DH may need knee surgery

justbreathe2 · February 16

My 78 year old DH with MCI has been getting injections in his knee for several years. The injections have not given him much relief lately. He had meniscus tear repair 5 years ago and he feels it was not completely healed. He was very active guy and difficult to keep him down while healing.

Has anyone LO been through this kind of surgery? We have not discussed with doctor yet.

I like to get him out with me, but he tires just walking around the grocery store. He likes walking dog and also wearing on him.

Have not encouraged surgery because not sure how difficult it will be for him…or me caring for him. Appreciate any advice.

Denise1847 · February 16

Hi JustBreathe2,

My husband was 72 and in stage 4 at the time of his total knee replacement. He did ok, but he had a difficult time in the hospital with disorientation. He would try to get out of bed, tried pulling out his IV and brought me to tears because I couldn't manage his behaviors. I had to get the nurses to settle him down. He did ok with PT. He has no pain now. Anesthesia can have an effect on a person with Alzheimer's with a possibility of advancing it, according to our internist.

M1 · February 16

it's tough surgery (I have had both knees and both hips done), but can have very good results. They can probably do one knee under a spinal anesthetic and a local block, which would spare him most of the effects of general anesthesia. But it's a tough go, and the post-op therapy is pretty important to getting the function back. they usually require participation in a pre-op education class, which you would probably have to do with him.

Quilting brings calm · February 16

I just had a knee replacement in December. It was spinal anesthesia ( I was not awake) with a 12 hour pain block shot in my thigh afterwards. Home by late afternoon.

I did have a pre operating class to attend where they discussed things before and after surgery, Can he follow instructions? I had to sleep on my back with my leg extended straight out for weeks. I had Hydrocodone and Tranadol to take on a schedule, eventually replaced by Tylenol and Naproxen. I had to ice my knee multiple times a day. I had twice daily exercises to do at home beginning the day of surgery and twice weekly physical therapy sessions requiring me to go to the area rehab location. It’s been 10 weeks and I still have exercises to do every day and am still icing my knee once a day. Can he do all of that? It’s a must to have a decent outcome.

justbreathe2 · February 16

https://alzconnected.org/discussion/comment/198432#Comment_198432

Thank you Denise1847. This is my worry with Anesthesia and pain meds. With any previous procedures his anxiety is high.

justbreathe2 · February 16

https://alzconnected.org/discussion/comment/198435#Comment_198435

M1 thank you. I may speak with the doctor before I discuss further with my DH. He has not had another mri since the last surgery. The pre-op class not a problem and he liked the physical therapist with last surgery.

I heard knee surgery is more difficult than hip. Glad both were successful for you.

Since the increase in Aricept and taking Zoloft he is happier and wants to go often with me. A big change for him. Struggles and hard for him to keep up with me.

He has a bunion that is starting to bother him too.

justbreathe2 · February 16

https://alzconnected.org/discussion/comment/198438#Comment_198438

Quilting brings calm. Thank for your reply. He can follow instructions, but will have to be reminded often. Icing is important as I remember my rotator cuff tear surgery years ago.

A lot to think about. It may be just as difficult for me dealing with all of it. But I wouldn’t mind if it was successful and without a set back for him.

M1 · February 16

Yes, knee is much more painful than hip. Shouldn't need another MRI frankly, just a plain x-ray usually suffices so you won't have to worry about that. I hope he can have it, he'll feel much better. FWIW a lot of the injections they used to do are no longer recommended-steroid injections are still given sometimes but very temporary, and hyaluronic acid no longer recommended or covered by most insurance.

charley0419 · February 16

Just befor diagnosed wife had a knee from 12 yrs ago replaced again. You need to not miss PT and keep doing. My wife did PT but then this issue with things kind of kicked in and did less. My kids firmly believe that all the times wife has been under effects memory. CANT HELP

harshedbuzz · February 16

@justbreathe2

If it's a poorly healed meniscus tear, would that be an arthroscopic surgery or TKR. My ex and my mom both had torn their menisci and had repairs done. At the time, mom's surgeon reshaped some of the bone where arthritis was already causing pain. Mom had that knee replaced 15 years later. They're 2 very different procedures.

If he has MCI, and meets the criteria for the surgery, I'd be inclined to do it for the improved quality of life after. That said, in my own TKR I regretted the decision for the first 4 months because of my pain levels. I didn't have the pre-op class but had been doing PT for months trying to avoid surgery and the PT was really helpful in preparing. I did my exercises after religiously (I still do them a few times a week 5 years out) after and have had an excellent result.

Anesthesia for either TKR or arthroscopic procedures is a spinal with light sedation. I went to a specialty hospital and had the procedure outpatient although I did stay the night. My place had a pullout couch for DH-- I would ask about this if you proceed. Mom had her procedure in a big teaching hospital because of some health conditions she has; she developed some severe hospital psychosis that may have been related to Lyrica and ended up there for 2 days because she couldn't meet her PT discharge goals. Mom doesn't have dementia, so this was a shock-- I couldn't stay with her as I was managing dad (my PWD) and a health emergency he was having. Anesthesia, the time in the hospital and pain medications are all things that could change your DH's baseline of function; this is usually temporary but not universally so.

The PT is absolutely critical. Many orthos put together their own online self-directed PT these days before they'll refer to an outside PT. This might be an issue if DH won't cooperate to do them properly especially if you can't easily coerce him into doing them. My PT program had 3 sessions of movements followed by a short walk each day after the first week. YMMV.

That said, my widowed auntie had TKR in about stage 3. my aunt obtained guardianship and ordered the surgery for her as she had a lot of pain. I suspect my late uncle recognized some cognitive changes in his wife and declined risking hastening the process with surgery. Fast forward, a few years and the knee was twice the size of her other one and she could barely walk. The surgery went well but she had a stroke in recovery that left her unable to walk. As a result, she was unable to actively participate in the post-op PT. She did benefit in that it relieved her constant pain.

Good luck whatever you decide.

HB

JDancer · February 16

From your original post, I'm not clear if your LO needs knee replacement or arthroscopic surgery. Many of the replies seem to refer to replacement surgery, which is much most serious than arthroscopic.

justbreathe2 · February 16

https://alzconnected.org/discussion/comment/198536#Comment_198536

We have not had a recent X-ray or seen a surgeon yet. He had a meniscus tear surgery 5 years ago. We feel it did not heal. So, we do not know what surgery he needs yet if we decide to move on with it.