knee replacement

[Rosebud1027]

I see my liver doctor again in January and if all goes well I’ll have knee replacement surgery in Feb.

it’s taken me awhile to decide because I was worried about the impact post op that anesthesia and pain meds might have on my liver. My lab numbers have remain within normal range for the past 2 years but I still am considered F3. The liver doctor encourages me to go ahead saying “you are the healthiest now then you will ever be “ 🤷🏼

The orthopedist will replace the knee under local anesthesia and propanol neither of which I’m told go through the liver.

My question is has anyone had a knee replacement or any surgery requiring pain meds and if so what pain meds have you used to get through the 2 weeks after surgery?

[Alterity]

I have had back surgery, both hips and both hands have had surgery while in stage 4 NASH. Just make sure to ask for pain meds that go through the kidneys and not your liver or as my dr. says both, rotate the pain meds. You don't want the kidneys to get weak too. Get both Aleve which goes through the kidneys and Tylenol which goes through the liver for pain and alternate them. Get lots of rest, don't over due. The liver works best at rest. Most of my surgeries were 5-7 years ago and I've not seen a change and I've been in stage 4 for 22 years that I know of. Good luck, don't worry, that causes stress.

[Rosebud1027 in reply to Alterity]

Thanks so much for this. I feel more positive about moving forward. I can’t wait to be able to walk pain free again!

[ThyroidDeb]

Although I have heard knee replacement is more painfull. I had hip replacement few years back and just had trigger finger surgery 3 weeks ago and on October 10th I am having eyelid and brow lift. I took one prescription pain med after hip replacement, while in rehab I took regular Tylenol only when needed. With the trigger finger surgery I took just regular tylenol once, the night I came home, although I was given tylenol with codine. I had general with hip replacement and local with finger as I will have local with the eye surgery. No problems with my liver numbers. Good luck.

[Rosebud1027 in reply to ThyroidDeb]

Thx Deb!

[Ilovejoe]

Hi, I had total knee replacement in July. I took oxycodone for a week at the most. I took (1) 500 mg of Tylenol the first week. Luckily I have a high tolerance to pain and for 2 1/2years since diagnosis I never took any pain medicine. My doctor was great and surgery was assisted robotically. I was under like you will be and I was home in less than 12;hours. My hepatologist said no more than 2000 mg of Tylenol a day for a while but I didn’t need it. I bet you’ll be ok too. The physical therapy didn’t bother me either but don’t let them push you to a point where you’re hurting so much you’ll need many Tylenols! Good luck to you. It’s not easy but it’s worth it in the long run (so they say)! I am 11 weeks and I still have pain if I over due it! Good luck!

[Rosebud1027 in reply to Ilovejoe]

thx I too have a strong tolerance for pain and have had both hip and knee replacements so I know what I’m in for but that was 16 years ago before liver disease. It’s good to hear that the meds didn’t impact your liver. After I posted my question I checked some common painkillers used after surgery at ncbi.nlm.nih.gov/books/NBK5... for liver toxicity and it seems many don’t have harmful effects on liver if used as directed. Tylenol however as you mentioned needs to be used cautiously. My gastroenterologist also said no more than 2000 mg of Tylenol/day.

I’m feeling some much better about this surgery after everyone’s responses and am looking forward to taking walks without pain next spring!

[Stewarpa]

I am currently considered F3 NASH. I had a full knee replacement May 10th. I had probably waited a little too long to have surgery. My muscles and tendons had a lot of “aching” pain because they probably had more damage they were recovering from. I used same anesthesia which also included a spinal block. I only took pain meds for 5 days due to other complications they give me, with headaches and itching not being my only problems. So I quit taking them and moved to just Tylenol and Tramadol. Honestly the Tramadol didn’t do much if anything and after taking it for 5 weeks, I developed an extreme sensitivity of my skin in the “other” leg that was not operated on. So I dropped that medication and in 3 days the sensitivity was completely gone. So don’t recommend Tramadol. Probably 8 weeks in, I went back to my muscle relaxer because my PT left me with leg cramps during the evening following each session. I recommend you just switch out to just muscle relaxers and Tylenol 5 days out. You will have some strong discomfort from the aching of the bones, but that gets better after about 3-4 weeks. And everyone is different. Some people do not have as tough a time as I did. I did PT 3 times a week for 4 months and it is critical to keep it up. It’s a tough surgery but I am ready to do my next one when it’s needed, probably 7 years from now. I am 68 years old and my liver doctor had no concerns about me having the surgery. In fact it was critical to get me back to a level where I can excercise effectively as that is so important for liver health. Good luck and stick to your PT, it is life changing.

[Rosebud1027 in reply to Stewarpa]

Thx for your response & recommendations. Being able to exercise is the main reason I’m doing it. I am at F3 NASH as well but 75. I used Tramadol after I had a reaction to OxyContin then I had my first knee replaced and I agree it helped make the pain only slightly bearable and I didn’t have any reactions like you but that was Pre- liver diagnosis.

[Rosebud1027]

hi I’m post op a little over 2 weeks from my TKR. Had extreme bruising on my leg with a bilirubin bordering at the very highest level of normal but liver enzymes remained in normal range at post op lab results. I’ve weaned off Tramadol and am taking sometimes up to 2000 mg Tylenol/day. The pain is slightly bearable with icing helping but am very achy in my calf and thigh. I’ve used lidocaine cream on these parts with a little relief. Starting outpatient PT next week and know what I’m in for. I’d like to minimize my Tylenol by mouth and wonder if a Tylenol cream is a better option with less liver impact. I’m also thinking about ibuprofen cream to help with soreness. Any thoughts?

[Alterity]

I have been in Stage 4 for 23 years. 8 years ago I had back surgery, I did fine as far as liver, 7 years ago I had both hips replaced so within 1.2 years I had 3 major surgeries. All went well. Don't worry, eat right during this time to remove less stress from the liver. rest and enjoy your new knees. I would not wait another year in pain, get it done now.

[Rosebud1027 in reply to Alterity]

I didn’t wait / it was done and now looking forward to taking our mini poodle out for long walks this spring! Glad to hear your surgeries went well.

[Stewarpa]

just wanted to give you an update on my status post TKR now almost 10 months. It was a tough recovery but so worth it! I have spent last 2 weeks working in my yard, bending and moving freely! I also am doing Pilates with very close to full mobility in my knee and walked full 18 holes of golf last week. I am a different person. Hang in there, the pain and work is well worth the results. I go in next month for updated MRE, so hoping there will be at least no degradation and hopeful improvement. Hang in there as right now I know it’s tough. But hard work over the next 4-5 months will pay off in long run. Keep PT for as long as you can go.

[Rosebud1027 in reply to Stewarpa]

Thanks for update and so pleased for you. I’m progressing and am off the opioids relying solely on 2000mg of Tylenol/ day and ice. It been 3 weeks now and have begun OP PT. Because I can’t dose any higher for pain the PT agreed we will take it slow. It’s a balance and just hoping the Tylenol isn’t having a big impact on liver. I’m getting bloodwork done in 10 days to check liver function. I don’t have an MRI scheduled until July though. I keep focused on being able to move pain free soon so I can exercise more. 😊