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Is this the right decision? BTKR 12/12

Discussion in 'Knee Replacement Pre-Op Area' started by diatom, Dec 3, 2017.

  1. diatom

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    Really reconsidering surgery next week. This is a long post...

    When I scheduled surgery at the end of the summer I was having more discomfort with my athletic endeavors and this has been my main driving force for surgery- keep active, cycling, long family vacations hikes. I developed trochanter (thigh bone) bursitis after a hike I should not have attempted...level of intensity was unexpected. I did turn back early. About 2 months ago I had cortisone shots for both trochanter bursa (not my knees) and started getting my whole body...core and upper body (I have strong legs already) ready for Dec surgery.

    Since then my knees have felt fabulous....2 months ! So here I am at preop testing Fri saying my pain level is zero. I had been thinking my strength going into surgery will be a plus, and that my knees are only going to get physically worse (bowed, bone spurs esp on right knee). Have been bone on bone lateral sides for a few years. But now I'm second guessing everything.

    I am blessed to be one of the few who have little day to day pain. I score extremely low on the arthritis score chart on this website. Sure I'm stiff after sitting awhile. But it's doable. I have adopted hiking poles and knee braces for hikes and my strong arms help me up and down stairs....Im really good at adapting to my bad knees.

    I have come across just one too many posts lately (here and elsewhere) of extra tough recoveries (I KNOW it'll be hard...year or more of pain and healing) and just poor outcomes. I also realize people with issues post more than those having none. I'd be crushed if I came out of this surgery worse than going in....need to have faith that I won't.

    So I am becoming less and less mentally sure of my surgery choice. I have had a lot of anxiety over this, leading to stomach and bladder issues (history of both) the past 2 week. I have had some success with acupuncture to help me feel more grounded (awesome..first time trying this!!)

    I know that I have to be the one to make the final decision. I'd appreciate any input from this great group !
     
  2. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Diatom,
    Funny how our knees suddenly feel better before surgery. I had a pain free time before my TKR, then suddenly one morning I could hardly walk.

    Seems to me you are making a lot of accommodations for your knees.
    In the end if you feel more comfortable cancelling, you can always reschedule when you knee(s) become painful.

    @Roy Gardiner had a BTKR, and leads a very active life.
     
  3. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    The decision to have a major, elective surgery is deeply personal. Only you know if you are in the right place mentally and emotionally to undertake something this life-changing. You’re right, a surgery can change your life for the better, but also for worse. It happens, though the vast majority of TKR surgeries are successful. Still, you’re not going to die if you don’t have the surgery. The worst that can happen not having surgery is your knees might, and probably will, deteriorate... but that could be a few years down the road and there’s no urgency to have the surgery right now.

    I put off having my knees replaced for several years after they were pronounced bone on bone. In those years I availed myself of every treatment that offered relief from my increasing pain. For months at a time, I might be pain-free, until the next treatment. Eventually, those didn’t work. Eventually, my left knee became too deformed to work on stairs. I dragged it behind me up the stairs. But I could do that for a while. I have very high pain tolerance, so I waited a long time because of the very same anxiety you are feeling.

    What if the surgery didn’t work... for me? I had family members with very successful TKRs. But this was ME. What if mine went wrong and I was worse off, not better? What would I do then?

    So I waited until the pain was so horrible I couldn’t bear it anymore. The day came I would rather face my chances with all the possible complications than live with those knees anymore. So I had the surgery. BTKR.

    Each of us had our own journey to make to this decision. And once we make it, we each have our own, unique, surgery and recovery.

    I found out after the fact —though my surgeon hinted he saw signs on my x-rays— that my left knee’s deterioration made surgery on it more difficult. Though the end result is excellent, Lefty’s recovery has lagged that of my right knee by two months. My right knee was less damaged to start with and recovered much faster and better. But both knees are doing great. I’m thrilled beyond my ability to convey that I had this surgery. It has truly changed my life more than I’d dared to hope. I wish I’d done it sooner.

    The only “right” time to have this surgery is when you are ready. Maybe you should ask if you are trying to talk yourself out of surgery... or into it. Surgery can wait until you are sure of what you want.

    You will be in my thoughts as you figure it out. :friends:
     
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  4. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    for perhaps 2 months this will be true...

    ... from about 3 months you should be as good or better than before.

    But your post talks so highly of your knees I wonder how you even know they are bad? Have they been so in the past?

    Anyway, some more points to consider

    - if your knees rule your life , it's time
    - take charge, don't be dictated to; it's your knee, your future
    - don't believe in either horror stories or miraculous recoveries that happened to 'a friend of a friend'
    - there is no such thing as too young or too heavy or even obese for TKR
    - choose a specialist surgeon who does several hundred TKRs a year. Ask the nurses, if you can; they know who's best
    - all replacement knees are very similar, don't believe that a special new one will give magical recovery -- it's the skill of the surgeon that counts
    - if you need two done, think carefully about the time gap between surgeries, it's not a trivial decision
    - try to plan for at least 12 weeks off work
    - your recovery is your time to be selfish and idle; plan to embrace this, you'll need it
    - don't think you can work hard (even if you're an athlete ) to speed recovery, healing works at its own pace
    - look at our FAQ (Frequently Asked Questions) thread and for full reference the Library index.

    - finally, if there's any part of this that you aren't clear about, ask here; it's what BoneSmart's for.
     
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  5. diatom

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    The xrays show just how "bad" they are. And hiking down the mountain this summer was pretty awful (with thigh bursitis following). Also stopped bicycling towards the end of the summer. So yes the knees do need replacing. I just don't have the day to day pain most others have. This has been noted in the osteoarthritis research- they cannot explain why people have none to excruciating pain. I am on the "low pain" end of things, despite what the xrays show. I think that keeping my leg muscles strong has really helped support the knee. I do worry about the continued deterioration of the worse knee. It is weaker and smaller than my better knee.

    I do have 12 weeks off from work (supposed to start training my replacement today) family that can be around me for the first month.
     
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  6. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Before I had my last TKR, like you @diatom , I also wondered if I was jumping the gun and having the knee replacement too early. After a couple of months of pain, my knee stopped hurting as soon as I had scheduled the surgery date.

    I went ahead with the surgery, though, because I knew from previous experience with my other knee, that waiting too long could cause problems. I waited too long for my first knee replacement and that resulted in loss of muscle power and distortion of some of my tendons and ligaments. That caused a slower recovery than should have been necessary.

    Doing my second knee as soon as it was clinically ready did seem to help with an easier recovery.

    It's your decision, but it does sound as if your knee is already affecting your quality of life, even though you currently don't have pain.
    It's your choice, though.
     
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  7. diatom

    diatom
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    I definitely have some distorted tendons/ligaments in the worse knee. Probably related to bone spurs. I have had a pain that comes and goes, traveling from behind the knee and up the back of the leg. Using a foam roller over all muscle/tendon areas in my legs has helped I think.

    After taking into consideration all Bonesmart feedback (thanks all :), my family input, and re-reviewing current articles on total knee replacements (most recoveries go ok, most replacements last a long time), I'm leaning towards having the surgery.....
     
  8. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Yes, your later few posts do seem to show you need it done. You will be able to ride your bike afterwards, and hike. Running is a no-no in some people's opinion (including mine).
    OK BTKR should be a go, then, you'll be able to get about a bit after a month.

    Don't expect a super-fast recovery because you're fit; I was, too, and it still took 3 months to be better than pre-surgery.
     
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  9. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    Having 12 weeks off is wonderful! So many people hope to go back to work in a month or six weeks, and that’s really too soon. It’s not just the knees —like Roy said, you’ll be up and about in a month, just not yet ready for long walks or a full day sitting at a desk— but there is the energy drain of surgery, and between medications and other things some people have difficulty sleeping at first. Three months is a sane and sensible timeframe for getting back up to speed.
     
  10. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    As others have said it is a personal decision. Before my 2nd tkr I wondered if it was "bad enough" but realized though I was coping, the knee really was that bad. Looking back at each knee--I can't believe I was functioning at all with my first knee & knee #2 is so good by comparison to what it was it's like it's taken 20 or more years off my age. I don't feel 70 anymore. (No offense to actual 70 year olds. :) but you know what I mean.)
     
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  11. diatom

    diatom
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    Ugh ! My naturopath dr suggested I get a bone scan before surgery since I hadn't had one and I'm a few years postmenopausal. Well I just found out that I do have osteoporosis and the dr. wants to meet with me this afternoon. More tests are in order.

    My surgeon uses the Stryker Triathlon, which relies on the bone growing around/into the implant.

    Kind of thinking this might be grounds for postponement of the surgery in 6 days? I'll find out more this afternoon.
     
  12. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    Finding out new information about yourself just days before surgery is no fun. I’m sure your OS has encountered this situation before and there’s a plan for how to go forward. Our thoughts are with you.
     
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  13. Kayaknlady

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    I’m an athlete like you, but 70. I’m 8 weeks post bilateral TKA. I’ve been managing with bad knees for 20 years. The last year and a half I’ve been planning my life around cortisone injections. I could bike 20 miles but had to give up hiking then walking in the park. I could kayak 24 miles but couldn’t walk. I limited my activity to water aerobics, biking, kayaking, swimming. A friend with successful surgery encouraged me to do it while I’m strong for a better recovery. I worked out every day and pain wasn’t bad because I wasn’t walking much. I’m having a great recovery. I’m biking 3 miles, kayaking 10 miles, even rolling, water aerobics, senior aerobics, and hope to do my first short hike this week. By spring I hope to increase all my activity. My knees almost feel normal. It’s hard to do it while you feel good. Last fall I went to Costa Rica instead, but I had to keep cutting back on walking. Walking is essential. Glad I did it. Glad I had a bilateral. One surgery, one recovery. The stronger you are pre op, the better post op, I believe. Good luck on your decision.
     
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  14. diatom

    diatom
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    Thank you Kayaknlady for the great post ! Wow- someone who had the same experience I'm having. Glad to hear you are doing so well :) Keep on truckin!

    Unfortunately it looks like I am going to have to post pone the BTKR, probably for another year. I just found out yesterday that I have osteoporosis in both thigh (femur) bones. My t scores were -2.5 so I need to get this under control before thinking of cutting those bones. So glad my naturopath dr suggested a bone scan before surgery. I walk over 10K steps a day virtually every day and still have this issue! Sigh....
     
  15. jaschembra

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    My implant is also the type where the bone grows onto/attaches to the femur and tibia portions. Along with a few (4) screws!! Not completely happy with it yet at all. But I'm holding out hope. My OS said this type of implant aches longer and recovery is longer (He said don't be discouraged when the seniors are doing circles around you lol)

    I'm post-menopausal and in the past had peri-osteoporosis so I was also concerned. However, bone scans in the past few years have shown me to be okay and my OS felt I had good bones to work with. Hoping you can get the bones in good shape for surgery in the future. This is not medical advice at all, but one year I had an 11% increase in my bone scan (increase to the good) and the only 2 things I had changed was: I did Body Pump class at the gym (my knees can't do the class now though) and took juice plus (I used a Costco brand now). So, I'm not sure if it was the "weighted exercise" - like walking is a weighted exercise, or if it was nutrition. But that's a huge jump.
     
  16. diatom

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    That's great news that you were able to increase your bone density so fast! I guess you did not have to use meds? Just weight bearing exercise and supplements? Cool. I can't believe that my femurs are affected because I've been lifelong runner, xc skier, and hiker and have logged over 10K steps a day for decades! Lots of weight bearing activities.

    I am being referred to a osteoporosis specialist, and my regular dr is developing a battery of blood and urine tests to make sure my thyroid levels are optimal (I've been hypothyroid for over 10 yrs but have had it supplemented well by meds), and also check the parathyroid. The urine test has to do with determining how the bones are being compromised?

    My surgeon's office said that osteoporosis was not grounds for stopping surgery....really? In my case it involved the femur bones and once the implants are attached to them, the femurs cannot have density scans done because of the metal. So I would never know if diet, supplements, meds, etc. were stopping it or reversing the disease!

    Today I did officially choose to postpone the surgery. Once I see the bone specialist, get the tests done, and maybe take some meds, we'll re-do the scan (in 6 mos?) and hope for positive changes. Then I'll reschedule the BTKR.
     
  17. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    I am so sorry to hear of your set back in hour surgery. I agree that it's best to wait and see your outcome in 6 months. If only your OS wasn't set on using that particular implant, you probably could go ahead and have the replacements done. I am a firm believer that things happen for a reason.
     
  18. jaschembra

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    Sorry, just now seeing this (If you use @ in front of jaschembra, I would get an alert). No, when I had that jump in percentage, I wasn't on any medicine except exercise and supplements. I didn't know you can't get a density test done due to the metal. I didn't have my 2 yr. test because my dr. said it wasn't necessary every 2 years anymore so I was going to get one done this next year.

    As @sistersinhim said, you could probably go ahead and have the surgery using the glue/cement type of implant but I would wait too until you get the tests and try to improve your bone density. When I see my OS for my 1 year appointment on Jan. 4, I'm going to ask about a bone scan or any other tests to confirm I don't have issues since I'm not 100% with this yet. I wouldn't go this same route (cement less) if I don't ultimately become pain free (or at least a whole lot better than I am). I don't think my body likes all the extra hardware. :) This is why I have not yet scheduled my other knee.
     
  19. Jockette

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    I think if you’re not mentally ready to have the surgery, you shouldn’t have it. I’m sorry a medical reason came up that postponed it, but at least you got the postponement.

    I really wanted to cancel mine but went through with it.

    Best wishes as you regroup and take care of the other issue.
     
  20. Cocomart

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