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 The Venerable Bogatir X » Wed Jul 06, 2016 2:39 am

Good luck with all that bullshit, Jack.

I had my left one done, too, NAFOD, but I am totes looking forward to getting the right one done, too.

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

Post by powerlifter54 » Sun Jul 10, 2016 12:06 am

Home from hospital. Surgery more complicated than he anticipated as the acetabulum was even more messed up than we thought, and Vastus Lateralis gave doc huge problems is getting it retracted. So hip flexor and quad is pretty beat up. But not much pain from hip and off pain killers. Developing...
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Blaidd Drwg » Sun Jul 10, 2016 12:20 am

powerlifter54 wrote:Home from hospital. Surgery more complicated than he anticipated as the acetabulum was even more messed up than we thought, and Vastus Lateralis gave doc huge problems is getting it retracted. So hip flexor and quad is pretty beat up. But not much pain from hip and off pain killers. Developing...
Good man getting off that junk. Strictly recreational or emergency use on those.

I can imagine the upper VL and flexors on a moderate stance deep squatter would present a fair bit of flesh to work through. If you want to make the quad pain easier to manage, ask about a mild muscle relaxer. Flexiril or a skelaxin. Won't leave you too terribly loopy and will help those quads and IT band to calm down while you're rehabbing. I know my training partner Ricky says the worst long term pain from his broken arm (735 to a 2 board...K-pow..sounded like a branch breaking) was from the way the surgeon thrashed and tossed his left arm around in while they were installing the plates in the right arm. They left his arm and shoulder unsupported and splayed out and back in a nasty position and it still bugs him 5 years later. That meat keeps score of the insults done to it...if they can help you relax it early, it may make a big diff. I'm a huge fan of narcotics but not for pain, esp. not for muscle pain. You may find Cyclobenzaprine is the shit.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Spiller » Sun Jul 10, 2016 12:32 am

Blaidd Drwg wrote:
Grandpa's Spells wrote:I'm surprised how little I see on how to avoid ever needing hip/knee replacements.
That is weird... You really dont see articles a d such truck on that topic often even though the procedures are so. Common.

I'm I wonder if the factors are so multifaceted or so closely tied to individual morphology and activity that you can't make solid blanket recs.
It's actually pretty easy to prevent severe OA that would need a TKR. The problem is, by the time it hurts so bad you're seeing a doc, it's usually too late.

Simple stuff like ankle and hip abductor strengthening, rectus femoris stretching and maintaining full ROM of knee joint goes a long ways.

Pete Egoscue claims to have a case study of a mid/late 50's (?) woman with an ugly X-ray that begged for a TKR. After doing his program for a year or so, a repeat X-ray showed a more-aligned knee (less valgus) and increased joint space (= more joint cartilage). Of course, it's just one case study and I believe his documentation could have been better, i.e. having a reputable Ortho do the X-rays and exam before and after.

Plus, there is NOT a one-to-one correlation between what your X-ray looks like and the amount of pain/dysfunction you have. Which many MDs fail to acknowledge.


PL54, did you get an anterior approach THR? Is the scar on the front of your hip? Or, the side?

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

Post by Blaidd Drwg » Sun Jul 10, 2016 1:01 am

Spiller wrote:Plus, there is NOT a one-to-one correlation between what your X-ray looks like and the amount of pain/dysfunction you have. Which many MDs fail to acknowledge.

Ain't that the troof...

After both my knees got distal realignments (fulkerson) I was told to expect lifelong pain and to never be able to hike, run or squat heavy. As long as I walk a lot, do loaded carries and/or squat heavy, I have little pain and the joint that looked "like garbage", now look pretty solid on the xrays with no signs of increased OA. They aren't perfect but the stuff that as supposed to be undoable is what keeps them rolling. Sedentary life for more than a week makes my knees howl. I have a full inch leg length discrepancy and a bulging disc at L1/2 with near zero back pain (at least no back pain I didn't have coming)

OTOH, the boxers fracture I got with an ill timed straight left at 19 still hurts like a motherfucker some days.

Pain is such a liar sometimes.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Shafpocalypse Now » Sun Jul 10, 2016 1:19 am

BD...can you discuss how you altered your previous form after your knees were fixed? I'm at a point where every heavy-ish training session seems to end up with me dividing by zero wrt the knees not feeling great, and I'm about ready to strip things down and revamp technique.

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

Post by Shafpocalypse Now » Sun Jul 10, 2016 1:20 am

Just as a data point...anything over, say, 365, isn't that great. Anything 315 and under seems fine and that's with SSB free, box squats, fronts and zerchers.

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

Post by Shafpocalypse Now » Sun Jul 10, 2016 1:26 am

Let's talk about ankle and abductors too, Spiller, mi amigo...what are the go to things for those?

Just shit like band X walks, maybe fire hydrant type movements for the abds?

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

Post by Blaidd Drwg » Sun Jul 10, 2016 1:38 am

Shafpocalypse Now wrote:BD...can you discuss how you altered your previous form after your knees were fixed? I'm at a point where every heavy-ish training session seems to end up with me dividing by zero wrt the knees not feeling great, and I'm about ready to strip things down and revamp technique.
I had SHITE form before that...bad baseline probably. Was very much a football squatter, likely high, feet forward...yadda yadda.

Oddly, I started back with a total Louie derived box squat, hips back, single ply-ish back and hamstring squat which got me to 405.....then I went to a more neutral super moderate flair and bar position squat (wendler's form basically) this worked well with hi reps stuff that i liked...I also found, the front squats bothered even less...and not just based on loading. so the opposite of what i would have guessed, deeper and more knees forward.

Jump foward to dunking 600 and I found the moderate stance won;t let me hit depth consistently but it's much stronger..still no knee pain. Switch feds, come to Jeebus on depth (never thought I'd utter the words "convincingly deep") and now I'm back to heeled shoes and correcting the leg length thing....then....we found, moderate heel, moderate bar position and moderate width work again but in a totally different form from the knee friendly sit back squat.



Max Aita's description completely changed the way I thought about it and now as long as the heel height on the shoe is modest and the stance modest, I can sink it deep with no knee pain. The shifts are almost counter-intuitive...break at the knees and hips at same time, keep weight on midfoot, not rear foot, and pay more attention to flair than to width.

Nowadays, if my knees hurt, it has more to do with getting forward because I wasn't tight enough on the abs or I couldn't wedge snugly under the bar because my shoulders are fatigued.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Shafpocalypse Now » Sun Jul 10, 2016 1:58 am

I'll check it out

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

Post by powerlifter54 » Sun Jul 10, 2016 12:10 pm

Spiller wrote:
1. Plus, there is NOT a one-to-one correlation between what your X-ray looks like and the amount of pain/dysfunction you have. Which many MDs fail to acknowledge.


2. PL54, did you get an anterior approach THR? Is the scar on the front of your hip? Or, the side?
1. Right on. My hip was a mess for years, and an an MRI or X-ray would have shown that due to incomplete forming of acetabulum, but i only had moderate discomfort from it for years. Last year it got harder and harder to get my left shoe and sock on. And after an eye operation in January and sleeping on my left side afterwards it just went from annoying to lifestyle changing. i was doing mobility work but it was too little too late, Even the PT which was very similar to my Mobility work helped a little but not enough to live the lifestyle i wanted.

2. Yep, anterior full hip arthroplasty. Surgeon preferred, and i agreed to avoid metal on metal so i have metal acetabulum cap and femur rod, and ceramic ball on crosslinked polyethylene liner. Considered hip resurfacing but questions about my femur neck bone loss (noted in MRI, but ortho doc said looked fine and my bone density was pretty off the charts), insurance issues, and most of all posterior approach, where they have to cut at least some muscle and has more post op precautions was a decision maker for me.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723683/

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

Post by powerlifter54 » Sun Jul 10, 2016 12:19 pm

Blaidd Drwg wrote:
powerlifter54 wrote:Home from hospital. Surgery more complicated than he anticipated as the acetabulum was even more messed up than we thought, and Vastus Lateralis gave doc huge problems is getting it retracted. So hip flexor and quad is pretty beat up. But not much pain from hip and off pain killers. Developing...
Good man getting off that junk. Strictly recreational or emergency use on those.

I can imagine the upper VL and flexors on a moderate stance deep squatter would present a fair bit of flesh to work through. If you want to make the quad pain easier to manage, ask about a mild muscle relaxer. Flexiril or a skelaxin. Won't leave you too terribly loopy and will help those quads and IT band to calm down while you're rehabbing. I know my training partner Ricky says the worst long term pain from his broken arm (735 to a 2 board...K-pow..sounded like a branch breaking) was from the way the surgeon thrashed and tossed his left arm around in while they were installing the plates in the right arm. They left his arm and shoulder unsupported and splayed out and back in a nasty position and it still bugs him 5 years later. That meat keeps score of the insults done to it...if they can help you relax it early, it may make a big diff. I'm a huge fan of narcotics but not for pain, esp. not for muscle pain. You may find Cyclobenzaprine is the shit.
Thanks. i took most of what they offered in the hospital and don't want to play hero, but had some pretty scary interactions with Oxycontin users while in the Navy. Lots of good folks who got on for back pain or post surgical issues and next thing you know they are literally wrecking their lives to get more. i also know i respect pain and if i override it, i will be pushing my rehab too hard. Every day is markedly better. Which is my main goal. Over many cycles and many years i learned that laying out numbers in a plan led to frustration an dbad decisions. But going in and taking what i was getting, and having my cycles dialed in i had reasonable expectations, worked a lot better. You don't want to hard plan 585 raw double on week 2 and struggle with one, then have a helmet fire stressing over the implications to the rest of your cycle, when you could go in and know at 515 it ain't happening to you take a hard 565 and go home with a few extra downsets. i toyed with goal of off walker and cane in a week and two weeks respectively. Maybe, maybe not. Only measurement that matters is the end product. But a PR whether it be in in bed foot slidesx15x 2 sets (yesterday couldn't do one) or board press is still a good day.

Small victories.
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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 Jul 11, 2016 12:04 pm

powerlifter54 wrote: Thanks. i took most of what they offered in the hospital and don't want to play hero, but had some pretty scary interactions with Oxycontin users while in the Navy. Lots of good folks who got on for back pain or post surgical issues and next thing you know they are literally wrecking their lives to get more.
Truth.

Oxy turns me into a big asshole once it wears down, but I love the shit out of it way too much. They gave me the short term punch stuff and the long term (I guess it's timed released?) stuff, to take at the same time. I used all of it. Fortunately, I am not addicted to that drug, have not taken it in a few months now, but I do understand why someone can get hooked on it.

Heal fast, brother.

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

Post by Spiller » Sat Jul 16, 2016 8:52 am

Shafpocalypse Now wrote:Let's talk about ankle and abductors too, Spiller, mi amigo...what are the go to things for those?

Just shit like band X walks, maybe fire hydrant type movements for the abds?
Hey Shaf,

When talking hip abductors, the main one to strengthen is the gluteus medius. The problem with fire hydrant movement is your hip is in flexion and that preferentially recruits the TFL over the GMed. Band X walks are good, but again when doing them, it's better to be in full hip extension, so no bending at the hip at all. No hip external rotation either, keep the hip neutral.

It's easy to get sloppy with hip abd movements and let the TFL take over. So, I like to start hip abd strengthening with GMed isolation movement. You should be able to lie on your side and lift your leg up 45 degrees for 3 sets of 20 for a minimum level of glute med strength. You have to keep your hip in full extension, no flexion at all. (some people like to lie with back against the wall and keep heel against the wall). Also, cannot let pelvis roll back to get your leg up, again this will recruit TFL. And don't substitute with lumbar spine side bending , keep your spine stable. A mild abdominal bracing helps. Also, don't let toes roll up towards ceiling. Keep hip/ankle neutral. Think lift with your heel. Make sure you get to the top of the ROM. Check your ROM lying on your back and see how far you can abduct your hip. This should be the same motion you have on your side. Most people only do about 30-35 degrees out of their 45. If you do these correctly (strict), 3x20 should be difficult, or you need to work up to it.

Once you can do 3x20 'easy', then I feel more comfortable about you doing the X-band walks stuff. I use a loop band around my ankle. I have different strengths/thicknesses from Perform Better.

For ankle:
I like to start with simple AROM ankle circles, 40 in/40 out, full slow-ish, big circles. Then 40 dorsiflex/plantarflex full movements. Most people have trouble doing these correctly. Do these once a day for at three weeks, then add/progress to band resisted ROM . Some people if they jump right into bands may use substitution patterns, using only one muscle group to invert or evert instead of all of them. Once you've done band exercises for awhile (3-6weeks), you can add/progress to weight bearing foot/ankle ex. Walking with feet turned in, turned out, on inside of feet, on outside, on heels, on balls of feet. Barefoot on grass is ideal. 20 steps each foot, each way, once a day. Then I like to progress to seated calf raises, sets of 15-20. And one legged calf raises with dumbbell, sets of 2-5. And FW , walking on balls of feet.

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

Post by Spiller » Sat Jul 16, 2016 9:04 am

2. Yep, anterior full hip arthroplasty. Surgeon preferred, and i agreed to avoid metal on metal so i have metal acetabulum cap and femur rod, and ceramic ball on crosslinked polyethylene liner. Considered hip resurfacing but questions about my femur neck bone loss (noted in MRI, but ortho doc said looked fine and my bone density was pretty off the charts), insurance issues, and most of all posterior approach, where they have to cut at least some muscle and has more post op precautions was a decision maker for me.
Thanks, I was curious because I've talked to one highly regarded Ortho here in the Modesto area (William Whang). He does posterior and anterior approaches. So, I asked him how he decides. He strongly prefers the anterior approach. Says it's a better surgery. (I know there's less chance of dislocation, although the risk for posterior approach has decreased a ton over the years.) He chooses posterior approach if pt has certain anatomy (I believe he was referencing anteversion/retroversion and femoreal neck angle, but he wasn't specific) and a younger male athlete with a lot of muscle to cut through.

I'm not saying you should have got a posterior approach. I would just think that with the muscle you did get cut, it would be good to make sure it gets fully stretched out and treat all the incision/scar tissue to limit adhesions.

I hope your rehab is progressing well.

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

Post by DikTracy6000 » Sat Jul 16, 2016 10:15 am

Spiller wrote:
Shafpocalypse Now wrote:Let's talk about ankle and abductors too, Spiller, mi amigo...what are the go to things for those?

Just shit like band X walks, maybe fire hydrant type movements for the abds?
Hey Shaf,

When talking hip abductors, the main one to strengthen is the gluteus medius. The problem with fire hydrant movement is your hip is in flexion and that preferentially recruits the TFL over the GMed. Band X walks are good, but again when doing them, it's better to be in full hip extension, so no bending at the hip at all. No hip external rotation either, keep the hip neutral.

It's easy to get sloppy with hip abd movements and let the TFL take over. So, I like to start hip abd strengthening with GMed isolation movement. You should be able to lie on your side and lift your leg up 45 degrees for 3 sets of 20 for a minimum level of glute med strength. You have to keep your hip in full extension, no flexion at all. (some people like to lie with back against the wall and keep heel against the wall). Also, cannot let pelvis roll back to get your leg up, again this will recruit TFL. And don't substitute with lumbar spine side bending , keep your spine stable. A mild abdominal bracing helps. Also, don't let toes roll up towards ceiling. Keep hip/ankle neutral. Think lift with your heel. Make sure you get to the top of the ROM. Check your ROM lying on your back and see how far you can abduct your hip. This should be the same motion you have on your side. Most people only do about 30-35 degrees out of their 45. If you do these correctly (strict), 3x20 should be difficult, or you need to work up to it.

Once you can do 3x20 'easy', then I feel more comfortable about you doing the X-band walks stuff. I use a loop band around my ankle. I have different strengths/thicknesses from Perform Better.

For ankle:
I like to start with simple AROM ankle circles, 40 in/40 out, full slow-ish, big circles. Then 40 dorsiflex/plantarflex full movements. Most people have trouble doing these correctly. Do these once a day for at three weeks, then add/progress to band resisted ROM . Some people if they jump right into bands may use substitution patterns, using only one muscle group to invert or evert instead of all of them. Once you've done band exercises for awhile (3-6weeks), you can add/progress to weight bearing foot/ankle ex. Walking with feet turned in, turned out, on inside of feet, on outside, on heels, on balls of feet. Barefoot on grass is ideal. 20 steps each foot, each way, once a day. Then I like to progress to seated calf raises, sets of 15-20. And one legged calf raises with dumbbell, sets of 2-5. And FW , walking on balls of feet.
Thanks for this info. Good to know.

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

Post by powerlifter54 » Sat Jul 16, 2016 1:35 pm

Spiller wrote:
2. Yep, anterior full hip arthroplasty. Surgeon preferred, and i agreed to avoid metal on metal so i have metal acetabulum cap and femur rod, and ceramic ball on crosslinked polyethylene liner. Considered hip resurfacing but questions about my femur neck bone loss (noted in MRI, but ortho doc said looked fine and my bone density was pretty off the charts), insurance issues, and most of all posterior approach, where they have to cut at least some muscle and has more post op precautions was a decision maker for me.
Thanks, I was curious because I've talked to one highly regarded Ortho here in the Modesto area (William Whang). He does posterior and anterior approaches. So, I asked him how he decides. He strongly prefers the anterior approach. Says it's a better surgery. (I know there's less chance of dislocation, although the risk for posterior approach has decreased a ton over the years.) He chooses posterior approach if pt has certain anatomy (I believe he was referencing anteversion/retroversion and femoreal neck angle, but he wasn't specific) and a younger male athlete with a lot of muscle to cut through.

I'm not saying you should have got a posterior approach. I would just think that with the muscle you did get cut, it would be good to make sure it gets fully stretched out and treat all the incision/scar tissue to limit adhesions.

I hope your rehab is progressing well.
My doc said he cut nothing but skin and fascia, and the bone. But i am being very careful. The challenge in my case according to my doc is my acetabulum had to be not reconstructed but actually constructed. There is bone missing that never developed. So we are giving the bone time to grow into the screws around the acetabular shell and femoral stem. Interestingly my femur bone density was such that he had to use a much smaller stem to fit it in the opening inside the femur. The bone apparently gets more dense on the inside from load. But i have lots of easy basic work to do on just the issues from disuse before surgery. This is a three phase rehab. First 6-8 weeks to let bone grow, gain some mobility, proprioception, and hypertrophy from light high rep and measured ROM work, basic movement, and work with PT. My daughters wedding is in mid September and no limping and fluid dancing is in the MOE. Second phase is around 8 months to get back to some baselines. 315x3 and 405x3 in the Bench and deadlift at around RPE of 7. And 10 perfect scap retracted no internal rotation pullups. No grinding. This could come much faster but the goal here is to keep the goal the goal. Then phase 3 is recalibrate and figure out where to go from there. Haven't desired to compete in a while and perhaps more interested in getting to a life below 200lbs. We will see.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Shafpocalypse Now » Tue Jul 19, 2016 1:05 pm

A friend of mine got an anterior procedure and they broke part of the femur inserting the new joint. So, they wired it and he has to stay off it while everything grows back together. Kind of a shit deal for him.

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

Post by powerlifter54 » Tue Jul 19, 2016 1:32 pm

Shafpocalypse Now wrote:A friend of mine got an anterior procedure and they broke part of the femur inserting the new joint. So, they wired it and he has to stay off it while everything grows back together. Kind of a shit deal for him.
Getting on elevator two days before surgery at Medical building a well dressed guy came on in a walker. Asked him if he had his hip or knee replaced. His hip he replied, and then said he had fallen twice and broken the femur twice. Geez. ASked my doc about this and it is a real risk, but my bone density protected me here a bit. One of the reasons i avoided a resurface, which cuts the femur on the neck right before the ball is i had an indication of bone loss there in the MRI. Which was wrong it turned out. All you can do is anticipate problems and take steps to mitigate the risk.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Testiclaw » Tue Jul 19, 2016 2:22 pm

Have you ever watched a pin being put into a bone along its axis?

Good fucking lord, it's stomach turning.
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Re: Full Knee Replacement: who has had it done or knows a thing or two?

Post by Testiclaw » Tue Jul 19, 2016 2:25 pm

My cousin is a redheaded german-mexican, we call him a beanerschnitzel

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