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Mom is diabetic with many health issues. She had hip replacement about 2 years ago and we got through that. Her doc says there's nothing left but replacement for this knee. She's barely mobile and getting zonked out on pain pills which will probably cause a fall or diabetic coma. I'm open to any info, suggestions or experiences regarding knee replacement at this age.

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Windyridge,
I'm sorry your Mother hurts so much with her knee and you have such a big decision to make.I think it would be awful hard on her and may cause more problems.I take Prolia,but it only slows down the progression of my bones thinning and if the doctor said that a knee replacement is the only answer,it probably is.I don't think I'd do it if it were my Mom and I'd work hard to get the pain medicine leveled out,finding the right one that controls the pain but doesn't zonk her out.Maybe a long acting pain killer that she doesn't have to take as often or a fentynal patch would work.The biggest problem with those though is constipation but that can be worked through by taking a stool softner like miralax and a poop stimulator like senna.I hope you find an answer and soon.
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I had my knee replaced 3 1/2 years ago when I was 63. I could only walk about 10 steps before the pain became so bad I would pray for death. I was one of the lucky ones, I was able to have in home therapy and did as the doctor told me, "keep the knee moving". The pain was 10+ on a 1 to 10 scale. The therapy left me in tears and my husband hated having to cause more with the help I required from him. But, after 2 months, I was so far ahead in my therapy, my therapist said I didn't need his help any longer. Just keep up with what I did daily. Truthfully, at 86, the surgery could be more painful and traumatic than the patient could stand. Walking a lot is required and I almost fell several times. I am glad I had it done now that it is over but it does get stiff on me sometimes and now, I am looking at needing the other one done also. See if there is an alternative to a total replacement. If it was my mom, I wouldn't do it. The best to you.
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Lots of good discussion. Carla, thanks for your comments. That's certainly a consideration, how long will she live, is it worth the pain etc. Send, what my mom wants is for nothing to change, just like most old folks. But if the pain becomes too much, like her hip did, she may consider the surgery. But we're getting very late in the game here.
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What does Mom want?

I know of someone taking "Prolia" injections, surgery is delayed. But not enough to be conversant on the topic.
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Windy,
You said:
"Getting them here is not going to happen until we have the crisis that ends their independence."

This is that crisis, imo. If you take action earlier instead of waiting, major troubles can be averted. Your Dad should not be alone. If you wait, they may end up in separate facilities or homes.
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If I already responded to this, forgive me for saying the same thing twice. I'm not seeing my previous post on this thread.

My mother had knee replacement when she was 78 and already had pretty severe mobility and balance problems. As well as high blood pressure and diabetes, but no cognitive impairment. I was not in favor of the surgery from the outset. I asked her if the doctor expected it to improve her mobility, and she said no it would relieve her pain. I thought she should get by with pain patches. Of course, at that time I didn't think she's live more than a few more years.

Her surgery did not go well. She had cardiovascular complications, a pulmonary embolism, was in the hospital days longer than planned and then had to go to rehab for 6 weeks, which hadn't been the plan at all. I think among other things she didn't want to do the physical therapy or exercise and that made her recovery long and complicated. Of course, 6 years later, maybe it's a good thing she had the surgery because that's a long time to live on pain meds. But now she's 85 and the other knee needs done, and at this point I would say it's not worth going through again what we went through last time.
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Like Jeannegibbs, 2 of my nieces have had both hip and knee surgeries, both of them said the knee was the most painful and harder to get through rehab.
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My husband just had knee replacement surgery one week ago. He's 87. He was in the hospital 3 days. They gave him a block during the surgery and he did very well. He told them he was going home and I am the caregiver. The first days were exhausting for me but now that he is a little more mobile things are better and I can get some rest. He's sleeping and on the machine :). I'm a little younger so am able to do the lifting part and did my homework concerning items needed to care for him. The patient really can't be alone. If no one can be there a rehab facility would be needed for safety and care. He said he is glad he had the surgery because his knee hurt anyhow .
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Mom is normal weight, her mind is pretty good still, and she did really well in a rehab facility after hip replacement 2 years ago. Dads dementia wasn't that bad then but it has progressed. I would have to stay with him or hire in home help, most likely a combination of the two, for the period of surgery and rehab.

I've been talking to her about where this is going and discussing options.

-No surgery but would have to have in home care/help daily

-Move to assisted living where her lack of mobility can be handled

-Surgery and a month of rehab

Of course she doesn't want to do any of this and I can't force her. My gut feeling is she will have a fall or diabetic episode that will put her in the hospital and from there to a nursing home. Dad will then be the problem. He's not quite ready for memory care but would have to be in a locked facility or he would try and walk home. He can't be on his own for more than a couple days. So for now I take it one day at a time.
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The further down the body you go the more difficult the replacement and rehab.
The hip joint has the weight of the head and torso. The knee joint has the weight of the head, torso and the upper portion of the leg. So weight bearing is more difficult.
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The knee is a more complicated joint than the hip ball and socket. Most people do much better with hip replacements than with knees. My mom had three knee replacements when the first one done in the late 1970s, and it wore out and had to be replaced in 1993, but she never really adjusted to that. I am fortunate to still be mobile at 79, the age of my mother's third knee replacement, with only minor pain in one hip easily controlled with naproxyn as needed. I think it is because I keep active with walking and weight training, or maybe I just didn't inherit the "bad joint" genes!
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The biggest question here is...
WILL SHE BE WILLING AND ABLE TO PARTICIPATE IN REHABILITATION.
If the answer to either of these is no then do not bother. It will do her no good. If she is barely mobile now without doing rehab she will be completely immobile.
I am sure that the reason she is barely mobile now may be due to the pain from a joint that does not work well. But if she is over weight it will make moving more difficult with or without a working joint. (Your question does not state if she is overweight now so that is pure conjecture on my part.)
If she does have the surgery the question would be will she come home for rehab? or would the doctor suggest inpatient rehab given her age and having no help at home.
You say your Dad is there but I would not count on him for help with all that would have to be done for her.
If she goes into rehab in a facility who then would care for Dad?
These are questions that I had to deal with when I had surgery and who then would care for my husband? Thankfully I am healthy enough and no other problems that I was able to come home and carry on pretty much the same with slight limitations.
This might be a case where a "respite" stay might be good for both, your Mom can recover and your Dad will have someone to watch /care for him.
You might want to check into an Assisted Living facility that would allow both to stay during this time and it would also be a way to "try on" the style of living that they may need sooner than later.
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Vstefans, just so I'm clear, your mom had the surgery, didnt do well with rehab but was still better off having the surgery?

How old was she?
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Mina, thanks for your comments. Lots to think about.

When mom went through hip replacement I was very worried given her health issues and depression that she would never make it through rehab. But she got her butt in gear and got through it because she knew it was the only way to get out of that nursing home and get back to her home.

Now we are again at that same crossroad except she's two years older and has declined overall. It may again be a "What have we got to lose" situation.

I have a feeling my winter vacation will be spent in my boyhood room dealing with this one way or the other.

Again, thanks to all you kind folks for the discussion.
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I think the key may be zonked out on pain pills and immobile, and the risks of not doing surgery are not so hot here either. Yes there are risks to knee surgery, but even if rehab does not work out well, THAT knee will not hurt with weightbearing on it any more once the post-op pain is better. That is pretty much all my mom got out of hers since she did not do well with the rehab. She only walked a little in therapy and did some weightbearing transfers without it killing her.
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Windy....good Q, very difficult decision....sorry you are faced w/this. My Mom had both knees replaced at 83 or 84 YO. She did them separately. She actually came thru the first surgery and rehab so well and so quickly that she convinced the Dr. to do the second surgery in less than the 6 months he had recommended (I remember this because I was not happy w/her decision, but she was a stubborn, stubborn woman, so....). Huh....repeat of first experience and she absolutely loved her new knees.....was rapidly racing around like the energizer bunny once again.

Having said that, I also have to say that Mom was healthy as could be - no MCI/dementia at that point, still living on her own, very active (not immobilized or on painkillers like your Mom tho she did complain a lot about her knees), no prescription med's except prescription Prilosic for GERD and glaucoma eye drops for eye pressure. So, yes, your Mom's diabetes and "many other health issues" do raise concern.....my Mom didn't have to deal w/those.

I will also offer as just my personal opinion / observation that "attitude" makes a huge difference. My Mom was not only the total optimist but an absolute warrior when it came to rehab/recovery (and there was a lot of pain involved). She just never gave up.

This was never more evident than, when, at almost 91 YO, Mom had her devastating first awful fall.....broken leg 6" above the knee and completely busted that relatively new knee replacement.....introduce #2. right knee replacement....at 91 YO!.....Mom's physical health and med's hadn't changed but she did have MCI at this point.....BUT.....once again, she came thru brilliantly and was up and walking w/out problem or complaints in 6 weeks!

I used to go thru the PT and OT sessions w/Mom, esp. the 2nd time. She always completed every session cheerfully, never complained, whined, gave up or quit. I really do think that this, in addition to the "physical" challenges your Mom faces, is a very, very important factor to consider. Do you think your Mom has the energy, drive, desire, motivation and willpower to push thru the difficult rehab process?

I mention this specifically because the 2nd time Mom went thru this, there were a lot of knee replacement patients in rehab and I observed them fairly closely. All, I believe, were younger than Mom, but many struggled greatly. I will say this as a final consideration: Mom was always a petite, thin, wiry, very physically active person. The people, many of whom were only in their early 70's, who seemed to be having the most difficulty in rehab, were all above average weight for their height and frame and, in general, did not appear very "physically fit".....just something else to consider.....because good rehab/PT will kick your butt....if you want good, long-lasting results.

So sorry, Windy.....but hope these considerations help you at least a little bit w/such a difficult decision.....best of luck to you and your parents!
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My aunt had a knee replacement and a hip replacement. She said the knee was a much harder recovery.
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Thanks for all the responses. As some may remember I'm 600 miles away. Getting them here is not going to happen until we have the crisis that ends their independence. If we went through with the surgery and it does not go well they may indeed end up in care near my home.

Right now they are still too competent to force any move to my area or to care where they live. It's been driving me nuts for 5 years.

If we end up doing the surgery I see a combination of me making the trip at the beginning, using hired care help for awhile during moms stay in rehab then another trip to get her home and assess the situation.

Dad thinks he can take care of her but he cant remember what day it is and would be living on cokes and little Debbie cakes.

That they are still hanging on at home is frustrating. I've been expecting the final crisis any minute for five years now.
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Just thinking....wouldn't a knee replacement be less complex than a hip replacement? How did she handle that? She's a few years older, but that might a clue to how well she could tolerate the surgery and recovery.
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I have only limited experience with actually seeing someone who's had it, and that was when my mother was in rehab. A few other women in their 80s were there for post surgical knee replacement. I don't recall that they had specific issues, but each person is different.

I do recall the staff using a machine that automatically moved the lower leg back and forth. The women laid down on their bed, the machine was connected and they could just rest while the machine moved the lower leg for them.

I've heard of others in my father's church who've had the replacement but have no personal knowledge of the ease or difficulty of surgery or recovery.

I think the issues with your mother are ones you've already identified, but I think the flip side is how will she cope w/o the surgery, given her existing pain level?

Seems like this is "6 of one, half a dozen of the other" in terms of positives and negatives.

W/o the surgery, what is she facing? What will her limitations be? More pain, more likelihood of falling? Knowing that your mother feels strongly about taking care of your father, would she be likely to insist on continuing that, to her own physical detriment?

On the other hand, diabetes would probably prolong the recovery. What is that estimate though? I'm assuming she'd recover best in rehab, so that would mean your father would be alone, or with you. Are you in a position to spend a month or so with him?

Do you think this is the time to address the issue of moving to assisted living or memory care for your father? My concern would be the trauma of his wife recovering, not being able to care for him, and the sense of isolation he'd feel. And your mother might feel she's letting him down by being unavailable.

What do you think would happen if you brought them both here, perhaps finding a facility for rehab as well for memory care? Would that be too traumatic for either or both of them?

This seems to be another of those conundrums that families often face. Neither option is a good one, but decisions have to be made that in turn affect other complex decisions.

I don't really have any good suggestions, but offer my support for whatever you decide to do.
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This is bone on bone, lots of pain and swelling. She can get steroid shots for temporary relief. If they were in assisted living ( Should have been for the last 4 years but no "We're just fine") she could probably get by with some help, wheel chair and regulated meds.

I'm just wondering if it's common to do this surgery at her age and condition. I know younger people that sailed through it and others that had a h*ll of a time with the long rehab.
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Oh, I see. Hmmm....some people do well, others don't. I think I would get two other opinions. You might check on that substance they inject into the joint. that is mentioned above. I told a friend about it, but, she said she had bone on bone and that was not an options for her. She had surgery and it went great. Of course, she's in her 60's.

There is also something called "Cold treatment." I saw it on tv. I'd check out all options, but, you do what you have to. Pain is sometimes just too great to deal with. It's a touch decision. Her blood sugar levels would concern me. High levels make healing tough.
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Sunny, it's Dad with dementia, Moms mind is still pretty good. FF, she has been using some topical concoction her doc ordered but it doesn't seem to be helping much yet.

She did the hip surgery and endured the 30 days in rehab but that was 2 years ago, she's weaker now and I would have to stay with Dad for the duration. He can be on his own for a day or two but that's about it.

I've heard that knee replacement is a tougher and more painful ordeal than hip replacement. Just don't know if she's up to it.
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I heard of a man who had a hip replacement without general anesthesia, so it seems it can be done.
I wonder, could you use the need for rehab care as the thin edge of the wedge to force a change in their living arrangements?
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WIndy, couple years ago my Dad saw a specialist regarding his knees... the knees were bone on bone... and the only thing the specialist could recommend is surgery. The specialist was determined.

The Chiropractor across the hall from my office got wind that my Dad was thinking of knee surgery, he said it wasn't a good idea because of the rehab which could last a year and the fact my parents were still living at home on their own. If my Dad was thinking "yes", the Chiropractor wanted to talk to my Dad before any surgery was scheduled, to talk him out of it. Dad was in his 90's.

Since my Mom refused caregivers, there would have been no way my Mom would have been able to take care or even help Dad walk.... and no way she would want him to stay in a rehab center for numerous weeks.

Thankfully my Dad decided "no" to the surgery. He preferred to use the prescription Voltaren Gel which he called his "liquid gold" which apparently worked well for him, and taking Tylenol Extra Strength [I know everyone's pain tolerance is different]. He also wore a light weight knee brace. And where he lived he had physical therapy so that helped a bit. He had to use his walker at all times.

I think modern medicine now offers a jell that is put into the knees via a needle which will help cushion the bones. That route sounds much easier to deal with.
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I would be very concerned with her dementia, as stated in your profile. You can discuss alternate forms of anesthesia due to her dementia and see what is available. But, also is the follow up care. She will likely need around the clock care close to her for a certain amount of time. Is she even able to understand what is being done?

Why is she in control of her own meds and responsible for her own blood sugar control having dementia? Will poor blood sugar control, healing will be slow. Talk to the surgeon about that. It can be a huge problem with surgery.

I hope someone who has actually had the procedure can provide their opinion.
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