My new knee

I had my third joint replacement today: my right knee is now a sturdy mechanical hinge like the one shown above, installed by the same talented surgeon who handled both of my hip joint replacements nine years ago, Dr. James Bruckner of Proliance Orthopaedics & Sports Medicine. Huge thanks to Dr. Bruckner and the staff at Overlake Hospital!

I've put together this blog post as a summary of how it went to share with friends and family. Short version: it went great, even better than I had dared hope. There's still a long road ahead, but the recovery process is off to a great start.

For the story of how my knee came to be this way and the decision to get it replaced, see the blog post Time for a new knee.

An early morning

I made the appointment for today's surgery over 6 months ago, but due to the possibility of last-minute scheduling changes due to things like procedures running over their allotted time, or fitting in urgent operations on short notice, the exact time wasn't pinned down until yesterday. Surgery was at 7:30AM, with checkin at 5:30. That meant we had to be up before 4:00, to allow time for my final anti-bacterial shower, feeding the dogs and handing them off to a caretaker for the day (thanks, Jana!), and driving from the South End to Overlake Hospital in Bellevue.

That all went smoothly, but my knee was a mess. It had been steadily swelling since I stopped taking all anti-inflammatory drugs 7 days before surgery (as required by my surgeon's protocol), and by this morning it was the worst it's been in months. When we arrived at the hospital, I was unable to walk without hopping on one foot and gasping in pain, so Megan got a wheelchair to take me from the parking garage to checkin. The silver lining: by that point, I could not wait to be rid of this damn knee!

Checkin went smoothly, and we met with the anesthesiologist and then the surgeon, who signed his initials on the knee to be replaced, per the “Universal Protocol” used by surgeons to prevent wrong person, wrong procedure, or wrong site surgery.

The right surgeon for me

We had gone to great inconvenience to have this surgery done by the same surgeon who did my hips in 2015, Dr. James Bruckner of Proliance Orthopaedics & Sports Medicine, because I really like his approach. I hesitate to call him "old school," because he uses many state of the art techniques, but he's a surgeon who works with his own highly developed hands and eyes, rather than using computer-aided robotics. He did my hip replacements using the traditional posterior approach, which is more work for both the surgeon and the patient (in terms of physical therapy required afterward), but gives the surgeon better visibility to line up the joint perfectly.

After Dr. Bruckner signed my knee, I mentioned that I had heard most orthopedic surgeons these days use a robotic saw to cut off the ends of the femur and tibia for a knee replacement, to assure a perfectly square surface. "Not me," he said, "I am the robot."

As an amateur woodworker with no interest in gadgets like 3D printers who loves to practice perfecting my technique with a perfectly balanced handsaw instead, I feel like Dr. Bruckner is the right surgeon for me.

In the blink of an eye

The sedative that was used with my spinal block was one of those that alters your perception of time. I was talking to the anesthesiologist about what she was doing, and it felt to me like it was one second later that I came to consciousness in the PACU (post-anesthesia care unit).

My PACU nurse, a charismatic young man from Los Angeles, told me that everything went well. I had no feeling in my legs or feet, and couldn't move them, which is normal – he spent the next 30 minutes testing me occasionally while my sense of feel and motor movement skills slowly returned.

I was delayed for a while in the PACU because my heart rate dropped extremely low for a few minutes – down in the 30s (beats per minute). Apparently some people can have that reaction to a spinal block, and I'm one of the lucky ones. They did an EKG to verify my heart rhythm was fine, and after my heart rate rose back up and stabilized in the 60s they kept me under observation for an hour before moving me to my recovery room, where I was reunited with Megan.

First PT session

One of the things that Dr. Bruckner is big on (as are many orthopedic surgeons these days) is the importance of getting up and moving around as soon as possible after surgery. I took my first walk within hours of my two hip replacements, and today it was the same approach.

The physical therapist took me through a set of exercises to be done hourly through the day (mostly focused on stimulating blood flow) as well as a set of strength and flexibility exercises to be done three times a day. Megan has been keeping a logbook since we got back from surgery – in fact, she just mentioned while I'm typing this "time for hourly PT."

The physical therapist also verified that I could go up and down steps reliably, which they require before discharging a knee replacement patient. She mentioned several times that it's obvious I did a lot of preparation, so that felt like nice validation of all the time I've spent doing "pre-hab" PT the last few months.

After we finished the PT steps, Dr. Bruckner dropped in for a minute, and he gave me the same simple advice he did after each of my hip replacements: "above all, don't fall!"

Getting on with things

I'll be spending the next week in Seattle with Megan and the dogs, and then if all goes well in my wound check and suture removal appointment next Tuesday, we'll be heading back to Butte on Wednesday, where my life will revolve around physical therapy and ice for the foreseeable future.

A couple of final thoughts on this long and long-awaited day:

• I love looking down at my leg and seeing that it's straight. My right leg has had a pronounced outward bend in it for some time, giving me a knock-kneed look that I hated. It looked weak and awkward, but now it looks straight and sturdy.
• It amazes me that I left the hospital with a better gait and less pain than when I arrived 9 hours before. I would not have believed this was possible, if I hadn't experienced it myself.

I'll probably do another blog post about how my recovery is going after a while, but for now I just wanted to get this one out to let everyone know the surgery went well and we're moving forward. I'm in good hands with Megan, and looking forward to diving into the recovery process and eventually getting back to hiking with her and the dogs, with my knee hopefully stronger than ever. Can't wait.