knee surgery.

[Twizzle1962]

Hi I had my 2nd ablation last May and I’m Happy to say all seems ok. I’ve been waiting for knee replacement surgery for over a year now. It seems the anaesthetic teams are so worried to touch me stating it’s because I had an ablation last year. I would be having it done under epidural so I’m not being put under. Finally been referred to another hospital who are going to do the op as long as enhanced bed is provided. Is this normal when you have Af that having ops etc takes so much time. Has anyone had a knee replacement and it’s all been ok? Thanks

[CDreamer]

Surgeons are always very nervous about any heart arrhythmias so always tend to take advice and make risk assessments with the anaesthetist and cardiologists, rather pleased they do!

I’ve not had knee surgery but am about to have facial surgery and gone through a similar risk assessment and cannot have GA anyway for other reasons but I know at least 2 people who have been through this and come out the other side. I gather it is complex operating on knees and if I were you, I would ask if I could take a device into the operating room to listen to music or an audible book so I could distract myself - just a thought.

Good luck.

[Twizzle1962 in reply to CDreamer]

Thanks for the advice I will certainly be listening to my audio book. Good luck to you too.

[BobD Volunteer]

I think it depends on the anaesthatist and surgical team whether they are prepared to go ahead. I had radical prostatectomy (a four hour pluss job) for cancer in 2011 since my third ablation in 2008 had stopped my AF. The team did tell me that without that they would not have been prepared to operate so I was lucky since they discovered things were far worse than they knew. Without it I would likely not be here as they were able to remove other areas followed by radiotherapy and hormone implants. etc etc. .

[Twizzle62 in reply to BobD]

Thank god you got your op done. Best wishes x

[Jalia]

I had hip replacement 2 years ago (self funded) which was rescheduled as anaesthetist was not prepared to go ahead before I had an echo and consultation with cardiologist ( more ££££s....). This was promptly arranged , all OK and instructions given to anaesthetist should I go into AF during procedure. I had 4th. ablation just 6 months previously. There were no problems. I had spinal anaesthesia and completely unaware as I had requested !

More recently, last year I was about to be booked for knee replacement but as I was waiting to see cardiologist for possible pacemaker they would not proceed until this was sorted. Then 5th ablation & LAAO happened 🙄.....pacemaker will be implanted in a few weeks . I will eventually get my TKR when I've got over that!!

The anaesthetist I had assured me that he was used to patients with AF and had spent a long time at Harefield hospital so was used to heart patients.

[Twizzle62 in reply to Jalia]

Having 5 ablations is a big deal , I truly hope you get your knee replacement soon. Wishing you all the best x

[BenHall1]

Hiya Twizzle1962,

I had a partial knee replacement in November 2015. Right knee, medial compartment. At that time I had been on Warfarin 5 years ( I'm still on it today at 15 years with the exception of a disasterous 6 months on Edoxaban, after which I returned to my old mate, Warfarin ).

The surgeon who was to do the job told me to stop Warfarin 6 days before surgery, which I did. Now here is the rub ............. I perform my own blood tests which is common with Warfarin - I self test my INR at home on my own personal Coaguchek device, with my own prescription test strips ....... no sweat !

When I was being prepped for surgery I had seperate visits from surgeon and anaesthetist and we discussed Warfarin and I was able to show them the Memory Function of my Coaguchek to prove to them - beyond doubt - how my INR had dropped over the 6 days and what it was the morning of surgery. Absolutely no problem. Surgery went ahead without a hitch ..... after I returned to my rooom nurses gave me a bridging anticoagulant (Fragmin) and that evening I returned to my normal dose of Warfarin .... no sweat thereafter.

I would conclude by saying that when first diagnosed with paroxysmal AF in January 2010 I rejected all notion of going the ablation route .... said I'd take the medication route, even if it meant meds for life. I'm 80 now and quite active, even managing long road trips ( just done a 700 mile round trip) by car. I have never had ablation.

[Ossie7]

Hello Twizzle , I have also had a medial compartment replaced in my L knee at age 53 when I had AF . It was controlled at the time by betablockers and I was in sinus rhythm thanks to my first cardioversion . I had spinal anaesthetic and no issues post op except low heart rate and BP on sit to stand . Im coming up to 60 in a few weeks snd have since had 3 ablations !

[Cat715]

Hi

I was listed for a total knee replacement shortly following paroxysmal AF diagnosis. On Rivaroxaban and Bisoprolol. Had an ECHO showing dilated left atrium.

The Orthopaedic consultant said that the anasthetist was used to coping with AF so no problem .

I had my TKR under epidural with no sedation. I did not go into AF at all during the operation.

During the operation, chatting to the anaesthetist (like you do) he said had I gone into AF he had an option to put me under a general anaesthetic.

It was back home recovering when my AF raised its ugly head. The pain started it as did straining on the loo ( opiates make you terribly constipated) apologies for tmi.

Hope all goes ok for you Twizzle1962.

[Twizzle62 in reply to Cat715]

Thanks very much fingers crossed and I hope you are doing well now x

[Belle11]

I had a knee replacement2 weeks ago under spinal block. It was done at the NHS hospital rather than being outsourced to the local private hospital as many are, so that if any complications arose, there would be cardiology advice/help available, but other than that it wasn't a special bed - just in the orthopedic ward. My other knee was done similarly 20 months ago. I haven't had an ablation, but have been in NSR each time, having had a couple of cardioversions. Each time I stayed in normal rhythm. I don't know what difference, if any, having had an ablation makes to risk.

I did opt not to have the steroid that's usually prescribed following knee surgery here, as my AF started after steroid injections in both knees 6 years ago.

[Qualipop]

Well, my mum had heart failure ( Not AF) from her 20s to her 60s and had a hip replacement at around 65 by epidural and was absolutely fine. I just had urology refuse to treat me last year ( needed deep sedation or GA ) because I'd just been in hospital with arrhythmia. It makes them nervous.

[CTblood]

I had TKR 9 weeks ago with epidural and sedation, it felt as though as I was asleep the whole time and then being woken and told the operation was over. I had my 6th cardioversion 4 weeks before to get me back into NSR, I had a steroid injection into my knee in September and that triggered AF. Good luck with your op.

[FraserB]

I've had a TKR last November. The anesthesiologist is your most important surgical team member and the one I had said he sees a lot of patients with AFl/AF and ablations who are undergoing TKR and knows what to do if it extremely rarely happens and ablation makes it even more rare. My doctor approved spinal anesthesia and not GA. Much better outcomes. You'll be surprised that its not the surgery or even the recovery but something as simple months later after surgery like forgetting to drink enough fluids (dehydration) or even emotional stress which you have control over.