Has any knee replacement not gone well?

[Henry]

I'll soon need to pick a surgeon and a facility for a total knee replacement. The local hospital is small with two doc who do knees & hips. I like the guy I've seen. A much bigger facility is an hour away.

How have any of the skiers with knee replacements here picked their surgeon? Has anyone had a replacement that didn't go well? Knowing what you do now, what would you suggest for a better outcome? I know, keep fit & flexible, follow the instructions, but about picking the surgeon and the facility...any thoughts?

 

[mdf]

Not knee replacements specifically, but you want a surgeon who does lots of whatever it is you are having done. And ask your surgeon about facilities.
When I had ACL reconstruction, my surgeon worked at two hospitals, but "I don't really like to operate at X". I picked Y.

 

[Brian Finch]

As already noted, you want someone who does a lot of volume. That & where they were trained.

If you are an avid skier, you are fitter than 98% of the folks having total knees performed.

I get a fair amount of destination rehab clients & can say for certain, the better trained, busier surgeons have better outcomes. Also working with some of the US ski team med staff, stratification of provider is huge.


Feel free to ask anything further.

 

[scott43]

Yeah, just to echo what's been said, my buddy had to undergo a procedure with a 6-8% mortality rate at a non-specialist hospital..that dropped to 1-2% at a specialist hospital... That's a huge difference...

 

[cantunamunch]

Yeah, just to echo what's been said, my buddy had to undergo a procedure with a 6-8% mortality rate at a non-specialist hospital..that dropped to 1-2% at a specialist hospital... That's a huge difference...

More AI and more robotics has been thrown at knee and hip replacement than any other surgery except eyes, at all stages from image analysis through ligament stretch modeling, design of the bone interface and joint mock up, on through tool path planning and real time monitoring.

I am starting to wonder if anyone, therapists like @Brian Finch maybe, have started to see tech-related outcome stratification. And, if yes, how does OP navigate that?

 

[Beartown]

One thing that your local surgeon (or their department or hospital) should be able to provide for you is his/her complication rate, specifically joint infections and re-operations. Hospitals keep tight tabs on these things and have whole departments to follow/analyze data in infection control and quality. I worked at one rural hospital where the total joint program was suspended completely due to high infection rates. I believe the benchmark for joint infections was <0.5% (1/200). One of the surgeons was at about 8% . Huge investigation followed and found facility problems (OR air-handling, etc) were mostly to blame.

Best case scenario is to have a friend/family member who works in the department and get their opinion along with the quality data. If you can't get that, I'd find out who does the most of your specific operation (joint, approach, specific tech like robotics/etc) and go to that person. Threre are certainly talented surgeons in smaller hospitals, but speaking in generalities, a larger center will usually have more numbers and a higher density of experience among the surgeons.

 

[Jenny]

I'd also want to talk to a doc who does minimally invasive knee replacement. Two of our friends had three knees between them replaced two summers ago and had what seemed to be really quick recoveries.

 

[Andy Mink]

If you have a physical therapist already and they are willing to tell, ask who they would have work on them or their family. They see results from numerous surgeons and have a good idea of who's better.

 

[Big J]

It appears that the VA is now starting to offer robotic knee replacement at some faclities. I believe Huston is one. I do not need it yet but am bone on bone on both knees so will for sure need them both replaced in the future. Do not know if robotic is better or not.

 

[Henry]

One of the local docs says that the minimally invasive procedures make it much harder for the surgeon to see what they're doing. He claims more complications and no better outcomes 3 months afterward.

I know with prostate surgery that the robotic stuff seems more for marketing than for better outcomes. I don't know if it is an improvement for joint replacement or just an expensive marketing tool. As with other things, one needs to ask the cutter how many hundred robotic surgeries they've done.

I get the point about finding a facility and a cutter with many great outcomes. Paging Dr. Hackenslash....

 

[dondenver]

My wife, Betsy, had total knee, staged bilateral replacement surgery (right knee first, then left knee) on November 26th, 2018. She skied at Loveland, wonderfully, happily, and at a high level on her birthday, May 1st, 2019 (notably with several members on this site). This attached video shows the robotic technology used in her surgery, and while only demonstrating a "partial replacement" of one knee, it examples well the practice of her surgery. Of particular note, the doctor highlighted in the video is her surgeon and is a good skier (understood her desire to keep skiing, cycling and running about with the grandkids on a soccer field). Betsy went through his specific qualification process to be able to qualify for the total replacement of both knees on the same day. As important was her prehabilitation work to ready herself along with the arduous post-rehab program. She committed to a positive attitude going into the major event with eyes wide open — a damn painful experience indeed, but necessary for the quality of life she wanted going forward. Good luck and good health for you.

 

[Big J]

Perhaps Brian Finch or others could give me some information in regards to where I should go. My Ortho just told me I need TKR (both knees) now but we are in the proceess of moving from Marysville Washington to Fredericksburg Virgina. I can go to Johns Hopkins that is a 2 hour drive from our new house in Virginia. Would I have to make multiple trips there or could I rehab closer to home? Other suggestions? Perhaps a different (closer) medical facility or surgeon. Thanks in advance for the responses. Jerry

 

[Jim Kenney]

I used to live near F-burg. Mary Washington Hospital there is pretty bigtime. I suspect they have plenty of docs that do TKR frequently, although possibly not for many skiers. Fairfax Hospital about an hour north is even bigger-time. Not sure you'd have to/want to go all the way to Johns Hopkins.

 

[Big J]

I used to live near F-burg. Mary Washington Hospital there is pretty bigtime. I suspect they have plenty of docs that do TKR frequently, although possibly not for many skiers. Fairfax Hospital about an hour north is even bigger-time. Not sure you'd have to/want to go all the way to Johns Hopkins.

Thanks. I will look into Mary Washington hospital.

 

[Jim Kenney]

You might try asking your question on www.dcski.com
Perhaps someone on there would know of some TKR docs in the Northern VA area? Also, that website is a good resource for info on mid-Atlantic skiing for your future reference.

 

[VickieH]

You have a lot of choices in that area. Some people favor Charlottesville, though I don't know what's special about it. You also have the Medical College in Richmond.

I have friends and family in Fredericksburg and Richmond. If you want recommendations -- surgeon? hospital? physical therapy? -- I can throw out the question and see what people say.

 

[Ski&ride]

Paging Dr. Hackenslash....

You’re probably not going to find any negative experience on a ski forum.

If the surgery didn’t go well, they probably stop skiing.

Just saying...

 

[Living Proof]

I am now 3 months post TKR. My experience is the entire process is much less painful and troublesome than many others in the past has experienced. Perhaps it was just me, although my wife went through the same 2 month prior to me, but modern techniques have advanced. I do not think my surgery was robotic, never asked. I did do leg strengthening and lost weight prior to my surgery. Weight is not your friend. I now walk without limping, play golf, live without pain, and, for the most part do not know my knee was replaced. That is not to say that it was easy, just a lot more manageable than we expected. First few days, after the initial nerve block wears off, are intense. Bending the knee joint takes time and therapy, I was always ahead of the curve per my PT. It takes a while to get past 90 degrees, but, when the breakthrough occurs, get to 120 degrees is almost easy. It was a month before I could sleep at night in comfort. If the virus situation permits, I will ski for the first time in 3 years next season with no fears. I'd go through the process on my other knee, although, it is much less problematic, so no present need.

My best advice is to research the surgeon who will do your replacement. My guy is a member of the largest orthopedic practice in the Phila region. My surgery was done at a hospital 60 miles away from Phila., done near where I now live, so, you do not need to go to a big city location. My wife and I asked around our community, checked internet references and the same name kept popping up. He only does knee and hip surgery, typically 6 or more procedures a day. In physical therapy following, my therapist stated he only had good experience with the patients from my surgeon. From day 1, in pre-surgury discussions, he just looked us in the eye and gave us all the time we needed to ask questions. Do not just go to a "name" big practice and get the next name up.

BTW, get follow-up therapy near where you live, no need to return to surgical location. I had 2 follow-ups, 2 weeks and 6 weeks. never saw the surgeon, his work is done in the operating room.

My surgeon is a skier, his biggest concern about returning is to ski where there are fewer other skiers as getting the knee hit by another skier is not something anyone needs to experience.

Good luck, TKR is not as big deal it was in the past.

 

[rcc55125]

I just had TKR of my left knee on June 2. It was done at an orthopedic speciality clinic (Tria Orthopedic) by a surgeon not robotic. As at @Living Proof said modern techniques have changed a lot even from a few years ago. My surgery was done as an outpatient procedure! That's right, I entered the surgery center at 7:30 AM and was home by 1:30 PM! I'm fortunate that this facility is only 20 minutes from my home. Also, I have no medical complications so as long as I came out of recovery well I was able to go home. Should I have needed post-op nursing care for a day I would have gone to a Hotel next door where they have rooms reserved with 24 hour nursing care. However, since I was a healthy, low risk patient, the out patient procedure was a fantastic option. My surgeon, specializes in only knees and hips, does the same procedures in a hospital (Park Nicollet) setting maybe 3 days a week and the speciality clinic 2 days a week.
I came home with a Game Ready cold therapy machine which I have been using almost continuously. I was walking around my home with a walker the day after surgery. I had a PT session, prior to surgery, to practice exercises for post surgery and prior to my first post surgery PT session. I've been doing those several times a day. Yesterday I walked outdoors 0.24 mile with only a cane. The pain is not severe and controlled with gabapentin, meloxicam and Tylenol. I was also prescribed oxycodone but am staying away from it.
@Big J, as long as your heathy, with no underlying health conditions, you may want to look into an orthopedic speciality clinic that do these new out patient procedures. I'm super happy with the outcome.

 

[Living Proof]

Some thoughts for those who probably need TKR and just keep waiting until you really need it. My knee surgery was a little more on the proactive side as the pain level on a daily basis was minimal, the only thing I could not do was ski. My last skiing was the Aspen Gathering I was in pain on every turn. The knee was becoming unstable, my doc said about 5% his patients had this condition, which was related to arthritis on the outside, non-primary weight bearing part of the knee.

My wife surgery is much more on the reactive side. She has known for at least 2 years she needed both replaced. Her doctors always told her she was bone-on-bone in both knees. There was always a reason why she could not do it. She tried cortisone and gel shots, worked for a little while then pain returned. All of a sudden, she could only walk short distances and was in constant pain. She is very glad the first one is now done, and, looks forward to the second one, hopefully this fall. Her life is better now, and, she regrets not doing it sooner.

I know there are many factors that enter into an individuals decision to get TKR. Certainly, age is a major factor, we are aged enough not to be concerned with a future replacement. I've many friends who live with knee pain but not willing to do it. If you limp, you stress your other joints and spine. Taking pain meds has adverse effects. Having it done during good health years is important, aging is not your friend. The recovery is not the horror story many had told me about. While I am not advocating getting it done just-in-case, your aging knees will not remain as-is and will only get worse.

End of rant!