Total knee replacement - Enlighten me (implants, infections, skin, bleeding)

[SickofJersey]

Originally Posted by karen_in_nh_2012

Wow, that is REALLY too bad. I had both knees replaced in 2020, the left (the worst) in February, just before things closed down because of COVID, and then the right in July (postponed from May due to COVID). I had horrible arthritis (as do most of my family members) and it was not getting any better.

The recovery was indeed VERY painful and made it extremely hard to sleep, but I gave up on the narcotics within a couple of days because they weren't helping much (and I definitely didn't want to take higher doses). I lived with the pain and it got better day by day, as I figured it would. (Of course I especially knew that with the 2nd surgery.) I was diligent about the post-op physical therapy although I did that mostly on my own after I had a routine going.

Now I have 2 knees that I can RUN ON again! Yeah, it's all my treadmill now, but running was what I missed the most.

I don't know if they would do the surgery on someone in her 90s, but geez, it's horrible to be in pain all the time. I am very, very, very thankful for both of my new knees!

If you don't mind me asking, how old were you when you had the first one? And how long was the recovery until you were able to walk at least somewhat normally without much pain?

I haven't run in 10 years, but can speed walk. There's just a bit too much pain jogging.

[GotHereQuickAsICould]

My understanding is that the key to a successful knee replacement is doing the exercises before and afterwards. Perhaps the significantly overweight folks don't do that, so surgeons don't see results as good as they would like.

[karen_in_nh_2012]

Originally Posted by SickofJersey

If you don't mind me asking, how old were you when you had the first one? And how long was the recovery until you were able to walk at least somewhat normally without much pain?

I haven't run in 10 years, but can speed walk. There's just a bit too much pain jogging.

I turned 61 on 1/1/20 and I had both TKRs that year. I had been in really awful pain for years before then -- should have had the surgeries much earlier but you live and learn.

The left knee was done in February 2020 -- I was in the hospital overnight getting Oxy, which did nothing for me, so they gave me a prescription for hydrocodone when I went home. That didn't do much either so I stopped taking it within a few days -- I was told that if I took larger doses, they would likely work, but I wasn't willing to do that with an opioid. The pain was the worst at night when I was trying to sleep. During the day, IIRC I used a walker for a few days (I was sleeping on the 1st floor of my house, but gave that up when my kitties kept waking me up overnight -- was able to get up and down the stairs, albeit slowly).

I DO remember that the pain was absolutely horrendous at night for the first few days -- as in, it would keep me awake for HOURS and I'd be screaming at my knee, "STOP HURTING!!" (Normally I don't scream at body parts, but when you think about what the surgery entails , of course it makes SENSE that you'd have pretty severe pain afterward.) Within a few days, I gave up on the walker and just used a cane. Within 2 weeks, I was driving, and my car was a stick shift so that was a big deal -- they had told me I wouldn't be able to drive for at least 6-8 weeks, but they probably assumed I'd still be on the opioids, and I wasn't.

By the time I was driving, I wasn't using even the cane any more and had very little pain. But I was quite diligent about the daily exercises, and I think that helped TREMENDOUSLY.

For the 2nd surgery (July 2020), I knew what to expect and ended up using MAYBE 1-2 opioid pills TOTAL in the first day or two -- but again, they did NOTHING for me, I think they just don't work on me -- and then it was just Tylenol every 6 hours. Tylenol had never worked for me for "regular" pain like an occasional headache, but everyone at the hospital told me that if I took it consistently, it will keep the pain down somewhat, so I just did that for maybe a week or two. Then I gave up on that too.

I didn't use the walker at all after the 2nd surgery -- just the cane for a few days, then I didn't need even that. I was driving my stick shift within a week after the 2nd surgery. Pain was again really bad at night for the first week or two -- more screaming at my leg! -- then it lessened and lessened day by day.

I may have a SLIGHTLY higher pain tolerance than many people, but I am not superhuman and I still managed it just fine. I was definitely feeling totally normal by the end of 2020, and right now, if you saw me you would never know I have 2 artificial knees.

I was a little afraid to start running again -- I TOTALLY overdid it many years ago, and that contributed to my crappy knees -- but I started on my treadmill and had no pain at all. It felt fantastic!! I MAY try running on the street again (which I like better, especially in cold weather but before snow and ice comes) but I know I can't overdo it as I did 20-25 years ago.

OK, that was probably more info than you needed!! But if you are approved for the surgery, I would definitely have it sooner rather than later!! I love, love, love my new knees. Good luck to you!

Originally Posted by GotHereQuickAsICould

My understanding is that the key to a successful knee replacement is doing the exercises before and afterwards. Perhaps the significantly overweight folks don't do that, so surgeons don't see results as good as they would like.

I wasn't given any exercises to do before, although I DID try physical therapy the year before -- it helped some, and I ended up buying an expensive piece of equipment that was similar to what I used in PT (I still use it, although I like the treadmill better! ). But I really, really NEEDED the surgeries.

I have a sister (a few years younger than I am) who desperately needs a TKR but she is something like 100 lbs. overweight and they won't do it yet. I think she would be diligent about the exercises afterward because she certainly knows how important they were in my case. The irony is, right now she can't exercise much because of her size (I know her, I know she tries), and she could likely lose weight more easily by exercising AFTER the surgery.

[SickofJersey]

Thank you so much for the details Karen.

What I got out of it was...

1. Expect pain the first 2 weeks and, unless you're willing to take opioids (which I'm not), it's gonna be tough... especially at night.
2. PT is crucial to a quicker and more successful result
3. I can be active and moving again within a week or two and full recovery can happen quickly
4. If you knew you would've had it done sooner rather than wait as long as you did.
5. Life is better now and you're extremely happy with the results

I will add another one for others pondering that I did for my back surgery... do your research and get the very best hospital and doctor you can find, even if it's a bit far away. The decision for having surgery is very personal and can be life changing. I would never have anyone work on me who is less than the best.


I'm glad your life is better and the surgery was everything you hoped it would be for you.

[xray731]

Originally Posted by metamorphosis

To folks in medicine:

I have a couple of questions about TKR surgery.

I was told (or read) that if a person weighs too much the procedure won’t happen because the weight would damage the manufactured knee.
If that’s true, why don’t they make stronger knees?
If that’s true, how can 200 pounds (for example) on the new knee of a tall person be different than 200 pounds on the new knee of a short person?

I’ve read that there are more risks (recovery, infection, etc) involved for an overweight person.
If that’s true, how do they manage to operate on large people for other issues?


Thanks

I worked for an orthopedist who did a lot of TKR and THR. A 200 lb tall person carries the weight differently than a 200 lb short person. If you are overweight it puts a lot more strain on your joints and you have less muscle tone. Often the fat accumulates around the joints making healing much more difficult. Our physicians used staples which were removed within 7-10 days after surgery. I removed the staples post surgery and most normal weight people already had closure of the incision site - overweight people would have little healing and often would split open requiring steristrips and extra care due to the soft tissue depth. It also makes it's more difficult for the surgeon to get proper positioning of the total joint because so much fat is in the way.

The femoral component is made of metal - it can't get much stronger.

Any type of surgery on overweight people is much more difficult for a surgeon be it a gallbladder, knee ect... as the extra fat is hard to work with and the patient is more apt to have other medical issues due to their weight.

Best to you on your surgery! It's can be scary but our patients would always say - why didn't I get this done sooner!

[Deserterer]

A 60's coworker is very overweight and had one TKR. He is not happy and said he will not do the other one. A different HWP 60's coworker had one and seems OK with it, but he complains that he still cant kneel years later.


A friend's wife is very overweight (though not as bad as #1) and had both done, and she was very happy at about the 2 year mark. I haven't seen them in a few years since then so I don't know how she's doing. I was very surprised she was doing so well before, due to her weight.

[Scorpio60]

Originally Posted by karen_in_nh_2012

Wow, that is REALLY too bad. I had both knees replaced in 2020, the left (the worst) in February, just before things closed down because of COVID, and then the right in July (postponed from May due to COVID). I had horrible arthritis (as do most of my family members) and it was not getting any better.

The recovery was indeed VERY painful and made it extremely hard to sleep, but I gave up on the narcotics within a couple of days because they weren't helping much (and I definitely didn't want to take higher doses). I lived with the pain and it got better day by day, as I figured it would. (Of course I especially knew that with the 2nd surgery.) I was diligent about the post-op physical therapy although I did that mostly on my own after I had a routine going.

Now I have 2 knees that I can RUN ON again! Yeah, it's all my treadmill now, but running was what I missed the most.

I don't know if they would do the surgery on someone in her 90s, but geez, it's horrible to be in pain all the time. I am very, very, very thankful for both of my new knees!

I think my Aunt was in her 60's when she had the knee surgery, now she is in her 90's.

Yes, we all tried to talk her into having her other knee replaced but she refused. I guess she couldn't handle the pain and she's one not to take any medication.

Good for you for having both knee's replaced, you did the right thing!

[dizzybint]

Originally Posted by metamorphosis

To folks in medicine:

I have a couple of questions about TKR surgery.

I was told (or read) that if a person weighs too much the procedure won’t happen because the weight would damage the manufactured knee.
If that’s true, why don’t they make stronger knees?
If that’s true, how can 200 pounds (for example) on the new knee of a tall person be different than 200 pounds on the new knee of a short person?

I’ve read that there are more risks (recovery, infection, etc) involved for an overweight person.
If that’s true, how do they manage to operate on large people for other issues?


Thanks

I had hip surgery three months ago... and was told about all the dangers involved...


Being overweight was a factor.. but Im slim.
Smoking is a big one and they urge you to quit.. I dont smoke so lucky
Heavy drinkers... thankfully not me..
The consultant told me 1 in 100 get an infected... same with blood transfusions after surgery... good luck with the op.. and get your protein and vitamins into you..

[stephenMM]

"My Aunt weighed over 200 pounds and had 1 knee replaced and was fine. Her doctor wanted to replace her other knee but she refused because of the painful recovery"

True. I haven't had this procedure, but once had a girlfriend who did (she was about 110 lbs, it was caused by an accident, so no obesity here). I was always at her side in the hospital and when she did the exercises to regain movement after the operation. It was an amazingly painful, long and difficult recovery. They take a saw and chisel to cut the old knee out, then use bone cement to hold the new one in. The scar on her knee was more than a foot long. So yes, this is not a small operation.

[Southern Retirement]

I had bilateral total knee replacements. I was somewhat overweight when I first tried to get knees replaced. I gained over 75 pounds while waiting the 4 years to get insurance approval so was obese by the time I had the surgery. My right knee was so messed up that the surgeon had concerns about how much function I could get back. There is an issue with waiting too long. I had an ice machine that circulated cold water thru wraps worn around the knees that was a big help with pain. It was also much easier for me to sleep the first or four weeks in a recliner but that may have been because I had both knees done at once. Sleep deprivation was more of an issue for me than pain. I found a book on CD with a very boring narrator and would listen to it to put me to sleep. I did do exercises before and after surgery to make recovery easier but they are not exaggerating the length of time it takes to fully recover.