My new knee!

Here’s the update on my total knee replacement.

First off, I had what’s called a Kinematically Aligned Total Knee Replacement (KA) by Dr. Stephen Howell out in Lodi, California.  This procedure was invented by Dr. Howell back in 2005.  This differs from the more common surgical technique which is called Mechanical Alignment (MA).  I think about 85% of procedures are Mechanical and most of the remainder being Kinematic.  There are a number of differences between the two philosophies and both have strong proponents with very good efficacy track records.

I could ramble about how they are different (Kinematic takes into account 3 dimensional alignment vs. 2 for Mechanical for example) but the basic difference is that the more common MA design intent is to give the patient a straight leg from the hip, through the knee to the foot, while the approach I went with is designed to replicate the geometry that the patient was born with.  

Lots of people are born with quite straight legs but some are either bow-legged or knock kneed.  I’m not talking about disease caused crookedness but rather normal and relatively slight variation.  I was born a bit bow legged.  For people like me, if I were to have a MA procedure I’d essentially end up with one leg straight (my new knee) and one leg bowed (my natural shape).  This tends to lead to unnatural feelings and results in less patient satisfaction, especially among more active people, which given the age of most knee replacement people, I’m at the far end of the activeness bell curve.

In general, straighter legged, generally older, generally heavier people are better suited for MA, while bow-legged/knock-kneed people who are more athletic tend to be better candidates for KA.

As it turns out, Dr. Howell is a colleague of my ortho, Dr. Galinat in Wilmington and as we reviewed my case we all quickly agreed I would be a great candidate for a KA knee from Dr. Howell, hence my journey to Lodi for my knee replacement.

Wednesday 11/30

Judy and I drove to the hospital and checked in at 5:45am as I was first on the docket, scheduled for 8am.  I went through all the pre surgery prep (and btw, I had been cleaning my nose, mouth, and skin for 5 days prior and attended a 2.5-hr class on Tuesday).  I won’t bore you with all the details but at one point my blood pressure came in at 155/120, which is very high relative to my typical 120/90…I guess my calm exterior belied an underlying nervousness about what the day would bring.

Anyways, about 7:45 I said goodbye to Judy and was wheeled into the OR.  I looked around and marveled at the high tech lights, the various beeping, clicking machines and the 7-8 people there including a couple in full hazmat like surgical gear.  I didn’t see Dr. Howell and then….

The nurse was waking me up and asking me how I felt.  Apparently, I didn’t even know I was going under or maybe it was erased from my short-term memory but the procedure was done and I had a new knee.  Judy soon walked in and there were 4-6 people buzzing about talking in cheery tones and doing various things like adding fluids to my IV drip.  I wasn’t that engaged because frankly I was a little loopy at that point.

Here is a pic in my surgery attire pre-game:

This is the somewhat anxious moment when I said goodbye to my bride and was wheeled into the OR:

Back in recovery feeling pretty good but definitely a bit loopy:

My femur implant was of a relatively new type that has a wider channel for my patella which in theory will giver me greater athletic performance potential down the road.  Due to this I am taking part in a study that will track its effectiveness and as a result when I got my wits about me I was wheeled off to get a Cat Scan of my knee:

Hopefully this new device will lead to a better outcome for me and others down the road!

After a while, they came in and had me walk for about 100 feet or so on my new knee with the assistance of a walker.  Apparently, the implants are cemented in and one can walk on them in as little as 10 minutes after implantation.  The PT also demonstrated some exercises for me and showed me how to climb up and down stairs properly during the early stages with the new knee:

Dr. Howell came in and chatted for a while and told me 25 times to take it easy in the early days and after I was able to demonstrate that I could still pee I was allowed to exit via wheel chair and Judy drove me back to the hotel.  I went for 6-7 5-minute walks and frankly felt like I didn't even need the walker.  Later, I elevated and iced my knee and watched Argentina crush Poland on my iPad:

Late Wednesday/Thursday

I knew the pain would come at some point over the first 36-48 hours but mine arrived early.  About 9 or 10 pm my knee and quad (from the tourniquet) began to swell to an amazing size and with it some pretty, disheartening pain.  It was a rough night that led to zero sleep.  Not fun.  In retrospect, we were too slow to dip into our pain killer arsenal and I paid the price the night.

By morning, we flipped the switch and began throwing Aleve, Extra Strength Tylenol and Percocet at it.  I also walked much more timidly and tried the various PT moves to try to get the swelling and pain under control.  The meds kicked in and I begin to get my pain level down to about 5 on the 10 point scale.

By nightfall things improved greatly and I was able to actually sleep for 30 minute stretches.  These were interrupted by trips to the bathroom for amazing amounts of pee as my body began to dump the accumulated fluid.  By morning my knee had deflated considerably (really crazy to experience) and with it the pain subsided to quite manageable levels.  We removed my ace bandage to reveal the incision and it looked very good indeed (or at least as good as they things can).

Friday

48 hours after surgery my knee was down to a much more manageable size and the scar, while quite big looks pretty good:

As we roll into Friday night things are progressing nicely.  I had a consult with Dr. Howell and he is pleased.  My pain is manageable and I'm able to walk a bit further, which I do with my walker every hour or so.  I've also stepped up my modest PT exercises but am taking things very easy at this point.

My GI track is back on line and I have no blood clot symptoms so we are good to go for a return to DE tomorrow night.  My prognosis appears excellent and I am motivated and optimistic!

As a result of the surgery my left foot has shifted inward by about an inch and half and now my feet are nearly together when I stand (like normal people).  Look back at my pics from Kona and you can see that was certainly not the case before surgery.  I'm excited to see what its like when I get to put the new knee through its paces but first I have a bit of road to travel before I can ditch the walker and see what it's like to walk like a normal man and to hopefully be relatively pain-free after 20+ years of chronic pain.

Onward and Upward!