Post op TKR problems

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Dorset_Geoff
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Re: Post op TKR problems

Post by Dorset_Geoff »

The_KNEEguru wrote: Tue Feb 06, 2024 9:39 am Hi Geoff
You are certainly diligent in following up on all the links to related material. It must be so hard to have such pain problems that were so immediately worse after surgery.
The op started pretty well. I had an epidural and while I was sitting up on the edge of the trolley getting the canula fitted. (yes, sitting up talking to the team!) they applied the sedative and my memory ceased at that point. To them I suppose I looked conscious and I doubt I would have fallen off, but I have knowledge of that period. All quite relaxed and pleasantly informal. The surgeon did not want to apply a nerve block which in retrospect would have helped, because he had known patients to have serious long term problems should the nerve sheath be damaged accidentally, which I guess is fair enough - there was a risk. When coming round in recovery, it really did hurt. I didn't know where to put myself. Morphine eventually provided some relief. Normally coming round from an op is quite a pleasant experience and one is aware of a bandage and a little discomfort. They didn't know what to do to ease the pain and were visibly distressed by the situation. An anaesthetist was required to apply a nerve block, but was tied up with a road accident case at A&E, I asked for a local anaesthetic but there was some reason why not. My poor wife was mega upset. Nothing could be done except tough it out. Looking back on it, something had to have happened during that op that was not normal and they had no real experience of.
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Re: Post op TKR problems

Post by The_KNEEguru »

Epidural catheters are not always easy to insert into the correct space, in which case a patient may not get the anaesthetic effect, which is usually good and carries over into the post-operative period. It may have been that it was not in good position but because of the sedation you were not awake enough to confirm whether your leg was properly numb? From your description of 'coming round in recovery' I presume you had a general anaesthetic as well as the epidural....
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Re: Post op TKR problems

Post by The_KNEEguru »

Hi Geoff
I know you are hungry for reading. I thought this might interest you, because of concerns you raised about everting the patella during surgery -
Isn't the medial retinacular snipped and then reattached after the joint is replaced?) I thought that the lateral (i.e. outer) Retinacular ligament could be damaged.
[ps. correct spelling is retinaculum (noun)]

"The Postoperative Effects of Patellar Eversion in Total Knee Arthroplasty" - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9071891/
Dorset_Geoff
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Re: Post op TKR problems

Post by Dorset_Geoff »

The_KNEEguru wrote: Wed Feb 07, 2024 8:34 am Epidural catheters are not always easy to insert into the correct space, in which case a patient may not get the anaesthetic effect, which is usually good and carries over into the post-operative period. It may have been that it was not in good position but because of the sedation you were not awake enough to confirm whether your leg was properly numb? From your description of 'coming round in recovery' I presume you had a general anaesthetic as well as the epidural....
I don't think I did have a full anaesthetic, I reckon it was just the epidural and the sedative. Could it have been similar to Midazolam? I had a whole shoulder replacement in 2012 and that used a nerve block for regional anaesthesia (hope my terminology isn't too wayward). At the time I assumed I had a General Anaesthetic, particularly as I woke up in the recovery room in the normal manner. No memory of anything. The nerve block was applied after I went out. [I have also had a number of Caudal Injections of steroids through the coccyx which requires patient feedback (which is hospital jargon for "this is going to hurt big time, but we need be so careful as too much pressure can lead to serious damage". Oh really? The feedback would be supplied quite scientifically and is made up of a little "ouch" graduated in increments up to a high decibel, bone chilling "aagh!!") to limit the pressure that can be applied safely when injecting the steroid liquid, which has to reach as far into the cavities of the lower spine as possible for maximum patient benefit.
The surgeon was a brilliant Snr Registrar, who managed to inject almost all the steroid fluid and told me afterwards that I tolerated the pain quite well and the procedure was successful. This told me I was awake at the time, yes it did hurt and I was coaxed through it all at the time, but remembered nothing. Was my knee the same sort of procedure? i.e. Regional anaesthetic plus a sedative that blotted out memory. So that is why I was able to be sent off to what I thought was sleep, but was still sat upright on the edge of the trolley rather puzzled that I had not been told to lie down, no doubt looking all around wondering what was happening next. Next time something like this looks like happening, I will have my questions all ready. I do know that knee surgeons will often pop in a local anaesthetic to ease any post op pain when coming round. Not in this case it seems, and didn't I know it! Can anyone provide more info on this subject - as applied to TKR's?
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Re: Post op TKR problems

Post by The_KNEEguru »

I wondered - since I know you are enjoying reading the medical literature - if you might be interested in this paper which - if you scroll down to Appendix 1 - has several of the scoring systems for evaluating outcomes and patient satisfaction after knee replacement. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779800/

Just for interest...
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