10 Weeks After Surgery

At 10 weeks post surgery, I continue to have gradual improvement of motion and strength of the right knee. Over the last two weeks, I swam 50 laps in a pool, and I even walked 1.4 miles outside in my neighborhood. My leg did ache and stiffen a bit after the walk. Ice and ibuprofen helped to abate this.

However, one development that emerged slowly over the last 6 weeks and reached a crescendo this week was difficulty in sleeping. During the past 6 weeks, I increasingly noticed that I was waking up frequenlty at night, sleeping for brief periods--sort of cat naps. This past week, the sleeping difficulty grew into imsomnia, hardly sleeping at all throughout the night. By last weekend, I was spending nearly the entire night tossing and turning, unable to fall into a comfortable sleep. I did not really have pain, just a restless feeling in my leg where I kept moving it for a comfortable position. I was taking 200mg ibuprofen to help with this, but without success. I also checked my blood pressure, and I was shocked to see a reading of 155/95. My normal blood pressure is 130/80. On Tuesday, I called my orthopedic doctor and my family care doctor for advice on this.

Both doctors prescribed medication. The orthopedic doctor prescribed 600mg ibuprofen, suggesting that my sleep problems were the result of low level pain in my knee keeping me awake at night, and the resulting anxiety from this. But my family care doctor warned against stronger ibuprofen as she thought that the ibprofen was contributing to the increase in blood pressure. Instead, she prescribed Norco for pain medication, and ambien medication to help with sleep.

I followed my family care doctor's advice. I am happy to say that the Norco is helping with the low level pain, particularly after physical therapy, while the ambien is helping with sleep. For the last 3 nights, I have slept fairly well. I have also noticed a drop in my blood pressure, where it is approaching normal levels. I suspect that the combination of weeks of inadequate sleep, stress from this, and ibuprofen were contributing to the higher blood pressure readings.

On thing I will add to my workout regimen is going to the driving range to drive golf balls. The doctor told me at the hospital back in December that I would have to retrain my knee for driving a golf ball. He said that chipping and putting should come back easily, but that I would have to work on the "driving" with the new knee. Regaining my golf swing for driving is important since my wife Margaret and I play golf in the summer months. We are fairly well matched in terms of golf, but with our competitiveness, I worry that she may have an edge if I do not recover my golf swing for driving a golf ball. And I cannot let the wife have the edge--<grinning>.

At my February 7 appointment with the Dr. Denzin, I asked several brief questions:

1. While "googling" on the Internet, I discovered that the company Zimmer who makes the Zimmer Nexgen System knee prosthesis that was put into my knee was facing lawsuits. See Zimmer Lawsuit. Dr. Denzin indicated that there were problems with cementing the prosthesis into the knee, but he assured me that my prothesis was cemented in correctly. Nevertheless, this was a bit disconcerting to see on the Internet.
2. I asked about any restrictions. Dr. Denzin responded that other than running and high impact sports that I had no restrictions. He confirmed that I should let the pain and swelling guide my activity level.
3. I asked about hot tubs. He said they are fine and that I should do squats to improve the knee flexion when in the hot tub as the muscles around the knee should be relaxed.
4. I asked about doing curls with 70 pound weights. He said that this was not a problem.
5. I told him that my formal PT will end on February 21, and that I would continue my own private PT with bike riding, swimming, weight training and walking. He thought that this would be fine and indicated that many patients do just fine without formal physical therapy.

My next follow-up appointment with Dr. Denzin is March 21, 2011.

8 Weeks (2 Months) After Surgery

After this entry, I will go to bi-weekly updates, and eventually to monthly updates.

Here are some status updates after 8 weeks of recuperation and physical therapy from total knee replacement:

• At the Physical Therapy clinic this week, my knee bend was measured at 101 degrees, 9 degrees shy of the PT goal of 110 degrees and 19 degrees shy of my goal of 120 degrees. I hope to reach my personal goal of 120 degrees in 6 weeks (by mid-March 2011).
• My ability to walk increasing distances without assistance of a cane is occuring to my satisfaction.
• I think I am starting to sleep better too. While I continue to wake up more often than normal throughout the night, it does seem that sleep interruptions (insomnia) are decreasing. A Google search confirmed that others who have undergone total knee replacement also experience difficulty sleeping during the primary convalescence phase (the first 3 months).
• I am now completely off narcotic pain medication. If there is pain or swelling, I am taking
  over-the-counter ibuprofen or aspirin.
• I am increasing my workout on the stationary bike to 20 minutes. I have also increased the peddle resistance to force the leg muscles to work harder. Hoping to work my way up to 40 minutes by March.
• I swam 40 laps at the pool tonight. This is the first time I have tried to swim since the December 8 surgery. I probably could have swam my normal 60 laps, but I decided not to push things this first time. I also sat in the whirlpool for 5 minutes without issue.
• My formal physical therapy sessions should end in the next week or two. After this, I will continue my own workout program with the hope that I will be able to perform my normal routine (pre-surgery workout) by the early weeks of March. In late March, I may also add the Golf driving range to my workout to begin working on my knee pivot when driving a golf ball. Since Margaret likes to golf, I will need to confirm that my golf swing is working well as we move into Spring here in Michigan.