knee replacement surgery

cabingirl

I've developed lymphedema problems in my arms and left shoulder. I've just started therapy for it. I have total knee replacement surgery scheduled for March. My question: Is it really dangerous having surgery when one is at risk for lymphedema?

barbe1958

I don't believe the replacement will affect any lymph nodes in your knee area. Quality of life is very important, don't deny yourself that for something that might not happen. Kira will be along soon with some advise! Make sure you mark your left arm as "NO STICKS or BP" while in for surgery.

kira66715

Cabin girl--I spoke to a noted researcher at the NLN, who developed arm LE after her surgery, some time ago, and she had a knee replacement this year, took all the precautions, and still developed LE in her leg.

That said, you have to do what you have to do--if you're "bone on bone" and can't walk, you need to weigh the risks and benefits.

The best bet is to get a LE therapist involved, and treating you in the pre-op and post-op stages.

LE impacts us, but it's just one factor. And what I wrote about the wonderful researcher, it's the story of one woman--but a woman with knowledge and resources.

Hopefully others will chime in here.

http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

Kira

barbe1958

Kira, how can that happen when they're working on bone and not tissue? I may have to get one as well as I am bone on bone, but am just avoiding it for other reasons, not LE....

kira66715

Barb--after my fracture, I was watching a physician lecture for an LE training school, and discovered that the periosteum of the bones are rich in lymphatics.

Although there is not significant cluster of nodes at the knee--but there is a cluster in the popliteal fossa (knee), there are lymph collector vessels and there are lymph nodes.

I believe the mechanism is trauma, inflammation, genetic predisposition.

Think about how we swell when we sprain or sustain any trauma to our body--it's complex, and for those of us with lymphedema, we likely have a genetic predisposition to develop permanent swelling.

I know my LE therapist has LE in her legs due to varicose veins and vein stripping. There are often mixed situations where people have venous insufficiency, and swell and then some lymphedema as well.

I can't totally explain it, but I do know that it happened to this great researcher, and there's a lot of trauma involved in a total joint replacement--I know some people are going with mini-replacements.

I don't think it's a guarantee, but I think it's a risk, and maybe Binney has more thoughts on the mechanism.

And Barbe--if you ever watch a knee replacement--they sure are working on tissue--they pull off the muscle attachments, the bones just don't magically appear--they have to work their way down to them, and then remove the joint. 

I was always taught that nature creates an amazing surface of the patella--the resistance is 1/10 of ice on ice--you can't do that artificially, but when the meniscus are gone and there is arthritis, then quality of life is huge issue.

So, none of this is solid evidence, just me speculating.

I work in radiation oncology, and we do single bursts of radiation to hip replacement patients, to discourage tissue growth into the artificial joint, and most the patients are fresh out of the OR, and are not happy campers...

Kira

barbe1958

Holy crap! I did not know all that!! My problem is that I take so many pain meds I've been walking around bone on bone (and didn't know it) and my knee swelled up HUGE at the end of November and I had to go to the ER and get it drained. They say it will just keep happening if I don't do something, but I've been wearing a neoprene brace that helps keep the swelling down. I have truncal LE which I find painful, but don't get the same feeling in my knee so I hope it's not LE already!

Sher

I have widespread osteoarthritis and both knees have needed replacing for several years now.  I kept putting off the surgery as I really didn't want to go through this if I could somehow avoid it.  Then I had a local recurrence and so put it off again, thinking why go through knee replacement then.  In January after I developed LE in my left arm (at low risk in right arm after prophylactic mastectomy) my biggest fear for knee replacement has been how I'd need to use my arms so much throughout the recovery rehab phases.  The thoughts of LE in both arms as well as my leg is just too much to deal with and overall, I'm not as strong as I used to be, so just continue managing with worn out knees as best I can. 

Kindergarten

Hey, Kira, Just wondering about having hernia repair surgery. I have an inguinal hernia. My surgeon wants to repair it soon. Having lyphedema in left arm, more chance of infection. I sure would appreciate your advice. thanks so much, Kathy

kira66715

Kathy, When I had a D&C a couple of years ago, I made the gyn give me antibiotics--she remembered, and I found the op note, and she dictated that we were doing it because of my LE.

It only makes sense to get antibiotics with surgery if there is a chance of introducing infection--a hernia repair is superficial and sterile. But, my LE therapist always recommends at least three days of prophylactic antibiotics if there is going to be any sort of puncture/procedure--she got that recommendation from Robert Lerner MD--a physician who practiced LE therapy in NYC.

When my husband had his, they did it "open" with mesh--but offered laparoscopic--which one are they doing?

Kathy, my suggestions would be to write on your left arm in marker--NO IV, NO Blood pressure. You can get a band from Pennisula medical--for an alert band

http://www.noblemed.com/alertband.htm

Some women go into the OR wrapped--since most my swelling is in my hand, I do a gauze finger wrap--a good visual to stay away--there's also a g-sleeve--which is a pink sleeve to wear to tell people to avoid the arm--a piece of stockinette will do.

http://www.g-sleeve.com/

Good luck--wouldn't it be nice if we didn't have to factor LE in? But we do.

Kira

Kindergarten

Dear Kira, Thank You so much for your info. I am having it done laparscopically, I think. Thank you too for the info about being on antibiotics before surgery. I so appreciate your message back so quickly. Have a great day!!!!! You are a wealth of information.

kira66715

Kathy, you are so kind.

Kira

cabingirl

thanks, you guys.

i never really thought i would have a problem with this, so i'm truly grateful for your info and support. (and i hadn't even mentioned my need for hernia repair, as well!!!) i insisted the surgeon lop off my boobs and thought that would be the end of things. wrong! i don't think i can go on without the knee surgery, though. being crippled up has damaged my outlook on life much more than the breast cancer ever did.

please keep the advice and reports of your experiences coming.
gratefully,

kay (cabingirl)

kira66715

Kay, one more thought--while you're rehabbing--will you need to use crutches? If so, that can be hard on an arm with lymphedema.

But, as you said, the bad knees are holding you back, so it sounds like with some planning, you'll do what's right for you.

Let us know how things are going.

Kira

Kindergarten

Dear Kira, You are the kind one. You are always so willing to post and help others!!! God bless you, Kathy

Binney4

Kay, hello!

Do you have a lymphedema therapist you trust? If your surgeon is willing to consult with her/him that would be ideal.

Knee replacement surgery is one of the causes of non-cancer-related secondary lymphedema, which means that even people with no cancer/LE history at all sometimes develop LE from knee replacement surgery. It's a challenge to find orthopedic doctors who are even aware of it (sound familiar?!), so many people with knee-surgery LE never get the therapy they need.

Kay, if you know going into this that it's a possibility, and if you have a good LE therapist already on board you are WAY AHEAD of the game! Ya' gotta do what ya' gotta do, and none of this is easy, but taking the precautions you can before and after surgery, and intervening early with proper LE care will have you minimizing the effects of this surgery, LE or no.

LE is not inevitable with knee surgery, at any rate, and the bone-on-bone knee damage is not going away by itself, so please don't let LE be the deciding factor about how you live the rest of your life.

One further thought: how about some very LE-wise PT prior to surgery to begin to build up some strength in your arms and ready you for post-surgery PT? Being prepared can really make a difference to your confidence level and your recovery.

Keep us posted!

Gentle hugs,
Binney

hymil

You will likely get antibiotics anyway to protect the new inplants, as infection in a joint replacement is the pits and a big source of unspeakable complications. Two things that come to my mind are (1) fluid replacement, drugs and other IV's, this would be by the anaesthetic team - I'm liking the pink sleeve idea! - and (2) knee replacements are usually done with tourniquet which can put the operated limb at risk and also overload the other three limbs fluid-wise. Maybe the surgeon would consider whether the tourniquet could be avoided? Good luck!

cabingirl

Hi, all

To answer a few questions:

I am seeing an LE massage therapist, and she seems knowledgeable and good, but I have nothing to compare that to. At my last treatment she taped my shoulders with Kenesio tape, and that has truly helped ease my pain. (In fact, I think I will try taping my knee.) So, I do at least have a therapist on board in advance of the surgery.

As far as I know, I will be using a walker, not crutches, during my recovery. I had worried about that.

So, it sounds like I need to wear the pink G-sleeves during the surgery, insist on antibiotics and guard against a tourniquet being used. And also try to get some LE-wise PT in advance. Thank you all for this advice.

Kay

barbe1958

Good luck Kay!!!

Binney4

Kay, if you're going to tape your knee, get your therapist's help -- Kinesio taping can be learned, but it's not a do-it-yourself sort of project. Here's the StepUp page about it:

http://www.stepup-speakout.org/kinsiotaping_for_lymphedema.htm

Quite a journey you're on here -- keep us posted!

Big, gentle hugs,
Binney

sisterinspirit

bump

sisterinspirit

Dr recommended that I have knee replacement surgery due to OA.  I have stage 2 LE in upper arm so I am concerned whether the surgery could trigger LE elsewhere especially if there is a genetic pre-disposition to LE.  Also concerned about how I would get around after surgery.  Crutches are out of the question.  Walker maybe, but putting downward pressure on arm is a trigger for me.  Found this thread which has some great info and am looking for any other feedback you would like to share.  Thanks!  

Deb

LoveLau

yes I had same situation take both off and problem solved! not! I have anxiety all the time. Orthopedic recommended knee surgery pencilled in for March 31, had sentinel node .9mm so they took out 25 nodes on rt side all clear. Knee will be on rt side. I have been having tingling of right arm and both upper arms recently, so now I’m freaking out about developing lymphedema in rt leg after reading this information although not happening now but the tingling is it a symptom that it will happen after knee surgery then won’t ba able to fly if I am ok. Such stress need prayers as we all do.I’ve been trying to strengthen my thighs so pain stops and I can cancel surgery. Thanks hope I get positive answers and any good ideas on prevention of anxiety, anxiety meds don’t help much pit me to sleep.also dr put me on riserpone as adjunct for antidepressants off label use.- any one try that