Knee Surgery Update

Yesterday, Thursday, January 12th, marked five weeks since my total knee replacement surgery. The surgeon told told me that at six weeks I would be recovered to the point that any pain or disability I experienced would be no worse than the state I was in before the surgery. I don’t think this will be true across the board but it is already true in some regards. Before surgery, whenever I stood up, especially getting out of bed, the first step on my right leg was painful and immediately caused me to shift my weight to my left leg. Now, when I get up, I stand slowly and carefully, expecting the same pain I used to feel, but it is no longer there. This still surprises me and it seems too good to believe that it will last, but I know that it will. For years I have protected my right leg, using my left to bear most of my weight when I stood. I don’t need to do this anymore, and I’m consciously trying to stand evenly on both feet. My right leg used to be slightly misshapen, with my knee unnaturally bent inward. That has been straightened, and when I start cycling again I will probably find that I don’t need the shim that I wore beneath the cleat in my right shoe to adjust for the leg length discrepancy.

The physical therapists judge recovery progress by how much range of motion I have, and I have been at or ahead of goals with each visit, although it is not comfortable when they force my knee to achieve maximum flexion. The knee is still swollen and stiff, though, and not close to being able to bend as far as it could before surgery. They have been reluctant to tell me how active I should be, other than emphasizing the importance of the strengthening exercises they prescribe. They just say I should do as much as I can tolerate. At my three-week visit I was still hobbling around with a cane but was feeling pretty good about getting out and taking a walk around the block. The therapist said that was great, and then went on to tell me about a patient that, although he said was an extreme case, was only a few weeks past his surgery and was walking ten miles a day. He said he had others who were still barely able to walk across a room, and that recovery was an individual thing and everyone had to set their own pace.

The physical therapy sessions have been very helpful. On my own I’d been hesitant to do things like walk stairs normally or get on the stationary bike when it hurt. I’d been afraid I could do damage. But they had me try climbing and descending stairs using alternate steps, and even though it hurt, I could do it and was told I would not do myself any harm, and in fact would strengthen my leg and increase flexibility. So, even though it isn’t comfortable at this point to walk down stairs, I try to do it normally. Going up is easier than coming down. The stationary bike has been great. I knew I wouldn’t be able to use my smart trainer for a long time (it uses software to simulate outdoor rides, including long, steep climbs), so I found a fairly inexpensive spin bike on line, and set it up about two weeks after my surgery. At first I could not do a full rotation, but would go as far as I could in one direction and hold that position, forcing it as much as I could tolerate. Then I would reverse the direction. At one of my therapy visits the therapist suggested raising the seat to see if I could make a full rotation without having to bend the leg so much. Voila! It really hurt at first but after a few pedal strokes the knee started to loosen up and I could even increase the cadence. Since then I’ve been slowly lowering the seat, increasing the resistance, and staying on the bike for longer periods of time. Now I can work up a sweat and get my heart rate into the aerobic zone.

But I expect that in another week my knee will still be stiff and sore, and my leg will still feel weak. I don’t trust it completely, although I think this is mostly in my mind. But before surgery I didn’t have any limitations with regard to cycling. I think I’m months away from being able to go out and ride forty miles at a fifteen-mile-per-hour pace, but that is one of my goals. Walking and hiking were where my knee damage really showed up. It’s been several years since I could hike steep terrain without a lot of pain on descents. My physical therapist said I should be able to do some moderate hiking this summer, but he recommended using trekking poles. That would be fine with me. This past summer even long walks on flat ground got to be painful after fifteen or twenty minutes. When I walk outside now I am slow and careful, and there is some discomfort. I don’t think this will change over the next week, but maybe in a month or so I’ll be able to take a fast-paced walk around Sloan’s Lake without wincing.

The week before my surgery I had a consultation with a surgical nurse practitioner. She wanted to make sure I knew what to expect during my recovery, and give me a final chance to confirm that I wanted to go through with the operation. She told me that since my right knee was having the procedure I should not expect to drive for six weeks. I’m hoping I am cleared to drive next week, and I certainly feel as though I can drive. Besides the lack of physical mobility as a result of the surgery, not being able to drive and the subsequent isolation have resulted in a great deal of restlessness and even depression. I’m going to mention to the surgeon next Thursday that the psychological aspects of recovery, though not as significant as the physical aspects, are still very real and should be considered when putting together a recovery plan. I think at a minimum it would help to be able to join an online group of people who were in the same stage of recovery as I am to talk about progress and coping strategies. Before my surgery I met with a friend of a friend who had undergone surgery several months earlier and she offered me some great strategies for how to prepare my house and what to expect that weren’t specifically covered in the materials that Kaiser and St. Joseph provided.

Generally I’m encouraged and I see small progress day to day, but I am very eager to reach the point where I can start doing more normal physical activities, and especially regain the independence that will come with driving. It doesn’t help that until earlier this week the streets and sidewalks had been frozen and sketchy for someone to walk on who wasn’t completely confident of a new knee. But spring isn’t far off, and I still expect to be able to repeat what I’ve heard so many others say, “I don’t know why I waited to long to have this done.”