Stu's Knees

Why I Chose a Bilateral Knee Replacement

[salimfadhley via photopin cc]
I am no different then a lot of "Baby Boomers". I grew up in a comfortable lifestyle with my Dad being career Navy and Mom working in the Federal Civil Service system. We weren't rich by any means but were able to do many things with a healthy amount of free time. My school years were not spent doing sports, but filled with every kind of adventure you could think, climbing (and falling out of ) trees, chasing girls and fixing cars. We took a ton of risks and somehow managed to survive numerous trips through the ER.

One of those was a pretty severe injury to both knees. Seems the penalty for trying operate a 57 Ford Fairlane (named Wrinkles) with barely any brakes, questionable door locks and no seat-belts was to have the door fly open and propel the driver out only to be dragged over a metal storm grate injuring both knees. By the time we finished whatever the hell we were doing and got back home, I could barely walk and both knees were about the size of grapefruits.

But I had my story straight and it had nothing to do with a car, something about an old fence post in a field where we were playing football. (see previous mention of my sports activities. The parent bought it and off to the ER we went. A few weeks later and many exaggerated stories I was off to find other ways to abuse myself.

Flash forward to the ripe old age of 26 and the Fire Department called on me for a 31 year career in the best job in the world. I fell down a few fights of stairs, tripped over fire-hoses, fell out of windows, slipped on ice etc. Needless to say, the knees took a beating, but I was still young and "just hitched it up" and moved on. I finished my career with only a single arthroscopy to the right knee for a torn meniscus.

Well, shortly after retirement things began to change. The knees would ache, stiffen and make some awful noises. A trip to the Orthopedic Surgeon got some relief with a shot of cortisone. Additional injury to the left knee got the same short term relief. We moved up to Ortho-Visc (4 months relief) the Syna-visc with an even shorter relief. My Doc said it was time to escalate me to the replacement guy. X-rays now showed a bone on bone condition in both knees.

Dr. McDonald of the Orthopedic and Sports Medicine Clinic, LLC, Annapolis Md is a highly recommended surgeon, specializing in knee replacement. He has done many of my fire fighting colleagues. Everyone talked highly of him and his staff. We discussed the option and agreed that both knees were finished. So which one he asked, I said should we do both? What are the pros and cons? We made the decision together and scheduled the operation.

Discussion and factors leading to this decision:
  1. Was I healthy enough to get through the surgery?
  2. Was I motivated to go through the rehab process?
  3. Could I tell him which knee should be done if only one were replaced?
  4. Did I have an adequate support system for the post-op rehabilitation?
This was pretty straight-forward for me. Although heavier then ideal, I have good health. I was definitely motivated, (see this link). After losing my wife of close to 20 years less than a year after retirement, I was not going to take any more time out my life for these repairs than necessary. Complete recovery can be 6 to 12 months, you do the math. Each knee seemed to moan and groan about equally. It depends on the recent activity or lack thereof. Who knew? I planned on coming back the Maryland where I lived and worked most of my life, my kids were there, my friends were there and I was very familiar with the medical system. I had the support system. Other thoughts came up as the date for surgery was nearing. My primary care doc said many of his bilateral patients seemed to have less issues with limps. Seems balancing the the surgery/rehab process equally left and right reduced the chances of a limp. A few friends have said: "After the first one, I'm not getting the other done," or they wait until they can't stand it anymore. Not me, I've got stuff on my bucket list, grand-kids that need Disney and Scuba diving to do. Oh yeah, and something about a motorcycle and Route 66. Now the down-side:
  1. PAIN - I'm not kidding, there is some serious discomfort! But it is completely manageable by following directions, doing PT, medicating regularly, elevating and icing down.
  2. PATIENCE - Look it took 60+ years to get here, we ain't going back to the promised land in the HOV lane. This is a major procedure involving the largest bones and muscles in the body. All that stuff gets cut, stretched, displaced and sewn. The nerves in the area do their best to let you know about it. Listen to the professionals, follow their direction and your pain will go down and your mobility will improve... it's just gonna do it on a schedule that's out of your control.
  3. PREPARATION - You should do PT before surgery. Not all Docs require this nor do all insurance plans cover it. However, you should do plenty of exercising to strengthen your knee. The more done pre-op means a shorter, less painful PT after.
If you are overweight, then lose whatever weight you can. Your new knee (as well as your old one) will function better, last longer, and the effort required during PT will be reduced.

Pre-Op and the BIG DAY

Pre-op consisted of many appointments with all my medical professional. Because this is major surgery, all your systems need to be examined and approved for surgery. It was off to my Primary Care Physician for a physical and report as required specifically by the orthopedic surgeon. Appropriate "Labs" requested and sent in. Next the dentist. I was due for my usual cleaning and exam so this was a scheduled visit. Again a specifically requested report had to be sent to my surgeon.

 Next it was off to Joint Camp class for our introduction to joint camp. This was a very informative session. We went through the daily activities while in the hospital, toured the facility and talked with volunteers that had joint replacements. The "2 a day" physical therapy (PT) was discussed. The program really gave us a complete overview of what to expect while at the hospital. Let me tell you, they have that center "dialed in" (more about that later)

 With completion of all those, it was on to meet with the orthopedic Surgeon and his Physician Assistant. A routine exam along with new x-rays, then we received a detailed explanation of the procedure and what we could expect. We left with some special soap for showers to be used for the three days prior to surgery as well as a prescription for an antibiotic ointment to deal with any "bad guys" in my nose. A huge concern during any type of surgery these days is the possibility of a MRSA infection. Read about it here. The showers and nose ointment were used to reduce this risk.

The day before surgery, the hospital called and told us where to go and at what time for our admission and pre-op procedures (IVs, some additives to prepare for the surgery etc.). We were told to be a the hospital at 11:30 with surgery scheduled for roughly 1:30. Surgery was anticipated to last 3 1/2 hours followed by two hours in recovery.

I actually got in at 3:15, made it into recovery by 7:00 and in my room at 9:05. No PT for me that night, had I been scheduled before noon, I would have done PT that afternoon. (no messing around here) My memory of that day can be described as follows: rolled into OR, I see a mask coming down over my face, I wake up in my room looking at my lovely Donna. We kissed she said goodnight and I woke up for breakfast.

That's it, no drama in recovery, no writhing in pain, no waiting for something after hitting the call button..none of that.

Post-Op Hospital

I spent 3 days in the hospital. During that time all of the joint replacement patients had physical therapy (PT) twice a day - every day. All of us walked to the PT area, followed by our recliner, accompanied by our various IV poles.

The Hospital volunteers were all over the place, gathering the various patients, getting equipment and chasing down slower patients. All this done with a smile and lots of encouragement. A bonus, all of them were joint replacement patients themselves at one time.

PT was hard but extremely important in order for your healing to start in the right direction for long term success. All the day seemed to be a blur.

On day three things really went blurry. Seems my blood count had been getting low. Not that unusual for a bi-lateral knee replacement. It's not treated until symptoms show up and day three, boy did they show up. Two units of blood were ordered. Here I am thinking no PT, I'm going to fall behind and have to work harder to regain my flexibility. NO way, PT is gonna happen no matter what, I just wasn't allowed to walk there.

I felt much better after the transfusion, dizziness gone, energy somewhat restored and my head cleared as much as it could have. Because the transfusion was ordered so late and took so long to finish, Donna was not able to get me to Spa Creek Center until 10:00 PM. However, in-spite of a few small mishaps along the way, at the end of day three post-op I was tucked away in bed awaiting the next chapter of my recovery.

Spa Creek Center

We arrived at Spa Creek Center late in the evening. The staff there at that time of day just wasn't use to having an admission and it showed. We were delayed for a bit with Donna standing outside waiting for someone to get their act together while I sat in the truck. After a bit of finagling, I was admitted to the center, evaluated and fell fast asleep after a long day.

 Day one at the center was spent getting used to the routine, being evaluated by the physical therapist and starting my two a day PT sessions. Each session started with a warm-up and then specific exercises designed to stretch all the tight tissues and increase range and strength.

On Monday a more regular schedule was started and the days fell into a rhythm. Wake up, walk, breakfast, PT, walk, ice, nap, lunch, walk, PT, walk, ice, nap, dinner, walk and finally to bed for the night. It was like that for the majority of the 2 weeks in the center.

During my time at Spa Creek, my range of motion increased to 130+ degrees. I went from using a walker to crutches and finally a cane. I was able to decrease the pain meds and come off all narcotics within a week of getting home. All of this was due to the motivation of the staff at the center and a little bit of hard work on my own. I usually walked about a mile a day.

The middle of week two I had an appointment with my orthopedic surgeon and got the staples removed. The doctor was pleased with my progress and I was ecstatic about being able to finally take a shower. OH the joy of hot water flowing all over!!

After two weeks the final evaluation was completed and I was scheduled for release on Friday. I made the rounds and thanked all the staff that made my stay pleasant and productive. I was well on my way to a successful recovery.

I am positive that spending 2 weeks at a rehab center with two PT sessions a day was the best way to go. Not only did I recover quickly but a tremendous burden was not thrown on Donna. She was able to come to the center each day and coach (and count my reps) my PT session and didn't have to deal with the routine care and feeding of an occasional grumpy/demanding patient. It was a win-win for both of us.

Kaye helping practice getting in and out of truck

Here is my day nursing staff and my PT gals....
Nurse Carol and Nursing Assistant Janet (Smoothie)
PT staff Yasmeen, Sara, Kaye, Karen
The defining moment....Free, FREE at last!!
Nurse Carol cutting the "Chains"

Anne Arundel Medical Center Out Patient Rehabilitation

My next step/destination was to "Out Patient Rehabilitation". I chose Anne Arundel Medical Center Out Patient Rehabilitation for this. It was located in the same building as my Orthopedic Surgeon and on the same campus has the Hospital where the surgery was performed. The staff there was very familiar with the rehab program used by my surgeon, seemed like a wise choice to me.

First step was evaluation and quickly to actual exercising, stretching etc. I was challenged by new exercises. Some hard and difficult to do at first, but like much of this journey, persistence paid off. The therapists were pleased with the condition of my knees after my release from the rehab center and I quickly made additional progress.

I opted for "Group" therapy, in that a group of patient with similar surgeries did our session together while being attended to by a single therapist and assistant. It was a similar set-up as the rehab center and we all enjoyed the comradery and encouragement we offered each other. The biggest challenge was stairs, particularly going down. I did fine after a session but it was still difficult during my normal days activities.

I did continue my therapy at home on my "off" days, improvising as best as I could. Even Sadie's toys weren't safe from me.

Each session brought some progress as well as some new way to move and strengthen my muscles. The goals were to increase strength and flexibility and increase stamina. At this point my biggest surprise was how slow my stamina was returning. It seemed I was worn out all the time. Much of this was the trauma of the surgery as well as the medications I was taking. It's going to take some time for both of those to resolve and return to a pre-op level. Ah yes, persistence will be the watch word of the days to come.

Donna joined me during a number of the sessions to coach, count and smile. We would "walk the track" between exercises holding hands and chatting. We heard a lot of "You guys are so cute" comments. It made the session go by quickly and was fun as well.

I soon met the therapists goals and was scheduled for release. The Center has a phase 2 program for $25 a month. You basically do the recommended exercises on you own, using the equipment in the center. Cheaper then a Gym membership and the staff was there to ask questions. I went every other day until leaving for Tennessee.
A big thank you to all the Doctors, Nurses, Physical Therapists and staff for all the hard work you do for us annoying/whining patients. We are in your debt!

Life After Rehab

Slowly, and I do mean slowly, my knees have improved. Still not to pre-op or back to normal but better just the same. The Docs say it takes about a 12 to 18 months before the process in complete. Meaning no swelling, stiffness and pain with good flexibility.

I can attest to this in that I type this at a little less then 4 months post-op. I still have some days with pain and stiffness. The swelling is there but not bothersome. I take Aleve at night for pain. I try to incorporate the movements of the rehab session into my daily life. Stairs are still with effort but are getting better each day. My stamina is slowly returning.

I was able to attend CMA Fan Fest in Nashville and had to go up and down steps to our seats many times over the 4 days we were there. Additionally we recently returned from a trip the Florida to visit family and I went on two Scuba diving trips. Two dives each day. I needed help getting to my feet with all the gear on but after that I was able to get in and out on my own. Of course in the water there was no weight and kicking the fins was easy. I'm looking forward to three more (2 tank) dives scheduled for our January cruise.

We had a shed delivered to our Tennessee property this week. See our blog about it here. I was able to clear the trees and pull the stumps in order to make room. I built the ramp for getting the bikes in and out. I was working on this project for a solid 3 days and my knees gave me little to think about. I proceeded slowly, watching my footing to avoid tripping. Stay hydrated and took frequent breaks.

I'll update this story in a few months to give readers an idea of how things are progressing.


Would I do it all over again?
YES absolutely
What would I have done differently?
More PT pre-op and add a dose of patience post-op
The relationship between all the professionals is important. It should be a team with all the players working together with YOU, the patient, in mind. Find the Medical Center that specializes in joint replacement. Ask questions of others that have had the surgery.

Do the PT. Consistently and with persistence. I have seen patients that didn't. The rehab for them is even more brutal.Take the pain meds as directed. Learn to time them for maximum benefit during the PT sessions. It will enable you to do the sessions to the max.

Ask what you can do the improve in between your PT sessions. I walked a lot.

If you can, get to a rehab center. Yeah I know, you'll be more comfortable at home etc. But think about your significant other and the burden on them and what about you? want the best healing possible? Sure I missed Donna, Sadie and my own bed but I knew this was short term aggravation for a long term improvement in our quality of life.

ICE and ELEVATION. Ice, no more then 20 minutes and keep your knees above your heart whenever you can. It really reduces the swelling and makes you PT sessions more effective.

One last thing: Do you know the difference between a Physical Therapist and a terrorist?
You can negotiate with a terrorist.

PT----Just do it and quit yer belly-achin

Progression of Incision - don't click unless you really want to see.
[ 3 days post-op | 2 weeks/staples | 2 weeks/staples out | 4 weeks post-op ]

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