Full Knee Replacement: who has had it done or knows a thing or two?

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Cave Canem » Fri Mar 18, 2016 9:28 pm

Contact someone at HSS in NYC. I know with hips, some of the docs will review your records and the findings of your hometown ortho for free. Many of the same docs also do knees. But don't go through the hospital website, they'll charge you $1,000 that is not likely to be covered by insurance. Check one of the hip/knee replacement boards to contact a doc directly. Although they can also be conservative, they are less likely to postpone necessary surgery because of age. And you'e likely to find a guy who does 60-70/year verses 6-7.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Mon Mar 21, 2016 4:28 pm

Getting a partial knee replacement in 2 weeks.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Mon Mar 21, 2016 4:33 pm


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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Cave Canem » Thu Mar 24, 2016 4:26 pm

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Grandpa's Spells » Thu Mar 24, 2016 5:42 pm

The Venerable Bogatir X wrote:Getting a partial knee replacement in 2 weeks.
Good luck!
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Thu Mar 24, 2016 6:02 pm

Grandpa's Spells wrote:
The Venerable Bogatir X wrote:Getting a partial knee replacement in 2 weeks.
Good luck!
Thanks, hombre.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Sangoma » Sat Mar 26, 2016 11:49 pm

Good luck, man. Knee replacements are generally more painful than other operations, and the use of regional blocks - spinal, epidural, for example - is a bonus if your anaesthetist is willing to do it. In any case, recovery from the partial should be fairly quick. Just don't get too vigorous. All the best.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Blaidd Drwg » Sun Mar 27, 2016 12:53 am

Sangoma wrote:Good luck, man. Knee replacements are generally more painful than other operations, and the use of regional blocks - spinal, epidural, for example - is a bonus if your anaesthetist is willing to do it. In any case, recovery from the partial should be fairly quick. Just don't get too vigorous. All the best.

Any ideas on limiting use of narcotics post surgery with something invasive like that? Ill-advised? benchmarks to look at? best practices? I know a lot of folks who get repairs really worry about limiting the Oxy train but it's also needed for that initial PT? guidance on balancing those?
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Mon Mar 28, 2016 2:11 am

I actually have to go to a 'mandatory' class for people getting knee replacements. That class is tomorrow.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Cave Canem » Mon Mar 28, 2016 7:46 am

The Venerable Bogatir X wrote:I actually have to go to a 'mandatory' class for people getting knee replacements. That class is tomorrow.
I had to do a class for hip replacement. It's important but they usually give you hand outs that cover all the material anyway. It's good opportunity for Q & A though. And a lot of it helps with daily living problems you'll face during the first few weeks of recovery.
Don't try to anticipate how things will go based on anything you've heard, everybody's ride varies.
If you can, try out crutches before you go in. I found out after my revision (I had a hip resurfacing first, then it was revised to a total hip less than 6 months later) that I liked the forearms crutches better. More freedom of movement and better mobility even if I looked like Jimmy from South Park.

If you haven't already, you may want to check out http://bonesmart.org
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Cave Canem » Mon Mar 28, 2016 8:01 am

Blaidd Drwg wrote:
Sangoma wrote:Good luck, man. Knee replacements are generally more painful than other operations, and the use of regional blocks - spinal, epidural, for example - is a bonus if your anaesthetist is willing to do it. In any case, recovery from the partial should be fairly quick. Just don't get too vigorous. All the best.

Any ideas on limiting use of narcotics post surgery with something invasive like that? Ill-advised? benchmarks to look at? best practices? I know a lot of folks who get repairs really worry about limiting the Oxy train but it's also needed for that initial PT? guidance on balancing those?
Just a general article http://bonesmart.org/joints/pain-medica ... p-surgery/
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Mon Mar 28, 2016 12:05 pm

Cave Canem wrote:
The Venerable Bogatir X wrote:I actually have to go to a 'mandatory' class for people getting knee replacements. That class is tomorrow.
I had to do a class for hip replacement. It's important but they usually give you hand outs that cover all the material anyway. It's good opportunity for Q & A though. And a lot of it helps with daily living problems you'll face during the first few weeks of recovery.
Don't try to anticipate how things will go based on anything you've heard, everybody's ride varies.
If you can, try out crutches before you go in. I found out after my revision (I had a hip resurfacing first, then it was revised to a total hip less than 6 months later) that I liked the forearms crutches better. More freedom of movement and better mobility even if I looked like Jimmy from South Park.

If you haven't already, you may want to check out http://bonesmart.org
Thank you. Although I was extremely confident in this doc and like him a lot, not only by the fact he's done over 5k surgeries on knees and is team Ortho doc for a major Us football and wrestling teams, and I got in to see him by way of referral, the headhunter in me still does back door checks (insert Shape jokes here). I sent out 3, two are back thus far, and really nice references. Also, I just learned yesterday it so happens he did a clean up job for a high school gal my wife knows the mom.....I guess she was (or maybe still is, I don't know), a high level softball player and she had glowing reviews, too. So, I feel good about him, I just need to hold my end of the bargain post-op. I've lost over 30# this year and am gunning for another 10#, pre-op, which is in about a week and a half.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Spiller » Tue Mar 29, 2016 5:39 pm

Blaidd Drwg wrote:
Sangoma wrote:Good luck, man. Knee replacements are generally more painful than other operations, and the use of regional blocks - spinal, epidural, for example - is a bonus if your anaesthetist is willing to do it. In any case, recovery from the partial should be fairly quick. Just don't get too vigorous. All the best.

Any ideas on limiting use of narcotics post surgery with something invasive like that? Ill-advised? benchmarks to look at? best practices? I know a lot of folks who get repairs really worry about limiting the Oxy train but it's also needed for that initial PT? guidance on balancing those?
My experience is mostly with total knee replacements. Partials will get better quicker, but quicker is relative. Your partial rehab may take longer than someone else's total.

Ice and proper Physical Therapy Rehab can go a long, long way towards limiting pain medication usage. Rehab is individual and paying close attention to your body's responses to cold, exercise, etc. can save you a lot of pain the first 3-6 weeks.

For cold therapy, continuous cold with something like Polar Care (TM) can help tremendously. Patients usually use it 24/7 the first 2-3 days in a hospital. My recommendation after that is use it as much as needed for pain control, with the goal of weaning off completely by three weeks. Having it on for multiple shorter periods is better than one long period. 'Most' patients who follow this advice are off narcotics within one week and just use Tylenol.

For rehab, don't go crazy. Some mild to medium ROM exercises 2-3x/day and short (20-50 feet), easy walks 5-10 times a day (in the house). Many people over-do it with their therapy and pay for it with swelling and PAIN. Good nutrition and adequate hydration and sleep are important too.

There is an almost 1:1 correlation between incision length and rehab time length of recovery. Your rehab is not based on the damage/cutting to the bones, but the soft tissue. So, it's good to find a MD who is aware of this and makes the smallest incision possible. With some of these surgeries today, the doc is cutting 1-2" only and the patient walks out of the hospital. It' also nice to find a MD who does at least 150-200 surgeries a year and has done at least 300-400 total of the specific one you want. A surgeon who doesn't do a particular surgery often will often not be up on the latest techniques. It's not in his/her best interest to learn a new technique he/she won't be doing often.

Regarding rehab exercises, a lot of PTs don't think and give the same protocol to an 80-something couch potato as they do a 50-something athlete. For the later, like I said, simple ROM exercises are all you need. Passive motion is more important than active, because strength can be gained very easily, while ROM is easier to get (not necessarily less painful) the sooner after surgery as possible.

For extension, I like static knee extension. Just put sit in bed with legs out straight and keep toes pointed up. If you have any loss of passive extension ROM, gravity will take your knee down to the bed. Aim for 30 seconds to 3 minutes. If it's too painful, stop or put a towel under knee to give some (not total) support. 2-3x/day

For flexion, sitting in chair sliding foot under chair works well. Sock on smooth floor. This is primarily active motion, so for passive, you can plant foot and scoot hips forward. BUT, go easy! It's easy to put too much force too soon. Hold just one second, repeat 10 reps, 2-3x/day.

Some people need more than this, especially if they had a large loss of ROM pre-surgery. But, for 'most' people, this is enough the first 3-6 weeks. Then you can crank it up as needed without worrying about a big flare up of pain and swelling.

Many docs push rehab too much nowadays. The pendulum has swung too far to the other side. Your body has a healing ability that you can not be rushed or sped up no matter what. This also means don't do "too much" "too soon". Almost every single person, no matter how much they are warned, will start feeling good and do too much activity (walk, clean the garage, etc.) too soon. I advise waiting at least 6 weeks for anything besides rehab. When you do flare up, back off, ice more, take more pain meds, etc.

One popular study looked at every variable they could think of for TKR recovery. The two factors that stood out for a good outcome were (1) early cold therapy and (2) getting knee extension ROM as soon as possible. Most docs focus on flexion ROM. The general rule of thumb used to be 90 degrees in 4 weeks. Now many docs say 90 degrees in one week. Part of that is newer/better prosthetics, but if it takes you 4 weeks, your long term outcome (12 months) will be no worse than if it took one.

Other factors to avoid taking more pain medication include making life as simple/easy as possible the first 3-6 weeks after surgery. Tall/elevated seats can help standing up especially if the non-surgical leg is not 100%. A 3-in-1 commode can be nice because you can use it as an elevated seat over the toilet, or as a shower chair, or as a portable toilet next to your bed to avoid a walk in the middle of the night. If you have a bathtub shower, they make "tub transfer benches" that is a bench that sits half in and half out of your tub, so you can sit down on it outside the tub without having to step over the tub. Then slide butt over to part inside tub.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Wed Mar 30, 2016 4:31 pm

Spiller wrote:
Blaidd Drwg wrote:
Sangoma wrote:Good luck, man. Knee replacements are generally more painful than other operations, and the use of regional blocks - spinal, epidural, for example - is a bonus if your anaesthetist is willing to do it. In any case, recovery from the partial should be fairly quick. Just don't get too vigorous. All the best.

Any ideas on limiting use of narcotics post surgery with something invasive like that? Ill-advised? benchmarks to look at? best practices? I know a lot of folks who get repairs really worry about limiting the Oxy train but it's also needed for that initial PT? guidance on balancing those?
My experience is mostly with total knee replacements. Partials will get better quicker, but quicker is relative. Your partial rehab may take longer than someone else's total.

Ice and proper Physical Therapy Rehab can go a long, long way towards limiting pain medication usage. Rehab is individual and paying close attention to your body's responses to cold, exercise, etc. can save you a lot of pain the first 3-6 weeks.

For cold therapy, continuous cold with something like Polar Care (TM) can help tremendously. Patients usually use it 24/7 the first 2-3 days in a hospital. My recommendation after that is use it as much as needed for pain control, with the goal of weaning off completely by three weeks. Having it on for multiple shorter periods is better than one long period. 'Most' patients who follow this advice are off narcotics within one week and just use Tylenol.

For rehab, don't go crazy. Some mild to medium ROM exercises 2-3x/day and short (20-50 feet), easy walks 5-10 times a day (in the house). Many people over-do it with their therapy and pay for it with swelling and PAIN. Good nutrition and adequate hydration and sleep are important too.

There is an almost 1:1 correlation between incision length and rehab time length of recovery. Your rehab is not based on the damage/cutting to the bones, but the soft tissue. So, it's good to find a MD who is aware of this and makes the smallest incision possible. With some of these surgeries today, the doc is cutting 1-2" only and the patient walks out of the hospital. It' also nice to find a MD who does at least 150-200 surgeries a year and has done at least 300-400 total of the specific one you want. A surgeon who doesn't do a particular surgery often will often not be up on the latest techniques. It's not in his/her best interest to learn a new technique he/she won't be doing often.

Regarding rehab exercises, a lot of PTs don't think and give the same protocol to an 80-something couch potato as they do a 50-something athlete. For the later, like I said, simple ROM exercises are all you need. Passive motion is more important than active, because strength can be gained very easily, while ROM is easier to get (not necessarily less painful) the sooner after surgery as possible.

For extension, I like static knee extension. Just put sit in bed with legs out straight and keep toes pointed up. If you have any loss of passive extension ROM, gravity will take your knee down to the bed. Aim for 30 seconds to 3 minutes. If it's too painful, stop or put a towel under knee to give some (not total) support. 2-3x/day

For flexion, sitting in chair sliding foot under chair works well. Sock on smooth floor. This is primarily active motion, so for passive, you can plant foot and scoot hips forward. BUT, go easy! It's easy to put too much force too soon. Hold just one second, repeat 10 reps, 2-3x/day.

Some people need more than this, especially if they had a large loss of ROM pre-surgery. But, for 'most' people, this is enough the first 3-6 weeks. Then you can crank it up as needed without worrying about a big flare up of pain and swelling.

Many docs push rehab too much nowadays. The pendulum has swung too far to the other side. Your body has a healing ability that you can not be rushed or sped up no matter what. This also means don't do "too much" "too soon". Almost every single person, no matter how much they are warned, will start feeling good and do too much activity (walk, clean the garage, etc.) too soon. I advise waiting at least 6 weeks for anything besides rehab. When you do flare up, back off, ice more, take more pain meds, etc.

One popular study looked at every variable they could think of for TKR recovery. The two factors that stood out for a good outcome were (1) early cold therapy and (2) getting knee extension ROM as soon as possible. Most docs focus on flexion ROM. The general rule of thumb used to be 90 degrees in 4 weeks. Now many docs say 90 degrees in one week. Part of that is newer/better prosthetics, but if it takes you 4 weeks, your long term outcome (12 months) will be no worse than if it took one.

Other factors to avoid taking more pain medication include making life as simple/easy as possible the first 3-6 weeks after surgery. Tall/elevated seats can help standing up especially if the non-surgical leg is not 100%. A 3-in-1 commode can be nice because you can use it as an elevated seat over the toilet, or as a shower chair, or as a portable toilet next to your bed to avoid a walk in the middle of the night. If you have a bathtub shower, they make "tub transfer benches" that is a bench that sits half in and half out of your tub, so you can sit down on it outside the tub without having to step over the tub. Then slide butt over to part inside tub.

Thanks for all that great info.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Sangoma » Wed Mar 30, 2016 10:14 pm

In term of reducing the use of narcotics post op the best option is some sort of regional anaesthesia - spinal, epidural or nerve blocks. In the last few years another technique came into fashion: leaving a small catheter in the wound for infusion of local anaesthetics. It works surprisingly well. Being a patient though it is not easy to make sure what technique the anaesthetist on the day will use, unless the surgeon has the routine template for pain management. Other ways - small doses of Ketamine during the op, Buorenorphin patch, Gabaoentin pre-op etc.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Spiller » Thu Mar 31, 2016 2:30 am

A couple Orthos told me the adductor nerve block works best if anesthesiologist knows what they're doing.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Fri Apr 01, 2016 6:38 pm

A rep is coming to the house on Monday to show me how to use a Kinetec passive motion thing for the knee and also deliver some portable compression device to prevent clots post surgery. Last but not least, a cryo cuff, which I have used in the past and love the thing.

Spiller, do you think the Kinetec can be helpful for me to also use on the right leg for my hamstring tendon? Knee replacement is on the left, but the hammie tendon on the right is like a steel rod and doesn't tickle. I think that is from favoring the left so much. Thoughts?

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Spiller » Sat Apr 02, 2016 12:20 am

There is no indication for using Kinetec on R knee. I've never heard of anyone doing it for something like that. Doesn't mean it won't work. No harm in trying. I'm sure it's from favoring left leg. I usually use a direct pressure on the tendon, holding until tendon starts to soften or 'melt'. Can take up to five minutes or more. If it gets more painful, stop and try another, less painful spot.

Pain/stiffness will likely come back due to favoring. But, surgery is soon and it's an easy temp relief. There are other fancier ways to treat tendon, but this is one of the simplest/most effective.

Cryo cuff = +++++++!!!!!!!!!

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Sat Apr 02, 2016 2:35 am

Many thanks, Spiller.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by The Venerable Bogatir X » Sat Apr 02, 2016 3:21 pm

Spiller wrote:There is no indication for using Kinetec on R knee. I've never heard of anyone doing it for something like that. Doesn't mean it won't work. No harm in trying. I'm sure it's from favoring left leg. I usually use a direct pressure on the tendon, holding until tendon starts to soften or 'melt'. Can take up to five minutes or more. If it gets more painful, stop and try another, less painful spot.

Pain/stiffness will likely come back due to favoring. But, surgery is soon and it's an easy temp relief. There are other fancier ways to treat tendon, but this is one of the simplest/most effective.

Cryo cuff = +++++++!!!!!!!!!
After reading this last night, I had my wife take a softball to that tendon while I was on the floor and put some heavy pressure on it.....temporary help, and will have her use a pool table ball later for some more specific pressure.

I have several ice things for knees but none of them come close to the cryo cuff I used a couple of years back.....not even close. Good thing my fridge has an icemaker.....

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Cave Canem » Thu Apr 07, 2016 6:12 am

So did you have the surgery yet?
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Sangoma » Thu Apr 07, 2016 6:55 am

Spiller wrote:A couple Orthos told me the adductor nerve block works best if anesthesiologist knows what they're doing.
Not exactly. Adductor canal block blocks femoral nerve distal to it giving branches to the quadriceps, which helps with post-op mobilization. Femoral nerve supplies most of the knee, but there is still considerable area supplied by the sciatic nerve. So blocking both femoral and sciatic works the best for pain. Sciatic block can last up to 48 hours sometimes, and surgeons get nervous when the foot drop persists for so long.

Many surgeons now infiltrate the area with large volume of local anaesthetics, and if done properly it works really well, with or without the adductor canal block.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Shafpocalypse Now » Thu Apr 07, 2016 1:19 pm

Good luck and speedy recovery lie nap!

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Shapecharge » Thu Apr 07, 2016 2:19 pm

Nappy, stay strong devildog! Soon you'll be more awesome than Col. Steve Austin!! Hey if you can remember ask your doc if he knows anybody that can help a "friend" with a droopy ball sac situation.

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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by nafod » Thu Apr 07, 2016 3:24 pm

It'd be cool if they stuck it on backwards so you could walk like a chicken.

Full speed ahead, shipmate. Everyone I know that has one (and I know too damn many people) has been happy with it.
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