Knee , full replacement, January 3, 2024

 I had the new knee installed a bit over 1.5 weeks ago on a Wednesday, the 3rd of January, 2024.

This narrative is for anyone who might be considering getting a new knee.  It is just a hodge podge of my own slightly odd observations.

Where to go for a new knee:

The operation was done by EBJ, Everett Bone and Joint's Dr Bill Huang (Wong) and his staff.  There have been so many positive  testimonies from former patients and his count on knee installation is over 5000 apparently.  High marks from me!

Narrative begins:

As of now, almost two weeks in short a day or two, I move up and down stairs slowly and am monitored by my lovely.  Doing email just about sucks all the concentration out of me.  Needless to say, reading and audiobooks are tough to keep on with.  Naps seem to be a prevalent part of the day.  Mostly because I cannot sleep well.

Memory of the operation:

I was wheeled into the operating suite whcih was quite large.  There was a table about 15' long full of various equipment and I was curious to see the drill bit they were going to use to drill out my bones for the implant.  The nurse was surprised by the request but dug out a very shiny 1/2", new drill bit!

Then the anecdotist got there and a spinal knock out came on.  Total darkness until...

I was laying there peacefully napping when I felt my right leg raised into the air and then a pound (rat a tat tat) from a robotic hammer on my thigh, shortly after that the same pounding took place on my right calf.  It didn't hurt but woke me up.  I noticed I was strapped down tight all over and couldn't move.

I was told later that there had been a huge tourniquet applied to my right thigh to stop the bleeding and that was the reason most of those upper quads were sore.

Dr. Huang told me, post surgery in the Providence Hospital, that my interior ACL was non existent.  Not sure if I ever noticed it being an issue.  

Another interesting bit gathered in post surgery conference.  Robots were used and part of it was to flex the joint after installation and my leg went to a robotic measured 120 degrees of flex!  This was jut a gravity flex too, no muscles or outside forces.

It seems this installation was number 5000ish for Dr. Bill Huang.  He has it down.

Complications:

As you might know, I got home on Thursday after the installation and on Friday went into the ER in the local hospital (Cascade Valley) for what is known as twisted bowel.  I have had this two previous occasions and it reoccurs because I have had 4 abdominal surgeries and the bowel scars if one even touches it.  When the scars align, then a block can occur.  

Apparently the use of a spinal anesthetic has a tendency for the scarred bowel to twist again as it is not moving during the surgery because of the drugs.

The procedure is gross to deal with it.  They stick an NG tube down the nostril into the stomach and suck out whatever is in the stomach..  Over 36 hours I was in the ER as they pumped this out and resting as best I could hoping the blockage would dissipate.

ER sucks!  Beds are WAY too short, nurses are being run ragged, no windows.  The only nutrition was from an IV drip.  NO food or water for 36 hours!  A few ice chips were awarded to me, yummm.

More on all this experience later, I will use this reply as a start in my blog experience.  Concentration is waning.

The move to the general population found me in a private room, food, water, tea, coffee, etc.... and a window!  All was much better and then discharged after 2 nights.

HOME:

Arriving home was a big deal the second time, more relief of being out of the hospital!  Up the stairs at the entry with the walker (2 steps) "Up with the good foot" Not bad at all

Real food, although hunger was very restrained.

An unpleasant result.  The doctor was surprised by the extent of the bruise!

An example of the bruising caused by the surgery.  My entire leg was bruised but
no pain was noted.  The baby aspirin regimen thinned my blood enough to lose the bruising 
in 4 weeks.

Observations:

When admitted to a hospital all the other medical services get disrupted. I was slated for home visits for Physical Therapy and monitoring of my knee dressing..  Those got cancelled!  Restarting took a couple days and many phone calls.  EBJ assisted!

Pain Medication:

I had requested NO OXY pain relief products, as it makes me mental, but had requested morphine and it worked very well for pain.  Mental ambiguity (confusion) was present plus the narcotic blocked up the  bowel movements in spite of several softeners, laxatives, prunes,  and the like.  4 days of the morphine was plenty!  After that ibuprofen/Tylenol regimen worked a treat.

Side note on Morphine:  I had been given this previously for twisted bowel relaxing and for the recovery of my spleen removal.  The stuff was smooth and worked a treat.  This time it seemed to be overkill.

I was cautioned by friends who had new knees that one shouldn't get behind the pain but the pain dissipated and now it is just stiffness and tightness.  I guess that was good for me to get off them.

The REHAB:

Probably because I am old, certainly because I had Dr. Huang, I got home PT and nurse visits for the first 5 weeks of rehab.  Younger friends who got a knee installed had to go to outpatient PT right away.

I will say the PT I got at home was superior and inspired me to work the exercises hard.

I am currently about to finish my 6th week, post surgery, and the heel slides are still tough.  I am using a strap to pull my heel closer and get more flex, holding each one for 5 seconds.  Sets of 10, 2xs each workout, 2 workouts a day.  I am also doing the heel slides without the strap trying to get the momentum to swing the heel a bit closer.  Same regimen as with the strap.

FLEXIBILITY:

(The goal is 125 or more of Flex)

The first measure was 83 D of flex, then 86 D 3 days or so later (they came twice a week), 89 D, 93 D, 98 D, 103 D, 110 D.  Shifted to outpatient at Joel Anderson (APT) and was measured at 115 in my 5th week after surgery.  After 8 weeks the Out Patient PT massaged my leg and then measured 128 degrees.

EXTENSION:  (This is how straight you can get your leg, goal of 0)

Starting with 5 D off straight (zero being the goal), then 2 D, 1.5 D, 1 D, 0 D, 0 D, 0 D etc...  Keep using the pillow under the heel for the quad sets to keep the 0 measurement.  10 reps, 2xs a workout, 2 workouts a day.  At the end of the 6 week there is still some tightness.  Holding each quad set 5 seconds.  The measurement here at 8 weeks was zero!

Stairs:

I was going every other step after 5 weeks but this was not fast or smooth going.  Very tiring and the railing was needed both up and down.

Entering the 6 week after, I am not using the rail all the time, more on the down for safety.  I can carry stuff up and down the stairs now.

Walking:

I am told to not limp.  I am using my phone as a step counter and am averaging about 10,000 steps a day with highs at 13,300.  I was using hiking poles but have not used them for 4 days now.  Not even sure where my cane is.

The Throne:

Point to note, getting to land on the throne was very tough to start with when the leg wanted to not fold.  These are comfort height toilets with no grab bars to assist going up or down.  I can't imagine using the short toilet, even now.

Getting up still requires the assistance of the cane at one point and certainly pushing off on the seat between my legs to get to the point where the legs can be effective enough for lift.

I use the handicap stalls when out and about, the grab bars do help.

Practical observations:

This is now after week 9.  I am able to rise up without using my arms to push up if my thighs are level.  Not so much if my knees are up hill from my hips.  Very helpful in getting on and off the throne. I still have to use my arms to come in for a soft landing.

Going up and down stairs/ladders is every other step, although it is slow.  I still like to hang on the rail or something, going down especially. Less than 4 steps needs no rail or handhold. 

I am hauling firewood around with the cart and bringing it in using the sling. 

Mounting and dismounting the tractor is easier than pre surgery times.  Same for the riding mower.

Starting the chainsaw made me realize I had lost a lot of upper body strength.  Hopefully, our trainer will kick my ass so I can use that thing! 

Applause-O-Meter:

Here is a photo from my phone which has been recording my steps for 6 months on this screenshot.

Physical Therapy for knee surgery:

Surgery January 3, 2024

 

Preoperative Exercises:

Ankle Pumps:   Gently pull toes up towards your knee then point towards the floor.  Both ankles together or alternating.  30xs every hour.

 

Quad Sets:  Press the back of your knees down into the surface as if you were trying to lock your knees.  Hold for 3 seconds, relax.  2 x 10, 2xs a day.  Advanced:  use pillow under heel

 

Glut sets:  Squeeze buttocks together as tightly as possible. Hold for 3 seconds.  2 x 10, 2xs a day

 

Side Leg Slide (Hip abduction)  Lie on your back, Slied your operated leg out to the side keeping your kneecap and toes up.  Keep your leg straight by tightening your thigh muscles; do not lift your leg.  Gently return to the middle.

 

Heel Slides:  Slide operative leg heel towards buttocks, keeping heel on the surface.  Slowly return to starting position.  Once you have gone as far as your leg will go, slowly straighten leg.  2 x10, 2xs a day.

 

Straight Leg Raises:  Keep your non operative leg bent for support.  Slowly lift operative leg off the bed, keeping the knee straight throughout the entire motion.  Lift no higher than the height of the bent  knee.  Slowly lower. 

 

Long Arc Quads:  (Knee Extension)  Sit your back against a chair.  Slowly straighten your leg and hold for 5 seconds.  Use non surgical leg assist  your surgical leg into extension.  Hold for 20-30 seconds, then relax

 

 

 

Post surgery : Pretty much the same as presurgery.

Quad Sets:  Press the back of your knees down into the surface as if you were trying to lock your knees.  Hold for 3 seconds, relax.  2 x 10, 2xs a day. 

 

Glut sets:  Squeeze buttocks together as tightly as possible. Hold for 3 seconds.  2 x 10, 2xs a day

 

Side Leg Slide (Hip abduction)  Lie on your back, Slied your operated leg out to the side keeping your kneecap and toes up.  Keep your leg straight by tightening your thigh muscles; do not lift your leg.  Gently return to the middle.

 

Heel Slides:  Slide operative leg heel towards buttocks, keeping heel on the surface.  Slowly return to starting position.  Once you have gone as far as your leg will go, slowly straighten leg.  2 x10, 2xs a day.

 

Straight Leg Raises:  Keep your non operative leg bent for support.  Slowly lift operative leg off the bed, keeping the knee straight throughout the entire motion.  Lift no higher than the height of the bent  knee.  Slowly lower. 

 

Long Arc Quads:  (Knee Extension)  Sit your back against a chair.  Slowly straighten your leg and hold for 5 seconds.  Use non surgical leg assist  your surgical leg into extension.  Hold for 20-30 seconds, then relax

 

Advanced PT from home visits:  (Sean)

 

Double leg Heel rises with support, calf raises:

While standing next to a chair or countertop for support, raise up on your toes as you lift your heels off the ground.  Return heels to ground and repeat.  10 xs, 2 sets, 2xs a day, hold for 5 seconds.

 

Walker Marching:  While standing with a walker, lift up one knee allowing it to bend as your raise your foot off the floor.  Set the foot back down and perform same on the other leg.  10 times, 2 sets, 2xs a day.

 

Walker squats:  Stand in a walker with feet shoulder width apart.  Begin by bending knees and lowering your body into a squat, as if you would be sitting into a chair.  Don’t sit, your body weight  should be directed mostly touching the chair with your buttocks, straighten  your knees and rise back up to a fully standing position.  Knees should bend in line with the 2 toe and not pass in front of the foot. 

10 times, 2 sets, 2 xs a day.

 

Walker Hip Abduction:  While standing up using a walker, raise your leg out to the side.  Keep your knee straight an maintain your toes pointed forward to the entire time.  10 times, 2 sets, hold 2 seconds, 2 xs a day.

 

Walker Hip Extension:   While standing up using a walker, extend your leg behind you.  Do not allow your back or chest to move.  Also, keep your knee straight the entire time  Lower your leg back down and repeat.  10 times, hold 2 seconds, 2 sets, 2 xs a day.

 

Quad Sets:  Press the back of your knees down into the surface as if you were trying to lock your knees.  Hold for 3 seconds, relax.  2 x 10, 2xs a day.  Advanced:  use 5 “ pillow under heel.

 

Heel Slides:  Slide operative leg heel towards buttocks, keeping heel on the surface.  Slowly return to starting position.  Once you have gone as far as your leg will go, slowly straighten leg.  2 x10, 2xs a day.

 

Heel  slides advanced :  Attach a strap to operative foot and pull the heel as far as you can.  Count to 5 then release.  10 times, hold for 5 seconds, 2 sets, 2 xs a day.

 

Out Patient Physical Therapy:  Joel Anderson (Anderson Physical Therapy , Arlington WA)

 

Double leg Heel rises with support, calf raises:

While standing next to a chair or countertop for support, raise up on your toes as you lift your heels off the ground.  Return heels to ground and repeat.  15 xs, 2 sets, 2xs a day, hold for 5 seconds.

 

Walker Marching:  While standing with a walker, lift up one knee allowing it to bend as your raise your foot off the floor.  Set the foot back down and perform same on the other leg.  15 times, 2 sets, 2xs a day.

 

Walker squats:  Stand in a walker with feet shoulder width apart.  Begin by bending knees and lowering your body into a squat, as if you would be sitting into a chair.  Don’t sit, your body weight  should be directed mostly touching the chair with your buttocks, straighten  your knees and rise back up to a fully standing position.  Knees should bend in line with the 2 toe and not pass in front of the foot. 

15 times, 2 sets, 2 xs a day.  Lower to bed with out siting.

 

Single leg balance:   While standing up using a walker, raise your non-operative  leg out to the side.  Keep your knee straight and maintain your toes pointed forward to the entire time. Raise leg forward, then raise leg back.   15 times, 3 sets each leg, hold 2 seconds, 2 xs a day.

 

Standing Balance:  Stand on operative leg, balance for 30 seconds.  5 times, 2 sets, 2xs a day.

 

Step downs:  4” step,   Step down with your non operative leg until the heel touches, then come back up.  10 times, 3 sets, 2 xs a day.

 

Standing Knee Extension:  Straighten operative leg while standing, step your weight on to the non operative lege keeping it straight.  20 times, 2 xs a day.

Quad Sets:  Press the back of your knees down into the surface as if you were trying to lock your knees.  Hold for 3 seconds, relax.  2 x 10, 2xs a day.  Advanced:  use 5 “ pillow under heel.

 

Heel Slides:  Slide operative leg heel towards buttocks, keeping heel on the surface.  Slowly return to starting position.  Once you have gone as far as your leg will go, slowly straighten leg.  2 x10, 2xs a day.

 

Heel  slides advanced :  Attach a strap to operative foot and pull the heel as far as you can.  Count to 5 then release.  10 times, hold for 5 seconds, 2 sets, 2 xs a day.

Out Patient Physical Therapy Version 3 (assigned March 9, 2024):  Joel Anderson (Anderson Physical Therapy , Arlington WA)

 

Heel Slides:  Slide operative leg heel towards buttocks, keeping heel on the surface.  Slowly return to starting position.  Once you have gone as far as your leg will go, slowly straighten leg.  2 x10, 2xs a day.

Heel  slides advanced :  Attach a strap to operative foot and pull the heel as far as you can.  Count to 5 then release.  10 times, hold for 5 seconds, 2 sets, 2 xs a day

Standing Balance:  Stand on operative leg, balance for 30 seconds.  5 times, 2 sets, 2xs a day.  JUMP TO THE LEG AND CATCH BALANCE

Walker Marching:  While standing with a walker, lift up one knee allowing it to bend as your raise your foot off the floor.  Set the foot back down and perform same on the other leg.  15 times, 2 sets, 2xs a day.  FLEX KNEE FULLY

Walker squats:  Stand in a walker with feet shoulder width apart.  Begin by bending knees and lowering your body into a squat, as if you would be sitting into a chair.  Don’t sit, your body weight  should be directed mostly touching the chair with your buttocks, straighten  your knees and rise back up to a fully standing position.  Knees should bend in line with the 2 toe and not pass in front of the foot. 

15 times, 2 sets, 2 xs a day.  Lower to bed without sitting.

Jump Balance:  Jump from foot to foot and balance on each side as much as possilble.

Kettle Ball Squats:   Right leg forward, left leg straightish.  Reach down and bend the front leg to pick up kettle ball. 10xs, 2 sets

Partial Lunge to 14”:  right leg forward and back leg bending, working the front leg most.  10xs, 2 sets

 

Out Patient Physical Therapy V. 4.0 and at the three month mark:  Joel Anderson (Anderson Physical Therapy , Arlington WA)

My flex was 130 degrees without effort.  My extension is staying at zero.

Probably as good as it going to get. Need to build strength and balance!

Double leg Heel rises with support, calf raises:

While standing next to a chair or countertop for support, raise up on your toes as you lift your heels off the ground.  Return heels to ground and repeat.  15 xs, 2 sets, 2xs a day, hold for 5 seconds.

Marching:  While standing balanced lift up one knee allowing it to bend as your raise your foot off the floor.  Set the foot back down and perform same on the other leg.  15 times, 2 sets, 2xs a day.  FLEX KNEE FULLY

Lunge lifts:  Use the new knee forward (right in my case) and kneel on the left knee.  Then lift to standing on the right leg.  Left hand can go to a steady support and even help lift until it is not needed. 2-3 sets of 10-15, 2xs a day.  This is new and very tough to do but it is seemingly effective.  I like it.

Squats:  Stand next to bed or chair with feet shoulder width apart.  Begin by bending knees and lowering your body into a squat, as if you would be sitting into a chair.  Don’t sit, your body weight  should be directed mostly touching the chair with your buttocks, straighten  your knees and rise back up to a fully standing position.  Knees should bend in line with the 2 toe and not pass in front of the foot.  15 times, 2 sets, twice a day.  These are getting easier but are still making me breath hard.

Snap Heel Slides:  Slide operative leg heel towards buttocks in a snapping motion, keeping heel on the surface.  Slowly return to starting position.  Once you have gone as far as your leg will go, slowly straighten leg.  2 x10, 2xs a day. This exercise is very effective in stretching the bits.  

Strapped Heel  slides, advanced :  Attach a strap to operated foot and pull the heel as far as you can.  Count to 5 then release.  10 times, hold for 5 seconds, 2 sets, 2 xs a day  This exercise is losing it's effectiveness seemingly but it took a while to stretch (one of my favorite exercises) as much as it did.  I suspect I would be much less stretched if I hadn't used the straps to pull as hard as I could.

Standing on one leg for 30 seconds:  I use my electric toothbrush to time this and get two balances on each leg per brushing session.  Do as many balances as one can.... I do 2 twice a day.

The three month mark:  Balance and daily living observations.

Getting dressed:  Inserting my left leg into a pant leg or brief first occasionally requires a steady hand on the part of the closet.  Putting the right leg in nearly always needs support.

Stairs:  Going down with hands full is slow but getting a bit better each day.  Going up with hands full is slower and a bit wearing, energy wise.

I have concerns that 10,000+ steps a day is a bit wearing on the unoperated knee.  I have been averaging over that for weeks now and am cutting back a bit to conserve it's use.  The right leg is stronger each day.

Balance is a big deal and I need to try and get it back.

My disc throw is not any longer.  Starting my chainsaw is getting harder but with a bit more workout maybe I can get past that for this season.

Had the CT scan of my left knee yesterday (4/5/24) the data is sent to the firm that makes the new part so the process is started.  May 1 has the interview with the team at Providence Hospital.  Then the date for my surgery can be scheduled.