Surgeries Part 3

When I talk about my joint replacements, I am talking about total joint replacements.  Total knee and total hip replacements are more invasive than partial joint replacements or other joint surgeries.  Just to clarify...

The first day of outpatient physical therapy after my knee replacements was pretty tough for me.  I wasn’t anticipating staying for a full session/workout that day, I hadn’t taken painkillers in over 24 hours, I had no idea what to expect for PT, and it had only been one week since I had been released from the hospital in the first place.

 

The first exercise I did was called wall slides.  I was lying on a table with my feet against the wall, knees bent about 90 degrees, and I slid my feet down and up the wall for several minutes.  The goal was to get my feet as low as possible so my knees could bend and stretch, hopefully increasing my range of motion each day.  My left knee still had staples in it, but they still wanted me to work it.  The skin was being pulled tight as I slid my feet up and down.  My knees were still terribly swollen and my incisions were so new, I felt like they were going to pop open and the staples were going to fly at me.  Enough of that image…

Staples holding things together

 

I don’t remember every exercise that I did, but I do remember there was a lot of bending and straightening my leg.  The worst part for me was when the physical therapist pushed down on my knees while I was lying on the table.  As if that wasn’t enough, immediately after that, they put ice packs on my knees and prop my feet up in “swiss cheese” blocks, putting the bend of my knee at zero degrees, hook up the electrodes, and let me hang out for 10 minutes while the backs of my knees were yelling at me to stop the madness!  And!  I did those exercises twice a day at home!

Time went by, I got the staples out of my other knee, I continued to go to physical therapy three times per week, did exercises at home, walked around with a walker for several weeks, had a birthday, increased exercises, increased range of motion, decreased the need for pain meds, went back to work, and finally was able to walk without crutches or a walker.  For a couple of weeks…

One day at physical therapy, I was lying face down on a table with my legs hanging off the back.  The physical therapist added weights to my ankles to weigh my legs down and increase the stretch on the back of my knee.  My hip started hurting during that exercise.  I guess it was just stretched a bit too far that day.  I expected the pain to go away, just like other pains when I overexert myself.  But, weeks went by and it didn’t.  I started to hunch over again and walk with my knees bent which hindered the healing process of my knees.  Scar tissue was building up behind my knee and I couldn’t straighten them again.  I started walking with crutches full time again.  I saw my orthopedic surgeon again, and in October 2008, I had my first total hip replacement.

Most people who have experienced both hip and knee replacements will say that the hip replacements are much much much easier to recover from.  There isn’t much range of motion that needs to be gained or exercised.  The best physical therapy you can do with a hip replacement is walking.  Walk, walk, walk.

I wish I could say that my first hip replacement was “easy”, but it just wasn’t.  I would almost go so far to say that it was the worst surgery I have been through, and here’s why.  My knees were replaced just 4 months earlier and because I was walking hunched over and scar tissue had built up, that scar tissue needed to be “broken up” so I could straighten my legs and walk normal again (or at least as normal as someone with RA deformities in their legs can walk).  It’s a simple process.  The doctor or physical therapist simply pushes down on the knee as hard as possible to break that scar tissue.  It’s extremely painful.  Sometimes the patient will even pass out from the pain.  My physical therapist told me many times that if I pass out, he will just push harder on my knee and get ‘er done.  I never passed out and I always told him to stop before it got to that point.  I usually ended things in tears, but not unconscious. 

While I was in the operating room and under general anesthesia for my hip replacement, the surgeon popped my knees and broke the scar tissue while I was out and not able to feel it or remember it.  Now that I had my hip replaced and the scar tissue broken up from my knees, it was like I was restarting knee replacement recovery all over again.  The physical therapist in the hospital did the same exercise as before, except I couldn’t bend my hip more than 90 degrees for fear that it would pop out of place because the ligaments around the hip had been stretched during surgery and they weren’t holding things in as well as they used to.

One problem I had with hip surgery was with a drain tube in my leg.  They insert a drain tube near the surgery site to help any residual fluid and blood drain into a collection bag.  In order to empty the bag, the nurse needs to clamp off the tube so it doesn’t make a huge mess.  After one of the nurses emptied the bag, she forgot to unclamp the tube, and I felt a lot of pressure and buildup after a couple of hours.  We didn’t notice that the tube was still clamped until after I had already been in an increased amount of pain and we couldn’t figure out why.  Even though the tube got unclamped, it didn’t relieve any of the pressure or pain associated with it.  I had to have a portable toilet brought in my room and 4 nurses had to help me go 2 feet from my bed just so I could go to the bathroom, the entire time I was screaming in pain.  This went on for 2 days in the hospital.

Before that, I was able to stay on top of my pain with Lortab and Percocet, but it was just too intense and I had to take Morphine just to get through the next 30 minutes.  I couldn’t sleep.  I couldn’t eat.  I was feeling sorry for myself that I was a 24 and had already gone through three total joint replacements.  I was absolutely miserable.

I was released from the hospital and went home on Halloween in 2008.  I continued to go to physical therapy for my knees.  I went back to work after only a couple of weeks, and even though I was on pain meds and not feeling like my best self, I was still able to accomplish all I needed to.

My doctors and physical therapists stressed the importance of doing daily exercises to increase and maintain the range of motion in my knees.  Especially keeping the ability to straighten my leg to zero degrees.  I have a friend who had a total knee replacement (well actually total knee and thigh bone replacement were done because of a tumor), and her physical therapist didn’t stress that enough.  She has scar tissue built up behind her knee so she is unable to straighten her leg to zero degrees and she walks with a limp because of it.  I am grateful that I had such wonderful physical therapists that helped me achieve the goal of zero (or nearly zero) extension in my legs.  I didn’t appreciate them at the time, but I definitely do now.

I will say it again, I sound like surgery and physical therapy are horrible things.  While I admit, they are very difficult for a short time, the long term benefits have been absolutely magnificent!  I can walk upright.  I can bend over.  They have given me a much better quality of life.  I just had to get through those first few months.

I can smile about it now :)

Riley