9 replies to this topic

[sandimartini47]

Has anyone with CML had a partial or total knee replacement.  I have to have total knee replacement and with the cml, I am concerned about complications or anything special the surgeon would have to do for me.  Any input would be helpful.  Thank you, sandi 

[Trey]

As long as your blood is clotting normally there should not be much to be concerned about.  The doc may take a conservative approach and stop the Gleevec a few days before the surgery.  There is some evidence that Gleevec inhibits metabolism of some minerals needed for tendon and ligament health.  You may want to ask the doc about taking mineral supplements starting well before the surgery.

[hannibellemo]

Sandi,

the other issue with Gleevec is how well can you take it on light foods? You will not be given the foods you are used to eating with the drug right after surgery and maybe even for the following day. That is the main reason I have heard for stopping Gleevec for a short period following the surgery.

Good luck with your surgery - it has made a world of difference for my husband!

Pat

[Susan61]

I do not know anything about the Gleevec and Surgery.  I am on Gleevec for 10 years.  My husband did have to get total knee replacement a year ago this month, and he did very well with his surgery.  He is like a new person, and pain free.  I do know he was put on blood thinner Coumadin for 6 weeks after the surgery for his clotting factor.  He was able to eat whatever he wanted except for anything with Vitamin K.  That would be salads mostly.  There is a whole list f what contains Vitamin K.  I myself have a blood clot in my  leg, and I am now on Coumadin with restrictions on certain types of food. I have not had to make any changes with my combination of Coumadin and Gleevec.  Just thought I would share that information with you.

Let your Oncologist and Surgeon consult with each other on how to proceed with your medications etc.  I wish you well.  I am sure you will feel a lot better after you get your surgery.

Susan 61

[susanlathers]

I had my second total knee replacement 3 yrs into CML.  The first one was 6 mo after lumpectomy and radiation for breast cancer.  I was on Sprycel for the second one and went to a rehab after surgery.  I had to supply my own Sprycel, (because of expense) which was no problem.  I had no special treatment or problems recovering due to TKI or CML, second one was a little harder to recover from and seemed more painful but I was 5 yrs older (68) and a lot of life had taken its tole, so it may have just been from that.  I can tell you this, my experience has been it is well worth the pain but you have to be willing to do the rehab exercises and go thro the pain or moving when you don't want to and walking, walking ,walking.  The knee pain you have been used to will be gone, if all goes well, but the expected discomfort of this kind of surgery takes some effort to get thro.  It's one of those, the more you put into it the more you will get out of it.  Be patient, be persistent and give it a good 6 months.  If you need or want support while going thro this, feel free to e-mail me.

Susan

[Susan61]

That was good information regarding the rehab part of knee surgery.  I forgot to mention that.  My husband did three times a week outpatient rehab for 16 weeks, and it definitely had a impact on how he healed.  It definitely takes a lot of effort on the part of the patient like you said.

Glad your doing well after having 2 of them along with everything else you went through.

Susan 61

[jjg]

Hey Trey,

Could you tell me a little more about the minerals needed for tendon health.

I was only recently dx and started Glivec 600mg 2 months ago tmr. Before CML I was running 100+ km per week and competing at a good level, but leading into the diagnosis and subsequently I've had way more than my share of tendon problems. I was diagnosed with a WBC of 12.8 (x10-9/L Australian units) by a very on the ball sports doc. Even with the so very close to normal WBC count I knew something was wrong by how I felt when running (higher than normal heart rates / effort) and it seems that my tendons knew something was up too. The docs say now they don't know if the tendon trouble is related to CML and all I can do is the normal rehab things. I sort of hoped that once the meds kill all the bad guys in my blood the tendons might cheer up a bit. Of course I now have other issues with exercise but strong intentions to keep doing as much as I can.

Josie

[Trey]

I also noticed increased tendon and/or ligament issues, especially at first.  I believe it was more related to the Gleevec than CML.  Here is some info about this issue:

http://www.ncbi.nlm....pubmed/16687713

Here is some info about supplements for tendons & ligaments:

http://www.livestron...aments-tendons/

[rubyrm]

Depending how old you are, I would not advise anyone, who already has CML or any type of blood disorder, to get any kind of implanted medical device and here is why:

1. Everything that is made will age, degrade and decay. The process is called entropy and it's outlined in the hard to understand second law of thermodynamic but it's a law of nature, we all have observed. An example is iron turning into rust, through corrosion from exposure to oxygen and water. When metals, found in implanted orthopedic medical devices, are put into the wet and oxygen rich environment of the body, over time, the process of entropy and corrosion, will happen.
2. The medical industry has defined wear debris, from both metal and plastics medical devices, which have been liberated from aging and failed medical devices - as a serious systemic problem,It which has created a new illness they call "Particle Disease".
3. Metal rubbing on metal, from orthopedic medical devices, also creates nanoscale wear debris. The particles are small enough for some of the metals to end up as ions. Metals ions have the potential to cause diseases such as cancer, including blood cancers. Even FDA is worried about the heath risk of liberated metal ions from orthopedic medical devices.
4. While there are environmental, industrial and workplace limits and standards for exposure to toxic metals, such as cobalt and chromium, there are not any exposure standards or limits, to the same metals, if they are released inside the body from aging and degrading medical devices.
5. There is an acknowledgment in the medical community that wear debris from implanted medical devices is creating major problems, as it is the prime reason for revision surgery due to implant loosening. (particle-induced osteolysis)
6. Anyone considering a medical device should be told that they have the potential in developing cancer and another systemic, chronic, non-treatable illness that are created by their medical devices.
7. Currently, manufacturers are disclosing the problem of wear debris to patients but they leave it as an abstract concept. Manufacturers are not fully explaining the long-term dangers of wear debris or how it will impact an individual's health in 25 to 30 years

Before making a decision on knee replacement surgery look at the recalls on medical devices, they are numerous.

Also ask:

- Do you have a choice on the make, model and manufacturer of a medical device or do they just agree to the

   operation itself and leave that choice up to the doctor?

- How much influence do the manufacturers and/or sales force have in doctors choosing a specific medical device?

   Are they getting kickbacks, which is the regular practice? (see links to articles below)

- Do doctors have a financial interest in the companies whose medical devices they are choosing to use on their patients?

- How long has the medical device been on the market? Is it is latest and greatest or is it a proven work horse?

- What is the success/complication rate of the device?

- How long will the medical device last  - is there a difference in the life of the medical device in active or sedentary patients?

- What research is the life-span of a medical device based upon - or are docs just reading from the manufacturers pamphlets?

- How many revision surgeries can a patient have?

- What are the infection rates?

- How many medical devices, of a particular make and model, has this doctor implanted? What has been their continued training?

- What is the shed rate of a particular medical device? (The rate at which they shed particles, after specific times, 5, 10, 15 yrs.)

- And finally, are patients being fully informed of all of the long-term complications from particulate wear debris and in particular

   the long term implications from exposure to metal ions from their aging and degrading medical devices?

People are more concerned about the practical day-to day logistics - like insurance, taking time off of work or who will take care of

the family when they are laid up.  Unfortunately, very few are thinking in the terms of researcing  their medical device but it's really

necessary in order to make a fully informed decision.

My 81 year-old mother is currently in the hospital getting her ninth round of chemo to treat non-Hodgkin's lymphoma that I believe is

directly caused from particulate debris from her having three bi-lateral knee replacements surgeries over the last 30 years.

About 18 months ago, her oldest knee prosthesis started to fail but she decided she was too old to go through another stressful and

painful knee replacement surgery.  So the aging and degrading medical device continues to shed particles polluting her body.

Of course, I can not definitively prove that her failing knee prosthesis directly caused her lymphoma - because as the Lancet article (listed beloe)

stated there just haven't been any studies done to prove a link between metal ions exposure and cancer. But you just don't need any special

training or education to understand that it creates a chronic, systemic problem.

Look at the number of recalls on hip and knee implants - there are no guarantees. It is buyer beware.

I hope this information helps you.

rmr

Kickback Articles

KOHL EXAMINES MEDICAL DEVICE INDUSTRY PRACTICE OF PROVIDING PAYMENTS TO SURGEONS

February 27, 2008

WASHINGTON - Today U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) held a hearing

entitled "Surgeons for Sale? Conflicts and Consultant Payments in the Medical Device Industry,"

http://www.aging.sen....cfm?id=294092http://www.dotmed.com/news/story/5625/

Senate Committee Investigates Med Device Company- Surgeon Conflict ...

DOTmed.com (press release), NY - Mar 19, 2008

The Department of Justice settled late last year with four medical device manufacturers.

The manufacturers paid $311 million to settle the investigation of ...http://www.dotmed.com/news/story/5625/

http://www.dotmed.com/news/story/5625/

Medtronic Will Settle Accusations on Kickbacks

NYTIMES By REED ABELSON

Published: July 19, 2006

Medtronic, one of the nation's largest medical device manufacturers, said yesterday that it had agreed to pay the federal government $40 million to settle accusations that its spinal-implant division had paid kickbacks to doctors as a way of inducing them to use its products.

http://www.nytimes.c...r=1&oref=slogin

Journal articles - read Lancet

Genotoxic effects of particles of surgical cobalt chrome alloy on human cells of different age in vitro.

Papageorgiou I, Yin Z, Ladon D, Baird D, Lewis AC, Sood A, Newson R, Learmonth ID, Case CP.

Mutat Res. 2007 Jun 1;619(1-2):45-58. Epub 2007 Jan 25.PMID: 17376492 [PubMed - indexed for MEDLINE]

Complexities of chromium carcinogenesis: role of cellular response, repair and recovery mechanisms.

O'Brien TJ, Ceryak S, Patierno SR.

Mutat Res. 2003 Dec 10;533(1-2):3-36. Review.PMID: 14643411 [PubMed - indexed for MEDLINE]

Wear debris from hip or knee replacements causes chromosomal damage in human cells in tissue culture.

Daley B, Doherty AT, Fairman B, Case CP.

J Bone Joint Surg Br. 2004 May;86(4):598-606.PMID: 15174562 [PubMed - indexed for MEDLINE]

Chromosomal aberrations in the peripheral blood of patients with metal-on-metal hip bearings.

Dunstan E, Ladon D, Whittingham-Jones P, Carrington R, Briggs TW.

J Bone Joint Surg Am. 2008 Mar;90(3):517-22.PMID: 18310701 [PubMed - indexed for MEDLINE]

Increased chromosome translocations and aneuploidy in peripheral blood lymphocytes of patients having revision arthroplasty of the hip.

Doherty AT, Howell RT, Ellis LA, Bisbinas I, Learmonth ID, Newson R, Case CP.

J Bone Joint Surg Br. 2001 Sep;83(7):1075-81.PMID: 11603526 [PubMed - indexed for MEDLINE]

Metallic debris from orthopaedic implants.

Learmonth ID, Case CP  Ian.Learmonth@bristol.ac.uk

Lancet. 2007 Feb 17;369(9561):542-4.

Chronic inflammation, joint replacement and malignant lymphoma.

Lidgren L.

J Bone Joint Surg Br. 2008 Jan;90(1):7-10.

Review.PMID: 18160491 [PubMed - indexed for MEDLINE]

[rubyrm]

From PubMed

http://www.ncbi.nlm....pubmed/21227681

Eur J Cancer. 2011 May;47(7):1061-71. Epub 2011 Jan 10.

Increased cancer risks among arthroplasty patients: 30year follow-up of the Swedish Knee Arthroplasty Register.

Wagner P, Olsson H, Lidgren L, Robertsson O, Ranstam J.

Institute of Clinical Sciences Lund, Department of Orthopedics, Lund University Hospital, Lund University, Sweden.

Abstract

BACKGROUND: An increasing number of young patients are undergoing knee arthroplasties. Thus, the long-term risks of having a knee prosthesis must be evaluated. This study focuses on the potential carcinogenic effects of the prosthesis; it is a long-term follow-up of all patients in Sweden between 1975 and 2006.

METHODS: The incidence of cancer in a total population of operated individuals was compared to the overall national cancer incidence in Sweden by means of standardised incidence ratios. Analysis of cancer latency period was performed to identify potential aetiological factors.

RESULTS: For male and female patients with rheumatoid arthritis (RA) or osteoarthritis (OA), the overall cancer risks were elevated, ranging from 1.10 (95% confidence interval (CI): 1.03-1.18) for men with OA to 1.26 (1.23-1.29) for men with RA. The greatest increases in risk were observed for the leukaemia subtypes, myelodysplastic syndromes (MDS) and essential thrombocytosis (ET), ranging from 3.31 (1.24-8.83) for ET in men with OA to 7.38 (1.85-29.51) for ET in women with RA. Increases in risk were also observed for breast cancer, prostate cancer and melanoma. The latency analysis revealed elevated risks late in the study period for both solid and haematopoietic cancers. However, only increases in MDS and possibly prostate cancer and melanoma rates appeared to be connected to the operation.

CONCLUSION: This study showed that OA and RA arthroplasty patients have a significantly higher risk of cancer than the general population. Elevated risks of MDS and possibly prostate cancer and melanoma indicated a potential connection to exposure to metals in the implant. The observed excessive incidence of ET was likely associated with the inflammatory disease.

Copyright © 2010 Elsevier Ltd.