WHAT IS KNEE REPLACEMENT DOING ON A MOTORCYCLING SITE?
  
    
  As I have said, I have now had both knees replaced (one at a time) and I have passed my 3rd anniversary for my first one. Besides some things that I no longer do that could damage the implants, I would not know that I had my right knee replaced if I didn't have a scar. My left one is approaching that point at two years and a half. Since it is not a procedure to be lightly or casually contemplated, I wanted to share my experiences and what I have learned from it. Hopefully, it will be a help to someone who is facing the prospect. I am not a medical professional by any means, but I am an 'experienced' knee replacee!   
   
 

1. Many folks do a 'bilateral' replacement - replacing both knees at the same time. The reasons vary from 'I don't want to go through the pain twice', 'I don't think I would ever do the second one', and on and on. The key to getting the most out of your new hardware is the serious pursuit of therapy. I as I say, 'The Doctors install it, the Therapists make it work!' From my observation, the therapy is difficult enough with one good leg to stand on. My 'opinion' from my experience and observation is that doing one at a time allows you to pursue a much more aggressive therapy and gives you a better quality of life during the process. You really use the 'unrepaired' leg during the healing of the 'repaired' leg more than you can imagine.

2. As much as possible, try to get in as good a physical shape as you can before surgery. Every pound lost will help you. Strengthening your leg muscles is very important as you will be surprised how weak your leg is after the procedure. But with bad knees, I realize there is only so much you can do.

3. When selecting a surgeon to cut your leg bone off, pick one that has done a lot of them successfully! Check out their reputation with real people besides what you can find on the Internet. See what hospitals they work with, because you will be admitted to one for three to four days. Does the hospital have a section dedicated to joint replacement? Once again, do you want to go to war with folks that have read a book about shooting a gun or the folks that have pulled the trigger many times?

4. The two biggest risks during the process are infection and blood clots. My surgeon does the procedure in a 'clean suit' and takes every precaution necessary. You will probably be put on 'rat poison' - blood thinner - for a while before and after the surgery to keep your blood thin and address the clot issue. If you have the surgery done during the cold part of the year, be prepared to have extra clothes! I'm usually very hot natured, but the blood thinner changed that for the time I was on it. I had one done in August and one done in December. I highly recommend doing them in the summer if you can.

5. Preparing your living quarters for your return is important. You will probably be on a walker so think about the space you will need to maneuver one of those contraptions - especially getting in and out of the bathroom. How many steps will you have to go up to get into your house? How low is the bed that you sleep in? How low is your toilet? When you try to get up in the first few weeks, the position of your thigh bones makes a big difference. It is easier if your thigh bones are perpendicular to the floor rather than bent downward. That is one of the major milestones in therapy - the degrees of bend you can get out of your new knee. However, they measure the angle 'backwards' from the way my brain thinks about it. Being the recipient of more orthopedic procedures than I care to remember, I've figured out a few things along the way. With knee 'stuff' (three scopes and two replacements), I slept in my recliner with my knees above my heart. It seems to reduce the swelling and the pain level. But most recliners sit too low to the ground so getting out of them can be a real pain. I built a platform out of 4x4 lumber for my recliner to sit in so it would be elevated. I could scoot to the edge of the seat and my feet would just barely touch the floor hanging straight down. This made getting up and down a lot easier than the first time I tried it without the platform. You may want to also consider getting a taller toilet (handicapped ones are taller) or one of the seats that goes over the toilet. Also, since you are not supposed to soak the knee with the incision, you will definitely want a shower not a tub. I've found wrapping the knee in Saran wrap keeps the water out of it during a shower.

6. After the surgery, do not try to be a 'hero' and stay off the pain meds. If the pain gets ahead of the medicine, it can take many hours for it to 'catch up'. Don't ask me how I know this! Also, if they offer you a 'block' before surgery, take it. Depending on your anatomy, it will really help with reducing the pain until it wears off - which can be a few hours to a day. On my first replacement, I was up whizzing around the ward on my walker a few hours after the surgery thinking this was going to be a cake walk. My opinion rapidly changed after the block wore off.

7. Not to scare you, but the first four weeks of the replacement you find yourself saying 'What have I done? It didn't hurt this bad before the surgery'. About Week 5 you begin to think 'This may work out after all'. About Week 6 it's 'I think I'll be okay'. By Week 8 you should be doing well and almost back to normal - assuming you do your therapy both at home and when supervised. It's not the time cut corners or be lazy. If you are not dedicated and determined to do the therapy, don't bother with the surgery.

8. To me, the reason the therapy was so unpleasant makes a lot of sense when you consider what is done. Basically, your leg bones are cut off, a metal spikes are inserted into the bones and metal caps rests on top of the cut off bones. I was discharged from the hospital on a Sunday and was in therapy on Monday both times. As you put your weight on your 'new' knee, the metal cap is pressing on the freshly cut off bone. So be sure to take your pain meds before your therapy like they tell you to do!

9. You and ice packs should become good friends. If you get 1 quart heavy duty Zip-Loc freezer bags, fill them with a mixture of water and about 15-25% rubbing alcohol, you will have a simple solution. The alcohol keeps them from freezing solid so you can mold them about your knee. If the mix is 'right', they will be about the consistency of slush. I 'double bag' mine, putting the filled bag inside another bag to be sure I don't get leaks. I was told icing for longer than 20 minutes does more harm than good. So on 20, off 10 seemed be a pretty good pattern for me.

10. Realize that after the replacement and recovery there will be some things that will be 'unpleasant' to do. Any activity with major impact on the knee is not recommended. This includes running, jumping, basketball and such stuff. You can do it, but remember you don't have meniscus or an ACL or any of that cushioning stuff down there - just a composite sort of cushion instead. Kneeling can be quite unpleasant, since your original kneecaps are now pressing up against the metal prosthesis. Squatting also is not something you may want to try either. But walking is more pleasant than you can imagine if you have suffered a long time with knee pain. Bicycling, both outdoors and stationary, is very enjoyable. I haven't tried swimming yet, but I'm sure it will be fine also. Besides impact sports, I have been able to do pretty much anything that I want to do.

My right knee replacement was 'expected' but my left knee replacement was not. But when it became the only option for the left one, I never hesitated for a moment about having the surgery. I knew that I would face about eight weeks of unpleasantness but there would be a light at the end of the tunnel and it wouldn't just be another train! One last interesting tale -

When I was in therapy for my right knee, the therapist asked me a question - 'Why are you limping?' I had never really thought about it but I had limped so long with my bad right knee that it had become an ingrained habit. She told me 'Phillip, you have got to learn to walk pretty'. With the knee replaced, there was no physical reason for me to limp. So we had to retrain my brain and my muscles not to limp.

If you have any questions about the procedure, I'll be glad to share what little I know and experience with you. Just e-mail me at unclephilus@hotmail.com.

 

**UPDATE - 12/10/2012 -

I just passed my two year anniversary for my right knee replacement. I can honestly say that it functions as well as the 'original equipment' in most cases. It is to the point that I don't really even think about it any more. The left one is progressing nicely and I feel it will be the same in another eight months.

 

**UPDATE - 12/31/2013 -

As I said, I would not know that I had a knee replacement on my right knee if I didn't have a scar. It is now at the point after the three year anniversary that it functions as well as the 'original equipment' - other than certain limitations that I don't do. The left one is getting close to that same feeling also. I currently walk briskly 3 miles a day and spend 30 minutes on a stationary exercise bike five days a week with no knee pain.