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Old 08-11-2018, 10:27 AM
 
Location: Southern California
29,267 posts, read 16,655,017 times
Reputation: 18903

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Quote:
Originally Posted by 2nccoast View Post
The ability to bend the knee is crucial for a lot of activities: climbing stairs, stepping over the rim of the bathtub, putting your pants on... Most of you are seated while reading C-D. Try this: stick one leg out, but keep your foot on the floor. Now try to stand up without using your arms. You'd find it very difficult.

When working with my patients, I aim for at least 90 deg of bending (flexion, in medical terms) by about 2-3 weeks after surgery. Over the next few weeks they should get to at least 110-120 deg, which is sufficient to be functional.

By the same token, the ability to straighten out your leg (extension, in medical terms) is also very important. If you cannot extend your leg, the surgical side will be effectively shorter than the other leg, when you stand up. Two legs of unequal length = limping. This will negatively impact your knee and hip joints over the long run.

True story: I am working right now with a patient who had a knee replacement in 2003. For some reason, she did not have proper physical therapy afterwards, and now she cannot bend that leg more than 70 deg. She has a heck of a time getting up from a chair, climbing stairs, etc... Lots of things we take for granted or do without even a second thought, are very difficult for her.
You are a PT...And as bad and damaged as my knee is, I can bend it good, straighten it out real straight, isometrically, and WHY would I want to do a knee replacement? When I was in the rehabs and before the staph infection was found, the PT's from the MD's orders kept pushing me to walk and I could not, could not stand on that messed up knee and it was due to the infection which they finally found from an MRI. The knee was so damaged from the constant PUSH as I see it now.

I'm seeing a new ortho MD next week, younger doc and get his opinion...he does PRP as well and I want him to see if there fluid that can be drained, mostly on inside of knee. He could be one of the UCLA docs trained in PRP/Stem Cells by Dr. Darrow who teaches it up there.
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Old 08-11-2018, 12:35 PM
 
5,644 posts, read 13,201,288 times
Reputation: 14170
Quote:
Originally Posted by jaminhealth View Post
Why wouldn't the hospital discharge her with some type of pain meds...the pain is HIGH with this replacement surgeries. People don't realize until they'e done a replacement. Even a schedule for ibuprofen of say 800mg for a while to get her thru the worst.
Every patient is on DVT prophylaxis with anticoagulants after knee replacement surgery...

Depending on the medication being used say Coumadin, your advice for scheduled Ibuprofen could kill that patient...
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Old 08-11-2018, 12:40 PM
 
Location: Southern California
29,267 posts, read 16,655,017 times
Reputation: 18903
When I left hospital after hip replacement, surgeon had me on aspirin therapy. Isn't that about the same as ibuprofen. No coumadin drug from him. This was his dx for blood thinner.
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Old 08-11-2018, 12:51 PM
 
5,644 posts, read 13,201,288 times
Reputation: 14170
Quote:
Originally Posted by jaminhealth View Post
I read so many who go thru these have a terrible time getting their knee(s) to bend. Whatever cartilage is there is all gone for plastic and metal. The MD I hear every week on the PRP/Stem Cell program says as long as one bends their knee there is cartilage there. I bend my knee quite well ENOUGH and that's why I resist a replacement for my knee.

I do a lot with this knee considering what it's been thru and 80 yrs old, but I know there are issues there.
You can keep repeating this same refrain, doesn't make it true...

By the time most folks opt for total knee replacement they have little to no cartilage remaining in the joint, what cartilage does remain is so worn down as to be next to useless and the reason for so much pain.

I have seen patients with plenty of joint space remaining on x rays that could barely bend their knees...

I have seen patients with x rays showing bone on bone arthritis with bone eroding into bone that could still bend their knees fine and you wonder how it is possible...

The ability to "bend the knee" has little correlation with the amount of cartilage remaining within the joint and to say as long as one can "bend the knee" they have cartilage remaining is clearly false...

A lot more goes into knee flexion than the amount of cartilage remaining in the joint.

Knee replacement surgery should be done for PAIN only....not for "loss of motion"

One of the key lessons I learned in Orthopaedics many years ago regarding knee arthritis and knee replacement surgery remains true today....the knee motion you have going into surgery is about the motion you will have coming out of surgery

So deciding to put off knee replacement because you can still bend the knee "good enough" will hurt people in the long run because when they can no longer "bend the knee good enough" a knee replacement likely isn't going to correct that issue...
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Old 08-11-2018, 12:55 PM
 
Location: Southern California
29,267 posts, read 16,655,017 times
Reputation: 18903
Quote:
Originally Posted by bluedevilz View Post
You can keep repeating this same refrain, doesn't make it true...

By the time most folks opt for total knee replacement they have little to no cartilage remaining in the joint, what cartilage does remain is so worn down as to be next to useless and the reason for so much pain.

I have seen patients with plenty of joint space remaining on x rays that could barely bend their knees...

I have seen patients with x rays showing bone on bone arthritis with bone eroding into bone that could still bend their knees fine and you wonder how it is possible...

The ability to "bend the knee" has little correlation with the amount of cartilage remaining within the joint and to say as long as one can "bend the knee" they have cartilage remaining is clearly false...

A lot more goes into knee flexion than the amount of cartilage remaining in the joint.

Knee replacement surgery should be done for PAIN only....not for "loss of motion"

One of the key lessons I learned in Orthopaedics many years ago regarding knee arthritis and knee replacement surgery remains true today....the knee motion you have going into surgery is about the motion you will have coming out of surgery

So deciding to put off knee replacement because you can still bend the knee "good enough" will hurt people in the long run because when they can no longer "bend the knee good enough" a knee replacement likely isn't going to correct that issue...
It's good to see the "new" ortho MD's are starting to work with other protocols like PRP/Stem Cells. The old time docs minds are closed, the one I talked to anyway..he's ready to retire and been doing surgeries for probably 30 yrs. I'm sure plenty of the surgeons have heard enough grief stories from their patients. I can just imagine. We have no idea, not even you doc.
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Old 08-11-2018, 01:03 PM
 
Location: Bella Vista, Ark
77,772 posts, read 104,433,328 times
Reputation: 49248
Quote:
Originally Posted by KaraZetterberg153 View Post
No, guys: not young. Just turned 68 a couple of weeks ago.
ok, that explains your concerns a little better but I was 10 years older than you when I had mine done almost 4 years ago. Still, you should be fine, but don't be alone the first few days to maybe a week.
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Old 08-11-2018, 01:04 PM
 
436 posts, read 575,832 times
Reputation: 1036
Quote:
Originally Posted by KaraZetterberg153 View Post
I may need to do either a joint replacement or a complete knee replacement on my left knee, due to damage I sustained from a riding accident. I'm thinking, based on what I've read so far:

• Buy a freezer, so lots of ice will be available
• Get into the best shape, physically, I can, including being both very slender and as strong as I can be
• I have my dad's canes I could use, but no walker
• Recovery could be anywhere from six weeks to several months, assuming no complications?
• I'm concerned about showering if I only have the use of one leg?
• The walk from the parking area behind the house to my front door is a flat surface, and I could lean on the house

Please share your experiences and book recommendations. I'm hoping I won't need this. I just turned 68.
You don't need a large freezer, if you have a freezer in your refrigerator it should hold the ice packs you need. You will probably be sent home with a small ice machine that has a pad that the cold water circulates through. I used 3 frozen water bottles floating in the water for cooling.

I would disregard the advice to get a walker with 4 wheels unless your Doctor specifically tells you to get this type of walker. My Dr. prohibits it because he said the 4 wheels can cause the walker to get away from you and possibility of falling using that type of walker. With both knee replacements the hospital sent home a walker that my insurance paid for, so I have two. There is no point in paying $300 for a walker. I used a walker for 2 weeks the first time and then 4 days the 2nd time and then moved to a cane.

Recovery is longer than 6 weeks, you can go back to work in 4-6 weeks if you work but you will feel the affects of the surgery for a long time. Three months was the turning point both times when I started really feeling better.

I showered the next day, wrapping my leg in plastic wrap to keep the wound and bandage dry. I think I used the plastic wrap for about a week or 10 days. I do have a walk in shower though so I never had to step over a bathtub. Anytime I have owned a house with two bathtubs I have ripped out one to have a walk in/stand up shower with shower doors installed. It just works better for me.

The first surgery I did not get a nerve block in the knee area, I didn't even know about it. The second surgery, different Dr. I was offered a nerve block and it made all the difference in the world on the pain. I recovered so much quicker on the 2nd knee replacement.

A physical therapist should come to your house for two or three weeks, then it should be out-patient therapy for another 2-3 weeks. If aqua therapy is in your area you can ask about that. I did aqua therapy the 2nd time around starting in week 4 after surgery and it was great.

The most important piece of advice I can give you is get the right orthopedic Dr. to do your knee replacement. Let me repeat this, find the BEST knee replacement Dr. in a 5 state radius and go to him or her even if you have to wait a year to get the surgery. Don't use a knee replacement Dr. because you like him, or he scoped your knee and did a good job, or he gave you shots for a torn rotator cuff and ordered physical therapy and it fixed it and you have gone to him for 8 years and really really like him. Don't fall in that trap.

I am going to repeat this one more time, find the best knee replacement surgeon you can. Every region and area has one or two that are well known and get the best results. If anyone is close to Oklahoma, PM me and I will tell you who I consider the best in Oklahoma. I have had two knee replacements, two Doctors because I lived in two different states when I had each surgery, two different results. I wish my 2nd Doctor had done both knees, but he did do one so it's all good.
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Old 08-11-2018, 01:07 PM
 
5,644 posts, read 13,201,288 times
Reputation: 14170
Quote:
Originally Posted by jaminhealth View Post
It's good to see the "new" ortho MD's are starting to work with other protocols like PRP/Stem Cells. The old time docs minds are closed, the one I talked to anyway..he's ready to retire and been doing surgeries for probably 30 yrs. I'm sure plenty of the surgeons have heard enough grief stories from their patients. I can just imagine. We have no idea, not even you doc.
1. "New" Ortho MD's aren't "starting to work with PRP/Stem Cells" because they haven't been shown to be effective. Your Dr Darrow is not an Orthopaedist. Stem cells remain a niche field with excellent reimbursement potential since its a cash business..There is no overwhelming push or tide in Orthopaedics to jump on the Stem Cell train. More made up nonsense....

2. Orthopaedic Surgeon's minds aren't "closed" because they don't believe in the same foolishness your preach about. The number of new innovations that have come in the last quarter century since I came into this field are innumerable, we do almost NOTHING the same way we did 25 years ago...

Change or die is true in ALL fields of medicine....once again you have NO idea what you are talking about..

3. Every surgeon has patient's that aren't happy that is life in medicine/surgery. No news there, fortunately the number of patients we HELP dwarf the unhappy patients by a large number or we wouldn't do what we do..

As you have been told over and over ad nauseam "WE" DO have a very good idea how many patients are happy and how many aren't and it doesn't take logging on to an anonymous message board...

The research is there....the studies have been done for DECADES....WE know VERY WELL how many patients are happy and how many aren't......just because YOU don't doesn't mean WE don't.....
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Old 08-11-2018, 01:08 PM
 
Location: Bella Vista, Ark
77,772 posts, read 104,433,328 times
Reputation: 49248
Quote:
Originally Posted by jaminhealth View Post
You are a PT...And as bad and damaged as my knee is, I can bend it good, straighten it out real straight, isometrically, and WHY would I want to do a knee replacement? When I was in the rehabs and before the staph infection was found, the PT's from the MD's orders kept pushing me to walk and I could not, could not stand on that messed up knee and it was due to the infection which they finally found from an MRI. The knee was so damaged from the constant PUSH as I see it now.

I'm seeing a new ortho MD next week, younger doc and get his opinion...he does PRP as well and I want him to see if there fluid that can be drained, mostly on inside of knee. He could be one of the UCLA docs trained in PRP/Stem Cells by Dr. Darrow who teaches it up there.
usually it is the bending that is the big issue. Like you, I really didn't have much trouble and after surgery I amazed a lot of people including the hospital how well I could bend less than 24 hours later. My reason for finally deciding to get it done: 1-the pain mainly and 2-it would go out on me with no notice or almost completely go out. I have never regretted having it done, though I look back and it may have hurt worse than I was about to admit at the time. I am hoping not to have my right one done, as after age 80 I am a little nervous about being put under.
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Old 08-11-2018, 01:10 PM
 
5,644 posts, read 13,201,288 times
Reputation: 14170
Quote:
Originally Posted by RedTexanTea View Post
You don't need a large freezer, if you have a freezer in your refrigerator it should hold the ice packs you need. You will probably be sent home with a small ice machine that has a pad that the cold water circulates through. I used 3 frozen water bottles floating in the water for cooling.

I would disregard the advice to get a walker with 4 wheels unless your Doctor specifically tells you to get this type of walker. My Dr. prohibits it because he said the 4 wheels can cause the walker to get away from you and possibility of falling using that type of walker. With both knee replacements the hospital sent home a walker that my insurance paid for, so I have two. There is no point in paying $300 for a walker. I used a walker for 2 weeks the first time and then 4 days the 2nd time and then moved to a cane.

Recovery is longer than 6 weeks, you can go back to work in 4-6 weeks if you work but you will feel the affects of the surgery for a long time. Three months was the turning point both times when I started really feeling better.

I showered the next day, wrapping my leg in plastic wrap to keep the wound and bandage dry. I think I used the plastic wrap for about a week or 10 days. I do have a walk in shower though so I never had to step over a bathtub. Anytime I have owned a house with two bathtubs I have ripped out one to have a walk in/stand up shower with shower doors installed. It just works better for me.

The first surgery I did not get a nerve block in the knee area, I didn't even know about it. The second surgery, different Dr. I was offered a nerve block and it made all the difference in the world on the pain. I recovered so much quicker on the 2nd knee replacement.

A physical therapist should come to your house for two or three weeks, then it should be out-patient therapy for another 2-3 weeks. If aqua therapy is in your area you can ask about that. I did aqua therapy the 2nd time around starting in week 4 after surgery and it was great.

The most important piece of advice I can give you is get the right orthopedic Dr. to do your knee replacement. Let me repeat this, find the BEST knee replacement Dr. in a 5 state radius and go to him or her even if you have to wait a year to get the surgery. Don't use a knee replacement Dr. because you like him, or he scoped your knee and did a good job, or he gave you shots for a torn rotator cuff and ordered physical therapy and it fixed it and you have gone to him for 8 years and really really like him. Don't fall in that trap.

I am going to repeat this one more time, find the best knee replacement surgeon you can. Every region and area has one or two that are well known and get the best results. If anyone is close to Oklahoma, PM me and I will tell you who I consider the best in Oklahoma. I have had two knee replacements, two Doctors because I lived in two different states when I had each surgery, two different results. I wish my 2nd Doctor had done both knees, but he did do one so it's all good.
Really excellent advice here...especially on finding the right surgeon
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