AF and knee surgery

[Lakky12]

Hello! I wonder if anyone can help… it looks like I need a knee replacement, and as I have AF I know the procedure would be done with a spinal block rather than general anaesthetic. However, I just wondered if anyone has experience of AF and knee surgery, and if so any advice/information would be much appreciated. Thanks ….

[Jalia]

I havent had knee replacement but i had hip replacement 7 months ago with spinal block. I understand that spinal block is normally the way to go whether or not you have AF. ( I'll also need knee replacement but I'm holding off as long as i can!)

Before i had the op the anaesthetist wanted me to have an echo and cardiologist report. He gave instructions on procedure to follow should i go into AF during surgery. As it happens it all went trouble free.( I had had my 4th ablation about 6 months prior to all this.)

If you are taking anticoagulants you will be given instructions on your dosage by the surgeons team.

Good luck when the day comes !

[Lakky12 in reply to Jalia]

that’s really useful, thank you so much. I did think I’d make an appointment to see my cardiologist, to talk it through with him. But hopefully there will be a plan already in place whereby the orthopaedic team liaises with him. Thanks again!

[Hidden]

G'day,

In a hurry as I'm going to work shortly ...... BUT ........... as a patient your only input for surgery is your health, how often you are in AF, your meds, especially anticoagulants - and getting this across to surgeon and anaesthetist. I had right knee medial compartment done in Nov 2015. No sweat ! After that its up to your medical team.

HOWEVER - what you need to address very very seriously is your approach to exercises and your lifestyle for the first 8 weeks or so Post Op. Thats where the drama comes in. If you don't get all this right and scar tissue problems occur your future walking will be affected, long after surgery. Do suggest you read up on scar tissue and look at YouTube short videos on knee replacement exercises. It'll give you a great idea of whats ahead.

I'll reply tonight in more detail on my experiences.

John

[Lakky12 in reply to Hidden]

really appreciate your reply. I hadn’t thought of YouTube - more research to be done!

[Hidden in reply to Lakky12]

Lakky,

Back again. I tend to be a bit dismissive of the surgical side of things, Consultants .... each unto there own and they'll tell you what they want and you can of course tell them. After I returned to my room and came round ( I had a GA - surgeons choice not mine - but hell my knee was so badly, incredibly painful I'd have let the devil incarnate operate if thats what it came to) and the nurses came and gave me two Fragmin ( a bridging anticoagulant) injections into my tummy area, then later that night I returned to my regular dose of warfarin. No sweat, No strokes. At no time did my AF make its ugly appearance. Job done - sorted !

Recovery - a horse of a totally different colour. I found it incredibly difficult to stand on crutches and simultaneously take the top off a bottle of beer. When you are discharged you'll be given a booklet of exercises you need to do. I found it good but I found the same exercises better illustrated on YouTube. ( A video is worth a 1000 words). Not much you can do in the first 10 days or so as you'll still be wrapped up , however, once dressings are removed and you are cleared of infection then is the time to really go for it in terms of exercises. In addition to all the normal stuff I was given courtesy of NHS ( bear in mind the NHS of 2015 was much more efficent than the NHS we know today) I elected to follow through with my sports injury massage therapist who proceeded with intensive massage right on the scar line and the surrounding area. This is to prevent scar tissue taking over and crippling you. There are plenty of testimonys around of the impact of scar tissue winning the battle. I just cannot emphasize enough the importance of exercises etc in preventing scar tissue. In terms of a time line ............ 10 days and dressings were removed .. exercises as instructed supported by You tube and Massage .., keep as mobile as possible with crutches and follow instructions on their use. About 21 days you'll need to return to hospital for a review. I was back driving my manual car at 8 weeks and back driving my bus at 11 weeks. Probably could have done it 2 weeks quicker but Christmas 2015 intervened and surgeon wasn't around to sign me off as fit to return to work and drive a bus.

Depending on your personal domestic arrangements you will need to seriously look at personal stuff like seats for a shower, doubt you'd be able to get in and out of a bath, also raised toilet seats etc. and how you are gonna self cater and cook in the kitchen. if you are on your own this becomes a major issue to consider ... comes back to the problems I mentioned of uncapping a bottle of beer or uncorking wine on crutches. 😂😂

Oh yes ..... and do keep up your prescribed dose of pain killers ......... they play their part in enabling the exercises to be user friendly, and if you don't get good quality relief bang on your GP's desk and ask for (demand) something stronger. I was in hospital and operated on as a NHS patient in a private hospital and was home in 3 days.

I have not read all the other posts but hope this helps a bit for you. Good luck ... may the force be with you.

John

[Lakky12 in reply to Hidden]

Wow! Thanks for your really detailed reply. I actually went to a seminar at the local private hospital given by one of the knee surgeons there. I was shocked to say the least when he said he didn't believe in a regime of exercises after a knee replacement - he was of the opinion it was better to just use the knee naturally. I have never heard of anyone say the same - before or since! I'll definitely have a look at Youtube. the other point the surgeon made was that he didn't believe in a general anaesthetic for the majority of people, yet a few of the lovely replies I've had have indicated a general rather than a spinal block. But as you say, it's no doubt a surgeon thing! From hour reply I can see I need to ensure I have support afterwards - uncorking wine will be of great importance! Thanks again for your replies, and I hope your knee has remained trouble free.

[Hidden in reply to Lakky12]

Knee absolutely fine ... no post op issues at all even to this day, almost 7 years down the track.

[Jalia in reply to Lakky12]

Re the spinal block, i must say that when i had this for my hip replacememt i was completely sedated and totally unaware of the procedure. I woke without the grogginess (?) following a GA and the advantage of having painkillers already in the system . It really is the way to go.

[Nan1]

Morning Lakky. I’m due to have a total knee replacement at the end of October. My AF is not too well controlled so I am concerned about that. I won’t know until the morning of the op whether it’s spinal block or GA. They are even suggesting if all goes well I will be home the same day as op! I’ve started to do a few exercises every day to prepare myself for what lies ahead. Good luck with your journey

[Lakky12 in reply to Nan1]

Hi, and thanks very much for your reply. Hopefully your consultant will be in touch with the cardiology team to make sure you are looked after in the best possible way. Interesting that you’re already doing some exercises - I’ll certainly look into that. Good luck with your operation - really hope it goes well!

[Maggimunro]

well quite unexpectedly I am having an arthroscopy this Thursday and probable menisectomy.

We are in France on holiday and On Tuesday I moved my chair sideways to avoid the sun in my face. I felt the tear in my knee and sudden awful pain. We went down tothe local clinic and I am booked in for surgery tomorrow.

I’m dizzy with the speed of it all.

I was told on Tuesday to stop taking my Apixiban and the nurse has been tothe house to give me heparin injections . The last one is this morning, when she will also do a Covid test. The anaesthetist knows I have Afib and that I can’t tolerate an anaesthetic with adrenaline. Apparently it is to be via a general anaesthetic. I wanted an epidural but apparently there is a real risk of a spinal haematoma for patients who have been on anticoagulants and their protocol would have demanded that I wait several more days if I insisted on an epidural.

My head is spinning withthe speed and efficiency of it all. What an amazing health system there is in France. However I do have to pay for it but hopefully either my travel insurance or my GHIC card will cover it.

[Lakky12 in reply to Maggimunro]

Hi Maggimunro - wow, what a shock for you! The last thing you expected while being on holiday. This forum is so useful - I’d never heard of the spinal haematoma risk so that’s something I will be asking questions about. Really hope all goes well tomorrow - good luck!

[Maggimunro in reply to Lakky12]

and all the best to you too

[Lakky12 in reply to Maggimunro]

thanks very much

[Nan1 in reply to Maggimunro]

wishing you well

[Auriculaire in reply to Maggimunro]

I think you will find the bill to be less than if you had private surgery in the UK! I am always surprised at how little the bill is for consultants here. I have been seeing my cardiologist since 2011 and his consultation fee has hardly gone up at all.

[Maggimunro in reply to Auriculaire]

true. I saw the cardiologist yesterday for a preop check up and had an echocardiogram, ECG etc. the bill was only €170. Amazing really.

[Jalia in reply to Maggimunro]

i paid £600 just for that in UK earlier in the year !

[irene75359 in reply to Maggimunro]

Just a thought - it might be a good idea to keep your insurance company in the loop, it may be written in their terms and conditions. Hope all goes well on Thursday.

[Maggimunro in reply to irene75359]

yes I have done that but because I had sprained that knee a couple of years ago I doubt they will cover me. I didn’t have any treatment because the MRI showed nothing untoward.

Also, the clinic I will be in is part of a private group, so despite it being the nearest accident and emergency department and strictly no frills, I doubt they will cough up. Fortunately my GHIC card covers 80% of the costs.

This has turned out to be an expensive holiday since someone punctured/ damaged two tyres so we have had to replace all four!

[irene75359 in reply to Maggimunro]

Unfortunately insurance companies will do anything to wriggle out of paying. But good that you are covered by your GHIC card. Sorry about all the expense you are having; not a holiday you'll forget in a hurry!

[Ppiman]

I read online about this only very recently as I might need some surgery eventually. I think the risk of embolism does increase but the surgeons are all geared up to deal with anti-coagulated patients.

Steve

[Lakky12 in reply to Ppiman]

Thanks for this - yes you'd hope so but I wonder if the standard pre-op procedures for those of us with any heart problems vary from one part of the country to another. If you also end up having surgery, I hope it goes well.

[Ppiman in reply to Lakky12]

Thanks. You too. It’s no fun being on anticoagulants though when it comes to this kind of thing.

Steve

[Lakky12 in reply to Ppiman]

I totally agree!

[Jalia in reply to Ppiman]

They certainly are on the ball.I had to see a haemotologist and stop my Warfarin 5 days prior and then bridged with Fragmin after the op until my INR was in range.

[Ppiman in reply to Jalia]

Let's look on the bright side - we maybe end up with better overall care because of it.

Steve

[Patient007]

I had partial knee replacement last November. I had a spinal block. Didnt have any problems with my AF

[Lakky12 in reply to Patient007]

That's good to hear - glad it was a success and you didn't encounter any problems afterwards. Hope your knee is much improved!

[Patient007 in reply to Lakky12]

thanks 😀

[Patient007 in reply to Lakky12]

I thought i would add that i paid for my knee replacement in Private Hospital but will be having my other one there with NHS. If was a problem they transfer you to main hospital usually not far away.

[sueallen]

I also have AF & am waiting for knee surgery, I know that I can’t have this surgery anywhere other than an NHS hospital so there is the availability of a Cardiologist if needed. I have have other surgery & was given general anaesthetic

[Lakky12 in reply to sueallen]

Thanks for the reply - are you saying you can't have it done in a private hospital? That might be my way forward but I'd hope that the cardiology team there would be on hand if needed. Something else for me to check - thank you!

[Ppiman in reply to Lakky12]

i seriously doubt private hospitals do other than rush patients off pronto to the nearest NHS hospital if need be.

I may be wrong!

Steve

[Jalia in reply to Ppiman]

I was booked in at a private hospital ( self funding) for my hip replacement on a Saturday but anaesthetist wouldnt agree to a weekend procedure in case of problems.....

[Ppiman in reply to Jalia]

The NHS operates at a minimum level at weekends, too. Mind you, doctors and staff are currently working their socks off to catch up with the covid backlog.

Steve

[Blutink]

Hi

I have had AFIB for about 16 years and last year had to have a full hip replacement, I was supposed to have a spinal block but my veins kept collapsing. After about six attempts to get a cannula in, they eventually used an infant’s cannula. The same thing happened with the spinal block, after several attempts. The surgeon started to prep me for surgery and I was still in pain so they knocked me out. I had full general anaesthetic and came round fairly quickly afterwards. My bp was a little low but after a couple of pints of water I was fine.

[Lakky12 in reply to Blutink]

You've really been through the mill then! Glad to know it all came right in the end. I am learning so much from everyone's replies - all really useful info!

[SuziElley]

Trust in your anaesthetist. I had knee replacement under spinal two years ago. I’d recently had an echocardiogram and ecg plus all bloods so he had everything to hand. If you’re at all worried then talk to both him and your surgeon.

[Lakky12 in reply to SuziElley]

Thanks for this - I think I've already decided that if necessary I'll make a private appointment to see the cardiologist before any surgery if this isn't something that would be arranged. Just shows how crucial a good anaesthetist is!

[Roo62]

Hi, I have paroxysmal AF and have had both my knees replaced, a year apart, the first one 5 years ago at 55. The spinal block was fine, didn't feel a thing and my AF didn't kick in during or after my ops. I wore headphones and played my favourite music to block out the hammering and sawing sounds! Be prepared for the pain in the first few days but this can be managed really well with meds and doing your exercises. Despite what you might be told you can keep increasing your knee mobility even after you have finished your physio, mine kept improving over two years. Scarring can be an issue, mine aren't pretty and I tried everything I could to improve them, but my 80 year old aunt has lovely, thin faint scars and did nothing, so it could just be the luck of the draw, though I had staples and she had stiches, not sure if that made a difference. I had to wear compressions stockings, she didn't! I found it to be quite a traumatic experience and at times wondered whether you have done the right thing, but I can honestly say it was so worth it. I have my life back and am pain free! Good luck 🤗

[Lakky12 in reply to Roo62]

Thanks so much for your reply - great to hear you have had two successful ops. I've lived with the pain for literally years but by left knee has suddenly deteriorated so need to have something done. A friend of mine showed me her scar - it was scarcely visible - I was expecting a thick line! To be honest I won't care if I end up with a noticeable scar - as long as the op works - that's the main thing!

[Lakky12]

That's brilliant news - I think I'd need my music up very loud to drown out the noises!

[Jalia in reply to Lakky12]

Whether you want to be awake or not is up to you! I said i wanted to be completely out of it...didnt want to hear any hammering or sawing 🤔😅😱

[Bob002]

I am in permanent and had a total knee replace 3 months ago right knee, will have the left knee replace next week. They used a spinal block and general and had no problems and know pain. You doctor will evaluate the risk, dont worry

[Lakky12 in reply to Bob002]

Thanks for your reply - glad your op went well, reassuring to know that the general anaesthetic didn't cause any problems. Good luck with the other knee!

[Desanthony]

Yes, I had a total knee replacement at end of August 2019. One of the best things I ever did. No problems with operation a little blip with recovery. Make sure you tell everyone that you are on anticoagulants so that they can advise you on when to stop and start taking them again. I made a mistake and was supposed to come off 36 hours before but took an extra so had to wait in the hospital while others had their operations ahead of me until the surgeon felt it was OK - ended up getting my operation at about 6pm. Worst thing about that was that I was incredibly hungry. They gave me double portions of the dinner that night. All I can tell you is to do your excercises as often as you can and then again. Take your pain killers about 20 mins before doing your exercises so that they will be working when you do the exercises. The importance of doing these exercises cannot be stressed enough. Unfortunately, possibly because I have always healed quickly - even when on anticoagulants - (my wife is amazed as a graze from the garden for her may take a couple of week or more to heal whereas I am fully healed within days - and I'm a lot older) So, back to the recovery I basically healed too quickly and didn't get the amount of movement I should have had back within the first 3 months so had a quick procedure called MUA (manipulation under anaesthetic) and since then haven't looked back and seem to have as much movement as I always had and can even kneel down in the garden - something I had thought I would not be able to do again. I think for about a month after the operation I took half the dose of anticoagulants and then back up to full dose prescribed. I was really lucky and had my op and MUA just before Covid and went to physio every week and then every 10 days up until around 6 months just when Covid was rearing it's ugly head. I went back into persistant AF in the October following the operation after having my second successful cardioversion in the February that year.

Advice: Take all your painkilling tablets prescribed on time. Do your exercises about 20 mins after taking your painkillers so that the painkillers have time to kick in and do your exercises as often as possible even when sitting in your chair watching TV - some you can even do in bed before you get up - unless like me you have to rush to the lavatory first thing on waking . Go to physiotherapy and do the exercises they advise at home frequently through out the day - sometimes it is better to do just 5 repeats of the exercises more often than 10 or 20 repeats which tire you out, especially at the beginning.

Hope all goes well for you.

[Lakky12 in reply to Desanthony]

thanks very much for your excellent advice. Really good tip taking painkillers before exercise - I’ll definitely remember to do that. I hope I’ll be able to kneel again, I certainly can’t at the moment. So glad your op was a real success!

[Desanthony]

Good Luck!