PERSONAL/QUALITY: Knee surgery update

So I had arthroscopic surgery at a Healthsouth facility from a Brown & Toland surgeon on Friday. The admin staff and the nursing staff were superb, and the majority of my information from the physician’s office had in fact got over to the surgi-center, so there was no need for me to repeat everything. They also allowed me to not pay anything up front, as I explained that I thought my previous office visits and MRI would take up all my deductible and out of pocket. I even have a new MSA (should be HSA) card from the "MSA Bank" which I should be able to use to make those payments tax-free. So I am now one of those health care consumers I’ve been warning you about!

The surgery was in some ways rather fun, particularly as it was minor enough that I was able to be woken up after a quick general anesthetic and was able to watch the monitor as it happened. I could see a huge drill blasting the odd bit of white scar tissue, and although there was a cloth barrier stopping me from seeing the surgeon, I was even able to get the nurse to bring it down by joking that I was watching a tape from another surgery. But there he was slicing/drilling away, and describing to me what he was doing. I’ve since told several people about this but none of them seemed to be anything other than queasy.

The most amazing thing is that although I had a couple of Percocet in the facility, I have taken none of the Vicodin I thought I’d need over the past 48 hours. The knee is pretty swollen, but I can already walk OK–it’s stiff but not painful. Hopefully in a couple of weeks I’ll be better than before. I’ll keep you in touch, but going through this experience is always interesting for those of us in the health care business who don’t often see things from the "business" end!

By the way, if you don’t know the history, the surgery was follow up to much more significant knee surgery 2 years ago when I had ACL/PCL grafts following a violent snowboarding accident.

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  4. Dr. A.K. Venkatachalam, MS (Orth), DNB (Orth), FRCS (UK), MCh. (Orth) (Liverpool), consultant Orthopedic surgeon trained in the UK & Belgium. He has performed over 3,000 knee arthroscopies including ACL reconstruction & over 1,500 knee replacement surgeries. He has pioneered deep bending knee, minimally invasive & less invasive procedures for total knee replacement, gender knee replacement, bilateral replacements, unicondylar oxford knee replacement and proxima hip replacement surgeries in South India.

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  6. my gf had a knee replacement sept 2008..she is still having abnormal swelling..just had labwork, no apparent infection. md ( a good orthopedic surgeon) wants to do bone scan, ct scan and wbc scan. I’m a nurse and know about these but her question is why so much to figure out this swelling? she is justifiably anxious that something serious is wrong. can anyone comment on that ? anyone else have this swelling ( more swelling and stiffness than pain) so long after surgery ?
    thanks jan

  7. My mother had problem of knee arthritis she can climbing steps even she can’t climb properly, her knee didn’t bend properly after some times someone told to my mother about knee braces for proper knee support she got it from http://www.drbraceco.com now she can climb even she can move her knee properly. thanks drbraceco

  8. my mother is going for total knee joint replacement in Rockland Hospital probaby by Dr. Maheshwari. I would like to hear comments about Rockland Hospital and Dr. Maheshwari and the post operative care there as Dr. Maheshwari is available there on call only. This kind of query has already been asked by one AKANKSHA on April 10, 2007. I would like to know the comments on this query also.

  9. For anyone considering total knee replacement using navigation, please be aware that there can be a complication requiring far more rehab than the knee replacement itself. I had such a procedure (i.e. replacement with navigation) and three months later I had a spontaneous femur fracture. Turns out that one of the pinholes in the femur to stabilize navigation at the time of replacement, did not heal and, three months later, the femur fractured. In the follow-up surgery to repair the fracture it was seen that the fracture emanated from the site of one of the pinholes which had, obviously, not healed. Be aware of this risk if you are considering navigation.

  10. You probably anticipate that life after the surgery will be much as it was before surgery, only without the pain in knee replacement or cardiology or somethingelse. For more info please check out url:)
    click Here

  11. My husband underwent total knee replacement on both knees August 6th. At the time of the surgery, the surgeon decided to let the bone grow into the bottom plate rather than cement it. My husband has had continuous pain and is told to keep waiting that maybe the bone will still grow into the plate. A second opinion has told us that we have waited four months and nothing else is going to happen as far as growth is concerned. We have also been told that the knock kneed position is off 3-5 degrees and is the cause for his problems with walking. We were also told that the bottom plate may be just a bit to large for his size leg. All of his pain generates from the plate area down his legs. He continues to take pain medication on a regular basis. Has anyone else had this problem?

  12. Great that you had a successful surgery. This is the reason why I like the concept of concierge at public places particularly in hospitals.

  13. My mom has to undergo total knee replacement, I would like to hear comments about rockland hospital as well as Dr. Maheshwari on the same.

  14. I am about to have a partial knee replacement. I would like comments about Doctors in NC and difference in equipment?

  15. Hey my name is Hilary
    My Boyfriend just had knee surgery to remove a bone chip, now three days later hes developed these massive “tape blisters”
    Why dont they tell you about these things in the hospital? We had to look online to find out what they were.

  16. My TKR was 8/10/06, so it has been almost 4 weeks ago that I had the surgery. I am distressed because I am not able to bend my knee over 60 degrees on my own. When my physical therapist forces it, it has gone to 70 degrees but with excruciating pain. I am still swollen at the knee and had a complication in that I was allergic to the adhesive solution used (?) and all around my incision, I had blistering and the blisters burst and formed scabs. It is still swollen. I do my exercises all day and still don’t seem to be making progress bending the knee and I force it with a result of horrid pain. Is thin an anomaly? Or am I becoming a candidate for a reduction under anesthesia, which was suggested by my physical therapist?

  17. I had total hip replacement in Dec., 2005. I am experiencing, with each step a sharp stab in the left thigh. The hip x-rays, and mobility in the hip appear fine. What might my problem be? Thanks,
    Jim Klein

  18. I had a knee problem in year 2000 due to tubercolosis of the one and though I can walk and bend my knee about 30 degrees but while climbing steps i cannot climb normally as the knee does not bend to the required degree , would like to know if there has been any procedure by which the gap at the knee can be increased and the any thing can be done to get better degreeof mobility for the knee,

  19. After a botched arthroscopy by a doctor in December 2005 in the uae, I have been told by a doctors in germany and uae that i am ‘bone on bone’. X rays proved that. Because I am 40years old they have recommended a a hight tibial osteotomy of the knee. I need to know if this is the only proven solution? What are the longterm after effects. How long willl this last. What are the complications if any… please help…

  20. I am a 31 year old female that has had Juvenille Rheumatoid Arthritis since I was 12. The past year my hip has gotten progressively worse and I have to have a hip replacement. Do you know of any sites or blogs that may give me some insight on what to expect? I am just scared. Thanks.

  21. I am a Combat-Wounded Veterean that, has had conv. Full knee replacements. So far so good.
    My question is about my mother who is 83yrs old with Osteoporosos, a hump in her back from several vertebras goig to dust. She needs a right knee replacement. What would be your suggestion? I feel that mine were very hard to rehab with the cut being overtop the knee. Is it possible for her to have the side entry done?
    Thank You R. Larry Weaver DAV

  22. good morning
    Iam yugasha gupta , IIyr student of physiotherapy, I am keen to work as an assistant physiotherapist with your esteemed institution .
    It would be a very kind of to you consider me .I have had worked in clinics before and i am very comformtable working with electrotherapy modalities and intend to learn more under your valuable guidance.
    thanking you
    yugasha gupta

  23. The benefits of computer assisted surgery seem to be much more a virtual effect than real. Several experienced North American Knee surgeons don’t use computers in surgery. This is more a marketing gimmick.
    Navigation equipment is expensive to own, surgery takes time and only one model of knee can be used with the system.
    Experienced knee surgeons say that balancing of the soft tissues is the main issue in a TKR in India. Alignning the components is easily achieved by eye balling. There is no siginificant advantage to usage of computers in Knee surgery.

  24. The latest advances in Knee replacement are High flex knee replacement, Minimally invasive knee replacement and computer assisted knee replacments. High flex replacements are desired by Indians, Asians and even by Westerners. Down South, the leading surgeon is Dr.A.K.Venkatachalam. Many Britishers and Americans have undergone knee surgery by him at Chennai. he performs the operations under laminar air flow operation theatres at two private hospitals. Patients are able to stand up without pain on the evening of surgery and can go home in 1- 2 days to return for suture removal after a fortnight. The costs are one fourth of that in the UK and one tenth of that in the US. He also performs arthroscopic surgery of the Knee and shoulder. He has handled many difficult cases forsaken by the NHS.

  25. I have some knee problem,and have been to either have orthroscopic suegery or Hyluronidase injection. Would you please let me know the efficacy of thia non invasive procedure.
    Thanks <

  26. Joint Replacement Surgery centre at Delhi Institute of Trauma & Orthopaedics in Sant Parmanand Hospital Delhi INDIA offers specialized surgeries like joint replacements of hip, knee and shoulder joints, (primary / revision); sports medicines and arthroscopic (key hole) surgeries spine surgeries and of course general orthopaedic surgeries by specialist consultants.
    Sant Parmanand Hospital has 4 state-of-art operation theatres including a dedicated joint replacement OT. OT’s are equipped with joint less stainless steel wall, laminar air floor HEPA filters, automatic doors, centralized AC.
    The faculty includes:
    Joint replacement surgery :
    : Dr. Shekhar Agarwal
    Dr. Vivek Mittal
    Sports Medicine & Arthroscopy :
    : Dr. J. Maheshwari
    Dr.Shekhar Srivastav
    Every year over 1000 operations are performed in DITO. Approximately 200 total knee replacements are done every year. Both side simultaneous TKR is done in approx 85% of cases. Female to male ratio is 5:1. Our satisfaction ratio is over 95% while infection rate is 0.1%.
    What is total knee replacement?
    With advancing age or diseases like rheumatoid arthritis, our knee joint articular surfaces gets damaged, our legs gets deformed and walking for activities of daily living becomes painful and difficult. Now with advances in modern orthoapedic surgery, damaged surface of the knee joint can now be replaced with artificial knee joint (knee replacement surgery), especially when patient’s have tried rest, analgesia, physiotherapy and other modalities.
    Primary Total Knee replacement
    Conventional Total knee replacement: Most common operation for the arthritic knee. Damaged surfaces of both femur and tibia are resurfaced and replaced with artificial implant. Replacement of patella bone is optional. The outcome of total knee replacement is good and predictable with 90% survival upto 15 years. As mentioned this operation is offered only when patients have deformed and painful joint affecting activities of daily living or crippled with rheumatoid arthritis.
    High flex knee replacement / Squatting knee: This surgery is also a recent development in total knee replacement. This new prosthesis allows very good knee bending (upto 1550, though not automatic). This movement allows patients to sit cross leg on floor and even squat, thus helping those who need these movements for e.g. prayers, social purposes, getting up from low stool, etc. This prosthesis also requires specialized instruments for implantation. Every patient is not suitable for high flex knee e.g obese patients, patients with stiff knee, patient with movements less than 1000, severe deformity etc.
    Bilateral simultaneous knee replacement: Most patients agree to total knee replacement when the deformity is very severe. These patients are suitable for simultaneous replacement of both knees, otherwise it is very difficult to walk comfortably after the operation with one side replaced while the other knee is still deformed. The other advantages of the operation is one time admission, one time anaesthesia, and surgery. One time physiotherapy. It cost less for replacing both knee simultaneously then replacing at separate time. However patient undergoes such procedures when considered fit by anesthetist and physician.
    Treatment of arthritic knee
    Non-surgical treatment of arthritis:
    Exercises especially quadriceps strengthening exercises
    Hot fomentation and local gel application
    Analgesics (NSAIDs)
    Injection in the knee joints
    Surgical options for arthritic knee
    Joint saving procedures:
    Arthroscopic debridement / lavage
    High tibial osteotomy
    Joint replacement operation
    Recent advances in knee replacement
    High flex knee: High flex knee replacement / Squatting knee: This surgery is also a recent development in total knee replacement. This new prosthesis allows very good knee bending (upto 1550, though not automatic). This movement allows patients to sit cross leg on floor and even squat, thus helping those who need these movements for e.g. prayers, social purposes, getting up from low stool, etc. This prosthesis also requires specialized instruments for implantation. Every patient is not suitable for high flex knee e.g obese patients, patients with stiff knee, patient with movements less than 1000, severe deformity etc.
    Unicondylar knee replacement : Unicondylar Knee Replacement / Partial Knee replacements: This is one of the recent development in knee replacement. In this surgery only partial knee joint (tibia and femur) is replaced. All the knee ligaments are retained in the surgery.
    This is considered in patients with involvement of one side of knee joint in early middle aged patients. Replacement of partial knee joint allows good post-op movements, faster recovery and less blood loss. The implant is less expensive than conventional total knee replacement.
    Computer navigation: For long term success of total knee replacement computer nagivation technology is now used during the operation. Computer technology helps in finalizing the optimal placement of implants during the surgery.
    Revision total knee operation : Those patients who developed failure after primary total knee replacement surgery requires revision total knee surgery operation. This operation is more extensive and more expensive compare to primary total knee replacement. If the failure is due to infection than the surgery is done into multiple stages.
    Total Hip Replacement:
    Every year approx 80 total hip replacement operations are performed at DITO every year. Large number of patients undergoing total hip replacements are young. Hip joint is a ball and socket joint between thigh bone and pelvis. Like any other joint, hip joint is also liked with a smooth and strong cartilage layers which ensure almost frictionless movements to the hip. However arthritis of hip, due to varius causes, erodes this layer leading to pain, stiffness with instability.
    Artificial hip joint are broadly divided into :
    Conventional total hip replacement
    Ball (head of the femur) is excised to performed this operation. It can further be divided into 3 types depending on the basis of fixation with bone.
    Cemented total hip : In this procedure both the cup and ball components are fixed with bone cement in pelvic and thigh bone. They are least expensive and good to patients with poor bone stock e.g. elderly
    Uncememented total hip : In this operation both the components (cup and ball) are fixed to bone by direct impaction, and no cement is required. Bone later ingrow onto the implant and hold it firmly. These implants are twice as expensive as the cemented implant and they are good for young patients with good bone stock and in revision total hip operation.
    Hybrid total hip replacement: In this type of replacement one part is fixed with cement wile the other part is fixed with direct impaction.
    Surface total hip replacement
    This is the recent advance in total hip replacement surgery. In this surgery the ball (head of the femur) is not excised hence it is also called conservative hip replacement. Femoral head is re-shappen to allow same size of artificial ball as of the patient own hip. The advantages are good range of motion specially flexion, stability of the joint and less chances of dislocation. Surface total hip allows patient to sit and squat on floor. There is no restriction of activities with surface hip replacement as compared to conventional total hip replacement. It is indicated for patient less than 65 with good bone quality. However, patients with poor bone quality, rheumatoid arthritis or insufficient bone stock are not good candidates. Both the components (ball and socket) are metal.

  27. Sant Parmanand hospital is a state of the art medical facility providing tertiary level of medical care. The hospital was commissioned in Oct 1997 and within the short span of its existence as a multi-specialty hospital it is regarded as a center of excellence in the professional circles. The 150-bedded hospital is renowned for its medical expertise, excellent nursing care and quality diagnostics. Specialists on the hospital’s panel include some of the most distinguished names in the profession. The hospital has earned national as well as international recognition as a center of excellence for Joint Replacements, Arthroscopic Surgeries, Spine Surgery, Advanced Laparoscopy and Minimally Invasive Surgery. The hospital is equipped with most modern equipments & provides a complete range of latest diagnostic, medical & surgical facilities for the care of its patients.

  28. TOTAL KNEE REPLACEMENT is an operation or surgical procedure to relieve disabling pain from end stage arthritis. It is a very rewarding knee operation, and has a high success rate. In INDIA osteoarthritis of the knee is the commonest and main indication for a TKR(Total knee replacement) Other indications are rheumatoid arthritis, gout, sero- negative arthritis, post traumatic arthritis. Knee, HIP and other JOINT replacements are ideally done in operation theatres with laminar airflow. The air is filtered though HEPA (high efficiency particulate air) filters. The frequency of air changes has to be greater than 300-cycles/ hour. The best centres are Sant Parmanand Hospital Delhi,Apollo Delhi,Fortis Delhi & Many More.The Best Known Surgeons are Dr Shekhar Agarwal,Dr J Maheshwari,Dr SKS Marya,Dr Ashok Rajagopal.

  29. how long after the surgery do u have to wait until you can sit through a 9 hour international flight? or do u have to wait at all??

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