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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.
My wife had both knees replaced last year (July and October).
She was obese but that was largely because of forced inactivity due to knee pain. In an ideal world, you would loose as much weight as possible and strengthen muscles in both legs as much as possible before the TKR surgery. In the real world, you may have to just go for it anyway. My wife has lost 35 or 40 pounds at this point (I am careful not to ask about it too much, lol) and is no longer obese. I think she will be down to an age-appropriate ideal weight by this time next year if she fully regains her health and becomes more active.
My wife's surgeon summed it up best: you have to really WANT a good outcome, be faithful on physical therapy and home exercise. He also does hip and shoulder replacements and says knees are hardest on patients in terms of pain, easy in terms of bleeding issues. Hips are less painful but tend to have more bleeding / clotting issues.
My wife was on oxy (and for the 2nd knee, which for some reason was MUCH more painful, Tramadol). It was a tradeoff. She's a light sleeper / insomniac to begin with and I don't think she'd have gotten any sleep at all without the meds. It wasn't hard weaning off them. Main side effect was lack of mental focus (don't expect to do writing of any kind ... my wife is a writer) and constipation (the provided stool softeners didn't even touch it, she used OTC pills to induce the Hershey squirts on occasion).
In retrospect I would not have done them just 3 months apart, it is too much of a blow. But we had insurance constraints (annual deductible) and there is the psychological burden of having the 2nd surgery hanging over your head to consider.
It might be a good idea to tune up your general health before hand. My wife is now dealing with gynecological issues, has some sort of abdominal tumor ... these may have been nascent and the pre-op clearance didn't catch them. We are now working through THAT issue, including the possibility of cancer. My wife was a chronic avoid-the-doctor sort of person, and it has caught up with her. The good news is that the need for pre-op clearance sort of broke the dam for her and she is now catching up on all the usual preventative stuff ... although ironically none of those would have caught this new problem.
Fast recovery from a TKR is possible but for people over 60 it isn't realistic. My wife's surgeon say it takes about 12 months before you more or less forget you have had your knees replaced. Sometimes 18 months. Most of the recovery happens by 6 months but that last little bit comes slowly and tests your patience. Somewhere around month 9 you begin to believe it was all worth it. Somewhere around month 12 you know it is. Or that is what we are told.
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. Now she is in her 90's and can't walk on the leg that didn't have the surgery.
I think it depends on the surgeon. Get different opinions.
Yes, I am not an expert on knee replacements and we don't know what the attributes of the OP are, plus it's not really our business...
What I can say though, is that for every drug that might be taken, every surgery that might be done, the doctor who advises on this should take into account the specific characteristics of the patient in question and weigh the likely benefits against the likely risks. If the likely benefits outweigh the likely risks for that person, then they are a candidate for the therapy, but otherwise they are not. Usually there are specific guidelines that come down from a physician's professional society to provide guidance on these "decisions". I put that in quotes, because even if a doctor decides you are a candidate, the patient is the ultimate decider, and they can always refuse the therapy.
There *are* doctors who over-use therapies. However, just because some bad actors are out there, does not justify branding all doctors this way. Most doctors do the right thing. I know in my life, I twice *requested* surgery from an orthopedic surgeon after a serious injury and was turned down. But then I hear some people claiming that you can't trust doctors, and if you ask a surgeon, he/she WILL cut! - and I think, what the h--- are you talking about? That is just a prejudice, it's not a fact.
To the OP, I'd speak with an orthopedic surgeon who specializes in total knee replacements, and who works in a big hospital and has done a lot of them. This person has "seen it all" through their great experience with this specific procedure on all kinds of different patients, and they know what to expect and what to watch out for. Write down your questions before you go in. Consider the following questions as suggestions... What the risks of getting this surgery? What the risks of *not* getting this surgery? Am I really a good candidate? If I go ahead, what will the process look like - how much time in the hospital, recuperating at home, physical therapy, etc? Will I need help at home? What should I expect in terms of function after full recovery?
If they recommend surgery but you still have real concerns, then go to another experienced surgeon and ask them for a second opinion.
Just saw this today. A new non-replacement treatment for people with medial compartment arthritis. Just approved by FDA in 2023. It's a mini shock absorber they screw to the inside of the knee to offload it. No bone is removed. It does not take the place of TKR, but might postpone it for years in some people. In fact I'm going to look into whether it might be appropriate for me, although I suspect my medial compartment is too far gone and my insurance likely wouldn't pay for it, either one of which would mean no.
I have surgical metal and my ortho tells me a vast network of blood workarounds going on in there. In order to have my knee replaced I would first need to have all that metal taken out and my knee/leg would need to heal for about 18 months. Then, I would need to go through a complicated knee replacement (due to all the previous damage). He feared tissue death and skin grafts due to needing a vertical cut across my hockey puck scar. They would want to graft off the back. If I lived through it then there would be a long recovery. He did not recommend I do that. The new young doctor got excited and then I asked him about still needing to go through the process of taking metal out that's been there 20 years and healing from that. He backpedaled and said that is something that you would really need to think about.
I did the math with my life expectancy and I do not want to spend 25% of my remaining life dealing with all that (besides my body does not do well with all the drugs for surgery due to being immunocompromised I suppose). I am pretty used to my limited hobbled life as it is and at least I have my areas of enjoyment.
I have surgical metal and my ortho tells me a vast network of blood workarounds going on in there. In order to have my knee replaced I would first need to have all that metal taken out and my knee/leg would need to heal for about 18 months. Then, I would need to go through a complicated knee replacement (due to all the previous damage). He feared tissue death and skin grafts due to needing a vertical cut across my hockey puck scar. They would want to graft off the back. If I lived through it then there would be a long recovery. He did not recommend I do that. The new young doctor got excited and then I asked him about still needing to go through the process of taking metal out that's been there 20 years and healing from that. He backpedaled and said that is something that you would really need to think about.
I did the math with my life expectancy and I do not want to spend 25% of my remaining life dealing with all that (besides my body does not do well with all the drugs for surgery due to being immunocompromised I suppose). I am pretty used to my limited hobbled life as it is and at least I have my areas of enjoyment.
So, I am a no vote on the TKR.
I feel the same as you. My situation is a bit different; but I would have no interest in trying to survive and rehabilitate my knee another time. Smashing my patella was devastating; and I still have not fully recovered 16 months later. I also have blood clots and surgery with anesthesia is very risky for me. At least at this point I do have some mobility and can still do things, even if I have had to give up a lot. Going to continue to work with what I still have.
I feel the same as you. My situation is a bit different; but I would have no interest in trying to survive and rehabilitate my knee another time. Smashing my patella was devastating; and I still have not fully recovered 16 months later. I also have blood clots and surgery with anesthesia is very risky for me. At least at this point I do have some mobility and can still do things, even if I have had to give up a lot. Going to continue to work with what I still have.
Yes, I had the broken kneecap on top of the already crushed knee and metal implants.
I am very high risk and it's just not the same scenario of a 65ish year old having a lot of arthritis and getting their knee replaced.
You have to weigh your risk/reward situation and make a decision (like us to stay alive and do what we can versus things getting worse or much worse (getting dead)).
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.
People don't usually think about this, but you can go online -- I forget where but wasn't hard to find -- and get the numbers for % of infections hospital acquired during surgery. I have had almost all my surgeries done at St. David's Central in Austin, Texas. Their rate of infections acquired during surgery is half the national average. The right doctor is important, the right hospital almost as much so.
A knee replacement that gets infected is one MAJOR PITA. Happened to me but nobody's fault except mine for a bad move I made about 6 weeks after. You do not want to have to get a second revision surgery, although mine eventually worked out fine.
My wife had both knees replaced last year (July and October).
She was obese but that was largely because of forced inactivity due to knee pain. In an ideal world, you would loose as much weight as possible and strengthen muscles in both legs as much as possible before the TKR surgery. In the real world, you may have to just go for it anyway. My wife has lost 35 or 40 pounds at this point (I am careful not to ask about it too much, lol) and is no longer obese. I think she will be down to an age-appropriate ideal weight by this time next year if she fully regains her health and becomes more active.
My wife's surgeon summed it up best: you have to really WANT a good outcome, be faithful on physical therapy and home exercise. He also does hip and shoulder replacements and says knees are hardest on patients in terms of pain, easy in terms of bleeding issues. Hips are less painful but tend to have more bleeding / clotting issues.
My wife was on oxy (and for the 2nd knee, which for some reason was MUCH more painful, Tramadol). It was a tradeoff. She's a light sleeper / insomniac to begin with and I don't think she'd have gotten any sleep at all without the meds. It wasn't hard weaning off them. Main side effect was lack of mental focus (don't expect to do writing of any kind ... my wife is a writer) and constipation (the provided stool softeners didn't even touch it, she used OTC pills to induce the Hershey squirts on occasion).
In retrospect I would not have done them just 3 months apart, it is too much of a blow. But we had insurance constraints (annual deductible) and there is the psychological burden of having the 2nd surgery hanging over your head to consider.
It might be a good idea to tune up your general health before hand. My wife is now dealing with gynecological issues, has some sort of abdominal tumor ... these may have been nascent and the pre-op clearance didn't catch them. We are now working through THAT issue, including the possibility of cancer. My wife was a chronic avoid-the-doctor sort of person, and it has caught up with her. The good news is that the need for pre-op clearance sort of broke the dam for her and she is now catching up on all the usual preventative stuff ... although ironically none of those would have caught this new problem.
Fast recovery from a TKR is possible but for people over 60 it isn't realistic. My wife's surgeon say it takes about 12 months before you more or less forget you have had your knees replaced. Sometimes 18 months. Most of the recovery happens by 6 months but that last little bit comes slowly and tests your patience. Somewhere around month 9 you begin to believe it was all worth it. Somewhere around month 12 you know it is. Or that is what we are told.
Had knee replacement at age 73. Did all the rehab and exercises and even did a short bike ride before 6 weeks were up -- no problem. Going great! Like others, I just said no to opiates and it wasn't that bad. Then our not-to-bright handyman didn't understand how to unclog the kitchen sink. You want something done right, have to do it yourself. NO!! BAD IDEA!! Kneeling on a hard stone floor caused the suture to spring a leak and less than a week later resulted in an raging full-blown infection. So a lengthy process before it can be redone. (You don't want to know what all it takes.) I took it a little slower the second time but was doing bike rides and generally quite well in a couple of months or so. Knee still working well 4 years later.
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