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Should I tend to my painful knee through a TKR or surgically treat an inguinal hernia first?

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Posted on Fri, 24 Aug 2018
Question: Hello I have knee that is candidate for partial knee replacement . Was going to get it done but now opted to get my inguinal hernia fixed (robotic assisted lap surgery) in ten days. hernia is reacurred but not giving me much greef right now. Now knee is becoming more painfull even when not on it .Something pops just above the knee sometimes when getting up. How can I deal with this now and after surgery (hernia). Can this become a emergency knee surgery Losing sleep over this. Should I opt for the knee first? Need to walk days after hernia surgery for recovery
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Answered by Dr. Bonnie Berger-Durnbaugh (4 hours later)
Brief Answer:
Thoughts on this

Detailed Answer:

Hello,

If you will need to be able to walk for recovery after the hernia repair, and the knee sounds as though that is becoming worse, then yes, you may need to address the knee problem first.

Inguinal hernia repair can be postponed if you do not seem to be at risk of entrapment - so consider discussing your risks with the surgeon who evaluated you for it. Usually it can be put off for a bit.

It's possible that you have a new injury to your knee on top of previous damage. It may be possible to stabilize your knee and strengthen it with exercises so that it will be strong enough for your inguinal surgery recovery.

So here is what I recommend:

1. Go in to have your knee re-evaluated. A physical exam and possibly also an MRI can sort out what has happened to it recently to increase the pain. This would be priority number one.

2. Talk with your surgeon about the need to attend to your knee right now and ask if your herniation appears small enough or stabile enough to put off for noe.

3. Based on the information about your knee and hernia, you can make a better, more informed decision about how to proceed.

Hope I have answered your query.
Let me know if I can assist you further.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (3 days later)
if a hernia becomes life threatening when a person has just had a knee replacement surgery who is on blood thinners have that hernia emergency surgery performed
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (27 minutes later)
Brief Answer:
Information

Detailed Answer:

Hi,

Typically anticoagulants are used for approximately 10 days after knee arthroplasty. But if during that time emergency surgery was needed, it could be stopped and an intermittent pneumatic compression device could be used instead.


From an article:
"Some studies have found that mechanical prophylaxis such as intermittent pressure compression devices are quite effective in reducing the risk of DVT and pulmonary embolism in arthroplasty patients by more than 50 % without any risk for bleeding. However, in the past, patients’ treatment ceased upon discharge from hospital and adherence to routine application became a challenge. Therefore, the introduction of portable, battery-powered devices allow patients to utilize these devices in the hospital or at home."

But you definitely should discuss the situation of having both a knee problem and hernia with the surgeon who is doing the surgery on your knee if you choose to do this first. And with the anesthesiologist who does that surgery. It may alter which anticoagulant they give. And if the situation arises after the knee surgery that you do need emergency inguinal hernia repair, again, be sure to tell the surgeon and anesthesiologist. It may alter which anticoagulant medication they choose to have you on. For example, some are shorter acting and could be out of your system more quickly, and some (warfarin/Coumadin) can be partially reversed with being given Vitamin K.

Take Care!
Dr. Bonnie Berger-Durnbaugh,
General & Family Physician



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3134 Questions

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Should I tend to my painful knee through a TKR or surgically treat an inguinal hernia first?

Brief Answer: Thoughts on this Detailed Answer: Hello, If you will need to be able to walk for recovery after the hernia repair, and the knee sounds as though that is becoming worse, then yes, you may need to address the knee problem first. Inguinal hernia repair can be postponed if you do not seem to be at risk of entrapment - so consider discussing your risks with the surgeon who evaluated you for it. Usually it can be put off for a bit. It's possible that you have a new injury to your knee on top of previous damage. It may be possible to stabilize your knee and strengthen it with exercises so that it will be strong enough for your inguinal surgery recovery. So here is what I recommend: 1. Go in to have your knee re-evaluated. A physical exam and possibly also an MRI can sort out what has happened to it recently to increase the pain. This would be priority number one. 2. Talk with your surgeon about the need to attend to your knee right now and ask if your herniation appears small enough or stabile enough to put off for noe. 3. Based on the information about your knee and hernia, you can make a better, more informed decision about how to proceed. Hope I have answered your query. Let me know if I can assist you further.