KNEE SURGERY

[AuntyJean15]

Hello all, just had a call from my Hospital informing me that my total knee replacement surgery is in 2 WEEKSAs I have Lymphoedema in both legs - left leg is worse. Surgery is on right knee. I have been told the leg will be tightly dressed from ankle to groin to try and avoid me having an ulcerated leg.

I'm very impressed and feel confident with my Surgeon but, as you can imagine, I'm now feeling anxious about it all.

I'm reaching out to anyone who has had this surgery for any advice you can offer.

One dilemma I'm faced with is that I've now got a gum disease and have loose teeth - mainly the front top 4.

I will be speaking to the main man, The Anesthetist, in a couple of days.

I'm thinking about a spinal block instead of General Anaesthetic because I might not have the tube in my mouth so teeth might be ok.

Anybody got any advice please.

[lovesradio]

Firstly let's celebrate this great news but I also acknowledge your anxiety. Think LSN website might have info on preparing for surgery on affected limb, or if not there are a good few posts and replies on this forum with hints, tips and updates post surgery.

[AuntyJean15 in reply to lovesradio]

Many thanks. I'll start searching 🤗

[Lynora]

I don’t have lower limb l/e (very mild arm l/e after breast cancer) but have had a right side TKR in 2017. I am a retired lymphoedema therapist and over the years saw many clients who had successful joint replacements - hips/knees. Once the surgical teams are aware of other health problems, they seem to take them into account.

I did not have compression bandaging other than a TDS sock on my left leg. Unless you already have an ulcer on your replacement leg, then question the need for bandaging. Usually they encourage use of the new joint within hours - under supervision.

The hospital where I was treated rarely use general anaesthetic for knees. Your anaesthetist may decide intubation is not advisable, due to your dental probs. I had a spinal block and mild sedation, and was able to watch what they were doing on a small screen - most people want total sensory deprivation, but I found it fascinating! Good luck - it’s life enhancing stuff!

[AuntyJean15 in reply to Lynora]

Thankyou, I will discuss alternatives to General Anaesthetic.Had my pre op today, should also have been speaking with Anaesthetist but that was cancelled!

After discussing the teeth and other issues, she is speaking to the Anaesthetist on Monday and trying to fit me in before my op.

Much better than a last minute discussion ie 1 hour before surgery. 😊

[Whitesugar]

General anaesthetic is not the norm for joint replacements. I’ve had two joints done and had spinal blocks both times.

[AuntyJean15 in reply to Whitesugar]

I've heard nothing but positive regarding spinal blocks.Personally, I don't do very well after General Anaesthetic, never been offered an alternative so I am going to discuss this with the Anaesthetist.

Enjoy your day 😊

[kHP22]

I have bilateral leg lymphoedema . I had a total knee replacement in 2019 on my largest lymphoedema leg and I never had any bandaging and there was no mention of ulcers . I used a juzo soft black wrap on my calf whilst I was immobile which I could just adjust myself to feel comfortable . I had a spinal block for the operation and I was very nervous but it was fine and the wound healed well . It took me longer to heal than normal as I had to do the excercises very carefully but it’s now got very good movement . I asked the surgeon to give me extra antibiotics for after the surgery to help to reduce the risk of infection . They also gave me an ice pack from the hospital to use on the knee .

[AuntyJean15 in reply to kHP22]

Thankyou. I was thinking about antibiotics. I will definitely ask my surgeon.

I'm nervous but not as nervous as I was about having a General and losing some of my loose teeth.

Good idea about the wrap, don't fancy trying mess with my compressions for a few days.

I'm so very grateful for the info, advice and support I'm receiving from people.

[Microsurgeon]

Suggest pointing your surgeon to the BLS Cellulitis Guidelines. They may be aware but many aren't. Look at section '3.5. Patients undergoing surgical procedures such as knee replacement or carpal tunnel surgery on the lymphoedematous region should receive a therapeutic course of antibiotics commenced before surgery (oral or iv as appropriate) as described previously (see points 1.2.2 or 1.2.3) or as indicated by the procedure.'

thebls.com/public/uploads/d...

A 'therapeutic course' is different from the normal 'prophylactic dose' that they give at the time of the operation. You are at a higher risk than the normal population of a post op wound infection and if you get an infected knee replacement that is a significant problem for you. The discussion of wound infection and prosthetic joint infection consequences should be important part of your consent process.

I suggest trying to reduce the fluid in your leg with compression and elevation for a few days before the procedure (using what ever works for you) so it is in as good a condition as possible immediately pre op to give you the best chance of good wound healing. Expect your knee to me more swollen post op as is normal after a TKR so your normal compression may not fit. Wraps and elevation are an option post op. Good luck. In the long term, if you get more mobility in the leg as pain reduces then that is normally good for lymphoedema so a TKR maybe beneficial for the lymphoedema if your mobility is reduced by pain at the moment.

Hope it all goes well.

BTW - Spinal anaesthetics are excellent and I would have one for a TKR.

[AuntyJean15 in reply to Microsurgeon]

This is fabulous! Thankyou so much. I will email this to him if that is ok with you. 😊

[Lynora]

How are you AuntyJean?

[AuntyJean15 in reply to Lynora]

How lovely of you to ask.My surgery was cancelled!

I have been told I will be have my operation ASAP and I won't need another pre op. Fingers crossed and staying positive.

I'm just a bit bothered at the moment because on the same day as my cancellation, I started with really bad pain on the right side of my stomach and a really severe pain in my right rib area.

I saw a out of hours GP who sent me to A&E with a diagnosis of possible gall stones and I may have a perforation.

I saw a Consultant and was prescribed Coamoxiclav and Codiene Phosphate.

She sent me home and said I was to return straight away if I started to be sick or anything else occured. This was purely because there were no beds and pt's were in beds in A&E. She arranged for me to have scans.

The situation now is - I stopped taking the pain relief as soon as the level of pain was capable. My scans were clear and I've finished the antibiotics.

I'm supposed to get in touch with my GP if I have concerns and he/she will be recieved a letter from the A&E Consultant.

My concern is the pain in the rib area is still there, it is bearable but it's stronger when I take a deep breath .

I haven't hurt myself in any way so no idea.

Being a Cancer patient with 2 years left of being under the watchful eye of The Christie, I'm trying to stay positive and level headed but it's a bit difficult.

This is the first time I've disclosed my thoughts and feelings.

Has anybody been in this position?

Thankyou 😊