What disqualifies someone from having TKR surgery?

Posted by janchan @janchan, Apr 9 9:57am

I was diagnosed last September as needing a total knee replacement. The surgery was scheduled and all looked good, but eventually had to be cancelled due to unrelated circumstances. Ever since then, I'm been having trouble getting another surgery scheduled. Can anyone tell me what cardiologists and surgeons see as being disqualifying for TKR? And if nobody will do the surgery, what will happen? Just wait until the whole thing breaks and I'm left totally immobile?

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cathymw | @cathymw | Apr 10 7:22am

1. Too much weight- the rehab process is brutal. A new knee will not work if patient can’t adhere to the physical therapy program.
2. Inability to prepare for surgery- exercises, quit smoking, lifestyle choices…
3. Cardiac issues
4. A1C high- indicates uncontrolled Diabetes
5. Smoking/ impairs healing process big time

All of these factors will contribute to poor outcomes. A surgeon has more patients than they have time. They can choose. It is elective on both sides.

thisfatoldlady | @thisfatoldlady | Apr 10 9:30am

If cardiologists are involved, perhaps it's a concern over the anesthesia. However with a TKR, you can opt to have a spinal block instead of general anesthesia, which shouldn't affect your heart at all. Just a thought. Good luck. I do know there are BMI restrictions (even though the science evidence is fat folks don't have any higher risk for negative outcomes than non-fat folks), but some surgeons will work around that. If you have a teaching hospital accessible to you, you might try there as they are often more willing to take on "difficult" cases.

karenheller | @karenheller | Apr 10 9:45am

I have Hereditary Spherocytosis (HS), a rare blood disorder. There have been no studies about its effect on TKA outcomes, but many studies have linked HS to increased inflammation. According to my physical therapists, my degree of inflammation in the first four months post-op was higher than average and I was quite ill during the first six weeks post-op (vasovagal episode and lab values out of range). My early post-op illness and excessive inflammation may have contributed to my inadequate range of motion. (At six months post-op, my active ROM is -3 to 102.) Although my hematologist medically cleared me for TKA, research is needed to determine is HS is associated with poor outcomes and should be a contraindication for this surgery.