Railway Preservation News

Full Knee Replacements --- Any happy campers out there ???
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Author:  QJdriver [ Thu Jul 20, 2017 6:01 pm ]
Post subject:  Full Knee Replacements --- Any happy campers out there ???

17 years ago, during a killer bee attack in Guatemala, my left knee was pretty well demolished when I smashed it into the crosshead of FEGUA #199 while escaping an even worse fate. I finished my job in Guatemala with no medical attention, then got by somehow until I went on Medicare. Two months ago I got it replaced, but I am seriously concerned that it isn't ever going to be strong enough for me to go back to doing an honest day's work as a steam locomotive mechanic.

To be fair, my surgeon is not to blame for any of this, because my leg was going to break anyway. I know that BNSF considers mechanical department employees disabled after this procedure, and I am now wondering if anybody in RyPN land has had any experiences that might be similar to mine.

My physical therapist (by the way, I tested out of therapy in a third of the estimated minimum time...) suggested that I get some tradesmen's knee pads. I think that's a good idea, and would offer protection from accidently knocking my knee on a handrail or wrench handle, stupid things like that (which happen to me all the time).

What really scares me is that she also pointed out to me that my replacement knee joint had the original kneecap still in place --- only thing is, they took it out, shaved it to half the original thickness, then they drilled THREE HOLES in it, put three steel pins in those holes (nobody can tell me if it's a slip fit, press fit, or interference fit), laminated a nylon pad to it, and then stuck it back in. I can think of so many times I have to get on my knees and really wail on something to make even the slowest progress, and I can think of so many ways for that thing to break while I'm doing said wailing. With my luck, it would happen when I'm inside the boiler.

Anybody else been through this ??? I'd appreciate some (good) advice, even if it's to hang it up and learn to live with being too damn old. I sure as all HELL do not want to go through any more knee surgeries --- I know they'd be glad to keep fixing it for me over and over.... The Doc also said I could work when it heals, but I don't think he understands what I mean by the word "work".

Thanks in advance, take care & WORK SAFE

Author:  John Deck [ Thu Jul 20, 2017 6:33 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

The tradesman knee pads will help you. I have had both knees replace and I use knee pads to help with the overall wear and tear on the knee cap. I had one cap that was shaved and a surface added so understnd your concerns. I am three years out on one and 5 yrs out on the other and doing fine with good mobility. I also know another person who as had both replaced and is doing traction engine rebuilds and he also uses high quality pads and is doing fine.

Author:  dinwitty [ Thu Jul 20, 2017 9:28 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Do you wear any knee supports? I have my real knees but age is getting testy and I do some daily physical work every day. I know what "real work" means, thats not flipping burgers, we're talking, people who work on cars that can get tough work but working on a steam engine is all out. been there done that railroad work is your tough guy work.

I wear a simple knee compression on my left knee, and just be very careful how I move, learn what moves work and not.

Hopefully those surgeons know what they are talking about but recovery takes time, and the right exersizes/recovery procedures may get you going the right direction but the body has to meld into its new circumstance. Its like new glasses, theres some adjustment.

I would talk to your doctors or proper personell how to better persue recovery procedures and try to get you going the right way.

Like some sports injuries, simple muscle injuries take a short time, bones longer, but ligaments/knees thats going to take some time, and might not be an easy time. All I can say is keep grinding and be carefull.

Author:  PCook [ Thu Jul 20, 2017 9:39 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Knee replacement is a wonderful technology. Yes, you need knee pads afterward for some work. Consider teaching and sharing knowledge as a possibly less strenuous alternative to doing the mechanical work alone. Museums are supposed to have an "educational mission" and to do so they need volunteers who can teach.


Author:  PaulWWoodring [ Fri Jul 21, 2017 9:36 am ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

PCook wrote:
Knee replacement is a wonderful technology. Yes, you need knee pads afterward for some work. Consider teaching and sharing knowledge as a possibly less strenuous alternative to doing the mechanical work alone. Museums are supposed to have an "educational mission" and to do so they need volunteers who can teach.


I tend to agree with Mr. Cook. Might be time to take more of a "supervisory" role. The avocation could use some serious and experienced teachers of much younger and willing apprentices. The bigger issue, discussed here ad nauseam, is museum/tourist railroad "leadership" that does not appreciate the need to bring along younger help. It also doesn't help that most younger people prefer to live in a "virtual", rather than the real World.

Author:  765nkp [ Fri Jul 21, 2017 10:13 am ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

I had a full replacement in July of 2011. By November I was crawling across the hood of our Lima-Hamilton in Connersville, Indiana changing out a head. I have been ecstatic with the results as I could hardly walk before the surgery. Rehab is the key and I would be concerned about "testing out" in a third of the time. Two months is not near enough time to strengthen a major joint replacement. Six weeks after my surgery I was beginning to wonder if I would ever feel somewhat normal again. Then one day it turned the corner and things improved by leaps and bounds, no pun intended. It just takes lots of time and lots of therapy, lots of strengthening.

Author:  Scranton Yard [ Fri Jul 21, 2017 12:04 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Mr. King - I have not yet had knee replacement but have had several other pretty serious orthopedic procedures which required extensive rehab. I have many of the same thoughts as 765nkp.

The quality of physical therapy varies greatly. I am not familiar with how all this works under MediCare but "testing out" of rehab/PT raises questions as to what standard they used. Things seem to be changing in PT but there still are places that are mills which have less expectations for activity levels of their clients based on their age. When looking at PT facilities, go to the ones that specialize in sports rehab. My anecdotal experience is that staff at those facilities gear the PT more to the post-operative activity level you want, and not assumptions based on an average person of your age. A good physical therapist should do an intake which includes establishing your goals for post-operative life. If you want to be able to crawl around a firebox (who doesn't?), you should not be discharged from PT until you can safely do that, unless of course it is a medical impossibility, in which case the therapist should discuss with you what is possible and reset your expectations.

You did not mention, did the therapist give you a home program for after you stopped PT? Even after a lengthy session of PT, I was only about 85% to where I wanted to be. As 765nkp stated, it is not just about range of motion and being able to do certain things. The most important thing is to properly strengthen all of the supporting soft tissue so that the repaired structure is protected. Proper PT and a post PT strengthening program are key. It is not just activity, it is the proper activity done the proper way that will strengthen what you need to strengthen.

My state does not require a prescription for PT but other states do. If you do not feel confident that the knee is reliable for what you want to do, you may want to consider looking into whether your state laws and Medicare can get you back in for more PT, or at least have a qualified therapist set up a home program for you. Your Doc may be able to give you some guidance.

Best of luck to you. Looking forward to seeing more updates on Audrey.

Author:  daylight4449 [ Fri Jul 21, 2017 2:33 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Sammy, I can't speak to a knee replacement as I've never had one. But I've dealt with employees and friends who have had a variety of joint injuries. My friend Dan had a hip replacement, but a number of employees either under me or around me have had issues with their backs (at the moment I work in an administrative role in HVAC, but you see enough of the guys on the ground getting hurt to know what happens and how it's fixed). Hell, my father/boss/pain-in-the-a**/grand pubah is in line for back surgery due to some serious problems with his T12-L5 (fracture in the T12, bone spurs of varying severity on all of them, blown disk, etc.).

With any surgeries it takes time. It doesn't matter what the issue is, you can't jump right back into the same stuff you did right away. For instance my buddy Dan had me helping him stack some wood for his stove either right before or right after his hip surgery (I can't remember for certain)... Well it was me stacking, and Dan trying to stack only to kind of flounder around until I told him to sit down before he hurt himself. Fast forward to today and you wouldn't tell that he ever had an issue with his hip just by looking at him. On the work side of things when I first started about five years ago one of the techs had two of his discs in his back fused together, and it was about six months before he could reliably move like he had before then. In both those situations, as in every other one where it all works out in the end, it comes down to keeping up with the PT regimen. As long as you stick to it after the surgery, you likely won't have a problem for a long time.

Now one final point, so far as the joint replacement itself is concerned... Will you have to take it easy on it? Yes, that goes without saying that you shouldn't bash it around. But on the other hand joint replacements and implants have become a lot better over the last decade or so. Instead of a knee or hip projected to last five years or so, they're projected to last well in excess of twenty and in some cases you'll never have to worry about it again. While that probably doesn't account for some thrashing around, I wouldn't worry about the occasional hard work... Just try to work smarter, not harder.

Hope the two cents or so helps Sammy.

Author:  Alan Walker [ Fri Jul 21, 2017 2:57 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

The late A. Paul Brock (Road Foreman of Engines) at Tennessee Valley Railroad Museum had a double knee replacement. He did the worse one first, then had the other done a year later. There was some related rehab physical therapy follow up but he returned to unrestricted service working on the locomotives. He had good quality PT and was pretty healthy to start with, considering his age.

Author:  QJdriver [ Sat Jul 22, 2017 2:56 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Thank all of you gentlemen so very kindly for your replies/ suggestions/ encouragement, etc. Yesterday I spent a lot of time composing a detailed answer for everybody, but THEN just before I posted, this stupid machine froze, and we have the cyber version of "the dog ate my homework".

First, Mr Deck. I'd say that working on steam traction engines is at least in the ballpark, the saddletanker of my dreams weighs 30 tons and is 104 years old, for comparison. Brother, I'm still VERY SKEPTICAL about this shaved kneecap business. You better be careful and not overdo it !!! Best of luck to you.

Mr Dinwitty, no I don't wear any supports. I'm the kind of guy who is deaf as a stump but won't wear hearing aids. It's an idea I had not considered, but can ask my surgeon about it.

Mr P Cook, I appreciate your suggestion, but am not being stampeded with volunteer help. However, we ARE keeping the weeds down, and I expect the young friend of mine who now does the nasty work to have the firebrick out in a month or so.... I'm honored that you would suggest I teach, BUT, nobody listens to me, or wants my advice, is the main reason I try to keep my mouth shut (sometimes unsuccessfully).

Mr Woodring, thank you as well for your input. I might mention that the GREAT teacher of young steam people out here where my engine and I live, would be Marlin Uhrich, who helped me get started many years ago.

Mr 765nkp I tested out of therapy so fast because I had gone for some time with no medical attention after the original injury, and my Viet Nam vet buddies showed me how to do stuff like move my bad leg with my good leg. I kept working as a steam fireman (no way I Hell I'd quit THAT job), and taking care of myself until it (sort of) healed. Also, I've played jobs as a bar band drummer since I was 17 or so --- within 5 minutes of getting home from the hospital, I fired up my drums and made sure my leg worked. In our state they MUST give you PT, and it must continue until the patient can demonstrate self sufficiency. After two weeks they asked if I could "sit on that stool" --- about 30 seconds of my Ginger Baker Toad solo, and they started digging out the discharge forms. My surgeon knows all the gruesome details, and he says I'm just dandy...

Scranton Yard, thanks as well for taking your time to answer me. I'm trying to get this out before another cyber meltdown, so will skip to Audrey. I haven't hit a lick on her in 6 months, but we HAVE kept the weeds down. We are planning to finish cleaning the mudring (I'm still chiseling out the last bits of the last washout plug), AND my helper is getting set to pull the firebrick out. And thanks for asking...

Yea, Dylan, your two cents helps. Basicly, I've decided to wear the best kneepads I can get. I've also decided NEVER to stress that composite Frankenstien of a kneecap, either. Like some of you fellas suggest, there are often several ways to do a job, and I can sit cross legged instead of kneeling, for instance.

Mr Walker, Thanks for this example of a survivor, I shall try to follow it.

By the way, my surgeon is the ortho man for the Denver Nuggets NBA franchise. Of course, he's the best, but I need to ask him if there is anybody with an active career playing pro ball with one of these composite kneecaps. I'm also inviting him to come visit my project, and try to turn ONE nut just to see what it's like....

Now, GET THIS. As soon as my leg gets good enough to mow and weed, they want to do tunnel carpal surgery and ulna surgery on both arms (not at the same time, fortunately). I've always heard good things about these surgeries from the pro musicians I know. How 'bout you steam mechanics out there ???

Thanks once more, you fellas Take Care & WORK SAFE

Author:  Steve Freer [ Sat Jul 22, 2017 3:08 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

I'm not quite old enough (but getting there fast!), so I don't have any personal experience with 'new' knees. I have noticed however that there are pants available with built-in knee pads. Duluth Trading sells several versions with pad pockets.

pad pants.jpg
pad pants.jpg [ 52.03 KiB | Viewed 5840 times ]

Author:  Tom Davidson [ Sat Jul 22, 2017 6:18 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

I have not had knee replacement surgery, but have had hip replacements on both sides about 10-12 years ago. If I hadn't had that done wouldn't have been able to walk. As it was, I was able to resume working at Amtrak as an onboard service employee on the Auto Train for another 8 years or so, retiring in 2014 at the age of 68. The technology of joint replacement has progressed at an amazing pace in the past 50 years. While it hasn't been reduced to a simple procedure, it has become much more safe, reliable, and effective than it used to be.

I understand knee replacement can be a bit more difficult than hip replacement, but I don't think the recovery process is that much more difficult. In either case, the surgeon has to go deep. The muscles are affected, so physical therapy is essential afterwards. Do every bit of therapy recommended, and then some. I found aqua therapy in a heated pool, with a good physical therapist, to be very helpful in the recovery process.

Now that my replacements have been in place for about 10 years, the right hip (first one done) is showing no signs of any problems. The left one is showing some indication that there nay be some wearing of the lining of the joint. As a result, it dislocated once in late January and once again about a month ago. My surgeon says it's too early to take any surgical action to correct this, but he may eventually have to do another surgery to improve the lining of the joint. This surgery should not involve any changes to the shaft that goes into the femur, nor the socket that attaches to the pelvis. As a result, it should be simpler than the original surgery.

Bottom line: Do it. Unless there is some condition that makes it unusually risky (which does not seem to be the case here), you should find a significant improvement after a recovery period of a couple months. It won't happen overnight, but it will happen, and it will give you years of pain-free mobility.

Best of luck to you.


Author:  robertmacdowell [ Sun Jul 23, 2017 7:07 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Medicare doesn't give you half the physical therapy you need for a full recovery. The good news is that a large part of physical therapy is simply a person goading you to actually do the exercises that you do know how to do. If you can be your own goader, you can make up for this poor service without having to spend on additional PT.

Other muscles atrophy (often they wee already atrophied, and the surgery or lameness makes this worse). Official PT makes no attempt to address *that* at all. And so you need to get to the gym on your own, and either build muscle generally in that area, or get some professional help to consult on what you need specifically.

Obviously, the more fit you are, the more capabilities you will have. Obesity is also a huge factor, obesity is very, very hard on knees partly because it affects your body mechanics. Doctors get fatigued telling Americans to eat right and exercise over and over and seeing no one listen. So when they see a flabby obese, change-resistant patient, they roll their eyes and go "not gonna waste my breath on THAT conversation." As a result, 5 years ago my father was told "you have weak kindneys" fullstop, and nothing to the effect of "Get it straight mister. You are going to get your ass on a renal diet NOW or spend 5 hours a day 3x/week at a dialysis center for the rest of your life".

Standard medicine doesn't do that. The American Experience is considered a juggernaut that is not to be stopped, only remediated with surgeries and pills, both very inefficient ways to practice medicine. Our food is now our worst enemy, GMO isn't poison, but it makes cheap foods *so very cheap* that healthy foods have left our diets. Remember when McDonalds drinks were sized 8oz, 12oz and 16oz no refills?

It is also valuable to think about how you use your body. I see lots of people use body mechanics which are absolutely terrible, and are racking their joints totally unnecessarily. I did a couple years of Tai Chi,(as a martial art, which it is), and now I'm much better at using my joints and weight correctly. Tai Chi, well done, also does Kundalini sort of stuff (as does Qi Gong, yoga, and Ba Gua) but of course, all this is waaaaay too frou-frou.

So if you really, really want to keep your freedom, the tools are there. Or you can take your habits to the grave. Either pursuit of happiness is the American birthright.

Author:  John Risley [ Mon Jul 24, 2017 12:27 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Excellent reply robertmacdowell. Spot on. Like all improvement related to this "human experience" one needs to take responsibility. Personally still working on it myself.

Worked as a nurse for last 12 years and we always had PT/OT dept where I worked. Early before this career change I had to go to PT for neck and shoulder rehab. I took it all very serious and had a great physical therapist who was good. But they are only as good as the patient. They loved me as I was very proactive in my rehab and did the recommended exercises at home. Saw a new guy at the same time, who came in and said "fix me". The whole rehab thing is personal and the experience for each is individual for sure. But taking responsibility and incorporating better body dynamics is somewhat of a life change kind of decision. Along with a better mental/emotional disposition you can do wonders. I think health issues makes one confront your own fragile existence and mortality for that matter. Embrace the changes as best you can and you'll be surprised at what your still capable of. Basically you are forced to work smarter and that isn't so bad. I am still working on this one too! Often your actual productivity will increase with some of the changes you might have to make. Some may not be as fortunate depending on circumstances but we all need to find our own "level". I no longer spit wood with a splitting maul, shoot heavy grain bullets with hot loads at long range {recoil lets me know my neck doesn't like them}. I can't swing a sledge hammer with any power or accuracy, ask Gary B. I don't jump down off of hay wagons or steps. Be smarter and you'll be fine for a lot longer than before. Get to know your limitations and respect them, focus on what you still do well and safely. Best to you. John.

Author:  train guy [ Mon Jul 24, 2017 12:40 pm ]
Post subject:  Re: Full Knee Replacements --- Any happy campers out there ?

Had partial replacements on both knees 6 years ago. Did full PT on both. Left did fine, right was never more than about 75%. I found it almost impossible to get down on my knees even with knee pads. If I bumped a knee on anything, I was down for the rest of the day.

Now at 66, doc says full replacement on right knee, should have been full knee 6 years ago (no warranty!). Been putting it off, but just about to the point where I can't stand the pain much longer, so will do it in the fall.

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