KNEE REPLACEMENT 101 - Elizabeth by the Sea

By Beth Zollars

Read Time 7 Minutes

THE BIONIC WOMAN

9 months ago I had knee replacement surgery. April 4th, 2018 to be exact.

The medically terminology is “Total Knee Arthroplasty”.

I am not alone. Millions of people are getting knee replacements, and more than 63% are women. But we each have a unique story, no two the same. Here is mine and a mini-guide to get you started on your own healing journey.

A side note, the information/prep in the post could additionally be used for other types of surgeries, with long-term healing requirements.

By 2030, total knee replacement surgeries are projected to grow 673% to 3.5 million procedures per year¹
Nearly 1/2 of American adults develop knee osteoarthritis in at least one knee of their lifetime²
More than 90% of people who have knee replacement surgery experience a dramatic reduction of knee pain³
In 2008, 63% of all knee replacement operations were performed on women

I wish I could say I’m back to “normal” or at least pre-knee problems.

…My journey continues

Suffering for 10+ years- with varying levels of knee pain I promised myself when I couldn’t walk – I would have the surgery.

The years of high school/college track, lacrosse, lifting ridiculously heavy weights, running, aerobics, cross-fit, and other high-impact sports definitely put a toll on both of my knees.

I didn’t enter into the surgery with rose-colored glasses. Researching became my full-time job. Trips to the Mayo Clinic for a second and then third opinion as well as interviewing local Dr.’s led to my conclusion.

Having the surgery in Kansas City at the Orthopedic Institute made the most sense – working the best for my recovery and family.

I entered into the surgery with the gusto of an Olympic athlete.

The upside – I’m walking relatively pain-free with limited mobility issues on the new knee. A big difference considering prior to the surgery I was basically in a wheel chair, brace, cane, and any/other apparatus for a knee.

Then what’s the problem?

I’m still “aware” of my knee and it does cause me a chronic ache, popping, clicking, and tightness. I try to describe it as “a water balloon inside my knee”. Still swollen obviously, but I believe it may be a combination of the healing process and my own genetic makeup of soft tissue related problems.

And as I’ve been told- It’s all normal.

I f^&*%$##@ HATE normal.

I went back for a second opinion after surgery, and a third, and you simply just get frustrated when a Doc says “seems to be all ok”.

Damn Ok.

There is a questionnaire you fill out when you go back for your scheduled follow-up appointment. It goes something like –

“How AWARE are you of your knee when you…”
            Get out of bed
            Go upstairs
            Walk a regular stride
            Etc…..

They stopped giving me the worksheet. After almost a year, I am still “aware” of my knee…

ALL THE TIME.

The new knee looking “Normal”. Yikes, the right knee not so great.

I don’t think the way my knee is feeling is the new normal.

However the thought of having to mentally prepare myself for a journey finding yet another “amazing” knee Doc, going through the thousands of forms, questions, x-rays, etc. with a questionable outcome.

I can’t handle the process right now.

It’s truly mental gymnastics, more than a physical issue.

I live a half full knee life – still. I can walk the dog- yipppeee, I truly missed my favorite activity. I can go up and down stairs, I can hike basic trails, and Pilates is my go-to saving grace. But I still feel like I’m missing out – oh and yes, the other knee looms large.

I’ve stopped complaining about it. Nobody needs to hear me drone on and on.

The challenge for me is a depletion of hope.

I was so very hopeful I would get my lifestyle back. I knew I wouldn’t be a long-distance runner again, or ski the black diamonds, but after almost a year, I truly thought life would be more active – I haven’t given up yet! I am determined to keep increasing my activity level through pilates, rowing, cycling and walking.

I also cancelled surgery number two. No way I could handle the second knee yet – if ever. Now I truly know why they do double knee surgeries.

I have made it almost 10 months! And acquiring a massive amount of knowledge about the process makes me one more person you can talk to.

Where to start?

Keep in mind everyone’s journey is different. Everyone’s body is different.

I have many friends who have had a knee replacement all with varying outcomes – from 0 to 10.

Before you enter into surgery talk to patients who have had the surgery. Nobody better than an existing patient, but keep in mind – Everyone is different, no two patients alike.
Find a specialist if you have specific health issues.
Set your benchmark for “absolutely having a knee replacement”. Mine was walking. I was 55 and needed to be ambulatory.
Have a list of questions and concerns written. Forgetting wasn’t an option – I’d whip out my sheet of paper – my Dr. was open to my questions, if yours is not- or you are getting a bad vibe- maybe not the best Doc for you.

Shortly after surgery – I was alert and ice was attached via the magic machine.

Questions assisting you with your decision.

Where applicable I add my personal experience.

Is there any harm in waiting?
Am I too young or too old for knee replacement?
What else can be done for knee arthritis besides surgery?
What is minimally invasive knee replacement surgery?
Which type of replacement would benefit me?
How much does knee replacement surgery cost?
How do I find out if my insurance will pay for knee replacement surgery?
Does insurance cover all of the costs or just some?
Do I need to lose weight before surgery? – I lost 15 pounds for my surgery it made a huge difference on the weight and mobility load.
What type of orthopedic surgeries do you do? Knee vs. Hip
How many surgeries do you perform ? A week/month/year?

Once you decide the surgery is for you – More Questions

Likely you will meet with a pre-op nurse. Ideally, you will cover all of the below questions, but it’s good to go into the meeting prepared.

Again, I’ve provided my personal experience where appropriate.

Is there anything that I can do before the surgery so it will be more successful for me?

Does it make a difference which hospital I go to? Look at INFECTION rates! Critical with a knee replacement. Number one complication is an infection. I opted for an ortho- surgery center opposed to a big hospital.

Are there exercises I should do to make my muscles stronger? Strengthening the quad is critical. I wish I could have done more of this, but my quad was weakened by being in a wheelchair for almost a month prior.

Should I learn to use crutches or a walker before I have the surgery? A walker helps the first few weeks- I would purchase/rent one prior to surgery

How can I get my home prepared before I even go to the hospital? For me, a shower chair was critical, I got really tired of standing in the shower trying to wash my hair.

How much help will I need when I come home? Depends on your caregiving situation. As a woman, I can tell you my husband was great, but he had limited cooking capabilities. I’ll go over food later.

How can I make my home so it is easier to get around and do things? One level living would be ideal if you can do it.

How can I make it easier for myself in the bathroom and shower?

What type of supplies will I need when I get home? See below

Do I need to rearrange my home? I would pick up area rugs

What should I do if there are steps that go to my bedroom or bathroom?

What are the risks or complications of the surgery?

What can I do before surgery to make the risks lower?

For which of my medical problems (such as diabetes, heart disease, and high blood pressure) do I need to see my doctor?

Will I need a blood transfusion during or after the surgery? What about saving my own blood?

What is the risk of infection from surgery?

What will the surgery be like?

How long will the surgery last?

What type of anesthesia will be used? Are there choices to consider?

Will I be in a lot of pain after surgery? What will be done to relieve the pain? I had some challenges here. I had a horrible adverse reaction to the Oxycodone. Have a plan B

What will my stay in the hospital be like?

How soon will I be getting up and moving around? I was up 3 hours after surgery.

Will I have physical therapy in the hospital?

YES, you will, bring walking shoes.

I had a very aggressive PT after surgery. I had some blood pressure issues as many women do, especially due to anesthesia thus making me very light-headed. At one point the PT wanted me to go up and downstairs.

I was very dizzy and I said I didn’t think I should. Her response “you just have to get it out of your head your knee is hurting”.

I won’t tell you what I now wish I would have said to that PT, but at that moment, out of surgery, trying to be brave even then I knew. “I’m going to fall”. I had to be rushed back to my bed with extremely low blood pressure. Nothing to do with my will or toughness.

The whole episode made me feel like a failure. Don’t’ let that happen to you, know your body and never let someone force you to do an activity you are not ready for.

And a few more questions;

What other types of treatment or therapy will I have at the hospital?

How long will I stay in the hospital? Usually one night.

When will I go home after surgery? 24-48 Hours.

Will I be able to walk when I leave the hospital? Yes- or they won’t discharge you.
Will I be able to go home after being in the hospital, or will I need to go to a rehabilitation facility to recover more?

Do I need to stop taking any medicines before my surgery?

What should I do the night before my surgery?

When do I need to stop eating or drinking?

What medicines should I take the day of surgery?

When do I need to be at the hospital?

What should I bring with me to the hospital?

Do I need to use a special soap when I bathe or shower?

I highly recommend getting an ice machine for home. It truly was my saving grace.

One of the most important quesitons I did not ask

“Will you (Doctor) be available after the surgery and the days following for questions/complications? “
While my Dr. was available immediately after surgery, he left town the next day. I had no connection to his partner nor did I know he was going away. I had issues with meds, pain management – I felt lost. Not the best scenario.

As prepared as I was – I didn’t have a plan b for pain management and I highly recommend having one.

I ended up cycling tylenol/advil and eventualy I got a prescription for DUEXIS^® (ibuprofen 800 mg, famotidine 26.6 mg). To keep stomach irratation down.

As a result, I wasn’t as ambulatory as I anticipated. I didn’t feel like eating, but I had to, especially with the meds. I’m glad I had meal prep, but I would have doubled the meals.

April 18th down to a cane at my 2 week check up.

Meal Prep

I would suggest preparing the below food ideas/snacks for at least two weeks. I had about a week, and it wasn’t enough. My besties had to circle the wagons and pitch in bringing food. Especially if your caregiver is not used to preparing meals ( I wanted to eat somewhat healthy. )

Breakfast/Lunch/Dinner

Prepare small meals with protein – 6 to 12 servings in Tupperware

Salad w/greens and your favorite ingredients. My favs were roasted chicken, avocado, peppers, cheese, nuts. Change up ingredients to give yourself a variety.
Wraps w/favorite ingredients. Store nicely
A big pot of veggie soup and stored in mini containers
Home-made chicken broth, for when I really didn’t feel like eating but had to. I can’t tell you what a lifesaver the broth ended up being. Kept me full, hydrated and able to take my meds.
Breakfast snack packs were perfect for am meals too. Using Tupperware for storage and added the following- hardboiled egg, turkey bacon, avocado, small cubes of cheese, berries.

Sorry, not a pleasant photo, but I freaked when I had a ton of bruising. Perfectly normal, most from the tourniquet.

Snacks –

At times a meal may or may not feel good to you. Or at 4 am you are ravenous.

Berries /fruit/plain yogurt – Small containers with some plain yogurt and fruit will store, keep that gut in check. Ask if you can take a probiotic or digestive enzyme. Most likely they will give you stool softener and lax, much needed after surgery.

Cut up veggies with some type of dip or hummus

Salty something. Not sure why but I think with all the saline I got I was craving salt.. so by a big box of saltine crackers by your bedside you can shove down when you have to take your 4am pain pill..

Most important the pain pills will cause nassau if you don’t eat with them. I learned that the hard way.

Make sure you get the right PT for you. Molly from Mpact physical therapy simply the best!

Other tips and hints

Dehydration with pain pills causes horrible headaches.. so keep hydrated, get a swell water bottle.

Slip on shoes work really well not sneakers. I like Sketchers.. I treated myself to a new 35$ pair.

No skid socks, might not wear shoes for a few days

Baby wipes..probably not a shower for a few days

325mg Tylenol, to offset pain if you are in between pain pills even the oxy with acetaminophen- you can take between 3000-4000 mg. I tried the lowest dose pain meds as I am super sensitive to drugs and the Tylenol acts as a bridge in between.

Netflix is your friend. Or whatever streaming service you like. I felt at times fuzzy, so nothing you have to work too hard concentrating on. I actually watched 6 seasons of Sex and the City. Again. No brain work needed.

Magazines – Again hard to focus at times. I bought lots of books but couldn’t get into them. At least not right away.

Lots of pillows of different sizes to act as props for your body, that has been a huge help in helping me get comfortable at night.

Ice is your friend. I highly recommend getting the ice machine that continuously pumps ice water around a brace-like device, your knee will thank you. We also found out that by adding frozen water bottles into the cooler device we (my husband) didn’t have to lug ice up and down the stairs.

Compression hose are a must and get various sizes and lengths. You will want to wear the full length for awhile and then wean yourself to what works for you. I also had compression brace just for my knee.

Basketball shorts were the only thing I wore for about 2 weeks. I bought men’s medium – roomy and perfect to slip on and off.

Get a nice pair of flat shoes. Once you decide you need to go out, you will have to wear flats for a while. Even with a dress.

Once you start feeling better, plan home visits with friends and short trips out. I felt extremely isolated and bored many a day. I would have planned more of both for sure.

Communications / Gate Keeper

Have a group text set for family and friends.. then you won’t be inundated with texts from well-wishers. Designate someone, to give status and updates. Care bridge application may be an option.

Keep visits to a min. especial in the hospital. You just don’t know how you are going to do, and you need to focus on you.

I thought I would want visitors but when I had a few hiccups, that was the last thing I wanted. Have a gate keeper… seriously.

Block your calendar off a week before to start preparing and taking care of yourself. You need to go into the surgery strong and not depleted. Have coverage for household tasks etc. at least two weeks after as well.

After-Care

Prior to surgery I would set up your PT. You will become very intimate with your PT. Make sure you like him/her and the facility is something that resonates with you.

I can’t speak highly enough about my PT. They were simply the most caring, nurturing but tough professionals. I suggest interviewing them if you can prior to surgery – you are going to be spending a ton of time with them. They will become your best friends or your worst nightmare.

Be open to non-traditional healing methods. Above is cupping to increase blood flow.

I struggled for awhile, not with the immediate tasks but pain, swelling and range of motion. It does fall into place, but the early sessions are critical. Get it right from the start. And again, a little uncomfortableness is perfectly on target, DO NOT do anything that puts you in severe pain.

I also recommend massage by your PT or a trained professional, Myofascial therapy and cupping was amazing for me. Water therapy, cycling, and pilates. All my go-to feel good therapies.

Balance exercises were critical in my recovery and I continue to do them today.

Patience, persistency, knowledge.

Is what I’ll leave you with. I think my expectation was a bit hyped as I felt I was an athlete and on the young side of typical TKR.

If you do decide to go forward with the surgery, be your best you going in. Do pre-workouts, be prepared at home with your support system, and don’t give up! It can be a very humbling and frustrating experience.

I am still on my journey and anything I can do to make a fellow traveler more aware of the process, I am sincerely glad to do whatever I can.

My first outing and the first time I had real clothes on – notice the flats.. no heels yet.

Please comment below and email me if you have specific questions. I won’t sugarcoat my answers – 🙂

As always, thank you for stopping by and checking out Elizabeth by the Sea.

_Sources:

_{Cisternas MG, MGC Data Svcs, Murphy L, Croft JB, Helmick CG. Racial Disparities in Total Knee Replacement among Medicare Enrollees — United States, 2000–2006. MMWR 2009;58(6):134-8}
_{Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Spotlight Knee Replacement; http://www.cdc.gov/arthritis/resources/spotlights/kneereplacements.htm}
_{Kurtz SM, Lau E, Ong K, et al. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009; 467:2606-2612. Total Knee Replacement Surgery By the Numbers ANationInMotion.org}
_{2008 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality.}