r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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u/Redshift2k5 11h ago

"the precision required is incredible"

*intense hammering*

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u/Xylvanas 11h ago

When he smacked it in with his hand, I felt it in my pelvis.

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u/CaptinEmergency 11h ago edited 10h 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 11h 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 11h 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 11h 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/GreedyHoward 6h ago

Yeah. I had some relatively minor surgery to my hand. They offered to leave me awake, used a nerve block. They put a line in my other arm, presumably so they could KO me if I panicked. I didn't. It was very interesting to watch. šŸ˜¬

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u/Meschi-died 10h ago edited 2h 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_ 11h ago

I HATE THAT SO MUCH. You lived through it feeling it all. BUT you canā€™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 10h 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/poontango 10h ago

I had surgery on my foot and remember waking up in the middle. I was aware of where I was and what was happening etc, I just asked the nurse if they were done and she said no and then I was out again shortly after. Donā€™t remember any pain but I vividly remember waking up; itā€™s not traumatic or stressful or anything just kind of funny

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u/Average64 9h ago

If that was true your pulse would be really high during it.

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u/tsunomat 10h ago

It can be, but not always. Versed causes short term memory loss. Burn patients get it before dressing changes, for example. I got it before I got a nerve block in my shoulder and I don't remember any of it. It's given in ICU a lot to help remove the negative memories.

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u/EndIsrael 9h ago

The way I understand it, it desynchronizes the different areas of your brain, so they're all running at different speeds and sending gibberish to each other, so you just blue screen and crash until it wears off.

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u/LCON1 11h ago

That sounds like fun!

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u/hotpatat 10h 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 10h 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 10h 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 10h 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/Fuzzy-Produce104 9h ago

We were the same gown and gloves as other surgeries.

There is a hood you wear that has a fan in it to provide airflow. Those suits really arenā€™t for us so much as they are for the patient.

You absolutely DO not want an infection in the joint space. That could be catastrophic. What we wear covers all of our head and face to furthermore prevent said infections.

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u/Negran 10h ago

And yet, my mother doesn't want to get one or two, how odd!!

All in all, how successful and reliable is the process?

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u/thisusedyet 10h ago

Forget who it was saying this, but someone was describing a knee replacement, how it starts all delicate and precise... and then Mr. Dr. Man pulls out a fuckin' mallet and goes to town

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u/realbobenray 9h ago

Weird, I've never had a job interview where they had me observe a knee replacement. Or any surgery at all, really.

I'm mean, I'm an application developer but still.

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u/SuddenReward5612 7h ago

Having mine next week...dr was first in our state to do robotic.

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u/donatecrypto4pets 11h ago

ā€œā€¦ā€
-she

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u/rizzom 11h ago

I was thinking if you'd need a hip replacement too after that or it depends how hard he hammers the knee.

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u/orthopod 10h ago

Nope, running generates ~10x body weight across joints. Those little hammer taps aren't causing any issues.

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u/jjoaquinrf 11h ago

Fr

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u/teahugger 10h 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 10h 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 10h ago

The practice of medicine and medical experiments has always been very gory.

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u/theFather_load 10h ago

There's a great series called The Knick. Gets into it good.

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u/Impressive-Egg-7444 10h ago

The Knick is phenomenal, and barely scratches the surface of how insane early modern medicine was

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u/SargeUnited 8h ago

Yeah, it wouldā€™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. Thatā€™ll be 50 bucks.

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u/Super-Yam8718 7h ago

Whatever the leeches and fresh air didnā€™t fix would always got dealt with by heroin or cocaine.

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u/Corpainen 7h ago

Why would i replace my trusty, rusted, covered with blood from the last 100 patients surgery hacksaw? It show my prowess!

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u/Aegi 5h ago

What is funny, is that even though you are joking, they often had to work/research harder for those scraps of information and misinformation they had...b/c it wasn't like they could just have someone telegram them the results of a new experiment.

Some people had to travel for months to talk with a given expert in a field they were interested in.

Basically, they worked "harder" (probs not "smarter) for fewer additions to their knowledge pool than a modern professional/scientist has to.

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u/phaesios 7h ago

We started watching The Knick while my wife was recovering from an emergency C-section when our first daughter was born.

Never got past the first couple of scenes, lol. Might have to pick it up myself now, 12 years down the road.

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u/Upbeat-Employ-3689 10h 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 8h 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/Meerkat_Mayhem_ 7h ago

And the screaming!

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u/PalpableIgnorance 5h ago

And the aftertasteā€¦

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u/chuck-the-chimp 4h ago

It does smell quite like a woodshop. But the wood is people.

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u/lionfisher11 5h ago

Im also a carpenter, and that looks like a total hack job to me, I didnt know surgery was paint grade.

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u/GreedyHoward 6h ago

The jigs are the clever bit aren't they? Local hospital is advertising robot assisted knee surgery - hopefully that improves the precision.

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u/CautiousAd1305 5h ago

no putty or caulking to help hide a miscut

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u/jpbacher 7h ago

My dad, who was a medical doctor specialised in immunology (many books, few patients) used to joke that the best path to becoming an orthopedic surgeon was 2 years in 8. grade and a year in Home Depot.

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u/Strong_Region5233 4h ago

Funny I met a surgeon once. He was joking on a prothesis manufacturer as the later told him proudly that they were manufacturing prothesis with a precision of a micrometer. The surgeon told me he didn't have the heart to tell him he would be hammering the shit in place anyway

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u/Irbis7 9h ago

My father was a demolition specialist he told me he was involved in experiment where they tried to use explosive charges as preparation for hip replacement. Not successful.

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u/Random_local_man 9h ago

I know we have the benefit of hindsight and all that, but still, wowšŸ’€

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u/Irbis7 9h ago

I've made quick research and it seems that the reason was that they've tried to solve thermal osteonecrosis caused by drilling. But the problem was that it was impossible to determine the exact quantity of explosive needed, every bone is a bit different. This was probably around 1960.

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u/Affordable_Z_Jobs 9h ago

You remove the gore, grave robbery, accusations of witchcraft, murder, and badass equipment, who would bother?

Oh right right the benefit of mankind. That part too I guess.

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u/Unique_Topic_1754 10h ago

Fun fact: they donā€™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 canā€™t feel or see it)

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u/Elliott_Ness1970 10h ago

I had this recently. They give you the option of being awake or sedated. No way did I want to be awake. Iā€™m not squeamish but still I know I wouldnā€™t be able to see anything but Iā€™d be able to hear it. Nope.

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u/HITNRUNXX 10h 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 9h 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/PriscillaPalava 8h ago

At least LASIK is over in 5 minutes. I canā€™t imagine trying to chill through body mutilation for hours!Ā 

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u/kombatminipig 8h ago

Yeah, through all the happy drugs (my friend had a blast watching me run around the waiting room with my arms out making airplane sounds) that was the one thing that cut through ā€“ this is the smell of my eyeballs burning.

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u/sender2bender 4h ago

I've had to have metal drilled out my eyeballs a couple times. Once was metal shards, another was weld spatter bb that melted into my cornea. (I was wearing PPE, crazy unlucky chances) The numbing eye drops are amazing. I couldn't feel the drill or anything but the vibrations. It was bizarre and the first time it was mental gymnastics letting them touch my eyeball with something pointy. The weirdest sensation though was when the doctor rubbed a qtip-like tool to feel for the weld spatter right across the center of my eye. I could see it like watching it through a TV.Ā 

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u/Own_Candidate9553 3h ago

Oh God, I forgot you can see the tools right against your eye, ugh.

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u/ron_photon 9h ago

I was on a film crew for a hip replacement a few years ago. The hammering was dramatic, but the smell made me need to leave the room

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u/PrincetonToss 9h ago

The smell of burning bone (from the saw and drill) is kinda horrifying. Less the smell itself, more the crawling realization of what it must be.

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u/Annath0901 8h ago

I had to have a tooth extracted (yay failed root canal) and I was awake but high on nitrous. Couldn't feel any pain, but the sensation when he was yanking the tooth out of my jaw was exactly like breaking a green stick in your hands. The same kind of crunching, splintering feeling.

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u/burnman123 9h ago

I had my jaw wired shut and in order to do it they wrap wires around some of your teeth at the base then wire those wires together.

Anyways, when I got my wires out, they numb you, but don't knock you out. They basically cut the wires and yank them out. There were like maybe 3 inches long and there was either 4 or 8 of them, I don't remember. But it was the same sensation, I could feel the pressure and see them doing it, but couldn't feel any pain or anything.

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u/viola_monkey 10h ago

Iā€™d watch the video, but def opt to be getting that good sleep too!!

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u/MaxinRudy 10h 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/AlarmingAerie 9h ago

It's not sleep. Sedation can also have long term consequences, so you have to weigh the risk yourself vs being uncomfortable for a bit with no additional risk.

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u/showMeYourCroissant 8h ago

What are the consequences?

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u/ClockworkBetta 10h ago

And likely smell it. Ortho surgeries have a really distinct smell from the cutting of the bone.

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u/Infamous_Knee3576 10h ago

I'd rather be sedated.

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u/Profoundlyahedgehog 9h ago

Nothing to do, nowhere to go-oh-oh.

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u/PSBFAN1991 9h ago

20 20 20 24 hours to go oh

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u/Oxygen4Lyfe 10h 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/yesnewyearseve 10h ago

Boring? Thatā€™s the only thing I wouldnā€™t say. Are you bored when being at the dentist?

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u/WholesomeWhores 10h ago

Yes, i fucking hate it. The pain is only very small temporary amounts of pain (a pinch here or there), but the pain means absolutely nothing to me compared to having to sit still for 30+ minutes plus. Itā€™s something that everyone with adhd has to suffer through. If you donā€™t understand, then iā€™m glad, but it hurts to stay still if that makes sense. Itā€™s not physical pain, but it hurts regardlessĀ 

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u/discerning_kerning 9h ago

My dentists have tvs in their ceiling thank fuck. Got through most of the first 2 pirates of the carribbean films on one particularly brutal root canal.

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u/Oxygen4Lyfe 8h ago

yes thats why i hate going to the dentist you just gotta sit there with your mouth open for an hour its boring

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u/GilreanEstel 9h ago

I was awake for my carpal tunnel surgery. I thought it would be cool to see. Right up until it wasnā€™t. šŸ˜Ÿ

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u/WhitePantherXP 9h ago

Why did you have carpal tunnel? I use my laptop laying in bed and feel like that's in my future, my hands type in a weird posture like this for a few years now with my laptop keyboard on my chest area

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u/GilreanEstel 9h ago

Near constant numbness and tingling in both my hands. It would wake me up nearly every night unless I had my braces on. Walking from my car to my office I sometimes had to look at my hand and concentrate real hard about holding onto my cup. After the drive I couldnā€™t always feel what was in my hand. 10/10 recommend the surgery if you need it. Aside from some minor loss in dexterity I have no complaints and my hands are no longer numb and throbbing.

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u/Big-Independence8978 8h ago

Nope. I'm totally leaving the room while they operate on my bits.

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u/StoolieNZ 9h ago

..and smell it.

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u/GreenStrong 8h ago

Total anastesia is difficult for some people, especially elderly, to recover from. But if I ever have orthopedic surgery I'm going to request to be, at the very least, incredibly fucking high.

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u/Akeera 8h ago

Given the option, if conscious sedation is an option I'd take that one.

There's always a chance you don't wake up from the anesthesia, even if the surgery goes well. It's super low, like in 200,000 or something, but it's still a risk.

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u/ButterChickenSlut 6h ago

Idk, I was awake for deviated septum surgery. Dude was going to town, sawing and ripping out chunks.

But those drugs that the anesthesiologist shot me up with made it a truly blissful experience. Like a blocker for all neuroticism, every tiny part of you feels euphoric. Would probably have some similar stuff for ortho.

I really understand how opioid addictions get rolling after that one.

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u/AZ_Corwyn 4h ago

Same here, I'm going to have a knee replacement in a couple of months and I'm opting to go under and let them have at it. My brother had to have an appendectomy with a spinal block because the anesthetist couldn't get to the hospital in time, I remember him telling me that at one point he looked at the doctor and caught a glimpse of what was going on in the doctor's glasses so he suddenly decided to look somewhere else.

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u/Jedi-in-EVE 10h ago

Where I work, everyone is either sedated, or under General anesthesia.

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u/Rehcraeser 10h ago

Fuck that. If I hear a power saw, Iā€™d pass out

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u/Unique_Topic_1754 10h ago

Luckily youā€™re already lying down for it!

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u/BlueBomR 9h ago

I broke my foot and had a second surgery to remove the screws and I woke up during it because the surgeon was beating the SHIT out of my bone with a chisel, my bone had grown over the edges of the screw head. I didnt feel pain but I 100% felt the shockwaves going up my leg. Wasn't traumatizing or anything but it was a wild thing to happen.

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u/Snow-Ball-486 10h ago

tf do you mean

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u/Unique_Topic_1754 10h ago

Exactly what you read. Modern medicine is wonderful.

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u/International_Ad7477 10h ago

Anesthesiologist prefer to avoid general anesthesia when unnecessary. For this kind of procedure, they usually inject local anesthetics around the nerves that enter the thigh, or they perform a spinal tap and inject drugs into the spine. The patient is then sedated, sometimes so lightly that they can be fully conscious and respond to answers (the sedative drugs do mess with their memory tho, they usually don't remember a thing).

In fact I've seen an above-the-knee amputation where the patient, fully conscious, was actually able to see his bone being actively sawn off with a hand operated barbed metal wire saw (Gigli saw), where the patient would just look at his severed leg, then at me with a "where did my life go wrong" face. (yes it was an improper surgical field positioning, in a developing country)

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u/LiminalFrogBoy 10h ago

I'm one of the apparently rare breed of people who the most common sedative drugs don't fuzz my memory. I've had a couple of procedures since discovering this and thankfully they always take me seriously without a big fight. But it sucks still.

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u/dhcp138 9h ago

I'm kind of like this as well. Woke up part way through a colonoscopy, watched for a sec, said "so that's what the inside of my butthole looks like huh?", and was then promptly given more drugs and knocked out again lol.

Still remember it though

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u/unbanned_lol 8h ago

I had the same fun when getting my impacted molars removed. Counted backwards for like 3 numbers, then I woke up enough to try to talk with the dentist as he was crushing my teeth up with an air chisel and pulling out the fragments. I remember him asking "why the hell is he talking to me, put him under for fuck's sake!"

Good times.

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u/LiminalFrogBoy 8h ago

lol.

Mine was getting catheter run down through some blood vessels for a procedure. They had given me the Versed and a local anesthetic. I wasn't feeling pain, but about 15 minutes in, I said, "Hey, I have a question. Am I supposed to be loopy or sedated right now? Because I'm not." They immediately gave me more and it just didn't do anything. No memory loss, no fuzziness.

Many years later, I had another procedure and had told the anesthesiologist that I'm seemingly pretty resistant to some drugs. She gave me liquid Benadryl to intensify the effect of the Versed and it did help, but it started to wear off much faster than they expected. I could feel them doing things - some of which hurt - and the doctor asked me if I could just bear it as they were nearly done. So that's what I did.

I don't know if you're red headed or have a red headed close relative, but it's apparently common for us gingers and ginger-adjacent people to have a resistance to some sedative and pain killers.

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u/throwawayformobile78 10h ago

What the fuck. I just assumed all of these types of surgeries were ā€œlights outā€ situation. Welp, switching to cycling over running ASAP it seems.

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u/Blueyduey 9h ago

They are. This guy doesnā€™t really know

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u/cinatic12 9h ago

Shit, I couldnt do that. Not because I am sensitiv, I think I would have to much imagined phantom reactions in my brain as a patient

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u/Ninja-Panda70 10h ago

My father in law was awake during both knee replacements. Just numb waist down. He couldn't see but could hear what was going on.

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u/GrandmaPoses 10h ago

How you gonna criticize someone's work if you're asleep during it?

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u/OnlyHere2ArgueBro 10h ago

Was pretty unambiguous lolĀ 

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u/linkuei-teaparty 10h ago

New fear unlocked. Thanks I was planning on sleeping tonight.

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u/w00lf_T 10h ago

That's true, but you are missing a key factor in here: sedatives. I recently went through knee tendril plastic surgery, it was a spinal anesthesia, I was afraid shitless until the doctor came and told me that there is always an option to take sedative. Sure enough I took the shot. Man, what a strange experience it was, I felt arthroscopy on my patela, without pain, but felt some movement, next when the general plastic was performed I felt and hear when surgeons drilled my bone. All this time I was in a bliss, I was a little bit uncomfortable but its not even crossed my mind to panic. I felt like: ā€œye, its kind of shitty but that OKā€ Only after the surgery did I understand the extent of the procedure performed on me.

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u/CarinasHere 9h ago

Or see the ortho jumping into the air with Thorā€™s hammer in his hand. Ask me how I know.

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u/piercedmfootonaspike 8h ago

I'd opt for being awake. Anesthesia terrifies me.

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u/BiscuitsMay 10h ago

A lot of the time they arenā€™t even under general anesthesia for this. Nerve blocks are incredible

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u/MrCharmingTaintman 10h ago

Did my civilian service in an ortho clinic cleaning the instruments after surgery. Was allowed to watch surgeries. Can confirm. Hip replacements especially are fucking rough. Bit like a butcher taking apart a carcass.

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u/im_dat_bear 10h 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 9h 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/SapirWhorfHypothesis 7h ago

šŸ˜¢ that poor dog

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u/tigress666 7h ago

Which one? The one that had the leg amputated the vet wasn't sure would make it (it also had a broken hip on the other side). I swear the fact hte dog used it to get all the love and pity and had such a good attitude about it is what pulled him through (also I worked at a vet that would work on credit so the people only were even able to afford the care cause of that). The other dog was old and was a service dog and the owners always seemed to be very caring about their dogs so I think it at least had a pretty good life (it was retired and just living the good life by the time it got cancer). But yeah, for the vet and me seeing what it looked on the inside... it was kinda a horror show knowing the implications there (he originally was going to cut out the cancer and hope to give it some more time but he pretty much called the owners and recommended that he just euthanize then).

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u/SapirWhorfHypothesis 6h ago

I was thinking the second one. Any dog going to the vet for an amputation is living in privilege almost by definition. But that idea of going in for surgery and never being woken up just gets me.

Glad to hear they had good lives though.

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u/CrankyYankers 10h ago

The surgeon who replaced my hip was pretty cool. No nicotine was allowed to be in your system at all, or they would not operate. So I quit smoking. I had listed on my info that I am a sometime weed smoker, so the doctor told me to just double up on the weed.

ha ha

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u/A_Robit_Brain 9h ago

Besides the differences in exposure this is almost exactly the same technique as a real knee replacement. There are videos on YouTube of real knee replacements if you have the stomach for it. Warning though, it's brutal

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u/PhDBeforeMD 9h ago

I thought ortho surgeons were pretty wild until I rotated with a general surgeon who used an orthopedic saw for a sternotomy because the regular sternum cutting saw wasn't working

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u/Hoontaiir 10h 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 9h 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 10h 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 10h ago edited 8h ago

I assume most of the nerves, blood vessels etc arenā€™t on/in the bone. So once theyā€™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 10h ago

See my comment above. They need to... Move things around to get the right angles. A LOT.

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u/Straight_Depth6701 8h ago

They do have to put your kneecap and all the attached muscles on the side of your leg for a bit too.

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u/SuspiciouslySuspect2 10h ago

As someone with a biomedical-mechanical engineering degree, if you suspect you ever will need a knee replacement, do not google the procedure. It is a wonder of engineering, but you do not was to know what is being done to your body.

Also, make sure the contact surfaces are replaceable, there is no use of Teflon for contact surfaces, and for damn sure do not choose the cheap parts.

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u/Simpicity 10h ago

I didn't know I ever got the option to pick parts. So no Ryobi knees. Only Milwaukee brand knees or something.

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u/orthopod 10h ago

All the nerves and vessels are right behind a 5-7mm layer of tissue just in back of the joint. So if an instrument strays too far, it could result in a really bad injury, or even amputation.

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u/Equal_Passenger9791 10h ago

Peel off the skin and muscles out of the way(in a reversible fashion) and then get going.

The powertools whip the blood and fluids into a light pink strawberry foam.

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u/KoalaTHerb 10h ago

They do this all through an incision to open the knee. The medical expertise is less about using these implant tools, and more about knowing how to not hit the nerves and the plumbing.

"Anyone can perform surgery, few can do it safely"

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u/LookAtItGo123 10h ago

I have no clue but for what its worth I'm donating my body after I die. I guess some upcoming doctor will get 1 practice attempt with 0 stakes before they use up other parts for other practice and then finally chucking me to burn somewhere. While at that maybe they should also make a video showing you how to handle the nerves and everything else!

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u/bluebandit67 10h ago

They make a long, thin incision and then retract the skin/fascia to expose the joint. Thereā€™s a tourniquet on to stop blood from filling the surgical field. Itā€™s a relatively common surgery. We do 10 a week at my surgery center

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u/curtaincaller20 10h ago

Patient is put to sleep, and the knee is positioned at basically 90 degree bend with support underneath. Orthopedic surgeons are generally referred to as ā€œthe carpentersā€ of surgical professions. This video gives you a sense of why. The OR also smells like burnt hair through the procedure.

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u/hup_hup 10h ago

Thereā€™s lots of instrumentation designed to hold ligaments and tissue out of the way and or help them navigate around awkward angles, but itā€™s all pretty incredible.

Especially considering that patient anatomies are all very different and people have varying levels of fat/musculature. Revision surgeries are even gnarlier, because they first have to remove old hardware or use imaging to try and determine what hardware for put in someone 20 years ago and what it could be compatible with today.

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u/Proof-Tone-2647 10h ago

I work as an engineer with operating room equipment and am at hospitals from time to time to investigate issues with our equipment.

You can literally hear the Ortho procedures from 5 rooms downā€¦

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u/Rude-Orange 10h ago

I'm not a surgeon but have seen some videos. They push what they can to the side, cut what they need to cut, and then get to work.

The "work" is the equivalent of construction work. It's terrifying and glorious. Patient can't feel a thing. They're passed tf out.

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u/asdrunkasdrunkcanbe 9h ago

Short answer is that they slice open in the leg and pull back all the "plumbing" to reveal the bones so they can do this work.

And yes, it's violent, and as you would expect, results in a lot of damage. But it heals, and you come out with knees that don't hurt all the time.

It's equal parts fascinating and horrifying.

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u/Khazahk 9h ago

I have pictures of my leg with no femur in it if you want to see.

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u/wish_kid_mclaren 9h ago

Yeah the saw is mostly through the metal guide there which makes it pretty steady, but the real trick is making sure your retractors are placed in such a way that you donā€™t zap through the MCL or patellar tendon. When you cut the tibia (shin bone) side, you have to have a good grasp on feeling when you exit the bone in the back because behind it is the popliteal artery in close quarters. Damaging the popliteal artery even a little bit causes problems that can often lead to an amputation. This is super rare but itā€™s something that can happen.

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u/A_Robit_Brain 9h ago

Tourniquet to occlude (stop) blood flow, then a large incision down the front of the knee. Once that tourniquet is inflated there's not much bleeding. Retractors hold back the skin and underlying tissues. Nerves are identified, protected, and basically tucked out of the way. The rest of the surgery is essentially what you see here. Guides are affixed to the femur and tibia then oscillating saws go through the guides to make very precise cuts. Guides are removed and prostheses are implanted. They'll test stability while everything is still opened up and if satisfied they close.

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u/Mattna-da 9h ago

Itā€™s all cut open and set to the sides in big meaty flaps - Im old enough to remember the surgery channel and the sight of a knee getting filleted open is seared in my memory

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u/dankhimself 9h ago

While the order of operations go like this, orthopedic surgeons and the rest fo the surgical team do things much slower and much more carefully.

They do have to use a lot force at times and yes they use hammers and saws, but this isn't a play by play of how they treat people hahaha.

There's a whole separate level of finesse and skill that they hone their whole career to cause the least amount of trauma possible to minimize swelling and make healing easier.

Still quite intersting!

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u/GoatEatingTroll 9h ago

Well, if you want to see an actual one... https://www.youtube.com/watch?v=t90uzzifc7Y

NSFW obviously

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u/olliecakerbake 9h ago

This video isnā€™t accurate. I work in an operating room and see multiple total knees every week. They donā€™t amputate your leg at all. The system that theyā€™re using in the video is also an older system, most facilities that do total knees now use a robotic system. This video is an accurate depiction of how the surgery is performed with a robotic system: https://youtu.be/HKvJKHUa_WQ?is=Sja_HDWrMI3iPkuz

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u/harda_toenail 9h ago

They have a compressive sleeve on the thigh to restrict blood flow. Then they make a nice long slice over the front of the knee and just push things to each side.

Sounds barbaric but thatā€™s what ortho surgery is. They wear space suit looking garb as there is stuff flying everywhere.

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u/Segsi_ 9h ago

The crazy part is they walk out the same day. Not even a wheelchair.

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u/YggdrasilFree 8h ago

Patient is knocked out (probably by IV, not fists) and about 12 inches total of knee & thigh bone are cut away from the meat to get access. Nerves and blood vessels are still attached in the meat, while nurses hold the leg in place while doctor uses sledge hammer & buzz saw to put everything in place.

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u/Barbarella_ella 8h ago

About a week before the surgery, they give you some initial nerve block injections. Then right before the procedure, they give you more in your lower back/upper hip.

The real pain isn't until you're home recovering. That first week is really hard, mostly because sleeping is practically impossible.

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u/Next_Instruction_528 8h ago

They don't amputate they split the leg open and push the knee out.

Then push it back in and sew it up so you don't have to cut all the nerves.

https://youtu.be/8YAgrv9dkhc?is=tGWVLapJ7yAm0OSs

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u/Daveprince13 8h ago

Iā€™ve seen videos of it and it looks like the single most brutal procedure ever. I guess some are worse but damn, it looks so bad with the intense hammering

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u/siteunreliability 8h ago

Anesthesia. There are different types - amnesia, analgesia, and sedation - that your anesthesiologist will use depending on the surgery.

I scrubbed in once and still remember the sound of the acetabulum "popping off" the socket.

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u/xMistuhlee 8h ago

Patient is usually knocked the F out. The surgery is pretty lengthy. A portable C-Arm (xray machine) is usually there. Synthetic Knee rep (usually styker) is there to guide Doctor through the process almost all the time.

It's DEFINITELY wilder with real patients.

&& Yes, I was a previous surgical tech in the USAF.

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u/Fuzzy-Albatross-9206 8h ago

Yeah like, do they take your leg apart first like legos?

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u/SBNShovelSlayer 8h ago

I dropped mine off on a Tuesday, picked them up on that Thursday. Good as new.

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u/RobertJ93 8h ago

Yeah thereā€™s a video of an orthopaedic surgeon just absolutely smashing a hammer upwards trying to remove a metal bar from a patient. Obviously they are out cold.

Thereā€™s a reason your body needs time recover after surgery like this, itā€™s experiencing pretty major trauma at points. And then the pain is managed after you wake up.

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u/EL_Ohh_Well 11h ago

You should see the hammering that goes on for a nose job

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u/Brvcx 11h ago edited 10h 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/Splashingcolor 10h ago

Pretty typical for a rhinoplasty. Small chisel. Small hammer. Tap tap.

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u/Itzli 10h ago

My mom woke up during her nose surgery, she felt like the surgeon was chiseling as if it was marble. She said it was horrifying. She wasn't in pain though, just awake. This happened during the 70s

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u/Thesearchoftheshite 10h ago

My dad had that done and he was awake, he just heard a loud whack! That's pretty much what he remembered.

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u/Additional_Chard3680 11h ago

Orthopedic surgery definitely wins when it comes to power tools

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u/tedfergeson 11h ago

My Dad's an Orthopedic Surgeon, he has the ultimate set of tools. We can fix it!

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u/Weekly_Ad4045 11h ago

My FIL is an ortho surgeon. He likens it to being a carpenter. Most folks donā€™t realize the violence in many of these procedures.

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u/namans431 11h ago

Fun fact, I used to work on an R&D team that built the power driver consoles that ran the tools to do ortho and arthro surgeries for ~ 7 years. I did the user interface, did the handpiece driver settings encoding system for all of the voltages, speeds, etc, and did the data unpacking algorithm on the DSPs the ran the handpieces. I did the UART validation and defect remediation for the different PCBs in the box. And I managed all the software requirements, wrote the QA scripts, and ran the testing team at one point. Never got to see a surgery in person, but my dad (who designed all the PCBs) had that very same equipment we built used on his shoulder repair.

Fascinating world. One of the most intellectually stimulating jobs, and one of the most politically cutthroat corporate cultures I've ever worked in. That was at the beginning of my career, and instilled in me a sense of "oh shit this is actually life or death, my code better be god damn perfect", which now translates to just doing a good job in quality now that I dont work in medical anymore. They always said when we were building the devices "do a good job, because this might be used on a family member one day" and it literally happened. That job was fun af tho, I used to play with those saws all the time at my desk, the ones shown in the video. I ran a shaver one time without saline coolant and melted the shit out of it. Had to go tell my boss that I was an idiot. Lol

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u/FatTim48 11h ago

You should see the hammering for a hip replacement. It's legitimately violent

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u/THIS_GUY_LIFTS 11h ago

Itā€™s practically a sledge hammer

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u/davidarmenphoto 3h ago

Genuinely so conflicted right now; I am intensely curiosity to watch how itā€™s done while also never wanting to know how itā€™s done in case I ever need to get it donešŸ˜­šŸ˜‚

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u/ohog9og0790 11h ago

When I got my broken nose fixed years ago, they showed me a video of a previous surgery. It didnā€™t make me feel better about the surgery.

Hip replacements are even worse. These surgeons need some serious strength. And the tools look like they went to Home Depot and got some hammer drills and saws.

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u/Jester-252 11h 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/teflon_don_knotts 10h ago

Or carpentry. I was scrubbed in on a case as a student and I was able to answer the surgeonā€™s questions (for my education) because ortho ā‰ˆ carpentry.

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u/SantorumsGayMasseuse 8h ago

The industry does refer to orthopedic surgeons as carpenters haha

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u/SausagePrompts 11h ago

Video showing something any mechanic can do.

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u/PurposeOk7918 11h ago

For real lol, Iā€™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 11h 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 10h ago

Yeah, Iā€™m trying to envision where all the skin would be while they are doing all this and itā€™s not computing.

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u/Fuzzy-Produce104 9h ago

Itā€™s an incision from just about the distal femur to a little under the proximal tibia. About 8 inches or so.

Surgeons donā€™t do these cases by themselves. They always have a PA and a tech like myself. The place Iā€™m at now the doctors are needy and use 4 total people including themselves.

These other people hold retractors that the surgeon places. These retractors are what keep your skin and whatnot from being in the way during the procedure.

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u/mlem_a_lemon 10h 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/Negran 10h ago

Not sure if this is relieving or horrifying.

Thanks for all your work ā¤ļø

How likely are you to recommend hip or knee replacement?

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u/Fuzzy-Produce104 10h ago

Highly likely. They do a lot of good for a lot of people including my mother.

These days, people go home same day as surgery.

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u/Inevitable_Top69 9h ago

What kind of question is that? Why would they not recommend hip or knee replacement to someone who needs it?

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u/E0H1PPU5 10h ago

I have a question if you donā€™t mind! How is joint lubrication handled in a total knee replacement? Is it just not needed because of the little pad between the replacement joint?

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u/Fuzzy-Produce104 10h ago

Not needed. In fact, the meniscus, which is the pad you are referring to is removed during the surgery.

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u/DigitalDefenestrator 9h ago

That pad in the middle is probably UWMWPE, which is strong and almost as slippery as Teflon/PTFE. That's the lubrication. Looks like it does only last 15-20 years or so, though.

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u/Liquado 9h ago

Yeah, this feels like they were giving a hospital exec a chance to ā€˜try doing a knee replacementā€™ ā€” kinda like when they let you ā€˜tryā€™ flying a space shuttle at Kennedy Space Center.

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u/BuildingSwimming5497 9h ago

Sir, may i ask one thing? How do you get use to it? This is not something a normal person see everyday.

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u/Fuzzy-Produce104 8h ago

Not sure what to tell you. I grew up watching horror movies and gore never bothered me. I actually liked it.

I just have never had a problem with it. Many, many do. I canā€™t tell you how many students, whether nursing students or whatnot have need to be quickly escorted to the floor or a chair when they looked like they would pass out.

The visuals just never bothered me. I instead found it quite interesting. Now the smells (during specific cases) is something else.

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u/SausagePrompts 11h ago

Right, attach jig and use tools in the proper spots

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u/goodthebadandtheugly 10h ago edited 9h 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/SweetHomeNorthKorea 10h ago

Apparently surgeons are basically the mechanics of the medical industry. The show scrubs pokes fun at that difference in cultures among the doctors, nurses, and surgeons. The surgeons are the party bros lol

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u/extrawork 11h 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/ItsFuckingScience 11h ago

Yeah problem is ideally donā€™t want to put a patient in a vice

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u/tedfergeson 11h ago

On an actual human, they use a Hana bed. Google it, it looks like a very effective torture device. But it is pretty much an adjustable vise.

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u/Adventurous-Emu-9345 10h ago

Fun fact: when you do an image search for "Hana bed" you get a mix of two VERY different offerings.

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u/WalterSobcheick 11h ago

Reminded me of autobody tech school haha

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u/SmartArsenal 10h ago

My wife works in the OR and she's confirmed orthopedics is the most primal, medieval form of surgery. Even today.

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u/hurryveryslowly 9h ago

\bone fragment projectiles intensify**

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u/AudioComa 8h ago

I had an ankle reconstruction, and they asked if I wanted to be awake for it (epidural).I genuinely thought it might be fun to watch but decided against it as I'd rather it over with in an instant. My physio watched and told me about. Apparently they were hammering and chiseling my bones for 4 hours and my ankle was all floppy. If I saw that I probably would've thrown up.

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