KNEEtalk

The LIBRARY => NOTES - Your success stories => Topic started by: blaze on August 03, 2005, 07:51:01 PM

Title: 10-plus tests for success of knee surgery, for reporting 'success stories'
Post by: blaze on August 03, 2005, 07:51:01 PM
Dear  fellow-knee-surgery-patients,

In the reporting of 'success stories' for knee surgeries,
it would help if the reporters included reports on some 'standard'
tests --- in their reports of complete or near-complete recovery
from knee surgery.

Following is a list of 10-plus tests of patient/knee function.

It would help if the reporter of any 'success story' would report on
the degree to which each test (or a majority of these tests)
can be completed.

-----

These ten-plus tests have been adopted mainly based on the web-page
report titled

"Knee Replacement Surgery from the Patient's Point of View"

by Tom Holzel (Boston, 2001), at

http://www.velocitypress.com/knee_replacement_surgery.php?PHPSESSID=86e4825fc15bc7dc7fb128258cc20ff9

----

There were 9 (actually 10) items (tests) listed by Holzel.

I have added a few more (esp. athletics-related) based on the
abstract of a report titled

"Arthroscopic treatment of anterior synovitis of the upper ankle joint
 in the athlete"
   by Jerosch, Steinbeck, Schneider, and Strauss
   --- at the Klinik und Poliklinik fur Allgemeine Orthopadie,
   Westfalishe Wilhelms-Universitat Munster.

A web page presentation of the abstract is at:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7584202&dopt=Abstract

These authors point out that a good set of scoring criteria to
determine 'recovery' include measures of
    - pain
    - function
    - athletic activity
    - walking aids
    - range of motion
    - swelling

-------------------------------------------

Ten-plus tests for successful knee surgery:

Is the patient able to:

   0. WALK on LEVEL ground without aids (cane, crutches, etc.)
       --- for at least 10 to 20 minutes --- with
      essentially no pain or irritation?

   1. LOCK the knee joints straight and STAND FOR MANY MINUTES,
      on BOTH legs, with no problem (because your bones are
      carrying your weight, not the quad muscles)?

   2. BEND the 'subject' knee enough to pull on SOCKS and SHOES?

   3. Get IN AND OUT of a CAR without having to grab THE LEG
      to help it BEND enough to CLEAR the DOOR?
 
   4. STAND UP from a LOW CHAIR or the toilet without pains ---
      and without having to use arms to reduce the load --- and without
      having to go through 'a ritual tweaking of muscles'?

   5. Sit still for a hour or so and be able to get up without
      the sense your knee has rusted fixed? I.e. get up from an
      HOURS-LONG SITTING-SESSION without significant pain and
      without having to go through 'a ritual tweaking of muscles'?

   6. STAND on THE ONE LEG (no weight on the other) for about
      a minute without pain?

   7a. LIFT THE 'subject' LEG up and BEND it and PROP it across the
       other knee in the SHOWER, to REACH your TOES (to clean between
       them)?
   7b. LIFT THE 'other' LEG up and BEND it and PROP it across the
       'subject' knee in the SHOWER, to REACH your TOES (to clean
       between them)?  (i.e. put all your weight on the subject knee)

   8a. Go  UP  STAIRS with no pain or stiffness?
   8b. Go DOWN STAIRS with no pain or stiffness?
       (Going down is generally harder than going up.)

   9. Stand on one leg and lift the other leg (with the 'subject' knee)
      by the ankle and PRESS THE ANKLE AGAINST one's RUMP?

  10. KNEEL down with the knee on a hard surface?

  11. Do a full, complete SQUAT?

  12. Sit (and un-sit) comfortably with your legs CROSSED?

  13. Do almost any 'normal' knee activity without bouts of SWELLING?

  14. Do almost any 'normal' knee activity without bouts of PAIN?

  15. Move the knee through the RANGE-OF-MOTIONS that one was
      'born with'?

  16. Do one's favorite ATHLETIC ACTIVITY --- or favorite 3 athletic
      activities --- with hardly any consciousness of the knee?
      (swimming, jogging, baseball, tennis, basketball, ballroom-dancing,
       football/soccer, break-dancing, hacky-sack, gymnastics, etc.)

  [Many surgeon studies/reports just use 'range of motion' to test
   success of surgery --- as judged by the doctor, with no feedback
   from the patients.  The tests above provide a set of
   patient-oriented, 'functional' criteria for success.]

----------
Conclusion:

In addition to the 'standardized' reporting of
knee-surgery-success-stories, it would be especially helpful
to conduct a survey to get an idea of:

   what percent of knee-patients --- who have made postings at this site,
   and are at least 1 year after their first knee surgery ---
   can confidently say that they are at least a 95% success story?

[Those patients who have had both knees operated on would have
 two 'votes' --- one for each knee.]

I suppose this compilation would be hard to do --- mainly, because
those who are past the 'success point' have little motivation to
take the time to post their results at this site --- especially
when there is no standardized way of reporting their results.

---

One way to compile the results (periodically) might be for a
'knee-guru' to poll all the e-mail addresses of the list of
registrees at this site.  Then weed out all those
who do not respond and those who are less than 1 year post-first-op
-- on at least one knee.

From the remaining respondents (at least 1 year post-first-op on their
left or right knee), ask them to simply say 'yea' or 'nay' to the
question 'Do you think you are at least 95% recovered?'.

Then report these simplified, 'all-knee-surgery-type' results -- like:

 Of 200 knee-surgery respondents (at least 1 year post-first-op),
 50 (25%) consider themselves at least 95% recovered ---
 and 150 (75%) do NOT consider themselves at least 95%-recovered.

  (Hopefully, the percentages would be the other way around, but
   from what I am seeing, it seems 'patient-views' of success will
   result in much lower percentages than 'surgeon-views'.)

---

If the survey would establish categories for the respondents to place
themselves in (like mainly-patellar-problem, mainly-meniscus-problem,
mainly-rheumatoid-arthritis-problem, etc. etc.), one could
report the 1-year success/non-success percentages for each category.

And, eventually, if respondents would provide the data, one could
include reports on the 'ten-plus success tests' --- via a link from
each respondent to their detailed responses to the 10-plus-tests
--- and/or via summaries for each success test (for all knee surgeries
or for categories of knee surgery).

---

But a comprehensive, meaningful SURGERY-SUCCESS-SURVEY like this
is probably too much to hope for --- unless some orthopedic
clinic or orthopedic department in a hospital/university would take
up the challenge to compile such results, objectively --- i.e. based
on the patient's rating of success, not the surgeon's or clinic's.

For now, a 'more achievable dream' would be for people registered at
this site to report success stories by reporting degree-of-compliance
with (most of) the 10-plus tests of successful knee surgery, above.

Best wishes,
Blaise
Title: Re: 10-plus tests for success of knee surgery, for reporting 'success stories'
Post by: Tholzel on October 29, 2005, 10:15:32 PM
The harsh realities of TKR is that you will NOT--at age 60--be returned to your former athletic skills of 21!  In fact, if your were a high-grade athlete prior to TKR, you will NOT get to 95% of your former grace and strength.  The quad muscle being cut will never regain its former strength and endurance, and the effort required to stretch it back to its pre-op length will also not succeed--mostly because it is now shorter and damaged. (The quad muscle, even when well, is extremely sensitive to abuse.)

So the idea of getting "back to 95%" has to be put into its proper perspective.  95% of what?  Certainly not 95% of the condition you were in before osteoarthritis began to set in--which probalby took 5-10 years to destroy your knee joint(s).

The realistic metric is how much better off are you than before you went under the knife.  In that case we're talking 150% to 250%!

As a life-long athlete, I had deteriorated to no longer running at all, my knees bothered me enough to require sitting down after walking a mere half-mile on flat ground; my knees ached when siting still in the movies; I could not stand up straight at cocktail parties (because of previous arthro cleansing).

After dual TKR (see www.velocitypress.com) I am now able to walk 6 miles with no problem; hike up and down Monadnock (3165-ft 4 hrs), sit still for hours at a time and stand up at cocktail parties.  And, yes, I can lift my ankle far enough in the shower to clean between my toes!

In other words, I am world's better off than before the operation.  That is the real measure.  For me there is no question about how "successful" the operation was.  It gave me back my life.