Tkr - when, when, when?

[33plycpe]

Well, I happened upon this website, read several of the comments, and have some of the same questions since I am facing TKR in the future.
Last July I had left knee surgery for a "torn meniscus." It turned out much worse. My doctor stated my knee "is a lost cause." I have made it so far without pain meds, and trying to decide when the moment is right. (Due to deterioration of muscles, etc. due to more inactivity.) My doctor stated it will have to be done sometime-two months to two years.
My questions are:
1. When will I know when it is the time? (At this time I have pain daily, but not severe. The knee feels swelled and tight with pain on the inside of the joint.) It is limiting my activity. Pain gets worse if I walk at the store too much. (Can't walk for exercise.)
2. How do I select the best doctor in central Indiana? I have looked at several. (My general doctor recommends Ortho Indy and Dr. Fisher. I have heard good things about a Dr. Highhouse in Lafayatte, IN and a Dr. Yoder in my hometown is receiving good marks.
3. Should I select the doctor based on the best knee manufacturer?
Several of you responded the type of knee isn't as important as the surgeon, but I would think there are definite advantages to using a particular manufacturer. I am concerned about durability, flexibility, and of course, a good track record when it comes to complications or failures.
Any advice would be appreciated.

 

[Josephine]

Re: Tkr

I made a post at the head of this forum entitled How to choose a surgeon and a prosthesis and in there is a list of crucial points about choosing the best surgeon. I suggest you read and digest it.

I honestly wouldn't worry too much about the type of prosthesis. I am of the opinion it should be the surgeon's choice - in other words, what he is particularly skilled at using and what he thinks is appropriate for you. Truthfully, patients do not have the appropriate skill or knowledge to make such a choice. Sure, you can research on the internet but most of the sites you access are the manufacturer's sites and they are naturally going to promote their own products with glowing testimonials. Won't make a scrap of difference if the surgeon you go to hasn't got top notch skills implanting it.

And let's face it - once you've had 'A' implanted, how are you possibly going to know if it's better or worse than 'B' would have been! It's not like you can take it back if you're not satisfied! Trust me - they're all pretty much of a muchness anyway so far as function and performance are concerned. Personally, I haven't given the type of prosthesis a moment's thought.

As for when - that is something only you can decide but my parameters were based upon the following ...
~ do I have pain every day or only sometimes?
~ am I having to use canes or crutches most/all of the time?
~ am I choosing not to do things I want to do because of the pain?
~ am I having to take pain killers 2-3 times a day and are they failing to hold down the pain?
~ is my sleep disturbed frequently/always?
~ how much is this affecting my life on a scale of 1-10 where 1 is perfect and 10 is I have no life?
~ what is my quality of life like on a scale of 1-10 where 1 is perfect and 10 is housebound and constantly in pain?

Based upon the answers I decided to crack on and get my knee done soon even though I can still walk about without aids and do housework and such. I have seen people leave it to the bitter end and end up in a wheelchair, unable to do much of anything, not even sleep, and having frequent pain-storms. I am not prepared to risk that.

 

[lnich]

Re: Tkr

Welcome!

When I was researching hospitals and doctors, I looked at the U.S. News & WR rankings of best hospitals in orthopedics (I know, it's like a beauty contest, but it's somewhere to start). Check out this link:

https://www.usnews.com/directories/hospitals/index_html/specialty+IHQORTH/

If you live in central Indiana, it looks like "Clarian Health" in Indianapolis is highly rated. If you check out its web site, you can get info on their OS's who do knee replacements:

broken link removed: https://www.clarian.org/portal/patients/clinical?clarianContentID=/clinical/hmi/totaljointindex.xml

It's interesting that Zimmer--a manufacturer of knee prostheses and promoter of MIS TKR--is headquartered in Indiana.

Good Luck!

 

[Josephine]

Re: Tkr

Interesting or ironic?

 

[CG'sknees]

Re: Tkr

I say don't wait! I went a year after having a injury that produced meniscus tear and useless arthroscopic surgery on my arthritic "knees of a 96-year old" (to quote the doctor at urgent care). During that time I struggled to do any of my activities, got more and more limited in my activities, and was depressed.

Now 7-weeks post RTKA I can see such a difference in my life. Yesterday I was out and about at the new mall here in SoCal, went to the movies, walked down the block to a restaurant, then dropped hubby at home while I went out to yarn store for some browsing. I'm anxious to be doing my outdoor cycling soon, as that is a favorite sporting activity, but I'm doing great on indoor cycle.

The sooner you get it done, the sooner you'll be through with the process. I'm excited about the upcoming months, as I see such big changes week to week even now.

Good luck in your doctor search. I went to one of the best in Los Angeles, and am fully confident of his opinion and abilities.

 

[Max Wallace]

Re: Tkr

I waited and regret all that I gave up. A second opinion is always a good choice. Choose the best DR. in your area and let him decide which implant to use. Some have favorites but some choose on age,activity,weight etc. he will know whats right for you. I had smith and Nephew OXINIMUM.

Max
Get well soon

 

[Gretchendz]

Re: Tkr

I'm another who waited and regrets it.

Frankly, I was not conscious of that much pain--except for lots of walking on family vacations. I was not on pain meds. However, in retrospect I was doing less and less and all the time. I would find excuses to sit. Avoid walking, exercise, even standing. The pain I had I chalked up to normal aging. Now that it is gone I realize how bad it was!

A family vacation with tons of walking and keeping up with hubby & three 20-year olds and knees swollen to twice their normal size made me realize I had a problem.

If you are limiting your activity because of it, it is time. Because I waited, my recovery was tougher regaining mobility (I literally had to learn what it is to walk straight and retrain my muscles.)

I agree with Jo--do not stress about the type of joint. Find a good doctor you trust and trust his/her professional judgment.

Good luck!

 

[Simon]

Re: Tkr

I am another one who waited way too long. I had numerous previous surgeries so I knew the knees were going to go. My OS at the time I would be lucky to make it to 45. Well, I did make it to 57 but I gave up alot in the process. I could control the pain with lots of aspirin and when it flared just went to bed. Like the others have said you will slowly stop doing things you like to do, adjust your schedule to avoid stores when they are busy becasue of the lines, you are cranky and basically life aint' that great. Sounds like you are there (I also tore the meniscus a few years before but the OS ordered an MRI before considering fixing it, one look at the results he said an arthroscope was a waste of time).

A good surgeon and hospital are more important than the implant. I would say the implant type is probably only important if you have a very specific need like you are a pro athlete, have a job that requires alot of kneeling or some anatomical feature that needs to be considered.

I found one of the most important thing is to feel comfortable with the surgeon and is one you can communicate with.

Simon

 

[33plycpe]

Re: Tkr

I waited and regret all that I gave up. A second opinion is always a good choice. Choose the best DR. in your area and let him decide which implant to use. Some have favorites but some choose on age,activity,weight etc. he will know whats right for you. I had smith and Nephew OXINIMUM.

Max
Get well soon

Max,
I just wanted to know how you are getting along with your Smith/Nephew Oxinium knee. I am looking at this one. I tend to believe the type of knee might make enough of a difference to warrant consideration. Due to privacy limitations the doctor that uses this knee can't release names of past patients in the area with this implant. Any advice would be appreciated.

 

[Josephine]

Re: Tkr

I think we all said it before - type of knee is less important than a good surgeon. And that bit about privacy limitations is nonsense! I know of no surgeon that is not prepared to contact his past patients to talk to new patients. I would be most suspicious of this.

Do you know, for instance, how many TKRs he performs annually, what his good outcome percentages are, what his infection rate is? Read the post I linked in my previous reply.

All knee prostheses are pretty much of a muchness and their success is subject to the skills the surgeon who put them in.

 

[shutterbug]

Re: Tkr

I waited until I was nearly crippled. Pain everyday!! I am now 12 weeks post TKR. This has been a life changing experence!! Yes I am still a little stiff and sore, but nothing like I was. My co-workers really noticed the differance in me when I returned. They were shocked when they saw me come to work with a smile on my face and my skin color normal. I say if you need it "DO IT". I'm glad I did.....I have my life back!!!
chuck

 

[Grandma]

Re: Tkr

I agree - get it done before you are miserable.
Because I had to have back surgery first (spinal stenosis and fusion of L4 & L5 vertabra) and before having it dealt with it was causing excrutiating pain all the time. That was done last Feb. After surgery ALL MY PAIN WAS GONE!!!!
It was during PT for my back that my knee became and issure and prevented me from finishing the necessary walking exercises important to my back recovery. My knee has gone downhill very quickly over the last year to the point where I am in constant pain - 2 Percocets every 4 - 6 hours control it but don't irradicate it. Even when I go to bed I wake up every two hours due to cramping and spasms and Often must walk around for a couple of hours before trying to go back to bed and get a bit more sleep. My shin bone has bowed and all in all "I have no life" at the moment.
I am in the worst physical shape of my entire life! The past two years have been so activity restrictive, I have gained about 60 lbs. I know that weight and more should probably lost ASAP - but on the bright side I have quit smoking and don't drink very often.
I have promised myself I will work my very hardest and follow PT, all my home exercises, at least to the letter, more if I am able. It will be so reassuring to have access to bonesmart members and their encouragement and suggestions. You guys are the greatest!!
How many of you think the Polarcare 3 machine is worth buying? How much would I be likely to use it for the first year after the procedure?

 

[Josephine]

For several opinions of Polar Care and other such machines, read this thread ... What would you do different?

 

[hollie9]

I had the arthoroscopic meniscus tear surgery and all it did was break down my knees further so that I then needed a TKR. I don't think they ever work.

I chose to have a TKR when I noticed I was gradually declining to go anywhere that involved possible walking. And noticed my quality of life was declining. I worked out with a PT up until the day of surgery, at first to try to get around better with bad knees, but I'm glad I was strong going into surgery.

My surgeon was Dr. Coon who does the "quad sparing" knee surgery which enables a fast recovery. Less that 24 hour hospital stay and walk out unaided to your car and go home. He is in California but has patients flying in from all over the US and the world. He has done over 3,000 of these procedures, about 700 a year.

My first question of an OS is how many procedures they do a year and how many TKRs over their career. I read a research paper that you'll get the best results from surgeons who do high volume. Although I generally agree with going along with the surgeon on the prosthesis, I read up on all of them, even checking the registries in Australia and other countries who keep registries, to see how long each prosthesis lasted before revision. That does also depend also on how good the surgeon is who installs them. I had some good discussions with Dr. Coon about which prosthesis he wanted to use for me, he uses many different brands, and some have rotating platforms and other differences.

I always asked potential OS's if I would be able to kneel after the TKR. Many very good surgeons said no. Dr. Coon not only said yes, but that I could also continue skiing, and other activities the other docs prohibited. With his volume, the quad sparing, talking to other patients of his, more activity afterward...the decision was easy.

Hollie

 

[Weezy]

I second and third everything others have said about putting off the surgery. I waited over 10 years, until I was "old enough" (barely), and had my left knee done last April. It was a pretty miserable 10 years with more and more pain, and less and less ability to be active and/or even moderately comfortable.

Consequently, I'm having my second knee done now. It still isn't as bad as my left knee was, but I am NOT going to wait this time. The last activity I had to cut down on was cycling and that was it. The last time I could only ride a mile without screaming and I came home and made the appointment.

Quality of life is important!

Weezy