Brownie51
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My Mom and I used to think that it would be fine if Christmas was only every other year.
TKR Onwards and upwards - my journey continues
- Thread starter robynhood
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ElanorG
post-grad
Marianne, I went and reread my whole thread and your are right my dates are off. From what I posted, it appears that at about 8 weeks I was noticing improvement in the non-op knee and at the 10 week mark it was markedly better particularly when I am walking. It was interesting reading the thread as I can see how far I have come! I highly recommend that to everyone as you really see your progress.
Brownie51
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Lisa thank you so much for doing that!!!! I didn't actually think you were off, I was just hoping! Whew I am so relieved. Now did you take an injection in your non op at 6 weeks? Someone on here did that.
So appreciate your checking. 8-10 sounds great, only 2 more weeks and it sure is what the doctor thinks will happen.
So appreciate your checking. 8-10 sounds great, only 2 more weeks and it sure is what the doctor thinks will happen.
ElanorG
post-grad
Marianne, I think Gail got a cortisone shot about 6 weeks out if I remember rightly but I did not. I am hoping after the first of the year to start another round of the artificial joint fluid injections as they help quite a bit. Glad I checked back on my thread.
OP
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robynhood
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Brownie51; Hi Marianne, sorry your good knee is not being very good at all. Mine is still grumbling but to be honest it is getting stronger. When I do physio I always do it for both knees. I asked my OS last week if I did say ok for op for un operated knee when would it be and he said February. Thats far too soon for me. Im aiming to get it stronger every day and its having a rest from helping my operated knee so Im just hoping i can last a year at least. When i first had the op my other knee was very painful as I pulled a muscle in it and since that has healed it hasnt been too bad at all. If it does get as bad as my op one I can go to my OS and set a date.
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robynhood
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Can anyone tell me in plain english what auctually happens in a TKR. Does the surgeon auctually break our bones or have I made that up. To be honest Im sick of people assuming I went in hospital for an aftn came home the same day and running a marathon next week . If anyone can tell me what the operation entails Im going to write it down, keep it in my purse and when someone asks again why am I still usng a cane at 7 weeks post op I can show them the details and say "this is why". All information appreciated and dont tell me to watch the video. No thank you. Not for me.
Brownie51
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Patricia I got ( and always do this) a copy of my operative report. Right in there it tells exactly which bones were shaved/sawed and which tendons muscles and ligaments were excised and cut. This way you can casually point out and mention the extent of the surgery. My son is a doctor and just to be silly he would talk about my double amputation...the bottom of the femur and the top of the tibia. You could also send a nice YouTube video of the surgery(you don't need to watch it!). It is grueling! The people who don't understand why you are still in pain need to be educated!
If you want I can type the basic parts of my op report and you can print it up. I didn't have the quad sparing minimally invasive procedure. Which did you have? How long is your incision?
If you want I can type the basic parts of my op report and you can print it up. I didn't have the quad sparing minimally invasive procedure. Which did you have? How long is your incision?
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robynhood
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Yes yes yes please Marianne. I will print it out for the kow it alls to read. I didnt have the mininmally invasive procedure no. Wasnt even offered it and my incision is ....... hold on will just measure........ cant find a tape measure guessing 8" does that sound about right
Brownie51
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Yeah mine is 8 inches. Okay I'll get started...
Brownie51
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Procedures: Total knee replacement: Right
Anesthesia:Spinal and Femoral block
Time in surgery 2 hr 45min
Blood loss 50
Fluids: Crystalloids and 3000
Tourniquet time 71
Surgical approach: Transpatellar arthrotomy
Finding Severe end stage degenerative disease of the knee. Stable well-tracking, well-aligned knee after implantations.
Specimens: Bone and soft tissue
Implant: Zimmer Nex Gen LPS Flex Mobile using PSI instruments
Then a bunch of measurements listed like the cuts off the bone.
Procedure: I will cut to the chase on this part. The anesthesia was given. Antibiotics were administered. Foley catheter placed. A pneumatic tourniquet was applied high on the thigh. Then they draped etc.
Get this....The limb was exsanguinated with an Esmarch bandage and tourniquet elevated. (Let all the blood out of leg!)
An incision was made 1cm medial to the tibial tubercle overlying the medial third of the patella in line with fibers of the extensor mechanism. The incision was carried down to the level of the retinaculum and a transpatellar arthrotomy was then performed. The infra-patellar bursa was incised.
A medial subperiosteal flap was raised around to the semimembranosus bursa.
The patella was everted (YIKES!) The knee was flexed up. The fat pad was excised. The anterior horn of the lateral meniscus was incised. The ACL and PCL were TRANSECTED. The tissue on the anterior surface of the femur was incised and STRIPPED subperiosteally. The patellofemoral ligaments were INCISED.
In order to avoid violating the femoral canal and disturbing the intramedullary enchondroma (oh I have a benign tumor that he had to avoid) so you do not have that part, the PSI femoral cutting block ws placed on the distal femur and pinned. The guide was then removed. The distal cutting guide was placed for the above noted distal resection and pinned to the distal femur. The distal femoral cut was performed(this is where they cut off the ends of our thigh bone. The cutting guide and pins were removed. I think you still have all the cutting blocks and pinning. Mine were custom blocks due to the little tumor.
The tibia was subluxed anteriorly (I think this means dislocated). The PSI tibial cutting guide was placed and pinned and then removed. The cutting guide was placed over these pins for a proper neutral varus-valgus aligned cut at the preoperatively templated level in appropriate posterior slope. The soft tissues were protected, and the proximal tibial cut was performed (cut off the top of the tibia or shin bone!). The alignment of the cut was verified with a block and rod.
The bony insertions of the ACL and PCL were removed from their femoral insertions and the bodies of the ligaments were transected from their femoral and tibial insertions. The femur was sized. Laminar spreaders were placed with knee in full extension. The medial and lateral menisci were removed.
Laminar spreaders were now placed with knee in 90 degrees of flexion. The anterior-posterior cutting block was placed, rotated and translated posteriorly until a symmetric flexion gap was obtained with a measurement 2 mm larger than the extension gap. This block was pinned to the distal femur in this position. The anterior cut was made flush with the anterior femur. The posterior femoral condyles were cut and then trimmed proximally in order to prevent impingement. The above noted block was placed with the knee in 90 degrees of flexion revealing excellent symmetry with minimal distractibility. The knee achieved full extension with excellent varus-valgus stability and balance.
The knee was flexed up. The tibia was sized and the appropriate preparation guide was placed in proper external rotation and pinned to the proximal tibia. The central hole was DRILLED. The keel was punched and the trial was placed.
I'll post this, there a bunch more still to go!
Anesthesia:Spinal and Femoral block
Time in surgery 2 hr 45min
Blood loss 50
Fluids: Crystalloids and 3000
Tourniquet time 71
Surgical approach: Transpatellar arthrotomy
Finding Severe end stage degenerative disease of the knee. Stable well-tracking, well-aligned knee after implantations.
Specimens: Bone and soft tissue
Implant: Zimmer Nex Gen LPS Flex Mobile using PSI instruments
Then a bunch of measurements listed like the cuts off the bone.
Procedure: I will cut to the chase on this part. The anesthesia was given. Antibiotics were administered. Foley catheter placed. A pneumatic tourniquet was applied high on the thigh. Then they draped etc.
Get this....The limb was exsanguinated with an Esmarch bandage and tourniquet elevated. (Let all the blood out of leg!)
An incision was made 1cm medial to the tibial tubercle overlying the medial third of the patella in line with fibers of the extensor mechanism. The incision was carried down to the level of the retinaculum and a transpatellar arthrotomy was then performed. The infra-patellar bursa was incised.
A medial subperiosteal flap was raised around to the semimembranosus bursa.
The patella was everted (YIKES!) The knee was flexed up. The fat pad was excised. The anterior horn of the lateral meniscus was incised. The ACL and PCL were TRANSECTED. The tissue on the anterior surface of the femur was incised and STRIPPED subperiosteally. The patellofemoral ligaments were INCISED.
In order to avoid violating the femoral canal and disturbing the intramedullary enchondroma (oh I have a benign tumor that he had to avoid) so you do not have that part, the PSI femoral cutting block ws placed on the distal femur and pinned. The guide was then removed. The distal cutting guide was placed for the above noted distal resection and pinned to the distal femur. The distal femoral cut was performed(this is where they cut off the ends of our thigh bone. The cutting guide and pins were removed. I think you still have all the cutting blocks and pinning. Mine were custom blocks due to the little tumor.
The tibia was subluxed anteriorly (I think this means dislocated). The PSI tibial cutting guide was placed and pinned and then removed. The cutting guide was placed over these pins for a proper neutral varus-valgus aligned cut at the preoperatively templated level in appropriate posterior slope. The soft tissues were protected, and the proximal tibial cut was performed (cut off the top of the tibia or shin bone!). The alignment of the cut was verified with a block and rod.
The bony insertions of the ACL and PCL were removed from their femoral insertions and the bodies of the ligaments were transected from their femoral and tibial insertions. The femur was sized. Laminar spreaders were placed with knee in full extension. The medial and lateral menisci were removed.
Laminar spreaders were now placed with knee in 90 degrees of flexion. The anterior-posterior cutting block was placed, rotated and translated posteriorly until a symmetric flexion gap was obtained with a measurement 2 mm larger than the extension gap. This block was pinned to the distal femur in this position. The anterior cut was made flush with the anterior femur. The posterior femoral condyles were cut and then trimmed proximally in order to prevent impingement. The above noted block was placed with the knee in 90 degrees of flexion revealing excellent symmetry with minimal distractibility. The knee achieved full extension with excellent varus-valgus stability and balance.
The knee was flexed up. The tibia was sized and the appropriate preparation guide was placed in proper external rotation and pinned to the proximal tibia. The central hole was DRILLED. The keel was punched and the trial was placed.
I'll post this, there a bunch more still to go!
Brownie51
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Continued procedure TKR for Patricia
The notch guide was lateralized on the femur. The notch BONE WAS REMOVED. The posterior femoral condyles were fretted.
The distal lug holes were DRILLED. The trochlear BONE WAS REMOVED. The chamfer cutting guide was placed and the anterior and posterior chamfer cuts were performed.
The femoral trial was placed and the trial liner was also placed. The knee was articulated and brought out to full extension. The knee was tight in both flexion and extension. The trials were removed and two additional mms of BONE WERE REMOVED FROM THE TIBIA. The trials were placed b ack and now the knee achieved full extension without hyperextension with excellent varus-valgus stability and balance, no mid flexion instability, easy flexion to at lest 120 degrees. There was minimal distractibility at 90 degrees of flexion and full flexion. This was felt to be the appropriate construct for the knee. The trial at this point was with the 12 mm trial.
The patella was EVERTED and measured with the thickness recorded as above. Using a freehand technique the patella was OSTEOTOMIZED (think thats making a hole in the knee cap) from the ostepchondral junction to the osteochondral junction leaving the above noed postresection thickness. The inner diameter was measured and the appropriate DRILL guide was placed. The three LUG HOLES WERE DRILLED. The trial was placed. The tissue on the undersurface of the qudriceps insertion into the patella was removed in order to PREVENT PATELLAR CLUNK. (? wow). Central tracking pertained without tendency towards lateral aift off or subluxation.
At this point, all trial componenets were removed and the knee was copiously irrigated with pulsatile lavage and thoroughly dried. CEMENT was mixed and appropirate doughy, a small amount was applied to the undersurface of the patella and pressurized into the cancellous bed. The patellar button was placed and held in place WITH A CLAMP and excess cement was removed. Cement was then applied to the proximal cut surface ofthe tibia and pressurized into the cancellous bone as well as into the keel HOLE. The tibial component was placed, fully seated and excess cement was removed. Cement was then appalied to the distral and anterior cut surfaces of the femur and pressurized into the cancellous bone. Cement was also applied to the posterior femoral condyles of the femoral component. The femoral component was slid into place, fully seated and excess cement was removed. The trial insert was placed. The knee was articulated (think this means put back together) brought out into full extension, flexed back to 90 degrees and any excess cement was removed. The knee was then held in full extension until the cement hardened. Range of motion, flexibility, stability, alignment and tracking were all verified.
The trial liner was removed. Any excess cement was removed. The tourniquet was released and hemostasis was obtained. The actual liner was dropped into place. The knee was articulated. Range of motion, flexibility, stability, alignment and tracking were all verified.
The knee was then copiously irrigated with pulsatile lavage and thoroughly dried. Bleeding points were cauterized. The fascial layer was closed with #1 vicryl in a figure of eight fashion. The subcutaneous tissue was closed with a running 2-0 vicryl stick followed by interrupted 2-0 Vicryl stick.
The skin was approximated with a running 3-0 Monocryl subcuticular stitch. Sterile dressing were applied. The anesthesia was reversed and the patient was awakened and she screamed bloody murder! haha just kidding!. The patient ws then transferred to her bed and taken to revoery in stable condition.
All needle and sponge counts were correct according to the circulating nurse.
That's it. Isn't it amazing all the cutting, excising drilling that is done. And then they do all the alignment trials, wagging our legs all around all the while our joint is completely exposed and cut open like when you cut a leg off the turkey.
No wonder we ache for a few months and it takes our bodies so long to repair/heal. There is nothing else like this operation. Very barbaric but we are so thankful it is available to us!
The notch guide was lateralized on the femur. The notch BONE WAS REMOVED. The posterior femoral condyles were fretted.
The distal lug holes were DRILLED. The trochlear BONE WAS REMOVED. The chamfer cutting guide was placed and the anterior and posterior chamfer cuts were performed.
The femoral trial was placed and the trial liner was also placed. The knee was articulated and brought out to full extension. The knee was tight in both flexion and extension. The trials were removed and two additional mms of BONE WERE REMOVED FROM THE TIBIA. The trials were placed b ack and now the knee achieved full extension without hyperextension with excellent varus-valgus stability and balance, no mid flexion instability, easy flexion to at lest 120 degrees. There was minimal distractibility at 90 degrees of flexion and full flexion. This was felt to be the appropriate construct for the knee. The trial at this point was with the 12 mm trial.
The patella was EVERTED and measured with the thickness recorded as above. Using a freehand technique the patella was OSTEOTOMIZED (think thats making a hole in the knee cap) from the ostepchondral junction to the osteochondral junction leaving the above noed postresection thickness. The inner diameter was measured and the appropriate DRILL guide was placed. The three LUG HOLES WERE DRILLED. The trial was placed. The tissue on the undersurface of the qudriceps insertion into the patella was removed in order to PREVENT PATELLAR CLUNK. (? wow). Central tracking pertained without tendency towards lateral aift off or subluxation.
At this point, all trial componenets were removed and the knee was copiously irrigated with pulsatile lavage and thoroughly dried. CEMENT was mixed and appropirate doughy, a small amount was applied to the undersurface of the patella and pressurized into the cancellous bed. The patellar button was placed and held in place WITH A CLAMP and excess cement was removed. Cement was then applied to the proximal cut surface ofthe tibia and pressurized into the cancellous bone as well as into the keel HOLE. The tibial component was placed, fully seated and excess cement was removed. Cement was then appalied to the distral and anterior cut surfaces of the femur and pressurized into the cancellous bone. Cement was also applied to the posterior femoral condyles of the femoral component. The femoral component was slid into place, fully seated and excess cement was removed. The trial insert was placed. The knee was articulated (think this means put back together) brought out into full extension, flexed back to 90 degrees and any excess cement was removed. The knee was then held in full extension until the cement hardened. Range of motion, flexibility, stability, alignment and tracking were all verified.
The trial liner was removed. Any excess cement was removed. The tourniquet was released and hemostasis was obtained. The actual liner was dropped into place. The knee was articulated. Range of motion, flexibility, stability, alignment and tracking were all verified.
The knee was then copiously irrigated with pulsatile lavage and thoroughly dried. Bleeding points were cauterized. The fascial layer was closed with #1 vicryl in a figure of eight fashion. The subcutaneous tissue was closed with a running 2-0 vicryl stick followed by interrupted 2-0 Vicryl stick.
The skin was approximated with a running 3-0 Monocryl subcuticular stitch. Sterile dressing were applied. The anesthesia was reversed and the patient was awakened and she screamed bloody murder! haha just kidding!. The patient ws then transferred to her bed and taken to revoery in stable condition.
All needle and sponge counts were correct according to the circulating nurse.
That's it. Isn't it amazing all the cutting, excising drilling that is done. And then they do all the alignment trials, wagging our legs all around all the while our joint is completely exposed and cut open like when you cut a leg off the turkey.
No wonder we ache for a few months and it takes our bodies so long to repair/heal. There is nothing else like this operation. Very barbaric but we are so thankful it is available to us!
Brownie51
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Patricia I might delete this later so let me know once you have copied it. It takes up a lot of space on your thread!
rlwintin
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Eek! Marianne I couldn't read all that. My doc gave me a nice DVD of the surgery. When I told him I haven't watched it yet, he said" we'll, you should because your knee was really bad!" Not that I would see that with my hands over my eyes. I was one of those denial people, " Are you sure I really need this?" I think people don't really know anything about it. I do feel like I have to keep telling people that I just can't do this or that. They probably think I am being a wuss but oh well.
Shubbles
senior
I just tell people that my bones were sawed off and all the other stuff was pushed and pulled all over the place and they haven't forgiven me yet. They remain very angry and aren't afraid to show it. If they still don't understand I tell them to imagine me sawing their leg off and how long it would take for them to forgive me. 
OP
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robynhood
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O MY GOODNESS. How dare people ask me "arent you over it yet" when my poor leg went through all THAT. Thank you so much Marianne for taking the time to type all that out. I have copied it out and keeping that to show people what we auctually go through. You are right it does sound barbaric. I could NEVER watch the dvd because I would NEVER have the other knee done if i did. Thanks again. What an eye-opener.
ElanorG
post-grad
I haver been lucky in that I have not gotten much of that from people. I think so many of the people I know have had a relative or friend who had a knee replaced and they saw for them it was not an easy road. But yesterday I went to a cookie exchange and there was a woman there who had her knee replaced 5 years ago, and we were talking and I said something like I was still fatigued and it was hard being back at work she said "Really, I had my surgery the end of a July and I am a teacher and was back at work the start of the school year, no swelling, no pain, nothing. I can't believe you aren't farther along." I WANTED TO SLAP HER!!!!!!! 
Maybe since it was 5 years ago she no longer remembers??? But I do tell people, if it comes up, that I had both bones sawed off and that always makes people wince! LOL.
Maybe since it was 5 years ago she no longer remembers??? But I do tell people, if it comes up, that I had both bones sawed off and that always makes people wince! LOL.
ElanorG
post-grad
Mariann, I could barely read your description let alone watch a video of it. Was this the medical report of the surgery that you requested? I have heard that some people get videos of their own surgery. I have not been motivated to ask for that.
Shubbles
senior
I watched a video of one last night and almost threw up! 
oh my gosh it was so gross! I will spare you the details but let me say, NO WONDER WHY MY KNEE HATES ME NOW!!! That would be considered one of the worst forms of torture!
oh my gosh it was so gross! I will spare you the details but let me say, NO WONDER WHY MY KNEE HATES ME NOW!!! That would be considered one of the worst forms of torture!
ElanorG
post-grad
Marianne, I should have mentioned that I did the same exercises at home on the non-op knee that they had me do in PT for the TKR knee. They told me not to use heavier weights on the non-op knee, but just to use the same amount of weight, so that the non-op knee did not get too strong as I would then favor the TKR leg too much. So I did that all along and am still doing it. But lots of the exercises that I do used both legs anyway, wall slides, step ups and step downs, etc. so I got even usuage.
Brownie51
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Lisa, yes, that was my operative report. I added some little comments.
Shelly yes the videos of the surgery are surreal. There surgeries that are more serious such as removing the heart for a transplant but I can't think of a surgery more barbaric. Even an amputation is less traumatic because they saw off the limb and then close up. You don't disarticulate the joint and then start waving the limb all over the place. So people who don't have any empathy are probably brain damaged and incapable of understanding. hahaha That teacher who went back to work what, 8 weeks later with no pain...was she old enough for dementia? hahaha sorry ladies but we are in this together. Although all my RN friends and other friends seem to understand the pain and trauma. Is it usually people who don't really know us well who make the foolish judgements about our situations?
So for all of us who run into these people who think they know it all about OUR surgeries and recoveries...as soon as they start in we need to pretend we are made of Teflon and let their words roll off of us. We should preplan our responses! Such as "oh so you have had this surgery?" or "what training do you have that makes you an expert?". I will be honest, I am not good at saying things like that to someone.
Hey I was just reading one of those thought-for-the-day books and here's yesterday's thought. "You can value the difference in other people. When someone disagrees with you, you can say, "Good! You see it differently" You don't have to agree with them; you can simply affirm them. And you can seek to understand." So I guess we can acknowledge their statement that we should be better by now, or whatever their inane statement was, but then we can inquire about what brought them to the conclusion that we should be jogging by now. It would be lovely to put them on the spot like that, but with a smile.
How about we all think of a good response that lets the ignorant person know they don't know what they are talking about yet we still come out with dignity, not losing our cool, yet still getting our point across.
Shelly I like your response! You just come out and say it! How are their responses when you do that?
Randi I want to watch your video! I don't think I have one of me. And yes Lisa that was my op report from my surgery but I added some little remarks and tried to put caps on when the barbaric stuff was mentioned.
Shelly yes the videos of the surgery are surreal. There surgeries that are more serious such as removing the heart for a transplant but I can't think of a surgery more barbaric. Even an amputation is less traumatic because they saw off the limb and then close up. You don't disarticulate the joint and then start waving the limb all over the place. So people who don't have any empathy are probably brain damaged and incapable of understanding. hahaha That teacher who went back to work what, 8 weeks later with no pain...was she old enough for dementia? hahaha sorry ladies but we are in this together. Although all my RN friends and other friends seem to understand the pain and trauma. Is it usually people who don't really know us well who make the foolish judgements about our situations?
So for all of us who run into these people who think they know it all about OUR surgeries and recoveries...as soon as they start in we need to pretend we are made of Teflon and let their words roll off of us. We should preplan our responses! Such as "oh so you have had this surgery?" or "what training do you have that makes you an expert?". I will be honest, I am not good at saying things like that to someone.
Hey I was just reading one of those thought-for-the-day books and here's yesterday's thought. "You can value the difference in other people. When someone disagrees with you, you can say, "Good! You see it differently" You don't have to agree with them; you can simply affirm them. And you can seek to understand." So I guess we can acknowledge their statement that we should be better by now, or whatever their inane statement was, but then we can inquire about what brought them to the conclusion that we should be jogging by now. It would be lovely to put them on the spot like that, but with a smile.
How about we all think of a good response that lets the ignorant person know they don't know what they are talking about yet we still come out with dignity, not losing our cool, yet still getting our point across.
Shelly I like your response! You just come out and say it! How are their responses when you do that?
Randi I want to watch your video! I don't think I have one of me. And yes Lisa that was my op report from my surgery but I added some little remarks and tried to put caps on when the barbaric stuff was mentioned.
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