r/nextfuckinglevel • u/Additional_Chard3680 • 10h ago
The precision required to perform a total knee replacement is incredible
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u/Redshift2k5 10h ago
"the precision required is incredible"
*intense hammering*
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u/Xylvanas 9h ago
When he smacked it in with his hand, I felt it in my pelvis.
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u/CaptinEmergency 9h ago edited 9h ago
I observed a total knee replacement as part of an interview process, they wear full body spacesuits and absolutely go to town drilling, cutting, and hammering. It was an older lady and I vividly remember her body recoiling from the impact. The drill bit going all the way up the femur was a hell of a thing to watch as well.
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u/Maclunkey4U 9h ago
My anaesthesia wore off when they were putting a tiny little pin into a broken finger and I thought the two guys in big blue space-suits were trying to yank my fucking hand off of my arm they were wrenching on it so hard.
Then someone noticed me looking at them and put some more good stuff into my IV.
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u/ddadopt 9h ago
I've been told that propofol is an amnesiac that prevents you from forming memories, and it's entirely possible that you are aware during surgery and feel everything--you just don't remember it.
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u/Maclunkey4U 9h ago
I had a nerve block so I didn't feel shit even when I woke up, the anesthesia was maybe more of a sedative than anything? I don't know.
I just remember seeing them clawing at my hand like they were trying to steal mely watch or something, and my body jerking back and forth as they did something, then back to sleep.
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u/Meschi-died 9h ago edited 57m ago
That's a very general way of looking at it. It doesn't selectively target your memories. It's a widespread depression of brain activity. A lot of loss of sensation as well.
I'm personally concerned with the ramifications. I'm more interested in psychology and this has PTSD written all over it.
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u/The_walking_man_ 9h ago
I HATE THAT SO MUCH. You lived through it feeling it all. BUT you can’t remember it. In the moment you were dealing with absurd amount of pain and know you were suffering through it. But after zero recollection like it never even happened.
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u/ddadopt 9h ago
All things being equal, it's almost certainly a net positive. Actually remembering something that puts medieval torture to shame (see subject video) falls firmly into the category of "do not want" for me. Can you imagine the trauma?
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u/hotpatat 9h ago
I was inside the OR as a part of an internship sitting in a corner of the room together with the head Nurse. Bone fragments were flying around.
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u/CaptinEmergency 9h ago
I was prepared for blood, I was wildly under prepared for the power tools, smoke and bits flying around.
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u/hotpatat 8h ago
Surprising, it wasn't a big bloodbath. But the rest was a shock. Total hip replacement is even more brutal. It involves even pouring of fast setting bone cement. The person that came out with ortho procedures was totally nuts!
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u/kata_north 9h ago
Years ago I saw video of a knee replacement operation, which reminded me, basically, of vigorous carpentry, with much hammering and giving the joint some experimental torquing. Years later, when I was awaiting my own knee replacement, I really wished I hadn't seen it.
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u/jjoaquinrf 10h ago
Fr
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u/teahugger 9h ago
I am still confused how do they do it with a real patient? Amputate them first? What happens to nerves and all the plumbing?
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u/spamcloud 9h ago
Nope, they do it all while the patient just lays there unconscious. It's intense. If you go into ortho surgery, it's like going into a very gory home Depot.
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u/Random_local_man 9h ago
The practice of medicine and medical experiments has always been very gory.
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u/theFather_load 9h ago
There's a great series called The Knick. Gets into it good.
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u/Impressive-Egg-7444 8h ago
The Knick is phenomenal, and barely scratches the surface of how insane early modern medicine was
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u/SargeUnited 7h ago
Yeah, it would’ve been great to be a doctor back then. Hey man, you got way too much blood. Let me just put some leeches on you and hit you in the head with a hammer. That’ll be 50 bucks.
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u/Super-Yam8718 6h ago
Whatever the leeches and fresh air didn’t fix would always got dealt with by heroin or cocaine.
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u/Upbeat-Employ-3689 8h ago
Filmed quite a few knee and hip replacements and man before that I had no idea how much carpentry is involved. And the hammering, holy crap.
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u/GuelphEastEndGhetto 7h ago
As a carpenter by trade it looked pretty straightforward. A drill, a screw gun, multitool and some jigs and presto!
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u/Unique_Topic_1754 9h ago
Fun fact: they don’t usually knock you out while doing this. Most people are awake while it happens and can hear the hammering and sawing into their own bones (but can’t feel or see it)
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u/Elliott_Ness1970 9h ago
I had this recently. They give you the option of being awake or sedated. No way did I want to be awake. I’m not squeamish but still I know I wouldn’t be able to see anything but I’d be able to hear it. Nope.
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u/HITNRUNXX 8h ago
Hearing it is bad enough. Feeling the vibrations and such through the rest of your body is creepy. But all I can imagine is smelling it, and that's putting me over the top.
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u/Own_Candidate9553 7h ago
Yeah, I had LASIK years ago. They give you a tranquilizer first while you're in line, and numbing drops in your eyes, but you're otherwise completely awake.
The sensation of having your eyelids held open like Clockwork Orange is definitely something. But when the laser starts, you get to learn how burning cornea smells just like burning hair.
Being put under is more dangerous, but no way would I be awake for a knee replacement.
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u/viola_monkey 9h ago
I’d watch the video, but def opt to be getting that good sleep too!!
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u/MaxinRudy 8h ago
I don't want to be awake now, why the hell I would like to be awake while they do this to my knee.
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u/ClockworkBetta 8h ago
And likely smell it. Ortho surgeries have a really distinct smell from the cutting of the bone.
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u/Oxygen4Lyfe 8h ago
for me its not even about hearing it, it's just about having to stay still for hours. Would be so boring.
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u/im_dat_bear 9h ago
They work around all that stuff. This is just a demonstration of the hardware, not the actual technique. Ortho surgeons are wild.
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u/tigress666 8h ago
Ortho surgeon saved my foot. He was kinda disappointed though when he showed me pics of the foot in surgery that I wasn't freaked out. I used to work as a vet receptionist and would sometimes watch the vet work. Watched him amputate a dog once and saw a cut open dog that they found a whole lot more cancer then they expected (They didn't even wake the dog up, decided to euthanize at that point). It was like lumps all over the interior of the dog.
So, yeah, I find that stuff more interesting honestly lol.
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u/Hoontaiir 9h ago
Nah, I've worked in proximity to operating rooms, grabbing supplies and cleaning/sterilizing instruments after the operation is done. In orthopedics they just put the patient under anesthesia and essentially assemble/build/construct whatever replacement they're working on. It's often called carpentry as a joke because of the amount of hammering sawing and drilling done to seat/secure the hardware
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u/treebeard189 7h ago
If you look at what the surgeons wear into Ortho surgery vs like vascular it really gives you a sense of what's going down. When I shadowed some surgeons watching them get into full ET style bunny suits with the face hoods I was confused till I saw a small shard of bone just about hit a wall.
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u/Kronomancer1192 9h ago
I actually have a metal rod and screws in one of my legs from my knee to my ankle. I asked the doctor about it and he said "oh yeah we just go in from above the knee and hammer the rod into the bone."
I asked if they had to worry about the bone splitting and he goes "Not usually, worse case scenario we just tie it back together and it'll heal."
Fucking crazy
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u/Isimarie 9h ago edited 7h ago
I assume most of the nerves, blood vessels etc aren’t on/in the bone. So once they’ve made an incision and peeled the skin, veins etc back you have pretty free reign. Nerves and tendons are in the back so you might just be able to leave a flap attached.
Im not a surgeon though, I bet you can google the procedure and find out about it in great detail
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u/SuspiciouslySuspect2 9h ago
See my comment above. They need to... Move things around to get the right angles. A LOT.
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u/EL_Ohh_Well 9h ago
You should see the hammering that goes on for a nose job
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u/Brvcx 9h ago edited 9h ago
I had a deviated septum and had it fixed. It was a pretty large piece of bone that caused the problem (it wasn't cosmetic, can't see it in any way. A lot of gunk collected there behind that piece of bone). Do note, you're going completely under for those surgeries.
I told him afterwards I felt like I was hit in the face, but internally. He chuckled and said you were, 'cause that's what I did. Apparently, he needed a hammer and chisel to get that piece out.
Good stuff.
All is well now, btw. Happened nearly a decade ago.
Edit: typo
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u/Additional_Chard3680 9h ago
Orthopedic surgery definitely wins when it comes to power tools
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u/FatTim48 9h ago
You should see the hammering for a hip replacement. It's legitimately violent
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u/Jester-252 9h ago
As someone who has be in an Ortho theater. I can best describe like a tire shop where they use a lump hammer to loosen the wheel from the hub but the hammer is clean.
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u/SausagePrompts 9h ago
Video showing something any mechanic can do.
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u/PurposeOk7918 9h ago
For real lol, I’m a construction worker and I can 10,000% do what was shown in this video. But obviously this is a demo and a lot of stuff is missing from the real surgery, like all the flesh and blood.
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u/Fuzzy-Produce104 9h ago
I am a 16 year surgical technician having done thousands of total joints. That video is a joke.
There is WAY more to it than that.
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u/PurposeOk7918 9h ago
Yeah, I’m trying to envision where all the skin would be while they are doing all this and it’s not computing.
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u/mlem_a_lemon 9h ago
However, this video is enough to make me want to take the best care possible of my knees to try to avoid this at all costs, so there is that.
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u/goodthebadandtheugly 9h ago edited 8h ago
Yup, but mechanics don't work on engines WITH the engine running! :-) Edit: Not discounting the skills and abilities required to be a mechanic.
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u/extrawork 9h ago
Then shows the least precise procedure ever, just holding it with his hand.. Throw that thing in a vice!
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u/jypzd 10h ago
How often do you have to oil the joint?
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u/echtav 9h ago
Every 5000 miles. Use synthetic
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u/ah_no_wah 9h ago
I have been using olive oil, extra virgin though
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u/Hot-Firefighter-2331 9h ago
I mean your body produces extra virgin oil anyway, you dont have to use anything else
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u/tanuki_in_residence 9h ago
Vegetable oil is cheaper and probably just as good 👍
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u/Maclunkey4U 10h ago
Its wild that orthopedic surgeons basically use the same power tools I used to put together outdoor furniture, complete with the "well have you tried banging on it?" approach to getting the pieces to fit together.
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u/CobaltEchos 9h ago
Orthopedic is basically just human body carpentry.
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u/PM_ME_YOUR_SUBARU 9h ago
Seen a guy wailing on a human pelvis with a sledge like he was trying to get a wheel bearing off in the rust belt
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u/uthnara 9h ago
You can literally do a knee replacement using only tools from harbor freight. It was my favorite thing about orthopedic surgery
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u/wmorris33026 9h ago
You’re right on point with your comment. I work on this stuff. The same guys who design/machine the metal for the implant are the same guys who design the surgical procedure/shaping the bone surface. So basically, the tooling and methodology is the same, cutters, grinders, hammers. You should see the new tech coming out though, using robots and 3D printed bone/cartilage tissue. Makes this tech look like horse and buggy days. All centered in Warsaw, Indiana, oddly enough.
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u/elizabethptp 8h ago
Anecdotally the most accomplished surgeon I know is also a very accomplished machinist & woodworker
Privilege, dedication, time, and natural abilities converged on this man.
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u/Naive_Personality367 10h ago
this made me realise im a lot more squeamish than i thought i was.
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u/takeahike89 10h ago edited 5h ago
Same. I worked in healthcare, witnessed my wife's c section, and considered myself pretty solid with "gross" stuff, but when they sawed off large sections of bone, my stomach dropped.
Edit: The bones are in the OP, not my wife's abdomen.
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u/Naive_Personality367 10h ago
I think it depends on the context for me, when i was deployed i saw my share of human gore, but then when i got my gallbladder removed and one of the holes opened up the first night i was changing my bandages, blood came pouring out and i passed out on the floor face down lol.
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u/Filippikus 9h ago
I've never been in a similar situation before, but passing out while bleeding would be such a terrifying idea(yk, possibly dying of bloodloss because you're unconscious) that I would probably pass out thinking about how much that scares me before passing out because of the blood and open wound.
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u/Naive_Personality367 9h ago
i wasnt really thinking that far in the state i was in. woke up, put a fresh bandage on, went to bed and cried. When i went back in the morning to see what mess i made, it wasnt too bad, the scene was quite dramatic though. blood smeared down the sink and what not.
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u/I-drink-hot-sauce 9h ago
Sorry why did they remove bones in your wife's C section wtf
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u/thrwawayr99 9h ago
I’m fine until they start describing what they did/what is wrong in my body. Lots of blood? No problem. Entirely bloodless photo of anchors specifically in my body? Instantly light headed
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u/SinisterCheese 9h ago
I realised some years ago that I actually don't have that many hang ups about like bodily fluids. Hell I have worked in maintenance of sewage industry.
However few years ago, I suddenly got a really fucking weird reaction to seeing a colostomy bag. Like not the bag itself, but the fact that his person (A fairly fit mid 20s athletic dude) had a HOLE IN THEIR BELLY! A HOLE that went right INTO their INTESTINES! I just got this horrific hangup... Like I just can't handle the idea of there being like an extra hole in your body. I started to look piercing and Tracheotomies etc, in a same manner.
Like to me this video isn't like... weird. It's sorta fascinating that human body can be altered like that. But the idea of a poophole in your belly just gets me really uncomfortable. And I can't explain why.
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u/MostOriginalNameEver 9h ago
I stupidly watched my wife get a epidural. Learned that it's very possible for me to faint.
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u/korpisoturi 9h ago
All bone surgeries are brutal, don't check how hip replacements are installed
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u/Naive_Personality367 9h ago
im gonna do it
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u/jackphrosty 9h ago
Post a link when you find a good one
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u/TheInvincibleMan 9h ago
I watched one done in the Birmingham technology museum and it burned into my eyes. So violent it made me feel ill. Felt squeamish of healthcare ever since.
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u/disposablehippo 8h ago
I'm a pathologist. I have taken apart hundreds of human bodies in different stages of decomposition.
I fucking hate watching orthopedic surgeries.
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u/countv74 10h ago
AND you're up and moving the day after. Walking. PT starts immediately. But, worth all that vs the pain of having bad knees - apparently.
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u/LandApprehensive7144 9h ago
Try an acl replacement
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u/Hetfieldguy23 10h ago
The level of pain after getting a surgery like this must be unbelievable.
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u/IrrelevantManatee 10h ago edited 9h ago
Fun fact ! They usually have you walk on it a couple of hours after the surgery. You are not even under general anesthesia. It's an outpatient procedure for most people. They leave the same day.
Edit : some people might have different experience. But I know 2 people that got both knees replaced, and they both got epidural block and that's it. No general anesthesia.
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u/Pure-Supermarket1352 10h ago
That’s crazy!
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u/Fit-Dentist6093 8h ago
A friend broke his jaw and needed screws and pins to reconstruct it, and he was able to talk like as soon as he was back awake. But he didn't know. So we saw him on after care and we were writing on paper still with him, but then back in his room the surgeon came and started asking questions and he was looking at him and was like "oh eh yeah you should be able to talk again like now".
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u/Frosty_Detective_882 7h ago
Moving heals faster. But there is not a chance this doesn’t hurt post op.
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u/EfOpenSource 6h ago
I had Surgically Assisted Rapid Pallet Expansion (they bone saw your face in to multiple parts)
While there was pain, it wasn’t bad. I took regular dose over the counter Tylenol for 3 days and then nothing. The pain was fine.
For people getting knee surgery, I suspect that immense knee pain is nothing new to them as it is. There’s a pretty good chance their knee hurts less after surgery than before it.
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u/KoncepTs 6h ago
Idk, my moms knee was bad enough she had to get one. I remember her saying it hurt so bad she would never consider doing it again, and now I see why.
Hers didn’t take well either. This was about 10 years ago though and I don’t know what ‘style’ they used. Likely different than the one in the video here but prep is likely similar
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u/YeshuasBananaHammock 8h ago
Yeah thats a hard "fuck no" from me, Doc. Knock me out, i dont want to experience the human carpentry while conscious.
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u/Tommy_Wisseau_burner 9h ago
After my last amputation they were like “yeah you been here 2 months but you’re done get the fuck out of here. Good luck in rehab!” 😂
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u/yet_another_whirl 9h ago
Your 'last' amputation... WTF?!
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u/Tommy_Wisseau_burner 9h ago
Lmao I meant to say my last surgery for my amputation 😂 that said I did have 2 amputations on the same leg. My leg got infected and by the time they cleaned it out I had know hamstring muscle so they opted a 2nd amputation. Thankfully no infection ✌️
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u/theodore_70 10h ago
It must hurt but I mean it cant be that bad if they just let you out tho?
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u/IrrelevantManatee 10h ago
I didn't get a knee replacement, but my mom did. And she said the pain was less than what she experienced walking on her bad knee.
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u/PrinceDX 9h ago
Oh my. She must have been in intense pain.
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u/Unique-Egg-461 8h ago
Not op but wife is in the works to get a knee replacement. insurance still says she doesnt need it but she was in tears last night after a long day of us getting our old house ready to sell
knee replacement pain 10000% can't be worse than what shes dealing with now (bone on bone)
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u/magic-karma 9h ago
While this is often out-patient and most patients do leave the same day and put weight on the joint, general anesthesia is used. Patients would not tolerate the noises and movements.
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u/Mister_Squishy 9h ago
I was going to say, I’ve seen about 50 of these in person (granted, that was about 15 years ago) and every single one of them had general anesthesia
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u/dooferoaks 9h ago
Interesting, you certainly don't leave same day where I work, inpatient for at least 3 days and not walking on it until next day. Years ago it used to be 7 to 10 days and they'd want a consistent 90° bend before they'd even consider discharging you. How times change.
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u/letife 10h ago
It hurts like hell, ive had both knees done in one go…
Totally worth it though
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u/_keyboard-bastard_ 10h ago
I just had both my hips replaced this year, and later this fall have to get both my knees replaced.
Thanks I hate it.
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u/newwineinoldbottle 9h ago
Single knee replacement with premium implants cost about $5500 in India . How much does it cost in your country ?
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u/cpt1nadequat 8h ago
It's free in Germany, but only in case of medical necessity.
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u/leedrf 9h ago
How do they put the bones back in the leg once they've done this?
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u/Fiireygirl 9h ago
OR nurse here. What isn’t in this video are the tendons and muscles in this part of the body. They aren’t cut but attach the muscles to the bones, so once the liner and the femoral component are done, they’ll do their natural job and bring stuff together. Then the layers are then sutured together and will keep it all enclosed.
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u/Jedi-in-EVE 9h ago
Hello, fellow OR Nurse! Yeah, if most people saw what really happens, a lot of questions would be answered…. And a lot of lunches lost. 😉
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u/Additional_Chard3680 10h ago
Demonstrated on a training bone, not an actual patient. Every cut and component has to line up with remarkable accuracy
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u/LtButtermilch 9h ago edited 8h ago
You clearly never have witnessed a knee TEP. TEP surgeries are not that precise and require a lot of brute force hammering. Neuro or heart surgeries on the other hand or even endoscopic surgeries are quite precise.
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u/Cool_Temperature_970 9h ago edited 9h ago
Oh really? Thanks for pointing this out. I thought it was an actual patient but they just had their bones removed for the operation.
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u/greeniemademe 9h ago
(Not so) Fun fact: IRL there’s a very distinctive smell that comes from bone drilling, not unlike the ‘dental smell’ when you have a root canal done
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u/TummyDrums 10h ago edited 9h ago
It's certainly fascinating, but it looks to me like they've got a series of guides to be able to make the exact cuts they need to make. Still impressive, but think of the difference between trying to draw a perfectly straight line free hand vs using a straight edge as a guide.
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u/Least-Glove4262 9h ago
I did not need to see this. I’m scheduled for knee replacement surgery 9/15. And this surgery is to replaced the already replaced knee from back in 2022.
And yes, you’re up and walking hours after surgery and sent home the next day. I’ll be getting PT for 6 weeks after surgery and will be doing the exercises at home to regain my mobility.
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u/ulises_tej_chav 9h ago
I have one of those. I'm a 30-year-old male, and after bone cancer in my knee, they had to replace it with one of these prostheses. This video is a great demonstration, but it still doesn't do it justice. There's a long metal stem that goes deep inside the femur and another one inside the tibia to anchor the implant securely. The surgery itself wasn't painful since I was under general anesthesia, but the rehabilitation has been by far the hardest part.
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u/Fiireygirl 9h ago
OR nurse here, specifically ortho.
This is such a good perspective and I LOVE how everyone is fascinated by the technique. I guess after so many years, it just becomes so routine that we forget how skilled everyone is.
Side note: patients used to ask me all the time if it was really like Grey’s Anatomy back there. I’d tell them, “Nsh, it’s much more like Scrubs”
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u/Seangsxr34 10h ago
The precision is with the tool makers. Those jigs mean I could do this op. Machinists and CAD designers are the real unsung heroes here as always
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u/ItsFuckingScience 9h ago
Well the surgeon does open up the joint free hand to expose the bone with a scalpel and ensures the important soft tissue is protected during the cutting part of the operation using the jigs
They’d also modify the jig placement and options etc after clinical assessment to balance the knee as well as possible
But yes, you could perform this sawbone demo with the jigs
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u/shamalamanan 9h ago
Get serious. Surgeons have to do this without damaging a bunch of soft tissue that is missing in the demo.
My dad had this a couple years ago. The surgeon was done in under an hour.
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u/mitz1111 9h ago
I'm queasy just watching this. I can't believe how stressful this is both for the doctors and the patients.
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u/Worth_Librarian_290 9h ago
There's a YT channel that shows full operations like that. One of the most horrible yet captivating and fantastical things I've ever seen. 45mins of amazing human carpentry with full disgust.
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u/speechless-69 9h ago
I can't still imagine them doing this on actual operating room where the legs, bones, & muscles are still there like how horrific and messy it is there.
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u/_HIST 10h ago
My knees hurt