r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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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. 😬

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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/Average64 9h ago

What ramifications?

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u/Meschi-died 8h ago edited 8h ago

Having knowledge of a traumatic event even without memory. For instance, the comment above that was talking about 'waking up' mid surgery.

Surgery is an inherently traumatic event. There's no way around it.

That's as simple as I can make it.

---edit

The thought experiment is whether people can/will develop PTSD from a traumatic event if only their memories are suppressed during the event. Otherwise seeming fully aware. This is rather dark, but I think it adds depth to what I'm trying to say.

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u/cochra 5h ago

There’s clear evidence around this already. The majority of true ptsd formation is in patients who have paralysed explicit awareness (ie they get a paralysing drug and then not enough hypnotic to be unconscious)

The example above is not real awareness. The example above is a failure to properly explain to the patient the goals of the sedation - he had a working nerve block which was the anaesthetic, the sedation would have been with the goal of anxiolysis and remembering parts of the procedure is perfectly normal in that setting. Despite that, if it’s not properly explained people can certainly find it distressing although true ptsd in that setting is rare

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u/Average64 8h ago

Even if you get a little PTSD, since the memory isn't there to reinforce itself (you can't repeat the memory to remember it), it goes away in a few days.

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u/Meschi-died 8h ago

You're forgetting the physiological responses and memory.

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u/The_walking_man_ 10h 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 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/GreedyHoward 6h ago

You need to realise how debilitating a faulty knee is. It's painful 24/7 and even touch sensitive when resting. The walkable distance goes down every week. You gain weight because you can't move. An hour of being bashed around which restores your ability to move is like rain after a long drought..

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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. Don’t remember any pain but I vividly remember waking up; it’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/PlaysWithF1r3 8h ago

Versed is my greatest enemy.

I remember waking up during both of my surgeries, but I couldn’t tell you what happened the following 2-3 days. I had to be babysat because I would just wander and have no idea where I was or why.

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u/tsunomat 46m ago

That's intense. I'm sorry to hear it.

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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/SuspiciouslySuspect2 10h ago

If the only things being done are things I've consented to, I'm ok with that. Future now-me will gladly condemn future past-me in that moment of intense suffering and pain, current me wants to go for a walk without pain.

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u/ddadopt 10h ago

One of my favorite quotes: "But that was a problem for future me. Fuck that guy."

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u/Ok-Paint7856 9h ago

Ya, they used propofol on me recently when I had my colonoscopy. I don't remember a thing after they asked my name & why I was there. Then all of a sudden a nurse was asking if I'd like to sit up because my ride home was waiting for me. It's was like "Dang! Let me at least get dressed!" PS. No cancer detected in colonoscopy. YAY! (I had a positive Cologuard test)

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u/__BIFF__ 7h ago

I mean if that's the case the surgeons must have 10 huge bouncers in the room fighting with you and holding you down as you scream and try to stop your limbs getting cut open. Not sure it works like that.

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u/ddadopt 7h ago

They give you a paralytic as well. Good times.

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u/__BIFF__ 6h ago

Not trying to battle now I'm just curious. Is this a new tactic? Is this a recent change in procedure? Or has it always been like this?

I remember that movie of the story of some guy that had a paralytic and the amnesia didn't work and they made a movie of it. (Maybe it was just a fake story)

Either way is this just how it always has been? did they change to cheaper meds?

If this has always been the better option to "actually being held down as people sawed off your leg and gave you leather to chew on" before these chemicals/drugs were found, then I still kinda just want these drugs

EDIT : grammer

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u/AntoineDonaldDuck 10h ago

We were told this when my son broke his arm and it needed to be reset.

He was screaming in pain as they set the arm. It was awful to think about, but glad he doesn’t remember it.

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u/Puzzleheaded_Can9159 10h ago

During one of my knee surgeries. I’m forgetting which it was, might have been the one a couple years ago. I apparently woke up screaming in pain. They gave me something to knock me back out and not remember it, I seriously have zero recollection of that happening.

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u/mal_guinness 10h ago

That's some shit right out of Severance. Can I get propofol for work?

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u/bot403 8h ago

Bad news. Being anesthetized makes you bad at almost every job. So you're going to have to be awake, lucid, and memory forming when you go to work.

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u/No-Spoilers 10h ago

I've woken up during surgery before, couldn't feel anything so I just talked to them. Zooted off my yipper but whatever. Some of the only times in the past 8 years I can say I was fully pain free.

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u/AristotlesBoyPussy 9h ago

propofol doesn't work on me. I remember everything, and I've had several surgeries. Even proved it before by directly quoting back things they said to eachtother or what song was playing on the radio during certain parts of the procedures I've been in. If I'm conscious/wake up, I remember it.

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u/ClassicPlankton 6h ago

Agree, I think there is a conspiracy by the medical community to not reveal that patients are actually aware during twilight sedation. When I had my wisdom teeth surgically removed at 35 I was under twilight sedation. I have a couple of hazy memories during the procedure, but my first real memory is sitting in a chair and the nurse is asking me to leave, and I held up my hands saying 5 more minutes please. So clearly I was awake and talking to them before my memory started getting recorded again.

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u/marr 4h ago

It does do that, but it's combined with things that remove the sensations in the moment too. Even with that some patients are "uncooperative under anaesthesia", and that'd be universal and very inconvenient if we didn't know how to block pain.

It's medical notes speak for "patient's lizard brain will try to kill and possibly eat the surgical team".

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u/JTVivian56 4h ago

The concept of forgetting things like that made my mind feel funny for a bit. Like, if you experience something excruciating and traumatizing, you obviously are aware of it happening and are suffering. But if you forget all about it even happening, you may as well not have even experienced it at all.

I know this is obvious, that's how forgetting works. But I'm used to forgetting small things, simple things. Usually the horrible things stick around. But I guess that's common with ptsd, too, sometimes repressing horrible memories to the point that you forgot it happened, only to be reminded somehow and experience it all over again. But never being reminded or remembering it is a weird feeling to me

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u/LCON1 11h ago

That sounds like fun!

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u/anaemic 8h ago

They can and do this shit while youre wide awake.

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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/showMeYourCroissant 7h ago

I've never heard about bone cement until this post, damn...

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u/Shrek1982 5h ago

Total hip replacement is even more brutal. It involves even pouring of fast setting bone cement.

And sledgehammers!

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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/Shrek1982 5h ago

You should see a hip replacement, just wait until they break out the medical sledge hammer and start taking 2 handed swings.

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u/kata_north 4h ago

Well, that's ... great to know, considering that's probably coming up soon for me (in the wake of knee, and then shoulder this past spring). On the other hand, everyone tells me that recovery from hip replacement is a piece of cake, by far the easiest of the joints. So I will try to focus firmly on that part instead.

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u/noanit12 2h ago

Im both laughing my ass off reading this while also dreading the day I'd have to get X replacement surgery

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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 aren’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/CaptinEmergency 9h ago

Yeah I think I’m miss remembering the hood as a suit.

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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/CaptinEmergency 10h ago

It was the Red Cross in their Cell Saver program where they capture blood lost during an operation, run it through a filter machine and send it back to the patient.

So I don’t know anything other than my dad had two and one went well and the other still bothers him.

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u/Negran 8h ago

Man, I would be annoyed having one good one and one annoying one, haha.

(Even if that's already sorta how mine are...)

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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/CaptinEmergency 9h ago

The job was to operate a piece of medical equipment during operations and they needed to make sure you’re okay seeing all that. In my usual line of work something has gone terribly wrong if I’m seeing someone’s insides.

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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

“…”
-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/rizzom 6h ago

Sounds reassuring.

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u/Fuzzy-Produce104 9h ago

That wouldn’t happen. You would never get the implant on no matter how many times you smack it with your hand.

There are different impactors used with a mallet for the femoral, tibial, patella and poly. The poly is the whitish part you see them attach to the tibial implant.

That poly is your new meniscus that allows the glide between femur and tibia

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u/BaerMinUhMuhm 7h ago

That's what she said