Total Knee Replacement - Preparing for Your Surgery

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Total Knee Replacement

I want to take a break from simply listing what has happened to me and talk a little more about what I did do and what I could have/should have done before my knee replacement surgery. Having a knee replaced is a significant procedure. It requires frequent therapy and exercise sessions after the operation to regain both strength and mobility. It is possible to shorten the recovery time afterwards. One of the simplest things you can do is to exercise in advance of the surgery to build strength in the joint muscles.

Deteriorating knees move the patient into a destructive cycle that makes recovery more difficult. Increased pain leads to a reduction in activity. Reduced activity means a gradual weakening of the joints associated muscles. And weak muscles mean recovery afterward is prolonged and made more difficult.

Talk to your doctor about pain management before the operation. With reduced levels of pain, higher levels of exercise are tolerated by the individual. They can embark on a muscle strengthening program before the surgery, ensuring they are in optimum condition for recovery afterwards.

Fortunately for me, I was in little pain or discomfort before my operation, which meant I could use my home exercise equipment at a relatively high level of intensity. Lynn and I had decided last winter to outfit a home gym, since our work schedules, and our inclinations made going to an outside establishment difficult. We picked up a very good quality elliptical device and an all-in-one weight machine. The elliptical is a very good quality, basic model. We elected to spend more for a basic machine and are happy we did. It feels very sturdy, and is whisper quiet. The weight machine is leverage based. You add plates to the bars and have to rearrange things for the different exercises, but it is not a huge deal. And, most importantly, it allows you to do squats, dead lifts and all of the major pressing exercises safely.

The weight machine is built by Powertec, and the elliptical is by Eurosport. They both make it easy to exercise, but they aren’t essential. Body weight exercises can do the job quite well. I’ll talk about some I use.

Exercising for flexibility, while useful, is not as critical as exercising for strength. Simple exercises using your own body weight are sufficient to make a difference in post-surgery recovery. Two simple exercises that the individual can do at home are described here.

1. Leg Extensions - Sitting on a straight back chair, place one hand on your thigh muscle and simply extend your leg in front of you, pointing your foot back towards yourself as much as possible. You should feel your thigh muscle tighten up. Try and get your leg straight and level at full extension. Do ten repetitions, holding your leg extended for a count of 6 for each rep. If you can do this easily, try extending the length of time it takes you to lift your leg. That is, lift the leg very slowly, taking 5 seconds or so to get it fully extended. Then hold it for a count of 6. Then take a full 5 seconds to lower it to a relaxed position. If this is still easy, try putting on a heavy shoe or boot while you do the exercise, making the leg work harder. You can repeat this exercise twice a day in the months leading up to your operation.

2. Step Ups - Standing at the bottom of a set of stairs, or a step, facing the handrail or wall, and place your foot up on the next higher step. Do you understand. You are actually standing sideways on the stairs. Using your hands to balance yourself on a handrail or door frame, slowly step up by shifting your weight to the higher leg and extending it. The key here is to do this exercise slowly, until you have fully extended your leg. Then slowly bend at the knee and allow yourself to lower back down to your starting position. No additional weight is necessary for this exercise. If you find it easy to do, do it slower. If you find it hard to do, use the back of a chair or an extended cane to help boost yourself. Maintain an upright posture, avoid stooping or bending sideways and take it easy the first week or so you do this. Perform 10 repetitions twice a day.

3. Assisted squats - Find a sturdy door, not a closet door, but something more along the lines of an exterior door. With the door partially open place one hand on each door knob. Now simply squat down until your thighs are parallel to the floor. You don't want your knee caps extended past your toes. In fact, if you are leaning back a little, supported from falling by the door knobs, you will be able to keep the angle made by your thigh and lower leg close to ninety degrees, which is as low as you want to go. Once you get to ninety, stand back up. Now, the last thing you need to do is fall. So the door knobs (or whatever else you may choose to hang onto) must be strong enough to support you. I used a steel column in my basement. It held me just fine.

The key with any exercise program is to start slow and build gradually. Do not fight through high levels of pain. Pain is a message. Find the best time of the day to do the exercises. For many people this will be morning. Consider placing a cool pack or bag of frozen peas or beans wrapped in a towel on your joint after exercise. As with any exercise program, discuss this with your doctor. Follow your doctors recommendations and best of luck.

Here's a couple of links to websites that talk about post surgery exercises. You should get well familiar with these exercises before you go into hospital.

University of Virginia

American Academy of Orthoepedic Surgeons

Total Knee Replacement Surgery Plus Eight Days

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Total Knee Replacement

Every day I have a little more strength and movement in the leg. My flexibility still hasn’t increased a great amount since the knee replacement, still less than 90 degrees of bend at my knee, but my strength has. The fear of having to independently move my leg has gone (okay, diminished). There are still twinges. Lynn was helping me take off the stocking and when it suddenly came off, my leg bobbed up about six inches, and then there was no support under it so dropped. I automatically tensed up and slowed the descent, but the knee didn’t like uncontrolled flight. Not really painful, just a clear reminder that things needed to be more controlled.

I really don’t have much appetite since I am not doing much. I guess all of the nutrients needed to heal a 10 inch (25 cm) incision in my leg are probably contained in a handful of food. I’m taking 3-4 one-a-days each day, a couple in the morning and another one or two each night. And a protein shake every morning, depending on whether Lynn has time or thinks of it in the morning, while she is getting ready for work.

It is certainly decadent-like to just lie there each morning, drinking the hand delivered coffee and juice/shake while she gets ready. Every once in a while I scratch the dogs on top of their heads or behind their ears. Lynn and I just chat about what’s on the radio or the coming day. She has the great good sense to make sure everything important that I am to do is written down for me.

The dogs start barking like crazy. I look outside and see a service truck. Then about 10 minutes later the phone rings. Bell telephone (or their contracted service rep I should say) tells me that the fuses in the junction box outside on my house wall had blown. They have been replaced. They no doubt saved me from significant damage inside and all is right with the world of telephone communications now. I thank him. Then smack my forehead. I should have asked him for the spec for those fuses. I need to get some for the next time. To think that a $2 part and 15 minutes of work would have saved me from 2 ½ days of no phone service. I will have to find out what is required. Once I get internet access again it shouldn’t be hard.

Now that I have phone service I make contact with xplornet again and once more we walk through all the reboot, power up and power down stuff. They decide it might be a problem with their equipment and assure me that they will assign a ticket to a local service rep. Here we go again, I think. There is nothing I can do. They are the only game in town.

I’m hitting the sack every night about 10:00. By the end of the day, I have had enough of hobbling around and look forward to resting in bed. I have been catching the odd ½ to 1 hour naps as well, usually after lunch. They seem to help with the energy levels.

Total Knee Replacement

Total Knee Replacement - Surgery Plus Three Days

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Total Knee Replacement

I feel really good today. I woke up with lots of energy. And guess what? Oh my God! An omelet for breakfast, with a hash brown potato patty. These guys are going all out.

Did rehab. Energy level crashed. Here’s the exercise/pill conundrum. If you take your pain pills and then the therapist comes around, you are going to be able to push a little harder. Which is good, unless you push too hard, which will aggravate the surgery site, maybe increase swelling, and make it more difficult to achieve good flexion next time you exercises. So there is a bit of a line to walk.

Janet, my physiotherapist says that a total knee replacement can be harder to recover from than a hip replacement. There are many more restrictions on what you can do with a hip, so you are not as likely to try as much, and less likely to set yourself back. I don’t know, never having had a hip done. I do know that after ten reps of all four knee exercises I was sweating and worn out.

I’m on one T3 and one percocet now. I tried just staying on the T3s alone, once the morphine self administered pain control device came off, but they didn’t quite cut it. The perc/T3 combo is working fine.

Every dose of pain killer includes an iron pill. And in the morning I get my blood thinner, cumadin. Funny, I always thought of iron pills as something you took if your blood was thin. And the cumadin is a blood thinner, but there is a difference between anemia and stickiness. We want to build up the blood iron, avoiding anemia that potentially could accompany blood loss during surgery and food avoidance caused by the regular menu. At the same time we want to cut down on the “stickiness” that could lead to clot formation. Cumadin is a standard prescription for any total knee replacement, in fact for any surgery, as far as I understand it. Very little downside and lots of up side.

I wonder about all the supplements touted by alternative medicine newsletters and books for post surgical recovery; everything from immune system boosters to specific formulas that are supposed to help wounds heal better. Do none of them work? Hard to believe that the diet served here includes everything that a body needs to heal faster. I was just reading about a study done in which a researcher examined the eating/supplement habits of 11,000 dentists. He compiled a list of the amounts of common vitamins and minerals (the ones listed on your one-a-day bottle) that the healthiest 5% consumed. It came out to roughly 4 times the recommended daily amount of those nutrients. I’ll have to look it up. Normally I take two multi-vitamins a day. When I get back home, I’m back on my two-a-day regimen for sure.

They are supposed to deliver a walker and a toilet seat with raised arms to my house tomorrow. Lynn suggested she better call ahead to make sure it will be delivered by the time I get home; otherwise it’s crawling from the car to the house. I wouldn’t want Lynn to try and assist me across our uneven field stone front walk.

I don’t think I will need the seat. I’m managing fine on the toilets here in the hospital. Of course, for the one attached to our room I have to sit sideways so my leg has someplace to stick out. It feels weird doing your business on a toilet with the oval running in the wrong direction.

Saw Lynn this morning. Actually she was there watching me do physiotherapy. So no screwing around with how the exercises are to be done, once I am back in my own house. I know she will be watching. She brought my sandals so it was a little nicer using the walker. We even scooted out to the waiting room. Even with other people there if felt like we had more privacy.

Lynn is in the middle of a horse hunt. No mistakes this time (though her last horse was a sweet heart, it came up lame). She is pouring over the internet, on email regularly, on the phone with owners, trainers and other horse people regularly. Almost every trip into the hospital is preceded by or followed with a visit to a riding arena or stable. So we get custom made news to talk about on that score, every visit. I’m not a good patient for visitors. After about 30 minutes I start getting a little antsy. I mean, with people you know and love, and one of you restricted to a space about 7’x3’ the news is going to be limited. So the horse thing is good. I mean I could talk to Lynn all day. I love talking to her, but not in the confines of a hospital room, surrounded with 3 other people. Oh well, out of here tomorrow.

Shannon and her husband Gord show up for an afternoon visit. It’s outside of visiting hours but I scoot out to the waiting area and we visit out there. Shan was helping at a wedding in Toronto yesterday and she really enjoyed herself. She got some great decorating ideas, made some good vendor contacts and took some photos she can put up in her gallery at elegantevenstbyshannon.ca to help give people ideas.

Gord spent the week working on the house they are building, south of Buckhorn.
They are only in their mid-twenties but are getting a very good start for themselves. Both are hard working kids with good ideas. They should be able to move into the house in November.

Today I’m dressed in my running pants and a t-shirt. Just like a regular person. It feels good not to have the hospital gown on. I am also wearing a “compression stocking.” Sort of like the left side of a pair of white tights. Dr. Blastorah likes his knee replacement patients to wear them to keep the swelling down. I didn’t get it till today through some glitch or other. I wonder if the swelling would be less today, if I had it yesterday. Whatever. I think the stocking makes my leg look shapelier.

I mentioned already that they hardly shaved any hair off my leg. I wonder if it is some kind of “We don’t want to make the patient feel different or alienated about their body” thing. I shaved my legs half-way up to my knee in high school. We used to tape our ankles before every game or practice. Shaving sure would have made bandage changing less of an adventure. Actually, I just found out it is because they want to minimize the chance of opening any little razor cuts, and increase the chance of infection. Give me a break? I've got a slice down my leg that looks like it was made by Jim Bowie or Conan the Barbarian, and they are worried about razor nicks? Hey, take my advice. If you have to go through this, shave the incision area three or four days before the event. it makes changing bandages easier.

My buddy John called this morning. John and I have been friends for right around thirty years. It’s nice to get calls from friends. And being in the hospital is a good excuse. Johns pretty good about keeping in touch though. He called a couple of weeks ago because he knew I was going in and just wanted to check up.

Lynn called back this evening. We have a beaver wandering around in our backyard. The dogs were going nuts. She got them into the garage thankfully. I don’t even want to imagine what a beaver bite would look like on a dog. Lynn got assistance from the neighbor’s daughter-in-law. She had a large cage and together Lynn and she convinced the beaver to get in the cage and they have set it loose in a big pond on the father-in-laws property. Now we have a happy beaver and a happy Lynn and dogs. Sometimes stuff just works out.

Total Knee Replacement - Surgery Plus Two

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Total Knee Replacement

Friday night was restless. Not a great sleep. Having your leg wrapped in endless layers of gauze and cotton batting is a real pain. And not being able to move it very easily is also a hassle. But it is nice having the ability to adjust the bed controls to elevate your torso a little. I have to admit that even after what turned out to be 5 days in the hospital bed, I had no back problems. I would not be able to say the same about my bed at home.

I remember lots of periods of wakefulness between Friday night and Saturday morning. But the nurse managed to empty my little urinal three times between 12 AM and 6 AM without me noticing her, so I must have slept sometime.

Jeffrey is moving a little more slowly today, but he is up on his walker early, before breakfast. He likes his shave and wash. I am going to have to give serious consideration to whisker removal and shampoo today. This is a hospital, after all, not a canoe trip.

The nurse has already been around with a kind of warm wet nap, a very cool handy dandy clean-you-up-without-soap-and–water towel. A very heavy paper wipe, about 30 cm (or one foot) square that is slightly damp and impregnated with a little soap, glycerin, aloe etc. that can be warmed up in its own package in the microwave. I think there are 5 or 6 sheets to a package and the nurses hand them out and close your privacy curtains. (Hi Rachael, hi public corridor). Then you can give yourself a good rub down. The nurse comes a long a minute later to do your back and voila, country scented clean. Hey, I’ll take that, as opposed to standing over a drain somewhere, naked, hanging on to my walker while some helper hoses me down.

They just took the bandages off and unwound about 20 feet of gauze wrapped around enough cotton batting to outfit three Santa Claus imitators. They took off the bandage put in after surgery. Ouch. What…, no time to shave the leg? I remember after my original cartilage removal it looked like they shaved everything from ankle to groin. Here they barely took out a half inch (12 cm) wide strip. The cut is about 8-10 inches (20 -25 cm) long. There’s a little drainage tube that just disappears into the side of the knee and leads to a little liquid collection container that sits on the bed at my left side. That tube comes out now as well.

When they remove the drainage tube it doesn’t so much hurt as send a little jolt though my knee. Very similar to getting a shot of electrical current. Weird. There’s a little bleeding from the drainage hole, but not much weeping from the main incision. And speaking of the main incision, it looks like some mad, serial stapler got a hold of me and just had his way. There must be thirty staples. I’ve seen model railroad tracks with fewer cross ties. I wonder what they will feel like coming out.

A few minutes of work with a damp clothe, a little rubbing away of cotton batting residue, application of a new bandage (over the unshaved hair on my leg – how often are we going to change that bandage now) the disconnection of some fluid IV lines and I am a free man. Except for this wonky knee that doesn’t want to bend and leg that hurts too much to lift without support. Still, a new threshold has been crossed.

Today’s breakfast is special. A piece of toast with three slices of bacon, cream of wheat, juice…whoa. What are they trying to do, make me stay forever?

Physio is a little more interesting without having to fight through all the bandaging. I sense the therapist isn’t that pleased with my progress. I try and explain to her the greater difficulty in lifting and straightening a long leg like mine, as compared to the little short legs she mostly deals with. It’s a simple matter of leverage. We all studied this stuff in school. She is not that impressed with the argument.

In Jeffrey’s conversation with his doctor this morning the possibility is raised, of him going home today. The doctor says, sure, why not, as long as the physiotherapist agrees. Jeffrey’s wife says “what am I going to do with you at home.”

Suddenly Jeffrey is an over-achiever again for the therapist. Last nights sweats and chills are banished from his mind. He meets all requirements and is gone by lunch time.

The therapist and I got up for a little scoot around the hallways. She is just a small thing. Maybe 5 foot high, maybe 90 pounds. But mean. Like an agitated rattler. During the rehab exercises, I go to assist my injured leg with the toe of my good one and her hand lashes out, giving me a smart little slap on the ankle. “There’ll be none of that,” is all she says. She obviously knows her stuff.

My hallway scoot is exhilarating, except for the fact that I am barefoot. I didn’t think to pack slippers or sandals for my stay. Of course, I didn’t expect Lynn to take the clothes I arrived in home with her on Thursday. They go in a separate plastic bag labeled “Personal Belongings” when you gown up for surgery. Lynn thought I would have no need for them until check out time Monday, so why leave them lying around in the hospital? Good thinking except for the no shoes dilemma I now find myself in.

Of course, I can’t catch her by phone before she leaves to come visit. It’s going to be an early visit today because there is another horse to see afterwards. So the visit winds up being a little broken. After the initial chit chat, Lynn takes off to find me a pair of cheap flip flops or equivalent at the closest store. Naturally, nothing has my size (13) so it takes a while. She finally gets back with what we used to call “bedroom slippers” in the old days. You know, the ones with the sponge rubber sole, plaid uppers over the toe and black stretchy material around the heel. Comfy. They really were a good fit, and felt secure under foot with the rubber sole, but anything with a back on it is a problem for straight legged people (like recent knee surgery patients). It’s a good thing I was able to touch my toes before the operation, so I can just barely bend enough to put the things on and slip the heel of my left foot comfortably into them. Sandals would have been handier. But now I have a pair of “bedroom slippers” that are the foot equivalent of comfort food.

Today was another stretch in the chair. Two hours today. It got cut short because I asked for help to get up and into my walker so I could travel across the hall to the handicapped “patients only” washroom. A lot more room in there and it is possible to sit on the toilet with your leg extended. My first bowel movement. I normally wouldn’t be so forward with this kind of information, but let me reveal a little secret. If you don’t manage on your own, then the nurses will provide medication to assist. My philosophy re: BMs shifted when I got that bit of info. Laxatives work differently for different people. They tend to work really well for me, so I preferred doing without.

Of course, I needed no assistance using the walker, and once I was done my business, I just walkered my way back to my bed (already made up) and got in. No need to be stuck in the damn chair for 4 hours again like yesterday.

Total Knee Replacement