MY TOTAL KNEE REPLACEMENT — FIGHTING BACK AGAINST THE DEMON TIME

One Boomer’s Story Of His Second Knee Replacement

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In a recent study performed by me looking around and eavesdropping in the pre-surgery prep area, and then in recovery, after I had my second knee replaced in January at the Hospital for Special Surgery, here in New York, I have concluded that the number of baby boomers getting their knees and hips replaced these days can accurately be described as a “boatload”.

If you had to choose from the ever-expanding buffet of age-related reasons for being wheeled into an operating room you could do worse than total knee replacement. As we say on the Surgery and Knee Replacement Advise Facebook Group, I’m now “9 weeks post-TLKR”. Two years ago, at 65, I had the right one replaced.

The knee joint is cushioned by cartilage which depends on the synovial fluid in the joint for oxygen and nutrients to stay healthy. Osteoarthritis happens when that fluid dries up and the knee joint cartilage wears down It’s not clear why my knees went bad. I suspect it was the 25 extra pounds I had been jogging with for too many years.

I decided to get my left knee replaced two years ago when, David Mayman, my beloved, patient, delightful, highly respected surgeon at HSS, looked at my x-rays and said it’s not a question of if but when. When Dr. Mayman, who is Co-Director of Computer Assisted Surgery at HSS, added that computer-guided surgery has vastly improved outcomes and that implants are now projected to last 30 years, I pulled the trigger and said “lets do this”.

I had grown tired of not being able to get in and out of cars without dragging my pant leg towards the door. It was annoying to have to hunt for theatre house managers to see if there was an empty aisle seat before the play started. I hated having to sit in coffee shops alone while my wife went on the walking tours without me on recent trips to England and Portugal. I also decided not to wait for the next decade because with each passing year more medical stuff is likely to go wrong making surgery riskier.

Another primary motivator for me was the impact of watching my late father-in-law’s, walker dependent, immobilized, sunset years. He was a tough WWII vet who landed at Omaha Beach on June 11, 1944 (D6). He relied on the standard bad advice to wait until the pain was unbearable. He held out until his 90s and by then no surgeon would touch him. His other mistake was having the temerity to defy his doctors’ unspoken longevity predictions by dying just before his 102 birthday.

When we use the words “knee replacement”, as part of our non eyebrow raising everyday language, we are missing the “man on the moon” wow factor of what actually happens. There is nothing routine about a team of doctors and nurses in space suits and hoods with large plastic face screens going at your open knee with scalpels, power tools and a hammer guided by simultaneous computer imaging.

For us, obsessive anxiety types the last few month countdown to surgery involves frequent consults with Doctor Google. The internet offers an ample supply of low budget promotional videos featuring surgeons looking awkward.

The British surgeon that did a knee replacement for Dame Judi Dench got her to sit for his video. Slumped into an overstuffed armchair Judy tells us that she decided to have the surgery done, at age 78, when things got a “bit dodgy”.

For the same dark reason that I slow down to stare at car wrecks, I also watched surgical training videos before my operation. These videos included one with the disconcerting image of a surgeon, fitted with a microphone, turning away from the poor sap with the open knee on the operating table to answer e-mailed questions being fielded by another surgeon acting as internet MC.

Just before you enter the HSS building on E 71st and the East River in Manhattan a large sign welcomes you to the David Koch Pavilion. Walking by that sign I tried not to think about one the best hospitals in the world owing its financial well being to someone who, with his brothers, dedicated their fossil fuel fortune to making sure my great-grandchildren inherit a planet that cannot sustain life.

The HSS surgical waiting area features a beautiful view of the East River. Each patient gets a number and families can keep track of their patient’s color-coded status on a digital board like the ones in airports. People can watch the colors on the big board change as the patient progresses from prep, through surgery, and into recovery. Surgeons have family members’ cell phones to deliver the post-surgery report.

When you get called to leave the pre-op prep area the pace picks up. A well oiled team of nurses, physicians assistants and assorted hospital staff on the prep team get you ready. They hook up an IV, look over blood test results, check your vitals, pore over your chart, make notes and do a final wash and shave of the surgical site. It was a lot like when Dorothy and her buddies entered Oz and immediately got spruced up by the oddly dressed people singing “ha ha ha, ho ho ho, in the merry old land of Oz” etc. It never occurred to me as a kid to ask why Oz was apparently some kind of cult-like over-staffed nail salon.

[The Merry Old Land of OZCanonFanon Wiki — Fandom.]

When a smiling Dr Mayman, appeared before me wielding a sharpie to initial my wrist band and my right knee I knew it was showtime. I tried, unsuccessfully, to not think about the lawsuit that gave birth to the presurgery sharpie rule.

A few beats later two good-natured, all-business guys in surgical scrubs and hats appeared to wheel me to the operating room where the team was waiting. As I kissed my wife Lori goodbye, I was zipped out the door and down the hallway, moving at a nice clip. Hospital staff scattered left and right against the walls as if we had red lights and a siren. A set of steel doors banged open, suddenly the temperature dropped and everything was made of shining steel. For a fleeting moment, I enjoyed feeling like I was cruising into an exclusive club where my brother was the bouncer with a clipboard at the velvet rope.

Knowing that the surgeon had Lori’s cell number for the post-surgery call let her follow up on a lunch tip from a friend whose husband had recently his hip replaced. Sotheby’s auction house, a block away on York Avenue and 71st, has an upscale Italian coffee bar on the ground floor with good lunch options.

When I was rolled alongside the operating table I scooted myself onto it in a kind of “I got this” farewell to my physical independence that was about to go on hiatus. Chatting with the anesthesiologist and the nurses I tried to be funny to make sure they all loved me just before the lights went out at around 1 PM.

A few hours later I woke up in a curtained off section of the recovery floor with my leg wrapped from mid-thigh to mid-calf in an expensive-looking bandage.

In the recovery area, kind, attentive and good humored, nurses scurry from patient to patient checking vital signs, pain levels and supplying meds. Thanks to the nerve blocking meds, injected during surgery I was feeling pretty good. The guy next to me-not so much.

A nurse asked my neighbor, on the other side of a curtain, how his pain was on a scale of 1–10. His answer, between moans and groans, was “12”. They ramped up his pain meds and eventually, he reported a 5 and the moaning tapered off.

A few beds away an annoying woman was having long and loud conversations on her phone. When the nurse checked on me to see if I needed anything I resisted asking if it might be possible to have my chatty neighbor sedated.

I was ready to break the long pre-surgery fast. My recovery three-course meal began with a jello appetizer, followed by a main course of jello and finally topped off by a jello dessert. There I was, with my brand new knee implant, thanks to computer guided surgery, happily slurping down 1950’s gelatinous red goop.

Part of the HSS anti-infection protocol includes not allowing wheeled luggage and a 15 minutes limit on family recovery room visits. This limited Lori to popping in and out leaving me alone to binge watch on my phone and send status notes to family and friends for the next 10 hours.

Not much sleeping in the recovery room that night. At some point, there was a little excitement when a nurse reported that Italian ices had appeared in the fridge. In a sad momentary setback, she later came in to break the bad news, that the ices had disappeared quickly.

During the night I could hear the wheels of the other folks in recovery being rolled out to in-patient rooms. In the pre-dawn hours, there were no new post-op patients and eventually, I was the last one in my class to get out of there — something about an unavailable sleep apnea machine.

At about 4 AM it was finally my turn to travel from recovery into a room where I waited for the day shift to arrive. As I was being wheeled into the room I passed my neighbor in the next bed — a late 60s Spanish speaking man with sad eyes. It sounded like he lived alone in an SRO in Manhattan’s West 50s. He reminded me of guys with the same lonely, scared look on their faces whom I used to help get government benefits when I was a young legal services lawyer in that same neighborhood.

His post-op pain was not getting better fast enough so he was not going home for at least another day. A young doc came in and mechanically explained to him the risks of opioid addiction and overdose. It was hard to listen to my roommate politely saying he understood the warning that was obviously not sinking in. I was getting Oxycodone to take home but I never got that canned speech. I assumed the anti-addiction lecture had to do with his pain, but I worried that it might be because he was a poor Hispanic guy living alone in an SRO.

Although full recovery takes 6 months to a year, they get you up on your feet right after surgery. To get the green light to go home the physical therapist had to make sure I could walk down the hallway and go up and down the physical therapy steps to nowhere. Thankfully the nerve blockers were still working and by 10 am I got clearance and the discharge process started.

At some point before you leave the hospital that large serious looking bandage comes off leaving a small, plain-looking waterproof strip running the length of the 6 inch incision. That thing stays on for a week. The stitches are self-dissolving and showering is ok. My knee had horizontal grid lines drawn with a black marker and some pretty massive black and blue areas appeared north and south of the knee.

In a final inspection of the wound a nurse drew a marker line around some bleeding from the edge of the bandage so I could call someone if it was expanding. The big deal post-surgery is monitoring for signs of infection and worrying about blood clots.

As I passed my neighbor’s bed on the way out the door we wished each other luck and made eye contact for the first time. He gave me a brave wave and a half smile as they wheeled me out to the elevator. Next thing I knew I was crosstown in front of my building, using a walker to get from the curb inside the lobby to the elevator.

Like any wallop-packing life event recovery from knee surgery has phases. The pain for the first two nights home was bad but Oxycodone and industrial-strength Tylenol got me through. One of the challenges of taking Oxycodone for post-surgery pain management is having to assure your friends and family that you will not become addicted, overdose and die.

As I was being discharged a nurse asked if I wanted one. I said no but I’ll put it in my pocket just in case. Without a missed beat she said “you will either take it front of me or wait for the prescription to be filled when you get home. My impression is that for folks who become dependent on Oxycodone it’s not about getting high, it’s about relief from nonstop horrible 24/7 pain. I find it much more challenging to resist a plate of day old lasagna.

The first few days of sleeplessness, stiffness and pain were pretty rough — but not Geneva Convention bad. It helped to remember that this was temporary and the ticket to a not too distant future without knee pain. In the beginning, getting out of bed and standing up, produced intense pain along the line of the incision that soon subsided with movement. Physical therapy at home starts right away. The pain and stiffness is a real challenge and the physical therapy goal is to get your range of motion and full extension back quickly in a race against the formation of scar tissue.

After two weeks there was lots of improvement but sleeping was still a problem. Post-surgery when you’re lying in bed at night it hurts and there was a tightness, itching and serious aching. The doc advised that three months is a big turning point for sleeping through the night.

Two first few days of walker dependence is followed by a cane. The cane is also useful on the sidewalk to slow down delivery guys on bikes and kids on skateboards. It’s also useful for getting a seat on a bus. After two weeks the cane went into the closet. With intense physical therapy twice a week, and 3x a day at home on my own, by the time of my 6-week post-surgery visit to the surgeon, where he inspects the x-ray, I was back to spinning class and the rowing machine.

The first knee joints replacement was 50 years ago in 1969. A total knee replacement in 1968 used a device that didn’t work so well. In 1974 surgeons and a mechanical engineer at HSS developed an implant that worked more like a real knee. It was just the beginning.

In my pre-surgery consultation, I listened to Dr. Mayman’s patient, caring explanation, that computer-guided navigation now enables them to cut as little old bone as possible. The new implants can now be more accurately aligned and the surrounding soft tissue and muscle can return to something much closer to normal than in the past.

My presurgical knee with computer navigation measurements used to design and position the implant.

A unique feature of knee replacement surgery is that when, and if, to do it is mostly up to the patient. I’m very happy I did both knees and I’m so looking forward to enjoying them. The decision to get a knee replaced Is complicated. It’s not right for everyone and there are risks including the immediate short term, low but real, risk of infections and clots. Down the road, there is a small percentage of cases that need revision because something went wrong with the implant.

The range of experiences with knee surgery is wide and varied. The Hip and Knee Replacement Facebook Group has daily exchanges between strangers, being kind and supportive to each other, before and after surgery. One of my favs was when Heidi was worrying about pain pill induced constipation and Melody suggested “sliders from White Castle”.

There are often tender moments of compassion, support and holding hands through cyberspace;

  • Ok so I’m just a little over 3 weeks since my surgery and I feel like I am going backwards! My PT added some exercises for me to do at home and I don’t know if that’s what’s causing the pain but I hurt worse last night than I have been and I slept none. I’m so frustrated and aggravated. I feel like I’m starting to limp again because I am hurting. My thigh hurts and so does my knee. I ice, I elevate, I walk, I do my exercises. I don’t think I’m overdoing or under doing. My Dr and the physical therapist says everything looks good but it sure doesn’t feel good!!!
  • K Three weeks is nothing. Knee replacement PT can be excruciating. Back off if it hurts too badly and let the PT know. Then keep plugging.
  • Oooo yes, this is me too. It was a REAL rollercoaster for 4 months for me, sorry to say. You are still really fresh, it goes up and down for no reason‼️‼️‼️‼️‼️‼️ hang in there, keep doing all the right things, take meds for pain and sleep if u have to, you can taper off later. ♥️hugs

Could all these knee replacements be a boomer surgical fad that gets questioned in the future or impacted by new alternatives to total replacement? Who knows? In making my decision it was hard to argue against doing something that will allow me to live a fuller, more active life now and in the coming decades, and maybe delay other physical maladies of aging with exercise. When the hordes of us deteriorating boomers start staggering into our 90s, the next generation of surgeons and biomechanical whizbangs, now in elementary school, will have to help us out.

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Bob Salzman

Bob Salzman

Past winner Funniest Lawyer in NYC; 2020 “Sorting out the Mess”, and contest winning essay in forthcoming anthology 2020- Hell We Should Never Forget”