Panni or Total Knee Replacement?

Hi there

I am 60 yrs old, had a rny in 04, a total knee replacement in '15, and now my other knee is starting to give me fits.

I know how hard it is to go thru a total knee replacement, and Im thinking perhaps a panni or tummy tuck could be an alternative.

At the time of my 1st knee surgery, I was advised to not schedule the 2nd knee for a while because often times the 2nd knee will feel better when the first knee is fixed and your walking stature is corrected.

In my research on tummy tucks, Im finding the skin thats removed doesnt weigh all that much. But, having that skin gone has got to free you up to be so much more active, and easier to lose more weight....which would lighten the load on my knee.

Is there anyone here that has had a tummy tuck and knee issues that could share their experiences?

Thanks!

Since we have no info on how much weight you've lost, or any idea of how much of a panni you deal with, it's hard to give advice. I'm 5'3", started at 360lbs, and I've lost 189 pounds, but if I had my panni removed I'd be lucky if I lost even 15 lbs from it. I have degenerative arthritis in both knees from carrying 200+ extra pounds around for 30+ years. My left one is going fast, and have been told I will have to have both replaced. For me, there would be no question, I'd replace the knee. How much better do you move with the other new knee you have? Being able to walk and do things and move, to me, would make it an easy choice. I know how great I feel just having cortisone shots...the idea of not having the pain at all seem like a dream.

So my vote is knee all the way!

If you need a panni to improve your mobility, then do both. Exercise is only a small part of the equation, though. Watching what you eat will help you lose your excess weight. Track your food, limit calories and carbs, drink your water and take your vitamins, etc.

Both of my knees were replace in 2010, one in April and the other in September. It's the best thing I ever did for myself, even more than the VSG. Now that I've lost weight I can walk for miles and miles without pain, and not get winded, unless it's a difficult hike. I'm not sure a tummy tuck would do much for me, the knees changed my life for the better, almost from day one.

A tummy tuck may lead to alleviate some strain to the knee, but it's not going to repair the knee. A shaping garment will hold the stomach in to help you be more active and confident, so you can have the best of both.

The vast majority of plastic surgeries I've seen result in 6 or 7 pounds of weight loss. So that really won't make a real impact on your knee. I'd go for the knee replacement.

Assuming osteoarthritis and lack of cartilage in the knee is what is necessitating the knee surgery, a panni isn't going to amount to a hill of beans on that. I'm staring down double knee replacement and that was one of the reasons I had VSG - my orthopedic surgeon wanted my BMI under 30 before he did my knees. Well, I'm down 106 pounds and feel a whole lot better. I use compression garments when i exercise because I have stuff flapping around everywhere, but I fence (en garde!) 5 hours a week and am in the gym another 3 hours a week.

Do my knees still hurt, yes. Do I want to have them done just yet, no. I'm 56. My mother lived til 95 and my dad til 90. I'm only having it done once, so I'm waiting until after 60 to do it. I haven't had plastics, either. I'm only 14 months out.

I've met with a plastic surgeon and will likely have the panni before I have the knees done, but I can tolerate my knee pain currently.

Have you exhausted all non-surgical alternatives - cortisone shots, viscous supplementation, physical therapy? I find that with the combination of cortisone and synvisc, I can be as active as I am, so i see no need to have the surgery yet.

As my ortho said yesterday when i went in for another cortisone shot because I twisted an osteophyte loose while fencing, the best indication of range of motion on recovery after replacement is the range of motion before your replacement. Get a referral to a physical therapist and work with them for a while.

Every pound of weight feels like 5 pounds to your knees - so if you can lose a bit more - pull up those compression leggings and get to the gym.

Best of luck.

Thank you for your reply Diana

Yes, I have osteoarthritis in my knees and the cartlidge is worn down. Im 5ft 3in and currently weigh 230, down from 295. My tummy apron started after getting so big at pregnancy and having a big baby (years ago) I can live with the uncomfortable daily pain. The spikes of hard sharp pain (after using stairs, or prolonged activity) is my downfall so I tend to sit when I get to this point. I dont use cortisone shots (personal choice) and I have had the synvisc, and it didnt do all that much for me. Ice bags is my choice of pain relief.

Knee surgery is.... Wow... Its a really tough recovery, and Im no baby when it comes to pain. Ive read that tummy tucks, LBL, panni is no piece of cake either, but Ive also read that the PS isnt as bad as total knee replacement(TKR).

I know of a few people who have OA in both knees, and after the 1st surgery of TKR, their 2nd knee isnt all the bad and they can manage without the surgery. I was told by each Doc I consulted with that this is true... But each case is different.

The replies to my inital post got me thinking. I guess Im trying to accomplish 2 things; go thru 1 surgery (panni) and end up with the ability to move more, then more wt loss/less knee pain. And, I can see that I cant use 'my knee wont get any worse' as a justification to get the panni... It may or may not.

I am interested in knowing more about the compression garments you use while fencing. Could you tell me more about them?

Thank you!

While I don't know your reasons, I can tell you that cortisone shots are my salvation. If the pain is so bad that you have to sit, please consider it. Also, you don't mention if you are using a prescription strength cox-2 inhibitor (I use Meloxicam - brand name Mobic) which was agreed upon by my ortho and my bariatric surgeon prior to my surgery. It helps. I had 2 10 pound babies - so I have a pouch, too - have had it for a long time.

The first thing I would suggest is that you try to get as much weight off as possible. I was 271 at my highest known weight, but think, in looking back at photos, I was closer to 300 at points a year prior to starting my journey in 2016. I'm down to 166 right now and my knees feel so much better - so work your plan. The 5 pounds I'd lose from a panni would be so much easier to take care of by limiting my calories.

Generally, I wear high waisted compression shorts under my fencing gear - Fila makes a nice pair that you can get at Kohl's https://www.kohls.com/product/prd-3038113/womens-fila-sport- high-waist-fitted-shorts.jsp?prdPV=5. You can wear a looser pair of running shorts over them. They also make high waisted capri workout tights and you can wear a long top if you'd like. Personally, I don't care how I look at the gym. I don't care what other people think. Never have.

My arms are my bigger issue - the flapping makes me crazy. I use Body Helix tricep sleeves for my upper arms. They make them for all body parts. https://bodyhelix.com/ They are amazing. Not cheap, but amazing.

At 5'3" you knees will feel tons better if you can get yourself under 200. Once I crossed that line, my knees really started feeling a difference.

Additionally, when I was heavier, water was my friend. I would do water zumba and water aerobics because it didn't hurt my knee - look into a Y or club near you that offers water fitness classes or talk to your ortho abou****er based physical therapy for the knee.

For point of reference, I was barely squeezing into a size 22 when I started my process. I was 246 on day of surgery in August 2016. In March 2017 when I started fencing I was about 190. I'm 166 now and sitting here in a pair of size 8 jeans. Movement is key - you need to keep that knee moving because the less you move before surgery, the less your range of motion post surgery will be.

Best of luck.

Actually, recovery from a panniculectomy -- where no muscle cutting is involved -- isn't that big a deal compared to other "open" surgeries. Other than the endpoints at the hips (which hurt for several weeks when I would twist), there was very little pain after the third day Ii had to have one of the two initial drains for 2 weeks (the other came out in a couple of days), so that was annoying, but not painful.

Lora