My F-I-L potential TKR surgery....

[hoolahan, ASN, RN]

My F-I-L is 84 yr old. He has SEVERE DJD esp bilat knees. He shoud have had TKR years ago, but I just found out he had refused.

Anyway, I approve of his surgeon, which doesn't matter a bit, he does not take my medical advice. He did have CABG about 8 yrs ago, and has never really been the same (frankly, I think it was b/c you can't fix cardiomyopathy w CABG!) He will defnitely have spinal for the TKR, so I feel better about that, and he has an excellent cardiologist.

The thing is, I am wondering if at this point he should hasve it at all. Yes he has poor quality of life now w the DJD, but if this surgery does not go well, things could be much worse, functioally speaking. I mean his DJD is so severe, he loses his balance, knees buckle, and his legs are now lowed.

I know a super duper best most excellent knee specilaist (He did Micheal Jordan's knees) and I just want my F-I-L to have a second opinion. If this guy says do it, I will feel somuch better. I offered ths optin to my F-I-L, and he prefers to go w his own doc's opinion. I respect that, but I wonder, shoud I try to push harder??

I would feel awful if things did not go well, and I hadn't insisted on the second opinion. He is VERY stubborn tho! I know if he is not able to walk or has to use a walker permanently after the surgery, he will wither up and die. BUT, he refuses to use a walker now, the thought that he drives scares the crap out of me. What kind of reflexes can he possibly have left??

Advice??Thanks!

[kmchugh]

Hoolahan

Done the anesthetic for a LOT of these. Given your FIL's cardiac history and age, I think a spinal is a pretty good choice. However, have done patients with the same basic problems under a general, as well.

The real question is does your FIL WANT this procedure. It is a bit painful, and there is some pretty significant rehab associated with the surgery. Most ortho surgeons I know base the decision to do this on how much pain the patient is in. Generally, they will tell you when the pain becomes unbearable, it's time for a replacement. If he is at that point, then its time to get his knee replaced. Given your FIL's symptoms, he was due for a TKA (total knee arthroplasty) years ago.

One of the keys is to get a surgeon who does knee replacements a lot. The guy who did MJ's knees didn't do a replacement, he did arthroscopy. He may not be the best choice for a TKA. And, your FIL's confidence in his current surgeon is important as well. In any event, I've see patient's your FIL's age have the surgery, and generally (from what the surgeons tell me) it almost always improves quality of life. There is something to be said for getting out of bed without terrible pain from DJD.

Kevin McHugh

[semstr]

My MIL had both her knees done (not at the same time of course, but with a year in between) at age 73.

First she had to lose weight, which she did, (that was the hardest part for her!) with help of the WW, she lost 30 pounds.

For anesthesia, a spinal was done and she was absolutely doing great immediately afterwards!

She then (after 7 days in the ortho clinic) to a special rehab centre, where she stayed for 4 weeks.

She came home and walked (with one cane for another 4 weeks) like never before!

Take care, Renee

[emily_mom]

Is you FIL able to get around enough to warrant it? I mean, can he make it through rehab? With his heart probs, he may not be able to tolerate activity...esp rehab.

Kristy

[hoolahan, ASN, RN]

It is so hard to tell whch is worse, the DJD or the cardiac. Maybe he loses steam from the pain? He isn't one to c/o a lot, but yes Kevin, you are right, his pain is severe, and I suspect that is why he wants this now. I just hope it isn't too late for real improvement. He is very compliant otherwise, and will do whatever work it takes to get thru rehab, so that should be OK.

It is certainly his decision, but I really just hoped he would let another doc take a look at him and say, yes, surgery is a good idea.

Thanks for your input friends!