Should I postpone TKR due to ankle ulcer not completely closed?

[Davi]

So my right knee tkr has been postponed a few times. The first time I was a scaredy-cat, 2nd time postponed to get a lot of dental work out of the way and now I am scheduled for 7/3. Only other surgery I had were 2 arthroscopies on left and right knee back almost 20 yrs ago. That's it. My right knee is practically bone on bone. Back at the end of March I was getting a sclerotherapy treatment. (treatment for varicose veins) I developed an ankle ulcer on my left ankle due to the sclerosant being injected outside the vein. (allegedly happens to 1% of people). I showed the vascular surgeon the ulcer but she said it didn't look infected and thought I was ok. But it did get infected and I've been seeing a podiatrist who does the wound healing. We are trying to get the wound closed by surgery date 7/3 with what's called an EpiFix graft. It's supposed to make healing go quicker. EpiFix is a bioactive tissue matrix allograft composed of dehydrated human amniotic/chorionic membrane that is used as a tissue graft to treat nonhealing wounds. The membrane typically incorporates into the wound bed within 2 weeks of application Ulcers take a long time to heal. I've had 3 treatments so far and will be having about 2 more b4 surgery. Because we were coming so close to the surgery date, I had the podiatrist contact the OS to let him know what was going on. He stopped by podiatrist office while I was in there a few days ago for the 3rd graft and he thought since it's not on the operative leg and it is healing nicely, that I can go ahead with the surgery.

I thought that open wounds were supposed to be completely closed before surgery but what do I know. I did ask him that and he said since it's the non operative leg and it is healing so nicely, he didn't think it would be a problem but said if I wanted to postpone I could. On one hand I want to get this tkr out of the way so I can move on with my life but on the other hand I'm wondering if I should postpone until the wound is completely closed.

If there is anyone out there that knows about these things, I would really appreciate your thoughts. Thank you!!

 

[Jamie]

Davi, this is a tough decision for you. It’s impossible for us to weigh in on what you should or should not do because we haven’t seen the wound that’s healing. I can understand you being worried, though, because of all you’ve already been through and the common knowledge that many surgeons want absolutely no open wounds when a knee is replaced. If you’re at all concerned, don’t feel bad about delaying the surgery one more time just to be safe. Did he offer any indication of what the surgery delay might be? Most surgeons schedule out about 3-4 weeks, so it could mean a couple of months before you would be getting your TKR.

 

[Davi]

Thanks for responding Jamie. I'm not in a lot of pain at all. Every now & then my knee feels stiff but that's about it so I will probably be okay to wait. Probably won't have to wait more than a few months. I just wish I had more faith & trust in what he said that it's ok to move forward even though not completely closed because there is no infection and it is healing well. Ugh decisions...

 

[EalingGran]

If you’re at all concerned, don’t feel bad about delaying the surgery one more time just to be safe.

I agree with @Jamie that it may be better to err on the side of caution- especially as you say you are not in that much pain.

 

[eaglemom]

I too agree that it may be better to err on the side of caution. Personally I would hate to be mentally ready for my surgery then at the last minute the surgeon look and say he wouldn't preform the operation. That would be my concern. You are the one in control of when your comfortable having the surgery.

 

[Jamie]

Hang in there! These big decisions are stressful, but I'm sure you'll weigh all the information you have, listen to your gut feelings, and make the best decision for yourself. We're always here in case you need to bounce thoughts off other people who may have faced a similar decision. Don't hesitate to post!

 

[InkedMarie]

It may not be a decision you have to make; the surgeon will. Have you talked to the surgeon or his assistant about the ulcer?

Marie

 

[Davi]

The surgeon said it is ok to move forward since the ulcer is healing very nicely and does not appear to be infected. Also it's on the non-operative leg. He continued to say even if it was on the ankle on the operative leg, he would still move forward. I ended up telling him I feel more comfortable waiting till the ulcer is completely closed. It's not just the ulcer though. It's the fact that I have not been in much pain for quite a while. I know during the winter months I may have more OA pain especially since I am bone on bone. It seems that most people elect to have the surgery because they are at the point of so much pain. I am not so it makes me wonder what I'm gonna feel like after I get the knee replaced since I wasn't in much pain going in. This is the hardest decision I've ever had to make in my life. I don't want to trade one thing for another if you know what I mean. I read that 20 to 30% of people are not happy with their tkr outcomes. I am so wishy washy :-(

 

[Kentpete]

I think the quicker you get it done the quicker you are on the road to recovery, and who wants to recover in the winter when going outside is a danger in itself because of snow and ice. I understand the idea of using any perceived problem real or imagined to put off surgery (I had my hip replacement last week and carried on smoking right up to the surgery in the vain hope they would cancel , very stupid and it didn't even work lol). Ultimately it's your choice but if surgeon is happy I would go for it.

 

[Rockgirl4]

I just wanted to offer a thought---sometimes the knee has other ideas. I had no pain at all for 4.5 years, then only 1 severe flare-up last Fall lasting only 2 days. I had another 8 months of no pain, then my luck ran out. Fast forward to May when I had a garage sale. My knee pain went from 0-100 in 3 days--to the point I can barely walk some days--and that's even after a cortisone shot 4 weeks ago. I only mention this because I never thought the choice would be taken out of my hands so suddenly. I have to wait 3 months from the date of my cortisone shot before surgery, and I'm terrified I won't be functioning at all without crutches by August. I actually made my surgery appointment last Monday, then questioned it because I had had a really good 7-8 days of no pain at all. Yesterday proved I made the right decision though. 45 minutes of yard work put me back to sheer misery and no walking today. The pain even woke me up in the night. I just hate to think of you putting if off only to have the choice taken out of your hands at some point. Again, this was just something to consider. I am glad you are doing so well though, especially with the healing ankle.

 

[Davi]

Hi Rockgirl4 I appreciate your thoughts. Looks like you've been through a lot. I made the mistake of Dr. Googling and have read too much about things that have gone wrong for a lot of people, like tight band feeling not going away after many years for some, spacer problems, clunking, and so forth not to mention I've had doctors that have made mistakes during two procedures I had in the past. Nothing to do with the knees. I wish you the best with your upcoming tkr

 

[Jockette]

not to mention I've had doctors that have made mistakes during two procedures I had in the past.

This definitely does betray our trust. Been there, and I feel similar.