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.”

 

Advertisements

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!

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)

LTKR: Six Months of Progress

painfree

I had my six-month post-op checkup today on my left knee. The X-ray looked great and my bend was 110 degrees/0 extension. Some swelling remains and the scar is still “delicate” (but healing well with help of applying Vitamin E/Bio Oil on it daily), but progress continues to be made. I can walk short distances and around my apartment without assistive devices, but still need a cane for either long distances or activities involving a lot of walking. Heat on the muscles, ice packs on the implant area, and the occasional dose of Aleve have also done wonders.

I’d developed a little rash on my leg which initially alarmed me. There are several cases where patients who had any type of joint replacement surgery have developed allergic reactions to their particular implants. When I first spotted my rash near the knee incision, the thought of a reaction first came to mind despite neither having any problems with my right knee nor a history of metal allergies.

My concerns went unfounded; all I have is a little eczema, easily treatable with a special cream.

Sometimes it feels as if we’re going backwards in our recovery; I’ve been there twice (longer with the left knee; complications early on), but while easier said than done, hang in there. Things will get better; maybe not today or even next month, but think where each of us will be in the long run – the pain, early erratic sleep patterns, swelling, or how our scars look nasty in the early post-op stages (among other things) will be worth the prospect of being able to walk again without the agonizing pain or wondering when we won’t be able to walk at all our “natural” knees limited us for long periods of time.

My surgeon said today that I’m doing well for being barely six months post-op. I don’t have to go back for another appointment until September!

Progress can be a great thing.

One Year After Right Total Knee Replacement

kneehealingprogress131151yearafterTKR

Recovery from right total knee replacement: January 2015 (top photo) and January 12, 2016 (bottom photo)

First blog entry of 2016! I hope all of you are having a wonderful New Year thus far.

One year ago today, I was undergoing total right knee replacement surgery (RTKR). That morning was freezing rain. Today it’s snow.

I remember waking in the recovery room and remaining there for most of the day since it took a great deal of time for a room to open on the orthopedic surgical floor. I was transferred to the Transitional Care Unit 48 hours later, where I spent a week undergoing inpatient physical and occupational therapy. You can read more here about my first post-op week following RTKR.

Both my knees once again bend normally (the left knee was done September 2015 complete with a few complications), and I’ve gradually returned to life before surgery.

The only differences between now and a year ago are not hearing my knees crack when I get out of bed each morning, being able to walk farther distances with far less pain (if any at all), no more cortisone injections, and best of all – able to once again exercise without having to take breaks because my knees hurt. As you can see on the bottom photo, the scar on my right knee is barely visible, thanks to the miracles of Bio Oil and Palmer’s Cocoa Butter Skin Therapy Oil (I recommend this formula enriched with Vitamin E. Straight Vitamin E oils also work well on some surgical scars).

Running, jumping, and almost any other kind of high-impact work are all but out of the question, but an important aspect is focusing on things I can do. Cleaning house in one day instead of breaking up specific chores like I’d done BBK (before bionic knees), dancing – long as I don’t go  nuts – attending a few hockey games on occasion, waiting in lines without wincing in pain or having stiff knees afterward, and dressing in a standing position instead of having to sit are only a few examples of how new knees gave me back the life I once knew.

I’m even considering the idea of trying a 5K walk sometime this coming summer. The possibilities are endless!

Attitude is everything; it plays a more important role in our recovery than we tend to think. Imagine not summoning up the drive to follow through on physical therapy exercises or basically moving little as possible if not at all because it “hurts too much.” While being in agony from moving our new joints may be pushing things a bit, we have to engage in some form of activity for successful results. Isn’t that why each of us had joint replacement surgery in the first place – to have quality of life? Not following through on post-op care – especially physical therapy and keep moving in general – will defeat the surgery’s purpose.

Life with these new joints aren’t perfect; my left knee feels stiff each morning, both knees have the sensation of me dragging around fifty pounds apiece on damp or extremely cold days, setting off a metal detector on isn’t my idea of fun, and forget kneeling unless I’m on a soft surface. In any case, the aforementioned are only small prices to pay for undergoing a major change in my life.

My only regret? Not having it done sooner!

Are You Considering Joint Surgery?

knee_joint_replacement

Factors That Influence Total Joint Surgery Success
Scientists continue to look for the best ways to help decide whether and when to undergo joint replacement surgery.

By Trish McHenry

Total joint replacement (TJR), also called total joint arthroplasty, is booming in popularity, but doctors and patients are still trying to understand which patients with arthritis benefit most – as well as the best timing for these major surgeries.

The number of total knee replacements (TKR) more than tripled and the number of total hip replacements more than doubled between 1993 and 2009, according to a study published in 2014 in the Journal of Bone and Joint Surgery. And some of those surgeries may be happening too early in patients’ course of arthritis.

Read More (courtesy Arthritis Foundation)

10 Weeks LTKR Post-Op: Thankful For My Milestones

painfree

With Thanksgiving around the corner, I’m sure many of you have a great deal for which to be thankful. What are you thankful for this week?

Today marks ten weeks since undergoing left total knee replacement surgery (LTKR), and while recovery had its rough spots, I’m thankful for the progress I’ve made in those ten weeks. Here are a few milestones I’ve reached since September 14, 2015:

Walking with a cane. I used a walker for at least 2-3 weeks after leaving the hospital because I was still experiencing degrees of weakness from blood loss. Once I felt stable – and with encouragement from the in-home physical therapist – I started using the cane. I don’t think I need to elaborate on how empowering and liberating that felt.

Walkers can be bulky and cumbersome, not exactly the best assisting device to use when trying to get things done. However, if a walker makes you feel stable, then it’s a good idea to stick with one until you’re strong enough to advance to a cane (or crutches).

Housework. Cleaning house, cooking, and doing laundry still take a little more time than my pre-op housekeeping routine, but find myself less exhausted if certain chores are broken down into smaller tasks. For example, my kitchen and bathroom can be cleaned one day, and other rooms finished the next. Laundry is divided into smaller loads than the usual two; while a royal pain at times, it’s lighter and easier to transport from my point of view.

I have to sit when folding clothes and use a utility cart to move clothes from washer to dryer. If you have household help, by all means utilize it much as possible; otherwise, find ways to get things done without overextending yourself. Your new knee will thank you.

Getting off the strong stuff. Here’s where things get tricky for people who had any type of joint replacement surgery. You get some good narcotics while hospitalized and perhaps about ten days to two weeks following discharge. Don’t get in a tearing hurry to gradually withdraw from them if you’re still having mind-blurring pain.

Asking for more doesn’t make you a “druggie” or whatever label someone wants to pin on you. Joint replacement surgery is painful, especially knees. It’s your body; you know it better than anyone. On the other hand, if you’re like me and got pain management down to a science within several weeks, you should be okay to wean from narcotics and eventually try over-the-counter goodies like Tylenol, Motrin, or Aleve, to name a few. My medication box is never without Aleve or its equivalent.

Standing in the shower. I’ll be the first person to tell you how spoiled I’ve become since having a hand-held shower nozzle and having the bathtub converted into a walk-in shower. For the same reason I used a walker after leaving the hospital, I took advantage of the shower stool.

One day when I started regaining strength from iron levels returning to normal readings, I had a successful attempt of standing in the shower and have been showering the same way since. As for the shower stool, it’s now used for physical therapy exercises between outpatient PT visits. A person has to be creative once something’s intended purpose is no longer needed.

Getting out of the house. Possibly the best thing to happen during my past ten weeks. In early post-op days, most of us are going to experience being shut in, albeit temporarily. Like experiencing “cabin fever” during long winter months, not able to get out and enjoy life prior to surgery can drive us a bit stir crazy. I’ve been there not once, but twice this past year after having both knees done on separate occasions.

A person can only read so many books, watch so much TV (in my case, mostly sports), spend time on social media, or work on whatever indoor projects usually enjoyed before an itch to venture outdoors sets in. The first time I went somewhere weeks following surgery was pure heaven. Running errands and being around other people never felt so good. I was tired and my knee sore a few hours afterward, but worth every moment of using ice packs and popping a couple Aleve.

Setting off a metal detector. With unusually warm weather during early fall in my part of the world recently, I decided to take advantage by traveling downtown and sitting in on a one-day court trial open to the public. Many places now have metal detectors and courthouses are no exception. Needless to say, I set off one of them. I didn’t make a fuss; only emptied my purse and showed the guard incision scars on my knees (Luckily, he was a nice guy. “Oh, you had that done too!”).

In any case, I should get a card from my doctor if I want to do a similar venture in the future. Setting off metal detectors can sometimes be embarrassing, but keeping a card stating you have joint implants should make things go smoother.

Walking around the house without a cane. Funny how this began: I’d gone into the kitchen one morning to make coffee and feed my cats. I sat at my desk not long afterward to work on the latest book project for a while before having to stretch my legs (sitting too long after knee surgery isn’t a good idea, least in my opinion).

I reached around to the back of the chair where I usually kept my cane…and it was missing. Turns out I somehow walked from the kitchen to my desk without thinking to use it. While I don’t use my cane in the house, it’s with me when going out. Sidewalks around my parts aren’t the most even, and I’m not about to attempt negotiating curbs and steps without using the thing (especially using steps with no hand rails if I can’t altogether avoid those).

Dressing without the “tools.” Occupational therapists sent home a reacher (which I nicknamed ‘Mr. Pinchy’, sock aid, long-handled shoe horn, and a device to help pull up my affected leg. I didn’t need the leg pull or shoe horn very long (I don’t wear shoes in the house anyway), but Mr. Pinchy and the sock aid came in handy for some time before I was able to put on my socks and pants without the use of either device.

The leg pull, shoe horn, and sock aid now sit on a closet shelf and Mr. Pinchy hangs near my desk for other purposes (such as reaching in high places).

Squatting. No, I can not yet do deep squats, but I’ve come a long way since the early post-op days. Don’t bend too far, though; you’ll feel it in ways that are less than enjoyable.

Walking half a mile. As we heal, it’s not abnormal to gradually gain confidence in our new joints. This past Saturday morning, I intended to enjoy a short walk in the brisk air. That “short walk” turned out to be half a mile, and my knee hurt like h-e-double-hockey-stick the entire weekend. Perhaps it was the knee’s way of informing me not to go completely nuts. I treasure my independence, but I guess some things aren’t meant to be done yet, especially since still being less than three months post-op.

With the holiday season and a new year approaching, I can’t wait to see what the next ten weeks have to offer.

What are you thankful for this week, bionic knee warriors?