Sunday, November 3, 2019

Total knee replacement surgery - arthroplasty - my experience ©billpurvis

Firstly let me say this is a record of my experience.
It is not meant to give advice or instruction of a medical nature.
You should be guided by your own medical professionals.
The other point is that there are different procedures and I offer no
information or advice on procedures or prosthetics.

My wife had her knee replacement several years ago.
Because of the advanced deterioration of my knee, bowed legs and
difficulty walking, she had been urging me to have a replacement too.
I had resisted for a long time but travelling to Canada and the USA,
where a gruelling week in the humidity of New York labouring with
my leg sapped my energy and enthusiasm, I decided the time was now.
On Saturday August 10th 2019 I had my knee replacement surgery.
Advanced techniques in prosthetic design enable a precise anatomical
replication of my knee joint, achieved through first an MRI scan and then
the creation of a plastic joint replica and jigs to assist the surgeon in the removal
of the deteriorated joint, and the placement of an accurate metal implant
specifically for my knee.
I entered the hospital at 7.30am. My surgery was scheduled for 10am.
I had fasted prior. There was a little pre-op preparation, my knee was shaved.
In the operating theatre I was asked to sit forward over the side of the table
with my arms folded on my chest on a pillow and my head bent down
The anaesthetist commented that I had a very straight back.
Thank you, I am 70 years old.
Whether I was anxious or the room was a little cool I felt a little shivery
and it seemed to take a while maybe 5 minutes or more, so it seemed, before
a spinal injection was inserted to numb the lower body.
At some point I was given a general anaesthetic intravenously to put me under.
To quite a few people I have related this to, the reaction was
uncomfortable, but to me I enjoyed the experience, I felt I was there.
At one point I became aware of the sound of the saw, and that I was
visually screened off from seeing below my waist. I did say something like,
'Oh thats the saw' and the nurse said, 'he needs some more'.
On another occasion I became aware of my body moving to the sound of
the hammer blows from the insertion of the prothesis.
This has not been traumatic for me and I have enjoyed the now fading memory
of the semi-conscious experience. There was no pain.
Post op recovery involved monitoring in ICU where I stayed overnight.
I was able to eat and used a bottle to urinate.
 The following day I was moved to another ward where with the aid of a
walking frame and a loop of plastic tube placed around my foot, and held
by hand, able to lower my leg to the floor and raise it back onto the bed
to take myself to the bathroom.
The leg was basically immobile due to swelling and bandaging but a
pulsating device was used to stimulate circulation and prevent clotting.
This device was annoyingly noisy and I guess not unexpectedly difficult
to get some real sleep. Pain killers were given for pain when required.
I did take some oxycontin but after one episode of blurred vision and weird
visualisation I preferred panadeine forte.
The care provided by the nursing staff was excellent.
The physiotherapist attended with instructions for exercises some passive
others more demanding. Post operative I was not in the best frame of mind
to cope with the demands which I thought were unrealistic. There was
an expectation on the third? day with the assistance of the walking frame
to step up onto a platform, apparently a standard step height. I had no
confidence to do it and refused. Also bending the knee is highly improbable
due to swelling and bandaging.
I had a shower each day with the bandaging covered and while seated.
Because of the trauma associated, and also the pain killers and anaesthetics,
toilet functions were affected. There was constipation and also urinating,
while flows were normal, there was diminished penile control of
direction, but hey it is a wet area, the nurses are aware
of the affects and limitations.
On the 14th October I was discharged into the care of my wife for a few days,
she had pre-booked travel interstate to stay with a friend, so I had to be
reasonably sufficient to care for myself. My son was also home.
On one occasion home alone I caught my toe on my walking stick,
while about to enter the bathroom, and smacked my head
on the door frame, which I was able to grasp and prevent my fall.
It was probably not a good idea to be on my own but I survived another tale to tell.
I was still using the walking frame too and the plastic tubing because leg control
does take time to recover the ability to lower  and raise the leg from the floor to the bed.
Sleeping is not easy having to find a comfortable position without the weight of
bedding on my foot. I used light bed covers and raised my leg on a pillow.
I did not do too much but exercise to maintain and develop muscle tone
and strength and keep the leg raised.
There is pain during recovery above the knee in the thigh muscle and below
in the shin and calf muscle due to the procedure and bruising
but pain killers assisted in pain management.
It probably took at least  8 weeks for the bruising and pain to slowly dissipate.
My surgeons incessant direction was 'more bending less walking'.
I really have not adhered to this but have done quite a bit of walking, out of
necessity, and not much of the bending exercises.
I am not one for exercise disciplines and regimes.
On my surgeons advice I attended a physio once a week.
He used a great deal of energy with my foot in his shoulder pit to attempt to
achieve more bending of the knee. I think I started with about 80 degrees.
I have at least 90 degrees now maybe 100 degrees.
There seemed to be a lot of resistance, was it me consciously resisting or
my bodies learnt behaviour to protect my previous arthritic knee?
I had a dream of my body on the physio bench moving back rapidly in reverse
like a bullet train due to the exertion of force from the physiotherapist.
After 8 weeks the physio no longer wanted to see me.
I really had not achieved much in improving bending although I was certainly moving
well without aids. I had been photographing field hockey finals and competitions
for my hockey club since week 4, the first, but with a 2 week break before the next.
I walked 4.6kms on one day and was averaging at least 2kms every day
walking the dog too.
I did not attempt to drive myself until about week 6 because of discomfort in my
foot and ankle and not having enough bend to get my leg into the car.
I attended my surgeon for a check-up on 29th October.
He showed me a new exercise to attempt to get more bend by placing my hands
on the bench and assuming a semi squat position to use my body weight to bend
the knee to the point where it causes pain and beyond.
I was to do this twice 4 times a day. He did show me that my thigh muscle was as
tight as a drum and said I need to relax it.
This was the first awareness I had of this tightness.
How was I to relax this muscle? I tried his exercises a few times.
Consciously I thought about my thigh muscle tightness.
Was it a subconscious protection mechanism.
I believe in self healing through self awareness and the surgeons information
was enlightening.
Now I write this on Sunday 3rd November, 11 weeks post-op, I have been able
today to ride my bicycle down the road arthritic pain free and with renewed leg power.
I had tried previously maybe 2 weeks ago but could not get rotation of the pedals.
I have been bombarded with advice and direction about exercises and bending
but I think a more holistic approach required me to do my own thing.
The knee will not break but it requires developing confidence and realising
that my new bionic knee does not need the protection my body gave my painful
arthritic knee.
I have renewed energy and vigour, pain free, and I am mobile on my bike again.
Apologies I have corrected the date of admission/operation in my first post.

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