Last I wrote about my knee, it was to report my retirement from running. The knee specialist had prescribed an ‘unloader’ brace that would shift my weight from the inside of the knee (where the bone-on-bone arthritis was the worst) to the outside of the knee, and informed me that my running days were over. He warned me that the knee would continue to get worse, and I should ask him for a referral to a knee surgeon when I was tired of dealing with the brace, or the bones rubbing together got too painful. At that point, I had already shifted my activity to the Peloton bike and hiking, though both caused pain in different ways. I used the brace when exercising, when walking through airports and on days when I was doing a lot of walking. I had to travel with it and found wearing it through the airport was easier since I couldn’t pack it for fear of damage, and airports always involve a lot of walking. It also helped me get pre-boarding a couple times when the gate crew noticed it, so there was some advantage to looking like I had a serious issue with the knee.
Over Christmas, my oldest sister talked about her own knee issues; we had been sharing stories for the past year or so as both of us started experiencing problems. She had already scheduled her TKR, and I was still in the ‘thinking about it’ stage. My sisters worked on me over the week we spent together to convince me to go forward with the surgery. I had noticed that it was feeling worse, so in some ways, it wasn’t a hard sell. I won’t go into too much detail, but I thought I could feel the bones actually shifting against each other when I stretched it in certain ways. While I wasn’t entirely convinced, I decided to schedule a consultation with the knee surgeon at the Rothman Institute (where I had my toe joint surgery 12 years ago). The x-ray showed that there was nothing between the femur and tibia; no cartilage, no fluid, just the two bones butting up against each other. As he went through the process and told me how the surgery worked, I asked him how long the knee replacement would last. He laughed and said, “Forever.” Basically, the new technology and materials do not wear out. I was duly impressed having been told before that they only last 20 years, and one of the key reasons I didn’t want to do it was the prospects of having to repeat the surgery in my late 70’s. As he talked recovery, he mentioned I’d be mostly back to full activity within 6 weeks. I lamented that it didn’t include running, and he looked at me quizzically, “Why not?” I was shocked and told him I had been told that the joint replacements couldn’t withstand running. He scoffed, and told me that wasn’t true, that he had other patients that played squash, tennis, and so on. He then went into some detail about the process for starting to run (involving using a treadmill and gradually increasing the incline, but not the speed until you’re forced to move faster and effectively run). Once I had these two data points, I messaged my daughter, “When can you come stay with me?”
And so, after delaying way too long, I scheduled the surgery for March during my daughter’s spring break at the school where she teaches. My son-in-law graciously offered to stay two weeks since I knew I’d be unable to drive for the time I’d be on painkillers (narcotics), and we set the plan in the motion. Naturally, once I scheduled it, the knee felt progressively worse. I don’t know whether it was ‘mental’ or ‘physical,’ but towards the end, I started cancelling hikes with my usual crew of younger, faster hikers and stuck to shorter and easier hikes on my own, or just the Peloton.
As usual, when preparing for some event, I designed a workout routine to get ready. For this one, I decided to add 20 minutes of yoga every night to my usual workouts since I thought the increased flexibility yoga encourages might help. There were the usual pre-surgery preparations from the doctor and hospital that included things like stopping all supplements and ibuprofen two weeks in advance. Unlike with the toe surgery, I didn’t feel the impact as acutely and for that I was grateful. The weeks went relatively quickly, and it was time to go through the myriad directions for the weekend before the actual event. My son in law arrived the night before to take me for check-in, so I wasn’t alone, and he could be there if something didn’t go right. Given that I’d have to stay overnight, my daughter and grandson waited to arrive until the day of the surgery.
Surgery day: Unfortunately, the schedule for surgery put me at 12:15, with a 10:15 check in time. I told the scheduler that I’d pass out since I wasn’t allowed to eat after midnight the day before and my metabolism is such that I can’t really fast, but she was unmoved. We arrived at the hospital on time for prep at 10:15. The lovely staff were very welcoming and told us that I’d be 3 to 5 hours from start to finish. The idea was that I’d get prepped, my SiL would come back to stay with me until they took me in, and then there would be the surgery, time in recovery and eventually me being transferred to the room where he could return and visit. This would give him plenty of time to go back to the house, do some work and come back to check on me before making the airport run for my daughter and grandson.
I was taken back for the prep, and the first question the nurse asked was ‘you’re an athlete, what’s your sport?’ I laughed and told her I am a runner. She nodded, ‘you’re not our average knee replacement patient.’ We went through the whole prep stuff and the surgeon came in to sign my knee (lol – they literally write on your knee to indicate which one they’re doing). The nurse told me he was running ahead of schedule. Then, the anesthesiologist came to explain the nerve block and other aspects of the general anesthesia, the key one being that you have no memory of what happens while you’re under. A few minutes later, they wheeled me into another area, and I thought ‘I guess my son in law isn’t coming back.’ After instructing me to put my legs onto a chair and sit halfway up (for the spinal block), I have no memory of what happened next. The next thing I knew, I was waking up. I looked at the clock on the wall and it was 12:30! I was shocked and disappointed; did something go wrong? There was no way the surgery would have taken only 15 minutes. The nurse laughed at me, ‘nope, you’re done.’ And so, the whole thing basically happened during the two-hour prep time. She then asked me for my SiL’s phone number so they could let him know I was done. I laughed, even when thinking clearly, I don’t know that number, he’s in my phone contacts, I don’t actually ‘dial’ his number.
Since the surgery went so quickly, I ended up in the recovery area longer since they weren’t ready for me on the regular floor. I finally got to the room about 3:30, and the nurses told me they would lift me from the stretcher to the bed. I shook my head, ‘I got this, just move the leg since I can’t feel it.’ I proceeded to press up and move the rest of my body to the bed, they laughed, definitely not their average TKR patient. I had been warned by a friend that I wouldn’t be hungry after the block, but once again, that didn’t hold for me. I was starving, and given the headache I could tell I hadn’t had my daily caffeine fix; after my SiL procured a cappuccino at Starbucks and I ordered off the food menu, I felt much better.
The time in the hospital was as expected; no sleep since they kept checking my vitals and giving me painkillers intravenously every three hours. At one point, the nerve block had clearly worn off and I could definitely feel the pain. I had one of those experiences with the pain that basically caused my blood pressure to drop significantly, so that was fun. Fortunately, once they gave me some narcotics everything stabilized, so it was just a blip on the radar. To be released, I had to prove to a physical therapist that I could go up and down stairs and get in and out of a ‘fake’ car. The stairs were easy given that I’d been dealing with a bum knee for a while now and would have to do the ‘one step at a time’ method occasionally, so I was already familiar with the technique. The fake car was relatively easy, though I have to say the real car was vastly different (and more difficult). I asked the PT why the post-surgery instructions said I couldn’t do upper body strength until 2 weeks afterwards since I could do them sitting and not move my lower body at all, and he said, “those instructions aren’t for you. You can do whatever you feel up to.” I also impressed him with my ability to bend and flex (like putting on socks without bending the knee and reaching a distance, so, no thank you, I don’t need a tool to put my socks on). When I explained that I had added 20 minutes of yoga a day to my workout regime, he said he’d suggest adding that to their instructions for patients since it clearly helped. So, once I cleared the PT hurdle, we prepared to take me home.
Recovery: The next several days involved lots of naps, icing and my helpers managing the multitude of medications as well as the schedule for them. It was so nice to have someone cooking and cleaning for me so I could just lounge. Though we got out every day for short walks, and even made a stop for ice cream. My grandson was very worried about me at first, and kept to a safe distance, until I told him it was just the knee that was a problem, otherwise I was fine. That seemed to help, and I got pulled into watching him build Lego creations and reading lots of bedtime stories. I had been warned that the swelling would kick in the second day, and sure enough, I woke up in pain the second night and my leg was very swollen. It dawned on me that I had bought a bunch of compression socks for running (one of those helpful tips about how to relieve knee pain), so those became a constant part of my wardrobe for the first couple weeks.
My first physical goal was to get off the ‘walker’ so that I wasn’t dependent on them carrying it up and down the multitude of stairs in the townhouse or having to deal with it when I showered (not in the shower, but having to plant it nearby so I could walk around the bathroom). I transitioned to my hiking poles after six days, and then quickly went to using a cane a friend loaned me. Of course, once I got tired of that, I stopped using it by the end of the second week. From then, I was walking independently albeit with a slight limp.
The two weeks flew by and on the day of my first PT appointment, my son in law also left to go home. I found that getting in and out of the car on the left was much easier, so was relieved that driving wasn’t going to be a problem. That appointment was disappointing from the standpoint that I could only bend to 60°, which is what I did at the hospital before my release. However, she assured me that once I started doing the PT exercises, I would progress quickly. So, then my weeks started to include PT twice a week. It only took me a week to get to the 100° bend and to be able to complete a full rotation on the recline bike. This, of course, gave me permission to get back on the Peloton and I started doing 10 minutes a day with minimal resistance.
The next personal hurdle was going up the stairs. I got tired of doing one step at a time and decided that I would start alternating feet. While it took a while and I had to hold the handrail, I finally got to the point where I could do it like a ‘normal’ person. After that, going downstairs became the next target. The PT told me that I should be able to do it, that the pain was just soft tissue damage (so nothing to pay attention to) and that I’d need to strengthen the quadricep since it had been inactive for a period. This took longer, but eventually, I conquered the going downstairs bit. I also returned to hiking, though I’m deliberately choosing ‘easy’ or ‘moderate’ hikes so as not to deal with difficult terrain. I then decided that limping wasn’t acceptable and focused on walking ‘normal’ too; that came relatively quickly once I stopped acknowledging the pain or soreness. The final piece which I had yet to achieve by the 5th week was getting the knee to straighten all the way. The PT could force it by pushing down on the femur, but when I tried to do it myself, it wouldn’t go. I also capped out at 118° on the bend which seemed to be caused by the quad tightening up and refusing to let me go further. The bend is a greater concern for me because I can’t start the process of returning to running until I can get it to 130°. Mind over matter seems to be the issue, and I’m trying mightily to fight my brain telling me to stop and the quad blocking it.
At five weeks post-surgery, I felt like I’d made some progress, though naturally I was anxious to just get it over with and get on with my life. I reminded myself that I need to be patient, and that running after my toe-joint fusion didn’t happen until about four or five months after the surgery, so I just have to wait it out. The surgeon told me beforehand that it usually takes six months before patients say that they are better off than pre-surgery and happy that they did it. I must admit that there were days when I thought ‘why did I do this?’ In the end, I know it was the right thing to do and the damage from the bones rubbing together would have created even more problems for me in maintaining my level of physical activity.
After a more challenging hike the weekend before the six-week mark, I felt like I had turned the corner. I could crouch to go under felled trees and walk across streams using steppingstones. I was able to go up and down the stairs without using the handrail and though I still can’t do a full quad stretch, or the yoga pigeon pose, or a ‘figure 4’ stretch, I am able to do most stretching and yoga poses with minimal modifications. And, sure enough, at the beginning of the sixth week, I was able to bend the knee to 125°, a major achievement. The measure is against the ‘good leg,’ so I’m nearly there on the bend. Unfortunately, for straightening I am at full extension, but it turns out that I hyperextend my right knee, so the actual target is to do more than just full extension. Overall, I feel good about how far I’ve come and am looking forward to the first real test of the knee, a trip to Copenhagen to attend EuroVision in Malmo, Sweden (just across the bridge from Denmark). While I’m optimistic about that trip, I did bite the bullet and bid on a seat in business class. Normally, I’d just curl up in the seat, but not knowing how the knee will be and the risk of blood clots it makes business class the more prudent option.
