Knee replacement ‘painful’ but worthwhile
Murray Hill gives a firsthand account of his knee-replacement surgery, from pre-op to first steps
As I lay on an operating table listening to my favourite Jesse Cook tunes on an iPod, I found myself reflecting on the role a Playboy magazine played in putting me there.
I was having my long-troublesome left knee replaced by Dr. Jeffery McKerrell, a prominent Saskatoon orthopedic surgeon. I was wide awake, and although I had a good set of noise-cancelling earphones and my own musical playlist running, I was quite able to take in some of the sights — and many of the sounds and smells — of complete knee replacement surgery.
My knee problems began nearly 50 years ago, when I was 17.
It was September. I was in Grade 12, and one of my friends brought a Playboy magazine to school. This was in small-town Saskatchewan in 1967 — long before the internet. For 17-yearold boys to actually see such a magazine was really something special. Being the good boy that I was, my only interest was reading the articles, so I grabbed the magazine and took off a full speed with my friend in hot pursuit.
The race lasted only until we came to a steel fire door in the school hallway. I pulled it open and ran my left knee smack into the butt end of the door. I can still vaguely remember how much that hurt, but I can’t for the life of me remember what happened to that magazine.
I don’t remember what damage the collision did to my knee, but I was in Saskatoon seeing an orthopedic surgeon pretty quickly and subsequently had surgery to remove the damaged medial meniscus and some bone chips.
Back in the ’60s, doctors weren’t using scopes to do the keyhole surgery on knees that’s so common these days. I ended up with a four-inch incision on the inside of my knee and spent six weeks in a bandage that was really more like a cast.
Two years later, I injured the same knee while training for the beginning of volleyball season. A second operation removed whatever medial meniscus was left, along with the entire lateral meniscus in my left knee.
So there I was, not even 20 years old, with a knee that had no cartilage and a desire to play competitive sports.
The next 20 years or so were spent playing competitive volleyball, squash and racquetball — all games that are really tough on knees.
As I aged, my left knee began to bother me more and more. During the last two years in particular, it started limiting what I could do. Long walks were out, and even short walks became problematic. I had to resort to taking anti-inflammatories every day just to function, and virtually every step was painful.
Finally, in November 2016, my doctor and I decided I should get myself to a specialist. We made the appointment with Dr. Jeffery McKerrell and I saw him on Jan. 12, 2017.
He advised me the knee wasn’t going to get any better and I was a candidate for full knee replacement. I was put on the surgical wait list on Jan 25. Again, he advised me the wait could be anywhere from eight months to a year.
On April 25, my wife and I attended the ADAPT Program (Arthritis, Diet, Activity, Pain, Therapy) at City Hospital. It’s a comprehensive session where people awaiting joint replacement hear from a nurse, an occupational therapist, an anesthetist, a physiotherapist and an orthopedic specialist. It’s a primer to let you know what you’re in for and help you get physically and mentally prepared for the surgery and recovery.
In mid-July, McKerrell’s office called with the news my surgery date was set for Sept. 20. It suddenly became real. What followed was a mad burst of energy to get jobs done around the house and cabin so I’d have the time to recover without worrying.
Eight days before my surgery, my wife and I went to City Hospital for my PAC (pre-admission clinic). This is about four hours you spend with the nurse, physiotherapist and others, where they go over your health history, medications and so on.
On Sept. 20, I was admitted to City Hospital for surgery.
I’ve had quite a number of surgeries, so the process of preparing for it and actually going into it was neither unfamiliar nor scary to me, but it had been four years since my last surgery, so this process was different — and much better.
The first thing I noticed was how much more involved I was in the process. At every step of the way, the nurse or doctor talked to me to make sure I understood what was going to happen. Being an active participant in preparations for my surgery kept me more relaxed and gave me a good understanding of what was to come.
I chose to have a femoral nerve block and a spinal, rather than a general anesthetic. It was a good choice because the nerve block kept my knee “frozen” for the night and there was no hangover from a general.
I’ve never had a spinal before; it was both comfortable and disconcerting at the same time. Comfortable because you can’t feel a thing from the site of the injection in your lower back down to your toes; disconcerting because you can’t feel a thing and when you try to move something you can’t.
I had my trusty noise cancelling earphones and my “chill” playlist all ready to go; once I was settled onto the table and the drape put up so I couldn’t see what was happening, things got started.
Surgery lasted about an hour. I could hear and remotely feel drilling, smell burning bone when they cut it away for the implants and felt the hammering as the various parts were put into place. None of it bothered me in the slightest. They might as well have been working across the room.
After surgery, I was wheeled into recovery.
With a general anesthetic, you don’t remember much about the recovery room. I was fully alert by the time I got there and had a nice talk with the nurses while they used a little bag of ice to see what parts of my lower body were starting to get feeling back as the spinal wore off.
I was eventually moved to my room and visited with my wife and son. I felt great until the femoral nerve block wore off much later that day.
The first day after surgery was one of the toughest days of my life in terms of pain. There was lots of medication, both fast and slow acting, but several times it needed bolstering with a shot of morphine.
The nursing care was amazing — they constantly asked me to describe the pain as a value from one to 10, with 10 being screaming, wall-climbing pain. I remember telling a nurse at one point that I had passed through 9 and was climbing. Morphine took care of that.
Day 1 saw me sitting up on the side of the bed to eat, but that’s as far up as I got.
By Day 2, I was getting out of bed with help, using a walker to go to the bathroom and doing some exercises with physiotherapists. The exercises weren’t much, but just being able to get up so quickly was wonderful — even though the therapist stayed right with me, holding onto a belt wrapped around my waist.
By Day 3, I could go to the bathroom myself, and was able to walk up and down stairs with a crutch and do all the exercises that needed to be done to get released.
Three days after my surgery, I was home — but very dependent on my wife for just about everything.
The drill was straightforward: take the meds, do your exercises, ice. Repeat three times daily. The exercises are ridiculously simple — sit in a chair and slide your foot back under the chair, sit in a chair and straighten your leg.
They’re simple — but they seemed impossible. I flat out couldn’t do them. Knee replacement involves a lot of damage to the muscles surrounding the knee, so once everything is back together and you try to use those muscles again, their response is to simply not work.
Exercises involved my wife lifting my foot, with me trying my best to help, and then her setting it back down while I tried to keep it in the air. It was frustrating and very painful, so it quickly became evident that the prescription for pain killers that was sent home needed to be used 30 minutes prior to exercises simply for me to have a chance to do them.
This struggle lasted a couple of weeks before I could actually lift my foot off the floor by myself — and I worked very hard at the exercises.
Meds were also crucial at night, so I learned right away I had to keep them in my system all the time rather than wait for the pain to come. By the time the pain hits, it’s too late and you have to take lots of meds to catch up with it.
Ten days after surgery, I went to my doctor to get the 41 staples taken out. That was a banner day because the exercises immediately got a little easier without the staples pulling.
In a total knee replacement, the end of your femur — the big bone of your thigh — is cut off, along with the head of the tibia (your shin bone). Both bones have steel pieces mounted to them; a hard plastic artificial meniscus between them mimics a real knee. My kneecap was taken out and resurfaced, so where it was all bumpy and gnarled before, it’s smooth now. My lower leg was straightened. Prior to the surgery, my left foot was migrating to the outside as my knee twisted and I was going bowlegged on one side.
Recovery is really a pretty simple process. I do my exercises three times a day and ice after each. Once a week I go to physiotherapy, where my progress is measured and my exercises are tweaked by making them harder or adding or subtracting exercises. I spend about three hours every day doing exercises and icing. After a few weeks, I stopped taking any medication prior to exercising.
My biggest problems have revolved around hamstring, adductor and calf muscles and possibly some nerve pain (it’s like a crick in your neck that aches, but hurts suddenly when you move wrong). I’ve found that to be quite discouraging — it doesn’t really seem to have gone away after seven weeks. My flexibility and strength are improving rapidly to the point where there isn’t all that much difference between my two knees. But this pain thing keeps on going. I’ve found that massage therapy has helped quite a lot in dealing with these issues.
In the first weeks I got around only by using a walker, but eventually I graduated to a pair of crutches. Then it became one crutch and by week five I was just using a cane. By the end of the sixth week, the cane was gone and I now walk around the house and indoors at malls without any support. I still use a cane when I’m outside, just in case I slip.
Aside from the muscle or nerve pain, all I have is stiffness, which quickly subsides when I move. I walk without a limp and usually don’t need meds to sleep.
I’m now getting to the point where things can get dangerous for me. I feel good; I can walk, and I think that I can contribute to things around the house more — but it will be easy to hurt myself, so I have to follow the plan and work hard at the exercises to get my mobility back.
Doing the exercises they give you is crucial to a full recovery. As much as they hurt in the beginning, you have to persevere. You only get back a full range of motion and control of swelling if you do the work. Along with the exercise, you need to give yourself time to rest so you can heal.
I’m told the full timetable for recovery from a knee replacement is about a year. In a month or so, you should be walking, maybe with a cane, but you should be getting around a lot.
Within three months you should be able to resume your activities, unless they involve twisting and jumping. No basketball or football, for instance. By the end of a year, you should be where you’re going to be for the rest of your life.
I know an increasing number of people who have undergone knee or hip replacements, some of whom are younger than me.
“Because of (better replacement parts that last a lifetime), we’re able to do knee replacements for younger people, so now it’s common for people in their 50s and even in their 40s,” McKerrell says. And because the general population is aging (the baby boomers) it’s becoming more prevalent.
“If you look at the curve of the population, the group of people that are older are much higher in number than they were 30 years ago ... there’s now more people in that age group that need joint replacements; there’s a higher percentage of people in that group that need joint replacements, and now we’re expanding the ages,” McKerrell adds.
Not too many years ago, a knee replacement might last 10 to 15 years before the hardware would have to be replaced. Not so any more. According to McKerrell, “(More than) 95 per cent of people that have a knee replacement now, it lasts the rest of their life.”
The first thing I noticed was how much more involved I was in the process. At every step of the way, the nurse or doctor talked to me to make sure I understood what was going to happen. Being an active participant in preparations for my surgery kept me more relaxed and gave me a good understanding of what was to come.