29 Nov Total Knee Replacement | The Good, The Bad and The Ugly
Growing up, I remember doing class assignments that asked us where we envisioned our lives to be in five, ten, twenty years. Being diagnosed with rheumatoid arthritis (RA) at eighteen and having a total knee replacement at twenty-nine years old was not on my radar.
My life changed fifteen years ago when I was diagnosed and I cannot say it has been an easy ride. This ride has taken me on a path of pain, loss, grief and disability. But it has also shown me on of path of hope, faith, spirituality, healing, acceptance, strength, bravery and purpose. Ironically, the path my RA has shown me is more that I started off with. Through the negativity and darkness of my chronic illness, eventually light and positivity shined through on areas of my life that I never thought would be whole again.
However, the moment of my deepest darkness and despair came over a year ago, with my first ever major surgery. The surgeon’s diagnosis that my knee cartilage was non-existent and that I had a bone on bone knee was not shocking to me. For at least couple of years prior to seeing a surgeon I had been experiencing a limp, bent knee and along pain and swelling. Intuitively, I knew something was seriously wrong and the x-rays confirmed my suspicion.
Because a total knee replacement is considered an elective procedure, I was offered two choices: either live with it or have surgery to correct it. The choice was mine and it was explained that they would only do surgery if and when I was ready. However, being a young female who wanted to stay social and active, my quality of life quickly became the main concern. In addition, my team of surgeons suggested to not prolong the surgery to avoid the possible risk of affecting my body’s alignment, hip, and ankle joints, which all work in tandem with the knee.
So, four months after my initial diagnosis, and after I weighed all of my options, I opted to have total knee replacement surgery. During my surgery recovery, I learned three things to be true of a total knee replacement: It is good, it is bad, and it is downright ugly.
Here are my experiences with these three truths:
You do, for the most part, get a new lease on life. It may not be exactly the same as before your knee was affected by arthritis or injury, but the quality of life improves significantly with this procedure.
The pain does disappear or lessen after recovery. A lot.
Total knee replacements, like hip replacements, have been performed by surgeons for decades. Though surgery in general is never guaranteed and without risk, orthopedic surgeons know a lot about the mechanics of this type of surgery. The shelf life is longer than many other joint replacements, which brought me comfort in making my decision to go ahead with it.
You get everyone — well mostly, to be at your beck and call when you come out of surgery and return home. Who doesn’t like to be pampered? After a gruesome surgery, we do deserve a little rest and relaxation, am I right?
If you don’t have a lot of one-on-one personal support, there are many resources online. Before, during, and long after my surgery, I found comfort in online support groups. It is true that each person has a unique experience with this procedure, but at the end of the day, people in support groups can understand and empathize. That is a huge difference. Out of all the people in the world, you will find one, or a select few, whose story is eerily similar to yours.
The hospital you are scheduled to have surgery at prepares you. I am the type of person that has to know every single detail before I do anything, especially with something this major. If you are the same way or just feel scared, lost and unsure, these mandatory pre-surgery classes are taught by either a nurse or physical therapist. No question goes unanswered, so be sure to ask away.
Humor and laughter will be your best friend and help you through any pain, frustration, and tears you may shed. Don’t be too hard on yourself and your recovery process. Before and after my surgery, friends and family dropped off cards, flowers, and stuffed animals that were meaningful. This put a smile on my face and gave me the push I needed to keep going. Listening to music, meditation, deep breathing, watching movies, reading and anything that can take your mind off your knee also helps.
One word of advice I received from somebody that helped put things into perspective before my procedure was “Do not be a martyr to your knee.” It’s easier said than done, but when I found myself in this energy, I was mindful of it and changed my course around. Surgery recovery gives you a lot of alone time. You get to know yourself better and catch up on things you never may have had time to do before.
I had my surgery the week of the 4th of July. I am not sure why I decided on this, but I would not want to do that again, mainly because I suffer from major FOMO (fear of missing out). However, I was hooked up with one of the best views to see the fireworks. My loved ones and I put the music on and had dance parties in the room. When life gives you lemons, make your own celebration, right? My family and I didn’t let my surgery stop us from enjoying the holiday in our own way.
Lastly, you come out a survivor and a warrior. And if that isn’t bada** in and of itself, then I do not know what is. We even have a scar to prove it!
Now on to the not so bada** part.
The overall pain, overnight stay in the hospital, pain medication, coming off of the anesthesia, swelling and bruising isn’t for the faint of heart. The second day out of my surgery I was expecting visitors, but the effects of the anesthesia wearing off was too much for me to bare and I had to cancel their visit. Not to mention that the pain medications ended up in a brown paper bag, too, if you know what I mean.
Having to rely on busy nurses to give you your pain medicine like clockwork can get tiresome. I couldn’t stare at applesauce for a while after because I got so sick of eating it in the hospital. Nurses had to watch me swallow my medicine every time, which was annoying, but is protocol to make sure patients take it. Trust me, with the level of pain I was in, I was going to take it. All that aside, my experience gave me major respect for nurses and especially those that helped me day in and day out.
Contrary to what people may think, after a total knee replacement, your knee is not bionic. Though we are warriors and superheroes in our own right, our knee doesn’t do any special tricks. If I could kick through a brick wall because I had metal in my knee, I would have gone through with the procedure immediately.
Recovering from your surgery takes work, work, work, work — as Rihanna says. If you think your 9-5 job or sitting through rush hour traffic is bad, you may want to re-think what you previously thought was hard. Recovery is a 24/7 commitment and the maintenance afterwards is lifelong to ensure your new knee functions for years down the line. My surgeon told me I would have to make sacrifices after my surgery, but I didn’t truly realize what he meant until it was done.
Contact sports such as soccer, running, football, tennis and skiing are often not recommended after a total knee replacement. Though there’s many patients who say they have no issues with the former, it may decrease the shelf life of the replacement. I wish I could partake in the sports I did before my arthritis, however, it’s just not physically possible anymore. So now I am the designated cheerleader on the sidelines with my tea in hand, but that is ok with me!
If you have autoimmune arthritis, like rheumatoid arthritis, recovery is different than for someone who just has osteoarthritis, a sports-related injury or other common surgeries from their youth such as ACL or meniscus tears. Because I have rheumatoid arthritis, the medications I take for RA I take slows the healing process and throw off other underlying factors. Infection risks and complications are also higher for rheumatoid arthritis and chronic illness patients due to our compromised immune systems. Further, I wasn’t able to take my RA medications or any supplements that helped with pain and inflammation for a couple weeks before and one month after surgery. As if the pain from surgery wasn’t enough, the pain from my RA took it to a whole other level. Talk about hell.
On top of all that I also had to have a manipulation six weeks after my total knee replacement because my flexion range of motion in my knee wasn’t at the optimal degree. The culprit? Scar tissue and inflammation.
My surgeon sent me home with a CPM, also known as a Continuous Passive Motion machine. I had a love/hate relationship with this furry mammoth — the designated nickname I gave it. CPM helped reduce swelling and loosen me up before therapy and workouts, but frustratingly, I never reached the same number on the machine that my therapist measured me at for flexion.
If you enjoy privacy or are a private person, beware. An unfortunate reality of surgery is that you will be exposed. Having people change your bedpan in the middle of the night, especially an attractive male nurse, can be mortifying as a young woman. But afterwards, I realized how ridiculous I was being. After all, this was my first time I slept overnight in a hospital since my birth thirty years ago and everything was new to me. Can you blame me? I hated that I had to have help showering; it made me feel dependent. I am usually an independent person who likes to do things on my own terms and in my own way. But showering is an extreme challenge with an incision in your knee, plus joint damage in your upper body, making it difficult to prop yourself from a shower chair, so help was definitely needed.
My last point is that surgery makes you weak. On all physical, mental, emotional, and spiritual levels. My particular surgery ended up being three hours. Usually, it only takes one hour and half. Due to the extensive damage in my knee, the surgeon and his team had a lot of cleanup to do. Afterwards I had a lot of cleanup to do with my emotions, my body and my spirit.
If having your knee cut open to the bone isn’t ugly enough, having to get up and go walking the next day is a complete horror. The “use it or lose it” mentality is the ultimate slogan on the orthopedic floors. But because I also have joint damage in my elbow, wrists, and finger joints getting up and using my new knee was incredibly difficult for me. The second day I got up to walk, my incision bled through onto the gauze pad. I wasn’t ready and they do push you, mainly because they want to make sure you are safe to go home. Then, there is the insurance company and hospital rule factors that limit the amount of days that can be covered.
Medicare and Medicaid are my insurance providers. If receiving social security benefits isn’t hard enough, coverage for continual physical therapy is a huge headache. Being placed in medical reviews, needing to send in proof that I do indeed need more therapy, and being cut from social security benefits all at the same time is uglier than the whole surgery process itself.
Alternative and spa treatments such as deep tissue massage, myofascial massage, osteopathy and acupuncture all help with scar tissue, pain, inflammation and overall healing. However, they are often not covered by insurance, even when there is proof that these services help people. Unfortunately no one wants to pay for these services, often leaving patients with an inability to afford any sort of alternative treatment, limited funds or in debt.
The younger you are, the faster your body builds up scar tissue. If you have autoimmune arthritis, a complication can arise that I now have called, arthofibrosis, which is pretty much the name used for a stiff knee. I am still fighting the scar tissue every day, but I refuse to give up!
In your life, you are going to face challenges, but you are not defined by those challenges; you are defined by the actions you take and the attitude you carry when you face your challenges head on. Through the good, the bad, and the ugly of my total knee replacement, I made it out of the trenches and I know you can too.
You can follow my total knee replacement journey on my 365 project page at 365project.org/effiek/profile#albums or follow me on Twitter @risingabovera