Tackling knee surgery
Wed 28 February 2007
John Hammond, Journalism
A Sunshine Coast man relives the trauma of knee replacement surgery, the obstacles to finding a willing surgeon and the long road to recovery.
At 46 years of age, relatively young to have advanced degeneration of the knee joint, I found an orthopaedic surgeon prepared to alleviate the ongoing pain.
Having grown up on a heavy diet of rugby union and rugby league as a boy, together with a number of demanding manual labour jobs, my knees had begun to noticeably give me trouble by about the time I hit 40. My friends and golfing partners noticed I was walking with a pronounced limp in my right leg.
After consulting several local specialists in Queensland, Australia, the general consensus was the right knee was in very bad shape, with total knee replacement the best option. However I was told I was much too young and would wear out the prosthesis, would need a second one installed, which would also need replacement, eventually placing me in a wheelchair as a virtual cripple in my old age.
Told repeatedly I would have to make do until I was 60, I resigned myself to accepting my fate. But I was only in my early 40s and wanted to be an active part in the lives of my teenage daughters.
Revisiting a local orthopaedic specialist, he agreed to perform an arthroscopic clean-up of my knee, removing several fragments, the largest about the size of a ten cent piece.
An Irish chiropractor who had worked out of the United States for most of his career made me view my situation from completely the opposite direction. He considered, with fair logic, that another 14 years hobbling as I was, with other joints compensating for the injured right knee, would put undue pressure on them to the point that when I finally received a new knee other joints and ligaments would be worn out or stretched, compromising their effectiveness.
This started the hunt for a surgeon willing to give me a knee replacement. Searching the internet eventually led me to Professor Michael Neil at St. Vincent’s Private Hospital in Sydney. One look at the x-rays convinced him of the need for total knee replacement immediately. His philosophy was the titanium replacement joint would not wear out; only the possibility of the artificial cartilage membrane doing so and replacing it was minor surgery.
The operation took about two and a half hours with a further two hours in the recovery ward. I had a choice of anaesthetic, opting for a spinal injection numbing me from the waist down. A further mild anaesthetic was administered to my upper half, enough to just put me under but not so much as to wake up in recovery with a thick head similar to a bad hangover.
Post operatively, the first 48 hours were spent in a morphine haze. A direct pain-buster morphine infusion to the wound site accompanied by a patient-administered intravenous boost of morphine as regularly as every five minutes kept the pain to a bearable level. Blood was drained from the wound site, for re-infusion after filtering, for several days as the most appropriate way of keeping blood levels at the correct amount.
Physiotherapy was started within 24 hours. Initially this consisted of the leg being strapped to a machine which bent the knee to 40 then later 60 degrees. While in bed I was attached to Inflatable Calf Compressors which inflated and deflated at intervals to prevent clotting in the lower legs and for skin integrity. Anti-clotting injections were administered six hourly.
All I could stomach for the first two days was ice. The assisting surgeon called in and said the knee was ‘pretty dodgy and well past its use-by date.’ Have I mentioned the catheter yet? Of course being restricted to bed for days meant a catheter tube is required to collect waste. Once I became mobile on day three all intravenous tubes were removed. To have a catheter removed is an experience no-one forgets. It is whipped out smoothly in one go. The trouble is it feels like everything is going to follow it out; very uncomfortable and irritating.
The dressing removed from the leg on day four. When cleaned up, the wound was only about 12 cm long and very neat. The physiotherapist had me up for a walk with the walking frame. I managed about 30 metres.
The next day I was on crutches and handled the stairs easily. Dr Neil called in and said to prepare for discharge on day seven.
“The operation went well, the cruciate compartment of the knee was terrible and replacement was the only option,” he said.
Because the muscles of the leg had been compensating for the knee for so long he said that it would take about 12 months for the knee to regain full range of movement with dedicated physiotherapy.
Each day after discharge there was a small but noticeable improvement in the knee’s flexibility. Bruising along the leg was easing. The bow in my tibia had disappeared with the new knee joint as it was no longer offset by the uneven surface of the centre of the worn knee joint.
Within days I had discarded the crutches and was walking up to a kilometre, at a slow pace however. Slopes were difficult, especially down hill and the same could be said for stairs. Instructions had been issued by the doctor, such as no driving for four weeks, no golf for 12, no kneeling for at least eight. The initial period of home rehabilitation drags on as you find difficulty with many simple tasks, mainly due to the residual pain of the operation. Gradually this eases as does the amount of swelling from fluid around the joint.
Two months later the operated knee still feels warmer to the touch than the other and every time you go through airport security you will set off the metal detector. The feeling of the knee I have to say, is like recovering from a ‘corked thigh’. It is a thick sensation with not total mobility but better than pre-operation.
I have just attended a ten week review with Dr Neil, who is very happy with the range of flexibility in the knee, at 125 degrees. He has said I may start hitting golf balls and even do some light sand running again. I have not been able to run for three years so that will be interesting. Dr Neil said that the prosthesis should last at least 20 years, even at my age.
Total cost of the operation, including private hospital room at St Vincent’s was over $A27 000. Thank goodness for private health cover. I am out of pocket $5662 but have no knee pain.
Image(s) designed by John Hammond