Knee replacement is sort of like giving birth. Everything you read on the subject discusses the preparation for it, perhaps describing the events itself, but there is not much on the aftermath. That is the subject of this blog - not what happens before and during knee replacement, but what happens after that new knee is in place. This then is my own personal journey - but as all the doctors and physical therapists will tell you - everyone's experience is different - so that is my disclaimer.

A couple of things you should take care of before surgery, but which concern the aftermath of surgery are: (1) Schedule your physical therapy in advance of your surgery. Your doctor will normally let you choose your own therapist, so do your homework, ask around, and then take the therapy order to them so you can obtain times that suit your schedule. If you don't do this, you may have to take a piecemeal schedule where you go at different times on different days of the week. I have six weeks worth of therapy scheduled at the prime time of 10:00 a.m. every Monday, Wednesday, and Friday.
(2) Ask your doctor to approve and give you an application for a handicap placard. Usually you can get one for 6 months and this will be very helpful in limiting the distance you have to walk to get somewhere. I plan to be able to walk really well in 6 months, but it might be nice to have that placard in the glove compartment. I'll try not to abuse it, but, well, you know.

Before I begin describing my experience, I'd like to acknowledge that my doctor used computer assistance during my surgery and I heard he operated in a space suit. It was apparent he was obsessive-compulsive about avoiding infection, including instructions to not shave my leg a week before surgery, use an antiseptic wipe after showering the night before surgery, wear clean pjs and sleep on clean sheets. Now I'll proceed with my tale.

Day 1
I had called the office in the morning the day before my surgery and was told I was scheduled at 6:30. I was euphoric because the instructions to not eat or drink anything after midnight the night before surgery always makes me so incredibly thirsty upon awakening. Now I could just tumble out of bed and would only be dehydrated for 30 minutes or so. That afternoon I received a call from the hospital telling me the schedule had to be arranged because there were two patients scheduled at 6:30. Guess who was moved from #1 to #5.  I had to be at the hospital at 8:30 so I would have plenty of time to put on a hospital gown, have an IV in place and spend hours yearning for a glass of water. My husband was allowed to join me after I was settled in. At least we had a TV in our little cubicle, but it froze during the Today show, and none of the attendants who came in and out had a clue why ours did this when everyone else's had moved on to the next show. My doctor's PA dropped by to check on me and to autograph my right leg to make sure they replaced the correct knee. My doctor dropped by between his #3 and #4 surgery to tell me I would go to get my anesthesia "very soon," and to also autograph my leg to make doubly sure they operated on the correct leg. Finally, I kissed my husband and travelled the maze of corridors to the anesthesia holding area. The anesthesiologist popped in to tell me he would be giving me my nerve block and to also autograph my leg - I guess three's the charm! I never felt the nerve block because the mild sedative they gave me through my IV knocked me out completely, probably because I was so dehydrated! It was late afternoon when I came back from "la-la" land. When I woke from the anesthesia my first observation was my right leg was swathed mummy-like in yards of gauze. There was a tube (a drain) leading from beneath the gauze to some unknown and unseeable destination, and some sort of machine was attached to my leg which moved my lower leg back and forth at a miniscule pace bending my new knee back and forth. Actually, all that was the second thing I noticed. The first was actually my husband's relieved face showing he was glad the surgery was complete and successful. I really didn't experience much pain as the nerve block I had was still continuing to work. I was hooked up to an IV with an antibiotic drip which probably lasted into the evening hours.  The therapist stopped by, unhooked me (with the help of the nurse) and escorted me into the hall with a walker where I strolled (well, maybe limped) up and down the corridor, but applauded as though I had just run a marathon. I did take this opportunity to use the bathroom. I learned very quickly that one should not bend the replaced knee to settle on the toilet, but rather bend the un-replaced knee and straighten the replaced one to lower yourself. Back in bed with my knee machine, IV, and an knee-icing contraption, I settled in for the evening. Still under the influence of the nerve block and with an IV pain killer, I spent a fairly restful night in spite of the comings and goings of the nursing staff.

Day 2
Days in the hospital begin early, and as the nurse told me, try to be awake by 6:00 because that's when the surgeon comes by, and he'll only be there 2 minutes, and he was right. I told the doctor that I wanted to exercise my option to stay in the hospital a second night - his response was that hospitals were for sick people and I wasn't sick, so I could go home that afternoon. You should be aware that insurance companies put pressure on doctors to "move 'em out," but you should exercise your rights, and spending a second night in the hospital if possible. If you stay, you have an additional day of PT, which in my case was an extended walk around the floor corridors, you have access to the machine that exercises your knee, and the nursing staff who if you are lucky to have a good one as I was, will refill the ice for your machine that helps with swelling, and will assist you in getting to the bathroom (or possibly help with the bed pan). Staying another day will also enable you to get IV pain reliever in case you need it after that 36-hour nerve block finally wears off, which is definitely preferable than waiting for an hour for pills to take effect. My surgeon told me he foresees knee replacement done as outpatient surgery within five years, but until that comes to pass, stay in the hospital a second night if you can.

Leaving the hospital
Before you leave the hospital, you will probably have a final visit from the doctor who will check your incision, and you'll be unhooked from the IV (if you're still connected) or have your port removed, your drain will be taken out and all that gauze that hides your leg will be unrolled and discarded. This takes awhile. Likely you'll be visited again by the PT for another stroll around the corridors who holds on to you by grasping the gaping ends of your hospital gown, performing two essential tasks at once. You'll be given some exercises to do at home. You'll also receive a visit from the Occupational Therapist, who, as far as I could tell, was responsible for showing you how to take a shower and helping you do that. If you have stairs that you have to negotiate at home, he/she will instruct you "up with good, and down with the bad." When you get your shower, you get your first look at your incision. Mine was not a "minimally invasive" surgery, so I had a six inch scar running down the middle of my knee cap. There will likely be lines marked on either side of your knee, which my husband figured out was to line up the skin when the incision was closed. Most incisions now are glued instead of stapled, and after the bandage was removed I found I had become "unglued" at one juncture and was leaking blood in a steady stream. Fortunately for me (not fortunately for my friend), I had a friend who had experienced this same thing, but he had left the hospital without completely stopping the blood flow. He ended up in the emergency room at 11:00 that night to be "re-glued" and had to go back to the surgeon the next day to again be "re-glued." I remarked to my OT that his surgeon (also mine) was extremely unhappy that he hadn't been contacted by the hospital staff about my friend's condition, so, of course, my surgeon was contacted. I was able to go by his office before I left for home to get a professional glue job. So, if this happens to you, be pro-active and get any thing taken care of correctly before you leave the hospital. Make sure you have all prescriptions in hand along with at-home instructions and exercises to perform prior to going to PT. It is always good to have this information in writing because no matter your mental abilities, it is helpful to have it in black and white and not just stored in one's memory. Most knee replacements are performed on people who have worn out the knee over the years, which means your mental abilities may have declined also, albeit at a slower rate than your knee. Anesthesia still probably lingers in your system, too, which can play havoc with your memory, too. 

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