Building decision for knee surgery

[Pumpkin]

Jeffntate,
I say find a surgeon you have confidence in, and then trust them to make the right decision for you once they have the knee open and can see the condition of your joint.

They may go in expecting a partial, but end up with a TKR if they see damage to the other compartment.
The condition of your knee will determine if you need a PKR or a TKR.

 

[Josephine]

My anxiety is high about all this. I fear having the surgery and I fear not having it.

I can tell!

I'm doing the 120 leg lifts a day now but am so afraid of pushing any harder out of fear of making the knee pain skyrocket out of control (hit 9/10 yesterday).

This is not advisable. If your knee is arthritic, then stop all this craziness and let it rest!

I was told to lose weight and that knee replacement isn't a slam dunk like a hip replacement and some are not satisfied.

Honey, there is always a number of dissatisfied patients with every surgery, even an ingrown toenail! But you should take this one board: knee replacement is now the MOST performed and MOST successful surgical procedure in medical history - ever! And further to that, nearly 2.9 million joint replacement procedures take place worldwide, annually – including more than 1.4 million hips, 1.1 million knees and more than 100,000 shoulder replacements. And yet the rate of dissatisfaction remains remarkably low.

I read that those who have a lot of pre-op pain tend to have more post-op pain even long term.

Really? I've never heard that! It's an urban myth!

I'm trying to take the minimum amount of narcotics but the less I take them the less I can do so not having much luck lowering my dose and usually I have to take more at night. I take close to 200 MME of pain meds

What's MME? Never heard that acronym before. But as for using pain meds to cope with an arthritic knee, it's not a battle you'll ever win because there is no pain med known to man that will manage this. What you need is a knee replacement!

Should I try to do cardio which I've not done much of since 2014?

Absolutely not! Your knee might not be locking up now but if you do that, it will do.

My BMI is 26.5

That BMI is pretty near perfect for surgery - well done you!

 

[Jeffntate]

Sorry here is the other partial knee replacement: https://www.visittoc.com/specialties/joint-replacement/arm-assisted-partial-knee-replacement/

 

[Jeffntate]

200 MME = Morphine Medical Equivalent. I take Oxycontin and Percocets every day of about 110-120 mg/day of combined oxycodone

 

[Jeffntate]

I'm going to get my knee fixed. Its just a matter of what surgeon and when. I fear I have waited too long and now its getting to an emergency level.

 

[Jeffntate]

Should I go to a big university hospital like Emory in Atlanta or Vanderbilt in Nashville to get a top notch surgeon, or go to a fellowship trainined local surgeon that is only 5 miles from my home?

 

[Jeffntate]

Its not the surgery I fear or the anesthesia, but the post op pain. I'm terrified because I take narcotics now for the pain. Should I be trying to reduce my narcotics as much as possible and use ice and rest, or stay where I am until I get a surgery date and then try go go down a couple weeks before surgery, or what? What else can I do to handle pain before surgery?

 

[Celle]

Yes, we've heard of the Mako - several people on BoneSmart have one.

However, it's not the type of knee replacement used that guarantees a good result. It's the skill of your surgeon.

Josephine has managed a suite of operating theatres for many years and she has assisted at many knee replacements. She knows what she's talking about.

 

[Jeffntate]

Can Josephine help me pick a surgeon?

 

[Jeffntate]

Actually anyone who has time to help me decide. My knee is killing me and I have it on ice right now

 

[Celle]

Should I go to a big university hospital like Emory in Atlanta or Vanderbilt in Nashville to get a top notch surgeon, or go to a fellowship trainined local surgeon that is only 5 miles from my home?

I say go to a big hospital, rather than your local one. They get more patients in the big hospital and will have a more extensive range of experience. They also do more knee replacements each year, whereas your local surgeon is likely to do a range of different surgeries.

Try to see surgeons who are not just enthusiasts for partials, but do plenty of totals as well.

Its not the surgery I fear or the anesthesia, but the post op pain. I'm terrified to be on such a strong dose of narcotics going in. Should I be trying to reduce my narcotics as much as possible and use ice and rest, or stay where I am until I get a surgery date and then try go go down a couple weeks before surgery, or what? What else can I do to handle pain before surgery?

Once you find a surgeon you have confidence in, you should discuss a plan for pain management after surgery. There isn't just "one way fits all" and there are plenty of ways of relieving pain post-op.
It's likely that you will be asked to reduce your dose of narcotics pre-op, so they will be more effective post-op.

In addition to intravenous and oral pain relief medication, some surgeons will place a local anaesthetic inside your knee capsule during surgery, which will reduce your pain for several days. You can also be given a nerve block that lasts for about 24 hours post-surgery.

There is a device called ON-Q that will deliver pain relief to your knee for several days post-op.
https://avanospainmanagement.com/solutions/acute-pain/on-q-pain-relief-system/

You should read these articles:
Pain management during TKR surgery
Pain management: importance of managing pain after a TKR and the pain chart
Pain management: New methods may help decrease side effects compared with traditional methods
Pain management: the multimodal approach
Pain management: topical pain relief
Pain medications: alternatives for those with liver issue

Are you using ice now to help control your pain? Ice is a good pain reliever, both before and after surgery:
Ice to control pain and swelling

 

[Jeffntate]

Should I send a list of orthopedic surgeons by PM or post them here for feedback on the doctors I'm considering?

 

[Celle]

Can Josephine help me pick a surgeon?

Actually anyone who has time to help me decide. My knee is killing me and I have it on ice right now

I already advised you in one of your other threads (I think) to use the "Find a Clinic" resource in the blue bar at the top of the page, or to post your zip code and tag Jamie:
https://bonesmart.org/forum/threads...er-how-to-answer-when-someone-tags-you.15223/

 

[Celle]

Should I send a list of orthopedic surgeons by PM or post them here for feedback on the doctors I'm considering?

Jeff, please can you keep your questions about finding a surgeon all on the same thread? Jumping from one thread to another is making me dizzy and I think you're missing some of the advice you've been given.

On second thoughts, I'm going to merge your threads, so that you have only one.

 

[Celle]

Now I've merged both threads. Please can we keep your pre-op discussion on this one thread?

I already advised you in one of your other threads (I think) to use the "Find a Clinic" resource in the blue bar at the top of the page, or to post your zip code and tag Jamie:
https://bonesmart.org/forum/threads...er-how-to-answer-when-someone-tags-you.15223/

Should I send a list of orthopedic surgeons by PM or post them here for feedback on the doctors I'm considering?

You need to do your own research first. Use the "Find a Clinic" facility to get a short-list of surgeons who you'd like to consider.
Then do some phoning of their clinics to ask questions.
Here's some information to help you with those:
Choosing a surgeon and a prosthesis
Anaesthetics - spinals, femoral blocks, GAs and everything else
Closing surgical wounds: how is it done?
FAQs - Questions/Answers about Knee Replacements

Jamie may, or may not, have some recommendations in your area, based on the experience of other BoneSmart members who have used them.

 

[Jeffntate]

Yes. Thank you. Will you see if this place looks big enough?

https://www.visittoc.com/specialties/knee-center/

Here is the doctor who has been following me locally. https://www.visittoc.com/people/christopher-parks/

 

[Celle]

As I live n New Zealand, I have no way of knowing either the facility or the surgeon. Let's ask @Jamie . She is not very well at the moment, but she will respond when she can.

I would be very wary of the clinic you referenced above, because of the false information given in their web page, quoted here:
In traditional surgery, the surgeon makes an 8 inch incision down the front of the knee, and tendon and quadriceps muscle (which control the bending of the knee) are cut.

That's an advertising ploy and it's, frankly, untrue. As Josephine and I have told you, almost no surgeons cut the quads nowadays. Quad sparing isn't new. It's standard procedure now.

 

[SusieShoes]

I agree with Celle: Be wary of clinics or surgeons who claim they are doing cutting-edge quad-sparing knee replacements. Only rarely does any orthopedic surgeon doing a PKR or TKR cut the quad-muscle, and if they do it’s because there’s a reason to do so (reasons most people never present). “Quad-sparing surgery” is a straight-up marketing ploy.

Pain is so very individual. There’s no way to compare pain between two individuals. But I had horrible knee pain before surgery. 9-10 every day, whenever I walked or stood. In both knees. And for two months before surgery I didn’t take painkillers. None. Just ice and Tylenol (and the Tylenol didn’t work). I had bilateral total replacements. And for me the pain after surgery was not worse than before. My pain control was good and my recovery became less painful every week. Now I have two fully functional, pain-free — yes, completely pain-free — knees.

My result is no guarantee of what you might encounter. I just bring it up to show that 1) super bad pre-surgical pains does not automatically mean more pain post-op, and 2) total knee replacement can provide excellent results.

I hope you soon find a surgeon you trust. Once you do, you may feel less anxious. Don’t be afraid to interview surgeons and ask questions. Also, you are more likely to find a first-rate surgeon in a bigger hospital or near a big city/university. The main thing is that the surgeon have a record of doing lots of these surgeries and having LOTS of happy patients who recovered from the surgery.

 

[Jeffntate]

My local rheumatologist suggested it would be a lot easier on my family to go to the local TOC or SportsMed center. The nearest university hospital is 2 hours away from us, in Nashville or Birmngham. The guy who did my hip replacement is in Atlanta which is 4 hours away from us. Would you go that far?

 

[Jeffntate]

What are the rules or guidelines about ice therapy pre-op? I find that this works best for me, but right now I have only 1 of them, plus some lesser ice packs that are mostly for my neck but are not as good, Can I use this all the time, or 50% on 50% off? I can't cut and paste the Amazon link, but the title is:

Vive Knee Ice Pack Wrap - Cold/Hot Gel Compression Brace - Heat Support Strap for Arthritis Pain, Tendonitis, ACL, Athletic Injury, Osteoarthritis, Women, Men, Running, Meniscus and Patella Surgery