New Knee Status: Drugs

Everyone has different pain tolerance so it is hard to tell what you will need after surgery for pain control. Here are some of my thoughts on my own pain med use.

I was able to "mostly" get off the hard stuff prior to my first months doctor checkup. I occasionally use Tylenol and occasionally will grab an oxycodone when I feel sore enough to really disturb my sleep.

While the new knee has its aches and pains related to rehab and healing the rest of my joints have the same old aches and pains they had before surgery (duh). I went off daily NSAIDs before surgery and have not gone back on it yet  so I am starting to feel some of those other aches now. I may end up on some regular NSAIDs but for now the occasional use seems to be working for the rest of the joints.

One trick I use for judging my use of pain meds. I try to keep my pain levels controlled enough that I get decent sleep. I also want to get back to my normal level of  activity and keep up my physical therapy. Sometimes it takes a couple tylenol or even an oxy to get there.

New Knee: First Hike!

One of my hopes for the new knee is that I will be able to get back into hiking again. This weekend was a gorgeous northwest weekend so seemed to be the ideal time to drive out of the city and do a little hike. And yes I do mean little! I used the Washington Trails Association Hike search (http://www.wta.org) to look for hikes UNDER 3 miles in the central cascades. I came up with Lake Elizabeth on the way to Stevens Pass.

Becky, Beethoven and I headed off after a fortifying breakfast to find what turned out to be the elusive Lake Elizabeth and circumnavigate it on foot! The circumnavigation was 0.7 miles and involved a small amount of stepping up roots and over streams on rocks. I had my hiking poles which helped on the sketchier bits.
I wore my sturdy running shoes although I had my hiking boots in the car in case I though I would need them. The trail was just muddy enough to do a number on Becky's cute shoes....

New Knee Tips

Remember while you rehab to be aware of your body position and especially the position of both hips and legs. It is easy to cheat your gait and end up with sore joints.

New Knee Day 42

Mr. BikePT said I could get on the bike! Short FLAT rides with flat pedals instead of cleats but that's a start!

New Knee Status: One Month

Yesterday one month ago I got to go under the knife and saw and crowbar and get a brand new knee joint fitted in.

I am all in all very pleased with the results so far.

My leg is no longer bow legged. In fact I keep looking at in in amazement that it is so nicely straight. 

My range of motion has been quite good from right after the surgery. My PT and I are working on getting it to go straight without having to work at it. As for bend I am now doing full rotation on the bike and only sometimes have to work at keeping the foot in the right position. 

Quote of the Day

If you are going through hell, keep going. 

-Winston Churchill 

New Knee: Heat part 3

And now for that hot knee later on.... It refers to heat generated in the joint with exercise vs heat generated in a normal joint. Interesting....

http://www.ncbi.nlm.nih.gov/pubmed/16394760

Clin Orthop Relat Res. 2006 Jan;442:195-8.

Heat generated by knee prostheses.

Pritchett JW1.

Author information

• 1Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA. Bonerecon@aol.com

Abstract

Temperature sensors were placed in 50 knees in 25 patients who had one or both joints replaced. Temperature recordings were made before walking, after walking, and after cycling. The heat generated in healthy, arthritic, and replaced knees was measured. The knee replacements were done using eight different prostheses. A rotating hinge knee prosthesis generated a temperature increase of 7 degrees C in 20 minutes and 9 degrees C in 40 minutes. An unconstrained ceramic femoral prosthesis articulating with a polyethylene tibial prosthesis generated a temperature increase of 4 degrees C compared with a healthy resting knee. The other designs using a cobalt-chrome alloy and high-density polyethylene had temperature increases of 5 degrees-7 degrees C with exercise. Frictional heat generated in a prosthetic knee is not immediately dissipated and may result in wear, creep, and other degenerative processes in the high-density polyethylene. Extended periods of elevated temperature in joints may inhibit cell growth and perhaps contribute to adverse performance via bone resorption or component loosening. Prosthetic knees generate more heat with activity than healthy or arthritic knees. More-constrained knee prostheses generate more heat than less-constrained prostheses. A knee with a ceramic femoral component generates less heat than a knee with the same design using a cobalt-chromium alloy.

New Knee: Heat - part 2

More on the 'Heat in the New Knee' phenomenon. 
Seems that there are a couple aspects - First and the one that lead me here is the fact that my new rebuilt knee feels warmer than my other one. 
The second I discovered during my poking about on the internet today and that is that the New Knee may in fact run hotter later on! Cool eh?!

So off we go....
Google search: joint replacement heat in joint

At the Twin cities hospital: 

"How long will my knee feel hot?"

"Expect to feel warmth for six to 12 months after surgery. The heat is the body’s indicator that healing is occurring."

The University of Texas has almost the same statement on their site.
But this doesn't really speak to the mechanics what does it really mean that "healing is occurring"?

For more on that question we hit the internet again....

Google search: heat generation in joint healing

After poking around a bit in sites about using heat to help joint healing I came upon the Britannica site:

  inflammation | pathology | Encyclopedia Britannica

"Inflammation a response triggered by damage to living tissue". The inflammatory response is a defense mechanism that evolved in higher organisms to protect them from infection and injury. Its purpose is to localize and eliminate the injurious agent and to remove damaged tissue components so that the body can begin to heal. The response consists of changes in blood flow, an increase in permeability of blood vessels, and the migration of fluid, proteins, and white blood cells (leukocytes) from the circulation to the site of tissue damage. An inflammatory response that lasts only a few days is called acute inflammation, while a response of longer duration is referred to as chronic inflammation."

 I recommend going over there and poking around for yourself. Quite fun!

New Knee: Heat

All during my rehab I have noticed that my new knee is hotter (literally) than my old knee. Sort of cool but weird. Why is this? My imagination says it has a lot of blood flow and super antibodies hard at work healing and putting off heat.

The side affect of this though is that when I overdue things my whole body starts feeling a little feverish. Last night it was noticible enough for me to find my thermometer and check my temperature. It was normal which for me is a tiny bit high. 

Next step? Google this. What is really going on?

New Knee Day 20

Yesterday was the first outpatient PT day I had a nice hour session getting the leg stretched, bent, massaged, ultrasounded and electrostimulated! After the session my knee was loose enough for me to walk normally down the 2 flights of steps out of the PT office! (Of course shortly after that it tightened up again.)

For anyone who has not spent quality time with a physical therapist I'll try to give some details....

Typically your session starts with some procedure designed to break up scar tissue and adhesions like massage as well as something to help blood flow like ultrasound. 

You may spend some time on one of the exercise machines. And at some point you can expect some stretching and bending of the leg. This tends to be the most teeth grinding part of the visit. Your job is to try to get your muscles to release and not work against your PT. You should also give helpful feedback so the PT knows when you are at your current maximum stretch or bend. This is where being a wuss only hurts yourself! Erik will typically gradually bend my leg and ask if that is a stretch. Once I start to feel it I will tell him and he will hold that position for a bit. Generally he will get a bit more stretch in between asking and my response. Erik and I have worked together for a while now and so he is used to my feedback. Be sure that you let whoever you are working with know what you are feeling and where you are feeling it. It helps to understand what they are trying to accomplish also so feel free to ask questions. Asking things like: "Is it supposed to feel like there is a hot poker in the side of my knee?" can often be enlightening.
Again when stretching and bending hurts you need to work within your pain tolerances. If you have a low pain tolerance you will likely want to take some pain meds before physical therapy. Your goal is to work the leg enough to get it moving correctly.

Today is my follow up appointment with my surgeon. 

New Knee Update: Weekend Warrior

After a positive week I cleverly decided that I was ready to spend Friday and Saturday cleaning up and setting up the patio for summer.

Friday I decided changing the aquarium water would be a great idea so of course ended up getting distracted and overflowing the aquarium. I had just finished cleaning that up and sat down with ice on the knee when the PT came for the last home visit. Needless to say my range of motion was down a few degrees but I was not surprised!

Saturday We had a late brunch followed by my new knee's first trip behind the wheel to the garden store! It was a lovely sunny Saturday and NZ Becky and I filled up a cart with plants. Once we got them home we got the guys to move the bags of soil and then started in on a couple containers.

After a short ice break we went off for a dinner where I found that the bar seating we were given was not ideal. Those high stools don't allow for very good post knee surgery leg support!

Needless to say by the time I got home on Saturday I was trashed. I popped some pain meds and put some ice on the knee but it was a pretty uncomfortable night. The next day I spent pretty much the whole day prone with leg elevated and iced.

Lesson learned - Don't do that!