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Partial Replacement - Long time coming

Discussion in 'Knee Replacement Pre-Op Area' started by ShedEnd, Sep 1, 2018.

  1. ShedEnd

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    Well, I almost made it 30 years. When I was 17 years old and heading into my 2nd knee operation, my surgeon told me that I would eventually have to have my knee replaced. A third operation followed a few years later that removed a huge chunk of my medial meniscus in my left knee, and I knew that the surgeon's prediction would definitely come true, it was only a matter of time.

    Well, that time has come. Knee has been getting progressively worse with the years, even though I gave up all my strenuous activities years ago. A few weeks ago I was sitting on my sofa reading, and when I got up I could barely move my leg without serious pain. This was not the first time this has happened to me - for years it was only once or twice a year. More recently it has been every month or two. Finally decided it was time to get the knee checked out again, get the MRI, and see what was going on. I've had the cortisone shots, the synvisc, and while they offered very temporary relief, I knew it was time to consider surgery.

    MRI confirmed what I had been feeling - medial compartment was kaput. Doc said that the meniscus that was left was frayed and "holding on by a thread." He asked about the conservative options and how they worked on me. I told him that while they offered some relief, it was very short lived. After a good long conversation, he recommended a partial replacement. He said he didn't like operating on someone my age, but in my case there wasn't any other good option. This was the conclusion I had reached as well. I have my surgery scheduled for September 26th.

    I'm not overly worried about the operation - I've had three in the past and I know what to expect. Main concern I have is with pain management. I have a very strange metabolism, and most pain medications do not affect me at all, even opioids. Don't drink frequently, and I have never used drugs, but I have an incredible tolerance to both. I've been prescribed all manner of pain meds, and I could be taking Pez for all I could tell - no relief from pain, no drowsiness, no disorientation. So I'm wondering how I'll do with the surgery. I do plan to talk to the surgeon and anesthesiologist to discuss options.
     
  2. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello @ShedEnd - and :welome:

    I'm glad you're going to discuss pain control with your surgeon and anaesthetist before your surgery.
    Do make sure that your surgeon is prepared to do a total knee replacement (TKR) if, during surgery, he finds any evidence of cartilage damage in the other compartments of your knee.

    Here are some articles to help you prepare for your surgery:

    Longevity of implants and revisions: How long will my new joint last?

    If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
    Recovery Aids: A comprehensive list for hospital and home
    Recliner Chairs: Things you need to know if buying one for your recovery
    Pre-Op Interviews: What's involved?

    Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

    And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:
    Stories of amazing knee recoveries
     
  3. ShedEnd

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    Had a discussion with my supervisor yesterday, and she already approved my leave requests for the first month after surgery. I explained to her that the first month would be a minimum of the time I'd be off work, and that it could be much longer. While I work in an office environment, the biggest problem I will have is actually getting to the office. My OS has already stated that I will be barred from driving for the first month, and that they will reassess in my first post-op appointment. I have a feeling that I'll be out much longer as I work in downtown Tampa, and my parking garage is about 5 blocks from the office. While I'd be able to park on the street, those spaces fill up very fast, and even getting into the office at 05:00 I often find the closest space a couple blocks away. I told my supervisor that I'd still handle the administrative functions of my job (time and attendance for my staff, training requests, travel orders, etc) while I was recovering, I doubt I'd have the bandwidth mentally to tackle any of the more demanding job requirements. She seemed to be agreeable to this.

    Thankfully I won't have too much to do to get ready for the operation and recovery. We live in a single level house, so I will have exactly one step to negotiate to get from the garage into the house. My wife also works from home, so she will be there constantly to help me as needed. My biggest fear is the cabin fever - I can usually only make it a couple of days without getting the itch to get out and about, so an enforced stay at home will be interesting. At least we will be getting out of the hot season during the recovery, and I plan to set up a comfy lounge chair on the lanai so I could at least sit by the pool while I recover.

    I think the biggest disappointment for me will be the inability to go to hockey games. We are season ticket holders for the Tampa Bay Lightning, and I know that I won't be able to get myself into those tight seats for the majority of the season. I could barely cram myself into the seats to begin with (I'm 6'2", at about 270 pounds and have long legs - I'm not a small boy), and I know that with a recovering knee, it'll be a while before I make it back to the arena...
     
  4. InkedMarie

    InkedMarie senior

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    @ShedEnd I’m 9 days post op from TKR. I hate being stuck in the house too but I have to tell you, I am so exhausted, the thought of going out is so unappealing. Just walking to the kitchen, getting a snack and back to livingroom is exhausting. So is a shower and I’m sitting down for that!
     
  5. ShedEnd

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    I have an idea of what it will be like, but not to the extent that I'll experience in about 3 weeks. My second knee operation (1989, age 17) was an attempt at repairing a meniscus tear. This resulted in me being in an immobilizer for 6 weeks, and the first three weeks of that was spent in my parent's basement on a fold out sofa sleeper. I'm not sure who it was worse on - me, being stuck in the basement, or my parents, who had to march up and down steps every time I needed something.

    Hopefully this one will be a lot easier to manage due to the technological advances. I'll be set up in our spare bedroom with a nice comfy bed, Kindle pre-loaded with plenty of books, an Xbox, and an AppleTV with connection to Netflix, Amazon, etc. At least this time I won't have to get up to switch out VCR tapes!
     
  6. SusieShoes

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    Don’t write off too much of the hockey season, just the early part. The main problem with things like sports events, theater, movies, or any event where sitting for long periods is required, is that the knee will be very unhappy with being in one position (especially bent) for too long. Cramped seats are even more of an issue.

    You will find that at around three months you might be able to handle longer bouts of sitting, with taking advantage of intermissions or breaks in the action to take a short walking break. If your seats are in the middle of a row, that’s tougher, of course. :sad: Moving down a fully packed row of seated/standing people isn’t easy even for non-operated knees.

    Can you do any of your work from home? If you can, it would help you ease back into the job by minimizing your trips to the office. If you must go to the office, find ways to elevate your leg(s) and ice as much as possible. It really will make a difference!
     
  7. ShedEnd

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    I've pretty much written off this season for the hockey. Our seats are in the dead center of the row, and right behind the railing over the handicapped seating area entrance. While this is great for watching the game (nobody sitting directly in front of me), it is bad for foot room. When I cram myself into the seat, my knees are touching the railing, slightly extending through the gaps. So that means my knee is at more than 90 degrees bent throughout. Add in the fact that I have to walk up and down a fairly steep set of stairs to get to my row, and that pretty much rules it out. While it is great that the team has had a string of really good years, it also means that the arena has been sold out every game for the last 4 or 5 years, and thus no alternative seating is available. When we renew our tickets, we're going to try to get into the handicapped seating areas - no steps and all the leg room I could want.

    As for work, there is a good bit that I could do from home, but I will be somewhat limited. First, I work for the federal government, and there is a significant portion of my work that I cannot do anywhere but the office for security reasons. Second, the nature of my work involves reviewing and comparing multiple documents at a time, which would be hard to do on a single laptop screen (my work setup is 2 27" monitors with the laptop on the side for emails). Finally, we do have a home office, but as my wife works exclusively from home, that is her domain. On the plus side, I have a very supportive manager, a great team who can handle the workload, and about 700 hours of sick leave built up, so I should be fine waiting until I can manage the walk. Thankfully, one of the good things of living in Florida is that I don't have to worry about hills - the walk from my garage to the office is absolutely flat, so I wouldn't have to worry about steps, just the distance, once I start back to work.
     
  8. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    On the plus side, the federal government is among the most accommodating of employers. Reasonably accommodation is something you can ask for. But true, they might not allow you to work from home unless you have a workspace of your own. :) It sounds like you have a really good situation for yourself in the office.

    Shame about the hockey tickets, but you are smart to know ahead of time that it won’t be possible.
     
  9. ShedEnd

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    I have a great situation here - I work in a field office for my agency, so the entire office consists of my immediate supervisor (who is very supportive), myself, and my 5 staff members. I've already discussed with my supervisor the work that I'll be able to do in the first month of my recovery, which will be limited to the administrative tasks I have, such as reviewing timesheets, training, and travel. After that we'll play it by ear.

    As for the hockey, I will definitely miss the atmosphere in the arena, but I have a good setup at home as well - we have a projector set up on our lanai, so I can actually watch the games on a 12' screen while floating in the pool (once I'm cleared for getting in the pool that is...)
     
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  10. ShedEnd

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    I had my pre-op physical with my GP yesterday, and things were going swimmingly for the most part. One of the tests ordered by my OS was a EKG. When the GP looked at the printout, he started asking me questions about chest pain, numbness, and shortness of breath. When I replied that I hadn't had any of those, and that my family doesn't have a history of heart disease, he listened to my heart with the stethoscope, front, back, and even on my neck. After checking me out, he pointed at one line of the EKG at a single blip (which to me looked no different than any other blip). He said that particular segment could mean that I might have had a very minor heart attack at some point in the past, but pointed out that since it was a single blip on a single heartbeat (it didn't repeat at any other point during the EKG) it might just be a misread by the machine. He didn't seem overly concerned with the EKG, and didn't recommend I do anything about this issue.

    His comment after this is my biggest concern - that the anesthesiologist may not approve the operation until I have a full cardiac screening. My operation is scheduled for the 26th, and I have a very narrow window where I can have this operation - my entire family is coming to my house for Thanksgiving this year, and I don't want to be just out of surgery when they are here. Even with the current scheduling, I will be at 2 months post surgery, so my activity (cooking in this case) will already be limited. I have a feeling that if I do have to get the cardiac screening, the surgery will have to be delayed until December.

    Thankfully my knee is not so bad that I can't function in its current state, but I've steeled myself for the surgery and I'd really rather not have any delays...
     
  11. ShedEnd

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    Oh, and I forgot to add. I spoke with my wife yesterday about the pain management issue. I was asking what medicines they gave me at the ER after I developed a kidney stone from getting severely dehydrated while working in the yard. She told me that they first gave me morphine, but that did absolutely nothing for the pain. About 30 minutes after the morphine, they gave me dilaudid. Once again, no relief from pain. About an hour later, after they got my blood tests back, they gave me toradol (NSAID pain reliever). Only then did I finally start to show some relief from the pain.

    Makes me nervous a bit about what it will take to get my pain under control after the operation. I do plan to talk to the OS and anesthesiologist about this prior to the surgery.
     
  12. Mutti3

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    Just to add my experience I had for the preop EKG. It showed I had a serious heart ischemia. My PCP redid the EkG in her office, because I had no history of cardiac problem and a previous normal EKG. The redone EKG was normal. The initial preop EKG wasn’t done correctly the hospital. Maybe they should repeat it?
     
  13. SusieShoes

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    If there's damage to the heart muscle from a previous heart attack, that damage won't disappear. It will still be there on subsequent EKGs. If your surgeon thinks you should get a full cardiac screening, get it. Tell your surgeon you don't want to find out on the day of surgery that you SHOULD have gotten it. Get a definite answer now if possible.

    My story: I do have a family history of heart attack deaths. All males, but still in the family. My doctors always get worked up about my heart, even though I apparently have a very good heart. How do I know this? Because with every darn surgery or hint of an EKG anomaly (so far just blips) they send me to get a cardiac stress test. Every which way you can do a cardiac stress test, I've done them. So before my bilateral TKR... yep, two weeks before the surgery my personal doctor said, "Oh, you should get a cardiac workup." Grrrrr. :blackcloud: Every. Time. I should have known that would come up. So I got (yet another) one.

    My workup, including a chemical stress test (because my knees were by now too horribly bad and painful to do a proper treadmill test), was two days before my scheduled surgery. I was panicked that my surgery would be postponed or cancelled if the test showed anything. I really (really!) wanted my surgery!

    Heart was fine. Had the surgery on schedule. A total hassle. Hassle was worth it.

    Just see if you can find out for sure if that anesthesiologist is onboard now or if you need to get the workup. It can take a couple weeks to get an appointment sometimes (which is what happened with me). Don't make it last minute if you don't have to!

    Oh, and don't get too worried about the pain control. Mention your experience to your surgeon, just in case. But kidney stone pain is in a whole different universe of pain. Mr. Shoes recently had kidney stones and only Toradol relieved his pain, too. It's apparently really effective for acute kidney stones. Toradol was one of the meds I received in the hospital immediately post-op. You won't go home with it, though. You will almost certainly find the usual painkillers work perfectly well on your post-op pain. :thumb:
     
  14. ShedEnd

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    My GP didn't seem the least bit worried, and since it was only one instance on the EKG (it did not repeat during subsequent heartbeats) he said he thought it was just a misread. I will discuss it with the OS, and I'm trying not to wait until the pre-op appointment, which is only a week before my scheduled surgery date (have a call in to his office now with the question).

    As for pain management, I know kidney stones are a whole world different than most things save labor (which thankfully I'll never have to experience). But it wasn't just this one instance - I generally do not take any pain meds because nothing I've taken in the past has helped in the least for pain. NSAIDS, opioids, nothing. I've been prescribed codeine, Percocet, and tramadol for various injuries in the past, and none of them did anything to relieve pain. In a similar manner, it is virtually impossible for me to get drunk - to celebrate coming home from Afghanistan, I sat by the pool drinking boat drinks. After about 3 hours my wife told me the party was over as I drank the entire 750ml bottle of vodka. I didn't even get tipsy.

    Just want to stress that I am not a drug user (I work in a mandatory drug test position) and I generally don't drink alcohol except for a dram of whiskey every once in a while. The one time I spoke to my GP about this he just guessed that my body metabolizes the meds and alcohol too fast for it to affect me.
     
  15. SusieShoes

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    Sounds like you have both a blessing and a curse going on simultaneously. It’s a plus to not get drunk, but...

    I’ll tag @lovetocookandsew to stop by. She has this issue too. Definitely something you and your medical team will be talking about. At least you know your body well and can prepare for this. Imagine only finding out after surgery. :flabber:
     
  16. lovetocookandsew

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    @SusieShoes I don't have the same problem exactly; my reactions are different. I do metabolize meds differently than most, but in a dangerous way as they cause some really bad reactions. Some of them do work well for pain in my body, but they all make me deathly ill, so I'm not able to take any narcotic pain meds at all any more.
     
  17. ShedEnd

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    Had my pre-op consultation with the anesthesiologist today. Discussed the EKG results and the doctor was not remotely concerned. He said that it was showing on only one of the 12 leads, and in his experience this is just a reading error and not evidence of a past heart attack.

    Also got a call from my OS. They completed the pre-op benefits check with my insurance, so I had to pay my co-pay.

    So, everything looks like the surgery is a go on the 26th...
     
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  18. ShedEnd

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    Have my pre-op appointment with my OS this morning. Topics I plan to discuss with him:

    1. Authorization to go to a TKR instead of a partial if there is damage in any other compartments.
    2. Pain management.
    3. Icing apparatus for the knee (cryo cuff).
    4. Handicap parking permit.
    5. Return to work timeframes.
    6. PT expectations.

    Anything else I should be discussing?
     
  19. InkedMarie

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    Good morning! I’m in a few forums for TKR’s. It seems like a lot of surgeons tell patients what they want to hear regarding return to work. I’m shocked when I read of surgeon’s who tell people they will be back to their on-their-feet job in six weeks. No one, including the surgeon, can know that. I wish they’d tell everyone 12weeks and if they can go back sooner, great.

    Handicap permit? Do you have other issues that would cause you to need that? Generally, they want you to walk.

    I have gel ice packs and Cryo Cuff; CC hands down!
     
  20. Jockette

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    My ortho office said I couldn’t have a handicap parking permit. The main reason it would have been nice would be because handicap parking spaces are wider and you can open the car door wider to get out, because for a while it’s hard to bend your knee enough if the door isn’t open all the way.

    By the time I was out and about, the walk from the car to the store was actually good for me. The earliest times I went out my husband would drop me off closer to the store than where he parked.
     

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