Knee Replacements and Sex

Question from the Message Board: Which positions are best during sexual intercourse so i dont strain my new knee implant?

Now let's look at the question of sexual positions after knee surgery. While there are a number of decent booklets out there with terribly non-erotic cartoons of patients in various "safe" positions, the definitive work on the subject has not been done. If anyone knows the adult film star Jenna Jamison have her call me and maybe we can put something together, like a DVD or Web Stream. All in the name of science, of course.

Here is what I can recommend from the experience of my patients who actually broached the topic with me.

In the realm of conventional positions, BEFORE having sex, give serious thoughts as to the types of positions and the speed of transition between these positions. Actually practice these alone (you do not have to bring yourself flowers prior this this).

It will be tough to do a figure skating triple lutz in bed with your partner if you haven't practiced it. I really am serious. Get into bed and without your partner there see the limitations of body positions before there is some pain during the actual sex.

In knee replacements, you will get into trouble if your knee is suddenly forced to bend or your partner (or partners- I make no assumptions here) sit directly on an extended knee - OUCH).

If there are specific positions you need explanations maybe I will include it in the DVD/Web Stream (note that this went from an idea to actual pre-production status in a few sentences).

Dr. K.

Related Topics: The Golden Age of Sex, When to Opt For Minimally Invasive Surgery

Technorati Tags: kneereplacement, surgicalrecovery

Knee Replacement: Stiffness and Pain

Specific Q&A

One question had to do with continued stiffness after a routine total knee replacement done approximately 8 months ago.

Let's look at some of the questions about stiffness and lack of function. Eight months after a knee replacement, it can be common to have varying degrees of stiffness especially after a long day of activity. You can also expect some persistent pain/discomfort. Why is this? One of the reasons is the we need to distinguish between stiffness or pain coming from a real problem or the natural course of your unique knee replacement.

What are some of the real problems that can cause knee stiffness or persistent pain?
1. Early infection
2. A surgical error in technical aspects (not as common as you may think)
3. A fracture of the patella or tibia

What are some "natural course" issues?

Each patient perceives pain differently. One person's floor is another's ceiling. Pain to you may be mild- the same pain to another is perceived as severe. Think of the analogy of dental work. Some people have it with no local anesthesia- I for one feel I need general anesthesia just for a cleaning. So I am a wimp when it comes to dental pain. Sue me. Oops, on second thought don't sue anyone.

Your disease prior to surgery was so severe that the results actually are a bit worse after knee replacement in these patients. We know that motion after surgery is correlated to your motion before surgery. Also, if your ligaments prior to surgery were so stretched out then it will probably be loose after surgery. A surgeon can't make gold from lead.

My advice to the persistently painful and or stiff - make sure there is no mechanical or real disease cause for the problem with evaluations, second opinions, and objective testing. If it is all negative, schedule an extended appointment with your surgeon to discuss your feelings (wow - what an amazing concept) about where you are and where you expect to be.

Related Topics: How Bad Is Your Knee Pain?, Arthritis Supplements in Question

Knee Replacement 101

Let's talk about knee replacements - partial and total.

This is a major operation. I don't care how many are done in the US, I don't care what the results that your Aunt Mildred had, and I don't care that someone told you something on some idle Tuesday while you were waiting for an elevator - THIS IS MAJOR SURGERY. A scalpel cuts into your body. The knee is essentially cut out with a high speed saw. Metal and plastic are inserted into a previously elegantly constructed body space. Then the surgery is over and people expect to run marathons, bungee cord jump, or dance in Havana in X amount of time.

Here is the 411 on knee replacement surgery. There are many factors that affect your outcome of the surgery. What do I mean by "outcome?" I mean everything - your time to heal the wound, how much motion you receive and how fast, stiffness after 2 weeks to 2 decades, the kind of sports and activities you can return to, and everything else.

I would like you to look at a knee replacement as the absolute custom fitting of anything you will ever have in your life. The work and elegance in this brutal experience makes the most beautiful custom dress that any Hollywood star wears at the Oscars look like an off the shelf schmatta (definition: rag) from the thrift store.

Your surgery is unique, your x-rays are unique, and your experience is unique.

Fortunately, though, looking at large numbers of patients we can see trends and statistically give you good ideas on what to expect - what the milestones are and where many people can be at a certain times.

Dr. K.

Oh, one more thing- cement vs. cementless- does not matter in joint replacement. There is more information on that issue but surgeons argue this all the time. There are real arguments on both sides.

Related Topics: Common Knee Injury Linked to Knee Arthritis, Arthritis: Therapy in Motion

Technorati Tags: knee, surgery, jointreplacement

Blogs and Boards

The New Frontier for Us All

On the Joint Replacement Message Board, there are many wonderful questions. There are also ridiculously stupid questions. Yes there is such a thing as a stupid question. When you ask it the following way "This may be a stupid question but..." and the doctor says "Don't worry, there is no such thing as a stupid question.", the doctor is really probably saying, of course it is stupid but I have heard this same stupid question for years so go ahead.

If you disagree, try this stupid question:

When I bungee-cord jumped 450 feet with the cords strapped to my ankles my total hip replacements popped out. Can I sue the doctor for not putting it in right?

Stupid question.

Consistently, of course, all the questions on the board have important issues raised, some more elegantly than others, but all right on target. In the 3 years of moderating the board there have been people who come and go, and questions tend to repeat.

Repeating questions are good and bad. They are good because medicine is an ever-evolving field (medicine was not designed intelligently - the knowledge base evolves) and the answer to a question 2 years ago may be different now. The bad part is that it sometimes gets a bit wearying to answer the same questions on a message board. I have realized that many of the answers are not catalogued so who can blame the repeaters.

In answer to this and the humorous slurs on my recent absence for some time on the Board (you guys have been nice- I have thicker skin than that), I am instituting this new experiment (not FDA approved by the way). I will summarize all the questions and try to put together a unified Blog post that answers what I think was asked and what I think could have been asked.

Try the following:

Read this Blog and my other Blog Mad About Medicine for two reasons:

1. Your answers may be embedded
2. I want you to

Add comments to the Blog instead of back to the message board if you think the public at large is interested in your answer.

Add comments to the message board if you think the answer pertains to the specific person who asked the question only.

Let's see how this works.

Dr. K.

Technorati Tags: blogs, community, messageboards

Surgery a Second Time

The Problems with Revision Surgery

Not all surgery goes well. That is a fact. Some operations fail. Sometimes we know why and sometimes we do not. When we do not patients sometimes think information is being hidden from them. I assume this does occur. But sometimes we just don't know why.

I perform a large amount of revision joint replacement surgery. Like most joint replacement specialists I actually do not revise many of my own. A joint surgeon's failure rate is generally quite low. I do a lot of revisions because I was trained in specifically doing them and many surgeons choose not to take these complex cases on. I am now well into my second decade of revision joint replacement surgery here are some pieces of advice I can share from experience.

If you are having a problem with a joint replacement it is extremely important to know exactly why. In other words- what is the cause of the failure? Is it infection? Is there a fracture? Did the metal crack? Did the plastic wear? Making a diagnosis is the most important step. This may include a series of many tests. Do them. Get a diagnosis.

What are your options? This is the next is to understand all the options- surgical and non-surgical. While I rarely recommend non-surgical treatment for a joint replacement failure, there have been occasion for this. A good example is a failure of a hip replacement in a bed-ridden patient. Another example is a patient with a severe medical history that will put them at grave danger in any operating room.

Who will do your surgery? Revision joint replacement surgery is not for the untrained, uninitiated, or general Orthopaedic Surgeon. There are a range of skills, techniques, and tools that are the domain of the specialist in this.

What result can you expect? In general, here is the bad news. Everything is worse after a revision. There is a higher infection rate, a higher limp rate, a higher limb length discrepancy rate, and so one. This does not mean that you will not get an extremely satisfying revision joint, it just means your risk of a worse result are higher.

I hope this helps some of the questions posted on my Arthritis message board with regard to this topic.

Dr. K.

Related Topics: Illnesses Hamper Joint Replacement Recovery, Is Less Invasive Hip Replacement Surgery Best For You?

Another interesting arthritis blog

Technorati Tags: joint replacement revision, joint surgery, arthritis