I have a friend whose knees are pretty trashed. He’s been putting off a knee replacement for years, dealing with a lot of pain, because he’s convinced that getting a knee replacement will leave him unable to work at his job. He’s a general contractor, which involves a lot of bending, kneeling, climbing up and down ladders, and carrying stuff. As he is only 54 and an outdoorsy guy, he’s not ready to give up working and retire due to the disability he feels he will incur by getting new knees.
Well, would this be the case with him or not? Would new knees reduce his pain but leave him unable to work in his profession?
(Just a note - health insurance is not an issue, he’s covered, and has the resources to deal with co-pays, etc. He is also under the care of competent doctors. This is my curiousity, not any form of medical advice seeking)
The replacement parts are not the problem. The gamble is how well you will heal. My father only had one knee replacement. He healed up just fine, except for a residual pain. Phantom pain if you will. My step-mother had both of hers done, she loves them. She is not very active, although the doctor has given her hell for not walking the dogs with my Dad. Her movement in one knee is a little restricted though, because she got lazy with the exercises.
So if he decides to get em done, the first thing is to talk with the doctor and maybe talk to some people who have been through it.
One at a time will give you less immediate pain, but will extend the time you will be unable to work.
Just so I don’t scare anyone off, Dad’s pain while real, is mostly a nagging pain, not acute or sharp. It is always there, never gets worse, never gets better. Not debilitating though.
He just won’t get his other knee done unless its a," I have to deal."
This guy is already in constant, chronic pain from his knees, he’s had about 4 or 5 knee surgeries already, so he knows about pain and the necessity of rehab.
He IS a really active guy - I’ve seen him climb up and down 80 foot sailboat masts, bad knees and all. Not to mention up and down ladders all day, on his knees laying new floors, etc. I’m wondering if new knees will allow him to maintain his active lifestyle or if he really will be forced to cut back on his activities.
(I think one reason he’s putting this off is that he wants to be an Old Goat and he needs, I think, two more Chicago-Mackinac races to do that).
NY Times health columnist Jane Brody had both knees replaced simultaneously several years ago and has done articles over the years about the experience. The last follow-up is here: http://www.nytimes.com/2008/06/03/health/03brod.html?partner=rssnyt and contains links to the previous articles.
Her story is daunting – she was not adequately treated for pain post-surgery and her recovery took longer than she had been told. She had both knees done at the same time, which some doctors would not advocate (although others obviously do). Also, the linked article describes some of the inherent limitations of artificial knees. Still, the takeaway message is that she did heal and has resumed a very active lifestyle.
For your friend, the question is the same as it is for everyone facing a joint replacement: Is living with the level of pain you have now worth retaining those small advantages over the replacement? When the answer is “no” then it will be time to have the replacement. Having said that, a LOT of people wait too long and don’t handle the surgery/recovery as well as they would have if they’d done it earlier. Also, for a lot of people, when recovery is done they realize they wish they’d done it sooner.
The best thing he can do is visit several doctors and get a range of opinions. Look for doctors who have treated very active people and be very frank with them about needs and expectations.
My father-in-law had both his knees replaced. He’s an otherwise healthy guy about 62. I have been working on his boat with him and, at least for him, getting down on his knees is definitely out. Squatting down low is a slow careful process.
As is climbing ladders. Oh he can climb a ladder but very slowly and carefully, not well enough to be doing it on a regular basis as part of a construction job. And he has made the comment on more than one occation that the doc told him he has a limited number of falls on those knees and even one good hard fall could put him on a cane or in wheelchair.
Suggest that your friend talk to some people who have had it done.
Oh, he’s been to doctors and talked to people who have had knee replacements - this is me asking the question, not him (and not me asking on his behalf). I was just wondering if what he’d heard was accurate or not. Or if his lifestyle/profession really was that significant a factor. Apparently it is.
Over the past decade the strategy has been to try and keep his knees as functional as possible, in hopes that the replacement technology will improve. Well, it has improved, but not enough for him.
He’s not stupid - he knows that there will come a time he really has no choice about the matter if he wants to be able to walk at all. He can swallow bitter medicine, but you can’t blame him for putting it off until it really is necessary, can you?
If it’s worth anything, when I was at physical therapy (not knee related) a few weeks ago, one of the patients who has had several knee surgeries was asking my therapist about the recovery and therapy for knee replacement, and he said that they actually don’t see a lot of people for knee replacement. The initial post-surgery pain is quite bad, and there’s a lot of rehab in the hospital, but unless something goes wrong Bob said there’s not a lot of outpatient therapy.
I’m a mechanic, so I work with a lot of guys with bad knees. From what I’ve heard, the knees work pretty good but they dont last forever. If you get one after you retire hopefully it will last til you die. But lets say get one in your 50’s, mostly like youre gonna wear it out before you retire and have to get another one.
On the other, if you really need to get your knees replaced in your 50’s you might not able to work at hardly anything until you do so, so you’ll do it just to get to retirement. And a second knee replacement is feasible - my limited understanding is that when you get past #2 is when it gets problematic.
My husband has an artificial ankle that’s lasted over 30 years, so artificial joints can go for decades. On the other hand, he’ll be the first to detail the limitations of that artificial joint, which are considerable. On the other other hand, he also feels it was a much better option than having his lower leg amputated, which was the sole alternative. Sometimes you just have to make the best of a bad situation.
My mother had a replacement knee joint in this year. It’s apparently quite painful (although less so than her original knee) and you can hear it rattle as she walks. She’s been unable to work for decades anyway (she injured her back shortly after leaving university to work as a nurse, indeed the damage to her spine may be partially to blame, because of how it changed her gait) so I couldn’t say whether it would effect employment.
He might want to consider a partial knee replace. A doctor in our area does them. He has told us most doctors do a full replacement because they can and do make so much more money on those.
In a full knee replacement, they go in and do a shit load of chopping and cutting out of stuff. They only last so long. My understanding is even getting a second one is a somewhat iffy situation.
A partial is very minor surgery in comparision to a full knee replacement. Basically they make one or two tiny incisions (very important as this doesnt disturb the tendons or muscles nearly as much), go in and do just a little “grinding” on the surfaces that rub against each other, and put in some pretty small teflon and metal sufaces that rub against each other.
They litterally want you walking on it in a couple of days and in no time at all are having you do a few hours a rehab and walking every day. Much faster recovery time than full replacement.
My impression was this was more likely to work, less likely to go wrong, and still leaves you the option to get one or two FULL knee replacements afterwards, which is an important consideration if you are younger.
I’ll get the Doctors name if you are interested.
That has already been looked into and he has been told by more than one doctor that such a course is not appropriate in his case as the damage is across all surfaces of the joint. Or something of the sort. I don’t quiz him detail about these things but he has mentioned that he is not a candidate for a partial replacement.
It would be great if that were feasible, but apparently it’s not in his case.
IIRC there are two kinds of partial. One where they “retread” one side. One where they “retread” BOTH sides. And my understanding is that both of these are way different than a full where they basically take out the WHOLE joint and replace it with something artificial. My understanding is that redoing both sides “retreads” all the surfaces yet still keeps the vast majority of original bone matter intact.
Remind him that he has to be careful that the full replacement salesman may be reluctant to send him to somebody else
It was his usual surgeon that suggested the possibility of partial, then changed his mind subsequent to additional tests and study. I am not privy to all details of course, but I am reasonably sure the possibility truly has been looked into and truly been ruled out.
Too bad. Hope whatever he ends up doing works out for him. And, of course, there is always the chance some other random person here gets somthing outa these posts.
He’s still hoping to put off the surgery until there is yet more improvement in the knee replacements. It does look like, given the current state of affairs, if he has them replaced he will be out of job.
Which means he will be forced to liquidate his business.
Which means I will be out of a job. As will several other people.
