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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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!

Recycling Artificial Joints After Cremation

With new lives among most of us following joint replacement surgery, death is likely the last thing on our minds. Since cremation or donating my body for research are among considerations of what to do with my remains once I’ve passed, the thought of whether or not my knee replacements would have to be removed.

I did some research to satisfy my curiosity and discovered a fascinating article in thePhiladelphia Inquirer’sonline edition entitled Ultimate recycling: Artificial joints after cremation.

A few key points from the article:

Specialty metals like titanium used to make joints are also used in airplanes but joints are 45 percent lighter.

Many funeral homes won’t advertise joint recycling services as to avoid putting off the public while others encourage recycling.

With the rising costs of traditional funerals, more people are choosing to be cremated.

Several crematoria once sent artificial joints and other non-combustible metals to landfills or collected it to bury in cemetery plots.

Harleigh Cemetery & Crematory Association in Camden and Philadelphia Crematories Inc. are among institutions utilizing Implant Recycling L.L.C’s services in Detroit. Implant Recycling is owned by a fourth-generation family of metal recyclers working with at least 1,200 crematoria.

OrthoMetals is a Dutch firm working with about 25 American crematoria to recycle joint implants.

California native Ray Saadeh founded the nonprofit Alternative Solutions USA in 2010, with a goal to end commercialization of joint recycling.

How does the process work and how is the recycled metal used?

Implant Recycling provides collection bins (about the same size as common recycling ones) which are picked up by a designated delivery service once the bins are full.

Once the metals are in Detroit, they are analyzed, sorted, and melted down before ingots are made.

OrthoMetals state no metals are implanted in another human, but instead used in airplanes, cars, and wind turbines, among other items. Understandingly, family members may not want their loved ones’ implants used in someone else. Several members of medical community also don’t feel comfortable using “secondhand” joints in their patients, no matter how practical recycling them are.

40 percent of Alternative Solutions USA’s metal value are donated to various charities.

With the aforementioned options among others available, would you give thought to having your knee replacements recycled once you’re gone (and obviously no longer need them)? Joint recycling is a good idea to discuss with family members and other loved ones. I’ve considered the idea with my own joints after reading more on the subject. For those choosing cremation, joint recycling is not a bad idea – just another way to save the earth.