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Nanny's Knee Replacement

dorlchas@tds.net 

I was asked to contribute an article to "Arthritis Insight" of my own experience through the process of having a total knee replacement almost a year ago, on November 30, 2000. It is my pleasure to do so, hoping that my own notes will help someone else face a similar surgery with boldness and courage. I hope you will find portions of my article to be an encouragement to you!

It seems appropriate to begin with a little background. I am 57 years of age, a wife, mother and grandmother. Up until 1989, I had worked 20 years as an executive secretary at a major oil company in my hometown. Prior to facing a total knee replacement (which I will continue to refer to as a TKR), my primary health problem had been Fibromyalgia and Myofascial Pain Syndromes. In other words, the muscles and other soft tissues in my body were undergoing changes beyond my control and causing me to adjust my whole lifestyle, as well as coping with a life of pain. It wasnt until approximately 3 years ago that my right knee joint began to give me problems, which increased in severity until my TKR. Osteoarthritis was the culprit this time!

When the problem became serious enough to interrupt my daily life, I decided to consult an Orthopedic surgeon in my own town. His diagnosis: moderate Osteoarthritis, with more degeneration in my right knee than the left. This first visit would take me through a few more steps and lots of frustration and discouragement before I would find the solution that would not just be a "bandage" for the problem, but would tackle head-on the pain and suffering I was beginning to experience. The Orthopedic surgeon, at this first visit, recommended we start with an anti-inflammatory medication a conservative approach. Having switched and tried 3 different ones, I concluded this approach was unsatisfactory and relayed this information to my doctor. He then suggested we go the next step in receiving Synvisc injections. This is a substance which is inserted directly into the knee joint and serves to provide a cushioning effect to substitute for the cartilage which was damaged. Another bad experience followed. The injections caused me further pain and my knee began to show swelling as well. This procedure, though covered by our insurance carrier, was very expensive, involving 3 different injections a week apart, each injection costing $300.00. To my chagrin and disappointment, the results were tragic! It was at this point I began to be mistrustful of my consulting physician, especially when he told me my reactions were not in line with others whom he has given the Synvisc injections. So what! I am not "everyone else" and I wanted to be validated and taken at my word that the pain and suffering I was enduring at this point was not acceptable. I tried suggesting that perhaps my Fibromyalgia was contributing to the problem, but he dismissed that proposition by NOT acknowledging my statement, therefore causing me to feel that he did not want to really involve me in my own healthcare.

At this point, he prescribed a cane for me, which I began to rely on as my means of transporting myself from one room to another, and from one place to another. This seemed to help minimally, but as time went on, the pain and immobility became more severe. The third step up the ladder was Arthroscopic knee surgery. Another very expensive procedure, involving my being under anesthesia while my surgeon made three incisions, or points of entry, for his instruments to snip and smooth those areas where the cartilage damage was most severe. It was after that surgery that he informed me that he was surprised to learn that while he thought there was some remaining cartilage in my right knee which was still doing its job, that in fact I virtually had NO cartilage at all in that knee!

My recovery from Arthroscopic surgery was very slow and tedious. I was prescribed a program of six-weeks of intensive physical therapy, 3 times a week. I was still optimistic at this point that my problem was temporarily solved and that after the healing and recovery process, I would once again have use of that knee. Not so! For a short period of time during the physical therapy program, I was able to discard my cane and walk on my own, but this was short-lived and by now I was becoming very discouraged, frustrated, and not a little angry at what I thought was mis-management of treatment by my Orthopedic surgeon, involving much wasted time and expense on my part. The pain and immobility is so bad that when I get out of bed in the morning, it takes me some time to even straighten my leg, and then more time and pain to take that first step. Every step thereafter, using my cane, is still wrought with excruciating pain. It is intolerable to me now!

Fortunately, at this point in time, I was to learn about another Orthopedic surgeon in a larger city about 2 hours away who had given knee replacements to two other women in the church I attend. This particular physician was highly recommended by them and had a reputation of specializing in hip and knee replacements. I obtained my medical file, made an appointment with him, and longed for a second opinion that would prove to be productive and lasting! My husband accompanied me and we both were able to meet and talk with the Orthopedic surgeon just mentioned and his staff of capable nurses and office manager. He took new x-rays, posted the results on his wall, and explained in detail what the problem was and why it was causing me so much pain and immobility. He pointed out, and I could see by the x-ray that the cartilage in the joint of my right knee was gone, and bone was resting on bone. To my surprise, he recommended a total knee replacement three weeks from that day! He said my problem was severe enough to cause a risk of further damage which would not have a good prognosis if I waited too long. A further bonus, I was to find out, was that same Orthopedic surgeon had had one of his own knee joints replaced a couple years prior to my meeting with him. Now, here was a medical professional who had personal experience with all that was involved in the recovery from TKR! In other words, though a surgeon, he was once the patient! At that first visit, he made a point to tell me that he was liberal in prescribing pain medications, both post-surgical and at home, if needed. That was a new twist for me, too, in my prior experiences with doctors.

On the suggestion of the ladies at my church, I decided to keep a journal of the period of time after surgery and my weeks/months of recovery from the TKR. I am so glad I did, because now I can share excerpts of that experience with you and it will always be a reminder of what was involved just in case I ever have the same problem with my left knee. I want to be totally honest at this point by telling you that recovery from a TKR is very tedious and slow, testing ones determination to get well one day at a time! And, though I was told that in 6-8 weeks I wouldnt need my cane anymore, the entire healing process (muscles, bones and nerves) could take up to two years. The doctor also informed me that the hardware (joint) he uses has a life span of 20 years plus, which is a great improvement over some of the others used. I want to stress at this point the necessity of faithfully and diligently going through the physical therapy exercises following surgery and during recovery, which at first are pretty painful. But, nothing good and lasting seems to just happen quickly and naturally, wont you agree? While many people having TKRs are required to get physical therapy outside their home, this particular Orthopedic surgeon believes the same results can be obtained in ones own home by following daily a series of 3-4 basic exercises. THIS IS A VERY VITAL STEP IN RECOVERY!

Because of the length of this article, I will not go into the details of my post-surgical hospital stay, which was 4 days. Only to say that due to the necessity of very sterile conditions during surgery replacements, it was necessary for the surgeon to operate in a "bubble suit". I can best compare that to an astronaut who is getting ready for a moon walk J They let me see that before putting me under anesthesia. Also, I would suggest that before having the actual TKR surgery, it is beneficial to have had made prior arrangements for the supplies you will need when you come home. In my case, we rented an adjustable hospital bed, as our home is two stories, and climbing stairs is a "no-no", at least for awhile. It is probably best, for your own comfort, to not sleep in the same bed with your partner for a couple weeks or longer. In my case, I used the hospital bed for 4 weeks. I also had a walker and cane on hand, which you will need. Crutches are optional, meaning while I had a pair on hand, I preferred using the walker.

Now that you have the background leading up to my TKR, which seems to be longer than I originally intended, I will refer to some of my journal entries. I will quote my own notes, giving you an idea of the "ups and downs" and progress involved in my TKR and subsequent results today.

On the 4<sup>th and last day of my hospital stay, they wouldnt release me until Id been given a unit of blood. My hemoglobin was 7.5, compared to 11.1 before surgery. It is NOT unusual to have a blood transfusion after TKR, and in my case probably due to the fact that I was at that time currently being treated for anemia by another doctor. The surgeon was aware of that fact.

First Night home: I slept fairly well in my hospital bed, although would awaken every few hours to take my pain medications (Lortab, Ultram & Ecotrin). The Ecotrin, which is an OTC aspirin, is primarily to help prevent blood clots in my surgical leg. Can only sleep on my back, though I elevate my head/shoulders and legs.

Day 2: My Home Health nurse, who would be with me throughout my recovery, made her first visit to check on me. My knee and surrounding area is painful and stiff, but still started my physical therapy exercises. Fatigue is minimal; took pain meds every 4 hours.

Day 3: I was prescribed an antibiotic, Cephalaxin, as the area around my knee had become red. Constipated. Home Health nurse said to take a laxative each morning and night until bowels are regular. She said the pain medication and inactivity from surgery contributes to constipation. Also the iron supplements I am required to take for the anemia.

Day 9: The Home Health nurse said that the average healing from TKR is at LEAST 6 months. However, my surgeon said it can take up to 2 years for everything to heal (bones, muscles, tendons, ligaments, nerves). My leg aches and swells more in early evening. I find that the leg brace they sent home with me relieves that discomfort somewhat. Still needing pain medication every 4 hours.

Day 10: I got curious and counted my knee staples. There are 73! The infection has cleared up, thank God! The surgery site is still very painful and tender to touch. I cannot as yet bend my leg enough to use the rocking chair, which is one of the therapies recommended.

Each night my husband helps me do 10 leg lifts, with my leg brace on. On my own efforts, I can only move the leg up a couple inches at a time while sitting in my lounge chair.

Day 11: I found that by lying on the couch, I was able to do 10 leg raises on my own! The Home Health nurse said I need to work more on bending my leg, doing the heel-slide exercise. This one seemed the most difficult for me and tedious. Little mobility of my surgical leg as yet.

Day 12: Went to the hospital for the routine leg doppler test to check for blood clots. It was a long, uncomfortable ordeal (nearly 3 hours), but the technicians said they didnt spot any blood clots. Another reason to be thankful!

Day 16: Although my bowels are moving, I still have some constipation. Ive been taking 2 Fiber-Com caplets a day, plus a laxative in the A.M. and P.M. The nurse suggested adding prune juice daily. I am going 5 hours now between pain medications. I continue to do my home therapy exercises twice a day and am now using the rocking chair minimally.

Day 18: I am going 5-8 hours between pain medication. Bowel stools are finally softening.

Day 20: Home Health nurse drew some blood to check my hemoglobin. Result: 10.5 and seems to be going up nicely again. Had lots of gas today, probably a release from my days of constipation and trapped gas J Am weaning myself off Lortab to 1/day and supplementing with Ultram, Excedrin, and Soma at night.

Day 21: The HH nurse removed my 73 staples today! Made the remark that I am doing exceptionally well.

Day 24: Went upstairs for the first time and took a shower, sitting on a special tub stool. Stopped wearing leg brace at night.

Day 26: My husband took me on my first outing since surgery to the local library. I used my walker. Slept upstairs in our own bed for the first time.

Day 28: The HH nurse released me from their care, and I called to have my hospital bed picked up.

Day 30: Cooked my first full meal for my grand-daughters birthday. Took first tub bath by myself.

Day 32: Started using a cane instead of my walker. Went to the Mall to eat and see a movie with my husband. Great to be out and around!

At 7 weeks following TKR, I am able to do the following: tub baths, laundry, ironing, cooking, but slower than usual and with the aid of my cane. The knee "bend" is coming, but very slowly. There is no longer any pain when putting my full weight on my right knee the "new joint" is doing its job Hurray! I still have numbness around my knee, particularly on the outer side, but some feeling is beginning to return. I am told this is normal.

Im beginning to find that when Im working around the kitchen and other areas of the house that without thinking, I take some steps on my own, leaving my cane behind. The next big step will be using no walking device at all.

January 17, 2001: After 7 weeks from my surgery, I had my follow-up X-rays and consultation with my Orthopedic surgeon. He said my knee bend was at 90% and he is anticipating even more as time goes on. Said I could discard my cane. His nurse said the heat, numbness, swelling and "hardness" around the knee is normal, and that it could take up to two years before the healing is complete. I am to report back to him in December, 2001. He is well pleased with my progress. And, so am I!

As I write this, it has been nearly a year since my TKR. My Fibromyalgia pain bothers me more than the Osteoarthritis pain. Would I recommend TKR to others? Definitely! Am I glad I had a total knee replacement? Most assuredly! Even though I do have some pain and discomfort on occasion, especially during weather changes, there is absolutely NO pain when I stand on my right leg or walk. That is a great accomplishment, I think! There is still some numbness around my knee and I use a small pillow between my legs at night to relieve pressure on the hips and legs.

I sincerely hope that by my sharing my own experience, that someone else will be encouraged when facing a decision to have a total knee replacement. Peace and less pain to all of you!

Gloria Wolfe (aka Nanny)
Page last updated on November 4, 2001