Seven Months after Surgery

Two events to report at the seven month status update. One is my first trip in an airplane since the knee replacement. And the second item is my first competitive 40 mile bike ride with my new knee. For both events, I am happy to report good news....

In late June I traveled by plane from Detroit Metro to the Chicago O'Hare aiport for a three day conference. I was anxious about the trip as I expected a long delay at security including a pat down. I arrived 2.5 hours before the flight departure. I was pleased to learn, however, that both Detroit Metro and Chicago O'Hare airports had full body scanners which made the "security check" brief and easy. At both airports I informed the security personnel that I had a knee prosthesis that would not pass the metal detectors. They responded saying that I should stand in line for the full body scanner. The line was short as many passengers were still not comfortable with the new scanners. I was asked to remove everything from my pockets including paper. I then stood on the footprint templates and raised my hands over my head during the scan. The scan took a few minutes, and then they informed me that I had passed the scan. With full body scanners moving into all US airports, I believe there will be no additional wait time at security with a knee prosthesis.

This past Saturday, July 9, I rode my bike 40 miles in an organized biking event held in Chelsea, Michigan. There were six different routes ranging from 15 miles to 100 miles. I selected the 40 mile route as I regularly work out with 15 mile bike rides. I rode the 40 miles in 2 hours and 35 minutes and only stopped twice at the refreshment sites for water and fruit. My knee survived very well. I did notice a bit of stiffness after the ride, but it abated after a few hours. Below is a picture shortly after I finished the bike ride.

As testimony to the durability of the knee prosthesis, I worked out for 35 minutes the following morning on the Precor Ellipitical machine without any problems.

Six Months after Surgery

I have had my first real awareness that my new knee is not a replacement for the knee I was born with. Over the past few weeks, I have seriously taxed my knee by doing painting and maintenance on my house. With summer weather upon us, I worked the entire Memorial Day weekend from sun-up to sun-down painting, standing for extended periods of time on a 32 foot ladder, moving the ladder, bending and walking about working. At one point while moving the heavy ladder, I felt a strained sensation in my knee and observed a tiny bit of swelling on the outer knee area. The knee also had a slight stiffness feeling to it. Fortunately, there was no pain.

I am assuming that I strained the knee area from all the work, but will watch carefully over the next several days/weeks to be sure that nothing more serious is going on. Of course, several depressing thoughts crossed my mind such as a loosening of the knee prosthesis where it was cemented into my knee or even a possible infection since I had cut my finger a time or two from working on the house.

A few weeks back, I did go to the Dentist for the first time since the knee replacement. I  took 4 capsules of 500MG amoxocillin (antibotic) as a precautionary measure one hour before the dental cleaning. All this went without incident.

I am next scheduled to see my doctor for a follow-up evaluation on the knee replacement in December. December will be the one year mark since the surgery. At the one year follow-up visit, the doctor will take another x-ray to review status and progress of the knee prosthesis.

And as a final entry to the 6 month update, here is a short video with me playing golf with my new knee and my three sons on Father's Day.

Five Months After Surgery

Not much to report at the 5 month post-surgery date other than saying that I am doing fine, and all is well.

I continue to work out 4 to 5 times a week by swimming, riding a bike, and working out on an elliptcal trainer. I am also doing some weight training including leg presses and hamstring pulls.

I find that I do not think very much about the prosthesis in my right knee. I am doing all activities other than running. Even when doing yard work, I find that I can easily move a wheel barrow with a 100 pound load, and carry 50 pound bags of sand and dirt. The knee feels very stable and strong.

Swelling in the surgical knee has abated some since I last reported in this blog. My right knee circumference is 17.5 inches. The left knee by comparison is 16.75 inches. The picture below shows both of my knees (Notice our cat Georgia walking by in the background behind my legs; she is 20 years old!):

This Wednesday I have my first visit to the dentist since my knee surgery. For the remainder of my life I have to take an antibiotic when I visit the dentist. The antibiotic is a precautinary measure to prevent infections. Apparently, there is an increased chance of getting an infection around the prosthesis from dental work which is considered a "dirty procedure". While data is not conclusive in this area, my doctor asked that I take the antibiotic as a safeguard. The drug prescribed to me is amoxicillin. About 1 hour before visiting the dentist, I am to take four capsules of 500MG amoxicillin.

Next report will be in June for the six month update.

Four Months After Surgery

Just a short update here at four months post surgery.

I saw Dr. Denzin on March 21. He continues to be pleased with my progress. My knee bend was 110 degrees at the appointment. He wants to see me for the next follow-up visit this December--one year from the surgery.

I am doing all normal activities now including walking long distances. On a long weekend recently, Margaret and I went to Grand Haven where there is a boardwalk along the river extending out to a pier along Lake Michigan. We walked the entire boardwalk, about 2.5 miles round trip from the Snug Harbor restaurant to the light house. My leg was absolutely fine, no pain or discomfort at all. I am also walking about the U-M campus without concern. Recently, I walked from LSA to the Palmer Commons twice in the same day without issue. At home, I am power walking two miles with our dog Buddy without any pain. Amazingly, I do not feel the need to sit down and rest my leg after walking. Before surgery, I had to rest my leg after long walks due to the arthritis pain in the knee. That is all gone now!

I am also walking up/down steps normally, even walking up/down steps two at a time to work the quadricep muscle a bit more.

In late May, I will be taking a plane to Chicago. This will be my first flight since the surgery. I will have to go through a pat-down since my knee prosthesis will set off the security alarm when passing through the conventional metal detectors. It will also be interesting to see how well my "knee bends" sitting in the cramped airplane seating in coach.

Three Months after Surgery

I am now 3 months post surgery. As recovery from this surgery is now very gradual, I will post future updates on a monthly basis.

Sleep problems seemed to have abated. For the past 10 days, I have not taken the ambien sleeping pill to fall asleep. I am falling asleep normally. I am hardly aware of my surgical leg at night. It is beginning to feel normal when lying in bed.

I have now recovered sufficiently to resume all activities that I did before the surgery. This includes workouts on the stationary bike, 2 mile walks, and 30 minutes on the eliptical machine. All this at the same resistance level that I did before surgery. On the stationary bike, for instance, I am using position 9 for the seat adjustment to achieve a 90 degree bend of the knee, and I am using resistance level 11 and 12 to exercise the quadracep muscle. The video below depicts this:

I am also retiring the cane. I have not used the cane much since early February. I have kept the cane in the trunk of my car just in case I needed it. I am now fully confident in the strength of my knee to retire the cane to the attic with the crutches. Below is a picture of me using the cane at the Detroit Auto Show on January 20. This was the last day where I significantly depended upon it for longer walks and prolonged standing.

After activity, my knee feels a bit stiff and slightly swollen. So I have not achieved the benefit I had hoped for as my knee (pre-surgery) would also swell and become stiff after activites (e.g bike riding, long walks, etc.). I suspect that as I continue to recover over the next several months that my knee will become less prone to swelling and stiffness after activities. I have noticed that my knee is responding better to exercise as time transpires. Increasingly, I am finding myself less aware of the knee as I walk and do errands about the house. This is in contrast to the first six weeks after surgery where I was thinking about every step my surgical leg took as I walked or navigated stairways.

The picture below shows both of my knees side-by-side after 3 months. Unlike the left knee, the right knee (the surgical leg) still does not show the outine of my quadricep muscle, but it is almost coming into view on the inner side of the knee.

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.