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My new knee

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by Tom Hardin

I knew it was only a matter of time. It had to be done.

The pain in my right knee had gotten so bad that I could walk only a short distance before having to rest. My limp continued to worsen and this caused my lower back to hurt and sometimes even go into spasms.

My right knee was so unstable that I had developed a pronounced bow in the shin bone of the leg. When measured by a chiropractor a few years ago, he said the bow had caused the leg to be two inches shorter than my good leg.

A few years ago I went to a physical therapist to see if she could help alleviate my back pain. She took one look at my knee and said, “Your back will never get better until you fix that knee.”

She explained that favoring the knee and limping caused my spine to be out of alignment, which put unnatural stress on the muscles of my lower back.

It had gotten to the point that my wife and children were continually hounding me to at least go to a knee doctor and find out what options I had.

After watching me walk, examining the knee and looking at x-rays, my doctor’s assessment was quick and to the point. “Your knee is pretty much blown up,” he said. “The cartilage is gone and you are grinding bone-on-bone.”

The only remedy was a total knee replacement.

I made an appointment that day to have the surgery on January 20, 2014. “You will be amazed how this will eventually improve the quality of your life,” said my doctor.

I believed him, and still do.

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This is an x-ray of both knees prior to surgery. Notice there is no cartilage between the bones in the knee on the left.

Preparation
To get ready for the big day and the rehabilitation that would follow, I began to exercise the muscles of my bad leg. My doctor said the better shape I was in going into the surgery the quicker and easier the recovery would be.

Two weeks before the surgery my wife, who had been designated “my coach” and post-operative caregiver, and I attended a mandatory class that covered all aspects of the upcoming surgery and rehabilitation. In the class were about 20 other patients, some older and some younger than me (61).

Above all else, the class instructor stressed cleanliness. The biggest fear was that a patient would get an infection before, during or after knee replacement surgery. For two weeks prior to the surgery, I had to shower using Dial soap, and was instructed to wash the bad leg several times during each shower. Dial, they said, is the best anti-bacterial soap for this.

The afternoon before the surgery I was instructed to take 4 mg. of Warfarin (Coumadin), which is a strong blood thinner that helps prevent blood clots during and after surgery.

The night before the surgery and the morning of the surgery, I had to wipe my entire body with sterilized cloths to kill any germs that might have been lurking about.

“Day 0”
The day of the surgery is called “Day 0.” I arrived at the hospital 90 minutes before my surgery time and the staff immediately started prepping me for the operation. As I lay in a gown on a gurney in the prep room, I was visited individually by the operating room nurse, physician’s assistant, anesthesiologist, and doctor. They explained what was going to happen during surgery and answered any questions I had.

I had heard of surgeries where the wrong knee was operated on, and I wanted to be sure they all knew it was my right knee. Before I could express this concern, however, the nurse asked me (even though she already knew) which knee would be replaced. When I said “right” and pointed to it, she handed me a marker and had me put my initials on my thigh above the knee. She then shaved my leg around the knee.

When the doctor arrived he asked the same question, and he then put his own initials above mine on the leg that was to be operated on.

Then, the fun started. An IV was hooked up and I began to get a saline drip. Before being wheeled into the operating room, the nurse gave me a shot of something through the IV that she said would make me feel “warm and fuzzy.” I didn’t really feel much effect.

In the operating room they sat me up and injected me with a “morphine block” (epidural). Now that is what I call “warm and fuzzy.” They also started a Propopyl drip and soon it was “goodnight Irene.”

At the end of the surgery they also gave me a pain-killing injection that would mask the pain for up to 48 hours.

The morphine block numbed me from the waist down, and when I woke up about 90 minutes later in the recovery room, I had no feeling from the waist down and could not move my legs.

I imagined this was what it felt like to be paralyzed, with the helplessness that accompanied it. The nurses assured me the numbness would wear off.

I now had my new mechanical knee. The operation was over. Later I realized that was the easy part of this whole experience.

With my leg securely wrapped, I was wheeled into my hospital room. I felt great. No pain whatsoever. My wife, Bev, was with me and she told me the doctor said the operation went well. Later that day I ate lunch, dinner, watched an ACC basketball game on TV, and went to sleep. Nurses checked my vital signs about every two hours throughout the night and always asked, “How do you feel? Any nausea or pain?”

My answer was always “I feel great.”

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X-ray with replacement pieces in place

The next day
I continued to feel good the day after the operation. The wrap on my knee was removed and I saw my new knee for the first time. It had a little swelling, but looked good.

The physical therapists got me up early in the morning and I walked down the hall with a walker and even walked up and down a few steps with the help of a hand rail. They were pleased with my mobility.

Then I got some good news. The doctor, therapists and nurses said there was no reason for me to stay in the hospital a second day and I could go home.

They didn’t have to tell me twice. I washed up, Bev got me dressed and packed, and I was ready to return to my home in Saluda.

Not so fast. It took about three more hours to get all my discharge papers approved and signed, acquire a walker, and get my prescriptions. Finally, I was wheel-chaired to our car, and Bev and I were headed home at about 2 p.m. It is hard to believe I was only in the hospital about 30 hours.

On the way home I felt so elated and good I called my brothers and some friends and told them I had a new knee and felt great. Little did I know that would change soon and the real work would begin.

Here comes the pain
I was now on a daily dose of Warfarin to keep my blood thin and lessen the chance of forming blood clots. I had to wear white elastic stockings on each leg to improve circulation and keep the swelling down. I also had to do “foot pumps” every 15 minutes to help my blood circulate back to my heart. I was prescribed pain pills but had not taken any yet.

The nurses and therapists told me to take the pain pills before the onset of pain. “Keep ahead of the pain,” they stressed. “It’s hard to catch up once it’s there.”

At about 3 a.m. on my first night at home, I realized what they meant. The morphine and other pain-killers had worn off, and the pain in my knee and legs was bad enough to wake me up. Give me those pain pills.

The first week I exercised the knee regularly, walked a few minutes every hour with a walker, iced my knee, and watched a lot of TV from my living room recliner.

Caregiver
This whole experience revealed to me the importance of the caregiver. A good caregiver is one who really cares about you, and I couldn’t have had a better one. I had a special bell that I rang to let Bev know when I needed something. Of course when I had visitors, I’d ring the bell for no reason, just so they could see Bev scurry into the room. We’d laugh, but Bev failed to see the humor in it.

Therapy
A home health nurse and physical therapist came to my house a couple days a week for three weeks and both said my “road to recovery” was going well. The nurse would check my vital signs, and the therapist would crack the whip as I grimaced through a variety of exercises. Both women were great to work with.

After the first week, I discarded the walker and began walking on my own. I had to learn to walk correctly. The limp that plagued me for the past 10 years was gone and my bowed leg was straight, so I concentrated on keeping my spine straight and shoulders square as I walked up and down the hall of our house. Walking actually felt good.

My ongoing physical therapy continues to be painful. I take pain pills about an hour before I work out, which helps a lot. With each visit, the therapist encourages me to bend my leg a little further and increase my range of motion. She always leaves me with a list of exercises to do until the next session, and a swollen knee from all the activity.

I returned to the doctor’s office three weeks after the surgery and basically was discharged from his care. There also would be no more home visits from the nurse or physical therapist. Now I am driving to see a physical therapist.

I still have swelling in the knee, and it is difficult to find a comfortable sleeping position, but overall I am getting better and I am very pleased with my progress. I have a ways to go, but hope to be hitting the golf ball by mid-March, and I can’t wait to take a long walk without pain. This is something I have not done for over 10 years.

My doctor and his assistant cautioned me that a lot of trauma occurs to the bones and tissues during knee replacement surgery, and it could be up to nine months before all the healing is complete.

I already waited 10 years; I guess I can wait a few more months.

Tips
My advice to those getting knee replacements is to get yourself in decent shape before the surgery. Strong thigh, calf and hamstring muscles really help during the recovery period.

Also, do what your nurse and physical therapist tell you. They are the pros. I’m told that after knee replacement surgery a patient has a window of about 30 days in which he can regain his range of motion. If the patient doesn’t get it done during this time, the knee will always have limitations.

So grit your teeth and push those muscles further each day. And, above all else, enjoy and be thankful for your new knee and the great health-care system we have in this country.

posted 03.05.2014

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