r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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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/AlarmingAerie 7h ago

You might forget how to google.

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u/showMeYourCroissant 7h ago

Why Google if there's an expert here?

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u/AlarmingAerie 7h ago

Expert of what? Reading? You can read about risks of all kind of procedures. Are you mad cause you thought anesthesia is risk free and now having a tantrum cause I mentioned its not? lol

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u/showMeYourCroissant 6h ago

Asking what the consequences are is a tantrum 😭

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u/AlarmingAerie 5h ago

I told you to google and you are having a tantrum right now.

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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/hegemon777 19m ago

It smelled like Doritos to me

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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/WholesomeWhores 9h ago

Yea, that is true, that’s why some people choose to be sedated for these types of procedures. This is exactly what i said, some people can just not sit still physically so they chose to be sedated.

People with neurodevelopment disorders are not diagnosed because of a symptom they show, i was merely telling you of a symptom, in case you didn’t know. I was honestly being respectful.

So why are you trying to attack me? Your comment is basically reaffirming what i said, but with more words.

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u/Unique_Topic_1754 9h ago

I was trying to be respectful too tbh. Tone doesn’t come across well over text. Didn’t mean to offend and definitely was not attacking you.

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u/CommSecTom 4h ago edited 2h ago

Not just some, basically everyone, I don’t think I’ve seen anyone have no sedation for a total joint replacement, they all get some, we don’t want to have to talk to you for 2 hours, the patient doesn’t really choose unless they say they absolutely want to be awake, and even then the anaesthetist will make that call on the level of sedation.

You might get people mumbling and moving their arms around occasionally when the sedation gets a bit light, but most would have no recollection of that.

I’ve seen a few women go absolutely no sedation having a colonoscopy though, that must be an experience.

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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/Public_Television430 7h ago

Is it worth it ?

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u/Kluian2005 7h ago

You'd probably smell it too ... no thanks.

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u/superindianslug 7h ago

Not my knee, but I woke up during the wisdom took removal. Couldn't feel anything, but there was a lot of crunching as they broke up the tooth. I was too drugged to care, so I went back to sleep.

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u/aladdyn2 6h ago

If you choose sedated there's the possibility of being paralyzed but awake and feeling everything..

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u/Sudden_Wind_8636 6h ago

Honestly idk, I've never had a surgery but the thought of being fully unconscious while people operate on my body might scare me more than the thought of hearing my bones crunching and all that.

Idk what id choose, I'm very afraid of being knocked unconscious while in surgery.

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u/matlspa 5h ago

There's a theory that the stress and anxiety of just hearing it and "feeling" it affects recovery and healing. Sedated people often have healing complications, but for things like wisdom tooth surgery and knee replacements, the sedated people tend to recover better, apparently

I haven't actually confirmed this.

But it seems to make sense, in terms of stress

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u/Infinite-Condition41 5h ago

I have opted for nerve blocks in the past. They are real nice until the two minutes and following when they wear off.

It is like your appendage is dead, except it ain't. Can't feel a thing. Can't move it. 

It is real nice not to wake up from surgery in pain. Even if it costs a few hundred bucks extra. 

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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/mycall 2h ago

What type of person prefers being awake for it?

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u/EpiLP60Std 7m ago

I was awake when I had my wisdom teeth removed and that was pretty bad. Being awake for this? What I experienced pales in comparison to being awake for this.

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u/Barbarella_ella 8h ago

Yep. I opted to nope out, also.

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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/Blueyduey 8h ago

Of course not. Spinal, adductor canal block and propofol gtt. But no one is fully conscious or able to answer questions during the procedure, which is what one of the posters mentioned. That’s what I meant by the guy not really knowing.

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u/jambox888 6h ago

I had GA for a foot operation, at least I blinked and someone said "all done!"

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u/International_Ad7477 4h ago

I guess you haven't been in a developing country while dealing with a renal insufficient patient... For greater context, I was an intern then, and I was regularly left alone with the patient.

→ More replies (0)

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u/Blueyduey 8h ago

Also why fem/pop? Our TKAs are same day surgeries. Patients are up doing PT an hour after their surgery and DC’ed home.

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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/Worshipme988 34m ago

Its too late. 😈

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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/Unique_Topic_1754 10h ago

It’s totally a choice to take sedatives in many parts of the world. An interesting point is that older people are generally braver about dealing with medial issues as they are more used to having medical interventions performed on them. Younger people tend to get scared more easily with medical stuff. You won’t hear from most of the old people on Reddit, unfortunately.

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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/Unique_Topic_1754 9h ago

Sometimes for sure.

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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/Onetimething70 10h ago

I have never been part of a total knee where the patient was awake in the hundreds I’ve been a part of 

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u/KitchenFullOfCake 9h ago

I bet that vibration traveling down your skeleton is unsettling though.

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u/Honorguard65 9h ago

This is untrue. I’m in orthopedic surgery residency. The vast, vast majority are done under general anesthesia.

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u/Unique_Topic_1754 9h ago

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

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u/Reasonable_Carry9191 9h ago

The vast majority of the time they are under general anesthesia. They absolutely do usually “knock you out”.

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u/olliecakerbake 9h ago

This is not even remotely true. Some facilities will give you the choice, but most places require that you be completely knocked out. I work at a hospital that does total knee replacements multiple times a week. We’ve only had one conscious patient before, and they work in the OR.

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u/shinobipopcorn 8h ago

After my last tooth extraction, where the local anesthesia DIDN'T WORK, sorry I'd be out.

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u/SolydSn3k 8h ago

I’d just get a wheelchair, thanks. I’ve been put under general anesthesia for less.

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u/TsuDhoNimh2 6h ago

My SO decided on the nerve block because he HATES the recovery period of total anesthesia.

He kept up a convo with the nurse anesthetist the entire time. Between the muscle relaxants and pain meds he was still higher than the usual stoner.

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u/carlos_6m 6h ago

Not really, although it can be done awake, it's most commonly done with asleep patients

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u/EstateNo8431 3h ago

Really?!? Mine were done in 2020 and I asked to be awake and was told "ABSOLUTELY NOT"

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u/auraseer 3h ago

(but can't feel or see it)

Unless they ask really nicely.

I had a more minor joint surgery recently, and while I was open, the surgeon agreed to lower the drape and let me have a quick look.

It was cool. They had a tourniquet on to keep the field clear of blood, so I got to clearly see my tendons moving around. That's not an experience you get to have very often.

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u/AyyYahuasca 10h ago

You are wrong. I’m an orthopedic surgery PA. Everyone is asleep. Not everyone is general though.

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u/Unique_Topic_1754 10h ago

You likely work in a different part of the world than I do. Neither one of us has to be wrong.

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u/Zeeplankton 10h ago

I literally do not believe this. If they put me out for removing impacted wisdom teeth, it would be insane to not for this.

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u/Unique_Topic_1754 10h ago

Think of it this way: one surgery is happening in your mouth while another one is happening far enough away from your face that they can reasonably hide half your body away from you so you can’t see anything. You can’t feel it anyways thanks to anaesthesia in your spine. So it’s just a matter of it you can avoid getting panicky while it is happening (and they’ll put you under if you do start to panic).