Craig Bieber

(First published at JustOneOpinion.com on February 5, 2009)

This is a short story. It’s a story full of pain and truth, yet with a happy ending.

In technical terms, getting a new knee is called a “knee arthroplasty.” Currently, almost half a million people in our country have either a knee or a hip replacement every year. It’s both a bane and a blessing of being a “Boomer” in our current world. Most members of our generation have led more active lives than our parents did, and we are fortunate to live in an era where technological advances are rapidly keeping pace with our drive to wear our parts out.

I had a knee arthroplasty two weeks and three days ago. Getting to the point where you are ready to commit to this surgery generally follows a period of years with angst and pain. Making the elective decision to go through a period you know is going to be full of even more intense angst and pain is not an easy one.

I began to write this article last week in late January while I was still in the early days of the rigors of post-surgery out-patient physical therapy to bring a sense of reality to what this is all about. Like me, I know many of you are facing the probability of needing joint replacement surgery. My intent is to give you some first-hand information that will help you with your decision, and to help you understand what to expect if you do decide to have the surgery.

Here are a couple of important no-brainers: Unless you have great insurance, the surgery and the follow-up physical therapy are expensive. The surgery is painful, and the physical therapy that begins immediately after surgery is monotonous and also very painful.

As the doctor I chose told me, having a bad knee is not life threatening. For me, if you can get some additional life out of your damaged knee with treatments, such as injections, it is worth trying.

I managed to get two pretty good years with injections of SYNVISC. Depending on the degree of damage to your joint, this visco-supplement can do some of the work that was done by the synovial fluid in your knee, which can break down over time. In my case, almost thirty years of participation in amateur sports had simply worn my knee out, so the injected fluid helped to lubricate the damaged joint.

Be sure to get more than just one medical opinion. When you think you have found the right doctor, check him out. Google search had a lot of information about my doctor, all of it positive. I found out he is a leading orthopedic surgeon who only does joint replacement surgery and has pioneered some of the latest developments that make the surgery less painful, less invasive, and easier to recover from. Frankly, I told my second opinion doctor that I thought the guy “was a little cocky.” His response to me was, “He’s probably just good.” I think he probably is.

To me, this is the most important part of this story. My doctor puts out a wonderful, inch thick booklet that tells you what to expect, and what to do before and after the surgery. The only thing I thought could have been stated more emphatically was the suggestion that you exercise as much as you can before the surgery. In the first few days after the operation, almost every little thing you do is difficult: rolling over, getting out of bed, going to the bathroom, sitting up to eat. You need strong arms and a strong good leg to compensate for the fact that you cannot get anything out of the surgery leg.

Until three days before the surgery, I was walking three miles every other day. Yeah, the knee hurt and swelled up, but I just iced it and took Advil. I also worked my upper body and my arms with a ten pound medicine ball on the days I walked.

My doctor and two therapists described my recovery in the early stages as “exceptional.” My hospital stay was supposed to be three days but I was out in just two, primarily because I did so well with the physical therapist. I understand that some people just aren’t used to physical activity, and some potential candidates for surgery have too much damage or so much pain that they simply can’t exercise.

I’d made my mind up to follow all of the directions that were given to me before the surgery. I ate smartly, limited my alcohol intake to a couple of beers a night up until three days before the surgery, and then just drank water and juice. We tried to prepare our house by removing all tripping obstacles such as throw rugs. I realize that everyone has different limits on what they can do, but if you can recover without dealing with stairs, it will be much easier for you.

There were many other instructions that come in the booklet the doctor gave me, and some of them relate to doing things that help to lessen the possibility of clotting and infection – both very real possibilities with this type of surgery. I did everything they suggested.

I attended a pre-surgery class with a group of about fifteen people who were scheduled to have knee joint replacement with four different doctors. From the beginning, the hospital representative issued a series of disclaimers. We were informed that those of us who had my doctor would have different procedures during the surgery and throughout the recovery period. To me, the first and most important difference was that we were going to receive nerve blocks.

When I awoke in the recovery room after the hour long surgery, my right leg was in a continuous passive motion machine (CPM). The machine was gently bending my knee every few minutes immediately after the surgery. With only occasional breaks, my leg stayed in the CPM machine for a good part of the time I was in the hospital. I don’t know how much pain medication would have been required to allow my leg to have this immediate post-surgery therapy without the benefit of the nerve blocks.

The CPM came home with me and I was required to use it for three two-hour periods every day. I reached the required bend of 90 percent on the CPM just nine days after the surgery.

This is probably a good place to take a little more of the glow off my story. This was major surgery, so the pain is real. You have to take pain medication to be able to do the therapy – and you have to do the therapy. Internal scar tissue can form quickly, and if you don’t do the proper amount of therapy, the recovery will be long and nasty. For most people, heavy amounts of medication cause loss of appetite and constipation. You can get through this by drinking lots of liquids and regularly eating small amounts of good food, including fruits, vegetables, and fiber.

Everything you do will be difficult and painful for a while. My doctor required me to have blood-thinning shots in my abdomen for my first week at home. I was taught how in the hospital, and it was easier for me to administer them to myself than to have my wife do them. In reality, the injections were very easy.

For the first week or so, sleeping comfortably is very difficult. You’ll be lucky to get a couple of hours of sleep at a time. Put a small, comfortable pillow between your legs so you can sleep on your side for part of the night. Be sure to leave night lights on between your bed and the bathroom.

If you chose out-patient therapy, as I have, find a good therapist. I found mine by doing an in-network search through our insurance company. My therapist works me hard, while making me feel positive about what I’m doing. Three days ago he gently worked my leg to 105 degrees – two days before my staples came out. As I mentioned above, it’s important to take your pain medication so you can manage the PT and was reminded to do this many times.

I wanted to get off the prescription pain medication as early as I could. I went to a therapy session last week after taking Extra Strength Tylenol, which had been working for me around the house, but it turned out to be a painful experience. Since then I use the prescription medication before each PT session. Now that blood thinning is not an issue for me, I can use Extra Strength Tylenol combined with Advil around the house. Unless you have a very high tolerance for pain, I would recommend that you also use the prescription medication before your physical therapy sessions.

Oh, and I have to mention the white surgical stockings – on both legs! They are for control and prevention of blood clots, so they are a fashion item you’ll just have to deal with.

I know it sounds corny, but being positive is the best medicine I can prescribe. I can already see a pain-free future where I will be able to do some of the things I love to do and haven’t been able to for a while. Don’t try to do it alone. My wife has patiently helped me through this, and I can’t imagine anybody making it through their first week at home by themselves.

As I stated, this story has a happy ending. Yesterday – just fifteen days after my surgery – staples were removed, the CPM was returned to the supplier, those sexy white stockings were discarded, and candidly, I don’t really need the cane.

Yesterday I had the best night of sleep I’ve had since before my surgery and I feel my only limitations will be based on how much I am willing to push myself.

The best trick I’ve learned? Put your left hand between your legs on the front of the toilet seat. Put your right hand on the right side of the toilet seat. Push yourself up with both arms and your left leg.

And now that glass of scotch in the evening tastes oh so good.

This article was originally published on February 5, 2009 at the news and commentary website JustOneOpinion.com. This is one of several articles that I’ve submitted there over the past few months. According to that site’s Senior Editor, “Getting a New Knee” has continued to rank near the top of most viewed articles on that site, even several months after its original publication.