@Injured Again
good to read....
I'll go back and read more through this thread as surgery x5 will now consist of total knee replacement. I fell down wet stairs in August and haven't been able to walk straight since. A few "hurdles" to go through (other medical, insurance, and life in general) but hope to get this done soon. Even sometimes sleeping my knee(s) hurt
So sorry to hear of your fall and the need for a knee replacement. Let me include some other things that you may want to check up on before you actually have your surgery. Some of these things I didn't know to ask beforehand - I found them out afterwards even though I thought I was fairly thorough in researching the surgery.
First, just a brief recap of a knee replacement surgery. They cut off the bottom of your femur and the top of your shin bone, and then cut chamfers into the bone to match the chamfers in the implant. They then drill holes into these bones and the implant with the metal sliding surfaces is inserted. In between, they will place a disk of plastic that provides a bit of cushioning and helps the joint glide. In a typical knee replacement, they cut your quadriceps tendon because that holds the knee cap in place and the knee cap is in the way of getting to the bones underneath. Cutting the tendon can also mean cutting into some of your quadriceps muscles, which means a lot of bleeding, so they will apply a tourniquet to your upper thigh throughout the operation. All of this significantly weakens your quadriceps muscle, and studies show that typically there is a 60% loss of strength at three months post-op. It's a brutal operation.
You have two primary ways of attaching the implant to your bone. Most commonly used is quick setting cement. This hardens and is strong within hours. The other method is a press fit with a different, more porous type of material which allows bone to grow into and attach to the implant. The general consensus seems to be that for younger patients determined to return to higher level athletics, a press fit is better because it grows stronger over time. The cemented implant is about as strong as it will be soon after surgery and supposedly the cement weakens over time but this hasn't been definitively shown in any studies I am aware of. Using a press-fit slows recovery by a few weeks. I got a cemented implant.
There is also a type of surgery called "quad sparing", in which a "C" shaped incision is made that allows the operation to happen without cutting into the quadriceps tendon and muscle. This is typically used on smaller-boned and thin patients, so typically women much more than men. This can shorten recovery time by a few weeks. You may want to ask if this is a possibility - it was not for me. Quad sparing will also minimize the bruising you will encounter. My entire leg, from hip to ankle, was purple at one time. Despite the tourniquet, there is a lot of bleeding after everything is stitched together and the tourniquet pressure is released. This is also why you will typically be anemic and feel low in energy afterwards.
You'll also want to ask what type of implant will be used. There are some which allow greater range of motion - up to 155 degrees, which is about where the knee bend angle if you sit with your shins on the ground and your butt on your heels. I didn't know to ask this but I have my first checkup with my ortho tomorrow and will find out more then. Otherwise, I think a regular implant is good for about 140-145 degrees of bend. I'm currently at 140 degrees, but my right knee is capable of 150+ so if I want to work towards that, I have to find out if my implant is capable of that much bending.
Also, ask if your ortho does a robotically assisted operation. My ortho did not - he has used robotic assistance in the past but he feels he can do just as good or better job because of what he sees after he opens everything up. My ortho is incredibly skilled - he has done knees for several players at my club including a couple of doctors that have recommended him to me. Studies have shown that with a skilled surgeon, a robotically assisted operation does not generate any measurably better long term outcome.
From the time I decided to have the operation, it was four months before my ortho was available. During that four months, I worked my butt off to get ready. The two most important things are range of motion and quad strength. You will want to make sure your knee can fully straighten (zero degrees) and work on as much bending as possible because the range of motion you have afterwards is correlated to what you are able to do beforehand. I also started a leg press and leg extension build-up phase, even though these hurt like heck with my bad knee. I figured that my knee was getting replaced anyway so if I did critically hurt it, it didn't really matter. So I just put up with the pain and tried to get as strong and flexible as possible beforehand.
You will likely have a choice of a spinal block or full general anesthesia. I had the spinal block with a sedative through the IV and don't remember anything. Post-op recovery from the spinal is much faster. I was in the operating room at 3 p.m., out at 5 p.m., woke up around 5:30 p.m., and was walking by 6 p.m. As soon as I was able to drink, eat, and pee, I was sent on my way. I was home by 7 p.m.
Because you will be anemic and your body will have endured a lot of trauma, it is really important to eat nutrient and iron rich foods. I was told to try to gain a few pounds over the first couple of months, just to ensure my body had everything it needed all the time to repair the damage. Taking a calcium supplement is also helpful.
The spinal block will last roughly 24 hours. After that, the number one thing is pain management. If it hurts, you won't be able to make any rehab progress. And it will hurt - for me the worst days were three through ten. The number two thing is to minimize swelling. If it puffs it, it's going to hurt and limit your ability to gain range of motion. And it will swell up. And that leads to number three - gaining range of motion as quickly as possible. There is a generally accepted timeframe of several weeks after surgery where you should make the vast majority of your range of motion gains. After that time, the knee will have healed and basically the range of motion you got before that point will be almost all of what you can get afterwards.
Okay, let me finish this post now - I'll continue in a short bit in the next post.