Total Knee Replacement – Right Knee – week 1 – preparation and hospital
Decision time. I’ve decided to have a Total Knee Replacement of my Right Knee.
Why. Over the last 9 months or so, I noticed a rapid decline in my right knee. It was probably aggravated by several factors. 1) Following my left knee restructure 55 years ago, I have over used my right knee to compensate; 2) that knee did not recover after the fall that I had in NZ on the Reese-Dart track when I pulped the VMO of the right quad; 3) I really overused that right knee during the move from Sydney to Wagga about 3 years ago; 4) I did not really recover from the severe flu I had in 2015; 5) I am still overweight.
When we got back from the ski trip to Canada in March this year, I was finding it very hard to walk anywhere and a physio I went to strongly recommended that I think seriously about a knee replacement while I had the strength and fitness to recover. Before we went on the Paris/Britain trip this April, I spent many hours trying to increase the distance that I could walk. After much effort, I increased the distance to 4km – but it took 2-3 days for my right knee to recover. In Paris (with its many stairs), I could walk very little. In London, this distance had reduced much further and I bought a ‘shooting stick’ – a walking stick with a saddle to sit on.
While we were away, I began an email conversation with one of the highly recommended orthopaedic surgeons in Wagga and had an appointment for a couple of days after we returned. X-rays showed that I had no cartilage in my left knee and very little in my right knee. A previous MRI showed that I have no ACLs in either knee – they have both been worn away. Which knee first? While we were away, I had thought about this a lot. Both knees are very bad. Most of the advice is to do one at a time rather than both together. I know that the left is structurally worse, but it is the right that gives me constant pain. So, right knee it is. I was booked in of a for surgery six weeks later on 17 August 2018, booked in for a CAT scan and with an exercise physiologist who gave me a stack of exercises.
I am extremely impressed with the medical care available in Wagga. We have several world class orthopaedic surgeons, 3 CAT scan and MRI companies, excellent physios. All probably because of the huge amount of sport played here plus the enormous catchment of Wagga Regional Health.
I’ve been working my way through my exercises following the advice that after surgery my muscles will be traumatised and ‘turned off’ and that 1) I must have muscles to turn on and 2) know how to turn them on. I’ve been getting to a gym almost every day for a good workout – mainly of small muscle groups (rather than big muscles).
Today (2 Aug), when I thought I had 15 days to go, I got a call to say ‘could you do that surgery 8 days earlier on the 9 August 2018?’ Oh shit!
Pre-op exercises. These are what I’ve been doing.
- Clams – several types – on back – with stretch band both knees 12 reps * 5 sets; one knee at a time 12 reps * 5 sets: on side – no band, top knee 20 clams reps * 3 sets; 20 clockwise and anticlockwise leg rotation * 3 reps
- Sidestep with stretch band above knee – 12 reps * sets to fatigue (4-5)
- Leg raise – very straight leg, foot flexed 40 reps * 4 sets
- Leg extension – knee on a bolster, foot flexed and rotated out – 5kg weight – 12 reps * 4 sets with fingers on VMO
- Balance – each foot – full stork bend forward with leg back – 12 reps * 3 sets
- Wall sits – knees with 100º – 60 secs * 3-4 sets
- Superman – kneeling – left hand forward right leg back, right hand forward left leg back 10 secs 10 reps * 3-4 sets
- Bumps 40 * 2 * 4 sets.
- Sit to stands – 40 * 3 sets
- After the op, I have a maximum of 2 weeks to work out how to walk again.
- Mainly I have to concentrate on getting the knee to bend.
- Following the op, the muscles around the knee will be traumatised and bleeding and will not want the work. They must be made to bend, stretch and work.
- When walking, concentrate on making contact with the middle of the foot and push off with toes 1, 2 and 3. DO NOT hobble around just on my heel.
- Before and after – exercise straightening the leg fully with the toes back, leg lifts with the toe back and leg extensions with the toe back. Failing to have the toe back brings the wrong (larger) part of the quad into play rather than the VMO – the essential part for walking.
- An exercise bike is a good investment and use it several times a day.
8 Aug 2018. Amongst the many tasks today was a phone call at 11am to find out my admission time tomorrow (6:45am) and fast (nil by mouth after midnight).
9 Aug 2018. Thursday Day 0. Up at 5:50 for the 6:45 admission. Third shower with special foaming wash (after two yesterday). The anaesthetist used a spinal (epidural) and I was given the choice to remain awake – so I did. For most of the surgery I was awake and able to hear what was happening (but not see because of the ‘barrier’). I think that they knocked me out for a few minutes when I got too talkative Anyway, I was fully awake for the end and when I was wheeled into recovery. However, I was very cold and my blood pressure was very low, so I was wrapped in warmed blankets with warm air pumped under the blankets and given a lot of fluid by drip until my blood pressure had risen to 104/60 at which point the ward would take me. While this was happening, movement gradually returned to my legs. All through the surgery I was certain that my knees were bent although they were straight (but had been bent when the epidural took effect) so I thought they were bent and that impression stayed with me until movement returned to my thighs. Movement returned first without feeling – which did not return till about 60-90 minutes after the movement. First, I noticed that muscles at the top of my left thigh were rippling (it was the right knee replaced). Quite quickly, all muscles in my left thigh could function and I could bend that knee (but not flex my foot). About half an hour later, the process began on my right leg – first a flutter at top of thigh, full flex of right thigh, full knee bend of right knee, able to lift right leg. Still no feeling in either leg, though that now began to return. Last to come back were my feet which suddenly I could flex but not feel. Feeling soon followed. No pain at all so I took the opportunity to bend my right knee a lot and flex and lift that leg. Surgery 9am – 10:30am, back to ward at 11:30am.
By 2:15pm, I needed to piss but could not. (I had drunk about a litre of water.) I needed assistance to stand so that could piss – thus avoiding the dreaded catheter. Soon after that the pain began. Ring early as advised. Endone. Much more difficult to lift my leg. Helen arrived for her visit at 3pm and we had a good visit. By 4:40pm another round of pain. Panadols this time. The day progressed like this. At one point, I got very cold and got more blankets. Occasionally a bit dizzy as the anaesthetic wore off. A few more pisses and a shit (unheard of) in a pan. Pain got a bit bad after the stir up of having a shit. (The last shit for a few days.)
10 August 2018. Friday. Day 1. Quite a sleepless night. They got me up for breakfast – sitting in a chair and then a little walk with a walking frame – just to the door and back. The physio came by while we were eating and gave us 4 exercises. [I keep saying ‘we’ in this because I share a room with another chap, Les, who also had his operation yesterday. We are on a very similar clinical path.] 1) Wiggle toes; 2) Straighten leg while lying; 3) Bend knee while sitting; 4) Leg extension. I can do the first one ‘ wiggle toes. I keep going to sleep in the middle of sentences – very narcoleptic.
Lunch was the next step. Again out of bed to sit in chairs. This is extremely good passive exercise. Who would think that getting from bed to a chair and just sitting with both feet on the floor would be so difficult. If I had left it at that, all would have been well. I decided for a shit on the toilet – which shit I failed to achieve. The nurse left me in there for too long. I might be confined to bed for a while to recover.
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| Incision with staples & blood |
During the morning, a team arrived to change my dressing – blood had been seen during the surgeon’s visit. There was a pool of blood under the dressing. The dressing was removed, incision washed and a new dressing applied and a compression bandage. After lunch, I dozed until I was rounded up for x-rays. I was just reaching for the piss bottle when the harassed wards-man tornadoed me down to x-ray. I had a difficult time and had just begged a bottle when Tornado arrived to zoom me back to my ward. On return, I pissed a litre.
What I can do and cannot do? 5:30pm Friday – pain levels are way down (not that they ever got anywhere near high or even moderate); shock/cold symptoms have chimed in; still drowsy. I can sit in a chair with my leg sort of straight-ish in front of me. I can walk 3m with a walking frame and some very slight pressure on my foot. I can flex some muscles & waggle my toes.
11 August 2018 Saturday. Day 2. A very good night’s sleep – fairly well pain free. I managed to sleep on my side – something that was impossible yesterday and was a recommendation from physio Paul. Today, Paul had me walk a few metres further and bend my knee a bit – maybe 40º. Still on the walking frame. Still need help getting into and out of bed.
12 August 2108 Sunday. Day 3. A good sleep to 4am, then more of a doze. Crutches from today. By noon, I was able to get out of and into bed without assistance. Pain levels are only ever low. Today, Paul our physio showed us a few tricks to bend our knees while sitting (lift toes, drive hip forward a little). A walked with crutches down to the nursing station and back – which was a lap too far. Shitting quite well at last. Calvary Hospital has a no visitors policy from 1-3pm so inmates can get a little rest. Today, at 1:30 noisy parents and a tribe of kids arrived. The kids played rugby in the corridor, ran into walls and shouted at each other. Why? Very unfair to patients trying to sleep and nurses who have no authority to pull them into line or boot them out.
13 August 2018. Monday. Day 4. They had kept our piss bottles away from us last night to encourage us to get up and use the crutches. Out of bed early to wait for breakfast when physio Paul arrived and took us along a corridor and up and down a set if stairs. After which I needed a good sit down again. We appear to be progressing well – bending my knee almost 90º and using the crutches well – but unable to lift my leg at all – that muscle set is still turned off. Advised to always go for a short walk before breakfast and not sit more than 1 hour at a time.
Anaesthetist Anthony came in to see how I am going. From his questions I might be going home soon. The ‘strong’ slow release package that he had left in me on Thursday is about to run out and will need to be replaced with other pain management. He asked question about my levels of pain and if they can be handled with pills. He is reluctant to load another slow release package because of danger of overdose.
Last evening my roommate, Les, suddenly began to have a bad time. A very impressive fast response from nurse Denny. It seemed that Les had only finished speaking when a pathologist walking in to draw blood. She began to have difficulty and immediately a resident doctor appeared, took blood and asked questions. Les appeared to settle down. Today, at the same time, he began to feel strange again. Within 2-3 minutes he was being whisked off for scans for blood clots – which he had and was zoomed to ICU. The speed of intervention is impressive. I have a new room-mate – Stuart – who has a dangerously virulent growth on his pancreas.
14 August 2018. Tuesday. Day 5. (‘Departure Day’ as it turned out.) 8:45am Physio Paul helped me with a few knee/leg lifting exercises (lean back, toes pointed) and I lifted my right leg for the first time – though not for long and with little control. 9:00am Nurses think that I am going home today. They’ve chosen to not make my bed and suggested that I do not get changed after my shower. We are waiting for Dr Redgment to arrive and sign paperwork. I showered standing up – first time and much better than trying to shower while sitting on a chair. Nurse Saj spotted that I should have had an ultrascan and booked me it for a scan at 12:45pm. The scan was for blood clots and is achieved by pushing on veins to see if they compress. (If they don’t compress by external pressure, they are clotted and will be extremely painful to the pressure.) No clots detected. However . . . the waiting place at Regional Imaging has space for 5 beds. Into the vacant space beside me was wheeled a bed holding a woman in a face mask – being wheeled by a wardsman in a face mask and full yellow protective coat. The woman kept taking her face mask off. She sometimes coughed. I was not given a face mask. I got parked next to her again when I came out from my scans. I have no idea what I may have caught from the selfish woman and due to very poor procedures.
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| Denny’s deft work |
3:30pm. Surgeon Andrew Redgment came in and said ‘How are you going?’. ‘I would like to go home.’ ‘OK, I will check a few things and see what I can do.’ A few minutes later, a thumbs up and I sent a text to Helen who arrived in minutes. At 4:30pm, nurse Denny came to change my dressing and remove every second staple. I was discharged at 5:45pm. I’ve had three excellent nurses here – Saj, Lorraine and Denny. All three with high levels of skills – caring, capable and conscientious.
A bit of a trick getting into the car given I cannot bend that knee much. At home, an immediate shower to get rid of the hospital and immediately to bed to rest for an hour. Helen has given a lot of thought into arranging the house for my return.
