TKR first referral appointment Monday - key questions to ask. Help please!

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I saw my GP last Friday as the time has come - have discussed in other posts - and asked for a referral. Phone call this morning with appointment Monday at 5:30! I have started to make a list of things I want to cover in the appointment but know the people on this forum know far more than me so I am appealing for your help. I am going on NHS Choices to a local private hospital I have been well treated at before under the NHS and luckily I am seeing an excellent surgeon. 

Many thanks - any help gratefully received.

Gill X 

 

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  • Posted

    In my opinion the two most important things to sort out are pain meds and post op physio.You need lots of both. If you already know what suits your stomach it helps as nausea can be nearly as bad as pain in the longer term. Also ask about the use of ice on the ward and make  sure it is freely available. That was my main problem as one or two night staff didn't understand the importance. Good luck!
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    • Posted

      Thanks Carol. I am concerned about the medication aspect as I don't take Diclofenac as it upset my stomach and am being treated fir IBS C. I was once prescribed Tramadol by my GP and it made me feel really weird! Good idea about the ice. Thank you.

      kind regards,

      Gill xx 

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  • Posted

    1st thing I do it s make them hold out the hands to see if they have the shakes. Seriously, I want to know about their education background, the number of these surgeries the have done and their own estimate of success ( which I reduce by 25%) and where they see the most difficulties in the recovery process. The type of procedure and what goes on me is rather academic as I'm not medically competent enough to know what's right or wrong anyway. I personally want to get a feeling if this is a guy I can communicate with at my low level of expertise or if he is going to be a guy that's talks to me like I'm another doc. Feeling good about your relationship with a surgeon is important. Ask about blood loss and transfusion possibilities, infection and clotting concerns. How he approaches rehabilitation. You'll get a lot more advice from this for. I'm in the US so have little knowledge of your system but others will be able to fill you in there. Good luck
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  • Posted

    Bit of a strange question, but I would ask if he inserts a catheter during the operation.

    Had my first knee operation on 25th June.  My consultant doesn't usually insert a catheter and I found it so difficult to manage sitting on a bedpan.  In fact, after three attempts, the nursing staff gave up, scanned me and found that I had too much urine. I then had to have a catheter for a day or so.

    It would have been so much easier to have one whilst under anaesthetic.

    For my second knee, I will definitely ask for this.

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  • Posted

    I also used the Choose and Book scheme.  It was great being in a private hospital.

    Please check physio arrangements post op.  SO important.  My package included three hydro sessions and three gym sessions.  Thereafter, I've been paying privately.

    Good physio is VITAL.

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    • Posted

      Thanks Lynn. I had some Physio last year to try to help but she said it was  no us, my knees were too far gone! I rang her this morning to tell her I had my referral and ask her for any advice and to tell her I would want some sessions with her post op. She said I should not tell them I would be paying for private Physio as they would then not provide additional NHS physio and let me pay so I will bear that in mind too.

      kind regards,

      Gill X

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    • Posted

      My private physio at the hospital is £192 per month.  Not cheap, but I formed an excellent bond with one of the physiotherapists there, and wanted to stick with her.

      Does the hospital have a hydrotherapy pool?  Those sessions were great to get me started.  Quite soothing.  However, as my physio pointed out, we're not ducks, so the gym sessions were far more beneficial, if not demanding!

      Good luck and please come back with any more questions either before and certainly after your op.  You really need to have gone through this to give the best advice.

      Lynn 17 weeks post op

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    • Posted

      My private physio is £40 a session which is about 45 minutes. Don't know about a hydrotherapy pool at the hospital but I doubt it. I will ask on Monday.

      i will certainly be coming back asking load of questions! 

      Thanks for your help.

      kind regards. 

      Gill x 

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  • Posted

    Agree with many points made but as I am now 5 weeks into my second TKR I would have to say that the person you need to speak to most is the anesthetist. The pain and discomfort is indescribable and unlike any other op. I consider in hindsight thati was not given adequate meds with my first knee. This effected my exercising which I was unable to engage in effectively for about 2 weeks. Although that knee has ended up finei think I went through needless discomfort. I had another anethesist the second time around and as soon as I explained my dread he immediately said that he would write that I was to have a very high dose of meds if I requested it. (25mg Endone) which for those who knows mega high. He said that I needed tobe aware that it was only if I needed it. So during the week in hospital I began on 25 then over the week cut down to 10 which is average. I ad hardly any pain because I never let it get that far, I was able to exercise immediately, my bend was always 100, I could walk with crutches immediately. The hospital physio discharged me from her attention day 3 because I could do everything. Even when my meds reduced I could still bend over 100 because my knee had been doing it already. I can't stress from my perspective how important it is to have high dosage meds to enable good bend etc. the other thing that was better with my second was that I had an epidural as opposed to full anaesthesia as with the first. One hour after theop I was wide awake and was never drowsy. During the op I was sedated and could sometimes hear the hammering smile but it didn't worry me because it sounded like it was someone else. The other plus with the second was that I has a  long sating block injection in my knee for pain as opposed to an infusion I think it's called. Where they have a drip of pain killer going into you leg for a few days. This stopped me being able to raise my leg or move my toes for about 2 days but with the block I could raise and move as soon as the epidural wore off. I loved my anesetist, I wanted to take him home and bottle him because he made it so much better the second time around. I'm sorry I don't know exactly what those blocks and fusion things are called. Hope that helps. Excuse the passion.
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    • Posted

      Gloria, thank you. So much info for me to use! I'm noting it down ready for Monday. After reading the posts on this forum I definitely want an epidural which I was sure I didn't want at first!  I didn't realise the anesthetist had anything to do with pain management but just looked after you during the operation. 

      I'm sure when I see the consultant he will think I'm the most genned up patient he has ever seen.

      Thank you!!

      kind regards,

      Gill X

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  • Posted

    Hi Gill,

    If this is your 1st appointment with the Orthopeadic surgeon, then i would suggest you have few more stages to go, this will also depend on where you are in the UK. I live on the Wirral, and the process here is that your consultant will more than likelysend you for an x ray and CT Scan to see how bad your Knee is before he would make the decision to operate, I had a Arthroscopy and a number of Injections before i went ahead with the Operation, but age is a Factor also, i was relatively young in comparrison. Following my CT scan my surgeon suggested for my own benefit to have a 2nd opinion, it was only then after the 2nd opinion did i decide to go ahead and have it done. A decision i now know was right. Some questions you should ask regarding your aneasethic, do you want a general or spinal, i opted for General! I wasnt given the choice about

    Uretha cannulation, but to be honest i could go to the loo Post Op, im not keen of having intervention in my bladder!!! As others have said Physio is so important, i am shocked how many people on here dont get offered it!!Ask them do they offer you a joint school pre op, our hospital does and its fantastic, it allows you to talk to others in your position, and the correct medical advisors who can organise anyy home aids you make require after your Op!! 

    Good luck on Monday.

    Pegs

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    • Posted

      Hi Pegs. I'm in Ormskirk so not that far away.  I had an arthroscopy a number of years ago and the consultant then said I needed TKR but it was up to me when it was done. He said my knees woukd tell me which seemed odd at the time but I know what he means now.  I hope I get CT scans as well as X-rays as these don't seem to show how bad they are. 

      I thought I would want an general anaesthetic but after reading posts on this forum i know now I want a spinal but will have to see what's offered. I would love knee school! I hope when I'm discharged I will get physio at Ormskirk hospital as it was good after my arthroscopy to meet others in the same boat.

      Hopefully after Monday I will have a better idea of everything! I am trying to arrange it so that the operation would be early February as we are on holiday until the end of January. I'm getting my other half to come to the appointment with me as I'm hard of hearing and don't want to get anything wrong. And when I've had any doctor's appointments he usually says ....did you ask about....!!! 

      Thanks for for all the information.

      Kind regards,

      Gill (age 59) X

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  • Posted

    when i went i let the surgeon explain to me what was going to happen , then went home and thought about it , i needed the op so didnt get too deep in to things ,they do a pre class at the hospital where i was so all the other things were explaned in a group where there are others having the same op so all aresa were covered , from going in to surgery to coming out ,the spinal was really good ,just a little strange ,and was aware of noise but again was in a nice dosey place and was quite happy ,if i had pain it was sorted out very fast , with my first i couldnt pee after but the nurses soon sorted that out , so for the second knee i made sure not to drink and sat on the toilet for ages , then i tried the bed pan , but no so i used the comode with no problems at all this was only 2 or 3 hours later , and again the physo was a group , with 9 diferent exercises to do all of which you can do at home ,hope this helps smile
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    • Posted

      Thanks Debbie, that's really helpful. It's good to know how you felt with the epidural. I had real concerns about one but after reading all the positive things people say on here about them I'm sure it woukd be better than a general. It seems to help also with the post op pain. 

      How many weeks ago was yours? How's your sleeping? I'm not good at sleeping on my back (only my side) and I don't think there's an alternative is there? 

      Did you you do any exercises before the op? Some say this would help both knees. I will need both doing so the other will suffer when the first one's done.

      kind regards,

      Gill X

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    • Posted

      im 11 weeks on my second knee , just dropped all pain meds , so sleeping not too good at the mo , i normaly sleep on my belly , i can start off that way but move in the night ,is a nightmare , sleeping on my side is ok for a while with a pillow , always wake on my back.you may find it better to sleep a little proped up . i was swimming lots before my knees were done ,upm to 2 miles a day ( nothing better to do lol ) .all i can say really is take it easy ,rest when you can , eat what you fancy , ice ,and dont worrie if you cant do things , every thing will come back , each day i found i could do some thing else , like putting my socks on ,one day you cant ,then you wake up and put them on without thinking , wow a great feeling . as for the other knee ,i didnt really think it made much difference ,while the first knee was recovering ,maybe the pain meds working , i only had 4 and a half months in between each knee , but now ready for work in another week smile ,ive been off with the pain for 18 months , busy busy job on your feet all day , cant wait to be back to a near normal life , good luck every thing will work out , where are you havong it done ? Debbie xx .
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    • Posted

      So good to get all this info Debbie! I sleep on my side and was thinking if possible I would try a small pillow between my legs - if allowed! I suppose until I've seen the Consultant on Monday I don't even know if he will do it. I believe I will probably have xrays and maybe a ct scan then he will ask my Health Authority for permission. With going away early December until the end of January (USA) inam hoping that most of the preliminary works will be done prior to going with just the pre op when I get home. That way the operation could happen early February. We usual go away again in April but won't next year. At the moment I don't know if it's best to have the other knee  done like you, about four months later or give it a year in between.  I know it sounds awful trying to fit the operations around holidays but we usually go to Florida three times a year for 6/8 weeks at a time  - we are both retired!!

      i am very pleased with Consultant I am seeing - I think! With it being NHS Choices and picking a private hospital I was so pleased when I looked him up. He also does surgery at other excellent hospitals and if I was paying (!!!£10,000 per knee!!!) I think he is the one I would have chosen! 

      Hope all my ramblings make sense and the predictive hasn't messed it up too much - I try to correct it as I go along!

      Kind regards,

      Gill XX

       

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