Bilateral Total Knee Replacement (both knees)

BILATERAL TOTAL KNEE REPLACEMENT

Sections

1. Introduction – My History
2. My Intention
3. The Hospital
4. Monday – Friday in the hospital
5. Weeks 1 – 16 after the surgery and beyond
6. Bilateral specifics
7. General Info
8. I wish
9. Tips
10. Thoughts to get me through this
11. Chart showing my transition from Vicodin to Tylenol & then Ibuprofen

1. INTRODUCTION – MY HISTORY

Hello and welcome to the story of my bilateral knee replacement surgery and recovery.

I am 61 years old and I was and am in moderately good physical shape – except for my knees. We renovate houses so that has kept me physically active but bum knees do not do well in this kind of work. Here is my story.

July 2007
My left knee buckled for the first time. I went to see Dr. Bond who was the orthopedic doctor who had treated my broken wrist three years earlier. He x-rayed my left knee and it did show signs of wear on the inside.

September 2008
I went back to Dr. Bond because now my right knee was rubbing and hurting. He x-rayed both knees and they were both worn down on the inside edges – bone on bone rubbing. Since I was 60 years old, I would not have Medicare for 5 more years and he said that I wouldn’t make it that long. I had several more appointments with him and we began talking about the possibility of having both knees done at the same time. He played the devils advocate and told me all of the reasons for not doing it this way (longer surgery, increased possibility of infection and blood loss). I got permission from him to speak to a woman (Nancy) who had both knees done by him several years ago. Nancy encouraged me to go for it. She was doing really well and was very glad that she did both knees at the same time. She forewarned me that she got depressed during the second week – I had read this somewhere online also.

In mid November, my right knee buckled. At my visit with Dr. Bond in early December, I told him that I wanted to proceed and have the surgery. Since I am one of the many uninsured in our great nation, I filled out financial aid paperwork at our local hospital. Three years earlier, they had covered the cost of my broken wrist 100% so I was hoping for the same. Unfortunately, they couldn’t tell me exactly how much they would cover until they had a dollar amount to work with but the term 100% was mentioned. I decided to proceed with the surgery on the faith that I would get this 100% coverage. The surgery date was set for January 26, 2009.

(April 17, 2009 – I received a letter from the hospital today saying that they are covering 100% of my hospital bills, which are around $42,000. The surgery ended up costing me personally around $750 for the CPM machine rental, the x-rays, the radiologist and my prescriptions. I feel very thankful.)

One day I had a good cry about the fact that I was going to be loosing my birth knees since they have supported me for my entire life. I felt better after the cry.

About a month before the surgery, I ordered a book online called Total Knee Replacement Surgery and Rehabilitation by Brugioni and Falkel ($19.95 new). I wish I had ordered this book sooner but I was thrilled to have it. I HIGHLY RECOMMEND getting this book at least one or two months BEFORE your surgery. My doctor now plans to order this book for his patients.

I began doing the pre surgery exercises suggested in the book to build up my muscle tone, which had really begun to atrophy. Doing the knee and leg exercises before the surgery would help my body know and remember what was expected of it after the surgery. I also strengthened my arms and they got strong enough to raise my sitting body about a half-inch up off of the seat of a chair. I am glad that I developed these muscles because I have definitely used them.

I chose to have this surgery done sooner rather than later. I was getting much more sedentary and I was aware that my legs were loosing more and more muscle tone. I was hobbling around and hurting so I didn’t see any reason to wait. Especially after my doctor said that many artificial knees were now lasting for 30 years – I was 61 and that seemed good enough for me.

I feel like I want to address the fact that according to EVERYONE who worked with me, my recovery went amazingly well. I asked my doctor why he thought I have done so well. He said that he thought it was because I was the most psychologically and physically prepared patient that he had ever done surgery on. I was physically prepared because I did all those exercises before the surgery, I am only 61, I am not overweight and I was in decent shape except for my knees.
I was psychologically prepared because I really wanted this surgery and I wanted both knees done at the same time. For me this was a fantastic decision. I wrote my intentions (see below) and that set the stage for a positive recovery. I also asked many friends to send me good energy and prayers as I recovered. (If you ever have surgery, I hope that it goes every bit as well for you.)

I am not religious but I am very spiritual. I believe that what I think assists in shaping my reality. (If this doesn’t seem possible to you, go to http://www.masaru-emoto.net/english/e_ome_home.html and look at the photographs of water droplets that change from being very beautiful to very distorted as people focus either positive or negative thoughts on the water. If our thoughts can affect the beauty of a water droplet and my body is about 60 percent water and my brain is 75% water, then I think I will play it safe and do my best to think positive thoughts. What can it hurt? My intentions reflect this positive way of envisioning my future.

It got hard waiting for the surgery to happen – I was ready to get it done. As I waited, I worked on what my intentions were for this surgery. I am very glad that I spent time doing this. I share it with you below – please feel free to use any part of this if you feel that it speaks to you.

2. MY INTENTION:

My intention for my surgery is that it goes completely smoothly. My body will have a healthy blood supply flowing freely, healthy lungs with breath that comes easily supplying oxygen for red pulsing tissues, and a strong, nausea free stomach. I will have perfect Susan-like knee implants with the cement forming a strong, long lasting “Bond” thus allowing these new knees to support my active body until I pass over. My intention is for fast healing knees, free of infection; supported by a strong immune system and other needed supports. My new knees will have maximum range of motion and flexibility and amazing strength to carry me in health. I intend the doctors’ hands to be guided by the angels to maximize my body, mind, emotions and spirit. I wish for my doctors and staff that everything go smoothly with the highest grace possible and I hope that when they are done with the surgery that they can say, “Wow – two at once – that was a great surgery – and it all went really well!” Or something better!
(Please note that my intention is stated in positive terms. My spiritual belief is that God/Goddess/Great Spirit hears only positive intentions. So, if I had said that “I wanted to have no nausea” – that could be interpreted as “I wanted to have nausea”. It was also a VERY good experience to write down what I wanted rather than what I didn’t want.)

I talked to my doctor before the surgery about having FUN during my operation. Dr. Bond and another doctor (Dr. Roberts) were to be my surgeons. My doctor told me that he and Dr. Roberts were talking the week before about how much they loved to do the surgeries but also how boring it would get when they finished one surgery and had to just sit and wait while the operating room was prepped for the next patient. They were excited about my surgery because they got to do two in a row. I asked my doctor to tell Dr. Roberts that I wanted him to have a good time as well. When Dr. Bond came out after the surgery to tell my partner, Kathy, that everything had gone very well; he also told her that they had FUN!

My 2008 December Birthday Horoscope
You’ll be disengaging yourself from unproductive activities in favor of taking new paths of promise.

MY BILATERAL KNEE REPLACEMENT SURGERY!

3. THE HOSPITAL

I asked that friends NOT come to visit me while I was in the hospital and this turned out to be a good decision for me. My room felt like a constant bustle of traffic – nurses, aides, the doctor, Physical Therapists, dietitian, finance office personnel, glucose testers, etc. A visit in this situation would not have been very pleasant and I didn’t need to expend any more energy than I was. I also asked that people not expect me to return emails for about 3 weeks after the surgery and that was a good decision.

I was glad that I brought my eye mask to the hospital with me. At night there were many small lights all over the room and I am used to sleeping in the dark. If you like a dark room, bring a mask or use a folded bandana or rag to cover your eyes. It is hard enough to get enough sleep in the hospital so do whatever you need to do to make it as easy as possible.

4. MONDAY – FRIDAY IN THE HOSPITAL

January 26, 2009 Monday – Surgery
I was in surgery for about 3 hours. I don’t remember being in the recovery room – my first memory was being in bed in my hospital room. I had an epidural, which was supposedly better for diabetics and it did not cause me to be nauseous afterwards. I was on a morphine pump and I hit that button whenever I felt that I needed it. It turns out that they used identical knee implants for both of my knees and that seemed to please my doctor. I didn’t care as long as it was the best implant for me.

January 27, Tuesday
I stood in the morning and walked a few steps – it wasn’t too bad. This had been my biggest fear – the first time that I was supposed to stand on both legs. Of course I was on morphine, percocet and one other pain drug – thank goodness! I had some physical therapy (PT) that afternoon and was told that I did very well. Everyone was very pleased with how good I was feeling and how well I was doing.

January 28, Wednesday
They put me on a CPM (continuous passive motion) machine, which moved my leg up and down so that the knee would bend. I could control the degree of the bending. I was on this machine for 2 two-hour sessions on each knee every day or 8 hours a day. This sounds uncomfortable but it actually felt pretty good – boring but good. When Dr. Bond came by to see me, he told me that I was his poster child for bilateral knee surgery!

January 29, Thursday
I had been on an IV since the surgery and it was removed today. This IV was delivering morphine, antibiotics and other needed stuff. I had donated my own blood before the surgery (good idea to do so). They didn’t use it during the surgery but they ended up giving it back to me because my iron count was low. It was so freeing to be IV free!
I was able to bend over to get something off of the floor before the surgery and I was also able to do this today. The surgery did not affect my ability to bend over. (I had been curious about this.)

January 30. Friday
I came home. I rode sideways in the back seat. I wore my nylon pants because I had read that nylon pants would allow me to slide across the seat easier than other fabrics and that was correct. I leaned on two pillows behind my back against the rear side door and I had one pillow under my legs. The 25-minute ride went very well. Later that day the CPM machine arrived. I was so blitzed on the percocet that I was happy to lay for 8 hours a day with my eyes closed. I got to where I could occasionally fall asleep while on the machine. Kathy of course helped me get my leg into and out of the machine.

NAUSEA
The best solution that I found for nausea that was caused from the Percocet or Vicodin, was to eat 2 saltine crackers (I prefer whole wheat) before the pill, take the pill, and then eat two more saltines. I drank water with each cracker. (More Nausea info in the TIPS section.)

5. WEEK 1 – after the surgery week

February 1, Monday
The home health nurse came and took blood for the coumadin check. I was walking to the bathroom to use a potty seat that was over the toilet. I ate meals in bed.

February 3, Wednesday
The home health physical therapist (PT) came and I got a series of exercises to do in bed. I did them with her for this first time.

The home health nurse came for the next two Mondays to draw blood to check my coumadin levels. The PT came about once a week and her last visit was on Feb 18, which was the middle of week 3. She could have come more often but I was trying to save the hospital (and possibly me) money. I was also doing well and was able to do the exercises without her being present so it seemed to me to be a waste of her time for her to come more than once a week.

Knees with staples – it looks worse than it felt!

WEEK 2

February 12, Thursday
I went to Dr. Bond’s office and had the 49 staples removed. Each knee has about a 6-inch incision. I didn’t know how much better it would feel with the staples gone. Steri-strips were put across the incisions. These were to stay on until they fell off – usually about 2 weeks. The ride into town made me a little nauseous – I rode in the back seat and I was sitting sideways so I think that is why it caused me to feel queasy.

February 14 Saturday
I didn’t mind the CPM machine. The percocet had me so blitzed that I was happy to just lie there and let the machine do its work. This was good because I was not able to be doing much else anyway so it was a win-win.
I was now able to get myself into and out of the CPM machine. This means that I could be at home alone for a longer time during the day. Kathy usually fixed my lunch so that I could just go and get it myself.
I carried our portable phone with me WHEREVER I WENT! Better safe than sorry!

February 15 Sunday
When I woke up today something seemed wrong and then I realized that I was depressed. I was tired of all of this knee stuff – like the TKR book said – recovering from TKR occupies you 60/60/7/24/4 or 60 seconds every minute, 60 minutes every hour, 24 hours every day and 7 days a week for at least 4 weeks. I cried and felt sorry for myself – that made me feel better. I did remember that Nancy and someone online had mentioned getting depressed at around week two so I was right on schedule. (I never had any other bouts with depression during my recovery.)

I still had no interest in reading (I am an avid reader) or watching TV – I guess because of the Percocet.

WEEK 3

February 17, Tuesday
They came to pick up the CPM. I had canceled it on the 13th but it took them a while to pick it up so I continued using it for free for those few days. (I had it for 2 weeks at $150 per week – my cost)

February 18 Wednesday
Today was my last PT at home. I had 94 degrees on my left knee and 99 degrees on my right. I was at 4 degrees with my legs straight out.

February 19 Thursday
I saw Dr. Bond today and this time I rode in the front passenger seat. This was much better for my stomach. I have a PT Cruiser so the seats are up fairly high. I would not have liked trying to get in or out of a small car. I got a prescription to go to outpatient physical therapy and I got permission to remove the steri-strips. Kathy and I went out to lunch – my first outing!
I chose a restaurant with a booth so that I could sit down sideways and then slide into place. I could also use the table and the back of the booth to help me stand up – it all worked very well and I was very happy to be eating out! I am still using the walker. I got a prescription from Dr. Bond for Vicodin.

February 20 Friday
I did make the switch to Vicodin and I am much happier. I don’t have as much stomach upset and my mind is much clearer – YEAH!

Boredom has definitely set in. I am not a daytime TV watcher but I can now tell you the latest from Dr. Phil, Ellen and Oprah!

WEEK 4 – ONE MONTH

Feb 23, Monday
A friend of ours died last Friday. She had a very nice walker and her partner offered to lend it to me so Kathy brought it home today. I felt like I had gone to walker heaven – it had 4 wheels and a basket and a seat and it was hunter green. It made life much better since I could transport items so much easier plus I could sit down anytime I needed to do so.

Feb 25, Wednesday
Kathy drove me to my first outpatient PT with Melissa who was very nice and seemed to be an excellent PT. Today we did mostly assessment. She did say that since I was doing so well that I might not need to use the pool, which really bummed me out. I told her how much I was looking forward to it. She had me attempt to balance on one leg and I could only do it for 3 seconds on each leg. I tried it again the next day at home and got to 20 + 30 seconds – much better. Regaining my balance will help me walk without the walker. Kathy and I went out to lunch again – this time I just sat in my new walker seat at the end of the table and it worked great.

Feb 26, Thursday
Went to PT again – climbed stairs – did stair lunges, used a step machine, walked unaided for a good distance, talked with her again about using the pool and she said that she thought we could do it. I now had many more exercises to do and I did them all twice a day. When I did the stair lunges at home, I had a handrail on the right side only and I felt unsteady. So, I used my cane on the left side and put the tip of the cane in the corner of a step above and then I felt more balanced.

This was the first day that I tried using Tylenol rather than Vicodin. It was OK at first but by the 4pm time I was hurting so I went back to the Vicodin.

WEEK 5

March 4, Wednesday
I got to go into the hot (90 degrees) pool today. It was fantastic! I had read that the warm water would feel really good and it did! I was able to stretch my knees further due to the buoyancy and the warm temperature. The therapist forewarned me that it is easy to over do it. I did over do it just a little on my left knee because it hurt more than usual that afternoon – but it was worth it! I drove a little today – just from the restaurant to the grocery store and it was OK.

March 5, Thursday
I tried Tylenol again this morning – same experience as before. I will just keep trying this weekly until the Tylenol takes care of the pain! Today Kathy was gone and I actually spent more of the day up rather than in bed – this was the first day that I had done this. When I say in bed, I am sitting upright in the hospital bed with my legs extended. The TKR book suggested retrofitting a recliner by building it up several inches higher so that the patients can get up and out of it by themselves. This would have allowed me to sit in the recliner in much the same way as I sit in the hospital bed. We did not do this to and I WISH WE HAD DONE I T. This would have allowed me to sit comfortably in the living room as well as in my bedroom.

March 6, Friday
Today in PT, Melissa really pushed down on my left knee during a stretch and it hurt – I had to finally tell her to stop. She did this several more times (this is her job) and each time she went until I just begged her to stop. I was almost ready to cry and I’m not willing to put up with that kind of pain. However, my left knee went from 94 degrees before the extreme stretching to 107 degrees after which made it the same as my right knee. That was pretty amazing. She had me walk quite a bit with only the cane. I had wondered about how I would use a cane since I had both knees done. Someone had said that I might use two canes but this seemed like an accident waiting to happen to me. Melissa had me try using just my one cane and I automatically put it in my right hand since I am right handed and that then gave more support to my more troublesome left knee. It felt safe and good to use the cane this way. I drove some more today and I think that next week I will be able to drive myself to and from my PT. It seems that every time I go to PT, I get new exercises to add to my regimen.

March 6, Saturday
At home today, I used the cane and did not use the walker at all. YEAH! Another big step!

WEEK 6

March 9, Monday
I drove myself to PT and everything was fine. I had a different Physical Therapist today. She had me walk on a board way with handrails on each side and I had to step over plastic orange cones. As I was doing this, I realized that I could not tell where my feet and legs were in relation to the cones. I mentioned this to her and she explained that I had lost the proprioceptors that had been in my kneecaps. These proprioceptors help the body maintain balance and provide relationship between the body and the rest of the world. She said that my body would learn to adjust to this. This information was so interesting and it certainly made sense! Many of the balancing exercises are designed to realign these proprioceptors and this is a big part of relearning to walk after the surgery.

March 12, Thursday
After PT today the bend of my left leg is 102 degrees and my right leg is 117 degrees. My left knee extension (straight out) is 6 degrees and the right is 2 degrees. It is important to get this extension number as close to zero as possible so that the artificial implant parts ride on each other properly.

I stopped by to visit a friend on my way home today and she noticed that I didn’t have any wrinkles. I looked in the mirror and she was correct – no crows feet, no mouth lines, nothing. (I later asked Dr. Bond about this and he said that my face must have still be a little swollen. A friend of mine had surgery a few weeks after I did and she had the same experience – she lost her wrinkles! So, if you have ever wanted to do a Glamour Shot – this might be the time to do it!)

WEEK 7 – boredom is still very present

March 16, Monday
Today for some unknown reason, I was nauseous most of the day – from 9 am to 4pm. Kathy was in town and so I asked her to buy some Pepto Bismol for me. I had never taken this but it did work and I finally felt better.

March 20, Friday
My left knee is 109 and my right is 116 degrees. The boredom of the last 6 weeks is definitely lessening since I am able to be up and about more. I continue to do exercises twice a day for about 1½ hours each time.

March 22, Sunday
I went to my first “away from our house” social event tonight. It was somewhat difficult. I was not comfortable standing around the potluck table so I missed some socializing. This was not unusual – apparently sitting and standing comfortably take longer than just walking. I had been to this home before so I knew that their toilets were not handicapped height so I took my donut style toilet raiser with me – luckily, I didn’t need to use it. After 2 ½ hours, I was ready to stay but my knees were saying, “take us to bed!!!” So, we left a little early.

WEEK 8 – TWO MONTHS
March 24, Tuesday
My last prescribed PT session was today but Melissa had contacted Dr. Bond and talked with him and they are extending my PT for two more weeks. I am glad because I want to make more progress. Today she had me go outside and I walked a lot without my cane – she carried it in case I got tired. This rehab facility is housed in what used to be our old Lowe’s store so when we were walking outside, I was walking on the cement where we used to buy 2×4’s and other lumber – sort of a strange déjà vu.
I am barely using the cane at home and I am using the stationary bike several times a day for 5 – 10 minutes each time.
I saw Dr. Bond today and he says I am doing great. I will see him again in a month and then not for a year. I asked what happened to the bone dust when they cut my bones. He said that they flushed the area with water and that probably a little bone dust stayed in my knees. As a woodworker, these things intrigue me.

I am currently taking ½ Vicodin every 6 hours. At 10am, I took 2 extra-strength Tylenol and it worked pretty well. I will try doing the Tylenol during the day if I am not out and about.

March 25, Wednesday
Today I drove over an hour each way to take Kathy and her mother to the airport to fly to Texas for 4 days – I will be home alone and I feel that I can handle it. We stopped at three thrift stores and I went into each one. All in all I was gone for 5 ½ hours, which is my longest outing so far. I came home, grabbed a quick dinner and gladly crawled into bed.

WEEK 9

March 30, Monday
I over did it today. Suddenly it was 4:30 and I had been up all day and I should have taken my Vicodin a half hour earlier. I was hurting. I went to bed and took the Vicodin and rested. We were going to a meeting tonight at 6:30 and I wasn’t sure I would feel like going. It was amazing – a half an hour of rest, some pain meds and I was good enough to go. Luckily, we were home by 9PM so that was good for me.

March 31, Tuesday
I could tell today that I over did it yesterday. I’ve felt sort of sluggish today. That was a good lesson for me to learn.

SIDE NOTE:
I am becoming more aware of what a long, slow recovery this is going to be. Looking back now I see that at first, I made huge strides in a relatively short amount of time. Now, I am making teeny, tiny strides and so the process seems to be taking a longer time. I’ve read that it will be a year before I feel free of issues from the surgery. I can see now that this is probably accurate. It happens to be spring now and I have a several blooming trees outside my window. I identify with them as I watch them make their teeny, tiny steps from bud to flower to full green leaf. I look forward to my own upcoming changes.

I am not using the cane at all at home but I still take it if I go anywhere else. I ride the stationary bike whenever my knees feel stiff and uncomfortable. Sometimes in the middle of the night I will hop on it for a few minutes and then I sleep more comfortably. I continue to do all of my exercises twice a day. I do some in bed and others in various parts of the house.

The stiffness from the scar tissue is such a strange feeling and it is very pervasive within my knee so I am glad to have the bike to help with this. This stiffness feels like my knees are filled with styrofoam that doesn’t want to move. I still need to use a handicapped height toilet in public and at home (thank goodness for potty seats!).

April 2, Thursday
I tried two Tylenol this morning and it just didn’t do as well as the Vicodin. My knees ached more and felt a lot stiffer so I took my ½ Vicodin before I went to my afternoon PT session. On my way home I stopped to visit a friend. Eventually, I needed to use the bathroom and she does not have a handicapped toilet. I decided to risk it and I was successful. Now, I did need to use both of my hands to get down onto the seat and up off of it but I did it! This felt like a real milestone – YEAH!

April 4, Saturday
Today was the first day that I did not do any exercises – well, I did ride the bike and I did a few stair lunges to limber up. I usually do the exercises right after breakfast but today we went to yard sales and I decided that after 9 weeks, I could take one day off and I enjoyed it.

WEEK 10

April 7 – Tuesday
Today when I went to PT, I found that I have lost range on my knee flexion. I lost 8 degrees on my right knee and 4 on the left. My extension was about the same. I had switched from doing my exercises (usually) twice a day to only once a day. I guess I have learned that twice a day is needed now – plus I took Saturday off. I was disappointed. I wish I liked exercising more but I can’t say that I do but I like me and so this is what I need to do for me for now. I asked how long I would need to exercise and she said about a year. Oh well, this too shall pass.

April 8 – Wednesday
Today I really exercised – so much that my left knee was a little sore. I hoped this would help!

April 9 – Thursday
Today was my last day of therapy. It was a sad/happy mixture. I felt sad because I am now on my own and happy because this was another milestone. I had better numbers today. My left knee was 110 degrees flexion and 3 degrees extension. My right knee was 116 and 0. I had achieved all of the goals that the PT had for me. She said that they wanted me to be at least at 110 flexion and less than 4 extension before releasing me so I was there. They did their goodbye ceremony for me – they blew bubbles on me and gave me a t-shirt since I didn’t miss or cancel any appointments.
I took 2 Tylenol at 4pm and it worked pretty well so I decided to try it for my 10pm night med. I have heard that nighttime can be more painful but I was ready to try it. Well, bad decision. At 2am I was still awake and hurting so I took ½ Vicodin and finally fell asleep around 3am.
I will keep trying to wean off the Vicodin.

April 10 – Friday
Just as I set my Intention for my surgery, today I realized that I could also set my intension to assist my exercise routine. So, here is my intention:

“My intension is that for any exercise or movement that I do today; that it greatly increases the flexion/extension/ balance and/or strengthening of my knees and legs – or something better!”

(I have continued to say this intention every morning for the day ahead.)

WEEK 11

April 20 Monday
Today I choose to not take my 10am Ibuprofen because my knees seemed to be feeling much better. It worked pretty well but I was ready to take one again at 4pm. I still took a half a Vicodin at 10pm.

I lowered the seat on my stationary bike about an inch because it wasn’t stretching my knees anymore. This seemed to be a confirmation that I was gaining range of flexion. I missed having a PT to measure that range.

April 22 Wednesday EARTH DAY!
Today I removed the raised potty seat from over the handicapped height toilet in the bathroom. I could get up and down fine – I used my arms and the furniture on each side of the toilet to help raise and lower my body.

April 23 Thursday
Today I saw Dr. Bond for my third and last visit (for a year). I asked him how much the implants weigh and he said about a pound each. I gave him a copy of My Intentions and told him that I thought the reason that I had done so exceptionally well was due to my believing in my intentions. I suggested that he read it later and he said that he would. He reminded me that I couldn’t do things like jog or play high impact sports. Good – I have no interest in those things anyway. I can walk, hike and swim which I love. He added, that if a bear chased me, I could RUN! We have bears in this area so I was actually glad to hear that. So, I will see him in a year!

I also stopped by the PT place to get measured. I had asked if they would do this for me. My right knee is now 117 and my left is 112 so I have gained a little more flexion.

This is a photo of my knees at about 3 months – lookin’ good!

WEEK 12 – THREE MONTHS

At three months, I feel like I’ve rounded a bend.

Up until this week, I still had to consciously put my right foot directly in front as I walked – it wanted to swing out to the right – it seemed to have a mind of its own! Now, my right leg is walking much better. I’ve tried to be aware of how my legs have been moving. I’ve also encouraged friends to give me feedback if they see me walking oddly. Several did and I appreciated it!

In the hospital, when I first stood on my new knees and walked, I remembered that I had read that, “I would need to learn how to walk again”. However, right then I thought, “I am walking so I won’t need to relearn that”. Well, I was wrong – the relearning is subtle but it is definitely there. I thought the relearning to walk part of my recovery was an interesting experience. In my PT sessions when I had to step over and around orange cones, I enjoyed feeling like a kid as I was learning something new.

It’s amazing how these fake knees feel pretty normal. I get a sense of the metal aspect when I cross my legs or when I am laying on my side with my knees touching. In both of these positions my new knees feel more metal like than my old bones! But, all in all, I have found it amazing that the implants feel so natural.

May 1 Friday
Last night I slept totally flat for the entire night – this was another first! I had been sleeping with the hospital bed slightly raised at the head and just a tiny bit at the knees so this was a welcome transition.
Today was also the first time that I skipped my 4am and 10am dose of Ibuprofen. By 3:30 pm I was pretty achy so I took the Ibuprofen.

May 2 Saturday
Last night was the first time that I did not take any meds at 10pm before I went to sleep. I also slept again with the bed flat and everything was great!
If I sleep on my side, I tuck some of the bedding between my knees to soften the pressure.

WEEK 13

May 3 Sunday
This was my first day to not take any meds. YEAH!
I can get up from some seats without using my arms but I still need to use my arms to get myself up from a standard dining room chair.

May 8 Friday
It had been cool and rainy for several days and I felt achy so I took one Ibuprofen around 11am. Last night was the first night that I slept back in my own bed and I did great – it sure felt good to be back in my bed!
I continue to do from 1 – 2 hours of daily exercises. My knees feel better after I exercise so I am motivated.
I saw an acquaintance in town the other day who had knee surgery before I did. She felt that she still wasn’t doing very well. I asked her if she still exercised and she said, “No, I know that I should exercise, but I just can’t make myself do it”. Now, she could CHOOSE to make herself do it – I believe that we always have choices. I still don’t like doing all of those boring exercise but I am motivated to come out of this experience stronger and healthier so I will do these exercises as long as they are benefiting me.

WEEK 14

May 11 Monday
I have been taking an occasional Ibuprofen when I have felt achy. The cool temperature and rain have made my knees feel achier than when it is sunny and warm.

May 15 Friday
The hospital bed was removed from my bedroom today and it felt great to have my room back. Of course I still have an exercise bike, a balance board and a raised cinder block (stair step exercises) in the room but getting that huge bed out was wonderful.

WEEK 15

May 20 Wednesday
I stayed up today until 9:30 pm and I was still not really tired. This is the latest that I have stayed up rather than getting into bed for the evening. I am feeling more energized.

I still have a hard time standing still (this is still normal) – I shift and raise one leg and then the other and somehow that makes it better.

WEEK 16 – 4 MONTHS

Standing is still not comfortable, I still do exercises once a day for about an hour, my weight has remained steady with only a gain of 2 pounds, I still rest mid-afternoon for 10 – 20 minutes, I now stay up until bedtime, my energy is almost back to normal, I can cross my legs at my ankles and at my knees, I continue to apply the cocoa butter several times a day and I am still using the original tube, I still walk very carefully, my right knee occasionally wants to swing out so I am always aware of it as I walk, I feel that my range of flexion is slowly increasing, I still don’t like to exercise but I do – I now take one day a week off, my balance has definitely improved but there is still room for more skill there, when I sleep on my side, I stuff some of the covers between my knees to cushion them,
I don’t take my cane with me in public any more, and I use the electric chairs at big stores if I have a lot of shopping to do – the cement feels to hard to walk on for long periods.

WEEK 24 – 6 MONTHS
Almost everything has continued to improve. Standing continues to be uncomfortable but I’ve read that this can take up to a year to improve.
I still exercise 6 days a week for about 45 minutes, my weight has remained the same, I no longer rest mid- afternoon although I do sit down periodically if I have been walking about for a while, my endurance is still somewhat compromised but I continue to see improvement, I apply the cocoa butter to my scars several times a day (still using the original tube), I can now sleep comfortably on my side with my knees together, I no longer use the electric chairs when I go shopping (unless I am really tired after a long day) and my right leg still wants to swing out when I am tired so I continue to be aware of that. My flexion has had no increase from what it was at 3 months even though I exercise daily. This is disappointing but I still believe that I can gain more range (112 degrees – left knee and 117 degrees – right knee).
I can finally walk up and down stairs bending both knees although my right knee still pops sometimes when I use the stairs.
Walking finally feels more normal – I don’t need to think about every step any more – YEAH!

ALMOST TWO YEARS

I am extremely happy with my new knees. At 14 months I actually gained more range in my left knee. I knew this because I was able to get out of our truck without having to scoot my body toward the middle of the bench seat. I was measured and I had gone from 112 to 115 degrees! I accomplished this by just being physically active.

Here is a photo of my new titanium knees!

TWO YEARS AND THREE MONTHS – just a few more bits of info

I am 63 now and I hiked 3 miles (half of it uphill) the other day and felt fine afterwards. (The waterfall was well worth the hike!)

I live in the country and when I used to walk along our driveway, I would kick away sticks away that had landed in the driveway. After the surgery, I was uncomfortable doing this kind of kicking. Now, it is fine – I can kick a stick off the road just like I used to do.

I saw my doctor recently for my 2 year check up and everything is great. I chose to not have him do any x-rays. My knees feel great, so why should I expose myself to the x-ray radiation. Luckily he is a great doctor who allows me to participate in the decisions about my body.

Both knees have maintained their fairly equal range of motion and I can do everything that I want to do.

I hope that this information has been useful for you. Feel free to email me with questions and I will do my best to answer them!

ALMOST 6 YEARS

It has been almost 6 years now and I am still doing great. Having both knees replaced was a great decision. Standing is still not very comfortable but since that is my only complaint, I feel very lucky.!

6. BILATERAL SPECIFICS

I didn’t find very much to read online about bilateral TKR so here is a hodge-podge of my thoughts about it.

It was interesting that my two knees responded differently to the surgery. My right knee was generally less troublesome and further along in therapy than the left. My left knee generally felt much stiffer and achier, but when I got to stair exercises, my right knee was more resistant – it sort of popped when I did the work. As I build up my muscles, this will lessen.

Another aspect of bilateral is that I had to do the exercises with each leg so that doubled my time spent doing exercises. It was still is a lot less time than the amount that would be spent in physical therapy with two separate surgeries. I was glad to be strengthening BOTH legs.

I have never regretted doing both knees at the same time. I was lucky that my weight of 149 pounds (5’5 tall) was pretty good. Supposedly one pound of body weight puts four pounds of pressure on the knees. I am consciously eating less since my surgery to maintain my lower weight of 138 pounds and so far, I have gained only 2 pounds!

7. GENERAL INFO

By week 9, I started being up most of the day but even now (week 13), I take a rest in bed around 4 or 5 pm. I stay for a half an hour or so and then I am ready to stay up until early evening. I am usually in bed by 8pm and we watch TV or I read until bedtime. I’ve never experienced a culture that has siestas but a late afternoon siesta sure feels good to me. If I had a recliner rocker in the living room, I might choose to rest there – the important thing is that my legs are able to stretch out and my body can relax. It will be a big milestone to reach when I am able to stay up all day – but I am not going to hurry this healing.

I learned that 145 degrees is the bend for a normal, healthy knee. Just FYI.

As I have been recuperating, spring has blossomed outside my window that looks out onto woods. Since the view is up about 20 feet, I see a lot of tops of trees that are blooming. I have closely watched a Sarvis berry tree and then a Dogwood bud out into beautiful white flowers. They remained open and gorgeous for weeks and now they have lost the blossoms as green leaves have begun to sprout out. I feel like the process has mirrored my own renewal as I have changed and adapted to my new bionic knees.

8. I WISH!

I wish that I had measured how far back each of my knees would bend before the surgery – just out of curiosity to see how it compares to where I am now. I would have sat in a chair with my back against the back of it. I would have tucked my feet as far under as possible and then measured from the tips of my toes to the front legs of the chair on each side.

9. TIPS – not in any particular order

* Have the knee surgery done SOONER rather than later.

* Go into this surgery with a POSITIVE ATTITUDE and do your best to maintain a positive attitude through out your recovery. Anytime I had a negative thought, I tried to notice it, cancel it and then restate it in a positive way. This is not an easy task but it has gotten easier the more that I have done it.

* EXERCISE BEFORE YOUR SURGERY so that your body will be in the best physical shape possible. You will be very glad after the surgery that you have done this. As a woman (who had frozen shoulders 15 years ago) my upper body strength was not as good as I wanted. I built up my arms by sitting in a sturdy wooden desk chair with arms. I would then use my arms to pick up my body from the seat. I got to where I could raise up about ¼ inch for several seconds. I am very glad that I did this and feel that I have used those muscles a lot since my surgery.

* EXERCISE AFTER SURGERY – if you don’t do the exercises, the only person you are affecting is yourself and your chance for a better future.

* HOSPITAL BED – HIGHLY RECOMMENDED!!!
I strongly suggest that you have a hospital bed in your home for when you come home from the hospital. Buy it, rent it or borrow it and if you don’t need it, then just return it. If you need it – you will be SO glad to have it. I am still using mine and it has been 3 months since my surgery. I can sit in it comfortably and I can raise the leg area just a tiny bit for when I sleep. Now, the PTs do not recommend this practice since the goal is to get the leg as straight at possible. However, so far, I have not able to sleep with my legs flat – I try to do this every so often because it is a goal. I lay flat and wait about a half hour and then I raise the leg part of the hospital bed and I am asleep shortly thereafter. To compensate for “cheating” about this, I do extra exercises during the day that help straighten my legs. Finally on May 1, I was able to lay flat in bed all night long.

I recently talked with my cousin who had both knees replaced 4 years ago and she did not use a hospital bed but she did use pillows under her knees. I prefer the hospital bed because I did not have to keep adjusting pillows and it provided a wide variety of ways for me to sit and lay.

As I got stronger, I lowered the height of the hospital bed a little bit at a time and built up my strength to get out of the bed at that new lower height without using my hands

Using the hospital bed meant that I needed a bedside table that could be about 4 feet out from the wall. I used a wooden TV tray and it worked very well. It was lightweight and I could move it in any direction to accommodate where I had the head of the bed. I also happened to have a chaise that I could reach – it was right next to the side of the bed where I kept the side rail up. I put pillows there when not needed, Kleenex, a trash container, my rolled up towels for exercising, books, my hair dryer, and weights for exercise – all sorts of things that I could use and reach while in bed. So, I would suggest having a card table or something on that side of the bed if at all possible.

A side story:
I planned on renting a hospital bed for $150 a month.
Kathy and I are very good at conjuring up things that we need. About 2 weeks before my surgery, we went to the Habitat Restore where I purchased an electrical hospital bed for $10.00! It cost more than that to hire two people to move it into my room. I have been very glad to have a hospital bed. I have spent a lot of time there sitting up with my legs extended which is very similar to how one would sit in a recliner. Luckily we had a twin mattress that we were able to put on the bed. When I tried raising the head of the bed, the mattress just stayed straight and did not conform to the bed. I got a ratchet strap and put it across the mattress and bed at the point that the mattress needed to bend and it has worked very well. I also added a foam egg crate on top of the mattress, which has made it very comfortable. I had all of this ready before I went to the hospital.
I put up the bedrail on one side of the bed and it has come in very handy. I can grab it when I want to move around plus it gives a place to hang the remote for moving the bed up and down.
If you do use a hospital bed, get a nail apron (available at most hardware stores for less than $2) and tie it to the bed rail. Mine has two pockets in which I keep the portable phone, the TV remote, a pen, my glasses, a small tablet and the paper on which I record when I took my last medication.

* NAIL APRON FOR WALKER
Again the same nail apron mentioned above can be stretched across the front of a walker thus giving 2 pockets for storage. Cheap and helpful!

* CARE OF THE SCAR – after the staples were removed I started putting vitamin E on the scars. A friend suggested using cocoa butter ($1.39 for a yellow tube of it from Cococare – only cocoa butter with no other ingredients) and I feel that it has worked very well. The cocoa butter is not as greasy at the vitamin E. At week 16 I am still applying the cocoa butter – still using the same tube.
My PT says that I need to put sun block on my scars whenever I am going out into the sunlight. The scar tissue will burn if it is not protected.

* STATIONARY BIKE – ANOTHER HIGHLY RECOMMENDED ITEM
I got my used bike for $15 at a Habitat thrift store. Also, many sporting goods stores sell new as well as used equipment. The bike loosens my knees faster and easier than anything else and it is almost fun. I didn’t use it for the first few weeks but I am very glad that I had it ready to go before I went to the hospital. It was particularly good to stretch both of my knees, which were always at different degrees of range. I could put my ball of my right foot on the pedal to give maximum stretch to that knee. Then, I could put my left foot more forward on the pedal so that it was not as flexed but still gave that knee the stretch it needed.

EXERCISE ITEMS
I bought a 6-inch diameter ball in the pet section for $3 and have used it for exercising (after about week 7).
Before surgery, I took a sheet and rolled it up along the long axis. I taped it in 7 places to hold it together. I have used this a lot to increase the bending of each knee. I place the center of the sheet under one foot and raise my knee (keeping the foot on the bed) and then use the sheet to pull my knee closer to my body thus extending the stretch.

* SHOWER SEAT
It was a good while before I could stand for long enough to take a shower so a shower seat (with adjustable legs) is ESSENTIAL.

* A GRABBER – another necessary item to have.

* BABY MONITORS
We had three monitors – one in my bedroom, one in Kathy’s room and one in the kitchen. Our house sort of rambles so this way we could talk to each other. When I first came home I would put my monitor on LOCK when I got up in the night to use the bathroom. This way Kathy would be able to hear sound from my area in case anything happened. It sure made me feel safer. Once I got back in bed, I would turn the lock feature off. As I got more stable, I quit doing this but we still are using the monitors.

* DON’T BECOME A COUCH OR CHAIR POTATO!
Don’t spend all day in front of the TV or at your computer – it may feel good to stay seated but it is not good for long periods. Sitting made my knees stiffen up even more. Get out and walk and try to go farther every day. Your knees will feel better and better if you do this. Use your walker at first and then your cane but get out and walk! Notice how stiff you are after you have sat for a while and then notice how much looser your knee/s feel after walking or exercising.

* NAUSEA
The best solution that I found for nausea that is caused from the Percocet or Vicodin, was to eat 2 saltine crackers (I prefer whole wheat) before the pill, take the pill, and then eat two more saltines. I drank water with each cracker.
In addition, if I still felt nauseous, I drank Clover Valley sparkling water beverage – no calories, no nutra sweet and no caffeine. This is available at Dollar General for 50 cents for 32 ounces. I also would chew Papaya Enzyme tablets. I did find that if I waited too long to take the next pain pill, I would get nauseous. Pepto Bismol also helped with the nausea.
Several times I got very nauseous and dizzy about 2 hours after lunch when I had taken the Vicodin with my meal (and with the four soda crackers). I began timing my meds so that I did NOT take them with food – this seems odd but it worked for me. I have been taking my meds and crackers at 10am, 4pm, 10 pm and 4 am and it has worked very well. My appetite did not return for about 3 weeks and at week 6 I am still eating less than I used to eat but I am satisfied. I lost 11 pounds and have not regained them so I am happy with that! I found out that each knee weighs about a pound so maybe I lost more weight than I realized.

DIABETES – I AM A TYPE 1 DIABETIC – info for other diabetics
My sugar definitely got out of control after the surgery for about 2 weeks – this is normal. I just kept taking Humalin/regular insulin as needed (in addition to my normal insulin) to attempt to bring my high blood sugars down. At one point in the hospital, they wanted to give me 16 units of Humalin and I told them that was WAY TO MUCH! I agreed to take 8 units and sure enough that was enough. You know your body best, so take control of your insulin when you are in the hospital.
I was also concerned about infection in my knees. With sugar in my bloodstream, it can be difficult to heal wounds. Luckily I have had no problems with infection. My doctor told me that the cement that was used to attach the parts actually contained antibiotics.

10. THOUGHTS TO HELP ME GET THROUGH THIS: (I wrote this during the several weeks prior to my surgery and printed it out to have available.)

Getting through this experience will make me a stronger, more physically active person and I will rejoice in this newfound strength.
I’ve heard that the pain level is like that of having a baby – so suck it up and take it – many, many women have many, many babies every second of each day. Some even go out and work in the fields afterwards. I have the “luxury” of having several months to recoup. (HA! HA!)
(Luckily for me my pain level was never really terrible and the drugs worked very well to cover it up.)

I can do this!!!
I can do this!!!
I can do this!!!

When in Physical Therapy, I will do what they ask me to do. (Whew – that’s a hard one but I know that this is in my best interest.)

If I feel like I can’t take it – BREATHE!!!

Keep the pain meds constant – do not let the pain level increase too much just because I don’t want those drugs to be in by body. Drink lots of water to flush out my system.

From a friend who just had rotator cuff surgery – don’t go off the pain meds too soon or the pain can come back with a vengeance. If pain meds are too strong, I may get a headache.

Stay in my adult – don’t become the whiny, crying inner child. A whiney child is not pleasant for me or for those around me. I can have a private cry if I need to.

Allow others to help me in their own way. I do not need to be the sole director of this experience.

Replace negative thoughts immediately with positive ones – there is always a positive choice.

I choose to walk in this lifetime using and appreciating both of my legs.

I’ve always said that CHANGE and DEATH are the only “for sure” things. I am choosing CHANGE. I am letting go of my birth knees and I am becoming a bionic woman. Pretty cool – who would of thunk it!

I choose life at this time and eventually “When the roll is called up yonder, I’ll be there” – but not a minute sooner.

Do NOT get angry with those who are caring for me – this is not in anyone’s best interests and it is especially not in my best interests.
(I used this thought the most and it helped me to just let go of some anger that I felt a few times toward Kathy.)

Others who have had bilateral surgery say that having both knees done at the same time is best because otherwise I would be relying on my bad left knee and that knee would only get worse.

Pain is inevitable – suffering if optional.
Greta Randolph

11. TYLENOL – attempting to change from Vicodin to Tylenol
This switch took longer than I expected.
(I eventually found out that Tylenol is very bad for the liver so I switched to Ibuprofen, which can be hard on the stomach. You might want to research these drugs for yourself before your surgery.)

Dr. Bond said that I would probably take Percocet for a month and then Vicodin for a month and then Tylenol.
I switched to Vicodin at 3 weeks after my surgery and I took my last Vicodin at the end of 3 months.

When I first came home from the hospital on January 30, I took one Percocet 4 times a day. On February 20th, I switched to one Vicodin four times a day and eventually I changed to ½ Vicodin. As the chart below shows, I eventually added two Tylenol and then switched that to one Ibuprofen. My first day without any meds was right at 3 months – May 3 although at week 16, I still take one Ibuprofen a day if needed (especially on rainy days).

Transitioning from Vicodin to Tylenol to Ibuprofen to Nothing!

DATE 10 AM 4 PM 10 PM 4 AM 1(bad) – 5 (good)

(sorry – I lost the formatting on this)

2/20 V V V V 4
2/26 T V V V 2
3/5 T V V V 2
3/24 T V V V 2
4/1 T V V V 3
4/7 T V V V 3
4/9 V T V V 4
4/13 V T T V 4
4/19 T T V V 3
4/20 N I V I 3
4/30 N I V N 4
5/1 N I I N 4
5/2 N I N N 4
5/3 N N N N 4
5/8 I N N N 4

Tags: "both knees", "total knee replacement", bilateral, blog, diabetes, diabetic, spiritual, TKR