Knee replacement surgery and DCS

[mddolson]

Dr. Deco,

At 47 years of age, I've been diving since 1972.
I have a chronic knee injury with 3 arthroscopic procedures over the last twenty years and it has degraded to the point I will be having Total Knee Replacement surgery in Feb 2002.

I have always dived conservativley, avoiding limits on tables/computer and doing extra deco with EAN 50 when technical diving. So far So good.

For those unfamiliar with the procedure here is a link to describe what's involved:
http://www.goldsteinortho.com/knee.htm
(it is animated and requires Shockwave plug-in I believe)

It is my belief that the implants, will add little DCS risk to the knee,(being gas inert) but this surgery is considerably more invasice than arthroscopy.
The inscision is about 20 -24 inches from mid-thigh to mid-calf. My concern is about the resulting scar tissue in the area. Is there any statistical data out there about divers with knee/hip replacements and DCS risk?

Mike D

 

[DocVikingo]

Hi Mike D,

This topic more appropriately belongs under the Dive Medicine section. I used to have the capacity to move posts around, but somehow have lost it. Perhaps one of the other little moderator gremlins will be so kind as to do so.

For openers, you might enjoy knowing that total knee replacement generally is a very successful procedure yielding excellent pain reduction & increased stability. Of course, no such operation provides 100% alleviation of signs & symptoms in 100% of cases, and sometimes complications do arise. You will need clearance from your surgeon before returning to any recreational activity, including scuba.

In the meantime, you should find a 1995 study encouraging. This paper, published in the "Mayo Clinic Proceedings," reported that over 75% of orthopedic surgeons recommended resumption of scuba diving following operative recovery from total knee replacement.

Also, here are some encouraging words from a world-recognized dive medicine expert, our own Scubadoc---our man Ern is the bee's knees:

"Q: My doctor says I need total knee replacement. How will this affect my diving after I've undergone rehab?
via e-mail

A: You should be able to return to diving after complete rehabilitation from your joint replacement. This would require a release from your surgeon for complete weight-bearing and physical rehab of the muscles with good joint motion.

The joint replacement would not be affected by pressure, depth or gases since it is solid and contains no air spaces. Whether or not the scarring and surgical changes would tend to be a site for nitrogen accumulation due to altered blood supply is debatable. Other good advice would be to remove your gear in the water and ask for help on climbing into the boat. Conservative diving would also seem appropriate."

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best of luck.

DocVikingo

 

[Dr Deco]

Hi Mike D:

[sp]Thanks for the reply, DocVikingo. As mentioned, this is really a medical question and does not deal with the aspects of decompression. I personally found the answer very interesting.

Dr Deco

 

[TexasMike]

Originally posted by DocVikingo
Perhaps one of the other little moderator gremlins will be so kind as to do so.

TexasGremlin at your service.

Will also report your loss of privs to TechAdmin.

 

[mddolson]

Thank you Dr Deco and Dr Vikingo for your replies.

I appologise for the using wrong discussion group.
Since my queary was directed at the DCS risk, as a result of the surgery, I thought this was the best fit.

I have already consulted with my surgeon, who has approved my resuming diving, after sufficicent recovery and post-op check up.

Mike D

 

[DocVikingo]

Hi Mike D,

Not a problem and you're welcome.

That is good news.

Take it slow & dive conservatively when you resume.

DocVikingo

 

[artsprite]

I have no business answering your question, and I'm not actually giving you advice on diving, but I thought you might find this interesting.

I think a lot of people are under the misconception that knee replacements automatically curtail a lot of physical activity, but I can tell you about one remarkable person with two replacements.
My father is 77 years old, and had his first knee replacement surgery about 12 years ago. He had the other one done about 4 years ago, and he has been snow skiing two or three times a year all his life. In fact, after the second one 4 years ago, he went snow skiing exactly 6 months to the day of the surgery. He's leaving in about a week for his first trip this year.

He had the last surgery on a Tuesday, left the hospital on Friday, and was back at work on the following Monday using no crutches, canes or anything. I understand he's kind of weird, but this ought to make you feel better about what you want to do.

Good luck on your surgery, and I hope all goes well. By the way,
I'm about to have my third knee surgery on my right knee (I'm missing part of my kneecap already) in about a week, and I've had one on my left. :loopy:

 

[mddolson]

Thanks for the reply Artsprite.
Per your reply:
"I think a lot of people are under the misconception that knee replacements automatically curtail a lot of physical activity"

Each case is certainly different. My surgeon has told me TKR replacemnts have a life expectancy of about 15-20 years depending on activity level, and I will likely require a replacement by the time I'm 65 or so. Running, court sports (basket ball, tennis etc) are no-no's due to heavy stress and impact.
Skiing (I am a down hill skier) is a "maybe" depending on stress level (mogols are OUT of course). In my case we have to wait and see. I am not an agressive skier, but will ski any pitch, I tend to carve big S curves down the mountain. I don't do bumps! So I'll likely be able to continue skiing. I'm a 2nd dgree black belt in Judo (25 years), was on 72 Canadian Olympic team and first damaged my knee in 76 nationals. I retired two years ago, due to my knee, and the surgeon says don't even think about resuming Judo.

Basically the advise was stick to low impact/stress activites: walking, cycling, swimming/diving etc.

Mike

 

[artsprite]

Sounds like you've got it all under control, and that's fantastic!

I didn't mean jogging is ok, I just knew that most docs, and people with replacements wouldn't think of snow skiing, and obviously it can be done. You're right though, my dad is a lot more conservative in his skiing than he was before the surgery. But, he's a lot better off now than when he had a torn ACL and was skiing with a brace.

The prosthesis that is just glued in without the long attachment being driven into the leg bones would keep a person from doing such things, but my father has the stronger type, and his old one at 12? years is showing no signs of loosening or having problems.

Since you've done your homework, I'm sure you'll be able to handle things just fine. I wish you the best with it. Also, I would love to hear how you do, since I'm just 2 yrs younger than you, and I'm headed for the same thing one of these days. I've had to quit a lot of things because of mine.

 

[mddolson]

Thanks for asking,
I'll let you know how I make out after February 2002.
For now I'm just working on bulding the muscle tone up getting ready for the surgery.

best regards to all

Mike