Having knee Replacement surgery

Hi,

Anyone out there who has a pacemaker have knee replacement surgery. I am scheduled to have the surgery on the 28th of August and I am very nervous. Not so much about the surgery, but the complications and the effect the surgery could have on
my pacemaker and heart. Any helpful words would be great.

Thanks.

Trekkienurse

10 Comments

Timing

by cohara - 2012-08-15 07:08:01

Don posted while I was typing. Great article.

Carol

Major surgery w/ a PM in you!

by donr - 2012-08-15 07:08:05

I posted this for Cohara just a few days ago. She is facing thyroid surgery - or something just a few inches from the PM. Granted that your surgery is a bit further away, but the same issues apply. To keep life simple, I just copied & pasted for you.

Trust me - you WANT to read every word of the document in the link. If it doesn't work, let me know & I'll find a way to fix it. It can mean your life.

Don

Begin Copy & paste:

Something you MUST read...
Comment posted by donr on 2012-08-13 09:02.
...your life depends on it!!!!!!!!!!!!!

Not a statement to be taken lightly by a person who will be zonked out for surgery w/ a bovie being used w/i inches of her PM. (Bovie = electrocautery device - dangerous to PM Hosts if treated incorrectly.)

I stumbled on THIS by accident while Googling for info on another question two nights ago. It is written for the host to a PM who is is plagued w/ COMPLETE HEART BLOCK.

Let me insert a "brief" sidebar here to tell you of two incidents I've had w/ anesthesiologists. I am NOT a complete heart block patient; I am not 100% dependent, but I have experience w/ some of what the author writes about. Shoulder repair surgery. Very carefully discussed this issue w/ my anesthesiologist du jour who wandered in just before my surgery. Oh, yes, he says, I'm up on PM's. If they are going to get close, I'll just stick a magnet over it!" Great, I said, naively, and went into surgery relaxed & stupid. And just for laughs, try this - the anesthesiologists tells me that my surgery will start on HIS shift & another guy will take over when his shift ends sometime while I'm on the table. OMG was I stupid, dumb & uneducated.

Second, I had a big toe repaired last month - now how far can you get from the PM & still be in the same body? Anesthesiologist du jour came in - a bait & switch guy after the one I talked to in my pre surgery conference told me specifically that he would do me. We started from scratch on PM's. He seemed to be educated on them & electrocautery. Had the same discussion w/ my surgeon, who was also savvy. Much moreso than "We'll just stick a magnet over it." So I went into that one w/ much better knowledge. End sidebar!

READ IT ALL! Every last word of it. It'll tell you why you want to discuss the surgery & your PM w/ the anesthesiologist very carefully & have a PM tech THERE. Also, get a download immediately afterward of your settings - BUT - even more important, have someone you trust know exactly what is happening & be prepared to check the post-op download for ALL correct settings, especially the MODE switch. Face it, you will be in no mental state to do anything for several hours & this must be done w/i literally minutes of you being out of the OR.

This is going to look assinine to you for the first few pages, but it is written by a smart Dr, for a bunch of dummies. You will scratch your head till you get to page three or thereabouts. But be of good faith & patience - you will see why it it so important to you. I have copied & pasted the URL below & it worked for me. Good luck!

http://www.cardiacengineering.com/pacemakers-wallace.pdf

Good luck!

Don

Surgery

by cohara - 2012-08-15 07:08:58

Trekkienurse,

I haven't had a knee replacement, but I am facing thyroid surgery next month. I too was worried about having electrocautery so close to my pacemaker. Donr has an excellent article on this subject. If he doesn't stop by, I'll send you the link.

After reading the information and researching the technical manual on what magnet application does to my make and model of pacemaker, I was informed enough to have an educated discussion with my surgeon.

My fears have been alleviated. I learned that not only does my surgeon perform this type of surgery every week but many of his patients have pacemakers or ICDs. He uses bipolar electrocautery a few times during the procedure (the current is contained between the poles of the instrument and doesn't wander through the body) but he also uses a harmonic scalpel that emits no EMI and cauterizes as it goes for the majority of the operation. He can perform the surgery without electrocautery if EMI is going to prove problematic.

I would read the article, gather the information about your pacemaker (technical manuals are posted online) and then sit down for a heart to heart with your surgeon. I only have complete heart block; my plumbing is fine. If you have other issues, your cardio is probably the best source for information. Take a list of questions with you when you go for surgical clearance.

Feel free to private message me if Don doesn't visit, and I'll send you the link to the article. It is a must read before surgery.

Good luck,
Carol

Similar Situation

by Jari - 2012-08-15 08:08:32

I had my shoulder reconstructed a few years ago and never really thought about the pacemaker being a factor until I read your post.

I just let the doctors know and they were be able to make the necessary adjustments. Other then that I had no complications.

Surprise!!!!!

by donr - 2012-08-15 08:08:33

Carol - isn't it annoying when that happens? You type your little heart out only to find that someone else has commented & covered some of what you say.

Sounds like you are in great shape. Also sounds like your surgeon is on top of the total situation. Now all you need is a savvy anesthesiologist!

Sound like you feel better already.

I am curious about your surgeon's attitude when you came in prepared for a detailed discussion of what he was going to do & how. Was he surprised, annoyed, miffed, curious about where you got smart? It sounds like you opened him up & he freely discussed the procedure.

Don

I had both knees replaced in 2002

by janetinak - 2012-08-16 01:08:26

& an AV node ablation with a PM in 2000. Actually had one knee done 6 wks before 2nd. If you want to private message me I'd be glad to answer any questions you may have based on my experience. Mine went well & my Ortho, Cardio & Anesthesiologist were all on the same page. I was (& still am) on Coumadin to throw that into the mix too.

Janet

Honest conversation

by cohara - 2012-08-16 07:08:06

Don,

You bring up a good point about doctor attitude towards knowledgable patients. Mine totally understood why a person who relies on a pacemaker for a heartbeat would want to cover all the bases before the day of surgery. We had a lovely, open discussion between two adults. If he had fallen back on "I am so above you that I can't be bothered" there would have been an issue. Knowledge is the key here. Only with some basic research can a person know what to ask and how to approach the subject.

You are right, the conversation lifted a big weight off my shoulders. I no longer fear having a fried pacemaker or Vfib after the procedure. The time I took to prepare is paying off with a month of reduced anxiety. I highly recommend it for everyone scheduled for surgery using electrocautery.

Trekkienurse, if you have a Biotronik Evia DDR-T pacemaker the magnet application places it in DOO with a rate of 90. If you don't have Evia, you'll need to see what your pacemaker does.

Being proactive rocks,
Carol

Having knee Replacement surgery

by trekkienurse - 2012-08-16 08:08:01

Thanks to all who have commented on my question. I am more nervous now then before. Had Arthroscopic surgery done on the same knee 2 years ago and the PM wasn't an issue. Didn't seem to have a problem I don't think. But since this surgery is nearly 2 hours and more extensive I am concerned it could be a problem. Haven't been able to talk to the surgeon except for 5 minutes. Been dealing with the NP. My pacemaker doctor didn't seem to be concerned at all, just to make sure they had
a magnet since cauterization will be used. When I mentioned this to the NP she said, she would check it out. That they would probably have a tech from the company be there for the surgery. She took a copy of my PM card. After reading the article you forwarded to me Don, I am even more worried now.

Judi

Thanks

by fishfighter - 2012-08-16 08:08:08

I will be talking to a surgeon come monday and yes, I didn't even think about this.

Thanks again, Paul

RECENT KNEE REPLACEMENT ~ ~ ~

by Carolyn65 - 2012-08-17 03:08:28

I had a PM placed 11/2009 ~ 100% dependent ~ I have AFib and on Pradaxa meds for blood thinner. I had been on Warfarin until about a year and a half ago.

This past May 15, 2012, I had a complete right knee replacement after ten horrendous years of extreme pain, getting to the point of not walking & crying alot ~

When making the appt., I have become so adapted to my 'energizer bunny' (PM) that I had forgotten to mention it! Thankfully, within all the paperwork to be filled out, the right questions were asked on my health issues. When the paperwork asked if I had a heart condition, a PM, etc., I filled out 'yes'. My Austin Bone and Joint office said I would need to call my heart specialist and get a release from him to be mailed to the knee surgeon's office. I thought, 'what a big deal over nuttin'! ~ I had seen my heart doctor on my annual visit in December 2011, so he cleared me for the knee surgery for May. When I was being 'prepped' at the hospital for knee surgery, no one seemed concerned of my PM. In fact, they said a whole lot of their patients had some type of heart disease/PM's.

I was fortunate to have the best hospital, Austin Surgical Hospital in Austin, TEXAS and the best doctors/nurses. The doctor said the surgery might take up to 4 1/2 hours before going to my private room. I was taken to my room, fully awake, talking and had no problem with my PM. Grant you, I had a 'block' in my knee (I guess like a spiinal block, but in my knee) which lasted for several days and pain meds ARE a must. Yes, you will have pain, but not anything like the pain I was in before I finally made up my mind for the knee surgery. I think I stayed on pain meds for about 2 mo. Now, I just take a regular Tylenol if needed. Since the surgery, I have had my 3 month PM 'telephone check' with the nurse at the Heart Hospital, and the administering person said all looked well and would call me again in 3 months.

I have never been so happy, glad, excited to have had the knee operation finally done. I had been too scared and afraid I did not have time for me to be off my feet from my Son, DIL, 2 teen Grandsons, etc. & all their activities. Plus, we run a working ranch.

I would offer advice of not becoming frustrated/ aggravated and develop a lot of patience because I thought I should just be back to 'normal' in a week. I never had been told that it might take 4 mo. to a year to finally feel great again. Do not 'rush' yourself/treatment, just as you would not with a new PM. THE main thing which IS a MUST ~ Do all the expected therapy and exercises to insure your knee does not 'freeze up' and the scar tissue will not be so bad. You will have some scar tissue, which is good, so the implant will attach to it. I have a Friend who had her knee surgery seven (7) years ago, and she still faithfully does all her exercises, just because she feels it is best for her.

I need/have to lose weight for all my health reasons. My knee surgeon told me for every pound I was over weight, 3 pounds of pressure was put on my knees ~ He said my knee surgery should give me at least 17 years, if I lose weight ~

PLS. feel free to private msg. me and/or ask me questions on this wonderful, great PM site. OH, a word of warning, as is with any pain/subject, people will want to tell you all the horror stories they know and/or have heard ~ Most people who have a positive attitude will be just fine with a good surgeon. I did alot of research on doctors/hospitals before choosing one. I used something called Health.com or a name like that. It showed my local hospitals, which ones had more staph, etc. germs/infections and the past history on doctors.

So sorry this is so long, but I know how many questions you can have and need a Friend to talk to.

Love to hear from you 'trekkienurse' (Are you a nurse?)
Carolyn G. in TEXAS ~ Hope you walk a mile soon ~

You know you're wired when...

You can proudly say you’re energy efficient.

Member Quotes

I have a well tuned pacer. I hardly know I have it. I am 76 year old, hike and camp alone in the desert. I have more energy than I have had in a long time. The only problem is my wife wants to have a knob installed so she can turn the pacer down.