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Building decision for knee surgery

Celle

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My GP / Pain doctor suggested a different surgeon who looks fantastic and now I'm in a quandary trying to swap from a 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 this new surgeon. 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.
All those things are important to you, but - IF this new doctor is into sports medicine, he may not be the expert on knee replacement that you need. How many knee replacements does he do in a year?
Sports medicine and joint replacement are two very different specialties.

With your history, you desperately need a surgeon who will "do it once, do it right". You don't want to choose a surgeon because of his attitude about pain relief, only to find that the surgery isn't successful and you have to go through a second surgery.
That's also a reason why having a total knee replacement , not a partial, would be a wise choice for you. PKRs inevitably, sooner or later, have to be revised to a TKR - some even within the first year.
 
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SpaceGirl

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Your surgeon did my daughters shoulder surgery, she had a torn labrum in high school from volleyball. However I still recommend going with a practice that specializes in joint replacements.
 
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Jeffntate

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I read every review on vitals dot com of all the doctors in Huntsville and with a rating of 4.9/5.0 and the only negative reviews of 1 star being erroneous entries, my wife switched my appointment. This surgeon did a friend of mine who said he felt sorry for all the patients in PT that wasn't doing as well as him, so given my high anxiety over this, I need a very compassionate doctor. I also noticed he is in all the videos of knee replacements, but I am still seeing a surgeon at TOC. Do you think TOC is better at joint replacement SpaceGirl and based on what?
 
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Jajakio

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So keep the appointment and keep an open mind. Make a list of questions . In addition to your pain/drug questions, you might want to know how many knee replacements he does a year, what prosthesis he uses and how long he has used it, what is his personal complication rate, infection rate, revision rate? Does he see you as a good candidate foe a full or a partial and why? Is there anything in particular about you and your situation that he thinks will create difficulty either in the surgery or the recovery process? It is imporatant to find someone you feel confident and comfotable with but it may be a good idea to interview a few surgeons and see how they compare. Its good you spoke someone who has recently had surgery with him and got a firsthand opinion. Now it's up to you to sift through the interviews and make your decision.
 
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Jeffntate

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First surgeon appointment done yesterday with a surgeon from TOC Huntsville. Nice guy. I liked him. He said my right knee is bone on bone and gave Bone Aspiration Concentrate AKA stem cell replacement a 50% chance of helping but said if I asked him point blank if it were the right approach, he would tell me no. I didn't know prior to the appointment that he even did knee replacements, and I went to him just to find out about the stem cell or blood plasma thing. He is a sports medicine guy who also does knees. My GP/Pain doc said he is a good surgeon though. He said my left knee must be a menicus tear because xrays of it didn't show much cartilage loss, so at least that pain might be fixable with an arthroscopic surgery which would put it a few years down the road after my right knee gets fixed, so no bilateral surgery is indicated than goodness.

He said he is 95% sure I can have a unicompartment partial knee replacement they call an "Oxford" yet after reading input from others, I'm going to see at least 2 more surgeons to make more sure this is the right approach. My stupid insurance is dropping my pain med the first of the year which I've been on for 7 years now, so that is a new wrinkle to iron out but I am going to try a new medicine that is a patch which might work out better. This surgeon said I could bring my current pain meds to the hospital and I'd have a 16 hour block on day one, spend one night in the hospital with a PCA pump too, then go home with a few Norco on top of the pain meds I already take. To buy some time, I got both a cortisone and SynVisc shot in the right knee, which seems to be helping. Today the pain hasn't been as bad so that is good news. Never had them do both at once before, and this time the shot me form the lateral side instead of the usual medial side and used a ultrasound thing too which after having about 12 total shots I'd never seen used before so maybe it hit the spot better.

I have another surgeon appointment coming up, then a third after that. Then I have one other surgeon to see at Emory as my fourth opinion. Its a bit too far away but he did my hip replacement and is one of the top joint replacement surgeons in the USA so not ruling him out, but logistics would be difficult as Atlanta is 200 miles away and it seems knee stuff takes a lot more follow up than hips, plus my pain doc is here local and couldn't help me in the hospital in another state. But it will be worth it getting 4 opinions on this partial vs. total situation. Prior to dropping my BMI from 36 to 26, everyone was only talking total knee replacement, but after losing that much weight, now it seems an option. They took an extra x-ray this time and the lady had to pull on my knee and had me on the table to shoot the xray, but was wondering why not an MRI if this PKR vs. TKR decision is really to be made.

I found out the difference between TOC and SportsMed here is that TOC doesn't believe in ice, in passive motion machines, but has the robot thing (Mako) so they have more tech, but that doesn't impress me. The SportsMed team believes in ice and passive motion, though both are pretty intense on immediate PT.

OK enough for now. Looking forward to input. Thanks for any advice, and I'm diligently reading everything now about PKR vs TKR.
 
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Jeffntate

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My family is wanting Christmas gift ideas so anyone with ideas to for things like ice machines and knee wedges and anything that I should buy for knee replacement whether PKR or TKR? I'm thinking February for surgery based on not seeing the last doctor until 3rd week of January so now is a good time for good gift ideas to manage the recovery.

We are going to relocate a bed for me downstairs as I don't like the idea of having to go up and down stairs right off the bat after surgery. I have a seated stationary bike and a weight bench with leg attachment that I also plan to move downstairs along with my 0 gravity recliner, and get some darker shades and live in the family room and put exercise stuff in our den or dining room. Since I can't take a shower for a while (its upstairs) it seems better to be on the same floor as the kitchen, and we have a 1/2 bath downstairs so I can put the seat lift there. Our kitchen floor is tile so I might buy some carpet runners and duck tape them down as I've heard too many stories of falls and tile floor would not be good for that. I'll make sure they are all anchored down and padded. Upstairs is all carpet but I don't want to have to go up and down our 14 steps very often and PT will be easier coming and going too without changing floors. Does that make sense? I regret having this 2 story house. I needed hip replacement only 7 years after we built it and I've regretted it ever since, and now its 20 years later and still wish we had a 1 story home, but life is life and you make the best of it with what you have.
 
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Mutti3

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I have a two story house, bedrooms on the second floor. Stayed upstairs for my recovery, with my husband’s help. But was able to go up and down steps from day one due to being taught while in the hospital. Very manageable without rearranging my home.
 

CAdesgirl

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You'd be surprised at how many things there are to make your recovery a little smoother. I'm getting ready for my first TKR but have been through but I had Autologous Cartilage Implantation (ACI) 5 years ago so I have a fairly good idea of what I needed then. Here's a list: Ice Machine - I got mine a while ago and use it every night during the week and a couple of times on the weekends. A basket to hook on the front of the walker - to put things in that need to go from one room to another. Raised toilet seat - because getting up from a standard toilet is challenging. If you don't have a shower chair or hand-held shower head, you're going to want those, too. The new thing I got for myself is a rolling storage cart with drawers to keep medications, snacks, art supplies, lotions,etc. The idea is that I can have everything handy the first few weeks. The top can hold my laptop and kindle.

The first few weeks after each major surgery, I was just exhausted because my body was expending so much energy to heal. I'm committed to my knee that she can heal at her pace and I'm going to do everything I can to assist. In other words, I'm going to not be a "GI Jane" with this surgery. My husband is taking a wait and see attitude because I'm not known for taking it easy or slow.

After reading all of the posts in post-op for the last few years, I'm convinced that the BoneSmart way is the best way. I've read through your thread, too. I'm glad that you're seeing surgeons and going to make your surgery happen. I know, as I think all of us know, what you're going through as far as pain goes. It's hard to imagine life on the "other side" because we've lived this way for so long.
 

SusieShoes

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Here’s a helpful list of aids we recommend to people planning a knee replacement: https://bonesmart.org/forum/threads/recovery-aids-a-comprehensive-list-for-hospital-and-home.12499/

Everyone’s needs turn out to be different. I bought things I never used (leg lifter) and ended up really loving things I thought were not really necessary (long shoehorn). The toilet rails for my comfort height toilets were a godsend. And I did love my Lounge Doctor.

As for stairs... I had bilateral replacements and I did stairs from the get go. Used my bedroom — and shower — upstairs every night to morning, and spent my days in my recliner downstairs, nearer the snacks and with more walking space. The stairs were never a problem, just slow going, and I only did them once down and then up a day for a few months, though I could have done more often had I needed to.

Keep interviewing those surgeons. You’ll learn more from each one and your new knowledge will help inform your final decision.
 

SusieShoes

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One more thing, and an important one: Surgeons often want to wait three months after Synvisc injections. Mine did. So that’s something else to mention to surgeons when you interview them. Ask if the injection will affect the scheduling of your surgery.
 
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Jeffntate

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I had the injection from the same guy who said he could operate in January. I got both cortisone and SynVisc.
 

kneeper

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Our kitchen floor is tile so I might buy some carpet runners and duck tape them down as I've heard too many stories of falls and tile floor would not be good for that. I'll make sure they are all anchered down and padded.
It's not just a slippy rug that's the trip hazard. You might not be picking your feet up quite normally at first, not to mention your walker or cane, so I'm not sure about any kinds of carpet/rugs even taped down...
 
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Jeffntate

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I'm as most of you know by now most terrified at pain management post due to the anti-opioid backlash in the USA with many hospitals limiting patients to 7 days of pain meds if you even get that. I've read many recovery threads where people had strong meds out to 8 weeks and some to 9 months depending on the individual. I can understand that but this idea of either no pain meds or 7 days worth after a total knee replacement seems impossible to even survive. I already have such knee pain at times I feel like I am going to have a heart attack and BP jumps up 20-30 points. How can I get through this if I'm already at a high dose of pain medicine and they could go LOWER post op? I'd love to hear from anyone in a similar situation or advice from you who understand my dilemmna.
 
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Jeffntate

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Asking the forum staff members to point me to anyone else that might have had trouble with post op pain similar to lovestocookandsew for other ideas for pain management. I'm especially interested in someone's experience with the ON-Q or Pain Ball or similar long acting blocks like a 3-4 day epidural block for knee replacement. I'd like to discuss these ideas with the next surgeon I see. If anyone has had experience with any of these blocks, just point me to your recovery thread.
 

SpaceGirl

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I didn't research doctors a ton to be honest, I found those who had my dr and had good results and I felt good when I had my initial consult. I had been searching for 10 years to get a regular doctor to listen to me about my knees because I was in that much pain but they all were like lose weight blah blah. I finally found one who listened and I pushed her to send me to the specialist and bam xrays showed how bad they were.

In the end you need to find a surgeon who has a history of knee replacements, one you are comfortable with, and who listens to you. Even if TOC for instance isn't about icing, I was. I iced my knee all.the.time, even asked for ice packs in the hospital, they brought them. I did pt as far as my body would let me but mostly daily activities was my pt.

Good luck in your decision!
 

johnnyutah

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I am hopefully a candidate for a partial knee replacement of the medial compartment. Before I lost 55 pounds, all the doctors were only suggesting a total knee, despite the fact that all my problems are in the medial only compartment (as far as I know based on a 2015 MRI). All my pain is in that compartment, so I have reason to hope this is a viable option.

My question - I was reading about President Bush getting a partial knee replacement by a top surgeon at Rush Memorial Hospital in Chicago, and one of the benefits they mention in this article or another one I read tonight (https://www.nbcchicago.com/blogs/ward-room/George-W-Bush-Again-Treated-at-Rush-University-Medical-Center-267020221.html) is that at least in the President's surgery, no muscle, ligament, or tendon was cut.

My question is simple - are all partial knee replacements like the President's, with no cutting of any muscle, ligament, or tendor, or does this Rush Memorial surgeon have such technical skill that he can do what no one else can do?

I'm trying also to decide whether to get my partial knee replacement done here locally or if I should travel to a major medical university like Rush, or closer ones to me like Vanderbilt in Nashville or Emory in Atlanta. What did most of you do for knee surgeon, partial or otherwise, did you go to a in town local doctor, or travel 2-4 or more hours to a top notch major medical university to get a top notch doctor and his staff to work your knee surgery?

Also, they have this local to me: Mako Robotic-Arm Assisted Technology for partial knee replacement. Anyone else had this partial knee by Mako Robotic arm? Are all partial knee replacements done with such robots now?

I will share the last almost 4 years of my wisdom of knee surgeons: I have been to most in the country, Brian Cole at Rush did my cartilage transplant. I saw Dr. LaPrade Steadman Clinic in Vail for a second opinion. Had surgery at the Stone Clinic in SF. Visited many other good surgeons in the country and talked to many in Western Europe.

Of all my experiences, my initial surgeon in Memphis steered me away from a partial. He said most of his colleagues end up doing total revisions to correct those. My other advice is find a surgeon that does several of the same procedures per year, not a jack of all trades. So most major centers like Rush, HSS in Manhattan and the clinic in Boston would qualify, but if you are in the South Emory, Campbell Clinic in Memphis or Andrews Clinic in B'ham or Mobile are solid choices. Feel free to PM me and I will share all of the biologic attempts that have led me to getting a TKR this January.
 
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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.
Great Comment!!

One of the first things I learned was that there are untold number of stories from people who know people who had TKRs. History has taught me not to believe a word of it, unless you're talking to the actual person who had the TKR, in which case it's worth its weight in gold.
 

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