Questioning need for TKR

Hello dna41@dna41,

I am fresh out of a right knee replacement yesterday so I’ll share why I went forward with it. I had a wonderful Aunt who lived to be 100 years old. She was a hardworking farm owner and very active. Around age 80 her knees really started bugging her but the surgeon didn’t want to operate due to her age. It really hampered her ability to drive, get out on her many acres and was just painful. She told me numerous times during those last 20 years how much she regretted not getting her knees done by another surgeon. Toward the end of her life, while her mind remained sharp, she was confined to a wheelchair.
When arthritis caused my knees to be bone on bone with swelling around age 58, I pushed off surgery for 4 years. I tried cortisone injections (didn’t help me much), custom orthotics, knee braces for hiking and finally the hyaluronic knee injections along with PT. I had to temper my activities but when the hyaluronic injections were working, I could get to about 65% activity level. When the injections wore off after 5-6 months, I could barely make it up and down stairs, no squats or lunges, kneeling etc. Since my problem was bone on bone in both knees it was very hard to bend down and harder to get up when I dropped something, etc…
The advice I took from my aunt, as well as seeking a 2nd surgeon’s opinion, led me to stop putting up with the pain and diminished activity level. I have high hopes for great results and will work with my PT twice weekly beginning next week.
It’s a tough decision for sure, but when I listed pros and cons it became clear. And since the Anesthesiologist gives a nerve block and epidural you can just be sedated without the extreme general anesthesia side effects.
Hope this helps even a little.
Best of heath to you!

I tried the shots for a few years. They were expensive, painful and useless, but I put off the surgery due to my doctor mostly. He always said that I would “know when it was time”. What a crock! After I got the surgery, it was night and day. For my knee and my wallet. I learned that his practice milked patients to get every last buck and after you get the TKR, there is no more money to be made. I wish I had done the TKR sooner. The TKR is painful short-term, but it is lifechanging. Thanks for reminding me that I am lucky to have had the opportunity to have a less painful life. Sometimes, in the day to day, I forget.

I personally waited until the cortisone injections weren't working any more and got the TKR in March of this year. Strangely, A bill is being looked at for Medicare to not cover but 41% of knee replacement and for us to pay the 59%.

Send your Congressman & Senator a letter requesting they not sign off on this bill. I saw this in my knee surgeon's this week.

Blessings & Prayers...

I am an 81 YO male and had my right TKR a year ago when I was 80. The decision to go forward is a very personal one and one that cries out for shared decision making. After a TKR many if not most have trouble kneeling so a new knee (so called) will probably not fix that.

Most would say don't do it. The only problem with delay is that you might be less healthy and less able to handle the surgery later.

(Note to some, this is a repost from an earlier discussion of the same basic topic)
I was 77 when I had my TKR three years ago. Before the surgery I had the cortisone shots (3) about 4 months apart with some relief but finally accepted the idea that surgery needs to be done. My surgeon had a MRI done to build the replacement parts and give him an accurate look into the knee before surgery. After surgery I was fitted with a prescription leg sleeve to control the swelling along with a Breg water/ice & pump cooler, which was issued to me after surgery. I wore the sleeve 24/7 and attached to the cooler wrap whenever I was sitting down including in bed. My suggestion is to ask for a replacement sleeve because they get dirty after wearing it 24/7, if you need to purchase one look for a vein specialist, they sell them as a pair for about $50-70 a set.
Shortly after surgery I made my first walk while I was in the hospital, only about 20 feet out and back of my room (with a walker), but each day after I added another 20 feet to the exercise. By the time I had a PT therapist at home I was doing about a quarter of a mile a day (with a cane, mostly for stability and balance).
Before surgery I had 5 goals:
1. Walk & sit without pain
2. Sleep without pain
3. Walk up stairs without pain
4. Walk down stairs without pain
5. Get down on my knees without pain
Within a few days I accomplished #1, #2 came after a few weeks, #'s 3 & 4 took me a year to do with confidence and #5 I do with kneed pads, mostly because my knee cap is numb and it feels funny.
One last note, a few years prior to my journey with TKR I lost a lot of weight, about 70lbs, for another reasons and I believe it made a difference.

@covidstinks2023 I'm not exactly sure what bill you might be referring to. When I read your post I immediately went searching, and here is what I learned.

CMS (Center for Medicare/Medicaid Services) is proposing a RULE for 2027 that reduces the physician fee reimbursement for knee replacement surgery by 20%, but I cannot find a bill before Congress like you mentioned:
https://www.beckersspine.com/orthopedic/proposed-medicare-rule-threatens-20-pay-cut-for-hip-knee-replacements/
Keep in mind that physician reimbursement is the very smallest part of the cost of the entire procedure.

What does this mean for patients? We don't know, but possibly fewer docs willing replace hips or knees for people with Medicare, or a higher copay TO THE DOCTOR. Or it might mean higher premiums for supplements to make up for the lower Medicare reimbursements.

Needless to say, knee & hip surgeons are not happy since Medicare reimbursement lags far behind their usual fees, and is a driver behind what other insurance carriers for specific services.

What can we do? Your suggestion to write to legislators is a good one, but have the facts correct. Ask them to introduce a bill to more fully reimburse providers for their costs, and not to allow CMS to impose more limits on fees. Especially, not to cut rates when we all know costs are rising, not falling. (Doctors already had an 8% cut for this in July.)

@sueinmn Thank You. I wish I had taken a picture of the post. I did try logging into the website and it was no longer available.

The post (in exam room in hard plastic) said that some doctors may be forced to discontinue medicare due to lack of payment from Medicare and what is proposed for patient to to pay out for knee/hip replacement was 59% and Medicare 41%. It urged patients to send a letter to Senator/Congress to not pass this bill. This post was not up 3 weeks ago when I was there.

I will dig further. Blessings......

@covidstinks2023 Aah.. that makes sense based on what I read. Their professional associations are responding, and hopefully this change will be withdrawn.

@sueinmn This might also be a push from the government for Medicare participants to purchase a Medigap policy or cutback on expenditures because Medicare is not going to last forever if something isn't done about the fraud and abuse.

@steve161 There is some fraud in Medicare as there is in all insurance programs. But most observers consider Medicare to be by far the most efficient medical insurance plans in the US.