Poppa's Got A Brand New Knee

By Gerald Ryan


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Three months ago, I wasn’t exactly ecstatic with my total knee replacement, but seven months later, I’m starting to take ownership of this new joint. It hasn’t been easy and I’m still recovering, which will take about a year.

Ten years ago, my doctor informed me that I’d need knee replacement. After two arthroscopic procedures and years of synthetic cartilage injections, I couldn’t put it off any longer. It was time: Total Knee Replacement.

This is not a procedure to enter into lightly; a major operation with months of rehab, it can be dangerous. While rare (under two per cent), blood clots are the most common complication, sometimes resulting in pulmonary embolism, which can be fatal.

At 59, I’m considered young to have the procedure. But why wait to have good knees when the rest of my body might not let me use them as I liked? I read the books, visited the websites, and talked to my orthopedic surgeon. We decided that my knee was affecting my “quality of life.” I’d always hated that term, but I finally understood it. I couldn’t do the basics anymore without extra planning and chronic pain. We picked a date. As I wrapped my knee in ice that day, I looked forward to a new me. I’d heard so many recipients of new knees say they only wish they had done it sooner. Was I in for a surprise!

The night before the operation, I visited the website to view the procedure. I was morbidly fascinated. The prosthesis, a honeycombed alloy artificial knee, would allow the bone to grow into the metal, making for a strong and glueless attachment. The operation reminded me of cutting up a whole chicken for dinner. They sliced open the knee, cut some muscles to make room for the prostheses, and stretched and moved other muscles and tendons. The rest of the procedure was sterile carpentry: shaving bone, drilling holes; measuring twice, cutting once; selecting the right-sized knee and installing it. I wondered if this was really a good idea.

The operation turned out to be a breeze. I slept through most of it, waking up about three-quarters of the way through the procedure. From the other side of the green surgical drape rising from my chest, it sounded like Santa’s workshop with the medical elves tapping and banging away with good cheer. The surgical team was a little surprised when I asked them to quiet down. The anesthesiologist did something mysterious, and then I was in recovery. That’s when this good idea lost its lustre and turned out to be the hardest thing I’ve ever done in my life.

Two hours after getting to my hospital room, I was hooked up to a Continuous Passive Motion machine that moved my leg to ensure scar tissue didn’t build and interfere with flexion (the 90-135-degree bend in the knee) and extension (straightening) as the new knee joint healed. I used this daily for the next six weeks. That afternoon, the nurses had me out of bed, standing, and in physical therapy. It was there that pain started in earnest.

A relatively younger patient, my muscle tone was better than most who undergo the procedure. I’m told this contributed to the level of pain I experienced. My muscles were thicker and had to be cut a bit more to accommodate the prostheses. My progress, compared to the others in my rehab class, was slower and more painful. Regardless of how much we were encouraged to root for each other, there were several in the class I would have gladly throttled had I been able to reach them. They did their exercises, walked on crutches, and smiled - yes, smiled - as they went about their recovery.

I have never in my life experienced so much pain for such little gain. Even taking my meds to stay ahead of the pain curve, it was agony for me to try to lift my foot an inch off the ground, to slightly raise my leg from a prone position, to use a walker to cover the five feet to the bathroom, or to sit in a chair. It was awful.

This painful process went on for weeks as I worked with my home therapist to break down scar tissue, rebuild muscle strength, and increase joint movement. It continued for months as I went through physical therapy at the hospital, exercised in the aqua therapy pool, underwent manipulation and stretching, and struggled through wall squats, leg raises, and lunges. Each small gain was accompanied by significant pain: before, during, and after.

In “The Botany of Desire,” Michael Pollan writes about the effects of some medicinal plants on memory. He suggests that not remembering isn’t a negative process, but a positive forgetting process. Who would want to remember everything they saw and felt? From the vantage point of several months downstream in time and pain, I truly understand his conjecture. While I know my recovery process included intense pain, the vivid memory is fading, only to be recalled with the occasional twinge of exercise excess.

After 20 weeks of hospital therapy, I finished formal rehabilitation, was able to walk and stand without a cane, and bicycle for short rides. The last day of therapy, I actually ran for the first time in five years. On purpose!

Of course, it’s not a completely happy ending yet. I cycled a few weeks back and it felt so good that, despite the hills and the wind, I put on too many miles too quickly. I’m back in rehab mode again, dealing with ice and ibuprofen as I recover from painful bursitis on the inside of my knee. But I know it’s a temporary setback. I can stand, walk, and climb stairs like I did years ago. I can exercise in the morning and not have to recover for the rest of the day.

I’ll be cycling again in a few weeks. Maybe I’ll be smart enough to pedal slower and for fewer miles this time.

I’m almost ready to say I wish I’d done this sooner.

 

SEPTEMBER 2010 SENIOR LIVING MAGAZINE VANCOUVER ISLAND

 

HANDY WEB SITES

TOTAL KNEE REPLACEMENT
http://orthoinfo.aaos.org/topic.cfm?topic=a00389 
http://www.medicinenet.com/total_knee_replacement/article.htm
http://en.wikipedia.org/wiki/Knee_replacement

SYNTHETIC CARTILAGE/INJECTIONS
http://en.wikipedia.org/wiki/Knee_cartilage_replacement_therapy
http://www.painclinic.org/jointpain-hyaluronicacid.htm

TOTAL KNEE REPLACEMENT PHYSICAL REHABILITATION
http://aboutjoints.com/physicianinfo/topics/kneerehab.htm

KNEE PAIN FORUM
http://www.kneeguru.co.uk/

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