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Building decision for knee surgery

Discussion in 'Knee Replacement Pre-Op Area' started by Jeffntate, Nov 17, 2018.

  1. SpaceGirl

    SpaceGirl member

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    Hi Jeff,

    I hope you got my message I sent back to you. I know what it's like to be in so much pain and can't continue to live like that. I have been overweight for a long time, my drs kept saying my knee pain was related to weight. I lost 80lbs and guess what that didn't solve my problem. I know many people have been turned down by drs to have knee replacement done unless they lose weight, but honestly if your knees are so bad they grind, there is no cartligage left and you have bone spurs, weight loss isn't going to stop the pain.

    I went with TOC here locally, my dr referred me, my surgeon was Dr Thomasson https://www.visittoc.com/people/thomas-thomasson/ and I liked him a lot. My knee is doing great a year out, life is normal and I feel like I can live life again without pain. Don't delay on at least meeting with a surgeon and talk your options out and do what is best for yourself.

    Good luck!
     
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  2. Jamie

    Jamie ADMINISTRATOR Administrator

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    I know it's tempting to try and compare your recovery from your cervical surgery to your upcoming knee replacement, but please don't. Recovery protocols these days for a TKR are quite different than they were even 5 years ago. Pain management is something each surgeon develops for their patients based on individual needs. It's more than just dosing out opioid pain pills following surgery. There are pain pumps, pain meds injected directly into the wound prior to closing, as well as the medications given by IV and mouth.

    Have you read our pain management section (tab at the top of the page)? If not, I suggest you take a look. There may be some information there you were not aware of. And there is other helpful information that you can take to discuss with a surgeon when you meet with them.

    We've had BoneSmart members with drug addiction problems and also those who have been using serious levels of pain medications prior to their joint replacement. They each worked with their surgeon and were able to recover. The goal will be for you to get the surgery and eventually no longer need any pain medication for your knee.
     
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  3. HoneyB

    HoneyB senior

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    Hi Jeff - Four of my friends and I have had TKRs since December 2017. Four of the five of us have had TKRs in both knees during this year. ALL of us have had good results. Since you asked about surgeons in north Alabama, you might be interested to know that all five of us live in Alabama: two in Dothan and three in Mobile. The five of us used four different surgeons with three different brands of knees (Stryker, Dupree, and Conformis), all with good results.

    I'm an engineer. I tried to approach knee replacement surgery like an engineer approaches most jobs. I did a lot of research, but in the end just had to find a surgeon with a good reputation who made me feel comfortable. Remember that when you're doing all that research on the outcomes of surgeries, you really don't know enough details to help with your decision. When you read of a bad result, you generally can't tell the pre-surgery, overall health condition of the person.

    The surgeon I used uses Stryker "off the shelf" knees and Conformis custom knees. As an engineer, I was intrigued by the thought of a custom knee and chose to go with Conformis knees for both of my TKRs. One of my friends also used the Conformis knees with good results. The other three used "off the shelf" knees and also had good results.

    Knee replacements are so common now that most everybody knows somebody who has had a knee replaced. I got surgeon recommendations at the grocery store, at the hair salon, from neighbors, etc. After several people said, "I had good results with Dr. Barber" or "My mother/sister/neighbor/friend had good results with Dr. Barber," I decided to go see Dr. Barber. You might also explore physical therapists that you might want to use after surgery and ask them which doctors' patients have good results. Finding the right physical therapist is also important.

    I was a candidate for a PKR in one knee, and possibly for both knees. My surgeon told me that a PKR usually does not last as long as a TKR, and that when eventually revising from a PKR to a TKR, I would no longer be a candidate for a custom knee. I chose to go with TKRs.

    Good luck to you!
     
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  4. Jeffntate

    Jeffntate junior member
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    I was told by one doctor that I might be a candidate for a partial knee replacement AFTER I dropped my weight by 55 pounds down to a BMI of around 26 from 34 BMI over the last 14 months. He really has only seen an x-ray of my right knee that is much worse than my left, but I'm pretty sure I'm only 1-2 years out from the other knee. In both cases, all my pain is on the medial side, and the arthroscopy done several years ago showed the medial meniscus had torn and separated from the bone and was floating around in my knee. But SynVisc injections and cortisone injections alternating every 3 months kept me mostly out of severe pain, but the recent injection in early November of cortisone didn't do much. I asked for the soonest appointment at TOC and ended up with the doctor who replaced my rheumatologist's knee 6 years ago. My appointment with him is December 31st, and I was hoping to get a SynVisc injection in both sides.

    Today I got another sooner appointment with another surgeon for December 11th. I have seen him before and was going to do a total knee in 2017, but backed out after seeing the surgeon who did my THR in 1998 that is still doing wonderful. I hit the brakes when he advised me to first lose weight because he told me that while hip replacement are "slam dunks" that knee replacements are not, and 10-20% of people are not satisfied with the results. He said ideally my weight loss would prevent surgery, but as others have told me, despite weight loss, my knee has only worsened over the last year.

    My physical therapist recommended this same surgeon as one who got his patients up on their knees on day one in the hospital. I like my physical therapist a lot and will use her for post op recovery she is the best PT I've ever known. I am worried about post op pain management in a case like mine if I go out of state. Plus Atlanta is 200 miles and 4 hours away from us. So a lot of travel for follow ups, which were not that often with the hip.
    But I am not ruling out Vanderbilt either and I have a recommendation there. I also got a recommendation for a surgeon in Nashville. Both were recommended by a MD we know at Vanderbilt in the Orthopedics department.

    I can't tell who does partial knees at one of the clinics, but I am hopeful that is all I need done to both knees, my right knee first. I also want to see if they can do stem cell work on my left knee as it is just now starting to hurt, but my rheumatologist told me I had 40% loss of cartilage in both knees back in early 2018. They have only xrayed my left knee when xraying my right knee, but it feels much the same as the early problems with my right knee.

    I walk somewhat with 10-20 degrees of external hip rotation probably due to the arthrits in both hips. In fact, in 1996 they were telling me I would need 3 hip replacements per side over my life, which motivated me to find the ceramic on ceramic hip trial in 1998 that turned out to be the best choice I could made. I literally got the last hip in the Stryker Osteonics ceramic/ceramic hip trial, the same hip that Jack Nicklaus the Senior PGA golfer got.

    I have not really gotten far in looking at knee implants, but I'm pretty sure I'll need at least a partial knee replacement on my right knee, as I think the osteoarthritis is too advanced for any type of platelet enriched plasma or stem cell bone bone marrow aspiration concentrate treatment, but I am wondering if it is possible in my case of medial damage only as far as I know.

    Has anyone had any luck with either Platelet enriched plasma or bone marrow aspiration concentrate treatment for knee osteoarthrits of the medial side?

    I have a lot of good choices and what is really concerning me is the post op pain management, especially as state governments tighten the rules, so I do not know what they are allowed to do in Tennessee and Georgia or if Emory or Vanderbilt has authority to better manage pain in a patient like me. I really need to know more about the rules in Atlanta and Nashville as they will exist in early 2019, the time of my likely surgery, or if I'm best put in my home city of Huntsville given my family PM is also my pain management doctor and said he would do what is needed to manage my post op pain.
     
    Last edited by a moderator: Dec 23, 2018
  5. Jeffntate

    Jeffntate junior member
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    Yes I'm also a former engineer too, so I have to really analyze my options, but I know time is running out and the pain is getting unbearable. I'm on full disability from primary spinal cord damage that causes ongoing neck, arm and back pain along with a fused spine from having arthritis, plus my hips, knees, even my big toes are all arthritic, though to date my non-operated "virtual bone on bone" hip has never hurt despite being told I could have it replaced in 1996, so unless it gets worse I'll focus on my right knee which is the only operable thing right now that could be fixed by surgery. My spinal cord got crushed by years of cord compression, and while nothing got paralzyed in the damage, it has resulted in ongoing arm, neck and back pain that resulted in disability. And my knees got so bad I've been in wheelchair or on canes/crutches for over a year now, and using a knee brace for over 3 years now to ideally avoid surgery, but even avoiding use of my knee now does't stop the pain which is 24/7 even in bed now, so I regret putting off surgery and getting in such a bad condition that I am really in, especially with the restrictions on pain management now that are everywhere.

    I have a friend in another state who has been in pain management for 20 years tellling me that his friend is a pain doctor and he has surmized that he cannot get a knee replacement in the "current environment". he lives in a state that has really restricted pain medication and he like me is opioid tolerant but I'm trying to find out more details and understand his situation and figure out how it applies to me.
     
    Last edited: Dec 5, 2018
  6. Jeffntate

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    One thing that would really help me plan this surgery is to understand the expected pain levels and amount of medication an ordinary non-opioid tolerant person would get for the first weeks after surgery, ideally week by week of how intense the pain will be and how much medication is needed.

    Ideally I would love to hear of someone like me who had knee replacement as was already on opioids for a long time like me. I have always taken my medicine EXACTLY as presribed and have a stellar track record of full and total compliance, so I am not an abuser. In 2001-2002, and took myself off all medicine once I got on a new biologic arthritis medicine that worked like a charm and stopped all my systemic inflammation, but by the time I got it, my spine was almost fused except for the 2 vertebrate in my cervical spine that took all the damage and injured my spinal cord. I had that surgery in 2014 and did wonderful, but I was on opioid pain medication post surgery. It was a piece of cake, but I know I cannot maintain those levels of opiate drugs for more than just a short period of time. I'm trying to figure out what that can be done and get a plan carved in stone with my pain management doctor and the orthopedic surgeon who hopefully will work together to ensure my pain is properly managed.
     
    Last edited by a moderator: Dec 23, 2018
  7. Jeffntate

    Jeffntate junior member
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    Years ago while I was working and had major spine surgery we spent a fortune to buy me a powerer recliner. Can you see if this would be useful post TKR or PKR surgery? Note: We bought it 4 years ago when it was much less expensive than this will show. Good grief the price has gone thru the roof. But is the leg angle OK for post op knee surgery?

    https://relaxtheback.com/products/x-chair-zero-gravity-recliner?variant=14774592077883
     
  8. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Looks like it's ideal, I reckon. Lean back, elevate the knee whilst supported - and I guess watch TV 'sideways' :)
     
  9. Jeffntate

    Jeffntate junior member
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    Thank you. I was wondering if the knee bend in the chair was sufficient or needed something under my knee to try to get my knee more straight. Is that what you are suggesting?

    Also - any help with the surgeons and pain management would be greatly appreciated.
     
  10. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    It will tell you; when it doesn't hurt, that's right. For the first while finding a pain-free position might be difficult, mind you.

    You should have a prescribed regime of painkillers, which you should follow.
     
  11. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    It can be tough finding a comfy position at first. Your knee will tell you what works, and when you find that position, stick with it. Eventually other positions (straightness, bends, etc.) will be pain-free too. Stay with your pain management schedule and icing and you should be reasonably comfortable.
     
  12. Jeffntate

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    I am very, very concerned about knee replacement as I have been due to multiple permanent painful conditions been on opioid pain medicine since 2012 and am quite "tolerant" though I am no addict of any type. I have been on the same stable dose for 3 years now, but with the government and insurance tightening restrictions I am terrified I will not receieve enough pain medicine post op to make recovery a success. I'm not a wimp and have lived in a lot of pain for a long time as anyone who knows me would testify, but I hear knee replacement surgery is very painful even for people who didn't take any pain medicine pre-op so I need a really tailored plan for me to make it a success. I know I have to do physical therapy or I won't recover, and I've heard people who didn't do well or had very long recoveries because severe pain limiited what they could do in therapy and I do NOT want to be in that situation. Looking for any advice on compassionate doctors, anesthesiologists who deal with cases like me, or ideas.
     
  13. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    You have been misinformed. Recovery from TKR is a healing process, which the body does all by itself. There is nothing you can do to speed the process, very little* you can do to help it, and much you can do to mess the whole thing up by doing too much.

    The little is gentle stretching exercises, very simple and easy.
    Have you spoken first hand to these people?
     
  14. Jeffntate

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    I have heard from a couple of people I know who had a tough recovery because they were already taking a high dose of pain killers post op.
     
  15. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Jeff, stop listening to other people and looking for more information.
    You've been given all the information you need.

    Now it's time to start interviewing surgeons.
     
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  16. Jamie

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    I know it's tough to wait to see the surgeons, but thankfully you do have appointments. These are things you need to discuss with the doctors you're considering as only they will have the answers you seek. Each patient's situation is unique. It's impossible to compare your surgery with anyone else's accurately. And each surgeon has unique ways of dealing with challenging pain situations. So try and stay calm, write out your questions, and know that you'll get some answers here soon as you start meeting with some of these doctors you've found. The right one for you is out there.
     
  17. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    First hand is good; there are too many 2nd hand stories of people either with their feet on backwards post-op, or who've come out of surgery and climbed Everest on their way home.
     
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  18. Jeffntate

    Jeffntate junior member
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    My GP / Pain doctor suggested a different surgeon who only saw me once in 2017 and even rushed me to schedule surgery but I cancelled on him after being told by another OS surgeon I needed to lose weight first which I have done (55 pounds). So now my doctor and my wife are calling tomorrow to see if I can swap to him. He looks like the type of personality I need, is in the hospital my pain doctor likes best, and a friend of mine had surgery with him and did remarkably well. I have an appointment with a different surgeon on this coming Tuesday but it was out of panic when my knee pain was 9/10. My GP gave me some prednisone which is helping the knee pain temporarily. Not sure I'll get more once that runs out or not.

    In addition to being opioid tolerant, I've been sedentary for the last year, resorting to wheelchairs, walkers, canes and crutches. I need to do some leg strengthening exercises and upper body exercises to get stronger. Any suggestions for pre-op TKR or PKR surgery?
     
    Last edited by a moderator: Dec 23, 2018
  19. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    My take on this would be not to bother about leg strength, you'll lose it all post-op anyway; but upper body strength would be very helpful. It's also the case that strength training will (of course) build muscle but also help to lose fat.
     
  20. SusieShoes

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    You can do some pre-op leg exercises if you wish and it doesn’t hurt too much. What helps most — and I wish I’d done more of pre-op — are those upper body exercises! Having stronger arms and core would have really helped.
     

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