Scheduled for total knee replacement on left knee. 74 yrs old. On Eliquis. Metropolol only taken when out of rhythm. Just this year my episodes increasing and not converting as quickly. Had my first cardioversion last month. Also t2diabetic, sleep apnea (stable) .Really concerned about having the Knee replacement surgery with afib and other complications that ensue. Considering an ablation first and then knee surgery later next year. Any insights/experiences most apprciated.
Knee surgery or cardiac ablation first - Atrial Fibrillati...
Knee surgery or cardiac ablation first
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rangerboy
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Which affects your day to day life more?
Speaking purely hyperthetically my thinking would go something like this:- knee surgery will require a GA and there is a risk that will undo any benefit I would get from ablation so makes sense to do the knee surgery first and during recovery time really work on getting fit and getting full control of diabetes (if possible reverse the diabetes) and sleep apnea as they will jeopardise success of ablation. Knee surgery takes at least 6 weeks for first recovery and 6 months for rehab and complete recuperation so that you can walk well and without any pain.
HOWEVER in the UK - you may not have the choice so talk to both your doctors and ask what they think. Lots of variables to think about as well - What is your weight and are you fit enough for surgery? What is your CHADs score? Presumably at least 2. What is your age and general health - all will be factors. Also it will ultimately depend if the Anaesthetist is willing to do knee surgery with a history of AF, some are more cautious and competent than others but it is a common enough condition so should be able to find one if your AF is not that symptomatic and you are considered otherwise fit enough.
Doctors look at me and shy away, I’m far too complicated so I pray I will never need knee surgery and keep working on my physio to make sure!
Other countries may work differently.
Ty for your insights. My weight is 190 (6ft1 ish) .. In US.. Getting TKR largely because can't take meds.. bone on bone both knees, gait impacted pain level maxes out at 4/10 so far and everyone says it can progress negatively very quickly and I will never be this young (74) again nor likely in generally good health with chronic conditions being managed. Most things dont get better with age... EP doc thinks I should get the ablation sooner than later and knee doc thinks I should be ok if i get surgery first. So no clear consensus. Thought Heart should take precedence over an elective knee surgery but did not think it could undo the ablation. I just thought getting the ablation first would put an extra layer of protection against knee complications.
So I remain very muddled as to what to do. Heard Pulse Field ablation should be available in US later next year but was told existing methods are just as good. So way may questions than answers.
I would do heart first, recovery from knee replacement can be brutal, you need everything in you favor before. I have had bone on bone for 14 years, pain varies from 4-10,. I have been taking Osteo Biflex supplement which I think has kept me mobile, no way will I do a replacement, they don't all turn out great.
BobDVolunteer
Different circumstances but about two years after my third ablation I was diagnosed with prostate cancer. I said I wanted it removed rather than have radiotherapy but they did not want to operate due to my AF. Once I convinced them I no longer had AF they did agree and that saved my life as they discovered that it had already spread so were able to remove extra areas and then I also had 33 sessions of radiotherapy(22 broad focus and 11 tight focus) and three years of hormone treatment. That was twelve years ago and no sign of cancer in my six monthly checks.
I also need new knees but whilst I can sleep at night I will not elect for surgery.
TY for this response... Happy to hear of your good outcome. I know everyone is different but your surgery did not undo the successful ablation and invite afib back in your life?
Hi rangerboy,
Not gonna comment on your meds or other medical conditions. Just gonna comment on my knee replacement experience …. perhaps a bit of a different take on things.
I was 71 in Nov 2015 when I had a right knee medial compartment knee replacement. At that time I was still in and out of AF (paroxysmal) and elected for the medication for life route ! For me that was Warfarin (Coumadin) and Bisoprolol – plus my normal package of BP medication plus Simvastatin. Didn't do the Cardioversion and Ablation route at all - my choice.
So, knee op ! For me I had to come off Warfarin for 6 days before surgery … surgery, on the slab for about 3 hours ( or thereabouts I think) – knee sorted. Back in my room I was given a bridging anticoagulant of Fragmin ( 2 injections into the tummy ), then that night I returned to Warfarin at my normal dose. No sweat ! I was in hospital for 3 days then home. And that’s where your mental health/stamina comes in. Exercises, exercises and exercises …. until you are in tears. Oh ! I forgot … pain too. Pain. I did make a full disclosure of exactly the course my AF took and neither seemed phased by the challenge - I disclosed everything about it including medication even family history. In the post Op period pain control ... and a very effective one at that - will be critical. As I was on Warfarin I could only take CoCodomol 30/500 as a pain control medication and it was very effective.
On discharge from hospital I was given a diagramatic sheet showing the exercises I need to do, 4 or 5 times a day. However, thanks to the digital world of YouTube, I found short videos of these exercises which helped heaps. I also consulted a Sports Injury Massage Therapist who, once my incision wound had healed and I was infection free began intensive massage of the incision line and surrounding area. I carried on doing this myself in due course over the ensuing weeks. The critical thing here is to keep the soft tissue area around the knee supple. Your healthcare professional should be able to recommend a course of action for you - and there is much to consider if advised properly, too much for me to go into here.
At 8 weeks I was back driving my car and at 11 weeks back driving a bus and living the dream once again. No problems at all during post op recovery and post op life in general – even up to today. The key to it all is the exercises ….. never let up on them. If you do the post op knee replacement recovery work correct you should have no problems thereafter.
Good luck to you in whatever approach you decide.
John
Thank you for sharing your positive knee surgery experiences and tips. Wish I could get clarity on whether to do the knee replacement or the ablation 1st!. If my afib episodes weren't getting more frequent and didn't involve the latest cardioversion, i would have stayed on track with the surgery. I don't want it to be a fear driven decision, but the significant complications of an afibber getting knee surgery are definitely getting the best of me. It just seems like I'm still confused about what to do, just on a higher level.
Hi, I've read over CDreamers post, her 2nd and 3rd paragraphs. If you have already got contact with the Orthopaedic surgeon and Anaethetist who would do the knee job I would go back to them and lay it on the line .... would they do the job or not. These days (compared to 2015 when I was done) knee surgery is much advanced to the extent that they can do knee jobs under local anethestic ... my sister had hers done like this and she could hear all the work going on and music too. Most knee surgery these days sees the patient in and out of hospital in 3 days. I went in on Friday morning early, On the slab, under the knife by early afternoon and doing my first range of exercises in early evening. Discharged home on Monday morning. - even though I did have a GA. At the 21 day mark I had all dressings removed and cleared of all/any infection. So this maybe another approach to consider. The other aspect is the amount of pain you are experiencing from the knee at the moment. I was desperate in the end for any way out of pain from the arthritic ridden knee.
My thought is go for the knee surgery under local anaesthetic. Another consideration ( and I apologise in advance for throwing in another curved ball ) is that intense pain as in an arthritic knee possibly has the opportunity of undoing all the good work your cardiac surgeon may have done if you go that route first. Pain ( and the stress it generates ) and AF are not good bedfellows in the normal run of things. My question to your cardiac guy would be ... " if I have the cardiac work done before the knee and the knee pain increases to any level .... what impact would this have on the success of the ablation.
I'll stick my head on the chopping block ..... go for the knee surgery first - notwithstanding all my comments earlier of post op exercises. As you recover from the knee op and do your exercises and get your life back your pain levels will reduce and cease. That I would have thought give your ablation a better chance of success. Do the ablation first and you still have to progress through a life of increasing pain until it is appropriate to have the knee done.
Just sayin', that's all.
John
On waiting list for right knee replacement, left done 5 yes ago. Waiting ablation but need to lose more weight for that. On edoxaban for PAFand semaglutide for diabetes, with weight loss benefits. I was given option of general or spinal anaesthetic for left knee, had general with no complications but will go spinal this time as I feel so groggy for ages after with a general. The pain from bone on bone has a negative bio/psycho/social affect on my life, the heart fluttering and racing when it kicks off is an ‘inconvenience’ that I can cope with and deal with. I know which I’d chose first, the knee surgery, although I did liken it to childbirth, in as much, you need to get over it and forget it before you do it again! I hope you can soon have both behind her snd wish you well. Take care 🦊x
If you're doing spinal make sure you tell the anaesthesiologist that you don't want to see, hear or smell anything. I remember nothing of my hip replacement.
I'd do knee replacement first. I had my hip replacement and developed afib from the inflammation post surgery in my opinion. There will be lots of inflammation post knee surgery for you, that's perfectly normal. But afib loves inflammation and personally I'd be concerned that the inflammation would kick off the afib after your ablation. Pain also raises the heart rate and that could kick off afib episodes. I'd be inclined to do the knee first and the ablation second to give the ablation a better chance of holding. Just my opinion. No medical training. Just gut instinct. Loads of research on google scholar about afib and inflammation.
Read that 30% of people do get NEW onset afib after TKR. So since I'm already prone, didn't want it to present before the surgery since i would be off my Eliquis, at which time I'd have to cancel the surgery, NOR afterwards when I was dealing with all the pain and immobility of the knee surgery especially since I would not want to have to go to the er and have a cardioversion since my episiodes are more atypical aflutter where my bpm's stay stuck over 150 and the meds lower my BP to 80/60 hence the risk of falls.
Why would you have to cancel your surgery off the elequis if you had an episode. I think you need to have a chat with EP and anaesthesiologist to see what their thoughts are. My episodes were always 180+ and beta blockers caused pauses in my ECG. Ah, I see where you're coming from. They could do a tee before cardioversion, they should probably do that anyway. I'd still be inclined to think the massive inflammation post surgery wouldn't be good for the ablation. A very thorough chat with medical team is required.
I understand full well what is going through your mind, I am 65 slightly younger than yourself I have had my right knee and hip replaced and due my left hip replacement soon. I have diabetes 2, sleep apnea and Pernicious Anaemia, I had a cryo ablation last Christmas which has not been successful and awaiting another ablation. I am choosing my hip replacement first providing they do not offer before ablation, this decision is I want to come off morphine Sr tablets 120mg per day this amount and the pain in my situation which is why I would choose to have my hip carried out first. As other comments have mentioned which is causing you the most problems!
sorry the ablation did not take and that your pain level is so high that morphine is indicated. . Heard that sometimes two ablations are necessary. diabetes is bad enough to manage let alone intense pain!
Thanks for your reply only been on the morphine for 10 years another reason to want my hip done before the next ablation, been told if this one is not successful he wants to give me a pacemaker, as long as my heart gives me some relief and my hip replacement reduces the pain I will be over the moon
Just to add my thoughts to the mix - I had my total knee replacement done before I had been diagnosed with AF. (At the time my GP was treating the weird feelings I was getting as indigestion and the AF didn’t make an appearance at pre op checks) So I had my TKR with undiagnosed and untreated AF. My ablation was done exactly a year afterwards.
For the TKR I had a spinal block and ‘light’ GA to keep me still and quiet. Fragmin anti coag afterwards that I self injected for 2 weeks. Post surgery I only took paracetamol for a short time.
If I had been faced with the decision you describe, with my AF a brand new and concerning condition - I would have sought advice, but I think my gut feeling would have been to fix the heart first, in spite of the dire state of and pain in my knee. Nowadays - should I need the other knee done and my AF gets worse needing a further ablation - I think I’d get the knee done before the ablation. This forum has helped to make me far more at ease with the AF.
As another has already said, plenty of knees are replaced under local anaesthetic - so that may be a route worth discussing with your ortho.
You will be up and walking 24 hours after surgery ( I was in the hydro pool after 48 hrs) and I was walking well at 6 weeks post op. It’s a major op and you have to put in the hard graft exercising to get results, but once the ‘carpentry’ has been done it’s just post op recovery and getting used to the new joint.
With hindsight I found it fascinating that on the knee and hip forum that I subscribed to at the time, there were a noticeable number that had AF.
Whatever order you decide for your ops - best wishes for successful outcomes.
Good afternoon
I have AF (DCM) and I had a total knee replacement in January this year.
My consultant had a meeting with the anaesthetist beforehand and they decided between them that I would have a spinal block.
All went well. Recovery was very painful and it took a good 8 weeks for me to feel human again.
I am due to have the other knee done around December and I assume another spinal block will be the method of anaesthesia.
I was mildly sedated of course, but did wake up half way through. I heard the buzzing of the drill and saw the surgeons beside me, they topped up my sedation very quickly.
Whatever you decide I hope it all goes well for you.
Carol
OMG... One of my many Worst fears is being even 1% aware during the surgery. and then to hear * weeks of pain. Cant take NSAID (allergic and on eliquis) No steroids (diabetic) and Opiods (make me vomit and trigger Afib), but then again so does all the pain and inflammation. Now I Am more concerned that ice and Tylenol will not be up for the task
Can I ask what opioids? Codeine gives me gastritis. Tramadol gives me a full body itch. Can't take NSAIDs, Xarelto. But I can take oxy norm and oxy contin and palexia. A good pain doctor will sort you out. There are also patches and pain relief injections. Do your homework before because pain relief is essential to be able to do the exercises. Though usually the exercise pain isn't as bad as the bone on bone pain. The anaesthesiologist might have some suggestions for you. Lyrica is another drug they try, it did help with the pain but I had double vision with it and therefore wasn't allowed out of bed on the evening of first hip replacement.
We are all very different and recovery time varies. You may be ok to have a general anaesthetic. I think they were just airing on the side of caution because of my DCM.
You may feel fine after surgery and breeze through. I was on various medications after.
Oxycodone being the main one. My AF wasn’t affected by any of the painkillers.
My apologies if I’ve alarmed you in any way. I was just telling you my story and how they looked after me so well before, during and after.
They will do what’s best for you and I’m sure you’ll be pain free after surgery.
Hi, from your post, I assume you are in and out of ablation and have periods of NSR. So why is your EP suggesting and ablation now. You will need adequate cardiac function to recover from knee replacement surgery but does that require an ablation prior to the knee work? Knees first, recover and then ablation if afib becomes more persistent or more nearly permanent. Best.
Correctionj:" in and out of afib".
Regards
Yes, Have been in and out of afib/flutter maybe 2 episodes a month that usually corrected with beta blocker. Last one did not and required cardioversion. EP said ablation sooner than later since episodes were increasing and better outcomes achieved now instead progressing to persistent/permanent status. I am so confused.
I would definitely have the knee replacement before the ablation. The recovery can be brutal and cause high heart rate which can put you into AF and undo the benefit of the ablation. I had sedation and local anaesthetic for my replacement not GA and had the same for my hip replacement as I have a reaction to most GA's so wherever possible I avoid them so am glad that local and sedation is becoming increasingly available . I had a cardioversion my second, with amiodorone about 2 months before my knee replacement but it was the shortest lasting cardioversion at 5 months where my other cardioversions lasted 13 and 15 months and I am sure the recovery from the knee op didn't help with the AF.
Hi all... in keeping with my EP recommendation... knee surgery on hold for now. Thinking was to address the heart issues first to include trying a daily 25 metropolol (instead of using it as PIP when an episode presents) and also to give consideration to doing advanced cardiac testing (a ccta to see if any blockages could be contributing to the afib episiodes and an EP mapping CT to see what this revealed) EP contended that knee surgery would not undue effects of the the ablation and since I also have Aflutter, ablation of this area tends to be more successful that just AFIB, thus potentially eliminating one area of cardiac concern when knee is done. Now considering a consult at the Cleveland Clinic in Ohio. If anyone has done this and can provide any direction/ tips on how to accomplish it.. pls lmk. Too long to drive (esp given winter is fast approaching) so flights and hotel stays also need to be factored in. TY
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