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WendyN
Reply with quote  #1 

My 85 year old mother is finally considering having knee replacement surgery.  She has osteoarthritis and bone-on-bone arthritis both knees.  She has tried all the injections without any relief.  Lately her knees are locking up.  She is using a cane, walker and wheelchair.  Her doctor is stingy with the pain meds and mom says they rarely work anyhow.  So, looks like surgery is the only thing that might help.

 

My questions are has anyone had experience with this, especially concerned with the rehab.  Just heard about a friend of my dad's who spent a month in rehab after this surgery.  Not sure mom will go for that, but I have already told them that I don't think we can do the rehab at home.  Mom is quite noncompliant and dad will not make her do anything she doesn't want to.  If I try to make her, they both get mad at me, so not going there! 

 

Second question is will they do both at one time?  I read a little about it and seems that if both are similarly diseased, best to do both.  This does make surgery time much longer though.  Most stories I see are about just one knee at a time. 

 

I did a search and found a few stories, but I don't see posts about how the surgeries turned out.  I know 85 is old, but mom has few other medical problems, so I guess the situation is quality vs quantity of life.

 

'daughter'(beth)
Reply with quote  #2 
Hi WendyN, 85 years old and knee replacement! Yowza.

I doubt they would do both at the same time, she needs one good leg to stand on during rehab, ya know?

No rehab at SNF? I have no idea, maybe some people do better with rehab in their homes, but my mom would not have agreed to physical therapy at her home (some non-compliance on her end as well) so I am glad she had rehab at an SNF after her broken leg surgery. I did not give her a choice.
It took her 2 months of SNF rehab. Then she went home. She was supposed to get more PT at home, but as predicted she fired the PT's after their 2nd visit. Said they were not "doing anything". Luckily, mom had a long ranch-style house, and her mailbox was down a long-ish driveway, so that was her physical therapy. Had she lived in a small home with very little mobility, I doubt she would have ever gotten out of that wheelchair. She eventually walked fine with a cane (2 years later).

The way you describe your mother, I don't see much rehab happening for her at home. She has a better chance at the rehab but she will probably kick up a fight. These elderlies!

BC
Reply with quote  #3 

an uncle had both knees done at the same time but he was only 78 when he did it.  He said he was glad he did both at once because he would never have gone back for the other one.. The rehab was brutal. He was highly motivated but for many elders, the pain is too much. 

 

If she is already using a walker, her arms may be developed enough to begin the process. I am a firm believer that rehab would be accomplished in a facility better than at home for elders. Granted, we have to still be involved. Facilities have to watched very carefully. A friend's mother (with mid stage AD) had to have a hip replacement after a fall.  When I visited her to assist with therapy, she was clearly (to me) in severe pain and totally non compliant with the therapist.  I asked the nurse when she had last gotten pain meds..and was told (drumroll please) "She hasn't had any, the doctor ordered it 'on demand'"..SCUSE ME???  they said they were experienced with dementia!!! KD was unable to process that..pain-ask-pill-no pain.. We got that straightened out and she got better after orders were changed to a schedule.

 

I know that your mom probably isn't in that catagory, but even in rehab they need an advocate. 

WendyN
Reply with quote  #4 

Thanks for the replies.  My parents both live with us, so no nursing home. No dementia, mom just forgets things often.  I think they would have to do both knees at once as she cannot use either much right now.  She will ask for pain meds, probably too often (very low pain tolerance). 

 

She does have a walker, but doesn't like to use it much, insists on wheelchair when we go anywhere.  She was never the most athletic person in the world, so her only incentive for the knee replacement is to not be in pain.  She would like to be able to get dressed by herself, but she still won't walk outside to get the mail (we have a long driveway).  I also think it would decrease the chance of falls as she would be able to support her weight. 

 

I'm beginning to wonder if the rehab will be way too much for her.  She goes back to the ortho doc the end of March, so we need to come up with a good list of questions by then.  She has had trouble sleeping in the hospital whenever she was been there, hoping a rehab would be a bit quieter. 

 

I have also heard the anesthesia is sometimes difficult for the elderly; causes some dementia, although not permanent.  Anyone have esperience with that? 

 

 

BC
Reply with quote  #5 

anesthesia is hard to handle, but a good anesthesiologist who meets with you and the patient should be able to minimize the risk..mostly the risk is when dementia is already present.. sometimes knee surgery is done with a sedative and a spinal block.  The risk of clots following the surgery is significant and serious strokes are not unheard of. Some people think that the dementia risk is actually risk of TIAs during and after surgery, I don't know. They will get her on her feet and it will hurt. I would recommend asking her to practice with her walker a lot before hand, because her arm strength will make a difference. How she does with that could be a clue about her ability to rehab.

 

Please ask about a partial knee replacement. It may not be an option for her because of the extent of damage, but requires less damage to the connecting tendons and less pain for less time. If you wish to discourage her, show her some of the videos about knee replacements--Google, there are several. 

'daughter'(beth)
Reply with quote  #6 
YES, anesthesia can cause issues. It took mom quite awhile to get back to normal cognition after her surgeries. I am talking several months! It was kind of scary because before her first surgery (hysterectomy) she was not having ANY cognition issues. I was really worried. But slowly, she got back to somewhat normal function. The 2nd surgery (broken leg) is what I think put her over the edge.

I typed a big huge post about my Mom and pain medications (she never requested them and hence had major issues!!). I don't see the post, so I guess it got lost. At any rate, since your mother has no problem with taking pain meds you won't have that same issue. My Mom was PRN (per requested as necessary or something like that) for the pain meds, but even though in a lot of pain she would never request it! It really slowed down her progress. And of course she experienced a lot of pain.

After mom had her leg surgery, she was in the hospital room, and there was another elderly lady in the bed next to her, who had had a knee replacement surgery. The next day the nurses/doctors put this lady's leg into a machine (in the bed) which would bend her leg back and forth for awhile, this was the beginning of the therapy I guess. Apparently, it was excrutiating. She wanted more pain meds!! but she had already had the max dose! It really made me wonder if I would think twice about knee replacement when I am 70+.  Yikes.


WendyN
Reply with quote  #7 

Just got back from the Internist and she said what you said BC, make her use the walker more.  She actually said she needs to increase her activity overall.  To lose weight and to strengthen her muscles. 

 

We had a talk on the way home and I told her that she MUST start using her walker (and not the wheelchair) more in order to strengthen her muscles if she is considering the knee surgery.  I told her that the surgery rehab will be hard, but it is her choice; she can get stronger or she can chose to let her muscles get weaker and live like that (ultimately wheelchairbound). 

 

My husband and I are leaving for a trip for two weeks.  Mom and dad will be home alone.  This is a good chance for mom to try to do more; shopping and cooking.  We'll see. 

 

BTW-this doctor said that they will not do both knees at once, but she is not a surgeon, we see him the end of March.

 

BC
Reply with quote  #8 

Joint replacement isn't for the people who aren't determined to get back on their feet. Other people use the pain as a reason to never stand again. My uncle got back on the golf course which he wanted desperately to do..

 

  

 

here are the basics.. a great deal of the pain involves the stretching of the connecting tissues. 

E-nuff4me
Reply with quote  #9 

I just want to tell you of my experience with total knee replacement and it might help you with your decisions. I had that surgery a year and a half ago and although I am in less pain now, I'm glad I did it, but I don't think I would survive getting the other knee done. I had to wait for so long to get this surgery because of my metal allergies but they have a process now where they can coat the prostheses to keep the metal from being in contact with the persons tissues. Hopefully this will be successful for me and I try not to think of what would happen if it isn't, but so far, with the exception of some minor problems, it seems to be working. My surgeon would not do both knees at the same time but knowing what I had to go though, I'm sure glad he didn't.


I was almost 20 younger then most of the others who were getting the same surgery when I did and who were in my rehab class and I guess it really does depend on your overall health, but I was surprised just how fast a person can go down hill. I came out of the hospital over a week later in a wheelchair that I could barely sit in for 10 minutes without being totally exhausted. The medications they gave me for pain etc wrecked my system to the point that I couldn't eat and my constitution was a mess and I told them that if they wouldn't let me leave that hospital, I didn't know if I would make it because I had to get home to my own place and slowly get myself back.


The risk was substantial and even with the spinal block, we had to inject ourselves in the stomach for a month after the surgery with anticoagulant medication and one of the people who got the surgery at the same time I did, got a blood clot and did not make it. You do have to be very committed to getting back the range of movement of your knee and I used a lot of ice packs for a long time after. The exercises they give you to do can be painful but no where near as painful of what we had to deal with before. I would say the first month or so after surgery you need some good pain medications but after that the surgical pain lessens and you have more of a stiffness kind of pain that is a way more tolerable. The other thing to consider is complications because, I also required a second surgery on that knee 4 months later because it wasn't healing so people who have circulation problems or diabetes or other conditions that affect healing can be compromised with healing issues too.


For me the main reason for the surgery was for the unbearable pain that I was having as it consumed my whole life and was very debilitating. It affects every moment of your waking hours and when it gets worse even your sleep in affected. You go through all the medications and therapy and everything helps for a while but it gets to the point, that nothing helps anymore. Just sitting in a chair can be torture sometimes and walking, well I would drive to the grocery store and park in the handicap and wonder if I could make it in to get my milk. Some days I just started my car up and went home and did without because I knew I still had to make it from my car to my condo.


It is a lot better now but because my other knee is over 5 years past needed surgery too, I still use a walker and my mobility is limited. I may have to get the other knee done too in the future but for now I am pleased with having even this limited break from the pain.

I also want to add that even now I still have issues with this knee replacement as it seems things like the flu shot or other illness that get in your blood, go right to that prostheses, a foreign body. You then can get an infection in that knee, and are in for months of medication and therapy just to get rid of it. You also have to go on mega-doses of antibiotic just to get your teeth cleaned and that then starts up a whole bunch of other issues like infections, urinary, vaginal, stomach and the latest thing that has been a real curse for me, skin infection and an increase my allergies.

All in all, though these side effects or conditions from the surgery or having this hunk of metal in my body, that I am allergic to can be troubling, it is worth it as it has given me some of my life back.


enuff

WendyN
Reply with quote  #10 

Thank you "Enuff" for that elaborate description.  Really getting LOTS to think about! 

 

My husband and I are leaving for a two week vacation tomorrow.  When I get back, I have lots to discuss with my mom.  It might be a mute point though as her liver enzymes are going up, so there might be something going on.  Need to find out what that is before we can even think surgery. 

anon1
Reply with quote  #11 
I had a total knee replacement at 50. Knee replacements are tougher than hip replacements, and are only successful if the patient wants to recover, and goes through the painful PT. Otherwise, I have seen a lot of elderly people with limited movement in the operated leg. Mine is still stiffer than the other one, although I did all the exercises, and am fairly young and active.
 
The woman who roomed with me in the hospital was a doctor who had a hip replacement at 83. She was informed, and dedicated, and it went fairly well. But a double knee replacement at 85? That is one of the reasons the doctors did not want to operate on me, because I will probably have to have a revision at an advanced age. But I have had knee problems since birth, and there was no other solution.
 
To put it in a nutshell - a knee replacement is major surgery, up to three hours of operating time per knee, depending on how much is damaged. It is painful, and recovery time depends on how strong the muscles are before surgery, and how much the patient works on it after surgery. My sister had an excellent time with recovery, but she really worked out in the gym before surgery, and was young.
incognito
Reply with quote  #12 
Wendy,
A total knee replacement requires major rehab.  Usually, in-home rehab is not a good idea, because the physical therapy must occur several times a day which would require a therapist to be there several times a day.  Having a family member do the exercises rarely works (and I don't think is even an option) as the patient is much more likely to beg off or outright refuse, and of course, family members are not trained therapists, usually.

On the other hand, a partial knee replacement is supposedly less painful, less invasive and has way less recovery time.  Perhaps she would be a candidate for this.  It depends on the extent of the damage to her knees and surrounding structures and tissues.

I've never heard of an 85 five year old receiving a double knee replacement.  Often very old people will receive a hip replacement, but apparently that procedure seems to be less painful and has a shorter rehab and recovery time.

And of course, whatever the surgery is, the patient has to be fully committed to working at rehab for the outcome to be good.  You know better than anyone what your mother's frame of mind and the extent of her recognition of the seriousness of this operation.  Usually people who do not have knee issues cannot fully appreciate the extent of rehab involved in recovering from these procedures.     
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