Tuesday, April 5, 2016

Total Knee Replacement Surgery

I recently went into the shop and had some parts replaced. My only previous experience with this sort of thing was having a lens replaced in my eye, and if I my vision hadn't been noticeably better, wouldn't known anything happened while I had a nap at the hospital.

This was a little different. I mentioned in my last post that my lower extremeties had been dominating my life lately.  Here's why.

The culprit.

According to the X-rays, both knees are really shot. Doctor picked the left one to go first, but in the two weeks before surgery when you're not allowed to take anti-inflammatory drugs, it became became pretty obvious this one was the choice for renovation. (They won't do both at the same time).

Pre-admission testing is one week prior to surgery.  First thing they put you into a room by yourself and roll a video of a nice little lady standing in a hallway talking to the doctor (Why don't they let this woman with bad knees sit down? Doesn't the doctor have an office?) explaining some of the necessity, benefits and risks (Haven't I already agreed to this?), and a little about the surgery and recovery.

I've been doing the pre-op exercises every other day for about eight weeks.  They consist of several isometric exercises.

Some dynamic exercises.

and some that combine both.

You have to arrive at the hospital at 5:30 am.  They do six of these a day and don't tell you what order you're in until you get there, but they get you prepped right away.  My turn was pretty early at 9:00, but that still left several hours to wait.

The only thing they really attach before going to the OR is the all important IV (Does anyone else hear "Sister Morphine" while looking at this picture?)

The surgical leg about an hour after surgery. The leg is strapped into a CPM machine that flexes and straightens it on about a five minute cycle.  For the first day I also have attached the aforementioned IV, now with fluids, antibiotics and a self-administered (but limited and closely monitored) morphine injector, a femoral nerve block, surgical site drainage bag, pulse monitor, respiration and gas exchange monitor, catheter and a pulsing cuff on each ankle to help circulate blood out of my feet that feels oddly like a cat walking over my leg when they start a cycle.

Later in the afternoon, with all this stuff attached, they get you to stand up on a walker, take two steps and strap you to a chair sitting up.

Dinner the first night is clear fluids - apple juice, jello, and chicken broth, but to be honest, all this sort of spoils your appetite.

They remove most of this stuff the second day including the femoral block, which has rendered the leg pretty numb and immobile, and the morphine injector.  They switch you to two Vicodin every four hours (if you think you need it. Ha, ha, ha). The Vicodin reduces the pain quite a bit but doesn't really eliminate it right away. The hospital really isn't a great place to sleep in any event. Here's a picture of the flowers my son sent silhouetted against the glow of the monitor lights of the CPM machine and the circulation cuffs, and the fully lit hallway from 2 to 6 am.

Made all the benchmarks to be checked out as scheduled on the third day.  After the occupational therapy guy taught me how to get dressed, I still had to wait a couple more hours to be released.

Sent home with a few little helpers. A common bit of advice from others who had experienced this was to "stay ahead of the pain". The lead story on the local news the night I had surgery was about the dangers of addiction to painkillers.

Bed rest is specified for most of the day the first few weeks.  The bedroom and bathroom in our house is on the second floor, so once I got up the stairs with much difficulty,  I was pretty much confined up there.  The helpful little manual they send you home with warns you that you might be a little more tired than usual.

Sarah did a great job of making it homey. We had meals at a little table she set up in the bedroom. It only turned out to be two days before I could get down and back up the stairs for meals.

You still have to do exercises -  fewer, but more often.  Everybody warned me how important these were.

You're only supposed to get up for thirty or forty minutes at a time.  Sarah brought the Telecaster up stairs. Luckily no problem sitting with a guitar.  Here I'm playing "Sister Morphine" to mark the occasion.

The bed rest is to prevent swelling.

The incision was looking good a week post-op.

Part of recovery is professional physical therapy three times a week.  A big revelation was that most of what you're recovering from is the damage they do to the muscles and tendons in order to fix the knee.

Almost all physical therapy locations are part of retirement homes and care centers. It was kind of odd to be a fairly healthy guy doing exercises among the rest of the patients who had much more severe problems. (Note the double duty of the walker as a camera support.)

It worked though.  I made the flexibilty measurements for a healthy knee by the second week (although nowhere near the muscle strength). I graduated from the walker to a cane by about two weeks.

I had my follow-up appointment yesterday morning and everything is doing fine.

All with the Populist. .15mm pinhole 24mm from 24x36mm frame.