Total Knee Replacements: the Ins and Outs

Subcondral Insufficiency
Fracture

Well, why and the heck am I writing about a knee replacement?  Maybe I am just bored stiff after 6 weeks or maybe this will help, just one person to more prepared: (I had a hard time finding personal experiences) possibly this could be someone you know who is going to go through this pretty challenging procedure. First things first, If you have a medial (inside) pain, the doctor may offer you a partial knee replacement option, (they just do the inside part of your knee joint) which is a quicker recovery and easier procedure with increased mobility at a semi-professional level, but with the likelihood you will have to have get it replaced in 10-15 years, I said no thanks for me. So I went for the real thing... and I have only one thing to say,

Townsend Rebel Reliver

try everything first: physical therapy, lots of ice, cortisone shots, the latest is something called Lipogems joint pain injections: Lipogems , PRP (platelet-rich plasma), arthroscopic surgery,  and of course rest, all are good for injuries and Osteoarthritis.  Gel injections with Hyaluronic Acid is proving not to be so successful in the latest studies according to my Nurse practitioner at Core Orthopedics. I have done several of them over the past 30 years. My one thing I didn't do is listen to my body, if the knee hurts--stop what you are doing, ice and elevate. In my case my Osteoarthritis collapsed the knee joint and caused a bone fracture in my femur called: Subchondral insufficiency fracture--big words, otherwise hurts like the hell. My doctor fitted me with a Townsend Rebel reliever adjustable knee brace, (only about $900- luckily Medicare took care of it) to no avail, the skiing season was blown, the trip to Japan was put on hold for the 3rd time and I made one mistake: I got the cortisone shot to help me skiing---Nope didn't work and so I had to wait an extra 3 months to get the surgery, double bummer! 

BORREGO STATE PARK: Once I was committed to the surgery, I started to go the gym 2 times a week and work with my trainer Randy Neuberg once a week. Wanted to go in strong---and it helped somewhat. The only problem, Loraine and I decided go on one last adventure, so we went out for a wild off-roading trip to the desert in Big Red- 2 weeks before the surgery. Turns out, bad idea, lots of flowers blooming this year, and we kicked up lots of dust spinning through the Collins pass.

BigHorn Sheep on Palm
Canyon Trail.

The result both of us had our old bronchitis kick in. Saw the pulmonologist 10 days before surgery and she juiced me up with steroids, nebulizers, inhalers you name it-- luckily on the day of the surgery I wasn't coughing up a ton of yucky green gobbity-goup- this was too close for comfort. 

Side view 

Front view

PRIOR TO SURGERY:  You have to do a 2 week check in with your family doctor who will give you an EKG if you are over 60, + read your completed bloodwork. Make sure you have you have the bloodwork done before you see the family doctor, so he can give you the thumbs up. They will give you all the information on meds and food restrictions you need to get at the pre-op procedure. Nothing big, but get all the meds regardless how you feel about taking them later. They will also explain the operation, timetable and show you the models beforehand. Make sure you get an ice machine -- around $200, our nice neighbor loaned us theirs. Get the one that is insulated like an ice chest, so it keeps the water cooler longer. ** Big Tips- Use 5 or six medium size water bottles instead of ice-- freeze them each night and rotate out only once a day. Get a walker from a second hand store-- I paid $25, and a portable potty (medical supply store, or a pharmacy- I only used it 4 nights, but boy I needed by the time I got out of bed). And a cane, second hand store, anything will do- I used mine for 3 days. And make sure you do the exercises they tell you to do beforehand. 

Ossur "Cold Rush"
ice machine-awesome

Iced bottles

First day home from
surgery

DAY OF SURGERY:  I chose the in and out on the same day. A 7am surgery out by 12:30pm and home by 1pm. We selected the Escondido Advanced Surgery--- they only do outpatients. My surgeon Dr. Nathan Hammel at Core Orthopedics, said you can suffer in the hospital or suffer at home, I chose the latter, this this is the only way to go, there is  no hospital nurses torturing (in their loving way in the middle of the night- just your spouse or caretaker. :)  The first thing they have you do is change and have you put on these thigh high compression socks on the non surgery leg. I had a great anesthesiologist, Dr. Valentine, he reviewed my chart and said he will be giving me an epidural (definitely do it), and a ultrasound guided nerve block in the upper femoral nerve. The good part is you are knocked out for the nerve block, and the last thing I remember is them pushing me forward in an upright sitting position for the epidural, never felt a thing. The surgery went great about and 1 1/2 hours, I ended up back at my pre-op station. I woke up screaming bloody murder, saying" " I needed pain pills", and they finally gave me some more pain medicine to shut me up--which was ok by me.  They called in Loraine and told her I was going to be a handful because I had a "low pain tolerance". Ha! The nurse just said keep on schedule with the ice and meds with this guy!

Blood spot 

So we drove home and the fun began. I came in the house with my walker and proceed to say, " that didn't hurt at all! what was the big deal I can already walk" so off I went around the house and over to the neighbors. Big Tip-- don't do it!  Still no pain the rest of the day and the morning of the next day. And then Whammy!! The nerve block and Anesthesia wore off at about 12pm and I had not taken my meds--- If felt like somebody had smacked me with a sledge hammer in the knee and my knee and leg had swelled up almost doubling in size. They already had another compression sock on my surgical leg.. thank goodness. The next 4 days was a blur, tried to do my exercises (leg slides, and quad contractions) it started bleeding. But that's is what they want you to do, so I suggest to do them, just don't overdue. Keep the compression socks on your surgery leg as many days as you can because as soon as you take it off the swelling begins. 

straight leg cast.

I went to PT 5 days after surgery, which normally would be ok, but my blood spot kept expanding, so they sent me to see the Doctor.  He said we have to get this stopped now. So he wrapped a breathable (very important) gauze tightly with an Ace bandage. Followed by a straight leg cast for 3 days. (had to cancel my PT for a week), no fun couldn't bend my leg for 3 solid days. 

I used Manuka Honey to help the wound. This is great stuff for wounds and burns, Manuka Honey UMF 20+ and Mgo 850 (Costco -on sale was $79.)  Make sure you check with the doctor first to see if they approve it. There's a lot research which talks about its benefit starting with WebMd-Web MD Manuka honey

MEDS:  We all hate to take Oxytocin (Percocet), because of the possible stoppage of the digestives system. But seriously, you just take the stool softener with it everytime and there shouldn't be a problem. It takes the edge off and certainly helps your sleeping. Make sure you ice all the time, especially before you go to bed. And I took Celebrex for inflammation (it is also a blood thinner) and a blood thinning Baby Aspirin-80 mg for 1 month afterwards. Actually, I still take the 200 mg Celebrex even now after almost 7 weeks. A hospital type bed is a good idea, sure helps for getting up and down and elevating your leg. I am sure you could rent one from a medical supply company.  And if you can stay down stairs, even better. We had previously purchased a Tempur-pedic mattress bed from Costco, it is great and is remotely controlled. 

A really good vitamin supplement is Ester-C, a gentle non-acidic supplement. You can get it at Sprouts or on line. It is recommended by some orthopedic surgeons, take 1000mg every day to speed up healing for the tissues. 

Highlight: Swelling goes way down in about 7-10 days. I used the walker and then briefly a cane, but was completely off of both after 10 days. Still keep icing using the ice machine off and on all day. I also used a gel ice pack on top and under the knee joint as an alternative when I was watching TV in the other room. You can get a gel pack on Amazon or any drug store. Sleeping on the other hand has taken 6 weeks where I can go to sleep comfortably, using a pillow between my legs and sleeping on my side. If I have any pain for my knee or back I use these Salonpas patches (have methyl salicylate aspirin, (aspirin) to take off the edge. i get them at Costco 140 pack for about $20. 

Physical Therapy: (PT) From now on is the major source of pain for the next couple months. I had a wonderful PT person, Pam Cloud,  at Core Orthopedics. And she worked me hard each time. Big suggestion- I signed up for the Laser low light, pre treatment before each appointment. Looks like a ultrasound machine, and does wonders for soft tissue. A 10 treatment packet was $400 and well worth it, made PT a lot more productive. After each PT, I was pretty exhausted, and it usually went into the next day. They will work on tightness and strengthening. Your knee  will continue to be tight for several months. Their first job, and yours is to get your whole leg (especially at the knee joint) to 0 degrees extended straight, and at least 115-120 degrees bent, so you can ride a bike etc. Once I got on the stationary bike it really helped on the tightness. So I always try to do this at home on my bike or the gym, or elliptical and then do any exercises.

Side view, you keep the patella
(knee cap)

For the 2 week check up at the Doctor's office they will take 2 more x-rays to see if everything is aligned properly, see X-Rays below. The NP gave me the thumbs up and everything was on track.

Front view- nice hardware

The Hypervolt ( I call it the pounder) is an invaluable tool for moving fluids around above the knee joint and below. In both of these areas, swelling appears often after any physical exercise, so instead or with ice I use it to loosen things above. Make sure you use the flat head. Now days they have cheaper ones on Amazon. 

It has taking me 6 weeks to start to feel normal. I can walk 1 mile, use the stationary bike for 10-15 minutes, and I started going to the gym for some upper body work and to use the leg lift and leg extension machine (on your back or leaning back). These are 2 excellent machines for strengthening the Quad, and your overall leg strength. Plus I love using the Swiss ball for wall slides and to do some core work for my stomach and back muscles. It will took me about 7 weeks before I could go in a community pool. (after the scab falls off). 
Scarring: It changes over time, thank goodness, it was a pretty gnarly scar at the beginning. Remember they stitch the muscles together below the skin and use a glue on top. Takes awhile for it to peel off. Luckily you can take a shower after 3 days. You may want to try Silicone Scar Patches which reduce the scarring and you can get from any pharmacy or online,  I bought the roll so I could roll it over the scar.  Loraine used it on her hip replacement scar and you can barely see it now. Silicon roll scar sheets

Roll on scar sheets

3 days after surgery

6 weeks after
surgery

9 weeks:  Getting ready for a huge hiking trip to Canada at the end of July. Using a hiking poles is a must.... probably won't hike over 2 or 3 miles, I will be almost 3 months out by then. It will take me about 7 weeks before I can go in a community pool. (after the scab falls off). 

Would I do it again: Absolutely, just be ready for the recovery- PT is a challenge 2x a week.   

Make sure along the way to ice and elevate if you do too much, swelling and tightness is just part of it. By icing you will feel better the next day.  Just remember you don't what the outside of your joint to keep swelling.