Knee Replacements: 10 Things Doctors Want You to Know

Hello, fellow knee warriors!

It’s been a considerable amount of time since my last post and I am continuing to do well. The third anniversary of my left knee surgery is coming up in September, and it will be four years next January since I had my right knee done.

On that note, here is an article I found on Healthgrades on what doctors want patients to know about knee replacements.

Patient with knee pain

 

Knee replacement is one of the most common orthopedic surgeries in the U.S. It has a high rate of success, but it’s not a walk in the park. Some top doctors talk about common misperceptions and the actual experience a knee replacement patient can expect.

The decision to have knee replacement surgery is YOURS.

“There have to be X-ray findings of arthritis, which means the cartilage is completely or almost completely worn out. But it is totally up to the patient when to proceed, based on how bad their symptoms are,” says Thomas Bradbury, MD, an orthopedic surgeon with Emory University Hospital in Atlanta. “Wear and tear of the knee is like treads on tires wearing out,” says David J. Mayman, MD, an orthopedic surgeon at the Hospital for Special Surgery in New York City. “If the ‘tire’ wears out, the only eventual option is going to be knee replacement. It depends on whether nonsurgical therapies are helping with pain and function.”

Patients who have realistic expectations about knee replacement surgery do best.

“I think the patient expectations part is huge. What’s critically important is that patients recognize what a knee replacement is,” says Dr. Mayman. “All too often patients come in and say, my knee hurts, and they assume they will have a knee replacement and all of a sudden they’ll have a knee just like when they were 16 years old. Knee replacements are very good, but they are not normal knees.” “If a patient is not given appropriate expectations, those are the ones that have a difficult time,” adds Dr. Bradbury. “I tell my patients for the first two weeks after surgery, ‘you will cuss my name on a daily basis, and then by two, three weeks you will have recovered enough to start to see the light.’”

You’ll probably do well, but your new knee will have some limitations (NOTE: I can certainly vouch for this!)

“Squatting and kneeling activities are difficult to get back,” says Scott Anseth, MD, an orthopedic surgeon with Abbott Northwestern Hospital in Minneapolis. Hiking, golf, and some tennis are all reasonable, but “impact activities, such as running, are unrealistic,” he adds. “You often end up with some numbness in the skin around the knee and the new knee looks bigger than the other side,” says Dr. Mayman. “A knee replacement makes noise,” he adds. “It’s metal and plastic, and the parts click a bit. The other issue is that probably 10% to 15% of people will still have some pain going up and down stairs—that’s something we have not solved.”

Get as healthy as you can before knee replacement surgery.

“Smoking dramatically increases the risk of delayed wound healing or infection,” says Dr. Bradbury. “Other medical problems like poorly controlled diabetes or obesity increase the risk of infection too. “Some obese people are malnourished, and they don’t heal well.” “My personal experience is that those who exercise generally have a much smoother progression during recovery,“ says Dr. Anseth. Your emotional well-being counts too. “Anxiety and depression have huge effects on recovery. We know that people who go into knee replacement with untreated anxiety and depression do not do as well,” notes Dr. Mayman.

Our pain management philosophy for knee replacements has changed for the better.

“We’ve made real improvements in pain management. We try to manage the pain the whole way through the system,” says Dr. Mayman. That includes a local anesthetic in the joint, a nerve block in the thigh, and an epidural during surgery. “We’ve found that if pain signals don’t get set up in the first couple of days after surgery, people tend to have a lot less pain overall,” Mayman says. Doctors minimize the use of narcotics these days. “By six to twelve weeks, we really need to start having these patients off narcotic medication,” notes Dr. Anseth.

Choose a knee replacement surgeon who does the surgery frequently.

“You want a surgeon that does a fair number of these surgeries so he can do it quickly but safely. Having the surgery done in an orthopedic specialty hospital is the ultimate option, because they do it every day, so the team works very well together,” says Dr. Bradbury. “Patients come in asking about small incision techniques. Quite honestly, that’s a small piece of what makes a knee replacement turn out great. Instead, ask, ‘Do you know how many patients are doing well? What is your complication rate?’” says Dr. Mayman. A low infection rate is also very important when choosing a surgeon.

The choice of implant is not important as you think.

“Patients come in and they’ve seen the latest ad and say, ‘what implant do you use? I want the best one.’ The fact is, there are five big orthopedic implant makers and there’s no difference in outcome between them,” says Dr. Mayman. “If there was one that was the best, we’d all use the one that’s the best. Patients should probably spend a little less time reading some of the marketing material and spend more time looking into the nuts and bolts of how the surgery gets done.”

We’ve made some significant changes in technique over the past few years.

“If you look at the things we’ve really improved on in the past five years, it’s decreasing the amount of bleeding people have with surgery and improving their postoperative pain management,” says Dr. Mayman. “We started using a medication cardiac surgeons have been using for more than twenty years, and it’s decreased the risk of needing a blood transfusion from 15% to less than 1%, so that’s a big advance. If there’s less bleeding, there’s less blood in the knee after surgery, and having less blood in the knee means less pain for patients and an easier time getting back range of motion.”

We are very cautious about replacing both knees at once. (NOTE: My own surgeon advised against this in my case)

Can you do both knees at once? “That’s a hotly debated topic. The answer is we can do both if the patient is healthy enough,” says Dr. Mayman. “Some institutions feel it’s too big an operation, but here [Hospital for Special Surgery] we do both knees at the same time in 10 to 15 percent of patients. We have very strict medical criteria, and we’re very experienced doing it.” “For me, that’s a difficult rehab pathway,” says Dr. Anseth. “Are the patients committed enough to go through that? I’ve had patients struggle mightily after bilateral knee replacement, for a long time, and they are not very happy with their decision.”

A knee replacement should last for decades, and is often a successful, life-changing surgery (NOTE: the latter is certainly true for me!)

“There are a lot of folks who have a lot of anxiety about the surgery so they don’t pursue treatment”, says Dr. Bradbury. “I think it’s important to understand that the safety profile of knee replacement is very, very good and it is typically capable of dramatically improving pain, function, and quality of life. My recommendation for someone who has a lot of concern about the operation is that the price tag you pay for the end result is well worth what you have to go through.”

 

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Positive Changes Don’t Only Apply To Knee Replacements

simplestwaytostayhappy

I haven’t written a blog post for who knows how long, so it’s time to catch up.

It’s now been 13 months since total knee replacement surgery on my right knee and 17 months since having my left one done.

With Spring 2017 on the horizon, it’s time for me to add more changes to the ones I began making on New Year’s Day. As of this post, I dropped 29 pounds and my blood pressure fell by little over 7 percent since January 1 by eliminating “bad” carbohydrates and fats, eating only serving sizes (or cutting those portions in half if I found them too large), resuming my workouts (I’d gotten lazy over the holiday season), and undergoing a supplement regimen: calcium, magnesium, fish oil, and Vitamin C.

My plantar fasciitis is finally healing! In addition to keeping up with treatment recommended by my podiatrist since September, I discovered an incredible line of footwear by Vionic and recently purchased a pair of the Action Sunset Mary Jane style as a birthday gift to myself (pictured below).

 

vionic-action-sunset-mary-jane

Not only did these shoes help alleviate the plantar fasciitis pain when standing, walking, and exercising, but also have done wonders for my now-not-so-new knees. I’ve noticed less swelling and stiffness after increased activity. My Vionics are the next best thing to going barefoot and I already have my eye on another style on sale. Vionic shoes can be found for reasonable prices on sites such as 6pm.com and Amazon for those of us more budget conscious.

Back to the additional changes I mentioned earlier. Giving up bad carbs and fat was only the beginning. With my health coach, a home workout was developed for me to keep up the strength I’d built working out at my gym from last spring to mid-November. I don’t like going out in cold and snow but didn’t want to risk having to start over when the weather eventually cleared.

I also ended a relationship that was turning destructive and plan to explore other “options” the world has to offer while continuing to work on improving both my physical and psychological being. Splitting from a partner is never easy but it’s time to let go when that person does one’s morale more harm than good. A burden lifted from my shoulders once I made that decision.

Remember me mentioning some time back I could go without my cane at home and to walk on flat surfaces but had to use it in public to negotiate hill sides, high curbs, and uneven sidewalks due to balance issues I had from post-op complications?

I no longer need a cane for anything! For the first time in 17 months, I am completely free of needing any type of assistive device. And I’m looking forward to returning to the gym on Monday.

Bad carbs, bad fats, lousy men, and a cane. All of them gone…and I’ve never felt better. Sometimes knee replacements can play huge roles in other aspects of our lives. How are they improving yours today?

The Latest In My (Fairly) New Knees Journey

 

knee_joint_replacement

Greetings, TKR friends!

I know it’s been a while since I last posted on this blog and noticed it continues to receive a substantial amount of hits. Thank you for the continued visits, and I hope at least one post helped someone.

Knee surgery is a painful journey, as many of us know, even times long after we had the actual procedure. My left knee replacement’s first anniversary was September 14, and next month will mark two years since the right knee was done – January 12, 2017 to be exact. While I’ve had mostly positive experiences since then, there were a couple of recent road bumps.

Degrees of discomfort can remain part of having new joints, as I experienced this past weekend. I went shopping on Thursday afternoon at a humongous store and began feeling the effects that evening. I figured plenty of rest, elevation, and ice would solve the problem the same as they had on previous occasions during my recovery from actual surgeries.

I felt okay Friday morning and decided to clean my apartment since the weather was too dreary for me to venture to the gym or take a one-mile walk. I had a rude jolt back to reality Saturday morning when I woke up with stiff, painful, swollen knees, and barely able to walk. Another reason I’m glad I kept the cane received after my first surgery (not to mention I still need it to negotiate high curbs, uneven sidewalks, and hill sides).

I spent Saturday and most of Sunday alternating between applying heat to ligaments and ice to the artificial joints, elevating, taking Aleve as needed, and relaxing much as possible. I was able to put a dent in the manuscript for an upcoming book set for release in 2017 in the process, so my entire weekend wasn’t a total waste. The left knee is still a little puffy as of today’s blog post, but at least I’m able to bend both knees without stiffness and pain.

Another issue I’d like to address is having a recent bout with plantar fasciitis in my right heel. I never experienced this condition until earlier this fall, when increased pain warranted a visit to the podiatrist.

plantar-fasciitis

Plantar fasciitis is the most common cause of heel pain, stemming from inflammation of the plantar fascia, which supports the arch of our feet. Also known as “runners heel,” plantar fasciitis is common among athletes (especially runners), flat-footed individuals (majority of our population have them), jobs requiring prolonged standing, and older individuals, to name a few.

In my case, both my legs “realigned”of sorts from knee replacement surgery and increased active lifestyle were two factors considered in process of diagnosing my foot issue.

Podiatry Today also highlighted another contributing factor in plantar fasciitis:
“Also look at the patient’s medical history for any recent surgeries such as unilateral total hip or total knee replacements. These surgeries may cause a limb length discrepancy or increased stress on a particular foot due to compensation.”

Fortunately, the condition is treatable. Since I prefer non-invasive options, I searched online for additional treatments to incorporate with some advised by my podiatrist, and turned up a plethora of information. This video is a favorite; it covers exercises, vitamin supplements, and other areas in treating plantar fasciitis without painful cortisone shots or surgical routes – both which should be done only when all other treatments have failed.

Some people – such as I – won’t be “cured” in a week, but the advice offered has helped a great deal. I also recommend these six exercises, which are done each morning to avoid those first painful steps after getting out of bed, and again before bed.

You can find additional plantar fasciitis details and treatments at this link.

Enough on the down side of knee replacements, however; now I’ll highlight a couple of recent positive journeys.

Having new knees allowed me to explore and enjoy many new things that were all but impossible pre-op. Once completely healed, one of the first things I did was join my local Planet Fitness in May 2016. I considered a gym membership for some time during the healing process, but never felt comfortable with the few I’d visited, and don’t get me started on their exorbitant fees. Planet Fitness is a perfect fit far as cost and suiting my needs are concerned; I try to visit at least three days a week to keep my joints flexible.

 

penguins_vs_sharks_102016

Many who know me are aware I’m an avid hockey fan, possibly one of few things I enjoy about fall and winter (well, that, football, and the holidays!). Some friends invited me to attend a game in October, knowing to see at least one game in person had been on my “things to do post-op” list for some time. PPG Paints Arena is a huge venue, yet I managed to walk everywhere with no problem. We had great seats and I immensely enjoyed the evening. The following morning was spent using ice packs on my knees, but I’d go to another game should the opportunity arise.

Oh, and I’m treating myself to to this shirt for Christmas!

If you’ve recently had TKR, the road is a long one and frustrations tend to arise along our journey. However, don’t give up; I speak from experience when I say brighter days are ahead. If not for TKR, I doubt I’d be walking today, let alone enjoying more of what life has to offer.

I wish you all a joyous holiday season, whether you have brand new knees or a seasoned “knee veteran.” Feel free to share your own milestones in the comments; I immensely enjoy receiving feedback and learning stories from fellow knee warriors.

Most important, keep on moving, icing, and elevating!

SEX AFTER A JOINT REPLACEMENT: THE DEFINITIVE HOW-TO GUIDE

 

Sex

Discussing sex in any amount of detail with a medical professional can be uncomfortable. So much so, it can take mature adults right back to that “sinking in chair” feeling from junior high sex-ed class. Take the topic of sex and add it to the fact that you’ll be undergoing surgery, are in pain, and have likely endured limited mobility for some time, and the topic becomes even more overwhelming. For these reasons, we’ve decided to put together this no-holds-barred post on all things post-op sex.

Read More (Courtesy Peerwell.com)

When We Turn the Corner: Best Days Ever!

end-of-comfort-zone

Anyone who has had knee surgery (specifically total knee replacements) is well familiar with the recovery process. Sometimes healing and returning to function is relatively quick (as was the case with my right knee) while other times bring complications and longer periods before returning to normal.

The journey with my left knee was a long process – eight and a half months, in fact. Total healing takes 12-18 months, but I was spoiled from quickly bouncing back after the January 2015 surgery on my right knee. Unfortunately, the second post-op period wasn’t as simple.

From bleeding out during surgery on my left knee, dropping blood counts, blood transfusions, painful physical therapy, days I nearly passed out, the whole lower leg (including my left foot) remaining swollen for months, walking everywhere with a cane, not being able to clean my apartment without either taking ten-minute breaks between each room or having to split tasks into separate days, and forget standing long periods of time or using a regular cart for grocery shopping without dealing with agonizing pain later. Short of a few recommended sitting exercises in addition to the physical therapy ones, any degree of working out was also out of the question. As result of the latter, I regained lost weight and then some.

I finally turned the corner in mid-May with small steps at first: gradually walking farther distances without the cane (with little pain or no pain to boot), all the cleaning chores done in one day without breaks, and once again able to comfortably stand while folding the laundry, to name a few examples. I still take my cane when going out, but it’s mostly used to negotiate hill sides, potholes, and uneven sidewalks.

When I recently started working with a health coach, she suggested joining a gym to help further strengthen my knees and shed the regained weight. I shot down the idea at first; expensive membership fees, potentially being locked into contracts, and horrifying thoughts of exercising in crowded gyms among scornful, mocking eyes of strangers didn’t exactly excite me. I have some equipment at home and felt content doing my thing there.

The health coach then brought me to a Planet Fitness that opened near my home a few months earlier. The place changed my negative views of gyms moment I walked through their front door. Friendly, well-informed staff, great equipment, small classes, lots of perks for affordable fees, no contracts, and – most important – I felt comfortable working out there. As of this post, I’ve lost almost 25 pounds since mid-May.

Joining Planet Fitness may have been the best post-op thing I’ve done for myself. Sure I felt odd wobbling around the huge building on my cane at first, but when someone in a wheelchair came in one day for their own workout session, I couldn’t help but think to myself “If they can do it, why not me?”  I continued to push forward despite the rest of my body remaining sore the first few days.

 

confidentinshortsPFwater

Yesterday was the best day since joining Planet Fitness. I not only walked through the entire gym during my latest session (entire workout takes little over an hour) without my cane, but also had confidence to wear shorts for the first time in heaven knows how long. In addition, I neither became winded nor had to stop because of pain while spending 30 minutes on the stair climber machine. Progress!

A man came up to me while I was working on free weights. He apparently noticed my knee scars and apologized for interrupting. He admired my courage and added his mother also had knee replacements done and  dealing with other health issues. He’d been trying to get her to come with him for workouts with a goal to make herself feel better both physically and psychologically.

I certainly hope he succeeds one day; we’re the ones who are living with these new knees, why not use them to our best potential?

I now have a new goal in place: walking the American Heart Association’s Heart Walk in late October. Needless to say, I’m not putting all this training to waste, love a new challenge, and always dreamed of doing a 5K walk.

Turning a post-op corner is the best day ever – least in my opinion – especially after long period of dealing with limitations. Be patient and stay optimistic, difficult as it may be at present; the magic corner will happen!

9 Things No One Ever Tells You About Getting A Knee Replacement

I haven’t posted an entry for some time, but did want to share this July 2015 post from Prevention Magazine:

 

After 20 years of pain and icing her knee nightly, Sue Minutaglio of Westchester, NY, knew she couldn’t put off a knee replacement any longer. What she didn’t know was what a long, grueling road was ahead of her. “After 2 months, I was still swollen, aching, and on painkillers and thinking, ‘Why was this a good idea again?’ ” says Minutaglio, who had her first knee replacement in January 2014 and her second knee done in January 2015. “No one said it would take 6 months to feel a little better and a year to fully regain my strength.”

Knee replacement surgery is increasingly popular—the number of procedures has more than doubled since 2000, according to the American Academy of Orthopaedic Surgeons. Baby Boomers are leading the uptick—the number of 45- to 64-year-olds undergoing knee replacement surged by a whopping 205% between 2000 and 2012. “There’s a generation of people who have been doing high-intensity exercise their whole lives,” says Claudette Lajam, assistant professor of orthopedic surgery at NYU Langone Hospital for Joint Diseases. “I’m now seeing arthritis in people in their 40s.” Obesity can also beat up the joints, and Americans are only getting heavier.

Read More (Courtesy Prevention Magazine)