It seems like everyone knows someone who has had a total knee replacement or is considering one. There was a lot of feedback about the Oxinium knee, so I decided to share some more about my knee replacement experience. Tuesday marked eight weeks since the surgery and I feel very fortunate that progress has exceeded my expectations. At the final physical therapy visit I had hoped to achieve a flexion of 130 degrees. The therapist bent the knee while measuring with his goniometer and the result was 131 degrees — the therapist was thrilled and so was I. A 120 degree flexion would be adequate for most activities but I was determined to get to 130, plus one for good measure.
My new knee has gone from a dream to reality. In a couple of weeks the real test will come — getting through security at Westchester Airport on the way to Florida. No doubt that the pound or so of oxinium will set off all the bells and whistles. The "knee card" shows a very accurate picture of the prosthesis and on the back of the card are the details of who did the surgery, when, and where. I have a hunch the TSA staff will not be impressed.
Perhaps the Fly Clear card will help. It contains nothing about knees but it does have biometric fingerprint and iris image verification. Clear is also working with General Electric to offer shoe-scanning technology as soon as it is approved by the TSA, which will enable Clear members to leave their shoes on during security screening. Some people have security concerns about "smart" cards. By necessity we all travel with complete strangers. I don’t feel a need to know about travelers life history but I think it is reasonable to know that each passenger is in fact who they say they are and that their travel history is not suspicious. Back to knees.
I feel extremely fortunate and happy that my knee replacement has gone so well and that the rehabilitation is ahead of schedule. Most knee replacements go well but it is possible to have an impact on how well. Following are the key factors from my layman point of view that I feel can make the difference.
First and foremost is to make sure you really want to have your knee replaced, your surgeon agrees, and you are prepared to make it your top priority. Some say you should be in your seventies to have it done, but the advanced materials used today can last 30-40 years. I had two surgeries on my knee (1985 and 2001) and I waited too long. If you have daily pain and can’t get the level of exercise you want, I say go for it.
Clear the calendar. It really needs to be your top priority. If you are a type A and can’t wait to get back to things you may end up taking shortcuts that end up preventing the fullest possible benefit to accrue. Your knee is numero uno. Medication and rehabilitation should take precedence and focus over everything.
Find a surgeon that does nothing but joint replacements. There are many surgeons who have done replacements but I would say find one who does nothing but. High volumes leads to high quality outcomes. You can go to big cities and famous places but if you have a local surgeon who does just joint replacements and who is accessible you will feel better about the process. In the end, a part of the best result is having the best attitude going into it and feeling a relationship with the surgeon becomes a part of your attitude. I feel extremely fortunate to have had Dr. Sanjay Gupta perform my replacement.
Learn everything you can about what is going to happen to you. Find out what company makes the prosthesis your surgeon will use and then visit their web site and read about what will go into your joint, how it works, what it is made of, and what procedure is used to install it. If you have the stomach, watch a video of a real operation at the National Library of Medicine. Maybe it doesn’t really matter but I feel it is part of the attitude factor. The more you know the better you will feel.
Prepare for it physically. Trim a few pounds, exercise as much as possible, cease any medications you don’t really need, and get your mind around what will be happening. Envision the pain and process but also envision the "desired outcome". Another part of the attitude factor.
If your insurance covers it, or maybe even if it doesn’t, go to a rehabilitation center after you leave the hospital. There are mixed opinions on this. Some say going to another institution after the hospital increases your exposure and risk of infection. Some say there is nothing like home as the place to recover. I spent four nights in Danbury Hospital and then six nights at Bethel Health Care Rehabilitation Center. The center specializes in short-term "rehab". They have a continuous flow of patients. They have seen it all. Pain management is a vital part of recovery and they administer it and monitor it three shifts per day. Physical therapy is not an option — you go to a therapist in the building twice per day, every day. It is painful but essential and the rehab center has it down to a science.
Whether you are in rehab for a week or two (two weeks is probably average), pre-enroll with a physical therapist (PT) and start the day you leave the rehab center. Three times a week is best and keep it up for six weeks. Don’t cut corners.
Plan and commit to a home PT program. Ask the therapist for printouts of home exercises and do them faithfully. The investment you will have made in your knee — in my case a lot more than my first house — should be thought of as an investment (more accurately a joint investment with Aetna Healthcare). To get the most from your new knee it will need strong and flexible muscles surrounding it.
Develop a balanced exercise program. For me, four marathons, many thousands of miles and dozens of races were too much. No doubt that my knee needed replacement because I wore it out. More exercise is not necessarily better. Not enough is not good either. I often heard the advice to "listen to your body". I let my mind be in charge instead. Don’t let it go to your head. Exercise, but think about your joints.