Patient Story: Knee Replacement Times Two
A winter weekend in January of 1967, my girlfriend, Jana, and I decided to go tobogganing at the ski resort at Soda Springs, California. As we raced down a slope blanketed with fresh snow, the toboggan hit a bump. The impact jarred my boot loose from our wooden sled as it streaked downhill. My right foot dropped into the whiteness that whizzed past just enough for the snow to grab hold momentarily. In that moment, the toboggan surged forward and my knee was twisted, torqued, and turned unnaturally. The snow released its hold on my boot, but the damage was done. The pain crept into my consciousness as my knee began to swell, only getting worse. This was definitely not the plan.
I was taken immediately to the hospital; I had torn ligaments in my knee that required surgery to repair. Following the surgery, and months of rehabilitation, I was able to resume my career as a carpenter. For the next fifteen years, I worked in housing construction rough-framing buildings, and later, continued carpentry in a cabinet-making firm. Over the years, the heavy physical work involved in my profession caused bowing in my right leg, and this was compounded by the onset of arthritis. As a result, I was plagued with pain.
As the years progressed, I experienced a corresponding increase in the level of pain in my right knee. It became excruciating and was so severe that the simple act of walking was an ordeal. Finally, in 2010, the pain was unbearable, so I sought medical help. That is when I found Dr. Robert Tennant.
After taking an x-ray of my knee, he decided to treat it with a cortisone injection which reduced the pain significantly. I was able to walk with far less pain for the next 18 months, and continued working at my full-time job with no impairment. However, the increasing pain forced me to return to Dr. Tennant to seek further relief. His prescribed course of treatment was a series of rooster comb injections which contains hyaluronan, a fluid similar to the synovial fluids found naturally in the human joints. Once a week for three weeks, Dr. Tennant had me come in and get these injections in my right knee which provided me with temporary relief for the next year.
Time and aging continued to take their toll. Not only did my right knee continue to deteriorate, the arthritis in my left knee worsened, increasing the pain and difficulty in walking. Over the years, my legs had continued to bow. It was so bad that if I stood with my feet together, you could throw a football between my knees. I went to Dr. Tennant again in April 2013 and a series of rooster comb injections on my left knee provided temporary relief, carrying me through August of the same year. Pain drove me back to Dr. Tennant.
At that August appointment, Dr. Tennant reviewed my record of treatment, the condition of my knees, and recommended a total knee-replacement surgery. Knee replacement was a big step that I wasn’t sure I was ready to take. It was major surgery and I would be out of action while I recuperated. That was the down side.
Dr. Tennant explained that having total knee-replacement surgery would eliminate most or all of the chronic pain I was suffering – no more injections. And, as an additional benefit, he said he could straighten the bow out of my leg. That was the up side.
After weighing the pros and cons carefully, I assented. Surgery was scheduled for October 21, 2013. The goal was long-term – if not permanent – relief from the impairment due to arthritis and my old injury and the resultant persistent pain. On the 21st, Dr. Tennant performed the required surgery. The whole procedure took about two and half hours. The surgery was a complete success, and he straightened my right leg as promised.
However, I have long had an aversion to reducing my mental acuity through the use of medication. In the past, I have always been willing to endure a certain level of pain in order to remain mentally alert; I would “tough it out.” Therefore, as I recovered after surgery in the hospital, I insisted that the prescribed medication be changed for milder drugs which I didn’t take as recommended.
As a result of resisting the pain medication while I was still in the hospital, I experienced intense pain during therapy exercises following the surgery. Because of the pain, I either didn’t do the exercises, or do them as thoroughly as the physical therapist recommended. Consequently, my slow and sub-standard progress in performing the exercises prolonged my hospital stay by two days.
After I was released from the hospital, the dreadful daily physical therapy began. My reluctance stemmed from the memory of the physical therapy sessions after the original injury, and the pain involved. Six weeks after my knee replacement, Dr. Tennant measured how far I could bend my knee. The desired angle was 110 degrees; I could only bend the knee through an arc of about 82 degrees. It was unacceptable.
Dr. Tennant scheduled me for another operation called a “manipulation adjustment.” He anesthetized my leg and forcibly bent my leg through the desired arc of 110 degrees, breaking the newly formed scar tissue. Once he was assured that I had the proper range-of-motion (ROM), Dr. Tennant sent me home with a continuous passive motion (CPM) machine.
Using the CPM machine, I would sit on the floor, strap the device onto my leg, and with motorized rhythm, the machine would repeatedly bend and straighten my leg. On the first day, I set the angle to 80 degrees. I spent seven hours attached to my mechanical assistant. The next day I increased the angle a little more, and endured seven more hours as the machine cycled through the bending process. Daily I increased the angle, and tolerated seven hours of CPM treatment. At the end of seven days, I returned to Dr. Tennant’s office. He measured the ROM at 105 degrees. This was acceptable and I was released to resume work.
As time passed, my knee healed, the pain decreased, my leg strengthened, and I could walk much better than I had in years. I decided to go ahead with the replacement of my left knee. A date was set for early July 2014. A week before the scheduled date, my wonderful care-giving wife, Judy, and I took a trip to the Oregon coast where I continued my regular exercise routine out of habit. Unfortunately, the floor on which I had done my exercising at the coast had been covered with Berber carpeting, leaving me with severe rug burns on both knees. This resulted in a postponement of my surgery by five week.
The postponement gave me additional time to reflect on what I had experienced after the first knee replacement. I gave serious thought to what had gone well and what had not. I considered what changes, both mentally and physically, I needed to make before the upcoming surgery. After much thought, I decided to approach my second knee replacement as an opportunity to change directions and assume a more positive attitude in all respects.
August 18, 2014, I reported to St.Vincent Hospital at 10:15 a.m. Once at the hospital, the process began that would conclude with the total replacement of my left knee. The process started with the administrative routine associated with hospital check-in procedures. Next was the pre-op activity – I traded all my clothes for a hospital gown. The nurses checked and prepared my left knee for surgery, and I was issued a variety of tablets and capsules which I dutifully swallowed. At 2:00 p.m., I was being rolled on a gurney to the operating room. I remember gliding through a pair of large security doors – my last recollection of the process.
As consciousness returned and awareness resumed, I found myself in a private room with my wonderful wife Judy sitting next to me. Finally at 1:00 p.m. the following day, I was wheeled out and loaded into our truck, and Judy drove me home after only twenty-seven hours in the hospital. This was a marked improvement over my first knee replacement.
That afternoon about two hours later, I checked the ROM on my new knee with my homemade protractor. It was about 90 degrees. This was very encouraging considering that at the six-week mark after my first surgery I could only bend my right knee 82 degrees. I faithfully continued taking the pain medication and religiously followed my physical therapy exercises. I put a great deal of effort into the act of bending my knee.
About a week after surgery, I had my first follow-up visit at Dr. Tennant’s office. He removed the remnants of the amazing tape that surgeons use now to close incisions instead of old-fashioned sutures. I was assured that my knee was healing well, and that only a couple of the 25 staples inserted during the operation appeared to be loose. He put on a new dressing and advised me to change it once a day.
By the end of August, I had made four scheduled visits to the physical therapist. At the end of the fourth visit, the therapist confirmed the ROM in my left knee was a full 90 degrees. A lot of icing and exercising proved to be the right recipe for excellent progress in healing and strengthening.
On September 2, I was in Dr. Tennant’s office for my second follow-up visit. His assistant, Gretchen, removed the 25 staples from my leg as gently as she could. Dr. Tennant then examined my knee and was satisfied with the healing. Pleased with my 90 degrees ROM – he challenged me to increase it to 120 by the end of the month.
On September 11th, my left knee could now bend through an arc of one 107 degrees, and the right knee had improved to 110 degrees. Over the next week, my ROM reached 110 degrees on both knees, and both my legs now lay completely flat.
September 26 marked my last physical therapy session – I could bend my left knee 112 degrees and the right, 110 degrees.
Before I underwent total knee-replacement surgery, I identified three things that I considered indicators of success when the process was finished:
- Be able to walk normally.
- Be able to do yard work and gardening around the house as I had been able to before pain had turned it into torture.
- Be able to exercise normally as I had been doing for years.
At the conclusion of my physical therapy, I had reached these stated goals.
Having gone through the process twice now, the contrast between diligently following doctor’s instructions, and not doing so, is clear. After the first operation, I was in the hospital for four days. I needed to use a walker at home for over a week. Then, I needed the aid of a cane for an additional week. Dr. Tennant had to make the manipulation adjustment to my right leg. And, at the end of the process, I had a ROM of only 105 degrees.
The second knee-replacement went much better. I was out of the hospital in twenty-seven hours. I needed the walker at home for only three or four days. The use of the cane lasted for only three days. Then, by the last physical therapy session, less than six weeks after surgery, I was able to bend my knees to 112 and 110 degrees, left and right, respectively.
I have developed a list of do’s and don’ts for anyone contemplating total knee-replacement surgery. Here they are:
|Walk immediately.||Make the other knee work harder.|
|Bend your knee. Aggressively!||Abuse your knee.|
|Do the exercises – increase your ROM.||Avoid pain medication.|
|Learn to use the new knee – more motion is better!||Forget about the skill your doctor has to be able to replace your knee.|
|Proceed with caution – use it, don’t abuse it.||Back off recommended exercises.|
|Use pain medication as needed.||Postpone post-op therapy.|
|Ice your knee – it does wonders!||Forget to work out on stairs.|
|Be grateful – you’re walking pain-free!||Avoid long walks.|
|Thank your doctor for doing a good job.||Skip physical therapy exercises.|
Knee replacement surgery is not an individual activity. It is a team effort that focuses on one person, and this one person is grateful to my team for providing me with two new knees, two straightened legs, and the ability to use them. It has definitely enriched my life.
Therefore, I extend my profuse gratitude to Dr. Robert Tennant, the surgeon who did an excellent job of replacing my knees and straightening my legs. Many thanks go also to Dr. Tennant’s assistant, Gretchen, who patiently answered my questions and solved many problems gracefully – even while removing the staples from my legs. Also deserving of many thanks is my physical therapist and rehabilitation specialist. And, last but certainly not least, I thank my loving wife, Judy, for the countless hours, days, weeks, and months of the tender and total care that she provided throughout the entire ordeal. I am sure, that without her support, I would not have achieved the level of recovery that I have.