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Knee & Hip Problems Message Board

Knee & Hip Problems Board Index

Hi nana b!

Yes I DO know all about TKR's! I better because I'm having my second one next month! (Had the right TKR last April along with an arthroscopic repair of the left knee.) Unfortunately, the cartilage in the left knee started wearing out much faster than my surgeon or I could have predicted because 8 months after surgery in early Dec, the left knee started really bothering me. I went back to my surgeon and he did an x-ray. He said after looking at it, that I had a "little" room left before the knee became bone on bone like the right had. So he downgraded his optimism to 2 to 3 years or less for needing the left knee replaced. He gave me a cortisone shot back in Dec but it only lasted six WEEKS instead of the normal six MONTHS! So mid January, I had another cortisone shot and I begged him to please do the TKR this spring. (I had developed a back spasm from having an EMG test and he had me go to a pain management doctor for cortisone shots in my back. My surgeon wanted to get my back squared away before he would consider the TKR.) Happily, the back got better fast after the cortisone injections, so that the next time I walked into my surgeon's office on Jan. 30th, he was able to give me the go-ahead for the left knee replacement surgery. My surgery is scheduled for the morning of Friday, March 23rd. Can't wait to get it over with because the knee is getting progressively more painful. He has me going for physical therapy till then to strengthen the muscles surrounding the knee so that my rehab will be a lot easier.

To answer your question about pre-surgery testing and doctor clearances, I will tell you what my surgeon is requiring. I don't know where you live (maybe you can let me know that), but each surgeon's pre-surgery testing requirements are different depending on the patient's general health and whether they have other medical problems.

Because I had bad asthma for many years, but have been in complete remission for about 15 years, he wants my pulmonary doctor to clear me. (May need to have basic pulmonary function testing - will find out this Thursday when I go to my Pulmonary doctor.)

My surgeon requires an ultrasound of both legs to rule out DVT's (Deep vein thrombosis or blood clots in simple English). The blood work I need to have includes: CBC with Diff; PT/PTT/INR (which measures blood clotting time); SMA-20 (which measures a whole bunch of different components in my blood; a urinalysis and an EKG.

After all that is done next Monday and Tuesday (has to be within 3 weeks of surgery), I go to my Internal Medicine primary care doctor for medical clearance. (He has to fill out a form provided by my surgeon okaying my general health and ability to withstand surgery safely.

As for the autologous blood donation, do NOT insist on it, since you are anemic! I did one pint last year, but because I could not tolerate the iron sulfate pills, I became quite anemic two days after surgery and they had to transfuse the one pint I did back into me! So this time, I am taking a different form of iron pills which are easier on the stomach, and my surgeon doesn't want me to give my own blood because of last year's anemia problem. What he does is, at the end of the surgery, just before he closes my knee, he has two drainage tubes in the surgical site and re-infuses my body with the blood that gets lost during surgery into those tubes. (It's about 200 cc's of blood which he said should be enough combined with the fact that I will be taking the iron pills right up until surgery. That way, I probably won't become anemic and most likely won't need someone else's blood.) I was a bit nervous when I first asked him about this, but I totally trust my surgeon and didn't insist on donating my own blood. (My surgeon is the top knee and hip replacement surgeon in the county where I live here in NY - Westchester County. He's been named to the National Top Doctors list ELEVEN YEARS RUNNING!!! About half of the knee and hip replacement patients here in Westchester go to him!) Plus, he has the most wonderful bedside manner of ANY surgeon I've ever been under the care of! They broke the mold when they made this guy! It is definitely his calling - he was meant to do this!

Hope this answers your questions. Please let me know where you live and when your surgery is if it's been scheduled yet.

CPW2012 (Carol)

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