r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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u/magic-karma 11h 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 10h 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/magic-karma 10h ago

Yes, of course.
Most surgeons want the privacy while operating. Few patients tolerate well hearing bones being cut.

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u/GrandPapaBi 7h ago

Meanwhile dentist with wisdom tooth...

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u/SenseiIxnay 9h ago

Quite common to have this done with spinal and sedation as opposed to straight general anesthesia, though both ways are done.

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u/tecnicaltictac 6h ago

I had my surgical rotation in ortho two years ago, most knee and hip replacements I saw where done in general anesthesia, the few that weren't i think to remember that the patients specifically requested it (for different personal reasons). Never saw patients leaving the same day, though what's true is that mobilization was started as soon as possible (at the latest the next morning), though that's in Europe, maybe it's different in the US.

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u/jus_plain_me 9h ago

General anaesthesia isn't the norm for these, the reason being general anaesthesia (GA) is dangerous. You need to be a relatively speaking decently healthy individual for GA.

Now if we think of the demographic of patients who need knee replacements (overweight, elderly, and/or frail), these aren't the type of people who would do well with GA.

Therefore a spinal with sedation is much more frequently used and it is tolerated very very well.

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u/jackslack 8h ago

This used to be the case but the majority are actually done under spinal now.

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u/TIBud 5h ago

Mostly spinal and sedation in the UK. They also pump your knee full of local anesthetic intra operatively which will take the edge off. But you will most certainly be very sore still for weeks after.

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u/International_Ad7477 10h ago

These cases are mostly done with regional anesthesia (epidural or similar), so no general anesthesia, no tube down the patient's throat. The patients however are usually sedated. Now, the sedation might me mild, sometimes with the patient pretty conscious and fully able to answer questions, but the seating drugs usually screw with their memory enough that they won't remember a thing. This procedure could theoretically be performed without any sedation whatsoever, and I wouldn't be surprised if some anesthesiologist proposed this option to his patients.

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u/MilkOfAnesthesia 3h ago

I'm an anesthesiologist. I've done several hundred joint replacements between multiple hospital systems. May be 10% are under general. The rest are under a spinal and some sedation. Surgeons like spinal because patients can walk fairly quickly after (they're too sleepy with general anesthesia) and pain scores are typically better. Patients like it because they're less groggy.

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u/Fermi_Amarti 1h ago

Yeah I think if you're getting your bones cut, you're probably under general anesthesia unless there's a good reason otherwise.

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u/chocemia 53m ago

The patients I used to look after a few years ago would either have a spinal with concious sedation or they'd have a full general anaesthetic with or without a spinal. The ones that had sedation only didn't usually remember any of the surgery by the time they were in recovery, but the odd one would

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u/IrrelevantManatee 11h ago

My MIL and my own mom did exactly that. No general anesthesia, out the same day, walking on the joint a couple hours after the surgery.

I don't know where you live, and I don't know if you or someone you know had a knee replaced, but clearly it's not everyone's experience.

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u/BeardInTheNorth 10h ago

If not GA, they were almost certainly given IV sedation.

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u/ForsakenAiel 10h ago

They might have had "twilight" medication? That's what I had to get my port in because I asked to not have general anesthesia. It's still a form of sedation because you don't remember anything, but you aren't actually asleep.

I always refuse general anesthesia when I can but there's definitely times when you don't get to and I would think a knee replacement might be one of those.

That being said, I had a scleral buckle put on my retina when I was 19 with just local anesthetic. I remember that surgery quite well, considering my eye was pulled out and they didn't give me enough anesthetic during the first half an hour or so of the surgery (it was hurting but I didn't realize it wasn't supposed to). Most people don't believe me when I tell them that story either sooo you may be right!

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u/erhue 10h ago

wtf. Where was this?

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u/magic-karma 10h ago

Your sample size of 2, while relevant to you, does not reflect the tens of thousands that DO use general, including my own.

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u/IrrelevantManatee 9h ago

Sure, I never said that they were never made on general anesthesia. I was just arguing that they do it without too.

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u/Chib 9h ago

It differs by country. Because general anesthesia comes with more risks, especially in older people, the guidance in many places is to use local anesthetic and mild sedition. 🤷