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Lucia

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I will have a TKR on right knee on Jan. 9. I'm 62 now and been putting this off for ten years now -- PT, exercise, injections, TENS units, pain medication, arthritis meds, you name it. It has come to the point that I might as well get a wheel chair or go for broke and have the TKR.

Just had amputation of a cross-over 2nd toe on R foot one week ago; had had previous surgeries to same foot and amputation was less severe than more corrective surgery with bone cutting, pins, etc.
I am in bad physical condition but because of pain in knees, my exercise options have been limited. Both L & R knees are valgus.

I tried talking my doctor into bilateral, but he said "No, wait 3 months between." This is the third doctor who said no to bilateral, so maybe it's me.

Doctor wants to send me to a rehab center. I have read on the forums that infection rates are higher in rehab centers and this scares me. However, my dear husband is no nurse, and I live in a 2 story house with no bedroom and only powder room downstairs, so I would like as much PR as possible. Also the doctor who runs the rehab part is on call for pain control which is a big issue. I've been taking Lortab 10's for pain for three years and am nervous about lack of pain control. Was given Percoset 10 after toe amputation and I find myself falling asleep sitting upright, so I wonder what they will do.

I feel like I am rushing into this, even though I have known it was needed. I did get my surgeon to draw a line where he thought he would have to cut and it definitely wasn't minimally invasive. He said sometime about having to cut bone to align the valgus knee.

Know I need to do this, absolutely sure of it, but scared out of my wits.
 
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I understand that you are frightened by the thought of TKR---it is a big undertaking with a fairly long recovery period and needs to have good pain management particularly in the beginning. My hubby had both his knees done 2 days apart. He had valgus knees plus super hyperextension--see pictures.Front View.jpgSide View.jpg These are thumbnails, you can click on them to get a larger view.


The next picture is of his knees three weeks after surgery---please note the short incision.006.JPG

Please also note how straight the legs are now.

This is what TKR can do for you--but be sure you have a really great surgeon. We had a really great surgeon who does MIS (minimally invasive surgery) which really means he keeps the incision as small as possible. Just be sure you have the right surgeon for this--it's the most important factor. Here's a link about finding a surgeon: Locating a surgeon in the USA

This surgery can be life changing for the better. My hubby has been unable to walk more than a few feet for years. He is now standing on his own and is on the way to being able to walk again. Please take care of yourself and keep us posted. We care.
 

Roy Gardiner

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Hi, Lucia, from the Biggest Girl's Blouse on this board. I was a gibbering wreck for months before, and a shameful hardship on my family. Now, just over a year in, it's a brand new super world.

I couldn't do anything about the fear, just had to live with it until The Day. But The Day itself is as nothing, trust me. They knock you out, you wake up with a new knee. Then you face recovery -- yes it's painful to start with, but the fear is GONE and you* are in charge. It's 100 times better.

Don't worry about minimal invasion. It won't alter recovery time; what's important is how good your surgeon is.


*Actually your knee is in charge for a few weeks, but that's a detail you tackle in recovery.
 

RestAssured

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Hi Roy,

We have gotten used to the date as 4/11/2012 meaning month, day, year. You might confuse our poor brains by trying to switch us now! :heehee:

America is probably one of the only countries that doesn't use the metric system as their standard of measurement.

I had to ask how much a stone weighed when someone said 17 stones.

It is a different problem, but that is how we are taught. Would you suggest that we switch just to confuse us? Maybe you are suggesting that everyone else should switch just to confuse them! LOL :heehee: :rolleyes:
 

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Lucia, Welcome to this wonderful forum!
We were ALL scared beyond description, believe me. I put my TKA off for probably 6 years, but the last 3 years of unrelenting pain REALLY changed my mind. Still I was terrified up until the last week, when it couldn't come fast enough!
READ the threads here and the articles in the Library.
As has already been stated, make sure you have a really great OS!
The first 3 weeks post op are the toughest, IMO, but after that things begin to improve exponentially.
Follow the advice here on Bonesmart- ice, elevate, pain meds, minimal and gentle PT, and you'll do fine.
You will be so glad you did it!
Good luck and keep us posted.
 
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Lucia

Lucia

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Thank you for your encouragement! Your husband's knees were far worse than mine, but my knees have been getting visibly worse each year. I HOPE and PRAY I have a great surgeon. I waited four months for an appt. with one of those who is "the tops" in my region, only to have second thoughts after consultation. It was a big university hospital 120 miles from home, would have me in and out in four days then home to manage. The surgeon I selected has a good reputation, did a fellowship at the Hospital for Special Surgery in NYC, and is very reassuring. He operates at DCH Northport (Tuscaloosa) which is only 50 miles from home. I'm planning on visiting the rehab center he recommends; it's a separate section of a nursing home, is owned by a orthopedic doctor who cut back on surgery because of his own injuries and now specializes in rehab. My decision was based on instinct as much as information, so I hope I'm heading in the right direction. My surgeon feels certain my insurance will cover the rehab center up to 21 days as needed. Again, I appreciate your willingness to share your wisdom!! I am so happy for your husband's successful outcome!
 
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Lucia

Lucia

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:gaah:LOL, I can identify with your description "a gibbering wreck" and "a shameful hardship on your family," because that's me!! My poor husband has been listening to me groan and moan for years. Glad you are on the other side of TKR an happy with the results!!
 
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Lucia

Lucia

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Don't really have the hang of this forum business yet, lol. Don't mean to copy your whole message, but did want to say thanks for the support. I've been reading articles in Bonesmart for months now and there's so much information!
 
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Lucia, I am about seven weeks out and have no regrets about the surgery. Recovery isn't easy, but you see steady forward progress every few days. You need a surgeon you can trust and you need to use this incredible community for the emotional support that you will need. At seven weeks I can grocery shop, run a few errands and get a bit done around the house. I am not working yet, I teach middle school science, and I can't say I have anywhere full energy but I can manage to get done what I really need to do. Hang in there the surgery is a life changing event and you will be amazed at how your life will open up so you are able to do so much more than you have been able to.
 
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Lucia

Lucia

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nmscienceteacher, to be able to do that after seven weeks sounds like a real accomplishment to me. I haven't done the grocery shopping in years and have delegated a lot of the housework. Good luck when you return to school! I hope you don't have to return until you feel ready. I waited until I retired from teaching which was probably a mistake as it's hard to teach when you can barely stand or walk or do stairs; I taught elementary school and had students who were so happy to be errand runners, lol. After I retired , we moved to a new city and had a new house to do, so the knee went back burner again. I am really looking forward to mobility at some point in the distant future. I hope you continue to do well as you get back to full strength. Thank you for your support!
 

Knitter4444

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Lucia..Since I assume that you don't have Medicare because of your age, I would suggest that you take it upon yourself to call the insurance company and get the information so that you can plan ahead. Doctors usually do not know the intricacies of health insurance. Assuming is not the same as knowing of course. Better to do the research yourself.

If you do have Medicare, they will pay for rehab if it is medically necessary after you have been in the hospital for three full days.
 

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Many of us were quite nervous before our TKR or BTKR. I was nervous and excited before my BTKR five years ago. The day of the surgery I wept like a child in the pre-op room.

I did stay in the rehab floor of the hospital, and I had no problems with infection.

I would not say that you are rushing into this. We all have questioned our decision---"Have I lived with this enough?" Can I do something else?" "It isn't really that bad." In reality, we all know, deep down inside, that there does dome a time to make a change for the better. If you have found a surgeon that you trust that does hundreds of TKR's a year, you are good to go. There comes a time when we have to say "enough is enough"

Remember, life is to be enjoyed, it is not meant to be endured. Are you enjoying your life, or merely enduring it?
 
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Lucia

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Knitter4444 - thanks, this is a good point. I need to do this ASAP, although both the doctor and his nurses have said that BCBS PEEHIP covers a stay up to 21 days. It sounded as if they had used them enough to be sure, but you are right: I DO need to be sure!!
 
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Lucia

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referee, LOL, "merely enduring it" fits the bill too well. I trust my surgeon but wonder if I have asked enough questions. The doctor at UAla-Birmingham fit the profile for a true specialist. However, I got to talk to him all of about five minutes; the nurse gave me a brochure and said call us after Christmas to set a date. That was it. Not reassuring at all.

The surgeon I have chosen is very reassuring, but I haven't grilled him. Sigh. I go see him Friday after Christmas to have the stitches removed from my foot where he amputated the second toe. I will have my list of questions ready. I do know he has a good reputation locally and trained at excellent schools. When I asked his nurse how many TKRs he did a year, she laughed and said "A LOT, a whole lot," but no exact numbers. I do not know that he specializes in knees. I asked him who I could call if I had questions and he said "You can call me."

My husband is a wonderful man but I would quickly wear him out if I let on how nervous I am. We have rarely been apart in our 30 years of marriage and if I stay at the rehab center, he will want to stay near by (accompanied by our dog) so I am looking into suitable hotels. (He could stay with me at the rehab center but not the dog!)
 

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Hi Lucia, welcome to the forum.

I interviewed several OS, all were qualified, and I had a list of questions including how many they do a year, had they ever had a malpractice charge, what are there post op protocols, who do you see after surgery, (the OS or his assistant), how quickly do they respond to questions, pain med refills, staples or glue for incision closure, etc.

The OS I chose teaches other surgeons how to do minimally invasive surgery and uses computer aided software to align the leg/knee. He is all business when you are his patient and explains everything fully and answered all of my questions completely.

Personally, I would always interview at least two surgeons and my health insurance actually encourages two. Of course, I interviewed more than two. One OS asked me why I came to see him as I'd already seen another, and I responded because I can. I have no problem whatsoever seeking as many surgeons as I think necessary til I find the one.

Here is some homework. This video is great for explaining the difference of a minimally invasive surgery vs. other types. Start at about 4:15 for the backstory or at 6:00 minutes where he uses a model to illustrate the difference between the different types of surgery.
Click Here
 
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Lucia

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1ELISEA, thank you for the excellent video. I have noted your questions (along with earlier suggestions from others) and my poor surgeon will be bombarded. I have seen three OS so far, but don't seem to have conducted my interviews very well. Maybe back to the drawing board.
 

1ELISEA

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Yes, I like that video as our lay conversations often revolve around long scar or short scar. The Dr. does a great job explaining the basics of minimally invasive surgery and why the external scar lengths are different due to the differences in surgical approaches. Plus he does it on a model rather than using surgery video clips.

Most surgeons will welcome a well informed patient with questions like mine did. Make a copy of your questions and give them to him when you start the conversation.

Also, there is lots of good information in the BoneSmart library on questions to ask, including questions on the administration of the anesthesia.

The question that really made me know I'd chosen well, was when I asked "how do they know what size implant to implant?". He very clearly and patiently spent several minutes explaining that a representative from the manufacturer was present with several sizes and then went on to talk about what he does as a surgeon.

Now he could have brushed off the question with "don't worry, I'm good at what I do" or something similar but he didn't. He was patient and fully answered all of my questions, including what size to implant. At that point I knew I had chosen well.

So more questions, in random thought order........
Is there a manufacturer representative in or near the operating room?
What is the drs protocol for preventing infection?
How long is the hospital stay?
Does the surgeon do the entire surgery or what part does the Physician Assistant play in the surgery?
We also discussed the specific implant because he was using a special non nickel implant due to my metal allergies.

Lots of questions lead to more questions so write them down. If they are important to you, then ask.
Hope that helps.
Merry Christmas!
 

Josephine

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Folks, there is no need to quote a post to reply to it, specially when you then put your message in a new post! Quite unnecessary!
 

Josephine

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Lucia, you have received some good advice thus far but I think you should not expect to be shopping at 7 weeks. Some people manage it at a cost but most don't. Read this Progression of activity for TKRs

You would do well to also read up on various aspects of recovery and I have just the thing for you - a little 'light' reading! It will help dispel those terrors about post-op. As Roy said, it all manageable so long as you remember that "Knee" is in charge and not you! As for those stairs, there's no reason you shouldn't climb them, it's actually good therapy provided the PT teaches you how before you leave hospital. You might like to read the potted version of my recovery to see how I did it and how little 'aggressive' PT I did as well! Knee recovery - UK style

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

And then the articles in order of importance .
Group A
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Progression of activity for TKRs

Group B
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice

Group C
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Group D
MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
 
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Lucia

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Josephine, thanks for the "light reading" list! The British approach to PT sounds decidedly more relaxed than the one I hear about in the USA! You sound like a much more intrepid soul than I am, however I do understand that cats can motivate you in a way that no one else possibly can.

21 steps up to my bedroom and a bathroom. What was I thinking? I've been practicing with crutches and think that they may be much more dangerous than my cane that I'm used to using. Unfortunately my right knee is my dominant knee and no amount of "retraining" has made my left leg take over.

I asked my OS to show where he would cut and he drew a vertical line straight through my knee, extending about two inches above and two inches below the kneecap. Doesn't sound like minimally invasive surgery, does it? I do have a valgus knee, so perhaps there is a reason. Add to question list!

Thank you for the prioritized reading lists, the mantra, everything!!
 
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