Followup

[unixronin]

This was another full week for medical appointments, with a total of five appointments in four days.  I have an orthotic crafted by my podiatrist now; it's sort of fine-tuned at present with strategically placed felt pads, and I have extra felt pads should they be needed.  I don't know whether it's getting pressure off the ball of my foot or not, but it os rotating my foot inward a bit closer to vertical, which helps my balance with shoes on, and it cuts the number of additional shoe inserts needed to get enough lift under my heel to walk from three down to one.  On the other hand (other foot?), it hurts my toes.

My followup with the orthopedist was brief.  Basically it can be summarized in two sections: care and recovery, and how the surgery went.  The care and recovery section is pretty much "Keep wearing the brace whenever you're up and about, keep up the physical therapy, use a little neosporin on that suture that's being slow to heal."  The answer to the "how did things look in there" question was that there's a lot of deterioration in my knees, the kneecaps are a lot worse than anything else, he cleaned up what he could, and there is definitely bilateral knee replacement in my future.  It's just not certain when yet.

Total knee replacement basically includes three elements:

• Cutting back the bottom end of the femur and replacing it with a metal (titanium or stainless steel) prosthetic close in shape to the original bone;
• Cutting back the top end of the tibia and replacing it with a flat-topped metal prosthetic capped with a high-lubricity plastic (teflon or delrin, for instance) bearing surface;
• And lastly, planing off the back of the kneecap and refacing it with a high-lubricity plastic bearing surface.

Out of more than idle curiosity, having studied this somewhat, I asked whether anyone had tried just refacing the kneecap if the rest of the bone surfaces and cartilage were fairly sound, to try and put off (or avoid) the need for total knee replacement.  The orthopedist's reply was that while it has been tried, it has a very poor success rate (60% to 65% at best, compared to 98% for total knee replacement), and nobody does it any more because of the low success rate.

Well, it was a thought, anyway ....

Comments

Replacment Knees

[fatcook.livejournal.com]

Just remember that the operational life of a knee replacement is 10 to 15 years, if you are lucky. The other thing to keep in mind is that the pain may not go away. The surrounding tissue really doesn't like the operation and lets you know it. Also there is the fact that the surgeon and the PT don't care if you can bend the knee, only if you can get lay it straight. It also weakens the femur, making it more prone to stress fractures. My mother wasn't told any of these things on her dual knee replacements and only found out about them after the fact.
She had a spiral stress fracture of the femur walking across the room. She now has another 2 pounds of wire, pins and a plate in her upper thigh.
Oh and your height will change, my mom lost 2 inches and one leg is longer than the other. And the surgeon is very pleased with how well her surgery went.
I'll tell you this not for the gloom and doom, but so you can have some first hand experience.
You might also want to see if the surgeon uses ceramics for some of the interfaces. The joint seems to work better that way.
If you are interested I can tell you all about the after effects of the surgery, the stuff you need to know before you get to PT.

Re: Replacment Knees

[cymrullewes.livejournal.com]

He's probably gone through more PT than anyone else except a professional athlete.

The loss of height WORRIES me. Okay, it would probably be more precise to say the uneveness of the legs worries me and the loss of height BOTHERS me.

I want them to hurry up and figure out stem cell cloning so they can grow him some of his own cartilege to replace the stuff that's breaking down. The spider silk/silica mix seems to be coming along fairly quickly so replacement bones look doable.

Re: Replacment Knees

[fatcook.livejournal.com]

I want the cartilage replacement very badly. I'm looking at full replacement in 15 to 20 years and I don't want to go that route, I want to replace the cartilage.
If he goes for the replacement surgery, he WILL lose height. That is not an option. The surgeon need to clean the site up for the insertion of the new joint. The main trouble with my mom's surgery was that one leg was much more damaged than the other. Her surgeon had told her that she would need an orthic shoe for the shorter leg and that she might need a cane.

One of the things you should know about is the flexation machine. Has he already used one?

Re: Replacment Knees

[cymrullewes.livejournal.com]

You mean the passive motion machine?

Re: Replacment Knees

[fatcook.livejournal.com]

Yes, the surgeon here called it the flexation device. Sounds like you know all about it. That and the tennis ball under the thigh were the worst for my mom, and learning how to walk again. But I don't think that he is going to get both knees replaced at the same time. Is he?

Re: Replacment Knees

[unixronin.livejournal.com]

We don't know, yet.

Re: Replacment Knees

[fatcook.livejournal.com]

Oooohh. Try and put it off as long as you can.

[jilara.livejournal.com]

One of the things my friend Dahveed found out about the knee replacement (total replacement at age 24, due to military incident) is it tends to seize up a bit if the weather is really cold. (He was in Minnesota.) Hot showers get the mobility back. But it's definitely something to avoid as long as possible.

[unixronin.livejournal.com]

Yes, I'm well aware it's a sub-optimal solution. But if my knees completely come apart, it's better than nothing.

'Course, what I'd personally orefer to do is just regrow both, starting just above the knee ... but medical science hasn't yielded that breakthrough yet.

[olafthunderfoot.livejournal.com]

oh man, knee replacement surgery sounds like a crap shoot. i'm worried about it too, since i have 2 bad knees. ~hands you a beer and a kitten~