Recovery from Minimally Invasive Joint Surgery
It's the same in New York, Chicago, and Tupelo, Mississippi
There has been so much press from all over the country about the speed to recover from surgery. Patient expectations are all over the map.
A former student of mine told me that his mother from New York was thinking of traveling to Chicago because she saw on the news and read on the Internet that there was a doctor there who send people home the same day of surgery after total knee replacement.
I told her to save her airfare. Last I looked, Chicago was not populated from geniuses from the planet Krypton to save mankind but rather had the same number of intelligent and concerned doctors that are present in nearly every community in this country.
So what is the deal here?
First of all, the surgery:
Absolute fact: certain types of techniques related to minimally invasive approaches to knee and hip replacement will give you decreased pain and faster return to function than a traditional method.
Absolute fact: The Orthopaedic community is in complete internal disagreement as to exactly what the term "minimally invasive surgery" means.
Absolute fact: At 6 months the results of minimally invasive and traditional techniques are the same in terms of function BUT the minimally invasive techniques CURRENTLY have higher complications.
Absolute fact: As we learn more about the successes and failures of various minimally invasive techniques, the better and safer ones will emerge and dominate the surgical landscape. Currently there is no agreement as to which is the best.
Absolute fact: If you see a surgeon from anywhere in the country- whether that is Chicago or Ocala, Florida - on the television then one of three things has occurred:
Recovery from any joint surgery is generally dependent upon:
Dr. K.
Related Topics: Patients Rate Knee, Hip Replacement,Joint Camp: Where Boomers Get Knees, Hips Replaced (WebMD Video)
Technorati Tags: knee replacement, hip replacement
There has been so much press from all over the country about the speed to recover from surgery. Patient expectations are all over the map.
A former student of mine told me that his mother from New York was thinking of traveling to Chicago because she saw on the news and read on the Internet that there was a doctor there who send people home the same day of surgery after total knee replacement.
I told her to save her airfare. Last I looked, Chicago was not populated from geniuses from the planet Krypton to save mankind but rather had the same number of intelligent and concerned doctors that are present in nearly every community in this country.
So what is the deal here?
First of all, the surgery:
Absolute fact: certain types of techniques related to minimally invasive approaches to knee and hip replacement will give you decreased pain and faster return to function than a traditional method.
Absolute fact: The Orthopaedic community is in complete internal disagreement as to exactly what the term "minimally invasive surgery" means.
Absolute fact: At 6 months the results of minimally invasive and traditional techniques are the same in terms of function BUT the minimally invasive techniques CURRENTLY have higher complications.
Absolute fact: As we learn more about the successes and failures of various minimally invasive techniques, the better and safer ones will emerge and dominate the surgical landscape. Currently there is no agreement as to which is the best.
Absolute fact: If you see a surgeon from anywhere in the country- whether that is Chicago or Ocala, Florida - on the television then one of three things has occurred:
- The surgeon's presence was somehow paid for a joint replacement company
- The surgeon's hospital has media connections
- A publicist set this up
Recovery from any joint surgery is generally dependent upon:
- The attitude of the patient
- The pain perceived by the patient
- The patient's own healing abilities
- The healing support provided by the joint surgeon and team- this means proper pain management, home care services, and most importantly education on expectations.
- Patient adherence to post-operative guidelines
- Patient's own internal definitions of "healed."
Dr. K.
Related Topics: Patients Rate Knee, Hip Replacement,Joint Camp: Where Boomers Get Knees, Hips Replaced (WebMD Video)
Technorati Tags: knee replacement, hip replacement
23 Comments:
DR.K I HAVE LEARNED THAT TENNESSEE ALSO DOES SAME DAY JOINT REPLACEMENTS AT LEAST WERE I COME FROM
Several years ago, when I was suffering mightily with hip OA, I too read accounts of a Chicago doctor who was sending patients out the door on a cane the same day as THR surgery. It sounded like minor surgery as opposed to the kind which involves an incision several inches long (actually, mine is 11").
At my first meeting with my OS, I asked whether he did this type of minimally invasive procedure and he murmured "well, maybe some day". That was the end of that.
Of course we are not surprised that my honking big incisions have healed nicely and I am fully functional on all fronts with no complications resulting from surgeries that took place over 4 years ago.
Everybody is selling something these days. It's tempting to want the latest and best in any field. Sometimes I think there's even an element of one-up-manship among patients, even in medical treatments - such as "my car is better than yours, my cell phone has more bells & whistles - and my incisions are shorter, too!". Too bad, really.
I had pkr surgery in NY in July 2006 and have what some call a "minimal incision." While it is smaller in length, about 4 in. and then another 1 in. incision above that. While it is smaller overall then the old surgical knee scars, it is still situated over the area of the joint that bends, so there will be some pain as it stretches. Personally, my os kept me in the hospital for 3 full days and let me go home on the morning of the 4th. I have read about other surgeons sending their patients home the same day of surgery and I think it sounds like torture. I don't believe I physically could have tended for myself at home those first few days postop. Your body has gone through major surgery, regardless of the size of the incision. You can feel weak, nauseous and just generally uncomfortable. I was appreciative of having the hospital staff attend to me, rather then go home to a family member that isn't sure what to do to help me. As far as pain relief, I was lucky. In the hospital, I didn't need a PCA machine, I had oral pain meds every four hours. I hadn't had any joint pain from the surgery, just incisional pain. I was given a prescription for pain meds at home and I never felt that I needed to take anything stronger than a couple of tylenol. It is now 9 1/2 weeks post op and I am walking without even a limp. Yes, the first couple of weeks were rough, first you have a walker, then you have a cane and you wonder if you did the right thing having the surgery. But, Dr.K is correct, your body naturally wants to heal and it will, but give it time. If you expect less, you will be rewarded. If you expect more, you will be disappointed. Let your body set the pace of recovery. After all is said and done, I'm ready to get the other knee operated on and set in motion the rest of my total recovery. I know I survived before and I'm confident I'll do it again.
Dr. K
I was wondering if you could help me.. Resentlly I started to get pains in my wrists and knees. Followed by swelling and then my arms and body would rash. The docters determainded that I do not have Lupus OR Rheumatoid Arthritis. But the fact is I'm 16 and my docter is not that worried about it, or at least doesn't act it.
Can you give me some insight cause I am a little worried about it and I is really bothering me!
Going home the same day following TKR sounds asinine to me. I had TKR almost a year ago and I am STILL recovering from it.
This is a BIG surgery. A misconception is that folks prior to surgery think it is going to offer something it is not..
TKR gives you back your mobility. End of story! Thats a big ending if you understand thats what it does. But, some people seem to think they will have their knee cut away and fill that hole up with plastic and metal, and then in a couple weeks they will be just like new, with no problems. Thats a false belief.
You always know you have a replaced knee. You feel it in there, sometimes it hurts, somtimes it gets stiff, but you CAN WALK. People think it is the answer for all their problems. They need to understand just what this surgery offers and not set their expectations so unrealistically high.
Also is the fact of PT. I see people who are totally blown away at how hard PT is following TKR...Education needs to be better at this..It is going to hurt and hurt alot but unless you want a stiff knee you better be able and willing to put the pain into it or you wont have a good knee replacement.
Go hame the same day of surgery...CRAZY!
Cathy
hi DR.K when i had my tkr i certainly was happy to hear i was not one of those cases were they would send me home that first day cause it was hell i think it would of been torture and is on patients today i know even when i waas in the hospiatl i kept passing out because of the need for blood it was easing out just as they were giving it to me also i was two pints low and if that were to happen at home that would be a big lawsuite for someone not that i love lawsuites but deathis death and whoever thought of this new revelation it must of been a hmo i know if my dr. would of sent me home the same day iwould of never been able to get out of bed for the toilet or for the torture chamber to move my knee and it was realy the hardest thing you could ever go through and when i have my second tkr in 22 to 25 years i will go to a dr. who does not believe in sending you home the same day thats if my ortho is not available of course
I am just 5 months into recovery for TKR and I must agree with the others. There is no way I could have given myself, or gotten from my family the care I needed. I had a 10 hour car ride home 5 days after surgery and I nearly passed out with the pain of getting into and out of the car and I still struggle with that. Overall, I am pleased with the result of my operation and having the left knee done is not nearly as frightening as it was getting the right done. Now I know what to expect post-operatively and how hard I have to work for my recovery.
Ah, the topic of recovery. I'm 6 months post-op on major foot surgery. Ant/Post calcaneal osteotomy, ICBG (allograft), talus ostectomy, PTT repair, FHL repair, spring ligament repair, repeat tarsal tunnel release.
My surgeon has always been honest with me about risks, recovery time, and recovery outcome. It's one of the reasons I trust him. In my opinion, there's two major milestones in the recovery process. There's functional recovery, when you can get through normal daily activities although there's still room for improvement. Then there's total recovery, when you're as better as you're going to get. It's an important decision, because at 6 months post op, I'm finally getting to the point where I can do just about anything short of heavy impact on my new foot. It'll be another 12-18 months before everything has healed totally and I'm no longer at high risk for stress fractures.
Now, I'm part of a support group with people having similar surgeries, and sometimes their surgeons tell them vastly overstated recovery times, such as walking in 6 weeks. To put this in perspective, I was barely walking at 13 weeks. People who expected to be walking much sooner than possible are very upset when they find out how long it really takes, and I cannot believe that their recovery is not hindered by this.
I agree that this new approach is totally insane. At the time I had my TKR I weighed way over 200 pounds and had not been very active at all. When I went to therapy they were determined they were going to get it to bend even though it wasn't going to. And the torture machine as they all called it--where I went it was called the "King Kong Machine" because the name of it was the Kin Kom I think or something similar. A many of time it would lift me completly out of the chair. And they had no mercy.
I still have trouble with that knee even though when you look at the x-ray it looks fine it isn't. I have arthritis in it as much now as I did before and the doctor clipped a nerve and the right side of my leg tingles and feels numb. The doctor also used my own kneecap.
The left knee is in desperate need of surgery but I won't even attempt to have it done now because I have had three MRSA's in the last three years two of which have been this year. Also both hips need surgery too.
Recently my gastronologist took me off my arthritis med because he thought it had caused my colitis of the large intestines. I asked him if he knew what kind of pain I would now have and he said maybe soon I could go back on it. Between not having them and the weather changes I have been in lots of pain. I go to a pain management center but all he does is put shots in my back and neck that last only a day or too. I have changed orthorpedic doctors and he said no more shots. He is going to try some therapy for a while.
Ann
My mother had a wrist operation where she had a metal plate inserted a year ago and now she's developed a large cystic lump that looks like a ganglion on the top of her injured hand.
It seems to be related - perhaps a reopened tear that is causing fluid to swell up.
Pictures at:
Pictures of her wrist
Is this serious?
To Michele Wolfe -
Have your doctor test you for Lyme disease and other tick-borne infections. I saw various doctors for several years with symptoms similar to yours and it was finally determined that I had Lyme disease. The sooner you catch and treat Lyme, the better
I had neck surgery sevral years ago and they used a metal plate and two screws. About a year ago I would hear and feel a pop in my neck. About three weeks ago popping more and musle pain. Could the metal plate broke? Does anyone know if surgery can come undone after all these years. around 8 years. For the most part I have done well with the surgery. If you have heard of any problems like this please email me at Eagletond3422@aol.com
I have had knee pain for over 25 years and all the doctors will tell me is that I am too young to have surgery. The X-rays told the story. I have absolutely no cartilage left. When I had them scraped over 20 years ago, the doctor said my bone ends looked like a can of tuna fish. How old do you need to be? Am I just seeing the wrong doctor? Would appreciate comments.
I have had 2 TKR's in the last 8 years, both on my left knee. The first one the pain was so bad I thought I would die! The second one was better, but, I have never been without knee pain. My knee swells up with fluid and it is hard to put weight on it. I just came back from the doctor and he says everything checks out ok! He will do a scope on it just to do a biopsy of the tissue in case something is wrong and isn't showing. I tell him how bad the pain is but it is like talking to a wall! I am awake almost all nite and have to take vicodin for the pain and that doesn't take it all away. I don't know what to do I am 57 and a diabetic.
Any Golfers out there? Headed in 3/4 for half knee (Oxford). Since its the outside left knee Im concerned that I won't be able to rotate over to the left side. With proper Rehab how long to the practice range?
I broke my talus in my right foot. It has been 14 weeks since surgery and i am barely able to walk. There is constant pain. I have been in therapy for 10 of the 14 weeks and they say it will never really be right. I had a great surgeon and awesome therapy team, but none of this matters without strong will and the ability to fight the war and not justthe battles. I am struggling.
My husband had also had surgery about 2 years ago for a fractured talus, his needed to be pieced together, this has been a struggle from the day it happened. He is on his feet for 8 hours for his job and when he gets home he is in pain and can hardly walk, he takes 2 Naprosyn a day just to get through work.(which he hates to do) After recent X-rays we were told he does have Arthritis in the area but the Dr. is amazed he doesn't have more dying of the bone due to the severe injury. Is ankle replacement the only way to have some relief? He is only 34 yrs. old and we arn't sure this is a good option at such an young age.Any other options for pain relief?(we have tried many non medication options in the past)
Dr. K, I just had surgery on my right knee to repair the medial miniscus which had a slight tear, the operation took place on Feb. 28 and I'm already walking and in physical therapy however, I have notice that the insicion on the outside of the knee seem to have a lump which I think is scar tissue, how do I go about disolving or getting rid of the scar tissue?
r3spawncamp3r:
Sorry, but you need to be over the age of 13 to use the site. I had to remove your comment.
Hi, i'm about to go through surgery on both of my ankles because of a fusion and will not be able to use my feet for 6 weeks. I was was wondering what the actual recovery was like? How it affected daily life such as going to the bathroom and such.
Dr. K, I had TKR 6 weeks ago. I am progressing well with PT, but I continue to have heat in the knee along with a slight fever. I've noticed in the past couple of weeks that I am having palpitations or fluttering which I have experienced in the past with Lyme disease. My question is, can a TKR trigger Lyme Symptoms. CA.
I work at the Hospital in Chicago that is the topic of this piece. From first hand knowledge I can tell you guys people do go home the night of surgery. Typically these are only people who are otherwise healthy enough to recover quickly (in shape, active, younger). People who have to stay in the hospital longer usually do. The Dr. or the hospital would not force you to leave if you were not stable enough to do so.
Dr. K
I had a Mini MIS THR, metal on metal, big head implant done in Feb 07, pain continued to worsen, celebrex didn't help, 2 bone scans showed hot spots at the prox. femur, I went in for a second surgery, capsulectomy in Oct. 07, That relieved pain for about 6 weeks, has progressively worsened. Ant. thigh pain, initial weight bearing from sitting to standing, incredible pain, after 5-10 steps, most pain is relieved.Can't stright leg raise while lying down, have to pick my leg up to put it on the coffee table. Am scheduled for a total revision, what do you think??
Post a Comment