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Topic: Total Knee Replacement Surgery Issues - Left Arm Lymphedema

Forum: Lymphedema — Risks, tips for prevention, and info about products that can address the symptoms of lymphedema.

Posted on: Jul 20, 2018 09:10AM

Sher wrote:

I am scheduled for total knee replacement soon and yesterday I attended the joint class and went through the presurgical testing. When addressing my concerns because of lymphedema, couple things came up that I need help with.

Original treatment - lumpectomy and axillary node dissection in 2000, then after local recurrence in 2008 had bilateral mastectomy.....lymphedema started 2010. So I understand no BP, IV on left arm and have manual BP done on right wrist/forearm with pediatric cuff, but this I know is not possible in an operating room. No nodes removed on the prophylactic side, but still I'm very cautious with that arm while coping with lymphedema in the opposite arm. The anesthesiologist said an arterial line could be used for BP during surgery only and would be removed right after. Not sure where exactly the line would be placed, but after reading a bit on the web, think possibly the underside of wrist/forearm likeliest place. Can I have IV in front of hand and arterial line on opposite side of same arm? Not sure why they don't want to use my non-surgical leg for BP during surgery.

Also learned yesterday that they need 2 IV's in place for the surgery, but only 1 would be kept in for a day or two after surgery. I planned on having the 1 IV put in my hand (have had this done previously for almost a full day), but it is suggested to have the 2nd IV in jugular. After putting off the surgery for many years because of lymphedema I have gotten to a place where day to day living is rather difficult and quite limited because of the knee deterioration, but the thoughts of all those things stuck in my veins has me freaked out and considering cancelling surgery once again. I'd greatly appreciate any information on arterial and jugular lines, risks, etc. and also any concerns with lymphedema because of this.

Dx 8/28/2000, IDC,
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Jul 20, 2018 05:09PM Spookiesmom wrote:

I’m approaching TKR too and have wondered about this. I do have a sleeve for my left arm I figured I’d wear into OR. Say no BP, IV or sticks on it. Of course speak with drs.

Hope you get some good answers, and good result from surgery.

Dx IDC, Stage IIIA, Grade 3
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Jul 20, 2018 07:52PM sbelizabeth wrote:

Wow. Arterial line, 2 IV lines, jugular IV, for a knee replacement? I don't get it.

I had most of the nodes removed from the left axilla and so far haven't had issues with LE (thanks, God) but I'm very careful with my left arm. No pokes, BPs, nothing. But my right side is unaffected and I get injections, lab draws, and BPs on that arm.

I had both knees replaced in the same surgery in 2016. One IV in the right arm, BPs done on right arm. After anesthesia recovery I was snoring in my regular room for a couple of hours, when the physical therapists arrive to help me walk to the bathroom. Oral pain meds only. They really, really don't want you lying around after surgery. Up and at 'em.

An IV in the foot or leg is just not frequently done. The circulation is poor, it's an infection risk, and some say it can increase the chances for a blood clot higher up in the leg. If your team insists on two IVs, don't worry about the jugular. It's an easy stick and it's done all the time in the emergency department. It won't be there for long.

An arterial line would be placed in your inner wrist above your thumb, right where you feel the pulse. It's an easy way to keep track of BP, but knee replacement surgery is relatively quick, and an arterial line sound like overkill (so to speak...heh...). Still, if you don't want BPs done on your upper arm, it's an OK alternative.

Can you have an arterial line and an IV in the same arm? Technically yes--one's in an artery and the other in a vein, so they don't get in the way of one another.

Congratulations on getting close to your new knee! I love mine. They're straight, strong, and painless. Blessings--SB

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC, Left, 1cm, Stage IIIA, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Jul 20, 2018 11:19PM jazziD wrote:

I can't have BP, etc. taken on my right arm, breast cancer / 0 lymph node side. One iv was in my left arm and when I woke up the other was in my neck. I was surprised about that. But that's how they addressed the issue of 2 iv sites for me.

Dee Dx 7/7/2006, IDC, Right, 2cm, Stage IIB, Grade 3, 3/27 nodes, ER-/PR+, HER2-
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Jul 21, 2018 08:37AM Sher wrote:

Thanks everyone for your replies!

After reading sbelizabeth's post, I was thinking maybe I misunderstood and they need a 2nd IV site to be selected ahead of time as a precaution, but jazziD did have 2 IV's in, so will need to check on that. I've read that sometimes a machine is used to filter drainage blood and then give back to the patient, so maybe that's why the additional IV?

With prophylactic right mastectomy and no axillary nodes on that side, risk is probably low for lymphedema, but already dealing with it in my left arm, I know I definitely don't want it bilaterally and do everything I can to protect my right arm. Automatic BP machines seem to me to inflate quite high and measurements would need to be repeated frequently during surgery so BP on arm is not acceptable. While an IV and arterial line in the same hand/arm is a concern, always thought that restricting fluid flow with BP cuffs, tourniquets, etc was more of a risk factor than infection or trauma from a vein stick. I have blood drawn from my right hand without a tourniquet.

Another thing in the back of my mind.....I've been by told there is no-way lymphedema can happen in the leg after TKR as there are no nodes in the knee and that any swelling is just from the trauma of the surgery and not actually lymphedema. But I have read that lymphedema can and has indeed happened after knee surgery.

When day to day living and getting around is this difficult, not to mention extremely painful (knee alignment also affecting my back), guess it's time to move forward......be as informed as possible about the surgery, take necessary precautions, have a good and caring surgical team and most of all, trust in God that I'm in His hands.



Dx 8/28/2000, IDC,
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Jul 23, 2018 08:15AM Sher wrote:

Just thinking......arterial line vs automatic blood pressure measurement on right arm during surgery - which of the 2 is the least risk for lymphedema?


Dx 8/28/2000, IDC,
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Jul 24, 2018 08:23AM brithael wrote:

I had TKR last October on my left knee and I have LE on my left arm. I had no problems and even wore my sleeve and glove during surgery

Check out my blog godmustthinkimabadass.blogspot... Dx 10/5/2015, IDC, Left, 2cm, Stage IIA, Grade 3, 3/27 nodes, ER+/PR+, HER2- (FISH) Surgery 11/13/2015 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Chemotherapy 12/28/2015 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 3/15/2016 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 5/26/2016 Arimidex (anastrozole)
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Jul 24, 2018 08:43AM Sher wrote:

Thanks brithael! I'm planning to wear my full length Tribute during surgery, then have 2 fingertip to elbow Tributes that I can wear during the rest of my stay. First thing home, all of them will go in the washer asap!


Dx 8/28/2000, IDC,
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Jul 24, 2018 10:13AM sbelizabeth wrote:

Anytime I get home from a hospital stay, everything that comes home with me gets washed on the "sanitize" cycle!

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC, Left, 1cm, Stage IIIA, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Jul 24, 2018 11:57AM octogirl wrote:

I had TKR on each knee in two separate surgeries (not both at same time) this past year. I only had one IV line (other than epidural stick in my back/spine area, more on that in a minute) and one blood pressure monitor, both on same side which was not my lx side, so not quite the same situation as yours, but still, not sure why multiple IV lines are needed....They put a medical bracelet on me before surgery that remained during hospital stay, to remind care givers no bp or pricks on right arm.

The only other thing I had was a machine they put on your legs after surgery to massage and stimulate them to avoid DVT (which is a significant risk after TKR). Sorry, can't remember what it is called. I can tell you that I asked to have it removed early because it was annoying and noisy and kept me awake (which they did do per my request).

One tip I can give you since you are discussing IVs etc with your doc: I urge you to consider an epidural for your anesthesia. I had it with both surgeries and it was GREAT! I believe it is lower risk than a general (they also sedated me heavily and I was not conscious during the surgery) but most importantly: when surgery is done and you come out of sedation, you are still numb, and the numbness lasts for about a day. That made recovery SOOOO much less painful, especially in those first few hours.

Best of luck. Getting my knees replaced has made a tremendous difference in my QOL; for me it was more than worth it. and do your PT!

Octogirl

Dx 6/18/2015, IDC, Right, 2cm, Stage IIA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 7/16/2015 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 9/8/2015 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 12/15/2015 Hormonal Therapy 1/14/2016 Arimidex (anastrozole) Hormonal Therapy 4/7/2016 Femara (letrozole)
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Jul 24, 2018 01:53PM Sher wrote:

Thanks octogirl! The surgeon wants 2 IV's in - with the 2nd just in case of trouble or failure with the 1st during surgery and this is standard procedure for their orthopedics department. Normally one would be in each arm, but in my case only one arm can be used (and that reluctantly on my part) so the other "in case" IV will go in the jugular vein. One will be removed immediately after surgery - I'm assuming it will be the jugular IV. The arterial line is to monitor blood pressure since I do not want the automatic thing on my right arm during surgery. Thoughts of the arterial line I must admit does scare me, but having lympedema already in one arm, I'll do everything in my power to prevent it in the other.

Epidural does definitely sound like the way to go. They sometimes also use a peripheral nerve block, but pretty sure I'll pass on that.

Looking forward to a fully functional and pain free knee! Wouldn't you know it, that a couple days ago my left knee,usually much less troublesome, has greatly increased pain now.

Dx 8/28/2000, IDC,
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Jul 24, 2018 02:40PM sbelizabeth wrote:

For anesthesia during my surgery, my anesthesiologist placed a spinal, which was just a brief sting. Then he sedated me so quickly I don't even remember lying back down on the OR table. Octogirl is right, spinal or epidural anesthesia is great for post-op pain.

Also, when I was barely awake in the recovery room, they were placing catheters in my upper thighs, and using ultrasound to direct them to the nerves that supply the knee. Then the catheters were connected to "On-Q" pumps--little tennis-ball shaped devices that slowly and continuously drip numbing medication and controls post-op pain. The catheters stayed in for a couple of days. It was remarkable how they controlled the pain and let me get up and walk.

Sher, I would guess they'll put in the arterial line after you're sedated, and remove it before you're fully awake, so don't waste much brain power worrying about it. Same with the jugular line.

My biggest annoyance with this surgery was my doctor's insistence that I wear thigh-high anti-embolism stockings for a couple of weeks. I really hate those things. But now I'm enjoying my strong, straight, pain-free legs. And my chronic lower back pain resolved too--who would have guessed my crooked, unstable knees were causing it?

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC, Left, 1cm, Stage IIIA, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Sep 9, 2018 06:49AM Sher wrote:

Surgery is done and recovery in progress, although not progressing as quickly as I'd like. I did opt for spinal and nerve block for knee. The anesthesiologist decided to use blood pressure monitor on my left calf and BP was also monitored on calf for the 2 day hospital stay. Even though the calf BP measures higher than my normal, he was more concerned with it being consistent. They never inserted a second IV, so guess they just wanted to have a location ready in case the hand IV failed. I was not permitted to wear compression on my left arm during surgery, but have 2 Solaris extended gloves that I wore the rest of time in hospital and LE was controlled very well. Right hand IV also was fine with no issues.

Because of calf pain few days after being discharged, I was sent for ultrasound - negative for clots. At 4 1/2 weeks out, pain continues not just in my knee, but also in foot, thigh, hip and especially right rear area (sit bone?) which is much worse than the knee pain. Have an upcoming appointment with chiropractor soon, so hopefully he can help with the lower back/rear/hip pain. Ortho said some of this pain is muscles learning to work with new knee.

I wore compression TED knee high stockings everyday for 4 weeks (3 on non-operated leg). Without stockings, swelling has increased in my ankle and calf, but the knee and thigh area has lessened. Question: What advice or suggestions would you have to help with this swelling. I do try to elevate whenever I sit and I think this helps some, but is annoying. Thinking to try compression socks of some sort or maybe bandage wrapping. I'm pretty sure the swelling around knee is normal at this point, but in the ankle and even top of foot is more of a concern for me.

Dx 8/28/2000, IDC,
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Sep 12, 2018 01:24AM cowgal wrote:

I had both knees replacement in July 2015. I did not have to have any IVs in my LE arm.

For swelling, continue to elevate when you can and ice packs. Everyone is different on recovery. I felt like it took me 4 weeks before I thought my surgery was a good idea. Past 4 weeks, the daily progress seemed to be better than before and by week 6, things really took off in improvement. I did still have to take it easy at the end of the day and tried to continue to elevate and occasionally would ice.

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Sep 12, 2018 07:39AM Sher wrote:

Thanks cowgal! I have felt exactly the same - when a friend asked if I was glad I had the surgery, my reply to her was "not yet". It's been tough and I'm sure my back issues have been responsible for a large part of this, but am now beginning to see the "light at the end of the tunnel". Feeling a lot more confident about my recovery and my decision to have the knee replacement.

I had dropped off on the icing, but going to pick that up again today along with elevating. It's hard when beginning to feel better and wanting to be up and around and doing stuff, to then make yourself sit, ice and elevate!


Dx 8/28/2000, IDC,

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