Knee Surgery Question/Poll

[dvcochran]

I met with my Ortho yesterday to discuss in detail knee replacements and learned some very concerning information. To perform the total knee replacements that are recommended the ACL and MCL will have to be sacrificed. The replacement structure supposedly provides the lost function of these ligaments. How I do not understand. This is exceedingly concerning to me.
Has anyone had total knee replacement and have experience with the loss of the ligaments? How has it went? Did you lose stability and motion?

Due to previous injuries I also discovered it will take 4 surgeries to do both knees. A fair amount of hardware has to be removed first requiring big incisions and the Doc says the sites would be too close to risk doing at the same time. Which just sucks even thinking about it.

I am putting this post out to various site to gather as much info as possible. Thanks for any advise.

 

[Buka]

I always liked to go to several Docs and see what they all say - compared to each other.

Although I've not had anything replaced myself, I worked for five years in a Physical Therapy unit that specialized in knee replacements, I took care of a lot of the patients. They all seemed to do well, ran into a lot of them down the road and they said they were great.

Good thoughts to you, bro.

 

[jobo]

I met with my Ortho yesterday to discuss in detail knee replacements and learned some very concerning information. To perform the total knee replacements that are recommended the ACL and MCL will have to be sacrificed. The replacement structure supposedly provides the lost function of these ligaments. How I do not understand. This is exceedingly concerning to me.
Has anyone had total knee replacement and have experience with the loss of the ligaments? How has it went? Did you lose stability and motion?

Due to previous injuries I also discovered it will take 4 surgeries to do both knees. A fair amount of hardware has to be removed first requiring big incisions and the Doc says the sites would be too close to risk doing at the same time. Which just sucks even thinking about it.

I am putting this post out to various site to gather as much info as possible. Thanks for any advise.

both of them are designed to provided stability to the knee joint, if you have a synthetic knee, it doesn't need them, , which is the good news, the bad news is they have neural receptors in them that sense the position of the knee, with out them running jumping and general being sporty is some what more difficult

 

[CB Jones]

You also don’t technically have to have an ACL. You can strengthen the muscles around the knee to provide the stability.

So it sounds reasonable that new knee replacements are designed to not need them.

 

[Danny T]

I've had total replacements, both knees. Has been 2 1/2 years on my left and 2 on my right. Was in rehab 1 week out of surgery and out of rehab in a month. Took approx a year to be totally healed and full strength. Other than not having as much total range of movement I do just about whatever I want. (NO RUNNING for it will wear out the knee and will have to do surgery again)

I still doing sparring, kicking, wrestling/bjj. The rehab exercises are designed to strengthen the knee and legs as well as relearning its proprioception.

 

[dvcochran]

I've had total replacements, both knees. Has been 2 1/2 years on my left and 2 on my right. Was in rehab 1 week out of surgery and out of rehab in a month. Took approx a year to be totally healed and full strength. Other than not having as much total range of movement I do just about whatever I want. (NO RUNNING for it will wear out the knee and will have to do surgery again)

I still doing sparring, kicking, wrestling/bjj. The rehab exercises are designed to strengthen the knee and legs as well as relearning its proprioception.

Thanks Danny. This is the kind of information I have been looking for.
Would you say your knees are more stable or at leas as stable as they were before your surgery? Do you understand how the implants take the place of the ligaments? I am having a hard time wrapping my head around that one.

 

[Danny T]

Thanks Danny. This is the kind of information I have been looking for.
Would you say your knees are more stable or at leas as stable as they were before your surgery? Do you understand how the implants take the place of the ligaments? I am having a hard time wrapping my head around that one.

In my case both of my knees have a 'post and cam' that takes the place of the PCL and the ACL. This stabilizes the knee and prevents it from being hyperextended but also prevents the knee from bending as much as a normal knee. The MCL and LCL were retained and work as normal to keep the joint stable side to side.

 

[dvcochran]

In my case both of my knees have a 'post and cam' that takes the place of the PCL and the ACL. This stabilizes the knee and prevents it from being hyperextended but also prevents the knee from bending as much as a normal knee. The MCL and LCL were retained and work as normal to keep the joint stable side to side.

Do you ever worry about breaking off the little post? I have a mental image of getting a kick jammed and snapping it off.
I think I understand the mechanics, it is positive stop in both directions. I was told I was loose the MCL and ACL. Do you know how the replacement hardware takes the place of side to side stability? There is a type of replacement where the PCL is saved, the name escapes me.
I have been putting this off the about 5 years so I am going to do my research and get at least one other doctors advise.

 

[JR 137]

I’d love to give some insight, but to be honest I have no idea what’s done for stabilizing ligaments. I asked while I was in the OR watching a knee replacement surgery, and was simply told “they dissect out.” The surgeon was pretty busy and in a zone, so I didn’t ask any follow up questions.

Knee musculature is pretty strong. The quads, hamstrings, and calf muscles (there are 2 of those) stabilize the knee pretty well. I wouldn’t be overly concerned about instability if you go through your full course of rehab and follow long term plans.

That’s easy to say for someone like me, simply because it’s not my knee I know plenty of MAists and people playing other stuff with knee and hip replacements. I’ve never heard any instability complaints. While it’s a healthy thing to scrutinize what’s going to be done to you, you shouldn’t dwell on it either. You don’t strike me as the type of guy who’ll go to any ‘ol hack for surgery and rehab. Trust your doc and therapist. Yet again, that’s easy for me to say

 

[dvcochran]

I’d love to give some insight, but to be honest I have no idea what’s done for stabilizing ligaments. I asked while I was in the OR watching a knee replacement surgery, and was simply told “they dissect out.” The surgeon was pretty busy and in a zone, so I didn’t ask any follow up questions.

Knee musculature is pretty strong. The quads, hamstrings, and calf muscles (there are 2 of those) stabilize the knee pretty well. I wouldn’t be overly concerned about instability if you go through your full course of rehab and follow long term plans.

That’s easy to say for someone like me, simply because it’s not my knee I know plenty of MAists and people playing other stuff with knee and hip replacements. I’ve never heard any instability complaints. While it’s a healthy thing to scrutinize what’s going to be done to you, you shouldn’t dwell on it either. You don’t strike me as the type of guy who’ll go to any ‘ol hack for surgery and rehab. Trust your doc and therapist. Yet again, that’s easy for me to say

My primary Ortho is a sports medicine doctor. He scoped the right knee after my Olympic run but that has been 33 years ago so maybe I need to have to conversation to make sure he doesn't think I am just the older, broken guy looking for purely pain relief. I do plan to get a 2nd opinion.
It is difficult for someone, like me, who is uninformed to understand the procedures. Just the terminology is a challenge sometimes. Any help with What to ask in regards to the kind of replacement sans loss of ligature would be much appreciated.

 

[Danny T]

Do you ever worry about breaking off the little post? I have a mental image of getting a kick jammed and snapping it off.
I think I understand the mechanics, it is positive stop in both directions. I was told I was loose the MCL and ACL. Do you know how the replacement hardware takes the place of side to side stability? There is a type of replacement where the PCL is saved, the name escapes me.
I have been putting this off the about 5 years so I am going to do my research and get at least one other doctors advise.

I have had any concerns. My surgeon told me I'm more likely to break the bone before damaging the joint. My understanding is the MCL maybe damaged or have to be disconnected with the surgery but is reattached and 'is not' remove. ??? But then I'm not apprised to all the different types of replacements.

 

[JR 137]

My primary Ortho is a sports medicine doctor. He scoped the right knee after my Olympic run but that has been 33 years ago so maybe I need to have to conversation to make sure he doesn't think I am just the older, broken guy looking for purely pain relief. I do plan to get a 2nd opinion.
It is difficult for someone, like me, who is uninformed to understand the procedures. Just the terminology is a challenge sometimes. Any help with What to ask in regards to the kind of replacement sans loss of ligature would be much appreciated.

Make sure you let him know what you want to do physically - work, recreation, running around with little ones, etc. What work involves, recreation involves, how many hours, etc. Those factors may or may not determine which specific procedure you get.

Questions:
What should I be doing before surgery? The better you go in, the better you come out.

Why don’t you leave the ligaments intact/repair them? What are the advantages and disadvantages?

If no ligaments are left, what about instability? Are my chances of injury greater, the same, or less than if the ligaments were there?

Do you do any other knee replacements where ligaments are left alone? If not, why not?

Surgeons are very data driven. They keep track of successes and failures. They want to know why a specific procedure is failing, and they want to use procedures they’ve had the most success with. And what’s proven more successful to one doc may not be as successful for another. They also typically like using specific rehab people because they’re happy with their post-op success rate. The good orthos I’ve been around have worked that way, anyway. If your doc is using something specific, it’s most likely because that’s what his data has told him works best for him.