TKR Update

[clarksvilleal]

Hello DOCCUKE,

I read your original post with interest. Sorry to hear it has been so painful for you. However I have a question that I hope you don't mind my asking: How were you able to achieve 130 degree ROM after only 3 weeks? Was this done with the help of a physical therapist in PT sessions and using PT-prescribed exercises at home? Or did you do it more or less on your own? In either case, what specific types of exercises did you do to accomplish that?

My reasons for asking this are related both to my own experience with bilateral TKA surgeries that I had about 4 months ago (2 weeks apart), as well as to your own ongoing experience with pain. I'll explain what I mean after seeing your reply on how you were able to get to 130 degrees so quickly.

Thanks,
Al

Hi Al.
I just did whatever the pt lady told me to do. I had 90 degrees the day after surgery

OK. I was thinking you may have gone overboard with ROM exercises on your own rather than following the PT's prescribed exercises. I had a bad experience with my first TKA when I tried to do excessive ROM exercises right away and caused the incision to open up. Fortunately the surgeon was able to clean it up and close it up again with no lasting ill effects and (thank heaven!), and no infection setting in, which was a definite risk -- though they did have me on intravenous antibiotics for a couple of days while I was in the hospital.

Prior to that I also had a bad experience with my left hip replacement. I was doing too much too quickly, in particular, after only a couple of weeks post-surgery I did a longer session on an exercise bike, and at a higher resistance, than the PT guy had prescribed. The day after this too-long too-hard session I had a dislocation of the hip just getting up out of an office chair. The surgeon said that it is entirely possible that this occurred due to trying to do too much to fast. The joint capsule takes a while to completely heal, and the lengthy exercise bike session may have caused the capsule to break open again leaving the hip susceptible to dislocation.

Fortunately it resolved itself in the hospital after a trip to the emergency room with no additional surgery required, and I haven't had a problem since (after 10 months). But the Doc warned me that doing too much too fast could definitely lead to problems. As he put it, "you're not going to heal 10 times as fast by doing 10 times as much exercise as prescribed". I guess I was over eager and -- as my dad would have said -- a little thick-headed. Took two bad experiences to learn my lesson. Got one more hip that may eventually need to be replaced, and if/when that happens I will definitely be more cautious about the post-surgery exercises.

 

[DOCCUKE]

As an update, I recently realized my plan to squeeze 2 more years out of my right knee is not going to work. This past Friday walking the dogs I could not get more than 4 houses away before I could not put any weight on it at all. It is a bit better this week, but I obviously am not going to get 2 years from this beat up old knee. I need to get back to dropping weight and finding a GREAT surgeon in Boston. The guy that hacked my left knee is not touching me again!! Any recommendations for outstanding Boston surgeons welcome
PEACE
DOC

 

[Jockette]

Hi, Doc,

I looked at Boston on our surgeon locator, at the top of our page here, and here is what came up. Not being from the area, I found there are many zip codes for Boston, so I just picked one.

Keep in mind, this is just a list, not a specific recommendation for each surgeon.

This list might be overwhelming, but it’s a start. I do have a report in asking Jamie if she knows someone specific that might be good for your situation. We’ll get back to you on that.

BoneSmart Surgeon Locator

bonesmart.org

 

[Jaycey]

We have a second database with surgeon recommendations - usually from our members. These surgeons are based at Massachusetts General Hospital:

Melnic, Christopher M., MD
Kwon, Young-Min, MBBS, PhD
Bedair, Hany S., MD

 

[DOCCUKE]

Thanks for the information ladies. I will definitely be taking my time finding a surgeon, I just realized that I needed to begin looking as 2 years is just not realistic unfortunately. It may end up forcing retirement earlier than planned, but I will make the best of it. I am uncomfortably close to being unable to walk, that is not an acceptable outcome.
Thanks
DOC

 

[WFD]

@DOCCUKE , I had a revision done with Dr. Matthew Werger at St. Elizabeth's, in Brighton, just outside of Boston. I believe he is a highly surgeon and I recommend him.

 

[WFD]

"highly skilled surgeon" not "highly surgeon'...

 

[InkedMarie]

Was your first one done at Concord Ortho?

Marie

 

[DOCCUKE]

"highly skilled surgeon" not "highly surgeon'...

Whew, was hoping he wasn't high!! Lol.
Thanks

 

[DOCCUKE]

Was your first one done at Concord Ortho?

Marie

Yes ma'am , Dr Neil Dion. Just say no!!

 

[Flashlight]

Jockette, I wouldn't go to any hospital in Philly to have surgery. They are dirty, parking is terrible not to mention traffic. Many of the surgeons do practice at other hospitals that is true. I went to West Chester PA after being seen at Premier Ortho urgent care in Malvern/Paoli. There are quite a few surgeons in that area. Mine was Dr. Andrew Old. I live close to Newark De and would not go to Christiana Hosp. I have been changing over to Penn Medicine.

 

[Sybilla]

Was your first one done at Concord Ortho?

Marie

Yes ma'am , Dr Neil Dion. Just say no!!

As long as we're naming names, do not go to the bottom of the list, despite his title and the (renowned) hospital... And Iorio belongs to the same elite (read "arrogant") group although his PA is really good. Smith may be an outstanding "framing carpenter" (my new knee sports a very sturdy, functional, elegant joint), but he is indifferent to finish carpentry with no regard for pain. And your muscles, tendons, ligaments and fascia matter just as much as your bones...
Hey Doccuke - you probably don't remember me, but I was in your club (awful, awful experience April 2019 right TKR) and I'm still in your club (will need left knee done w/in 2 years). Believe it or not I JUST got rid of the last of the pain in my surgery leg (it was never just the knee that was in pain). I did PT for >1 year (until the pandemic), then chiropractic, followed by more PT (after pandemic subsided), and more chiropractic. FINALLY I discovered massage (this Labor Day just passed) and it was like magic! Two days immediately following the massage where I could barely walk and then the cloud (of pain) just lifted. I can finally hike with my family again, and can practically "hustle" when I'm in a hurry. I haven't had time to read this whole thread to find out how you are doing, but hopefully better than me. Or as well as I'm doing now! Ironically enough I came back to this board looking for surgeon resources/references because now that my surgery leg is better, my old knee is much more of a problem. So I will be following, but I'm not sold on using a "hot shot Boston doc" - I tried that the first time. I think I might have a better outcome with one of the local/regional "bests" that so many others recommend (because they had a great outcome). Thanks for the post!
Sybilla

 

[DOCCUKE]

Greetings
I wanted to ask if anyone has a recommendation for an excellent surgeon in Boston for a tkr. Preferably someone that has had many large patients. I know I have to drop weight from where I am now at 340 pounds, but even if I get to my goal weight that is 260 to 270 pounds. Reason I say this is the implant I got on my left knee is apparently inferior. After I woke from surgery and asked the doctor how long before I can do squats in weightlifting he replied NEVER as he stated that would break the implant!! I wanted to slap his head off his shoulders. I have a Zimmerman persona that apparently even had a recall. He. Said this one was "ok" because it was cemented in.
My anger with that is I am a large person. 6'4" with heavy muscle mass . Why would a doctor put an inferior implant in someone my size?
More a rhetorical question at this point. In any event I am hoping to find a doctor that is actually good at what they do and has had experience with larger folks
Any suggestions appreciated. My right knee is so bad I am approaching not being able to walk.
Thanks
Hope everyone is pain free
Peace
DOC

 

[Layla]

We have a second database with surgeon recommendations - usually from our members. These surgeons are based at Massachusetts General Hospital:

Melnic, Christopher M., MD
Kwon, Young-Min, MBBS, PhD
Bedair, Hany S., MD

I wonder if you had time to check out any of the surgeons, Jaycey, listed for you back in October?
I am sorry you're struggling as you are and finding it difficult to walk. I wish you all the best in finding a surgeon to help you.

 

[DOCCUKE]

I need to find that page & look at her recommendations. I wanted to st least start narrowing down who would be best to go to. I am hoping to find someone that is experienced with larger people. Hopefully if I get a good tkr in the right I can get by with my left tkr. I really do not want a revision surgery
I doubt I have more than 10 years left in this life. I would rather not spend most of that time healing from surgery. I went to CMC ER a few weeks ago as my BP was 180/90 with nasty chest pains.they did a cardiac catheterization & found fluid on my heart an an artery 50% blocked. In general the last 5 years, day to day I feel pretty unhealthy. Hate my job but not a great time to.look for a new one at 65 and Dr appointment for something at least a few times a month. In the last 2 years I have had 5 eye surgeries for glaucoma & cataracts. I never have any vacation time as I use all my PTO time for doctor appointments. Getting pretty dang tired!!

 

[Layla]

I am really sorry you've dealt with so much and continue to. I hope with the care of good medical professionals you're able to turn some of this around for a better quality of life. All the best to you!

I need to find that page & look at her recommendations

Here are the names she left for you -
Melnic, Christopher M., MD
Kwon, Young-Min, MBBS, PhD
Bedair, Hany S., MD

In addition, Jamie, also from Admin left this list for someone about 3-4 months ago, but these surgeons are not local and you'd need to travel so that may eliminate them right off the bat for you.

Per Jamie from Admin -
Unfortunately the 40 BMI is the standard cutoff for most surgeons, due to the higher risk of infection associated with high BMI patients. But there are doctors out there....you may just need to travel to consult with them. Here is the list of surgeons to try.

Orthopedic Surgeons for Hig BMI Patients
Washington DC

Bethesda
Dr. Sridhar M. Durbhakula
Hip and knee primary and complex revision (recommended by Mark)
Works with high BMI patients also


Chattanooga, Tennessee
Dr. Kristopher Case Sanders, MD
Anterior/posterior hips, works with high BMI patients
Erlanger Orthopaedics
979 E 3rd St,, Suite C-430
Chattanooga, TN 37403
423-778-4900


Cleveland, Ohio
Cleveland Clinic
Primary and revision hips and knees
Dr. Bernie Stulberg(Cleveland Clinic) - works with high BMI patients
broken link removed: https://my.clevelandclinic.org/staff/13835-kenneth-greene(Medina/Cleveland Clinic) - works with high BMI patients


Durham, North Carolina
Dr. Ralph Liebelt (now retired)
120 William Penn Plaza
Independence Park
Durham, NC 27704
Phone: 877-959-2856
Works with high BMI patients. Recommended by Mark (via Daniel Hill; Area Director, NC, Joint Replacement; (919) 632-6352 Call to see if other doctors in practice will accept high BMI patients.


Richmond, Indiana (on the border with Ohio)
Works with high BMI patients.
Mario Lee, M.D.
Reid Health
1400 Highland Rd, Richmond, IN 47374
(765) 935-8905
Reid Hospital Orthopedics

 

[DOCCUKE]

Thanks for the information. Pretty sure as long as I get below 300 pounds I am below 40 BMI. I am more concerned with finding someone that will use an implant that is made for someone my size as opposed to the implant in my left knee that will ,break according to my doctor that put it in me. I know guys that are larger than me the got tkr surgeriey & were able to get back to significant lifting. I have to assume that the device installed in my leg is not particularly sturdy

 

[InkedMarie]

@DOCCUKE hello! I’m in Gilford, had four joints replaced at Concord Hospital. Have you inquired with them?

I have a sister in law in Framingham MA who is a bit larger & had a knee replacement. Would you like me to find out who did her surgery? Ooh. I have another MA friend who had a TKR. I’ll ask her as well, if you’d like.

Marie

 

[DOCCUKE]

I will check out anyone that might be good. I had my left knee done at Concord hospital. The hospital care was great, the surgeon should be cutting meat in shaws.

 

[DOCCUKE]

Good evening

Update, I am in the process of trying to get an appointmrnt with Dr Chris Melbic. He was on the list of doctors I got from here.Have left 2 messages and tried their website. If he doesn't get back to me soon I will have to try someone else. My right knee is getting worse by the day, couldn't sleep more then a couple of hours last night, now laying down spikes the pain up to about 100 on a scale of 1 to 10. I am guessing something tore somewhere

Wish me luck, I would like to get the process started as I know nobody is going to dO surgery right away. I am close to not being able to walk at all. I find my 1 to 10 pain scale keeps moving!! What used to be a 10 is maybe a 5 now as it keeps getting more intense.
Hope everyone is pain free as much as possible

Peace
DOC