Hi Firstly thank you to everyone who has offered their support previously since I was diagnosed with AF last November.
Over the last few years I have been trying to hold off a total knee replacement. (TKR)
I was walking more to strengthen my muscles to support my knee and managed to ditch the brace and the crutch. I walked a mile every day for Dementia UK.
I was offered a TKR but decided to hold off as I had grandma duties and my daughter needed my help as there was no one else. My grandson started school full time and I was needed for some of the school runs and other days for sleepovers
Now my knee feels unstable again. I have the added problem of increased risks undergoing surgery with having AF.
I also don't want to let my daughter and grandson down but of course if my knee gets any worse I won't be able to help anyway.
So sensibly I need to seriously consider having a TKR. The question is, how safe is it to have this surgery with AF? ( My AF is paroxysmal. I take Rivaroxaban and Bisoprolol) I am 65.
Has anyone on this forum had this op?
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Cat715
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You need to discuss that with the surgery team as to whether or not they will take the job on. We have heard of people being refused by the anaesthetist when AF has been bad.
I had a TKR back in 2019 I had had a cardioversion in the July before I had the operation sow as in NSR while I had the op and for a few months afterwards. I had persistent AF at the time and now in permanent AF. I had to stop my Anticoagulants 3 days before and went back on half dose for a month to help with inflammation as couldn't take anti inflammatories. I had no problems and it is great to have my new knee working so well - I can even kneel down in the garden to weed - they say you won't be able to kneel down after wards but I did all the exercises religiously numerous times a day and managed to achieve that. I honestly wish I had not held out for so long before having the operation really I wasted a good few years of my life walking with a wheeled walker and in chronic pain - almost collapsing when I got out of the car on a few occasions as my knee wouldn't support me.
A friend of mine with PAF, now sadly deceased, had the operation years ago and also had no problems with the operation or afterwards.
You need to be sure that everyone involved knows of your PAF and medication and keep asking about medication and dosage with PAF. I was given oramorph as painkiller after wards and the big trick was to take that 20 mins before doing your exercises so that it has time to work and you can do the exercises - it can be very painful to start with.
You need to really discuss this with your orthopaedic team. Especially the anesthetist. I think I saw the anesthetist more times before the surgery than the surgeon.
Forgot to say I had my hip rplacement in 2010 (before AF) and the TKR in 2019 with an epidural and sedation so no problems with GA - I don't like GA anyway and usually have a bad reaction to most GA's. The recovery is much quicker from the epidural than the GA. For the Hip Replacement they gave me music through head phones as well but i must have been dozing off most of the time because I remember absolutely nothing of the Op or the music!
Well done!It's good to hear from someone who realised the importance of doing the exercises, did them religiously and is reaping the benefits.
So many people give up and find they have no improvement after the knee replacement, and some are worse off than before.
My mother-in-law was in her 80s when she had the op and was always exercising -'I have to bend it 90°' she'd say. She was determined and could dance again afterwards.
A lot of total knee replacements these days are done with an epidural, so no need for a general anaesthetic. I am sure you could have light sedation if you were anxious. It’s worth having a conversation with a surgeon about.
Having said that, I had a partial nephrectomy, which was a four hour op, with general anaesthetic. My cardiologist told me to take extra Bisoprolol for 5 days prior to my surgery. No problems at all. It is definitely doable either way. You need to talk to your medics.
Thank you Mrsvemb. I could cope with an epidural and no problem watching the operation. Its just the thoughts of hoingbinto AF or clotting if they stop my anticoagulants pre-op.
They often give you a different anti clotting injection for the operation. I remember having the injection in my stomach for the Hip replacement but not the knee op I just remember them talking about it. Probably because I took one extra apixaban after they had told me to stop so they waited a few hours over the time I should have had the operation and did the patient who should have been after me before me so had my op at about 5 or 6 when should have been having it at 3 so things were confusing! The worst bit was that they didn't give me my half dose apixaban tablets to take home - it was a Saturday morning and our local pharmacy closes Saturday afternoon. My wife had to rush up there and try and get tablets but they didn't have the correct dosage so the pharmacist spent a while cutting a load of tablets in half until we could get back to the hospital! Such fun!
Not strictly on topic .... close enough though ! I had a partial knee replacement in November 2015 under general anesthetic .... long time ago, times change and so do approaches to recovery. 3 days in hospital and back at work about 9 weeks later.
What I did do though, in addition to my regular exercises ..... was to go to a sports injury massage therapist and get the area around my scar line really massaged - and also -massage right along the scar line. This was to ensure that scar tissue didn't form, had it done so, exercises would have been very difficult, if not, virtually impossible. AND YOU MUST DO THE EXERCISES .......... NO EXCUSES !!!
I had years earlier been diagnosed with paroxysmal AF but on the day of surgery was not in AF. My anticoagulant at the time (still is ) was Warfarin which I had to stop 6 days before the op.
Post op I was returned to my room and later nurses administered two doses of Fragmin, a bridging anticoagulant. Later that evening I returned to Warfarin ... no sweat. Oh yeah, at the time I was also on 5mg Bisoprolol - but that had no bearing on events at all.
Hello Cat715, I was due to have a TKR and went into AF during the night before op. Arrived at hospital in AF and surgical team sent me home and it wouldn’t be considered until my heart had been sorted. Had Ablation in February and will discuss op when I have my follow up next week. Wishing you all the best
I was in the same situation for two years. I tried cortisone shots and “gel” shots with minimal relief. My knee became unstable and was “locking” so I decided to have the surgery.
I was diagnosed with paroxysmal AF in May of 2010.
I had the TKR on March 25, 2024. I’m on Sotalol and Eliquis for afib along with blood pressure meds. I have done well with the recovery. Physical therapy is intense but I go in person 2x weekly, an hour each session, plus completing assigned exercises at home.
My leg is still swollen, but the surgeon says swelling often persists for months. Generally he has his patients take anti inflammatory meds , but I cannot due to the anticoagulant.
Yes very similar circumstances.I was on the journey with PAF management and had a TKR six months prior to an RF ablation.
Both surgeons exchanged notes and were all on the same page.
My only comment is the worse thing about the ablation was trying to keep my right leg still while the catheter wound initially healed. It was a RTKR very good result but six months is still fresh in recovery. So after three hours of immobility the pain was opioid worthy intervention.
The irony of wearing your knees out keeping fit only to have your heart kark it!
Hi Cat I had a total knee replacement two years ago aged 73. I didn’t have any problems with AF. I’m on the same medication as you. I’m waiting for a new hip and knee on other side. I’m not keen to have them done but what is the alternative (pain) I walk every day to keep going but I know I must make the decision. I paid privately for my knee but told the consultant out of choice I wouldn’t want to pay next time. Hope everything goes well for you Take care x
Thankyou. Yes hope you manage to get the help you need too.My sister in law paid privately for a TKR but she did not receive as much help pre or post op in terms of OT and physio as she might have done on NHS.
Morning , I had a half knee replacement with AF , but I was not in persistent AF at the time of the surgery, which was done under spinal . I had a great outcome too .
I had hip replacement surgery in August 22 I too have paroxamal AF I stopped dabigatron 48 hours before op. I was given epidural and sedation for the op, following the op I was put onto injectable anti coagulants for 10 days. No AF throughout. Do all your exercises no matter how painful. Now like you I am struggling with my left knee but walking and gardening as much a possible and regular physio to help me hold off as long as possible.
For what its worth I too was putting off knee replacement surgery (albeit for a different reason) though having eventually having had a partial knee replacement surgery under GA 2 months ago, best decision I made. (Had ablation 6 months prior to that for PAF) Providing of course surgery team and you are happy to go ahead. But factor in recovery time while you exercise & come back stronger!
Hi - I had TKR 10 years ago. I had not been diagnosed with AF at the time but had been experiencing the ‘now all too familiar’ weird feelings that my GP diagnosed and treated as indigestion! So, unknowingly to all concerned I had my op with AF. The AF diagnosis came when I saw a private cardiologist 9 months post TKR.
Lots of others have given you advice already. All I will add is that although I had a GA - it was only just enough to keep me under and quiet, the main player was a nerve block from the waist down. However, I know of many who had it done while conscious.
Everyone’s time frame for TKR recovery is different, but doing the exercises is vital to a good outcome and you will get through ridiculous amounts of ice. A vast number are unable to kneel after recovery (it feels very bony and hard) - but a cushion will do the trick.
I joined an online forum for hip and knee replacement patients worldwide and it was a real help. A bit like this forum, lots of folk with personal tips and advice. I made some very good online friends. I can remember everyone’s delight when I posted a photo of my bright red toenails the first time I had managed to paint them again! They had a pre-op area and a post-op one. With hindsight it amazed me that lots of people there mentioned having AF.
Your knee will only get steadily worse and more painful. Get yourself well prepared in advance and go for it!
Thanks ibuputih.Funnily enough I did wonder about painting my toe nails 😄
Also on the forum a lot of people talk about waiting til its worse, which I have been doing maimly so that I can still help with my grandson but now worry that my knee will cease up as it does sometimes or my leg will give way when I am caring for him. Also worry that my AF may become persistent if I wait too long.
Yes, I had a TKR last September, it has been a bit of a long recovery but absolutely no problems with AF. I’m now waiting to have the other one done. I had the last of 4 ablations 5 years ago and I only take Rivaroxaban which I had to stop a couple of days before the op. Good luck x
I had a TKR September 2022, and it was my best decision to go ahead with it, the recovery pain is hard enough but well worth it in the end. I also suffer AF like yours and of course it’s natural to worry about surgical procedures without the additional AF burden on top magnifying the worry.
The surgical team will look after you and provide anti-coagulant cover as needed, they have experience with patients who have heart problems and will select the best course to suit your needs in respect of GA or epidural.
At some point you just must trust them with your care during and after the procedure.
Make sure you do the exercises and don’t skimp on the Physio, and I am sure you will feel the benefit of having it done.
Hello, I have A fib too. Had TKR 4 years ago at the age of 82. No problems at all, you will be closely monitored by the Anaesthetist. Just make sure you do your exercises afterwards, so important to the success of the op. My very best wishes to you
Yes I had TKR one and a half years ago and I did not have any issues. I worried about my AFib, but the cardiologist was positive about it being all right and it was. At the time I was on Flecanide and Toprol. When I finished physical therapy and was able to walk on a stable knee again, I was so grateful. Best wishes.
You don't necessarily need a general anaesthetic. My mum had heart failure and had a hip replacement by epidural. You need to discuss it with the anaesthetist and surgeon. GO ahead with the referral anyway.The waiting times are very long. My husband has been on the list for 10 y ears now and keeps refusing it unless it gets worse. He sees the surgeon once a year
Back in 2018 my Husband underwent a TKR ….30 hours later he had a seizure because nobody told him NOT to take his Candesarten before the Op ..Candesarten causes your potassium to crash the whole episode gave him AF for the very first time …. He is now on Edoxaban for life … so please look into this
Ooh so sorry to hear this 51-1-64. What a terrible thing to happen to uour husband. You must have been worried sick! And now he is left with AF. I feel for him.
Had TKR Sept 2023 aged 73 surgical team said Epidural and Sedation would be safest. Was not awake at any time during 2 1/2 hrs surgery and woke up without the drowsiness associated with general anaesthetic . I too have AF and didn't have any problems. Stay in hospital is usually 2 days depending on what time of day you have the operation. Always take the morphine when offered and follow physio advice even when it is sometimes uncomfortable. Surgery is usually 1 1/2 hrs but I had an unstable knee cap. Hope this helps, I live in Wales and staff were brilliant.
Thanks Cat715 for posting your question. You asked the question I would about TKR surgery because I'm currently on a TKR waitlist and also have paroxysmal AFL. One minute I'll be glad to get it done, the next minute I'm also terrified. It's being informed and asking questions that helps. Great responses by those who've been there.
I am 71, I had a successful ablation for AF in early 2023 followed by a successful total knee replacement op on my right knee in October 2023. 6 months later I feel great. I take Apixaban for the AF which means I cannot take ibuprufen for pain. Following the knee op, I was in a lot of pain for about 4 weeks and I was put on Cocodamol and also morphine to treat the pain. There is no reason why you cannot have a TKR if you have AF......
I had a total knee replacement 11 months ago. At the time I was in remission from AF, and had been in NSR for 3 1/2 years. It was standard practice at the hospital to give a steroid injection in the knee as part of the procedure but as my persistent AF had started within 2 days of steroid injections in both knees, I opted not to have the injection. and my heart stayed in normal rhythm.
The TKR was done under spinal block rather than GA, and the consultant seemed very unbothered about my AF diagnosis. The only special precaution was that it was done at the NHS main hospital with access to cardiology should it have been needed rather than being outsourced to the local private hospital which does many joint replacements at present. I'm much more mobile since getting a new knee.
Definitely sounds worth discussing with your doctors. Good luck making a decision.
Thanks Belle. I was wondering myself if I should have the op in a hospital instead of a privare hospital ( even on nhs you can have an op in a private hospital) and also expect that the therapies post op would be more available in a main hospital. Must be nice having your own ensuite in a private room though.
The people I kknow who've had their knees done at a private hospital had it done on the NHS. Not sure if they got private en suites! Though that may be the only accommodation available there - must be nice indeed
I have had three (first one was done wrong) without any AF problems
Have had two ablations and now get the odd AF when the body is stressed
Didn’t have any AF during stays in hospital and only issue was swelling in the knee and ankles as the AF medications meant no anti inflammatory meds so took longer to heal
Did have an AF attack when in hospital with a nosebleed exacerbated by rivaroxaban but reverted after a pill in pocket of flecanide
The anaesthetist wouldn’t sanction having both knees done at once because of length of op in view of AF but now I am glad I didn’t go down that path
Had a TKR under general anaesthetic in 2015, now on list for other knee, 70 week wait in my area. Developed PAF in meantime so will ask for epidural, I find general anaesthetic makes me so sick anyway but it is the exercises that are so important post op. My knee isn’t as painful as it has been but getting very weak and giving way. Get the surgery done when you can. You won’t regret it. Take care 🦊x
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