Who here had had a full knee replacement.

Wife is going in 12/2 for some knee hardware.

She lost her ACL 30 years ago skiing - the Dr cleaned it up, and said just keep it strong.
6 years ago she had it replaced, couple years after it failed,
so she had it replaced again 2ish years ago.
through various mechanical processes, the knee has destabilized over the years,
and she did not recover from the revision - including 15 degrees of uncontrolled hyper extension.

her new knee will include a "stop" to prevent the hyper extension, and eliminate the need for an ACL and PCL.
I don't know how that works?

Dr Haas and HSS will be doing the surgery.

Anyway - where did everyone go for rehab? how often?
Stairs? using the bathroom?
What other major challenges?
 
Patrick said:
Wife is going in 12/2 for some knee hardware.

She lost her ACL 30 years ago skiing - the Dr cleaned it up, and said just keep it strong.
6 years ago she had it replaced, couple years after it failed,
so she had it replaced again 2ish years ago.
through various mechanical processes, the knee has destabilized over the years,
and she did not recover from the revision - including 15 degrees of uncontrolled hyper extension.

her new knee will include a "stop" to prevent the hyper extension, and eliminate the need for an ACL and PCL.
I don't know how that works?

Dr Haas and HSS will be doing the surgery.

Anyway - where did everyone go for rehab? how often?
Stairs? using the bathroom?
What other major challenges?
Click to expand...
@MrsMadisonDan had total knee replacement on 9/26. Dr. Mayman at HSS. She was at HSS for about 8 hours from check in to discharge. Ace bandage comes off the next morning. Allowed to shower on day 1. Had the terlit seat thing with handles, and after a day or two, was more annoying than necessary. They used the MAKO computer assist thingy, and 5 different nerve blocks (1 spinal, 4 in leg) which made the anesthesia hangover much more manageable than prior tkr in 2018.


Recovery probably runs along the lines of both luck, and physical fitness going into it.
 
Patrick said:
Dr Haas and HSS will be doing the surgery.

Anyway - where did everyone go for rehab? how often?
Stairs? using the bathroom?
What other major challenges?
Click to expand...
I’m sorry to hear the journey continues, but hopefully third time is a charm.

More later, but Dr Avocado there is the man- the main knee guy at HSS (I consulted with him but went local)

In home rehab for a week or so, then at IvyRehab- 3x/week for 3 months?
If she can pre-hab with PT, that’s a great prep and you can establish a relationship with her therapist/find one she likes.
Keep an eye on PT allowance for the year.

I was doing stairs from the get go.
No option.
Have a walker on each level, and she’ll use a cane/railing to do the stairs.

Bathroom- get a seat extender.

Other challenges, yes.
 
jmanic said:
I’m sorry to hear the journey continues, but hopefully third time is a charm.

More later, but Dr Avocado there is the man- the main knee guy at HSS (I consulted with him but went local)

In home rehab for a week or so, then at IvyRehab- 3x/week for 3 months?
If she can pre-hab with PT, that’s a great prep and you can establish a relationship with her therapist/find one she likes.
Keep an eye on PT allowance for the year.

I was doing stairs from the get go.
No option.
Have a walker on each level, and she’ll use a cane/railing to do the stairs.

Bathroom- get a seat extender.

Other challenges, yes.
Click to expand...
+1 for in home rehab for a week or three, then IvyRehab
 
@Patrick
Funny, I was just reviewing this as I prep for my next new knee in 3 weeks.
These are notes I wrote up about 2 weeks post op from the first.

Prep work is all in the range of motion and strength.
Wherever you are on the day of surgery is where your recovery journey begins.
You cannot be overprepared.

I also vote for the Mako robo-assisted surgery, and outpatient if she can vs hospital.
Surgery centers (like HSS) are only for elective surgeries (no sick people) and out the same day,
so less risk of infection.
And who wants to be in a hospital?

Of the 5 or so consults I had over the years, the best packet of what to expect was from Haas.
It was hands down the most informative and realistic regarding what happens.



Pre-op/prep:
-Pre-hab with PT if you can, if you can’t, get TKR exercises and do them on your own- focus on RoM and Strength- work on stamina and weight loss as needed
-Get multiple consultations- find the right doc and team- things to consider: in/out-patient, hospital/surgical center, minimal TKR, robotic assisted surgery (extra cost likely)- ask about revision rates, number of surgeries/year, infection rates, expected pain meds regimen, recovery timeline
- Plan on lots of pre-op screening- X-Ray, CT-scan, MRI, blood work, EKG, etc
-Dental work- get any pending dental work/cleanings out of the way- advice will be no dental visits for 3-months post-op, and you will need to take antibiotics prior to dental visits for life
-Do your chores- you are about to be really limited- take in the garden hoses or seed the lawn- whatever will need to be done while you are laid up
-Prep/plan the house- if you can recover on a single floor, great- if not make the situation best as possible- think about where you will be- tall chairs, stools, recliners will be comfortable - walk around the house and imagine navigating it with a walker-
-sleep prep- sleeping will be difficult post-op, get into good general sleep hygiene habits, and learn to sleep on your back if you’re a side sleeper
-Get things: pee bottles for bedside, yoga straps to help move your leg, a walker for each floor (you may be given one at discharge), canes for stairs, sock assisters, ice packs or machine, elevated toilet seat - summer weight pajama pants- slip on shoes/slippers
-Meal prep/shopping- look up good diet for post-op- stock up on these things, and prep/freeze meals if you can
-Be clear on pain meds schedule with your doc- pre-fill any new/existing prescriptions before surgery
-Plan transportation for post-op Pt
-Get a temporary Handicap parking placard- NJMVC form submitted to local cop shop
-take time off from work/submit for leave (FMLA)
-plan/set up some projects- simple stuff that doesn’t require lots of physical/mental ability/stamina
-line up TV shows to binge- 30-45 minute episodes are perfect for icing/elevation (I went NYPD Blue to start)

Post-op:
-Ice, ice baby- plan on icing a lot- aim for 20 minutes at a time as often as every hour- it will help to have multiple ice packs or an ice machine- if an ice machine, prep frozen water bottles- multiple sets
-rest as often as you can, but try to not nap to maintain a sleep schedule
-3x30: ice and elevate for 30 minutes, at least 3x/day
-use meds as needed- don’t get behind and have to chase the pain
- don’t sit in any one position for longer than 1 hour
-get back to work- pick up where you left off on pre-hab- the sooner/more often you get your exercises in, the better- post-op rehab will dictate knee performance down the road
-be gentle with yourself
- listen to your body- your recovery may or may not follow the expected timeline- this is okay
- plan on everything taking forever
 
Good stuff - thank you all,

Def going with Haas - he did not go right to knee replacement, we were sent to a neurologist who confirmed all the connections were there.
He reviewed the MRI beyond what was written. He is the "head of knees" (I know right..)

If you ever stood-up/step with your leg "asleep", your knee will lock out against the back immediately - neurologist says this is a reaction from the spine, not the brain.
They had to eliminate stroke/nerve block as a potential issue.

All done with x-ray, MRI, CT, pre-op scheduled - Sue has been on the stationary bike and rower.
She has full range plus some now - only certain positions hurt, as there is limited arthritis, and no bone-on-bone.

I'll ask if this is a combo of robotics - the type of hardware protrudes 100mm into the femur and tibia.
I asked if she could come out two inches taller - he laughed. I know one thing that isn't going to happen before surgery.........

While this is going to hurt more than the ACL surgeries - she is good about doing her PT, and pain meds.
even if I take most of them.

He expected an overnight stay because of the extra hardware

Pre-PT is scheduled tomorrow.

We have the ice cooler with the pump! after a couple knee cuffs. ya collect things.

we can't find the walker - on order - I like the idea of two, trying to find a second.
toilet and shower assist - on order

2-3 weeks in-home rehab scheduled.

Waiting for @jdog about the PT place he uses. I hear a horn when he goes by my place.
 
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Patrick said:
Good stuff - thank you all,

Def going with Haas - he did not go right to knee replacement, we were sent to a neurologist who confirmed all the connections were there.
He reviewed the MRI beyond what was written. He is the "head of knees" (I know right..)

If you ever stood-up/step with your leg "asleep", your knee will lock out against the back immediately - neurologist says this is a reaction from the spine, not the brain.
They had to eliminate stroke/nerve block as a potential issue.

All done with x-ray, MRI, CT, pre-op scheduled - Sue has been on the stationary bike and rower.
She has full range plus some now - only certain positions hurt, as there is limited arthritis, and no bone-on-bone.

I'll ask if this is a combo of robotics - the type of hardware protrudes 100mm into the femur and tibia.
I asked if she could come out two inches taller - he laughed. I know one thing that isn't going to happen before surgery.........

While this is going to hurt more than the ACL surgeries - she is good about doing her PT, and pain meds.
even if I take most of them.

He expected an overnight stay because of the extra hardware

Pre-PT is scheduled tomorrow.

We have the ice cooler with the pump! after a couple knee cuffs. ya collect things.

we can't find the walker - on order - I like the idea of two, trying to find a second.
toilet and shower assist - on order

2-3 weeks in-home rehab scheduled.

Waiting for @jdog about the PT place he uses. I hear a horn when he goes by my place.
Click to expand...
They will give you a walker and cane at HSS. You can't be discharged until you can walk (hobble) up/down 3 steps.
Hardware is Stryker Triathlon TS.


Add a non skid mat for IN THE SHOWER.
 
MadisonDan said:
Hardware is Stryker Triathlon TS.
Click to expand...

hope they have the proper install kit and adapters.....
😀

does it need to be lubricated? wax or t9?
(this is actually a real question - is it just that smooth that it never needs an injection until it wears out?)
 
Rollin Dice said:
I had bilateral TKR at HSS in 21 with Dr Sculco. Great experience. Only thing to add is think about renting a hospital bed. Game changer for me.
Click to expand...

I only know one person who did both at the same time. they stayed at the rehab place for 3 weeks.

How long until it felt like "your own knees" ?
Did the confidence come in small or large servings? (pardon the metaphor)
 
I stayed 3 days in hospital, went home after I was able to climb stairs. 1 week of in home PT, then went to Hunterdon Wellness center 3 days a week for PT. Probably 5-6 months before started feeling like mine. It was small servings.
 
Rollin Dice said:
I stayed 3 days in hospital, went home after I was able to climb stairs. 1 week of in home PT, then went to Hunterdon Wellness center 3 days a week for PT. Probably 5-6 months before started feeling like mine. It was small servings.
Click to expand...
Yeah, my guy said he would do bilateral for me if I insisted, but not older patients.
Kudos to you, I can’t imagine rehabbing both at the same time, though there is something to getting it over with.

@Patrick - nothing in the manual about lubing or maintenance schedule, but you know how those manuals are…

On the ice machine, those are pretty great, I borrowed one for a bit but the cuff was a bit small for me, but super convenient.

I will say my PT was adamant about ice for no longer than 20 minutes, otherwise it gets counterproductive.
That said, I heard lots of folks running the ice machine for hours on end with good effect. If you go that route, just make sure it’s not fully ice cold on the skin- thin towel under the cuff. Think cool, not cold.

Ultimately I went with a knee ice pack system- couple of ice packs in rotation, and it had compression - like a blood pressure cuff.

Either way, managing swelling is a big part of the battle.

As my anesthesiologist explained, there’s pain and there’s discomfort.
Try to manage what’s actually going on.
With the 3-day nerve block they hit you with post-op, you shouldn’t feel pain for a bit. Discomfort, yes.

I have a sorta funny story about a young post-op nurse maxing me out on fentanyl during recovery when maybe they shouldnta.
Kept asking if I was comfortable, and I’m like not really, and they’d give me another blast. This went on for about an hour.

Even looped I could see the anesthesiologist’s Wtaf face when the nurse proudly reported they had given me the maximum dose of vitamin F.
 
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New knee, new tree....

Getting it done early.

IMG_7845.jpeg
 
Heed my advice...

"My one and only regret is not sticking to a consistent leg-strengthening routine a year after the surgery. I thought I could get away with light weights and cycling - and for the most part it was enough - but now that my kids are snowboarding more (6 years post-op), I’m having trouble keeping up. The knee fatigues and starts to hurt after a full day. Boarding 2 days in a row is tough without a lot of Advil and a heavy brace. I am having the same issues with park and DH riding - anything with big impacts."

Once you get past the rehab and all the restrictions, make sure to keep your legs strong. I mean real strong with weights and a consistent routine. You’ll have less issues 6, 10, 15 years post surgery.

Good luck!

Reply
 
MadisonDan said:
Hardware is Stryker Triathlon TS.
Click to expand...

Dr Haas is going with the Smith & Nephew Legion - might be the HK version because of the hyper-extension.

He is using the CORI robotic assistant - he made a video

 
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