Surgery

Preparing for a Total Knee Replacement



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Diary of a Knee Replacement

April 26, 2008

Well it's the evening just before the big procedure. Tomorrow I undergo a total knee replacement to my right knee. At 1:00 P.M. I'm due to be at hospital ready for admitting. I have to remind the hospital staff that I'm doing my right knee,' instead of my original choice of my left. Three weeks ago I explained to my surgeon, Dr. H, that I was switching. My doc told me back in September I could switch if the one knee started to bother me more than the other prior to surgery.

Ever since my appointment on September 28th, with Dr. H, (when I decided to proceed with the replacement) I've been mulling this decision over in my mind.

I've asked myself too many times if I should go ahead with it or wait? I've spent endless hours in our basement on the computer all through the night cruising many internet websites searching for information. Mainly I was hoping to get a better understanding of knee replacements. Sometimes the material I found was professional advice from orthopedic specialists, arthritic clinics/organizations [i.e. the Mayo Clinic, U.S.A.]. Other times I investigated blog- postings produced by laymen, much like myself who seemed equally scared by the prospect.

At the time of writing this, I'm now 49 years old. I've worked ten years for the Post Office. The last seven years I've worked as a Letter Carrier (Relief) beginning in October 2000. Prior to that I served three years as as Driver (Mail Service Courier) starting in 1998. Before this I held many jobs which included gardener, bike courier, parts driver, to name a few. I had arthroscopic surgery done to my left knee in1997 & 1999. My right knee was arthroscoped back in 1996.

This current injury happened while I was walking doing my regular mail route in early May 2007 and I began feeling shooting pains in my right knee. A woman who was waiting for me to deliver her mail saw me limping and asked "What is your problem?" I stopped soon after this and returned my mail, and went to the hospital to have the knee checked by a doctor. It was inconclusive.
In June I found out from my knee specialist's medical report that he concluded from the X-Rays of my knees that both knees "were shot." In other words, I suffered from "bone-on-bone arthritis." This condition is related to the fact that I no longer have any cartilage left which normally cushions the knee joint. The femur (upper) leg bone and the tibia (lower) leg bone meet at this axis point to comprise the knee joint.

The Specialist suggested my only medical option available at that point would be a total knee replacement [T.K.R.].
This was an area he did not work in. Obviously this news did not leave me feeling very positive. I began asking around at work and from friends for the name of a doctor who specialized with knee replacement.

The big problem was that I felt I was too young for a full knee replacement. A month before my scheduled surgery date I came bolting into the living room telling my wife Nancy, " I think I'm going to cancel the surgery, I'm too young." My wife was speechless. I'd been off work starting in June 2007. My knee specialist didn't feel I was too young. How long would I be able to stand just hanging about the house? I hated being unproductive with little to do.

The first specialist suggested waiting as long as possible, to have the knee replacement. In September, my surgeon explained that he thought it came down to "a quality of life issue. If we know how many years we've got left to live then"
In other words in his estimation suffering for another ten years, with bum knees didn't make much sense, if there was a good chance that I could go back to living a normal life' after the knee replacement. His argument seemed to be a good one. Another consideration was the fact that, if I waited, I would get further out of shape and become vastly overweight. One's weight can represent a complication, if a successful knee replacement is the objective. For me, canceling surgery was not an option.

I had to push any second thoughts aside since I was down to the last day before surgery.
Actually I was mainly very scared. I don't like admitting things about myself like "being afraid." My father always taught me that boys don't cry, and there were certain things that had to be faced up to like a man. I'd never been the type of personality to let nervousness get to me. The fear I felt at that time was the fear of pain. Simple. I've always hated the thought of experiencing pain. Of course there was also my fear of surgery not being 100 % successful. Guess I'll have to deal with whatever pain comes up when it comes.
I had found out just a week and a half before the surgery that I was having an epidural anesthetic rather than a general anesthetic in which the patient is knocked out. An epidural is a form of nerve block that is injected into the spine. I would be awake for the entire procedure. My massage therapist advised me to take deep breaths to help me to stay relaxed once I was getting the epidural. It was good advice.
My surgeon had suggested that I would be a good candidate for a bilateral knee replacement. This means that they would complete both left and right knees at the same time. I turned that one down without a second thought. My pain threshold is too low for that. Initially I took Dr. H's advice and booked surgery for six months later. This way I could cancel after three months. A woman who was also waiting to book the surgery chided me for being a big chicken and suggested that I just get it over with. That's how I ended up being scheduled for Jan. 30th.

Prior to the surgery I purchased many items such as a pop-up bed so I could sleep in the living room. Grab bars to get in and out of the bath. A bath chair, a long-handled shoehorn, diabetic socks (without elastics), a safety frame for the toilet. I pulled my old wooden cane out of the garage. I had that from my knee arthroscopy. The list goes on and on.
After a nurse went through all the paperwork with me, I started to turn white and began sweating noticeably after the nurse had attached the I.V. drip bag to my arm. "Are you okay Mr. Buchin?" she asked. Oh yes I replied, "I'm okay just scared silly that's all." Once the I.V. gets attached, the fear factor starts to work on me.

Next thing I was on the Operating Table and being told to lean forward and I would feel a slight pinch from the anesthetic in my lower back. It was pretty much like a regular needle. The next thing I recall was feeling my leg being moved around. Then I could hear a drilling sound. Next came a sound like someone was banging some article into place. I soon realized that sound was the surgeon hammering the replacement knee into it's position. It seemed very strange an experience. And just like that, it was soon over and the surgeon came around to my side of the table and through his plastic face shield told me that everything had gone well. I was wheeled into the O.R. recovery ward.
The nurses had some concerns around my oxygen levels in my blood and this delayed my being sent upstairs to the ward. Eventually I was released to the upstairs ward, but the nurse there had to come into my room every ten minutes or so to check on my oxygen levels. I was told that there was a concern that I could have sleep apnea. The first night after surgery was somewhat rocky. The nurse was coming into my room to check up on me it seemed every ten minutes. Dr. H. came to visit me the next morning. He shook my hand and remarked that I wouldn't like him at all this painful day. I told him that the surgery had some weird moments. At one moment I felt like he was installing an addition on my house. He said I wouldn't much like him on the first day out. And he turned out to be right. When the epidural wore off I didn't like him at all. The nerve block had stopped me from having any feeling in my lower extremities for only twenty four hours. It wore off that afternoon. I would describe it as somewhat painful. I kept asking for more morphine. Even that didn't t seem to do very much.
That afternoon I remember moaning so loud, that I was sure the nurses could hear me. When I thought one was within earshot I would shout out, "I thought I was going to be kept comfortable?" It took forever to get my second morphine drip bag for my I.V.. The nurse had to get the anesthesiologist to sign off her okay for more. It helped a little, but not too much.

By the third day I began to feel more comfortable and the pain subsided. I began walking around the ward. By the third day the nurse had remove the drain from my leg. Amazingly, yes I was walking around and actually trying out some of the physiotherapy exercises. All in all the procedure was not so bad as I thought it would be. I went in on a Wednesday and came back home on Monday morning. I started doing physiotherapy on my second day after having the surgery. Once home a physiotherapist visited me a couple times a week. It's now been almost three months since the surgery was done. I feel much better now since my right knee doesn't hurt anymore. I try to do my special exercises at least once a day.

To anyone reading this account who might be thinking about a knee replacement please remember, this is my individual experience which has much to do with my knee condition, my overall general state of health, i.e. weight, muscle strength and so forth. You have to understand that everyone comes through knee replacement surgery differently. I wish you good luck, and remember to do your physiotherapy before and after the procedure. If I am any example, you should be fine.

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