# Replacement Knees, and worn out knees.



## farmpony84 (Apr 21, 2008)

My dad had gotten to where he couldn't walk w/out a cane so he finally broke down and got his new knee. He was up and walking the next day (with a walker) and was at lunch with his friends three days later. He has since been to egypt, the grand canyon, yellowstone, the aztec ruins, the list go's on and on. He is now talking about getting the other one done. He was very happy that he did it. He also lost a good 60 lbs after he did it because he was so much more mobile. He did all kinds of yard work and cleaned out the basement. It was like he found a new sort of freedom in motion.


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## AnitaAnne (Oct 31, 2010)

I wouldn't want to have surgery right before flying out of the country, one would want to be near their doctor in case of complications.


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## farmpony84 (Apr 21, 2008)

There might be a rule on flying. I can't remember how long it was, maybe 45 days?


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## AnitaAnne (Oct 31, 2010)

Achievable goal is to be standing within two hours of surgery, walk 300' by post op day two, use walker for first week, cane second week, no cane by third week. 

The more one exercises the muscles before surgery the better they are able to ambulate after surgery. Would consider some PT prior to surgery. 

If you are diabetic must really get that well controlled before surgery. 

I've not had any joints replaced but one day might need to.


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## Smilie (Oct 4, 2010)

Well, I had both knees replaced, at the same time, so I guess can actually speak from experience.
I had no choice, having put it off ,several times,until it was either have it done, or face being in a wheelchair. I had people comment, at horse shows, that they were surprised as to how I rode, seeing me walk, which was very ;duck like, as my knees became extremely bowed.
I had them replaced in NOv,and was showing the following summer. My cardiovascular fittness was actually affected, by the long period I procrastinated, as even getting a horse out of the pasture, was a chore, and forget any hiking
I was also on maxium dose of motrin, so I could even function, which had it;s own side effect, far as my GI. While I don't believe in rushing into knee replacements, putting it off as long as possible, not being blind to possible consequences, I also know that I had put it off too long

Used a walker, very briefly, in the house, as it was winter and very icy, so my exercise consisted of the ROM ones, plus walking circles in the living room of my son and daughter in laws house. 
Can't really remember exactly what i all did , except I was committed to having great ROM, so moved on to crutches and ice cleats soon as possible,walking down our road
I hike now, walk and ride pain free. I do mention that I have replacements,when going through airport security!
There are some joint replacement forums, and I visited them before replacements, searching for people that rode after knee replacements
Of course, those forums have a lot of posts from people with bad results, complications, which can be intimidating. You have to consider though, most with good results don't post as much. 
I certainly have not visited those sites for over 5 years


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## Golden Horse (Feb 20, 2010)

Both knees have been scoped, trimmed and cleaned up, I bought a recumbent bike before the first surgery, and afterwards would sit on it, swinging the pedals back and fore, just aiming to get a full revolution, such a great feeling when you can do that.

Got to see a physiotherapist here, who told me that trying to build muscle before the OP was a waste of time, mind you his first words were "you don't need me, you need a surgeon" so haven't been back. Will have to see if I can find another one. 

Most people I have come across have said that they were glad to have it done, and most ride after.


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## Smilie (Oct 4, 2010)

Well, the GP I had , and who I worked with in that boring local private lab, after we moved out of Calgary, told me I should not ride after knee replacements, the risk being too great, and that he knew people that rode after hip replacements, rode, but not many with knees-thus my search on the internet, to find people who rode after knee replacements.

My OS, on the other hand, when my knees got so bad, told me I was riding with more risk without replacements then with, and that I could ride, just try not to come off. I have tried to follow that advise, thus no more colts

Far as muscle strength, according to a lot of info I read, equestrians have an advantage, far as good quad muscles. Soon as I had enough ROM,i used my stationary bike
Being a lab tech, I was also very proactive of eliminating any risk of bacteria reaching those replacements, thus insisted on pre dental antibiotics even after the first two years, as research is still not definite, far as either camp, and they are, afterall, my knees, so my choice on risk. Only have to read a few accounts of people who got infections, had to have new knees taken out, and be on IV antibiotics for an extended time, before any repair.
Quite a few people on those boards, stated they quit riding after knee replacements, and then either bought minis or changed to halter. Some also followed the advise not to lift heavy stuff, but I figure I am not going to change my life, so still lift hay bales and load them all the time.
I was not going to post on this thread, but then thought how much I liked hearing from people that both had successful outcomes from breast cancer and knee replacements.


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## AnitaAnne (Oct 31, 2010)

Well, I speak from experience, but not my own. I'm an ortho nurse so I see knees, hips, shoulders weekly. 

I only see them back if they are getting another replacement or with complications, but I just don't get too many riders. Runners yes, riders no. 

Last rider I had come through had a broken wrist but it wasn't horse related. More folks in the Birmingham area maybe since they go to the specific Sports Clinic there. We have 8 orthopedic doctors in the area that do replacements, but one doesn't do scheduled ones at my hospital. 

Don't ask me about the complications, but I will say it is very, very important to do everything you can to avoid infections...


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## gottatrot (Jan 9, 2011)

I've met people who do endurance and jumping after knee replacements. 
The other complications I've seen besides infection (I'm a nurse too) are from people who won't move after the surgery. We had a surgeon who told people they would not be having pain after the surgery, so they were not mentally prepared. It is much better for people if they actually were having pain before the surgery and needed the replacements. 

The worst one I saw who wouldn't move said she had no pain before surgery but just thought it might be a good idea to have it done before her knee got bad. ?? Her knee got frozen in a locked position due to her not moving it for several weeks, and the surgeon had to go back in and forcibly work it loose. After that he got very harsh with her and she finally did move it after the second surgery.

The best people I've seen that had it done were horse people. They were realistic, tough and pushed themselves. 

I'd read a lot about your surgeon and talk to people who have had surgery done by him. I've rarely found that the patient could have done anything to prevent infection, but rather most of the time it is related to a surgeon with a high rate of complications. If you talk to some different nurses privately they can tell you which surgeon they would recommend. We see which surgeons have lots of issues and which ones have very good outcomes. 
Some doctors have patients that lose more blood than others, or have more infections, or have difficulty with the prosthesis.


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## Golden Horse (Feb 20, 2010)

The reason why my wait is long is that the surgeon I chose has good outcomes!

I know that it is up to me to some extent, both to try and lose weight and improve fitness, before the OP, and then to do all the therapy that I am meant to do after. Having battled back to full mobility after my accident, I am no stranger to that battle...but it is so worth it.

Anything a person can do before hand to try and lessen the infection risk?


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## AnitaAnne (Oct 31, 2010)

Golden Horse said:


> The reason why my wait is long is that the surgeon I chose has good outcomes!
> 
> I know that it is up to me to some extent, both to try and lose weight and improve fitness, before the OP, and then to do all the therapy that I am meant to do after. Having battled back to full mobility after my accident, I am no stranger to that battle...but it is so worth it.
> 
> Anything a person can do before hand to try and lessen the infection risk?


Not be diabetic? 

Getting fit and healthy, keeping your immune system strong. Stay away from people who are sick. Watch your carb intake. 

Our hospital has classes that everyone takes before surgery so they are better prepared. They also have a coach (family member or friend) that attends classes and stays with the patient at the hospital. 

Most patients are also required to obtain medical/cardiac clearance prior to surgery. They do pre-op labs the week before. If any infections show up (often UTI) the surgery is postponed until the patient is cleared. 

Like @Smilie said, be vigilant after surgery to keep your risk for infection down too. 

Most infections we see are not in our scheduled patients, they occur from car wrecks or gun shots; i.e. dirty wounds.


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## gottatrot (Jan 9, 2011)

Yes, boost your immune system with a good diet, plenty of rest beforehand.

Around here they usually will give you disinfectant so you can clean your skin very well before your surgery, taking a shower with chlorhexidine to help remove as many organisms from your skin as possible even before they sterilize the site for surgery.

After surgery they will give instructions, but it's very important to avoid touching the incision with your bare hands. I've seen people scratching at wounds with their fingernails and it's no mystery why they end up infected.

Also, even though there are many skeptics about Vitamin C (I've been one), there is some actual studied evidence now that it can help the immune system. We've recently been giving it via IV in the ICU, and some believe it will become an accepted therapy in the future for infections. Couldn't hurt to take some for a few weeks before your surgery.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423646/


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## AnitaAnne (Oct 31, 2010)

OMG scratching!! How many times do I tell people not to scratch :evil: It is one of my big pet peeves. 

If you feel itching, Wash don't scratch! I must say that 100xweek.


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## SwissMiss (Aug 1, 2014)

AnitaAnne said:


> OMG scratching!! How many times do I tell people not to scratch :evil: It is one of my big pet peeves.
> 
> If you feel itching, Wash don't scratch! I must say that 100xweek.


 then we can never meet in real life


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## Smilie (Oct 4, 2010)

Well, I was lucky , in the fact that I had an inside track, with my daughter in law being an orthopedic surgery nurse, who lined up my OR team.
The Ortho surgeon I had, has people flying in from across Canada, and one of the few to do bi laterals
Far as infections, it is not just an immediate possible complication right after the surgery (as a lab tech, I researched this part, and one of the reasons I put knee replacements off so long ) but low levels of bacteria in the blood, that cause no problems ordinarinarily, that are released by such things as dental procedures, and sometimes the source is not known, have been known to occur a year or several years later.
Because there is no normal blood circulation around those artificial knees, bacteria have a place to settle and wreak havoc.
Thus, when i sustained a skull fracture,on a hiking trip, was taken to a local backwoods hospital , for initial treatment, and before they shipped me off to a major hospital, once i knew I had a skull fracture, I insisted on antibiotics
I am more relaxed now, but first few years were a lot like the first two years after breast cancer!
Yes, i really did those exercises, and my daughter in law, said I was over doing it, but I was determined to have great ROM, which I do
In Canada, you don't automatically go into physio program, as seems accepted norm in the States,reading those forums on joint replacements, that are U.S.A based
I had two sessions before leaving the hospital, an evaluation a 4 weeks, and then one session afterwards, where I was told I was doing way better then average, and need not come back.
Of course, anticoagulants , that you administer yourself, and which are part of the protocol, have almost eliminated an embolism, caused by release of bone marrow into the circulation, as occurred in the past.
I did require two units of blood, which is not that common, with one knee at a time, but I was only offered bi laterals about two weeks before the first knee was to be done, thus had no time to bank my own blood
I held off long as possible, but when my hgb dipped to a dangerous level, that could affect my organs,I relented.

I recall one poor elderly lady, that was in the room with me, as she was a bit senile. We were given pain meds and IM antibiotics, but had to request those pain meds.
Second day after she had her hip replaced, she was in quite a bit of pain, and told me she did not understand why, as the first day had not been bad, and she was getting her shots. Well, she was getting the antibiotic but not any pain meds at regular intervals
One night, she thought she was at home, and was trying to get out of the bed, asking her 'son' who was not there, how he had gotten in through the locked door. Not much I could do, with two knees replaced, so I banged the call button,until someone finally came and caught her before she fell, trying to stand up. I don't know why she was not watched better,.


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## Smilie (Oct 4, 2010)

gottatrot said:


> Yes, boost your immune system with a good diet, plenty of rest beforehand.
> 
> Around here they usually will give you disinfectant so you can clean your skin very well before your surgery, taking a shower with chlorhexidine to help remove as many organisms from your skin as possible even before they sterilize the site for surgery.
> 
> ...


Yes, there are precautions here also,and I re call crying the morning before my surgery, scrubbing my legs as recomemnded, as I still had ;cold feet, and my daughter in law pretty much wheeled me to the oR door. She chose not to scrub in, but had the head nurse do so. Far as getting any infection in that staple area, while not good, those infections caught in the scar area are nothing, compared to one that settles on that joint, from bacteria in the blood stream! At one time, chronic urinary infections were blamed, as one source, but I think that has changed
Bath or shower, has you sealing off the scar area with a plastic strip. I did it longer then called for !


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## Smilie (Oct 4, 2010)

On those Joint replacement forums, there were people who developed an infection a year or more later, and sometimes from no known cause.
It is also required that you have a complete dental checkup,before surgery.
My dentist told me, when he first graduated, anyone having heart valve , or other similar surgery, where blood flows through some artificial surface, was required to have all their teeth extracted first. That has also changed.
It did send me running to my dentist, that first year or so,at any hint of a toothache. Again, there is a time some knowledge can be a double edge sword

Same thing happened when I had breast cancer. Yes, my lymph nodes were negative, other indicators were pretty good, far as the actual pathology, yet, I knew that 20%of women with negative nodes, got re- occurrences, either through missed nodes, or cells escaping directly into the blood stream

I thus envied women, who , when they found out their nodes were negative, declared themselves cured. Having read enough bone marrows where breast cancer had spread there, I was a bad cancer patient, and not much better , when it came to knee replacements, not because of any pain, as I can deal with that really well, but accepting having knees that were not my own, that had their own possible vulnerabilities-some rare, but still possible
Time out from both, and I seldom think about having had breast cancer or that I have knees that are not my own, as they feel completely 'normal'

Good luck.


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## Smilie (Oct 4, 2010)

Types of infection, possible, with them being rare, but Thought i would post this info

;Types of infections after knee replacement surgery
Superficial infection
After knee replacement surgery, it’s possible to develop an infection in the incision. Doctors call these superficial, minor, or early-onset infections. Superficial infections usually occur soon after your surgery. You may develop a minor infection in the hospital or when you go home. The treatment is simple, but a minor infection can lead to a major one if it’s not treated.

Deep knee infection
You can also develop an infection around your artificial knee, also called a prosthesis or implant. Doctors call these deep, major, delayed-onset, or late-onset infections. Deep infections are serious and can occur weeks or even years after your knee replacement surgery. The treatment may involve several steps. You may need surgery to remove the infected artificial knee.


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## Golden Horse (Feb 20, 2010)

SwissMiss said:


> then we can never meet in real life


Sounds like you will understand my biggest fear about getting my tattoo.."don't scratch it"

I'm still very proud it survived intact.


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## SwissMiss (Aug 1, 2014)

Golden Horse said:


> Sounds like you will understand my biggest fear about getting my tattoo.."don't scratch it"
> 
> I'm still very proud it survived intact.


Yep! And proud of you to keep it intact :biggrin:


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## carshon (Apr 7, 2015)

I haven't had a knee replacement but will at some point within the next 10 years or so. I have had 4 arthroscopic surgeries on my left knee. The first at the age of 18 (due to a sport injury) and 3 others to continue to repair torn ligaments and remove what little of the meniscus is left. My first surgery I "blew out" my knee with an ACL and MCL tear as well as meniscus tear. My last surgery was 5 years ago and I was told then you need a new knee now but at 41 was considered far too young to have one. My left knee has a very limited range of motion (mostly due to scar tissue I assume) and I try to do stretches every day to keep it limber.

Knee replacement for me will be put off as long as I possibly can because of the sheer expense of it. My last surgery was outpatient - and the final bill (after insurance) was almost $17,000 - AFTER INSURANCE - I cannot even begin to imagine what a knee replacement would cost.

My surgeon (who had done all 4 surgeries) has credited my riding to keeping my knee together for so long. He stated many times that my strong leg muscles were helping support my knee and delaying some damage. 

I agree with those above that said exercise to help strengthen your leg before surgery will help you after surgery. I used to wear a brace for any long distance walking or riding - mostly because when my knee became fatigued it would hyper extend and I would usually fall. Strength training helped with a lot of that and I don't really wear a brace any longer.

Good Luck!


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## Smilie (Oct 4, 2010)

Thank God we have health coverage in Canada for knee replacements!
SOmeone i know who used to gymkhana at the light horse show, and who did not qualify for knee replacements in Canada, because there is an onus to loose excessive weight first, which she did not do, went to the States to have her first knee done. I re call being aghast at the cost, and think it was around 20 grand
Yes, delay as long as possible. I first tore my ACL back when I was 17, in a high jumping accident. No treatment in those days, beyond rest 
When I came out west, at age 21, I had a serious skiing accident, renting skis, thinking I could ski, having learned on the "Hamilton mountain, down east. It was just an escarpment, and heavy wet snow.
I went up the chair lift, not even knowing how to snow plow, lost control, did a somersault with those rental skis not releasing-major torque!

What dis I do, rest in Banff, while my friends skied ? Yes, for one day, then I wrapped those knees, took pain killers and went back to skiing. Add in a few horse wreaks over the years, and I was advised to have knee replacements about 15 years before I committed . Even then, I cancelled surgery three years in a row

I could not jog a horse in hand, at halter, even with a double dose of Motrin, had to just walk fast, and taught my horses to pick up the jog when I did that. I could sort of climb inclines, but coming down my knees were not stable enough.

I was the poster child, far as leaving it as long as possible!Next step was the wheel chair, and my last x-rays, when I thought about leaving it again, confirmed it. My femur was half sitting out in space, as my legs were very bowed. i walked like a duck, and was shocked, watching myself walk up to those mall glass doors, I guess, in dinial as to how bad I moved
My OS said he would be afraid to wait even 6 months, and I could not deny the evidence of those x rays

Getting my legs straight again, was a major testimony to the skill of my O.S. I also regained two inches in height


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## jaydee (May 10, 2012)

I worked in the elderly care sector in the UK and found that probably one of the biggest deciders in the success of hip and knee ops was how determined the patient was to work through it with a physio and in their own time. A lot simply gave up because they couldn't cope with the initial discomfort and effort it took and they were never truly mobile again
I've got a couple of UK friends who've had knee and hip surgery and they seem to be doing great and living a normal life again - both were relatively young when they had it done and that seems to also make a difference.


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## Golden Horse (Feb 20, 2010)

jaydee said:


> I've got a couple of UK friends who've had knee and hip surgery and they seem to be doing great and living a normal life again - both were relatively young when they had it done and that seems to also make a difference.


I'm kind of wondering that, if you struggle on to long is it worse than going to early?


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## Smilie (Oct 4, 2010)

Golden Horse said:


> I'm kind of wondering that, if you struggle on to long is it worse than going to early?


To answer your question, as I asked my Orthopedic surgeon the same question, when I kept putting it off, year to year, during the last five.
- and no, the end results will not be affected
In can, in a case like mine, where there is a lot of deviation, making getting the legs straight again, a harder job
One good reason to put it off, until you really need to have it done, is the good possibility of those knees lasting for your remaining life.


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## Golden Horse (Feb 20, 2010)

WOW, I have a friend, who has struggled with a bad hip, that has been getting worse for a long time. She kept saying that the Docs didn't know what it was, or that it was soft tissue issues. Don't know what happened while I was away, but they have found her hip is just worn out and she is on a priority list for a replacement, will be in the next month or two..I'm both angry that she has been in such pain, and in increasing pain for 5 years, and NOW they find out what it is.


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## Smilie (Oct 4, 2010)

Actually, the friend that horse sits when i;m away, had a similar problem, far as her hip. She is an avid walker, but it became increasingly painful, until they finally decided she did need a hip replacement.

She walks as actively as ever, and our dog loves when she comes to take care of the place, she gets lots of walking in
The rehab might be a bit more difficult when you leave your knees for as long as I did. From all the reading I did, seems that knees should be completely healed in a year, yet my right knee still gave me some problems at times. Just took another 6 months until they truly felt like 'new knees. Not saying they were anything like before, but that first winter we went to Las Vegas and I walked a lot on pavement, they did hurt afterwards. That is completely gone now

Even in this picture, when Smilie was about 4 (now 17 ) and about 6 years before i had knee replacements, you can see as to how my knees were bowing, although I always tried to stand so it was not that obvious


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