Minimally invasive knee replacement

[renk]

Hi Demi
I agree with you that I can't imagine what traditional TKR surgery is like if this MIS surgery was suppose to be easier.  My scars also seem thick.  In fact, the left one still has a little scabbing on it.  The right is all clear but very pink and thick.  It does look like it's starting to fade a little and the doctor did tell me that it would fade in time.

I'm also new to this bulletin board stuff but I could relate to this so much, I couldn't resist writing. Anyway, here is my email address and please feel free to write whenever you want. It's renk1129@comcast.net   It's just a good feeling to know that someone else is going through the same thing and it helps to compare notes. 

I must have really been out of my mind to think I'd be back to work (desk job, also) after four weeks. I think I told you before that my surgeon told me I can go back whenever I want and feel that I can. He said he's leaving it up to me.  I thought I'd go this week maybe in the afternoon for a few hours for a couple days (the mornings are still too hard) but I don't see it happening. I'm just taking it day to day. Maybe next week.

I take one Vicodin at a time.  My prescription says I can take 1-2 tablets every 4-6 hours and I'm still taking it. I've never taken more than one at a time. In the beginning it made me sleep, too, but I think my body is starting to get used to it now. I feel asleep every day late in the afternoon without even trying.This tremendous feeling of tiredness would come over me and I couldn't help it. That has passed now. My husband isn't retired but he did take off a few days the first week I was home.  After the first few days, he started going into work late until I got "situated" and my mom lives around the corner and she would come over to help me. My husband has also done all the shopping and much of the cooking. My mom was doing much of the housework like laundry and light cleaning. Now I'm to the point where I can do the laundry (if someone carries it down for me) and a little housework but it takes me much longer. I keep telling myself it's just temporary and I couldn't even do that a couple weeks ago. Thank God I had a lot of help and someone here all the time. I think it would have been very depressing and hard to go through this alone.

So hang in there and write whenever you want.
Renee

[emphatic]

I've been reading this thread with interest. I had a lateral unicompartmental replacement on April 25th and, during my research, was disappointed to learn that there is no minimally-invasive technique available for the brand of uni implant I would be having.

What has struck me most is what appears to be a collective disappointment at the difference between what you expected your recoveries would be like (given the marketing materials descriptions, I suppose) and the reality you've been experiencing.

I've also seen some TV commercials and other marketing items and thought it looked far too good to be true. I saw one news story that blew me away -- I thought there was no way this person had a total knee replacement! On the other hand, your experiences sound pretty good to me, in many respects.

I do know there are several different techniques which are called minimally-invasive, so it's hard to compare directly. One patient might have a truly minimally invasive technique, while another might have a technique which barely meets the MIS critera at all.

Not having the quad cut is a really, really big deal. That alone would make a tremendous difference in your recovery. Those of you able to walk easily and go down stairs at 2 weeks or so -- that's because your quad was spared. The difference that makes in strength and ROM is unbelievable. For instance, I'm at 13 weeks and finally, in the last couple weeks, have been able to go down stairs somewhat better. It's been a long, long struggle to get my active flexion up to 120°, so again, I was quite jealous to hear one of you had that around week 2 or 3. Strength is an ongoing issue for me and one which takes tremendous work to achieve what feels like, at times, such minor gains.

The size of the incision is probably less of a factor, but there is a difference between your 5 or 6" incision and the 10- 12" incision for the traditional approach. My incision is 12", and I do know it's a bit easier to deal with the shorter incisions... so that made me a bit jealous.

Pain levels are another issue. I don't think most traditional approach patients can even think of going off their pain meds until at least 12 weeks or so. Of course, there are widely varying situations here -- some people go into the surgery with far less pain that others, and can rehab with far less pain, as a result. I've been told not to expect to stop my pain meds until 5-6 months post-op, given the state my knee was in before the surgery and the surgery itself.

Any at rate, I don't want this to come off sounding like I think you have it pretty good... I know each recovery is very individual to each person and it's obvious everyone contributing to this thread has had a lot to deal with (and does so quite graciously, I might add -- I am impressed with how you handle things). I've just been very intrigued at how the MIS approach is so different in many ways, and yet the rehab and recovery is the same in other ways -- chalk up my interest in this stuff to that's just how my brain works.  

My best wishes for continued good results and comfortable recoveries to you all!

Meg

[renk]

I agree not having the quad cut was probably the biggest difference in my surgery. However, I do believe after reading some of these posts, there must be other procedures that qualify as minimally invasive but they are not the MIS that I had.  I realize I am doing much better than others but I was led to believe (not by my doctors but from what I read) that I would have a much quicker recovery.  I am grateful for the recovery that I have achieved so far but knowing what I know now I would not have done two knees at the same time. I'm just glad the worst is over for me and maybe soon I can get back to my life the way it was.

[emphatic]

Yes, I totally understand. I can't even imagine how hard it would be to do both knees at once, MIS or not!

I was thinking after I wrote that post, that since there are so many techniques that are being labelled MIS, patients would be well served to ask their doctors exactly what about their surgery is going to be minimally invasive. That way, they'll know going in what to expect and won't be misled by the MIS label itself.

I know, for instance, that some surgeons call their technique minimally-invasive because they don't cut the quad, but they will enlarge the incision as necessary (which is actually good for the patient -- you want the doctor to be able to see as much as they need to see!), and they will make other cuts inside which aren't in the strict MIS criteria.

I hope you'll be back to feeling wonderful very soon. I certainly understand how tough the recovery is, and my hat is off to you for being able to get through having two knees done at the same time -- that is amazing!

Meg

[renk]

Meg
Thank you for your good wiishes. I wish you the strength that you need to completely recover soon.  Strength is a major issue here and it's something we all need to get through this and we will.   

[DemiWV]

Meg, Hi,

You made some excellent suggestions about discussing MIS with the surgeon to know exactly what his/her explanation of MIS is.   I did not.   I read the brochures and went to the web pages and heard the success stories and went in without many questions, expecting the best.  NEVER AGAIN.  I usually ask lots of questions but for all the reading I did, I asked almost no questions.  Duh.

Meg, your reminder of how much better it is that the quads were not cut encouraged me.  You and Renee are right, that is a big deal.  I will keep that in mind.

Yesterday was 2 weeks since my MIS  right TKR and I still hurt a lot.  My pain meds take away some of the pain.  I have pain all the time.  That I did not expect.   I take 2 Percocets every 4-5 hours and I still hurt.   I am always tired.  I shower and I have to rest/nap.   I take several naps a day.   

On the plus side; my leg extension is/was excellent from the very beginning.  My flexion is slowly coming.   I now can sleep in two positions:  on my back and on my right side if I throw my left leg way over so it doesn't touch my hurting knee.  By many standards I am recovering well, but not nearly as well or as quickly as I expected.  Again the lovely brochures and commercials encouraged me to believe that in 2 weeks I would almost be good as new.   NOT.   I shouldn't complain, though, I had only one knee done; Renee with two knees done at the same time really has my respect.  She is one strong gal and my hat is off to her.

Thanks for your good wishes, Meg.  Good luck and strength to you.

Demi

[TrueColours]

Okay - I am SO glad I found this board!

I have my long awaited appointment with my ortho next week (after an almost 2 year wait to get in to see him!) as I opted for the MIS option and we only have 2 doctors in this area that are performing them. Hence the L-O-N-G wait!

I was really under the obviously VERY mistaken impression that within a few weeks, life would be back to normal again. I run my own company and cant imagine being absent for weeks or months or I am really concerned that it will literally go down the tubes while I hobble around at home, am actively involved in riding and breeding horses and I really thought in my total naivete, that within a few weeks I'd be back to normal with them as well. I just cant even imagine handling a stallion during breeding if I am still trying to protect my knee following surgery!

Yikes ... I have been looking forward to this "fix" for so long, but am wondering if I really need to look at putting it off for awhile and simply putting up with the pain and limited range of motion

And to add to this dilema, I am lookng at launching a new product in Canada, which will involve trade shows and making a lot of sales calls and from what I am reading, none of that is going to be possible for several months

I am 50 years old, my surgeon (the ortho that did my arthroscopy on my knee several years ago) said I have the knees of a 65 or 70 year old and I could well use the TKR surgery now rather than waiting several years to get it done.

I know my pain tolerance levels are very high - I was back up riding within a week after my arthroscopy and I really thought with the "Mini Invasive" tag attached to this surgery, this would be the same ...

Stupid, huh?!

What are the chances that by gritting my teeth and saying "damn the torpedo's" and I WILL walk around, that I will be up and around and back to semi normal in a few weeks time? Slim to none???

Thanks a bunch!
 

[renk]

Everyone is different and it is possible that you will recover quickly.  I would discuss any concerns you have with your surgeon when you meet with him.  My surgeon told me some people did extremely well after the MIS and left the hospital with a cane (a few without a cane).  I told my surgeon the day I was leaving the hospital that I didn't think the MIS was what I thought it would be and he told me to take note at rehab what people who had traditional TKR were doing and he guaranteed me I would be ahead of them and doing more in the way of exercises and my range of motion would be better and he was right.  But it was still much harder than expected and I thought the recovery would be quicker. From what I'm told, this is quicker than traditional TKR. So maybe you'll be lucky and be one who has a quick recovery. Good luck.
 

[DemiWV]

TrueColours,  (TC),  Hi,

I am 54 and just had my MIS TKR on July 11.  My surgeon says I am progressing nicely and I can tell that I get a little better each day.   However,  from reading the lovely brochures and watching the nice TV commercials, my expectations going into the MIS surgery were way too high.  I thought that in 2 weeks I would be almost normal....I was wrong.   I am using a cane and still feeling weak and unsteady.   At night my knee aches and it is difficult to find a comfortable sleeping position.  I am just now starting to feel comfortable riding in a car for a long ride and I can now get in and out of the car without adjusting my seat.   The in house physical therapy has helped a lot.

As Renee suggested,  discuss the surgery with your doctor.   Ask him how long the incision will be and where it will be placed.   Ask him how many he has done and how soon after the surgery the average patient started to feel like her/his own self.  MIS spares the quads which means less blood loss and quicker recovery because you can still use your quads.  There are benefits.

**  TC, Know this:   while in rehab a woman who had her surgery one day before me, went home using a cane and she was hardly limping!    You may be like that woman, who after 10 days can walk out without even a cane and without a  limp.   You never know.   

Whether you should grin and take the pain is up to you.   The longer you continue without the surgery the more damage and wear and tear to the knee.   Right?  Does the pain affect the the rest of your body?  Your posture?   IF you need to buy a little time (less than a year to get your business where you want it) you might consider the 3 injections of synvisc.   For some,  the injections provide up to 6 months relief and you can take them twice without complications.  They helped me buy some time and they might help you, too.  Talk to your doctor about this option.

If you have any questions, let me know.   I will be glad to give you any info I can.

Regards,
Demi

[bhill]

Ok, I am glad I found this Site.

I am a 45 y/o female with a Left TKR on 6/15/2006.  I have been reading all your results from surgery and can identify with a lot of these problems.  My first surgery was not successful.  I had a Depuy Pivotal Joint placed and after 2 days in hospital I was discharged.  On the day of discharge, my surgeon was able to move my lower leg from side to side.  After asking him if I should be concerned with this movement, he replied that he was concerned.  He felt that the spacer was probably too small and that he would like to give it time until my Quad develped with PT.  I was willing to be patient and accepted this answer quite readily.

After 4 weeks of PT, I started to regress and realized that every movement with my knee seemed to irritate it and create more swelling and pain.  My knee was also giving out to the back and lateral areas.  I saw the Surgeon again and he gave me a brface to wear and "let's give it 1 more month."  After 2 days, I realized that I did not have 1  month because I need to return to work soon.  He was willing to schedule the surgery and so I went back in on 8/3/2006 and had a new spacer placed along with a new knee cap.  I was again inpatient for 2 days and released.

Here are my questions:

How many of you are female in your 40's and 50's?  I am starting to notice a correlation with being young and female and having post-op problems.


I am on Vicodin for 2 months and still can't sleep at night without pain.  Any solutions to help with position with sleeping?


I am very frustrated and just want to resume normal activities. 

Please feel free to Email me here or at bhillpa@comcast.net.

Thanks and Good Luck to all of you.

[knee deep in Goo]

Just my two cents ..    I just think the younger generation is talking about the pre/post op experiences via a web site more so than elderly people.

[milliebelle]

Am new to the board - five weeks tomorrow had MIS TKR on left knee; surgery was done July 31.
 I agree with those who say they were disappointed in and surprised by the amount of pain and discomfort post surgery after all they'd read and seen on the web sites and brochures etc. by the hardware makers. i'd about decided  this wasn't really major surgery.
i half expected to be dancing after three weeks! who ARE those people who do that?!
 My doctor told me it was major surgery and it was!
That said,  I don't know why anyone who has a choice would go to a doctor doing the old method, which is horrendously more painful. of course, not every area has doctors trained in the new MIS methods. and obviously, you need someone very skilled in this type of surgery, because there can be problems - but the really skilled doctors seem to have few complications. what you want is a doctor who specializes in mis joint replacements and does several hundred a year.
I can see from reading here and from observing at the PT office what a difference the MIS surgery is from the traditional type of surgery that cuts the quad muscle over the knee instead of going under it as doctors do in minimally invasive surgery.
I interviewed three OS in New Orleans, where I live, and of them, only Chad Millet did MIS. obviously others here do too, but Dr Millet was on the cover of New Orleans Magazine last year as the best joint replacement surgeon in town..
he does 300 to 350 knee and hip replacements a year, and virtually every medical personnel i met said he was the doctor they'd go to. I'm really glad i did.
Each of the three doctors I interviewed did something different re TKR and had different philosophies, which surprised me. one said there was no way that the mis surgery could be done as well. not true.
Also, i asked physical therapists about the best doctors. A pt friend told me that one of the doctors i had considered had a very high infection rate in his patients.
I think once more people realize MIS is available, more doctors will have to learn this much more complex surgery that takes twice as long to do, but cuts healing time in half.
I still get tired, and have to move my leg a lot when I'm sitting, but i can walk without a cane and am limping less, almost not at all. not bad for five weeks. also do stairs without much effort at all. am told by pt that my range of motion is excellent.
A woman who had acl reconstruction by another doctor (three days after me) was in PT the other day, and I can do twice as much as she can.
i have had no other surgeries prior to this, and that too helps in recovery, said my doctor. also, i decided after several years of pain to just go ahead and get it done instead of waiting until i was on a cane. that too is good, said my doctor, who told me that often the range of motion after surgery is similar to that before the surgery.
anyway, my knee still bothers me a lot. i have the same sleep problems as everyone else - getting comfortable is next to impossible (although a dose of lunesta, a prescription mild sleeping pill, helped last night).
one nice thing happened when the home health pt came to my house the first day, he said, "but you're so young!"
I'm 60 - and it had been a long time since anyone had told me that!
milliebelle

[DemiWV]

Hi, Milliebelle,

Your posting was great.   

As you can see from my older postings, I  am 54 and had my surgery on July 11 and it has been 2 weeks now that I can sleep in any position without leg ache.  I take 2 Advil 3 times a day, but most of the time I forget the afternoon dose; so I end up taking it only twice.

My surgeon told me that the MIS TKR surgery on me lasted for 45 minutes!   Fifteen minutes to prep me, 45 minutes operating,  and an hour to sew up and let me come out of the anesthesia.   Can you imagine?   The whole knee was replaced in 45 minutes!  My surgeon was great and has an excellent reputation.   I wish I had been like you and had my surgery before the terrible limp, and cane, and pain that was uncontrollable by pain meds.   The first had me getting injections to put off the surgery since I am "so young" but I know women in their 40's who have had to have TKR's.   Knowing what I know now, I would have switched doctors a lot faster and gone with a TKR instead of the shots and pain meds and cane which bought me a year or so.   Big deal!  I got an extra year...SO WHAT!  The TKR was inevitable, why in the world I tried to put it off for as long as I did?   Bad advice from my first doctor.   My second doctor was very encouraging and told me that I was a good candidate for the MIS TKR and that I would do well.  He told me the knee should last 20-25 yrs.   Hey, by the, TKR might be high-tech and drive through!

 My husband is meeting with my doctor next week and I suspect that he will have to replace my husband's knee, too.    Arthur  feels very confident  about having an MIS TKR seeing how well I feel and am doing.   I would do this all over again in a sec if I had to.

Milliebelle, I can slowly go upstairs  but going downstairs is still a  painful for me.  My flex now is 115 and I am working to get it to 120 if possible.  More flex and more strength should get me to the point where I can go up and down the stairs without pain.   What degree of flexion and extension do you have.  My extension from the beginning has been excellent, almost 0 degrees.  My flexion is what I am working on now. 

You are doing REMARKABLY well for having had the surgery on July 31!  That's great!    Hang in there, Milliebelle, the leg ache will disappear suddenly.  One night you'lll have it and the next night it will be gone.  That's how it was for me.

If you have any questions or want to compare notes using my email address, let me know and I will send it to you; otherwise, I'll watch for postings.

Demi

[milliebelle]

Hi Demi - I think my doctor said my surgery was about 2 1/2 hours, but i don't know what the breakdown was for what. i had an epidural and something he said would put me in la la land and erase any memory if i was aware of anything. i have no recollection at all. so that was good - and i didn't have to deal with after-effects of anesthesia.
i didn't mean to give the impression i didn't do other things before the tka. i had numerous cortisone shots over the past five or six years, when i had my slight miniscus tear. some cortisone was more effective than others. and i had the expensive series of three shots, which had absolutely no effect.
 but i just decided if i already was not able to do all i wanted, and if it already was making me limp and causing pain, that i should go ahead. doctors - three of them - told me i was bone on bone and it would get only worse. i have a friend at work who can barely walk at all, but she's scared, which i fully understand having gone through it all now and having read so much.
i asked the pt today to measure my flexion (is that the right word?).
 I'm minus 2 (0 being perfect) on the extension and 130 on the bend. the doctor told me pre-surgery i had a good bend, so maybe that's why - i have no idea, but the pt is impressed, so that's good!
my OS sends all of his patients home with a CPM and instructions to use it up to six hours a day until the first post-surgery visit (3 1/2 weeks later), and I was very faithful for about 2 1/2 weeks, least i used it right before appt. was an hour. i know some OS say you don't need it, but i found it easy and comforting - was so slow, i'd fall asleep.
OS said it stretches the scar tissue so patients don't have scar tissue issues later.
also did my exercises, and kept doing quad stretches and leg lifts while i was watching mindless tv.
but otherwise, i've really been lazy. i haven't done as much walking as i feel i should have (it's too hot in New Orleans!). i really have been awful about lying around and sleeping and reading magazines and trying to avoid watching too many of the first anniversary programs on tv about katrina (although spike lee's was excellent overall). the tragedy of it all is ...well....that's another story...
was felled over the weekend with a first cousin of the coughing cold i had for six weeks early this summer; it was so bad my regular doctor told me to postpone my surgery, which originally was scheduled june 24 (had it done july 31). now it's back, which is really irritating!
I think i'm going back to work thursday sept. 14 - decided it would be better to ease back in at the end of the week when it's slow (i work in an office, with a lot of computer time), rather than try to stay afloat in the busiest part of the week.
anyway, i'll see.
i still worry that the cold or something else will give me an infection in my bloodstream or i'll pull a PE - guess it's silly, but maybe a little info is - as they say - a dangerous thing!
thanks so much for writing me back! and you - and everyone else - take care too.
Milliebelle

[renk]

Hi Milliebelle
You sound like you're doing great. If you read my previous posts, I am 54 and I had bilateral MIS TKR on June 9th. I, like you, also thought I'd be dancing around in 3 weeks.  Was I wrong!  But today I am glad that I had the MIS surgery as opposed to the traditional surgery. When I was being transferred to the rehab facility, I told my surgeon that I was disappointed in how I felt after the MIS and he guaranteed me that when I got to the rehab facility I would change my mind after I saw what people who had traditional surgery could do (or not do) and he was right. My flexion has been great since the beginning but my extension isn't perfect yet but I'm almost there. I go up and down the steps and get in and out of my car with ease. My only problem at this point is that I still wake up during the night with my knees "stuck" in a bent position which is painful but ony for a few minutes and it's not as bad as it was. My surgeon came very highly recommended by my regular orthopedic surgeon who doesn't do the MIS. I agree that many more orthopedic surgeons will have to learn the new minimally invasive technique because I beleive it will be the only way to go in the future.  I also went through the Synvisc and Hyalgan injections (which didn't work) and cortisone injections and they stopped working, too.  It got to the point where I could hardly walk and I wanted my life back and I wanted to do the things I enjoyed again so I decided to have the surgery when I heard about the MIS. The only thing I'm not sure I'd recommend is having two knees done at once. That was really tough to get through but on the other hand it's over with and I don't have to go through it again. It sounds like your recovery is going well and I wish you the best of luck.
Renee