Dear Doctors: I need to have knee replacement surgery as well as spinal surgery on my neck. Would it be better to have the knee or neck surgery first? Which would take the longest to recuperate from? Which would interfere less with the other during the PT?
Dear Reader: Any kind of surgery takes careful planning. It requires learning about the procedure, choosing a surgeon, reviewing anesthesia options and arranging for aftercare. When two or more surgeries are involved, the decision-making moves into the realm of triage. This is an area of medicine in which urgency and risk direct the sequence of care. You also brought up a very important point: How will rehab factor into deciding which surgery should happen first?
Knee replacement and spinal surgery each involve a significant period of recovery. After these procedures, people typically need at least a day or two of help with the tasks of daily life. Some will need longer. Once they have recovered from the physical effects of surgery, a period of rehab begins. This often starts with the use of specialized equipment, such as a walker, toilet riser, grabber bars, body pillows or sometimes braces. The next important step is working with a rehab specialist. The goal is to restore range of motion and rebuild strength and stability while protecting the surgical repair.
In deciding the order of your surgeries, evaluate which condition would cause the most harm if treatment was delayed. Certain spinal conditions involve nerve compression. Spinal stenosis is a possible cause. This is a narrowing of the space where the spinal nerves pass through in the vertebrae. Herniated or ruptured discs, arthritis and traumatic injury are other possibilities. When these are present, a delay in treatment carries the risk of loss of function, or even permanent damage. Knee replacement is often needed due to severe and chronic pain that also limits mobility and can lead to loss of function.
When it comes to recovery, knee surgery involves weeks to months of continuous physical therapy. This consists of exercises to build strength, regain flexibility and increase range of motion. These typically include weight-bearing, stretching and mobility exercises. The demands of this therapy are at odds with the physical restrictions that often follow spinal surgery. These restrictions include limits to twisting, bending and lifting. Restrictions may be recommended for six weeks or more. However, failing to engage in physical therapy after a knee replacement puts full recovery at risk.
As you suspected, the postsurgical requirements of each procedure have the potential to interfere with the success of the other. This makes the triage portion of your decision even more important. We recommend you meet with your orthopedic surgeon and spine specialist. They will look at imaging, review the findings from your physical exams and update your medical history. They can help guide you in the surgical sequence that offers the best chance of repair and full recovery.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
