Yeah; I'd have a serious talk with the surgeon and the anesthesiologist. At that age with those symptoms there's a significant risk involved, and recovery will be very challenging.
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Yeah; I'd have a serious talk with the surgeon and the anesthesiologist. At that age with those symptoms there's a significant risk involved, and recovery will be very challenging.
I think I would advocate strongly against it and try to deal with it via medications or other treatments.
Agreed. Sounds like the QOL benefits are questionable and recovery will be challenging at best. Between the inactivity and the increased cardiac load the surgery alone might kill her.
Can she even be counted on to do the physical therapy? If not she has no hope. Even a motivated perfectly compliant patient of that age and health is looking at 6+ months before they're more mobile than they are now.
Serious conversations with mom and the surgeon are warranted.
I'm against it for sure and realize this might kill her. She has tried other treatments and now has her mind set on a FKR. She won't even use a cane right now she is sooo stubborn. She has said she'd rather die than go to a retirement home, and this may be her last try to avoid that fate, because the next option is being stuck in a wheelchair in a home. She may end up in a wheelchair for life anyways with this FKR.
I want her to fail the tests they give to people to see if they qualify for surgery (she has passed a bunch of them so far). Maybe the doctor thinks she has no chance of passing the tests because I can't figure out why he is entertaining the idea. I have to call him or his assistants next week and ask what the reasoning is. This was all thrown at me like a dodgeball to the face on Thursday with a text saying "I have a FKR scheduled for Oct 3rd". I called her and told her she is not doing it on the 3rd and you have to ask me my schedule first and I'm gone most of October. She got pissed, of course....
Wow that’s brutal. Good luck. I hope you have the hipaa waiver so the doc is allowed to talk to you directly. It’s an easy form, but she’ll have to sign it
I do have it already, thankfully.Quote:
Originally Posted by mcski
Thanks everyone for the advice and confirming that this is probably gonna suck for everyone.
Just being put under at 90+ is a huge risk.
My dad was a surgeon. People would always shop for the best surgeon, but didn't even research the anesthesiologist.
Who's going to be the one that kills you.
This is the worst of all possible situations. I can sympathize with her at least a little - in essence she's saying her life is not worth living as it currently is, and she's willing to gamble on the surgery. It sounds like she probably thinks if she doesn't survive the surgery/anesthesia, she's fine with that - solves the primary problem. Unfortunately if she does survive it, the next 6-12 months could be far worse than her pre-surgery condition. I recommend talking to the surgeon and anesthesiologist, one on one, maybe even backing them into a corner. Also get second opinions from Docs that don't have their professional reputations directly on the line.
https://wapo.st/3MOkr0EQuote:
Many of Americans like McHatton deal with chronic knee pain. The culprit nearly always is injured cartilage — the elastic, almost Jell-O-like substance that protects the joints and bones of the human body. More than 30 million Americans suffer from osteoarthritis, a wear-and-tear condition that occurs when cartilage withers away, a defect especially prevalent in the knee. The last-resort treatment for those with bum knees is replacement surgery. According to the Academy of Orthopaedic Surgeons, more than 600,000 Americans get new knees made of metal every year. Indeed, total knee replacement is now the most common inpatient surgery for people over 45.
First, the surgeon wants to do her surgery because that’s what he does. Orthopedic surgeons are surgery happy, especially joint replacement surgeons. When you have a hammer…
Second, the surgeon doesn’t care about her general health, he only cares that she has osteoarthritis and that she complains of pain.
Third, the anesthesiologist isn’t going to kill her. She’ll likely get a spinal and nerve block. No one that I work with would give a general anesthetic to someone that age and condition for what is an entirely elective surgery.
Muted, is your mother’s primary complaint with her knee pain? She really needs to use a walker or cane. If she does have surgery it’s not the surgery or anesthesia that will kill her, it’s the inactivity after surgery with her congestive heart failure. There will probably be no quality of life change after surgery other than less pain, maybe.
I would suggest that you strongly discourage your mother from going through with surgery.
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My grandmother had tkr in her early 90’s. She was fairly immobile and in a lot of pain. Surgery intent was to reduce pain. She didn’t have comorbidities and did not have plans for significant rehab. The surgery was successful and helped her with the pain. She retained her minimal mobility, but without pain and lived to be 99 with minimal medical intervention, which was early compare to her older siblings.
Wow that’s pretty amazing/lucky, but I think your grandma is an outlier
My dad had his second bka 10plus years after the first when he was 87. He was really good about exercise and rehab for both, but age made recovery from the second much more difficult. He got through it, but he was an outlier a bit as well. He got a couple good years out of it but in retrospect, I’m not sure I’d have had him do it again
Yes. Her lack of other health issues with no intent of gaining full mobility back made her a good candidate.
My father never really had a chance to recover from his tkr last winter. His spiral started with DVT likely as a result of the surgery. He was 78 and spent months prehabbing.
Despite my concerns and all your concerns (thank you for the advice) my Mom is having a TKR tomorrow morning. Her good leg now has edema since I posted, it is extremely swollen and 2-3 times the size of her bad leg. But all the doctors she has seen has given her the green light, including her surgeon (who I don't like) and her primary care doc who is beyond compassionate with my Mom when she visits. It's confusing.
Thanks Bunion for that link - I asked the surgeon about those alt options and he said he's never heard of any of them. He just does one thing and one thing only and doesn't care about alternatives - the fucker.
MagUni, you are right she is getting a spinal block - now as I read a couple pages back on this thread I'm realizing that means she will be awake the whole surgery?? How did this not register with me weeks ago...damn it.
Yeah, i would never want to be awake during a surgery like this, hear the bone saw?
I understand that for me, general anesthesia might be more dangerous, but the way i look at it, they put me to sleep, and if i don't wake up, I'll never know.
This is my opinion for me, not implying anything for your mother.
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I was going to suggest steroid injection(s), but oh well, good luck.
Spinal block and deep sedation (twilight) is pretty much the go to these days. They say it's not general anesthesia, but I have absolutely no recollection of between IV administration and recovery. Hopefully that will be the same for her.Quote:
Originally Posted by muted reborn
Best of luck.
What teledave says--she'll get a sedative, often Versed, that will keep her from being aware or remembering any of it.
Swelling in one leg is a concern--I assume a blood clott has been ruled out?
Steroids stopped temporarily solving the problem more than a year ago. They worked well at first.Quote:
Originally Posted by plugboots
You were right, and thank god. Thanks.Quote:
Originally Posted by teledave
It was checked and ruled out twice just to be sure.Quote:
Originally Posted by old goat
Overall today went well so I'm slightly slightly optimistic now. She is a tough old bird.
All the best. In some ways the apprehension is the worst. Now you have tangible issues to overcome, but the known is generally easier than the unknown.Quote:
Originally Posted by muted reborn
I've been milking bone-on-bone in the Left knee for several years. 18mos ago, saw a ortho and got an injection of Cortisone (which seemed to help, probably due to inflammation reduction). 2 more injections since that time. Most recently discussion was me asking/confirming that they said "I'd know when I need a TKR". Her answer was "oh, you're ready". This actually surprised me, but probably drove home the fact that it is time. 59yr old, would like to be able to enjoy my 60s before life starts to slow down.
So, what questions do you ask to ensure your surgeon is the correct choice? # of procedures a yr and total, rejection rate. What else? Is there a web site that I can get those stats? I trust his PA (the one I had the conversation with), is a competitive cyclist and understands where I come from (as an aged former competitive cyclist). But trust doesn't mean they are the right ones for the job. I initially found them via referrals and because they are the Ortho for the local college team.
It sure sounds like I'm due for TKR, so to me, the next choice is ensuring I have the right team in place to perform it. Any help on that decision is helpful. Thanks
(In Missoula if someone knows docs here)
delete - dup post
Similar age and knee boat here trying to decide when to get the upgrade. I have an appt in Feb with the doc I would use here in Maine, made the appt in June and Feb was first available for a new patient. Figured I’d best get on the books with an initial consult with him so I can decide when to pull the trigger and not have to wait another six - seven months just to meet the guy.
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I have a TKR sheduled for my right knee on March 11th.
Tore my ACL last March, and the doc who did a great job scoping my left knee convinced me the ACL was the way to go, even though I was assured that eventually both knees would need replacing. I asked him to just do the TKR, but he said he wanted to get me 10 more years (I'm 52). I trusted him, and while I believe he did a good job with the ACL, I'm in a ton of pain. Went to get a second opinion from a recommended surgeon, and he told me that he would do the TKR now since there is extensive medial narrowing and my pain level. He made the case that age should not be a factor, but quality of life. Well, my QoL sucks at the moment.
This will be a MAKO Robot assisted, and from what I can tell the surgeon is very good. Admittedly, however, it's not easy to find info.
Intently following this thread. Thinking within 5 yrs I'll be getting at least one done, but will put off until my knee guys says it's time.
What I'm finding here in Southern Maine is I'm not going to hear the doc say it's time, they want the patient to make the call. I'll confirm that theory when I have my consult in Feb.Quote:
Originally Posted by garyfromterrace
Sidenote of less than awesome, took a digger last Tuesday on a groomer and pretty sure I strained my PCL on the knee that is a TKR candidate. Been on crutches since then, full RICE protocol. Had my first ACL repair on that knee in '83, it's since had multiple scopes and a second reconstruction. Other knee has had two ACL recons.
Fuck me
Follow up - my 91 year old Mom is a month out of replacement and she is doing great. She was in a rehab home for 3 weeks and is now at home alone with a walker moving fine. As long as she avoids a home fall during her recovery I'm going to call this a complete success. I'm surprised and impressed.Quote:
Originally Posted by muted reborn
Great news! So happy to hear that.
Great news muted!
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Great news muted!!
My donjoy custom brace stabilizes my knee a lot. I’m in uniform sometimes hotlapping all day with a torn meniscus, possibly still torn mcl, and no acl. I also wear it when hiking, swimming, etc. They can stabilize pcl’s, too. It was super fast to get: I contacted the company, was given the contact info for the local rep, met the rep for measurements and to sign some paperwork, and got the brace 2 weeks later. My high deductible insurance covered the brace (expensive year!!), but it would have been fairly inexpensive if I paid out of pocket. Maybe worth considering while you’re waiting for the big surgery.Quote:
Originally Posted by ticketchecker
Thanks BWQuote:
Originally Posted by bodywhomper
I could start a show me your knee brace quiver thread with a pic of mine! Right now my brace quiver is 2.5 hours away from me and I'll be able to look through it tomorrow, I have a feeling the ones that are in good shape are for the other leg so I might be exploring the new brace route for this season. Going to see an ortho tomorrow for a manual exam, so far only x rays at the ER and talked to the ER Doc who knows less about knees than I do
Thanks everyone. I wanted to follow up to say if my old Mom with heart failure and a million other health issues can do it, probably so can you. She is already walking faster than before. (Results may vary. This is intended for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional regarding any questions you may have about your health or treatment options.)
Thanks, muted. Glad to hear she's doing well. She's a real trooper!
The one consistent comment that I have received from those I see at PT with a TKR is: "Don't wait."
Love to hear it muted. Go mom.
Follow up with ortho yesterday yielded mixed results. More x rays, still negative and no new damage to anything that's left in that knee. Apparently arthritis ravaged joints like mine don't do well with significant impacts anymore, was told the popping I felt was a result of a badly spurred joint hitting the deck. Swelling has come down completely but I'm left with pain and can kind of walk comfortably with a single crutch around the house, used two when going out yesterday. High probability when it fully settles down my new baseline may not be what the previous one was.
Dr's pat joke is arthritic old knees can't take a joke
That sucks. I skied on Sunday and Monday, and have been walking with a cane until this morning. We leave on a trip this coming Saturday, and the cane -- and possibly the crutches -- will be coming with me.Quote:
Originally Posted by ticketchecker
This past weekend was so bad, in fact, that I've started considering moving the operation up to maybe February, even end of January. Not sure I'll make it through the season yo-yoing like this: ski a few days, recover for a week; ski a few days, recover for a week. My PT did me a world of good this morning, but even he thinks it's time.
I hope you find relief sooner rather than later.
Iron, I really hope you can get fixed. 2 days skiing to 2 days limping is not a great ratio. My schtick the last 20 or so years is if I'm limping/wearing crutches or unable to do stuff I want to, I try to see my knee doc and come up with a plan (surg, physio, whatever). Next big trauma with either knee is going to lead to a reconstruct (don't know if it's partial or full). I am going to try and ski 100 days this season on my old arthritic knees (double custom fitted braces of course). This way I'll be ready for the knife and the ensuing recovery (physio like a pro athlete).
Thanks. Yeah, I'm a champ at recovery, but what makes this so difficult is there hasn't been any light at the end of the tunnel for a long time. ACL recovery was going smoothly... until it wasn't. And it's been a train wreck since then.Quote:
Originally Posted by garyfromterrace
Doc originally said I'd be a good candidate for a partial, but once he started poking at me, he realized I have soreness on the lateral side, as well. He was also afraid that if we prop up the medial, the lateral won't care for the new arrangement and will fail sooner rather than later.
Hey, it seems like this is a pretty dialed-in procedure. I guess the only trepidation I have is accepting the fact that they are cutting out pieces of me. Maybe that sounds silly - it definitely does to my wife - but something about removing my natural body parts and replacing them is... an interesting pill to swallow.
Well, FWIW, I got a total in 2019, and by mid-2020, I was jumping off the same (if not even bigger) stuff on the MTB than ever. Nothing but an improvement in every possible way.
That's music to my ears.Quote:
Originally Posted by rideit