(Send Mail)
TKR Support Group Online (Send Mail)INTRODUCTION TO THIS PAGE:
What follows is the account of three knee replacement surgeries
written by the patient who was 73 at the time of the first
surgery and 76 at the time of the third.
Some of the problems during and after the first surgery are unique to his particular
case and are related here in order to "get them off his chest," so to speak.
However, this story is not just for people considering knee replacement. It is relevant to any surgery and anyone interested in how patients are treated. Please note that all names are fictitious.
THE HISTORY OF ONE MAN'S BOUT WITH TOTAL KNEE REPLACEMENT:
IN HIS OWN WORDS.
MENU: You can read straight through or go chapter by chapter.
There's More To Come On Page Two
I considered and vetoed the idea of total knee replacement
repeatedly. "It's the cost/benefit ratio," I would say. By cost I
meant pain and discomfort. Would the pain be worth the eventual
benefit? As matters worsened, when every move caused severe pain,
I puzzled over what to do. My family physician precipitated the
decision. "Go see this man," he urged, handing me a card. "He's
an orthopedic surgeon. If he doesn't consider knee
replacement advisable he won't do it."
"But I've heard that infection is a problem," I replied.
He shrugged it off, "Infection is always a potential problem with
surgery. There is always a degree
of risk, but this operation has been improved over the years
until very few problems occur."
I frowned as form after form was shoved at me. "Sign at the X, please," I was ordered repeatedly. As I signed release forms, permissions, assignments and who knows what else I wondered what a lawyer would think of me signing at the X on each form; taking the lady's word for what I was signing. If I read every form I would be there all morning.
They even gave me a packet of information about preparing a Living Will. (I'm only here for a knee operation, for crying out loud.)
Finally, paperwork completed, an identification band was attached to my wrist.
"That'll be all," the admissions clerk told me, "Someone will be along to take you upstairs."
In my hospital room I exchanged my clothes for that singularly inadequate abomination the hospital gown. A gurney was wheeled in and I was wheeled out, my feet hanging over the end. (My 6' 5" creates an overhang.) Down a long, long hall I was treated to the study of ceiling tile and florescent lights. Then an elevator. Watch the feet!
Another hallway, more ceiling tile to count. I got a good look at
the underside of the orderly's chin. The fellow's adams apple
seemed to bob with every step. There was turn to the left, a turn
to the right, another turn to the right and I was in a room full
of beds and other people on gurneys. A surgery prep room,
apparently. Curtains were drawn around me for privacy while
nurses poked and probed. They took my blood pressure, my pulse,
my temperature. They shaved my leg. "Left leg?" the nurse asked.
"Right!" I answered, "Er ... correct. Left leg." The nurse
smiled. "We don't want to do the wrong one, do we?"
The anesthesiologist stopped by. I told him I tended to resist anesthesia. He said he would take care of it.
Then wait.
What one does most in a hospital is wait. The interminable wait; if not in pain then in boredom.
Return to Menu
Surgery Pre-op
Then I was on the move again. Another corridor, another elevator
and I was in a room adjacent to the operating room. OR. Another
wait, then there was a shot in the arm and memory became hazy.
I didn't remember being wheeled into the OR but ... Lordamighty!
Suddenly I was struggling with green-clad, masked creatures and
begging them not to hold me down. Then oblivion. (The doctors
had planned to give me a spinal but when I suddenly resisted they
were forced to give me a general anesthesia.)
The Surgery
According to what I was told, the operation was performed by
making a seven inch incision in my knee, then separating the
muscles and ligaments to expose the tough, gristlylike tissue
surrounding the knee joint (the knee capsule). The capsule was
opened, exposing the inside of the joint. The ends of the
thigh bone (femur) and the shin bone (tibia) were removed and
the underside of the kneecap (patella) was removed. The bone ends were prepared
and the knee replacement was inserted using a technique allowing the bone to
"knit" or grow around the metal parts. (The alternative would
have been to cement it in place. More on this later.) My new knee
consisted of a metal shell on the end of the femur, a metal and
plastic trough on the tibia, and a plastic button in the
kneecap.(When the knee operates the kneecap moves up and down in
this trough.)
Return to Menu
In The Recovery Room
I awoke after surgery and was not quite sure of my surroundings.
I thrashed around, rolling my head from side to side, disoriented
and miserable. "I can't see," I complained ."You'll be alright,"
a gentle voice assured me, "you're doing fine." I rolled my head
faster and more violently, trying to clear my head and my vision.
"Where am I?" I muttered through thick dry lips. "You're in the
recovery room and doing fine." I shook my head and flailed my
arms. "Why can't I see?" I asked again. "You're coming out of the
anaesthesia, it'll clear up." My eyes began to clear. I saw fuzzy
lights on the ceiling and rolled my head around, trying to see
the nurse. She seemed to be sitting at my head. I shook my head
vigorously and slapped my arms across my chest. "You're moving
around so much I can't write," the nurse remarked. "Then write
someplace else," I said. The nurse thought that was funny and
repeated it to someone else in the room.
I looked back over my head at the upside-down face of a pretty nurse and smiled. I was straightened out now. I dozed off and awakened slightly as the tiled ceilings and recessed lights of corridors sailed by. I was awakened by pain as nurses and orderlies slid me from gurney to hospital bed. I was a big man. They covered me, adjusted my bed and my pillows and left the room.
Following Surgery
Alone in my room, I took stock. "Everything is A-OK so far," I
assured myself. Recalling what I
could remember about surgery; about my vaguely remembered battle
in the OR I decided I'd
apparently had a panic attack.
My leg was encased in some sort of canvas splint to keep it straight. There were intravenous lines to needles in my arm, a tube from my knee connected to a suction pump, draining fluid from my knee. A refrigeration unit circulated cool water over my knee. There was some pain, but as time passed the pain would increase in quantum leaps. Pain pills would be called for.
The night was long and well-nigh interminable. I was forced to lay on my back which was not my best sleeping position. But sleep hardly favored me that night. Pain pills were available on request, but only every four hours. If I asked sooner I was refused but still had to ask at the end of four hours. I would sleep for a time after each pill, but only briefly. My mind was so totally absorbed in misery and discomfort that no other thoughts intruded. No dreams or nightmares, no thoughts outside myself. I spent the night in abject misery.
Surgery + One Day
Morning came and the day was a little better. I got more attention. There was
medication (I didn't know what or for
what purpose) and food I didn't feel like eating. There was a
visit from the surgeon who greeted me
with "What's this shit about panic attacks?" I assumed he was
referring to the incident in surgery and
let it pass without comment. He examined his handiwork, nodded,
said something unintelligible and
left without further comment. That was to be his way. A man of
few words and no compassion. As
a man not given to the use of epithets, I was annoyed by his
reference to my supposed panic attack.
The nurses came in and got me out of bed and onto my feet -- a
dreadful, painful experience. I was
taken by wheelchair to Physical Therapy were I sat on the
sideline until a therapist was available.The large room was filled with tables and low exercise pads where therapists worked with patients. There were others in physical therapy, not just knee replacement patients.
Although this was only an introductory visit, this was where I
would spend most of my daytime hours
for the next ten days.
I had a roommate now, a taciturn fellow who kept his eyes glued to the TV. "How's that new knee?" he asked In a profound understatement of fact I replied, "Okay, I guess. Well, actually it hurts like sin if you must know. Right now it's a useless appendage, but they tell me the muscles can be trained until the knee is as good as new."
I recalled moaning a lot through the night before. Tonight I'd have to suffer in silence.
Return to Menu
Physical Therapy
After a few days of being wheeled into the rehabilitation unit for physical
therapy, I was transferred to the rehab
unit for more intensive therapy. The rehab unit was in the same
hospital but there I wore my own
clothes and used a walker to get about. I had a few little
problems -- like I couldn't reach my left foot and I needed assistance at first in getting into my
trousers and shoes.
Exercises included "Straight Leg Raise." (At first physically impossible, then it weighed a ton, minimum.) In "Short Arc Quads" a pillow was placed under the knee, the foot was lifted until the leg was straight. As muscles strengthened weights were added to the foot. There were knee flexion exercises, but the most common exercise was use of a Continuous Passive Motion (CPM) machine that flexed the knee back and forth at a slow rate. To me it was "that infernal machine." They were always adjusting the range of motion just beyond my threshold of pain. I would lay there and cringe every time the infernal thing brought my foot back and bent my knee.
Bear in mind that all of this involved an extremely delicate and pain-wracked knee.
I understood the need for exercise. Muscles had to be stretched and strengthened and range of motion restored. "Vi" was my assigned therapist. I considered her a natural born sadist. She delighted in causing "accidental" pain to tender knees and knew how to create pain that would not show up until after the session was over. My evaluation was not entirely wrong. Vi was not a dedicated physical therapist. She was somewhat less than gentle at times and she tended to start me on an exercise and go off and forget me. Sometimes she would just stand and think and I felt sure she couldn't decide what exercise to do next, or what came next. In one effort to establish some rapport with her, I asked about her work as a therapist. "I have other interests," she answered in an offhand manner, "I'm not stuck with this." I thought, "So much for dedication." I didn't complain, but I was dissatisfied with my physical therapy. I didn't know then how much that dissatisfaction would grow.
I learned a lot about knees and muscles. The knee joint is more complex than the hip joint, it moves only forward or backward and needs strong muscles and ligaments for stability. The bones in a healthy knee joint are smooth and cushioned by cartilage. In my case the cartilage had deteriorated until walking resulted in the crunching of bone on bone, without benefit of the cushioning cartilage. My family doctor told me later that my knee was in such bad shape he thought it would lock up on me at sometime.
Much exercise was devoted to strengthening the quadriceps or thigh muscle and extending range of motion to approximate that of a normal knee by stretching muscles and ligaments.
Return to Menu
The Big Bend
Apparently I was not progressing as well as the surgeon expected.
Such an evaluation had to be based
on reports from my therapist because most of his hospital visits consisted of checking the incision
through which the old knee had been removed and the metal knee
prosthesis inserted. The incision
was generously stapled along its seven inch length from shin to
thigh. On this particular morning he
was checking the range of motion of my knee. How far I could bend
it. The range was far short of
the magic number of 90 degrees. "Bend it further," he ordered,
"or I'll bend it for you." My knee was
already at its flexible limit but I was unprepared for what
happened next. He shoved my foot back
hard, forcing my knee to bend further. The pain was excruciating.
My eyes watered and my head
spun. I fell back on the bed in misery. When my eyes cleared and I looked up he had stepped back,
watching me as if he enjoyed it. He left the room without comment.
Nancy, a friendly, compassionate nurse who always wore a smile, entered
the room. Apparently she had seen
what happened. "I know you're supposed to ask, but can I bring
you a pain pill?" she asked. "Thank
you, Nancy, but I'll survive," I answered.
As she reached out and
patted my shoulder she was biting
her lip as though she wanted to say something and dared not.
First the therapist and now the doctor. I began to feel no one was on my side.
Return to Menu
Who's The Boss Here?
My knee surgery had taken place on a Monday. By Friday I had been
transferred to the rehab section
and was undergoing physical therapy mornings and afternoons. When
I realized that the therapists
did not work on weekends I decided I did not want to go two days
without therapy, so I asked Vi
if it would be possible for me to use the CPM machine over the
weekend. She said she would arrange
it.
After a day of therapy I was pretty well wiped out. Exhausted.
After supper on Friday Nurse Weber
came in with the CPM machine. "Time to be hooked up," she
announced.
"Not tonight," I told her,
"I wanted to use that some over the weekend, but not tonight."
"NOW!" she ordered. "Doctor's orders."
"I volunteered. I asked for that machine and I'm not using it
tonight."
"You have no choice! The doctor has ordered it and you are going
to use it. Tonight."
"I asked for the damned thing -- me -- and I AM NOT using it
tonight."
"You most certainly are!"
"I most certainly am not!"
We stared angrily at each other until the nurse backed down.
"The doctor will hear about this," she said as she left.
I did not touch the machine the entire weekend. My volunteering had backfired, I'd made an
enemy of Nurse Weber. This was not a wise thing to do.
Return to Menu
Back To Surgery
During my second week in the rehab unit I received some
unpleasant news. I was scheduled to return
to OR for a "procedure." I was to be anesthetized and my knee
bent beyond its present limits. (I wasn't told this going in.) I was
concerned because I recalled fighting anesthesia before my first
surgery. Upstairs I reminded the
anesthesiologist of my previous problem. The man appeared
unhappy. "I'll take care of it," He
muttered, "I shouldn't have been given this case." I didn't
comprehend that last remark but
experienced no problem in OR. In fact didn't remember ever being
in there. What I did remember was
the recovery room. I recalled wailing, "I can't stand it!"
Referring to excruciating pain, and a voice
assuring me, "Yes you can." They finally gave me a shot that
eased the pain and returned me to my
room. The next day the surgeon told me, "I bent your knee clear
up to your ass. There's nothing
wrong with the joint."
The message I got was, I was a slacker, I wasn't working hard enough. Lord! How hard was I supposed to work? I had never endured more suffering in my entire life.
Return to Menu
Confrontation
The surgeon had a medical assistant called Carl. Some days Carl
came in and checked on me and the
doctor never showed. Other days the two came in together. It was
Thursday morning when Carl
came in to tell me that I was to be on the CPM machine for three
days, 24 hours a day. I was
shocked. "Are you saying day and night for three days? Without
rest?"
"That's what he wants."
"No. I can't sleep with that infernal thing strapped to my leg.
'Passive motion' my eye, the damned
thing hurts."
"That's what he wants," Carl repeated and left the room.
A few minutes later the doctor stormed into the room. "What is
this crap about you not wanting to
follow orders?" he demanded.
"You can't honestly expect me to stay strapped to that thing
without a break for three days and
nights."
"I don't give a shit whether you sleep for three nights or not. I
say you need the therapy."
"Not without a break. I won't do it."
"I'm not going to have you coming into my office six months from
now complaining about a stiff
knee. If you want to know about recovery, there's an 86 year old
woman two doors down. Go see
how well she's getting along."
I remained adamant and a compromise was worked out. I would be off the machine for mealtime breaks. The machine would be set for 100 degree flexion in the daytime and 80 degrees at night. 100 degrees caused considerable pain but the pain eased as time passed. As agreed, there was a lunch time break and a supper break. This was the only therapy I was to receive for three days.
Return to Menu
The Last Straw
Nurse Weber, the evening nurse, came in about 7:00 P.M. to attach and start
the machine. When it was adjusted she
flipped the start switch and left the room. The first bend of my
knee had me rising up from my pillow
in a futile effort limit the painful bend. Slowly my knee was
straightened and then the bend started
again. At its peak I was gritting my teeth against the pain. I
rang for the nurse. No answer. Another
cycle of the machine and another peak of pain. I rang for the
nurse again. No answer. I knew my call
light was on. Maybe she was busy. Finally I rang again. Still no
answer. I picked up my bedside
telephone and dialed the switchboard operator. I told her I was
in pain and could not summon the
nurse.
Within two minutes Nurse Weber came storming in. "It does
no good to call the operator,"
she declared, "she has no authority."
"That machine is supposed to be set at 80 degrees at night," I
told her. "It's set higher than that."
Weber came over and checked the setting. "It's set for 80
degrees. If you don't believe me, look for
yourself." She turned and left the room.
The movement was much more comfortable now. Obviously she had moved it down just now. Damn her! She knew what she was doing. She knew that thing was set high, that's why she didn't answer my call. If I hadn't called the operator I didn't know if she would ever have come back in.
There were two nurses on night duty, a woman and a man. Sometimes the male nurse came in alone but usually they came in together, especially if I called. They made routine rounds to empty urinals and to check on patients. The male nurse hardly ever spoke. I suspected he was really a security guard.
The infernal machine worked steadily, bend the knee, straighten the knee, bend the knee, straighten the knee. Slowly, eternally. If I slept at all it was only to doze now and then. Finally, about 4:00 A.M. I'd had it! I wanted to scream SHUT THE DAMNED THING OFF! I knew that nurses followed doctor's orders and raising a fuss would do no good. I found the off switch and turned the thing off. I couldn't reach my foot but I was able to work it free after I released the straps on my leg. I was trying to move the machine aside when the night nurse came in. When she saw what I had done she was horrified. Thinking I might be out of my head, she began asking me questions like did I know where I was and why I was here. I assured her I was lucid and I would take full responsibility for my actions. The male nurse removed the machine and I laid back in blessed relief. Before sleep came I had made up my mind. I was leaving this place. Today. Mistreatment by the nurse, abuse by my own doctor, an incompetent physical therapist.
It was more than I could stand. I had already signed up for physical therapy at home. I would be much better off there.
Return to Menu
"I'm Going Home"
When Carl arrived alone that morning, I announced without
preamble, "I'm going home today. With
or without medical approval."
Carl came back later to tell me his boss would approve my
release. He sent Carl to tell me this and I didn't see him again
until my follow-up visits after I was home.
Nursing care in the hospital couldn't have been better. At the time of my discharge I thought my surgery went well. My reaction to Vi, the physical therapist, and Nurse Weber went unnoticed by others. The unspoken sympathy afforded me for my problems with the surgeon were amply shown when Nancy gave me a big hug when I left.
A little compassion goes a long way.
Return to Menu
Surgery AGAIN???
At home a physical therapist visited twice a week to supervise my
exercises. As the weeks passed
muscles strengthened and healing continued, but the knee wasn't
as pain free as expected. After
repeated complaints to the surgeon and repeated wait-and-see
responses he finally listened.
Eight months after the surgery bone scans showed the prosthesis was loose. Bone "knitting" had not occurred properly. The alternative procedure had been to cement the prosthesis in place.
A second surgery was indicated.
This news came with all the shock of a slap in the face with a wet rag. To say I was devastated would be an understatement.
I could wait and see if the "knitting" improved. I could see no point in that, but agreeing to the second surgery was more difficult than deciding to have the surgery in the first place.
Return to Menu
The Second Time Around
Ten months later I was back for a re-do of the left knee. Much of the second operation duplicated that of the first. I had
no problems in surgery and there
wasn't as much pain. I'm talking degree here. There was
considerable pain, but less severe. (Sort of
like just cutting off half a finger rather than the whole thing.)
My attitude and spirits were better and I was out of the hospital and home in half the time. There was still the infernal machine and the physical therapy, but progress was swift. Flexing the knee was instantly improved. On the first go-round I hadn't been able to drive for over a month because of the tight knee. This time I could have driven home.
I seldom saw the surgeon. I checked out on Good Friday and there were no doctors around to remove the staples in my knee. A visiting nurse did that at home.
It is worthy of note here that the surgeon later admitted that he put the knee in too tight the first time. After all the yelling at me, taking me back into surgery and trying to force me into three days on the infernal machine -- it wasn't my fault at all. (Small comfort after all I went through.)
So. After two trips to the operating room, my left knee was and is fine 3-1/2 years after the first surgery.
Return to Menu
PAIN REARS IT'S UGLY HEAD. Right knee goes bad.
After the inevitable became obvious. I changed surgeons for replacement of my right knee. The new man said that it was normal for the second knee to go bad in about two years.
Surgery #3 went much the same as #1, without complications.The prosthesis was cemented in. There was one difference in pain control. At my request I was given a morphine drip that was under my control. Instead of a pain pill every four hours, I could press a button and get relief as need (The total dose was measured. I could not take more than prescribed in a given period.)
At this writing surgery #3 is one year old. #1 was three and a half years ago.
Return to Menu
Would I Do It Over Again?
Memory of pain and suffering has a way of diminishing with time.
Time does, indeed, heal all wounds.
I am so happy to be walking pain-free that, yes, I would do it again if necessary.
WOULD I RECOMMEND IT? (Assuming you are the potential patient.)
I can't -- that's between you and your doctor. If he recommends it ask yourself some questions: Is intense pain now worth the absence of pain for a few years? If you agree, go for it. But it might be well to get a second opinion.
The pain is bearable, I'm proof of that.
Return to Menu
Recommendations: Choosing a Surgeon
Don't hesitate to seek a second opinion.
DON'T let my problems with the first knee replacement influence you unduly. I include them here to offer a note of caution. Be informed. Be psychologically prepared!
Best wishes and thanks for spending time with me on-line.
Return to Menu
Comments? (Click to send mail)
Or e-mail me at rstewart@zianet.com