Total Knee Replacement – Before and After
by Ted Tenny

Every patient is unique. I’m writing of my experience to give one example of a person going through Total Knee Replacement surgery – things I wish I’d known. My only connection with the Health Care industry is as a patient.

I love to go hiking, and will do whatever it takes to keep up this healthy and most enjoyable activity. My hike pictures from all around Arizona show the beautiful state where I live. At home I have the support of my wife Jacquelyn and our young adult daughters, Beatrix and Clara.

Lessons Learned
Recovering from Total Knee Replacement is different from recovering from Triple Bypass.
    A few years earlier I’d had open heart surgery. Recovery then consisted of taking care of myself and not overdoing it, so that the natural healing could take place. But when there is a major joint involved, as with Total Knee Replacement, you have to actively work to get the joint moving properly.
Should have gone to rehab instead of coming straight home from the hospital.
    Had I understood the necessity of exercises to gain freedom of movement in my knee, I would have gone to rehab instead of coming straight home. There, highly trained professionals could work with me to advance my recovery.
knee pain    Started in 2005. For the next eight years it was kept under control by Synvisc injections (for the first five months) and then prescription knee braces to wear on hikes. With the brace on, I could hike all day without my left knee hurting — that is, until April, 2013. My last good hike was the David Miller Loop, Sedona.
choosing
a doctor
   The family physician referred me to an orthopedic group, where they assigned me a doctor based on my condition. I went there twice, first for X-rays and then for a Synvisc One injection. But the doctor whose patient I nominally was never saw me. Instead he just passed me off to his assistants. This is not for me.
   My half-sister is a nurse (though not around here, unfortunately). She advised me to ask the orthopedic nurses, who work with the surgeons and have first-hand knowledge of who does their job best.
   There I hit a stone wall. The nurses are forbidden from giving referrals.
   Well, then, how is an ordinary mortal like me supposed to find the best doctor? The answer was close to home. Dr. John Duggan, who took good care of my wife when she had surgery on her lower back, also does knee replacement. I made an appointment to see him.
2 months before    Dr. Duggan actually talked to me, answered all questions, and made sure everything which needed to be discussed was discussed. He gave my left knee a cortisone injection, because it hadn’t yet been tried and we should consider total knee replacement only as a last resort. The cortisone had little effect.
pre-op
testing
   Went to Banner Baywood Hospital in east Mesa, where the surgery would be performed. They did the pre-op rests, efficiently and with a minimum of rigmarole. The pre-op included an interview with a nurse, who went through the health questionnaire I had filled out.
sleep test    And here I thought my pre-op testing was all done on Monday. Not so fast. In my pre-op interview I’d mentioned that Clara reported both of her parents snoring. That must have woke up both the nurse and the family physician. A lady called me from the hospital and said I had to go in for a sleep test at Banner Baywood Hospital.
   Egad. Who ever heard tell of anyone actually sleeping in a hospital? I had visions of having to lie down on a rollaway cot – lights on, no pillow, noisy machinery, and an impatient nurse commanding me, “Now go to sleep! On the double! Or else!
   Wasn’t like that at all. The Sleep Center has an actual bedroom, plain but furnished with sheets, pillows, lights out, and silent instruments to record sleep. Everything but my wife.
   So the Sleep Center should have been a total bore. [yawn] No one could stay awake. ... Zzzzzzz ...
   But it wasn’t. On one side of the bed they had a myriad of wires with sensors on the end of them, all of which the nurse taped to me. She was a Chinese lady, polite and very efficient. But the bed and pillow were less comfortable than I have at home, and at home I don’t sleep with all those all those wires taped on me and a breathing sensor in my nose. At least the lights were out and it was quiet. Except when it wasn’t.
   Figured I got 3 hours of sleep, I told the nurse in my exit interview. A wasted night, but nothing more. I don’t suffer from sleep apnea. She said they would call me in a couple weeks with the results. Never did.
   Then I drove home, took my morning pills, ate breakfast, and went to Men’s Bible Study at the church. Men’s Bible Study was excellent: we went around the table letting everyone read a favorite verse or passage of scripture, then lead a discussion on it.
one day
before
   I’d made a list of all the chores that needed to be done but which I wouldn’t be able to do again until some time after the surgery. Finished all but one of them.
   Then I found a great way to cheer myself up. I composed, but did not send, a victory message for friends and relatives telling them that I was home from the hospital and all went well.
day 0
hospital

August 20, 2013
   Local anesthesia, or general anesthesia? They gave me both. When I opened my eyes I was still in the Operating Room, but the surgery was finished. They wheeled me to the recovery room, and then to a regular hospital room.
   My hospital bed had an iron bar running lengthwise over it, with a padded metal triangle suspended on a chain. “Trapeze,” they called it. Just right for grabbing with my hands to adjust my position on the bed.
   My wife Jacque and daughter Clara, and later my daughter Beatrix, were there to keep me company before and after the surgery. With them was pastor Floyd Anderson of Victory Lutheran Church.
   Floyd is a great guy. At church one time he presented a slide show of family pictures which he recorded on DVD. It was such an inspiration that I’ve started making my own slide shows on DVDs, with help from my daughter Clara.
day 1
hospital
   Couldn’t sleep. They gave me so much pain medicine that I was woozy all day. The therapist got me started on some exercises that hurt despite it all. Jacque and Beatrix brought in a letter from my cousin, which I struggled to stay awake and read out loud to them. Now why couldn’t I have had my cousin’s letter when I was trying to go to sleep?
day 2
hospital
   Couldn’t sleep. They changed some of the dressings because they were too tight on my knee. More exercises. Glad I’m not going home today – I’m not up to it.
day 3
hospital
   Couldn’t sleep. The pain medicine gave me constipation, for which I got an enema. It helped a little. Dr. Duggan stopped in and told me I would be going home. He said my knee was so degenerated from osteoarthritis, even worse than shown on the X-rays, that total replacement was the only option.
   Clara drove me home. There are a lot of adjustments that need to be made, especially in the computer room. My bed is sure more comfortable than the hospital bed. The right side is best for getting in and out.
   My dog Napper, a Papillon, jumped on the bed and went to licking my nose. Strange dog, he is. Napper, like me, is on the far side of middle age.
day 4
home
   Finally I got some sleep. Spent the day indoors in my pajamas. Both girls helped around the house.
   As an early bird I’m usually up while everyone else is still asleep. So I went around the house sitting in various kinds of chairs, without realizing that it’s got to be a chair with sturdy arms. In the evening while giving me a sponge bath, Jacque noticed that my left knee was all swollen and discolored, with a big blister below the knee.
   So I called the doctor’s weekend answering service. Later, Dr. Duggan himself returned my call, bless him. Nothing to be alarmed about: I’d just overdone it. As if he expected me to.
day 5    Quiet day indoors. The therapist came by and helped me with exercises and making the house safe.
day 6    Raelyn Stockwell stopped by, quite unexpectedly, and brought me some flowers. She is the wife of Brent Stockwell, youth director at our former church. The Stockwells are good friends of Clara.
   My first Coumadin appointment was quick, a mere pinprick blood test at the hospital.
   Gave away my best hiking camera, a Canon G12, to my daughter Clara. When I’m able to hike again I can reward myself with a new camera.
days 7-14 laptop    Things have settled into a dull routine. The bed and the recliner chair are the only places where I can get off my feet for an extended period of time and have ankle support. For now, I leave the house only for Coumadin appointments at the hospital. Indoors I stay in my pajamas and get around with a walker. Jacque and I use Motorola TalkAbout 2-way radios to talk when we are in different parts of the house. Haven’t shaved since August 19. My face is a gray fuzzball. Sure is a great time for me to catch up on reading!
   My left knee remains stiff, swollen, discolored, and painful. The therapist comes in to help me with exercises. I do those exercises daily, and life goes on.
   This laptop computer, an Apple MacBook Pro, can do almost everything the main computer can do. By putting it on a plywood board on the arms of the recliner, it works fine.
day 15    At last! I went back to Dr. Duggan to have the staples taken out. Mighty glad to get rid of that extra metal in my knee. The doctor said I have to work on bending the knee. He gave me a prescription for outpatient physical therapy.
day 16    My direction is clear now. Home therapy is over, and I’m enrolled in outpatient physical therapy starting on Monday. The exercises I must do, and lots of them, will be getting my new left knee to bend.
day 20    “No pain, no gain.” Outpatient physical therapy has begun. Also I’m doing lots of knee-bending exercises at home. The pain pills I have to take keep me from driving. At home I read, watch educational videos, and do some mild computer work.
day 22    After three weeks there is finally some measurable progress. At physical therapy my knee bent a little more than it had last time.
day 28    Clara drove me to the Arizona Trailblazers Hiking Club meeting. It was only my second outing that wasn’t to a medical or therapy appointment. I got around O.K. with a cane instead of a walker, using pillows to cushion myself on the chair and rest my foot on the floor. My hiking club companion Dave French, who had Total Knee Replacement surgery the day after me, is getting around more easily.
   As club secretary, I had to be there. Gave myself a head start on writing the minutes, so when Clara drove me home after the meeting I quickly finished them.
day 29    Returned to the Red Mountain Writers. Clara was very gracious about driving me there, and then she participated in the meeting. I sat on a pillow and put another one on the floor for my left foot.
  one month
day 36 Ted    My first neighborhood walk was on the sidewalk by the park across from our house – maybe 1/3 mile. We’re in the time of year when mornings are delightfully cool.

   Later, Clara drove me to physical therapy and then to the Red Mountain Writers.

   The chairs at the writers’ group are uncomfortable without pillows, so I had to stand up several times. But I lasted through the 2½ hour meeting.

   That proved to be a mistake: my back hurts. At home Jacque helped me by putting a heat pad under my lower back. It gave me some pain relief.
day 40    Returned to Victory Lutheran Church. Clara, our precious daughter, drove Jacque and me to the 10:45 praise service, then sat beside us. We took part in a spirited worship service with a fine sermon on Ephesians 2 by pastor Larry. The chairs are padded but plain with no arms. Although I wasn’t able to get up and down when everyone else did, I lasted through the service and was mighty glad to be there. After lunch I went grocery shopping with Beatrix and Clara, and came home exhausted.
day 44    Got a cortisone injection in my left knee. Cortisone is supposed to help the muscles cooperate more and resist and hurt less when my knee bends. Sure hope it helps.
day 46    Skipped my morning pain pill so I could safely drive to the church for Men’s Bible Study. We had 20 guys there to hear a fine lesson about faithfulness to God, taught by pastor Larry. Afterwards I drove to Walgreens, then came home and took my pain medication. It was the first time I’d driven my car since before the surgery.
day 50    The therapist confirmed what I thought I was observing at home: my knee can bend a little more after the cortisone injection than it could before.
   Went on a two mile walk this morning, then I had to take a nap.
  two months
day 64    My new left knee doesn’t bend enough. Dr. Duggan very quickly diagnosed the problem when I was in for my checkup this morning. So I’m going back to Banner Baywood Hospital on Friday for a procedure that reminds me of one of my favorite places: Big Bend National Park, in Texas on the Rio Grande. But it’s my knee that will be getting the Big Bend. Has to be done under anesthesia, so I’ll be in the hospital as an outpatient. Pray for Dr. John Duggan, the hospital nurses and staff, and me.
day 66
hospital
   Knockout drops. When I opened my eyes I was in the recovery room with an exceedingly sore left knee. The bending was successful, I’m told, but they had to give me more pain medication while I was in the recovery room. Clara, bless her, drove me home.
day 67
home
   Stiffness, soreness, and pain pills. Stayed in all day as Jacque gave me two Polar Care treatments. In the afternoon I put my latest story on the web for review: Lights of Apache Junction.
day 69    Physical Therapy: “Your knee will bend all the way, but we have to make it bend painlessly.” My knee bent visibly farther, but neither all the way nor painlessly. So I’ll go in for therapy every day this week.
day 85    What I’ve been observing at home was confirmed by Dr. Duggan: my new left knee is bending more and hurting less. Lots of knee-bending exercises are required every day, to be sure. But for the first time I feel confident that I’ll get back on the hiking trail.
  three months
day 96    Walked 3 1/2 miles, and yes, that wore me out. Meanwhile I’ve done something rash, but I hope not foolish. Saw a special deal on the Internet for that Canon G15 that will be my new hiking camera, and placed an order for it.
day 109
   On a cool, sunny afternoon I did the 4-mile walk on the rabbit trail to Higley Road and back. Came home tired, but happy. Jacque had to help me get my regular shoes on. I’ll do a real hike when my knee bends enough for me to tie my own boot laces.
GPS map
day 121

Dec. 19, 2013
   Put on my socks and hiking boots, then hiked a loop around the Cat Peaks in Usery Mountain Park on the Meridian, Blevins, and Cat Peaks Trails.
 pictures 
•  I’m hiking again! Getting my life back! Couldn’t dream of a happier Christmas present.
My thanks to God, who is the source of all healing.
Thanks to my wife Jacque and daughters Beatrix and Clara, who put up with me (no mean feat!) and helped me when I needed it the most.
Thanks to Dr. John Duggan and the medical staff, Anthony Lelo and the therapists, who all did their job right.
Thanks to my friends and family for their prayers, kind thoughts, and encouragement.
  four months
day 128    The doctor says I don’t have to come back, or go to physical therapy. Just keep up those knee bending exercises at home, and go hiking. What great news!

updated December 26, 2013