Total knee replacement

[spikey]

Less than an hour ago, I got an appointment to see a consultant first thing tomorrow morning about a total knee replacement. So there's a bit of a flap on here  ...

I'm mid-70s and my BMI's currently 22.6. Not on any medication, no history of medical problems, non-smoker, hardly drink, and am reasonably fit considering. Don't have a car so go everywhere on foot or by bicycle (>1000 miles a year, mainly on pedelec nowadays)

If you've had a TKR, what do you wish you'd known beforehand? What specific questions should I ask this chap? 

[woodenhead]

Generally I would imagine:

• What are the risks
• How long will I remain immobile (probably not very long)
• How long will I be in hospital (similar, they'll want you out asap)
• How quickly will I be walking
• How long before I can ride my bike again (probably not as long as you imagine)

My mother in law was down for one and she turned it down for personal reasons but nothing to do with the operation itself as her sister in law had had one and she seemed fine afterwards.  But waiting longer has meant more limping which then afflicted her hip due to the compensation on the other leg so now she's in a worse place than before and back on a waiting list to be seen before they set a date for the op.

[spikey]

Cheers woodenhead.  I know I'm reckoned to be out of hospital no later than 3rd day post-op and I know they say anything from 6 months to a year before I'm 100% back to rights, but I guess so much of it depends on all manner of variables.

 

I'm just trying to avoid the situation where on my way back home from tomorrow's consultation I'm thinking I wish I'd asked him ... whatever 

[woodenhead]

Forgetting to ask something is par for the course for any stressful event - hospital, job interview or doing an exam - after the event we always remember the things we forgot.  It's in the rules

[RedgateModels]

Don’t do what my ex brother-in-law did and ignore advice given by docs after the op. He was told not to go back to his warehouse job but did and buggered up his shiny new knee 

[Metr0Land]

One possible question to ask is whether all replacement knee parts are created equal or do some perform better than others, and how does the specific one your surgeon will use compare with others.

[rab]

I shall be following your progress with interest.

 

My brother is badly in need of knee replacements (x2).

We are trying to persuade him to at least get his name on the list,

but his excuse us always " I need to get this or that done first ".

He is also now reaching the stage where his hips are beginning to suffer as well.

 

I hope your op goes well and look forward to hearing of your recovery.

[sjp23480]

I know friends and relatives that have had the op and I would ask about the physio/exercise routine post op, I think you will told to do extensive stretching exercises every day.

 

I would ask how long it will last, assuming you follow all the guidance.

 

I would not recommend you have both done at the same time - my father in law did this and was never the same again.

 

Good luck!

[Rivercider]

My sister had a knee replacement some years ago. Edit - she is very sporty so they assumed it was wear and tear. 

During a chat with the consultant shortly before the op she  casually mentioned she also had 

aches and pains in other joints. He then changed his plan as it turned out her leg bone was also eroding, so the original plan would not work.

 

After the op she was not given clear instruction on what exercise or rest she should be doing to aid her recovery, so you might want to ask about that.   Edit sjp23480 has just suggested that!

 

Cheers and good luck

Edited January 17, 2022 by Rivercider
Already suggested!

[Siberian Snooper]

My local pub landlord has had his knee op cancelled 4 times so far, he should have had it last week,  his health is seriously deteriorating as a result, both physically and mentally.

 

 

[spikey]

Thank you one and all.  The hospital seems to be very keen on post-op physio and as an ex-runner I'm a firm believer in doing exactly what the physios say.  I'm going to be particularly interested in what yer man has to say about anaesthesia, as it looks like an epidural (or somesuch) is preferred rather than a general.  

[DIW]

1 hour ago, Metr0Land said:

One possible question to ask is whether all replacement knee parts are created equal or do some perform better than others, and how does the specific one your surgeon will use compare with others.

A supplementary to this - do you need a whole knee, or a half-knee replacement, and why the chosen choice?

[didcot]

Various Grandparents had replacement knees back in the late 80s. They definitely benefited from it. Although back then they were kept in for several weeks.

My Grandfather had 3 replacement knees, no he wasn't Jake the Peg with the extra leg. Complications mean the second became a third which was also removed leaving the bones to knit together and gave him a permanent straight leg. Even then he was happier without the joint pain. He had to have epidurals for all but the first knee and recovered quicker. 

[Jonboy]

Not so much for tomorrow but If you have any other relevant conditions make sure the physio team will be informed before the procedure…Physio turned up to father in laws bedside for the first session post-op having not been informed he was an amputee, and had to go away and consult on how the standard routines could be adapted…

[sjp23480]

39 minutes ago, spikey said:

as it looks like an epidural (or somesuch) is preferred

Combined with VERY loud music through headphones! 

[Michael Hodgson]

Best wishes for your Op and I hope the covid situation doesn't cause you too long a wait.  From what I have heard, they have quite a backlog and they might be setting up specialist centres doing nothing else; this should be faster if you are prepared to travel a bit further from home.  Luckily I only had to wait a few months before the first planned date for the op.

 

The diagnosis started with an X-ray, and is apparently often followed by an MRI or CT scan - but in my case they took one look at the X-ray and said it was obvious that replacement was needed.  

 

So I had my left knee replaced about 2 1/2 years ago, and it is essential that you do exercises to rebuild strength in the leg afterwards - these are necessary to regain your mobility, as you lose a lot of strength in muscles unused while you are recuperating and it is important that you gradually increase how far you can bend the knee.  The op was done under an epidural - they don't like using a general because of the risks, especially as I have had an irregular heartbeat for over 30 years and I'm still under Harefield hospital.  My heart condition was the cause of the planned operation being cancelled at the hospital that had been going to do it and a couple of months more delay for it to be rearranged.  However as I had said I was squeamish and didn't want to watch or to know what they up to, they gave me enough anaesthetic  that I was for all practical purposes out of it.  After the op I did all the exercises I was given (perhaps not well enough?) but I had real difficulty because I couldn't bend the knee sufficiently afterwards despite quite a number of trips to see a physio.

 

This does happen in a fairly low percentage of cases.  A few months before covid they therefore did a further op described as manipulation under general anaesthetic.  That is, they knock you out, then shift it - by brute force, which sounded pretty gruesome & frightening,  However that did the trick, and I was mobile again fairly quickly thereafter.   

 

The replacement joint still doesn't bend quite as far as the one I was born with, that's normal, and the one permanent problem with the replacement is that I can't now kneel on that leg. I gather this applies to most patients who have had knee replacement (not just those who have had this manipulation).  I also find it a little bit more difficult to get up if I'm on the floor, and if I knock into something with the artificial knee it still stings somewhat more than it did with the real one.  These are all more of an inconvenience than a real problem, but it doesn't help if you want to work under a baseboard!   I still count the whole thing as a success because I can walk without the pain I was suffering before I had it done.  So please don't let my story put you off - I would definitely still have the op if I had my time over.

 

It would seem logical that if you've worn one leg out the other has probably walked just as far, so should be equally worn, also if one knee joint is failing, the body probably compensates by unconsciously putting more weight on and thus stressing the other, and if that means walking slightly lop-sided possibly stressing the hip joints?   But I've not got pain there, so I'm hoping I won't need to have the other knee or a hip done - I've got a follow-up appointment soon.   I was told that if you need both knees replaced, they would do first one then the other after you've recovered, but if both hip joints need replacing, they can be done at the same time. 

 

[Ozexpatriate]

9 hours ago, spikey said:

If you've had a TKR, what do you wish you'd known beforehand? What specific questions should I ask this chap? 

Not had one. I know someone (in his early 60s) who did. Like others have suggested you should ask about the rehabilitation process.

 

There will likely be lots of physio-therapy. This might be painful. You should ask about the extent of this (how often and for how long) and what pain management plans they will have, including what they will prescribe - in light of recent coverage of opioids (which also have a lot of side effects).

[Oldddudders]

The OP is an orthopod's dream - BMI smack in the middle of the green zone and believes in real exercise. They waste an awful lot of effort on overweight folk who never work hard enough afterwards to get the full benefit of the op.

 

Subject only to surgical expertise this will be a complete success. 

[Compound2632]

All the best. I clicked on this topic thinking it might be about wagon building...

[spikey]

Just back from seeing the knee bod.  I'm now on the list for new knee in about three months, courtesy of the NHS

[boxbrownie]

I had my right knee replaced last year, smack bang in the middle of the lockdowns, it was opportune actually as instead of being carried out in the general hospital I was put into the local Nuffield Hospital (because of the precautions at the main hospital), I had the initial diagnosis in late 2019 and was told both knees needed replacement as severely worn (40 years of walking around carrying heavy camera gear ) , anyhoo the important bit was it went perfectly, I had heard some horror stories but my story was the hospital was like a hotel, lovely…..they gave me the choice of spinal or general and they recommended spinal (they won’t recommend but I asked if it was their choice what would they have) , I had spinal which initially was a bit odd and frightening for a few minutes as you just cannot move your legs, horrible….but then the other “juice” gets going and you feel great and that’s it…..although I do remember waking slightly during the op….no feeling or pain at all just remember seeing the sheet in front of me my foot high up and a lot of noise, the. I fell asleep again and that was it until recovery, apparently sometimes the sleepy juice needs another “push” but I thought it was quite funny and my surgeon did when I asked him if he was assembling a flat pack wardrobe it was that noisy!

 

Recovery went well, I was in for three days then home…..two crutches for the first week, one crutch the second and then walking stick for another week then I was wobbling around fine, after two months it felt like it had never happened and it’s been perfect ever since, no aches, no pains and I am actually looking forward to getting the other one done.

I did “most” of the exercises given but I feel the most important exercise was the straight leg stretching and forcing (gently with your own muscles) your knee back while laying flat/sitting……it is apparently the tightening of the muscles which cause most issues and stiffness.

 

My first visit post op to the surgeon after six weeks was a surprise for him I think as he was amazed how straight I could get my leg, easily that same as before (or better).

 

My only trepidation now is my surgeon has now moved back to Essex (he was here as locum) and I won’t get him again.

 

Maybe I shouldn’t have told you about the “wardrobe” incident…but honestly it was funny and just odd and dreamy at the time 

 

Good luck, but you shouldn’t need it as my Son (the Doc) said they do three or four a day, they tend to know what goes where.

[boxbrownie]

And the scar is almost neat and tidy too, although our GP nurse who took the staples out said she had never taken thirty one out of a knee before 

 

Dont worry, that didn’t hurt either.

[Nearholmer]

All the best with this Spikey. 
 

Kevin

[Chris116]

My wife had a hip replacement in February 2020 and a knee replacement in June 2021. Both done in Epsom hospital. Both went well and she is pleased with having had them done. Knee was more painful afterwards but soon settled down. The most important thing is to do all the exercises they tell you to do. Every day, without fail and you will have a much better outcome than if you skip the exercises. Good luck.

[spikey]

According to my Lady Wife, my biggest problem is likely to be not over-doing it with the exercises ...