TKR Over doing or not doing enough?

[referee54]

I do love onions, as well, and we grow delicious ones on the farm where I work, but the placing of the onion on the sting simply made me smell like either a burger or a hot dog with extra onion.

 

[Wanttobebiking]

Now I am really hungry!

 

[Wanttobebiking]

@Celle I know that some U.S. doctors are still cutting the quad tendon. A friend of mine had it done last year. Not sure if her doc cut the quad muscle as well. My doc used the subvastus quad-sparing approach and I was home in 28 hours. I think this is truly minimally invasive, right? He did not cut the quad tendon or any of the quad muscles. In the mid-vastus approach, isn't the muscle partially cut?

And thanks for the reminder about not derailing threads. I thought about that before I posted. Still have trouble finding my thread sometimes.

 

[Celle]

I'm going to ask @Josephine to answer your question, because she has many years of experience in operating theatres and has seen many, many knee replacements, of all types.
As Josephine lives in England, it will be several hours before she gets this.

In the meantime, I will give you this article.
Quads cut - why and when do they cut the quads tendon/muscle

 

[Wanttobebiking]

@Celle Thanks for the article. I am still confused. All I know is my OS told me the less I have to mess with your muscles and tendons, the better, and that I was a good candidate for the MIS approach that he is trained in, which I think was subvastus. He did not cut the quad tendon and did not invert the patella or dislocate the knee. He said if my muscles were larger or if I was too heavy, he would not have been able to use this approach. He said it would make my recovery shorter up front, but that there should be no doubt I was having a TKR and at six weeks I would be where the others were who were not having the non-MIS approach. It also allowed me to go home from the surgical center the next day.

 

[Celle]

What, exactly, are you still confused about? If you can tell us that, perhaps Josephine can clarify things for you, although I think the article was pretty clear.

Yes, you had a MIS approach and you're doing well. Your surgeon seems to have explained it well and he's obviously done a good job. As he said, MIS is not suitable for everyone.

As I said before, most surgeons do not cut the quads - that is a method that is going out of fashion because it does slow down initial recovery. Most people do not have their quads cut, even if they don't have MIS surgery, and many of them are now going home the day after surgery.

I did not have MIS surgery. In fact, my right knee that had a revision from a PKR to a TKR has a scar that is 10 inches long. Even with the need to remove the old implant, I did not have my quads cut. My left knee scar is a bit shorter, 7 inches. Again, no quads cut.
I have Stryker Triathlon implants in both my knees and I'm very happy with them. I think you said you had Stryker Triathlons too, didn't you?

 

[Wanttobebiking]

@Celle I just get confused about all I read. I even get confused listening to my OS. Sounds like all TKR surgery is becoming more minimally invasive, so if it all is then did I really have it? I guess that is my question. My OS said I did. I should just believe him.

Amazing that in revision surgery they don't even need to cut the quads. To answer your question, no I do not have the Stryker implant. I have the DuPuy Attune mobile bearing platform. At 3 months I am still not totally happy with it, but I hear that will come. Thanks for your explanation.

 

[Celle]

You can trust your surgeon when he says that you did have minimally invasive surgery. There are other differences, apart from not cutting the quads. Josephine may be willing to explain more fully.

Maybe you've just been reading too much?

 

[Wanttobebiking]

@Celle Probably. And thank you. I am good.

 

[Josephine]

I think this is truly minimally invasive, right? He did not cut the quad tendon or any of the quad muscles. In the mid-vastus approach, isn't the muscle partially cut?

Sounds like all TKR surgery is becoming more minimally invasive, so if it all is then did I really have it?

You actually practically need a degree in anatomy to fully understand the differences between one and the other because as far as the outside world is concerned, the differences are actually minimal. But I will try to explain.

As regards the infamous "quads snip" way back when, there was a procedure where the quads where the incision was extended quite a long way up the leg to provide extra access to the joint. However, it very quickly became apparent that not only did this cause a lot of pain to the patient but it also interfered with the progress of recovery and very soon died out. Nowadays the incision is a lot shorter which therefore spares the quads. But the same happens with the skin incision in that it used to be 12-14" long and nowadays is only 6-8" long. So while there actually isn't such thing as a 'MIS' or minimally invasive TKR, what there it now is a less invasive than it was say 25 years ago.

To be exact, it would be impossible to perform a TKR via what I call an MIS opening which would only be about 2-3" at most. You could get a partial knee implant through that but never a total - much too big! You have to have something big enough to get the jigs in place as well

Spoiler: graphic knee surgery - don't look if you're squeamish!

So, with all due respect to your surgeon, you didn't have a true MIS approach but a reduced incision and that's pretty much standard these days, as you said.

I hope that answers your questions ............

 

[Thesoutherncook]

I think we need to get you a new focus! How about knitting?

 

[Wanttobebiking]

@Josephine Yes, it does. Thank you for the explanation.

@Thesoutherncook I agree. I kind of get dragged into these topics because I find them interesting, but then I realize I am in over my head. On another note, I went swimming today and could barely kick. I was at the edge of the pool and tried to watch how fast I was moving compared to the pool wall--hardly moving at all. Then after I got out of the pool, the very nice lifeguard came over and asked me to join a conditioning and stroke improvement class on Tuesday nights. I can't do until January because I am taking Thai Chi on Tuesday nights until December. You barely move in Thai Chi, but it keeps me on my feet for an hour at a time, which has been good for me.

I read you are still in PT. I think about going back. How are you doing climbing down stairs? I am still having trouble with that.

As for knitting, unfortunately I have little talent in that area.

 

[Thesoutherncook]

I was just kidding you! Inquiring minds want to know.....! Before the surgery, I didn't want to know anything!
I had a surgeon who I trusted and I subscribed to the "ignorance is bliss" theory! Then at 2 weeks out of surgery I found Bonesmart! Boy, next time around will certainly be different!

This will be my last week in PT. I've decided I've had enough ( Josephine would say MORE than enough! ) I see the OS next Tues. and he'll say, " Do whatever the PT says. My work is done! " I'll bet money on that! Yesterday, the district mgr for the PT group was filling in for my regular guy and he said I am right where I need to be. I was happy with that. I have a gym 4 miles from here and will go back to it next week, starting out light. I ride my recumbent bike almost every day. My biggest issue is gaining stamina. I just wipe out after doing the simplest things! I am going down stairs to my art studio almost every day. Generally, I only go down and back up once a day! I can come up ok, but my old crappy knee still keeps me from going down like an adult! It will probably be replaced in January.

 

[Wanttobebiking]

@Thesoutherncook I am more than glad—very happy in fact—to get off the topic of MIS surgery. I didn't even start to do research until about 2 weeks before surgery and then I freaked out. On the pre-op table, when my OS came in to see me, I asked him if he thought we should postpone the surgery.

After my swim today, I took a walk with my husband to pick up his car which was being worked on, and I really was winded. I turned to him and said, I just don't have my stamina back. But I do have to say it is nice to be 3 months out. Every week things get better. I too will have to do my other knee eventually, but not sure when that will be. Hoping awhile yet—I am a bit envious of those who are done, though.

Nice day here in Minneapolis. Sitting at my computer not feeling much like working at all.

 

[Thesoutherncook]

Sitting in my recliner, knee elevated and iced, looking out at the Blue Ridge Mtns. Beautiful "Carolina Blue" skies and a little fall color beginning to show up. I worked on painting flowers on a chair for a friend's granddaughter this am, made caramel apples for another friend's birthday tomorrow and am resting until time to start supper for us and our part time neighbor ( who my DH invited over! ).

We have "full timers" -folks, like us, who live here year around; "part timers" - who have a house or condo in Florida and come here in the summer or occasionally throughout the year ; and "half backs" - folks who are originally from above the Mason Dixon Line, moved to FL and now have moved here, half way back to where they started ; and "locals" - born and raised here and barely tolerate the rest of us!

Yes, I agree that at 3 months every week is better! I would really like to see an end to swelling but fear it will stick around as a reminder not to overdo!

 

[Wanttobebiking]

@Thesoutherncook Where are you from originally? We have a beach condo in Florida that we rent as well. We are headed there Nov. 1. YAY!

 

[Thesoutherncook]

Grew up in Alabama, lived in ATL for 20 years and moved to NC 11 years ago! That makes us almost locals! Lol! I worked for Southern Living in B'irmingham, AL years and years ago hence the screen name ( and also my email address).
Where is your beach condo?? You could swing by to see us on your way South??

 

[hawk2go]

Every week things get better.

My answer whenever anyone asks how I'm doing is "every week is better, everyday is a rollercoaster". I'm only slightly further along than you and except for a few ODIC setbacks, experienced the truth of this recovery statement. For me, stamina is still an issue, though I am able to do a lot more today without fatiguing than I was able to do last month. Keep going!

 

[Wanttobebiking]

@Thesoutherncook Our condo is in Redington Beach about 15 miles north of St Pete Beach. Were you an editor for Southern Living? Great mag. I am a freelance editor/writer.

@hawk2go Isn't it nice to be this far out? I love the feeling of getting more back to normal. Put the last of the throw rugs back in place just this week. The big bottle of Tylenol and a slightly smaller bottle of Aleve sitting on my kitchen counter are the last visible signs of surgery in the house! I love that child in your avatar.

 

[hawk2go]

@hawk2go Isn't it nice to be this far out?

Absolutely! Soooo nice. I started taking the bus when The Pope was here a few weeks back and the other day I stood in the rain for 45 minutes waiting for the bus. Then I thought I stood for 45 minutes! I still deal with pain and limits but the pain is waning as are the limits.

The child is my granddaughter who visited me on her birthday when I was 1 week out of surgery. I couldn't run with the older kids but she hugged me in her sleep.