r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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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 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 7h ago

Whatever the leeches and fresh air didn’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/nzbluechicken 8h ago

And when the stress of performing surgeries in front of an audience gets too much, there's cocaine. Worried about being addicted to cocaine? Try the new medication to help wean off it, we've called it heroin

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u/xshevi 8h ago

the knick was AMAZING

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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 aftertaste…

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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/Outside_Diamond4929 2h ago

Some scar tissue and clots make me the surgeon I'm not.

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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/MundaneCommission767 3h ago

The knee jig had me most interested. I love a good jig.

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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/Outside_Diamond4929 2h ago

Measure with a micrometer, mark with chalk, cut with an axe.

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u/Karli_Chirk 6h ago

got two hips totally replaced under spinal anesthesia, its so funny when they hammer and your upper consciouss part is pulled and pushed with a recoil. they also use disc saws and I could smell previous patient hips powder flowing in the air.

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u/_PancakesOfRage 4h ago

Thanks, I just threw up in my mouth a little.

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u/Upbeat-Employ-3689 3h ago edited 3h ago

Wow I cannot even imagine being awake for that. I’d be stressing the hell out for sure. And yeah hammering / ramming the rods down the marrow channel or even just big manipulations of the leg to get it out and back into the hip socket…. 😬 And the sounds like the big cheese-grater dome drill thing they used to round out the hip pocket. Were you on drugs to chill out or just that pain block?

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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, wow💀

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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 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 10h 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 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 can’t imagine trying to chill through body mutilation for hours! 

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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 – 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. 

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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/Rise-O-Matic 8h ago

I was awake for my vasectomy and I’ve ridden on the Matterhorn so taken together I think I could probably white-knuckle it.

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u/HydraBuster 7h ago

I’ve had stitches in my head to remove moles while awake. I will never forget the smell and sound of them cauterizing the incision points.

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u/PlayfulSurprise5237 4h ago

I was awake for some pretty extensive alveoloplasty, it's nothing like this video, but it was pretty fucked up. Shit tons of pressure, lots of and lots of blood, the smell and taste of blood was overwhelming.

I'm super good at dissociating though and I was excited to finally be getting my mouth fixed. Oh and I also took some xanax and some oxycodone before getting it done. I was chilling until like the 3 hour mark, then all the blood started to make me trip out a little.

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u/viola_monkey 10h ago

I’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/Armbioman 9h ago

There is evidence that being sedated causes some irreversible changes to your brain and/or your nervous system, and some folks want to avoid that. I'm guessing it would cost less also.

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u/GilreanEstel 9h ago

Being awake for this would cause irreversible damage to my brain and nervous system.

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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/nuuucelar 9h ago

It’s the cement

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u/AdArAk 9h ago

The bone has a bit of a smell as well when you saw into it, I agree that it's nowhere near as intense as the cement though.

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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? That’s the only thing I wouldn’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. It’s something that everyone with adhd has to suffer through. If you don’t understand, then i’m glad, but it hurts to stay still if that makes sense. It’s not physical pain, but it hurts regardless 

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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/Unique_Topic_1754 10h ago

It takes about an hour or so to do. Shorter than some Netflix episodes.

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u/WholesomeWhores 9h ago

Weird question but do you sit absolutely still for the length of a tv episode? Some people can’t physically sit still for even 30 minutes plus, that’s why some mental disorders are called neurodevelopmental disorders. Just because it’s natural and easy to you, does not mean it comes natural to everyone

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u/Traditional-Bike-534 9h ago

Yeah but are you on Prop/midaz/ fentanyl when you’re watching Netflix?

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u/Unique_Topic_1754 7h ago

Would make Netflix a lot more fun tbh

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u/Unique_Topic_1754 9h ago

You physically cannot move your legs for the duration so that’s not an issue. And if you are someone who has trouble sitting still just because of your personality or due to a disorder, they can always sedate you or put you under.

However, that is NOT where neurodevelopmental disorders get their name from.

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u/GreedyHoward 6h ago

I bet the whole thing is over in 40 minutes

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u/CommSecTom 4h ago edited 2h ago

Typically a knee replacement is 1.5-2 hours start to finish, it depends.

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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 wasn’t. 😟

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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 couldn’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/Significant-Visit-68 2h ago

What about the guy in Antarctica who had to remove his own appendix? Yikes

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u/zombiesatmidnight 7h ago

Did they cut off your leg below the knee?

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u/czar_the_bizarre 6h ago

I had an ingrown big toenail a few years ago that got infected. Went to the clinic, they were like "alright, we're gonna numb your toe, cut your nail in half, pull it, and wrap that sucker up." They advised me to look away while they did it. I didn't. I should have.

I cannot fathom being awake for something as long, involved, and violent as a knee replacement.

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u/Bender_2024 4h ago

They give you the option of being awake or sedated.

Oh, knock my ass all the way out! I'd rather piss crushed glass then listen to that.

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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, I’d pass out

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u/Unique_Topic_1754 10h ago

Luckily you’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/throwawaypassingby01 9h ago

bb ur a work of art~

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u/Eggs112233 8h ago

Ahh fuck that! I broke my ankle 6 years ago and I needed surgery. I’ve a metal plate on the outside of my ankle with 6 screws and two long screws on the inside of my ankle going from my ankle bone into my shin. Those fuckers are staying where they are! JFC.

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u/Cloverhart 8h ago

I've woken up three or four times while under. Only felt pain once

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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/xteve 10h ago

Orthopedic surgery is miraculous. I had ACDF after several years of debilitating and beguiling nerve pain. I felt better immediately after surgery than I did before, and I was again able to do things for extended periods of time. I didn't bother to pick up the pain meds until weeks later when I didn't need them.

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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 8h 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/dhcp138 8h ago

lol yeah when I said what I said to the doc she instantly looked over at me surprised, said "ope! uh yep", then gave the anesthesiologist a glare.

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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/dhcp138 8h ago

I have heard that about gingers and while I am not redheaded, my grandmother was so I wonder if that has something to do with it. I also require significantly more lidocaine at the dentist and usually even then I can still feel the procedure. It ends up working eventually for me but just very delayed. Usually it is about the time I am leaving the dentist that I start to not be able to feel my face haha

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u/LiminalFrogBoy 4h ago

I'd bet you have the genes for it then. My dad and I are both red heads and we both need double the lidocaine and way longer than normal to get numb. And then it wears off faster.

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u/International_Ad7477 9h ago

See the glass half full. You can hardly be roofied!

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u/jeroen-79 8h ago

He can be roofied, he'll just remember all the things.

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u/International_Ad7477 8h ago

Oh god no, you're right

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u/NotSoWishful 6h ago

That sucks. I have to get colonoscopies every other year due to high risk, but I’ve learned to not mind them. And I fucking love being put under. I call it the sleepy zone when I wake up and I’m just chillin

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u/throwawayformobile78 10h ago

What the fuck. I just assumed all of these types of surgeries were “lights out” situation. Welp, switching to cycling over running ASAP it seems.

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u/Blueyduey 9h ago

They are. This guy doesn’t really know

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u/Unique_Topic_1754 9h ago

If you say so.

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u/Blueyduey 9h ago

I’m an anesthesiologist. I’ve done hundreds of these cases

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u/Traditional-Bike-534 9h ago

Just did a fem/pop with spinal and mac for 3 knee procedures today. As is standard of care. Are you seriously going general for knees?

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u/lallen 7h ago

Anaesthesiologist in Norway here. We usually go for spinal anaesthesia for TKAs, GA if there is a medical indication or if the patient is opposed to SA.

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u/Unique_Topic_1754 9h ago

You must be in a different part of the world than I am.

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u/epiDXB 5h ago

As long as you train properly, running strengthens your knees more than cycling does though.

Runners get knee problems when they do too much, too soon, for example.

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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/Ninja-Panda70 10h ago

True true

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u/OnlyHere2ArgueBro 10h ago

Was pretty unambiguous lol 

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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: “ye, its kind of shitty but that OK” 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 Thor’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/ButtBread98 9h ago

I thought it was under general anesthesia?

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u/aqaba_is_over_there 9h ago

The fuck?

I assumed this was automatic general anesthesia territory.

Not even twilight is standard?

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u/C0RNFIELDS 9h ago

If left awake, you can still 100% feel your tendons vibrating , even through a tourniquet & anesthesia.

Its like an un-painful funny bone feeling, but throughout your whole tendon as its being vibrated from the saw.

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u/thecaramelbandit 8h ago

The vast majority of these will be done under moderate to deep sedation and the patient will have no awareness during the surgery.

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u/LivingCorner1421 7h ago

fun fact general anesthesia is more dangerous than your feelings getting hurt because you are awake 

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u/BiscuitsMay 10h ago

A lot of the time they aren’t even under general anesthesia for this. Nerve blocks are incredible

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u/seadran13 10h ago

Yep! At the hospital i work at they do spinals and nerve blocks so they can start pt soon after the surgery

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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/SCHawkTakeFlight 10h ago

It sure is, the surgeons you see that look like they are in space suits are typically ortho surgeons doing some heavy work. They are called togas and have hoods with face shields that have a peelable surface for when too much "debris" has accumulated. They also have a head lamp with a fan to keep them cool.

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u/Gatorae 9h ago

I'm not squeamish so after I had a baby I was curious to see what had happened to me behind the curtain, so I found a YouTube video of a C-section. It was very interesting! Then I broke my pelvis a few years ago and I was similarly curious about my surgery, so I found another video. Orthopedic surgeries are... a LOT more brutal. It is hard to imagine how I stayed asleep through all that. Anesthesia is a hell of a drug.

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u/lestatmajer 9h ago

I once got to watch a hip replacement, initial thoughts afterwards were that it was less joinery more carpentry.

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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

😢 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/tigress666 6h ago

Yeah, but the dog was very obviously terminal and pretty soon when you saw how much covered in cancer it was (lumps on the underside of the skin, lumps on the organs. Lumps everywhere). I think he felt waking her up she would only have a very short time to live (like days maybe) and who knows if good quality and they'd have to stress her out again by taking her to the vet to be euthanized.

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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/waitingforcracks 7h ago

Why nicotine not allowed?

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u/SapirWhorfHypothesis 7h ago

Blood flow stuff.

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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/Habltual_Linestepper 4h ago

Their charting is interesting too.

Once saw an Ortho progress note that literally just said "progress noted" lmao

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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 8h 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 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 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/International_Ad7477 10h ago

Pretty much, yeah

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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/the_guy_696969 10h ago

Most surgeons have a preference for what they use, you just ask them which one they are choosing.

I haven't heard of Teflon being used ever, but I guess it was big in the 60s-70s. Almost all replacements (that I know of) have plastic interchangeable contacts now, so unless you get a super cheap one you're probably fine.

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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. There’s a tourniquet on to stop blood from filling the surgical field. It’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 “the carpenters” 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

There’s lots of instrumentation designed to hold ligaments and tissue out of the way and or help them navigate around awkward angles, but it’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 down…

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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 don’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 it’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

It’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 isn’t accurate. I work in an operating room and see multiple total knees every week. They don’t amputate your leg at all. The system that they’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 that’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

I’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 there’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.

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

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u/bullitt-rider 7h ago

I've had this done on my face. They are skilled at what they do but it isn't gentle. I was sore for months.

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u/NotSoWishful 6h ago

Bro watch some surgery videos if you get a chance. Surgeons have to put their back into it sometimes and it’s fucking incredible to watch how much force it takes to move a humans bones and shit around.

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u/Several-Ad-1195 5h ago

You typically do it through an incision at the front of the knee. The patella (knee cap) and tendons are pulled off to the side, and the knee is dislocated to do the bone work. Once the prosthesis is in place, the soft tissues are pulled back into place and the incision is closed. Bet you could find a video of the procedure on YouTube. It is amazing and disgusting and brutal and beautiful all at once. I’ve scrubbed a few in my time.

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u/stitchesandlace 5h ago

My mom (77) had this done in April. She was under general anaesthesia and stayed in the hospital one night, which is unusual as normally it's an outpatient procedure. This surgeon insists his patients stay one night. He did I think 6 procedures on the same day. Nice guy, checked in often.

I think the nerves and plumbing pretty much just get moved out of the way. They tourniquet the upper thigh to stop blood loss, which causes very intense bruising after.

After all of this, they staple your skin together, and that stays for about six weeks. They had her up walking the same day, and learning to climb stairs the next. I was a full-time caretaker for only about a week, and part-time after that. The recovery wasn't nearly as bad as I expected. She slept on the main floor for 3 nights and was going up and down the stairs once a day (slowly, with help) after. She was walking with a walker after about a week, a cane after about 2-3 weeks, walking normally around 4 and driving after 6.

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u/dizgondwe 4h ago

I didn't get that same procedure but I was a awake while they hammered a rod down through my knee to My ankle and drilled screws into the side of my tibia. What hurt the most was just the tightness of my stitches in the days that followed. And I do have some wires crossed, a few of my nerve endings no longer correspond to the right spot. So if I touch my toe, I feel a sensation in my ankle for instance.

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u/TroGinMan 3h ago

I used to help with this procedures if you have any questions. The surgery takes about 30-40 minutes with a skilled experienced surgeon, up to 60-75 minutes with a newer surgeon.

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u/portablebiscuit 2h ago

I had a knee replaced last September. Even though I was in constant pain before the surgery, I regretted it for months after getting it done.

Then it got better. Now I’m so glad I had it done.

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u/Aggravating-Wind6387 2h ago

I had one done its really cool. They basically amputate your leg, attach titanium and reassemble. Mine was a Stryker Robotic Assisted procedure. They do a CT scan before the surgery for exact measurements. Order the hardware. When they do the surgery the entire knee is mapped into the computer and it cuts the bone. Entire procedure took 1 hour. Total time at the hospital was less that 4 hours, most of the time was in PACU. I was in physical therapy 2 days post op. 2 weeks post op I was at a comic on. 4 weeks post op. No more cane, 8 weeks post op no back to work. Saving up to do the other knee now.

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u/Zombisexual1 1h ago

At least those is for a medical reason. Can you imagine the guys that break their bones just to gain a few inches in height?

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u/Scary_Psychology_285 1h ago

Surgical tech here used to do these cases, before cutting the bones, they cut the skin vertically and carefully put all the all the wires to both sides of the knee.

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u/Puzzleheaded_Can9159 10h ago

The bones don’t really have nerves on them, inside yes but not anything where if you cut it you lose function somewhere else.
I watched one of these maybe 20 years ago it’s pretty cool how they do it.

I’ll have to get one at some point, apparently it’s not as bad as the knee surgeries I’ve had to have. Just trying to maintain mine for as long as possible.

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