaterals but views them on a case by case basis.

Mine is similar---he views each case and determines if the patient is a candidate for a BTKR.

I have heard, though, that, as he has gotten older, he is doing fewer of them. It is also tough physically on the surgeon, too.

 

[wberry]

I am on the fence on my other knee. Like I have already seen hear, it hurts. No kidding. My left still creeks and pops but it doesn't hurt and functions okay even though the X-ray says I'm close to bone on bone. My OS wouldn't do the bilateral, his argument was all the risks and the recovery issues. On a cost side it makes since for me together other done this year, because insurance should cover it at 100 percent on the second. Not sure if my surgeon prefers to double dip or if he was being strait with me on the risks. The right knee was a no brainier, it was in sad snap and I was Ina brace just so I could walk without pain. But it had also had more injuries and scopes also. And it had a major injury from football when I was younger. At the time they just put it in a cast for 6 months and did no surgery at all. No telling what I tore up.


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[vinny]

When I asked my OS for some reasons to do a bilateral one of the things he mentioned was people not going back for the second one and I asked why he just said "it hurts"....I took a video yesterday that I should have done a few months ago...at 5 months out I am so glad I did them both...I do things I would have never dreamed possible without pain....this time a year ago I was riding in a golf cart with a handicap flag on it so I could drive up to my ball and hit and collapse back in the cart...one year later walking the course 4 times a week pushing a cart....I could do it 7 days a week If I did not work but fortunately that will not be a problem May 1 as I retire. Cannot tell you what to do of course but the recovery is just a short period of the rest of your life..no knee pain..

Vinny

 

[Roy Gardiner]

It's worth pointing out that those who will do bilats tend to be quite a bit younger than those who prefer not to!

Mr Ireland, who did mine, is older than me. I was 59 on the day.

Well I can tell you the inside story why some surgeons will do bilaterals and some won't - it's damned hard work! One TKR or THR is hard work but do a bilat and you're stuck in theatre for about 4 hours without a break.

And he talked about 'having a cup of coffee' between the surgeries, whilst I was oh you tee.

My recovery was very good.

 

[vinny]

I was 67 on the day and in and out of the OR in 3 hours including the spinal...OS told me 42 minutes on one and 50 minutes on the other as he had to straightenen it. Woke up as he as putting the TEDs on...it seems it does come down to the OS in many cases my OS did my bilat in the morning had lunch and did a single then went to his office to see patients.....

Vinny