Ms. Napier, 72, had first one and then the other knee replaced. Her pre-surgery knees were pretty much equal. The first replacement went great. The second, now 1.5 years out, is still more painful than pre-surgery. Her kneecap is displaced outward (laterally away from her centerline) an inch or so and doesn’t track on the groove of her now artificial femur end. She’s still doing PT, and for some months they’ve been tightly taping her knee to push the kneecap inward, which improves her pain. She’s had several X-rays and an MRI. She needs a cane and railings and often assistance to get up or down stairs and curbs. We’re still using handicapped parking with temporary tags which they just renewed for another 6 months. I think practically we have to do something to make it easier for her to get into and out of our house. Overall, she has significant disability and needs a lot of assistance for various aspects of living.
I went with her for her most recent visit to the surgeon’s office, this time with his assistant. They had been focusing on getting the kneecap to track properly but now say they don’t think that’s the problem. This time, they said there could possibly be an infection, which may show up on a blood test, so let’s get a blood test, but this is pretty unlikely to yield anything helpful. They also said there could be some problematic process going on in the bone, which may show up in a bone scan, so let’s do that, but this is also pretty unlikely to yield anything helpful. If neither of these yields anything helpful, we could consider another surgery, just to explore. But they cautioned that this is also pretty unlikely to yield anything helpful and could cause its own problems, so may be ill advised.
Then they said that about 5% of knee replacement patients “are never happy” with the result, and we should consider that this may be the case here. I found this phrasing noteworthy. They didn’t say 5% of replacements don’t work, or never stop hurting, or fail, or need revision. They said the patients “are never happy”.
I’m trying to gage what I should be pushing for. I think we should be trying a different surgeon, and should have some time ago. Especially, I think the current surgeon is shifting to a strategy of blowing her off. Our daughter has also been pushing for trying a different surgeon, but Ms. Napier doesn’t want to, she wants to give up.
Regardless of any problems with the current surgeon & follow-up, you may well discover that finding a surgeon willing to attempt “warrantee repair work” on someone else’s handiwork is difficult. I know of couple of cases (not knees) where they got a bad surgical outcome for whatever reason, and nobody else would go near attempting a repair. They’d consult, and run tests, and whatnot, but when it came to “Will you cut into this and fix this?” the answer was always “No. Too risky.”
Separately, while I agree that “not happy” was an off-putting choice of words, I’d be real cautious about reading too much into that choice. People aren’t speechwriters and don’t speak with full awareness of the implications of each word they use. Be nice if that was true(er). But it isn’t.
This. To me this phrasing implies that some of their patients have expectations that they will have results that are not realistic, such as having knees that feel like they did when they were 20. Some physicians are just not very good at conveying such things (or they could be assuming that a particular patient with complaints falls into that category even if they don’t).
If Ms. Napier were my patient, I would recommend against another surgery for purposes of “just to explore”. That would most likely be the worst course of action among those you listed, including worse than “just giving up”. Those other tests, even if they don’t show anything specific, are probably the best way to start. It also wouldn’t hurt to get a second opinion, even if it isn’t for purposes of a second surgery.
My surgeon told me that he had never had bad results. When I had a bad result, he believed that I was making it up.
My doctor told me that all doctors have bad results. If they haven’t had bad results, either they are a beginner with no experience, or deluded.
My surgeon was, apparently, very good, apart from being deluded, and the outcome, although bad, was in the range of expected outcomes. In my range of expected outcomes: I didn’t go in believing him.
I would certainly get a second opinion. Being deluded doesn’t help form an objective opinion. But I wouldn’t go in expecting a different recommendation. I’d be more worried about the delusion that a surgeon could fix everything by further surgery.
I vote for a new doctor. I can’t think of any rational reason not to, even if they only confirm what you’ve already been told.
But also: Washington Post just ran an article about some alternatives to knee surgery that may offer some pain relief, albeit less than a successful knee replacement. Perhaps one of these could help with her quality of life.
Absolute bias from things I’ve been reading lately: male doctor, female patient who is “never happy”. Hello, misogyny!
Obviously you and Ms. know more about the situation and this particular doctor to determine whether this is a factor, but the downplaying of women’s pain, and describing them as hysterical, exaggerating, “psychological”, never happy, etc is a very real thing.
Get a second opinion. Your wife has experienced this surgery on both knees, she knows which one feels “fixed” (within whatever limitations it still has) and which one doesn’t. She knows her pain, but she may have spent a lifetime being told it isn’t real (not by you, just by life and society in general).
A friend of my parents got a hip replacement and after several months, was no where near what she expected in terms of mobility and pain. After several consultations (no idea if a different doctor was involved), she ended up getting surgery done again, this time with much better results. She was mid-70s when she had the first surgery done.
I recommend to explore all the options. 72 is young to be so restricted.
Seconded. Ms. Napier can “give up” at any point – but before even getting another opinion is probably too early given the serious pain & mobility problems she’s experiencing.
Yes, it’s time to “give up” on banging your head against a medical practice that can’t / won’t address your real problems.
No, it’s far too early to give up on ever having a pain-free life and normal walking ability.
Those are two very different things and the OP’s wife seems to be making the error of combining them. Which is easy and common when someone is a) getting the runaround, and b) is in pain.
I have a problem with one foot with is sometimes bad enough to reduce my mobility, and other times i just ignore low-level pain. The first doctor i went to clearly felt like an older woman didn’t actually need to walk, much. (It first acted up when i climbed the Eiffel tower. He said, “but it was worth it”. No, a lifetime of reduced mobility was definitely not worth one hike up the Eiffel tower.) So I saw a guy who does sports medicine, and who was onboard when i said, “my goal is to maximize my lifetime use of my foot, I’m not too concerned about minimizing pain.”, he got it. But after looking at it, he basically said that there wasn’t much i could do beyond the PT i was already doing. But, you know, at least he understood that it mattered.
But having seen a doctor who i believe tried, i feel better about my having tried. (And the PT has been helping more than i expected.) And it’s entirely possible that the surgery didn’t work for some reason that can be fixed, like the joint not fitting right, or an infection.
I wouldn’t give up without a second opinion. And find the best doctor you can fit that second opinion. Recognizing that the doctor who is skillful at actually doing surgery and the doctor who is really good at diagnosis might be different people.
Agreed. These surgeries are a goldmine for the docs, and I’m sure yours doesn’t want to have to do one for free. But they’re putting bandaids on a gaping chest wound here.
But, you know, at least he understood that it mattered.