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wberry's First Timers TKR Nervous Cat

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wberry said:
There is a guy who before his knee replacement he had stopped playing golf and was barley getting around. Now he is leading the roster and killing everyone with natural knees.
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I can very honestly tell you that, when you are full recovered, you will be amazed at how great you feel and what you will be able to do and to enjoy.
 
Can anyone tell me the pros and cons for the two types of knee joints Fixed and Floating from your personal experience if you have either. From what I read the floating works more like a real knee. I am sure my ortho with have an answer for me based on my activity level. But I want to be able to hike, mountain bike, light skiing, play tennis and do all of my photography stuff including weddings again. If any have one or the other type can you comment? @referee54 can you or one of the other moderators point me to some post, my search is not yealding what i want
 
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Tomorrow I will hopefully have a date. I told my wife I plan to take my vacation when I am in recovery.
I plan to work hard and smart to get recovered in the most positive way. I will keep ya posted.
 
Lets see, here is my list of questions for tomorrows appointment @Maggie94, @referee54 :

Am I a good candidate for a bilateral TKR?
How many Knee replacements do you do a year?
What are your feelings about doing TKN, when and why?
Have you done bilateral total knee replacements before?
Will you be the only surgeon or will there be another and what is his experience?
I know there are other surgeons in this group are there any more experienced than you at TKR?
Who will do the closure?
Will closure be with staples or sutures?
How long will you keep me on coumadin to prevent blood clots?
Have you had any revisions needed following a replacement and why?
Which implant hardware do you prefer and why?
Do you think I should get fixed or non fixed and why?
What do I need to do now to prepare for my TKR?
What do you think my recovery will be like based on what you know about my case?
How long should I plan to be in recovery before I go back to work?
Do I need an inter-venial caver filter installed?
Which surgery procedure will be used, Frontal or side minimum invasive?
How will my pain be managed during the procedure?
Pain-management protocol---what pain meds I will be on, for how long.
 
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@referee54 Unfortunately, I will be the only one at the appointment. I have them printed out and will have a copy in case the doc wants to take them and send me a detailed reply.
 
wberry said:
@referee54 Unfortunately, I will be the only one at the appointment. I have them printed out and will have a copy in case the doc wants to take them and send me a detailed reply.
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Good idea! Leave room on your copy to scribble some notes, too.

You may find that the doctor who did your previous surgeries does not do TKRs. If that's the case, get a couple of referrals from him and make appointments to interview them. You've certainly done your research!
 
This was the longest appointment I have ever had. He had full xrays of both knees done. he checked movement, had me stand and walk. During my question both his nurse and assistant came in at different times, I think they are trying to let him know he was taking to long with me. But they didn't say anything, he just introduced them and they stood there. I was a little disappointed with the idea of doing them one at a time, but he spent a lot of time covering the reasons and the risk factors. Here are the questions and answers i got. Please let me know what you all think

Am I a good candidate for a bilateral TKR?
Answer - yes, but I prefer to do one knee and then the other knee a month or more later. Reason? - risk factors to system fat deposits in blood from bone drilling and work travel to lungs and brain, recovery issues, blood loss, need for blood transfusions. Worry about recovery and the lack of a non-operated or recovered knee to support me. There was more, but I think he convinced me that we could get them both done, just spaced apart a bit.

How many Knee replacements do you do a year?
150-200 depending on patient flow. Across the practice the 5 doctors combine for a little less than a thousand a year. In a good week he does 4, in a slow week he does 1-2.

What are your feelings about doing TKN, when and why?
Your time frame is excellent, gives us time to take care of all prep items, blood work up by your primary care, dental care, stretching and exercise and core strengthening exercise.

Have you done bilateral total knee replacements before?
Yes, but my strongest preference is one at a time.

Will you be the only surgeon or will there be another and what is his experience?
My PA has 15 years experience and assist, also Dr. Chase may also assist.

I know there are other surgeons in this group are there any more experienced than you at TKR?
Yes, Dr. Jones and Dr. MaCheffer have been practicing longer and thus has more experience.
I have been doing TKR for 13 years, they have been doing them for 17-20

Who will do the closure?
My PA normally

Will closure be with staples or sutures?
We prefer staples, but we will do sutures if you like, we find stables are easier and less painful to remove.

How long will you keep me on coumadin to prevent blood clots?
Xarelto for 2 weeks and then aspirin for 4-6 weeks
**I have looked this one up, and I see lawsuits about it, any ideas

Have you had any revisions needed following a replacement and why?
Not for the initial surgery, for revisions of patients that had bad TKR from other surgeons yes I have done them. The only revisions have been due to infections and we have an extremely low infection rate of less than 1%.

Which implant hardware do you prefer and why?
Smith-Nephew Oxinium Genesis II
** I forgot to ask if this is cement or cement-less, I will call and ask.
Anyone know much about this one

Do you think I should get fixed or non fixed and why?
Fixed - I find the difference is not substantial and the floating just adds an additional wear surface to add to faster revision issues in the long run.

What do I need to do now to prepare for my TKR?
Gave me a 8 page brochure of prep and actions to do. They had all the usual things i have seen in the forum.

What do you think my recovery will be like based on what you know about my case?
2 nights in the hospital and then you are at home., PT regiment 3 times a week.

How long should I plan to be in recovery before I go back to work?
Becuase you are doing desk work he might allow light desk work at 4

Do I need an inter-venial caver filter installed?
You have never had a case of blood clots, need for blood thinners, or heart issues so no.

Which surgery procedure will be used, Frontal or side minimum invasive?
Frontal, better alignment

How will my pain be managed during the procedure?
Spinal and general Anastasia

Pain-management protocol---what pain meds I will be on, for how long.
Oxycontine
 
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wberry said:
How long should I plan to be in recovery before I go back to work?
Becuase you are doing desk work he might allow light desk work at 4
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I am betting that this is too soon. It is not about the light desk work---the logistics of getting up, getting breakfast, lunch packed and getting to work can cause big-time issues---and then you reverse everything at the end of the day.
 
I have a couple burning questions I need advice on: @referee54

1. When I go to the website about the knee device he told me he used, it looks like it is a cement-less. Can anyone verify that or tell me if that is the case. I forgot to ask him that, but I will call his office next week and ask.
2. The spinal block, is there any risk of spinal cord damage with this type of process before surgery?
3. How soon can someone go back for the second TKR on the other knee?
4. Should I be concerned because he doesn't want to do the Bilateral or is his reasoning sound?
5. This is a fixed not a rotating device. I see a lot of folks on here that are active with floating, hat should I be thinking?

This last comment is not a question but I wanted to tell you what I saw on my xrays. The right knee is completely bone on bone on the inside, the upper and lower bone are actually out of alignment and it looks like it is sliding off to the inside. The left knee looks better, but the spacing is ans low as the lowest point on the right knee. The doctor took one look and said yeap, it is defiantly time.
 
wberry said:
5. This is a fixed not a rotating device. I see a lot of folks on here that are active with floating, hat should I be thinking?
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Trust your OS---he knows more about these than do you---most of them work with a specific company or two and their reps (my BTKR surgery was delayed about 15 minutes ans the Stryker rep was not there quite yet.) Let you OS choose the correct implant to meet your needs and your physiology.
wberry said:
Should I be concerned because he doesn't want to do the Bilateral or is his reasoning sound?
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No---many OS's rarely perform BTKR's---one reason is that it is very tiring for the OS themselves! I believe that he is looking out for what is best for you.
wberry said:
How soon can someone go back for the second TKR on the other knee?
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I think Kelly @skigirl had her TKR about a week or so after the first one. Others vary--weeks, a month or a couple of months, up to a year or so.
wberry said:
The spinal block, is there any risk of spinal cord damage with this type of process before surgery?
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With any type of anesthesia or surgery , there is always some sort of risk---but I can tell you that my spinal was wonderful for my BTKR---the last thing I remember was the anesthesiologist saying, "You are gong to feel a little drowsy now..." The next thing I knew, I was being wheeled to recovery..

As for your implants---I am not sure---maybe somebody who has them will chime in for you.
 
Several people on the forum have had one knee followed by the second in weeks or months. My doc normally just uses aspirin for blood thinning once you go home, but b/c I can't take NSAIDs, he presribed Xaralto. No problems.

Your doc gave what seemed like very satisfactory answers to me. Of course, you are the one having surgery with him. :wink:
 
I am pretty sure your OS will use cement with the Genesis knee---most knees in the US are cemented. Spinal anesthesia has a very high safety record.

I had my knees done a year apart--my doc also will only do one at a time. There have been folks here on Bonesmart who have had them done a few days apart---it seems your doctor wants to do them a month apart, which seems reasonable to me.
 
Xarelto worked "too well" for me for my second TKR....went back to regular aspirin about 5 days post RTKR....

Nearly two years out on my LTKR and just over a year on my RTKR....activities....this week....7K Yards in the pool, 6 miles walking and 2 nights of strength training. If you have any doubt about TKRs making a difference, they surely do!!

Best of luck!!
 
Thanks folks, i am feeling better, I also found some recal info online on the same implants but it is back from 2007-2010 time frame:
Recall issues with cement less device: broken link removed: https://www.fda-reports.com/knee-implants/

Base plate performance issues: broken link removed: https://smithandnephewrecall.com/
 
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