Thank you so much for all the additional information you provided. It certainly helps give me a better picture of your situation so I can hopefully help you decide what to do.
I took a look at information on Dr. Holmes and he appears to be just fine to handle your revision. I agree with you that you do need to get your knee fixed, especially because it is causing you to be at greater risk for a fall. That is the number one thing we want to avoid.
Your description of the surgeon's plans to check for infection once in your knee is right on target. If you had elevated blood levels previously, his plan is a good one to do the tests and then, if needed put a cement spacer in and treat any infection that's present. From what you describe, it seems unlikely that you do have an infected knee, but it definitely is something that needs to be verified before putting in a new implant. I'm betting he will be able to go ahead with the revision and start you on the road to a more stable knee and a good recovery. Now we just need to see that happens for you.
It appears to me that you had things worked out completely with Dr. Holmes before the disastrous meeting with his assistant. After going through your very detailed posts, I have listed what I believe to be your concerns below. I'll address each one individually so you can be armed with some information for your next discussion with your surgeon or the PA.
My recommendation to you is to call your surgeon's office first thing Monday morning and tell them that after talking with the Physician's Assistant, you have major reservations about the surgery and need to speak with your surgeon. If they put you off, tell them you must get these issues resolved or you are considering canceling the procedure. Hopefully that will be adequate to get the doctor to call you so you can talk this out. Don't be shy about telling whoever you talk with that the PA countered what you and Dr. Holmes agreed to, was totally inflexible, and you cannot go into surgery with things up in the air like this. If this does not work and you cannot get to talk with the surgeon, your options will be to go in for the procedure on Thursday and deal with the issues once you're there or delay the operation for now until you can have another appointment made with Dr. Holmes to work this out.
Here is what I believe are your issues. Be sure to have a written list of your concerns when you talk with the surgeon. Either print this off, or write your questions out so you don't forget anything.
* Having your husband with you in the hospital before and after surgery
* That this surgery will be much worse than your initial knee replacement and hard on your heart
* That the anesthesiologist might break your jaw during surgery
* That amputation or death may be possibilities if you have the surgery
* Walking and participating in therapy as little as 2 hours after surgery
* Walking to and participating in therapy twice daily while you're in the hospital
* Not being discharged from the hospital unless you participate in all therapy as directed
* You will only be given Tylenol for pain no matter what your pain levels are
* You might be forced to go to a rehab facility instead of being discharged home with home health
* You must participate in outpatient therapy once you are home and cannot have home health
* You will see your surgeon before surgery, but never again one the procedure is done
* Your care will be transferred to the surgeon's Physician's Assistant, who does not seem to understand your health needs, does not agree with what the surgeon has told you, and is inflexible
* That nothing more can be done with your leg if this revision doesn't work
* Having your husband with you in the hospital before and after surgery - With COVID on the upswing in some areas, your surgeon may not be in control of this. The hospital has the final say. But some facilities do allow one family member or friend to be with the patient prior to surgery. The person can stay in the waiting room and visit after you are in your room. The surgeon will know what protocols are allowed by the hospital and hopefully he can make this happen for you. If for some reason it doesn't work out, please be assured that your nurses and their assistants will take great care of you. This is their profession and they care about you. While the surgery is rightfully a HUGE deal for you, it's just another day at the office for these medical experts. You are a partner in your care and you need to communicate constantly with them, but you will be fine. I had no visitors by choice with my second knee replacement and my shoulder replacement and it worked just fine. If you have any concerns while in the hospital, your nurse will have a way to contact your surgeon immediately if you need to talk with him. You can always ask to speak with him (even if it's just by phone) and not the Physician's Assistant while in the hospital.
* That this surgery will be much worse than your initial knee replacement and hard on your heart - no one can say for sure what the surgeon will find once he's in your knee. There could be a lot of scar tissue that needs to be dealt with or maybe not. Your surgeon must give you all the possibilities when discussing surgery with you. That's what he did when he talked about it being "worse" than your first surgery. The longer a person is under anesthetic, the "harder" it is on their system. Your surgeon will do everything possible to keep tissue manipulation and surgery time at a minimum. This translates to less surgical trauma to your body. But even if the surgery takes more time than normal, that doesn't always translate into a more difficult recovery. For one thing, after the revision you'll have a properly fitting knee joint. That will go a long ways toward making your recovery easier. Having stents in your heart should not be a problem. Your anesthesiologist knows how to work with heart patients and has options should there be any concerns while you are in surgery. Assuming your cardiologist and/or GP cleared you for surgery, try not to worry about this. Again, it's just your surgeon being required to list out all the potential complications that "might" occur.
* That the anesthesiologist might break your jaw during surgery - I'm so sorry this happened to you with your first surgery. Please know this is VERY rare and it shouldn't be anything to worry about. It is possible you may not have a general anesthetic and you will instead have local pain blocks and a spinal. If that's the case there is no worry about your jaw. Each surgeon has their own procedures for anesthetic, so that's going to be up to him what is used. Even if it is a general, the chances of this happening are very slim.
* That amputation or death may be possibilities if you have the surgery - once again, these dire consequences are the "worst case scenario" that a doctor must advise you of prior to surgery. While there is a small chance for these things to happen, the chances are so small that you must not let it worry you. The important thing to focus on is that this revision is the ticket for you to you get your life back and that the vast majority of knee revisions are very successful.
* Walking and participating in therapy as little as 2 hours after surgery - this may be the surgeon's "standard" for knee replacement patients, but it is in no way mandatory. You are in charge of what you do and don't do in the hospital. If you prefer to have a therapist come to your room, you can request that. If you're feeling light headed, you shouldn't be up and walking around. Any walking you do right after surgery will be under the watchful care of a nurse or assistant. You should be able to stand and walk a short distance (like to the bathroom - with assistance) the same day as surgery and it is advisable to do that to get your knee moving gently as soon as possible. You shouldn't need a bedside commode as hospitals are all equipped with raised toilets in the bathrooms these days. There are grab bars and you'll be shown how to use them and your walker to assist with toileting.
* Walking to and participating in therapy twice daily while you're in the hospital - you have control over this. Yes, it's good to have movement at least a couple of times a day after surgery. But this doesn't have to be in a therapy setting. It can be done in your room by getting out of bed to sit in the chair or go to the bathroom or maybe a very short walk with assistance. Be sure whatever therapy is offered is not any more painful than a mild discomfort. There should be no pushing on your knee at this early stage. Should anyone try that, just ask them to stop and say you will move your leg on your own. Don't let anyone threaten you with reduced range of motion if you don't do a movement or exercise. Your knee will be in healing mode, possibly with significant swelling that can make bending much more difficult. The important thing in those first few days is rest and healing accompanied by gentle bends and stretches plus short walks as tolerated every few hours.
* Not being discharged from the hospital unless you participate in all therapy as directed - this cannot happen. You are in charge of what you will or would prefer not to do. The hospital has criteria for release that might include things like the ability to walk a certain distance, the ability to dress yourself and use the bathroom, and the ability to go up and down stairs. They have these requirements to ensure your safety once you get back home, so you'll want to work toward accomplishing these things after surgery. You can ask what the discharge criteria are for your hospital. It doesn't matter if you accomplish them in a formal therapy session or individually with one of your care staff. You know what is comfortable for you and you should not be forced to do anything that is painful or impossible for you to do.
* You will only be given Tylenol for pain no matter what your pain levels are - it is true that today's pain management methods are vastly different than what you experienced many years ago with your first TKR. For many reasons, doctors have reduced the amount of opioid pain medication used both immediately after surgery and once you are home. Some people actually do use just Tylenol and do just fine. Most people need at least some period of time on prescription pain medications. The important thing is to have a clear understanding of what the range of pain management support that will be ordered by your surgeon will be. When a doctor gives orders after surgery, he will always have several options for the nurses so they can respond quickly to any pain flares. Their goal is to keep your pain properly managed. You might ask your surgeon if he plans to use a multi-modal pain protocol such as Exparel. This is medicine injected directly into the incision are before it is closed up and it offers excellent pain management for several days after surgery. I hope he uses this. If you do receive something like this and you're relatively comfortable in the hospital, be aware that when it wears off on day 2 or 3, there can be a fairly significant pain rebound. You should be sent home with at least a few days worth of prescription pain meds just in case this happens. Work this out with your surgeon BEFORE the operation takes place if at all possible.
* You might be forced to go to a rehab facility instead of being discharged home with home health - no one can force you to go to a rehab facility. It will be important to ensure your safety when you are released, but that can be accomplished by having your home properly set up (which you do) and having home health. It's covered by Medicare and your surgeon can always order home health due to your specific circumstances. I preferred it to getting dressed and enduring a car ride to outpatient therapy. I had home health for 6 weeks following my knee replacements and it was never questioned. I just asked for it.
* You must participate in outpatient therapy once you are home and cannot have home health - this is the same situation. No one can force you to have a particular type of care once you're released. You can have outpatient therapy, home health, or even no service if you choose. I would recommend at least some home health if for no other reason than the fact that you are so far from your surgeon. This gives you access to a nurse to check on you, a bath aid, and both an occupational and a physical therapist. These are all helpful services as you work toward getting your recovery area at home set up in the best way.
* You will see your surgeon before surgery, but never again one the procedure is done - I've never heard of this procedure. You are paying for the service of your surgeon and not an assistant. Usually the PA will visit sometimes in the hospital, but you have the right to ask to see your surgeon prior to release (or at least talk with him over the phone).
* Your care will be transferred to the surgeon's Physician's Assistant, who does not seem to understand your health needs, does not agree with what the surgeon has told you, and is inflexible - Let your surgeon know how unhappy you were with your meeting with his assistant. Give details. This person is in training and the surgeon needs to know when there are problems so he can properly guide the PA. For follow-up visits at your surgeon's office, ask that the appointment be made with the surgeon and not the assistant. You have that right.
* That nothing more can be done with your leg if this revision doesn't work - this is absolutely not true. At conferences I've attended, I've been in sessions where surgeons discusses multiple revisions or surgeries on a knee. This can happen sometimes with infections, when there are problems balancing the ligaments properly, or when a patient develops adhessions. Obviously it's not something a person wants to have, but there is no need to fear that doctors will jump from a revision to amputation quickly. Losing a leg is not something that is done with any regularity these days. The Physician's Assistant was grossly uninformed about this. This is another bit of feedback that you should provide to your surgeon so he can guide her for future meetings with patients.