Cortisone shots, physical therapy, anti-inflammatories, and twice-yearly hyaluronic acid injections, which helped cushion and lubricate my joints, kept me upright. But both knees had lost almost all of their shock-absorbing cartilage. I was, in knee arthritis parlance, “bone on bone.”
A few months after my 60th birthday, I began preparing for one of the most common elective orthopedic surgeries in the United States: total knee replacement, also known as total knee replacement.
Between 850,000 and 1 million patients undergo total knee replacement each year, a number that is expected to reach at least 1.2 million by 2040, according to a study in 2023. About 60 percent of patients are women, and surgery remains largely the province of baby boomers: the average age of patients is 67.4 years, according to the American Joint Replacement Registry. But younger people are increasingly taking the plunge.
Before the operation, I did my homework. I consulted with five orthopedic surgeons before selecting one, read numerous articles and clinical studies, joined a Facebook support group for “knee replacement warriors”, watched YouTube videos of surgeons and physical therapists offering advice and does “pre-rehabilitation” to strengthen the muscles. in my legs for rigorous post-surgical rehabilitation.
But what I experienced after my surgery showed me that I was far from prepared.
For a total knee replacement, a surgeon removes damaged cartilage and arthritic portions of the thigh and shin bones and replaces them with usually metal components, which now serve as the surface of the joint, according to the American Academy of Medicine. orthopedic surgeons. These components will slide onto a smooth plastic disc inserted to replace the cartilage in the knee. The surgeon also often resurfaces the back of the kneecap and adjusts it with a plastic cover or “button” before putting it back into place and closing the surgical incision.
The procedure was described by many patients as “brutal.”
The difficulties are sometimes downplayed by surgeons, said James Rickert, a board-certified orthopedist and president of the Society for Patient Centered Orthopedics. “I think it’s easy for providers to market procedures as a panacea,” he said. “It’s easy to emphasize the benefits and it’s easy to minimize the risks.”
“It’s a crazy surgery, and patients are sometimes left in the dark,” said Samantha Smith, a Dallas-based physical therapist. Smith offers online courses for knee replacement patients and has created and moderates a Facebook group of more than 19,600 members for knee replacement patients, of which I am a member. “I talked to surgeons about everything they proactively share with patients,” she said, “and they told me that if patients knew before surgery what they would probably be looking at confronted, they would not go all the way. »
Other surgeons say it is the most effective way to treat incurable arthritis..
The satisfaction rate for knee replacement hovers around 80 percent, studies show, a near-record low for elective surgeries, said Daniel J. Riddle, a physical therapist and professor at Virginia Commonwealth University in Richmond.
“It’s hard to find a safer surgical procedure, and when it works, it works very well,” said Nick DiNubile, a Philadelphia-area orthopedic surgeon who specializes in sports medicine. It could be a “life-changing procedure,” he said, but some patients might be dissatisfied because of “unmet expectations.”
“We need to dig deeper into the dissatisfaction,” DiNubile said. “Is this pain?” Is this a functional loss? If you understand the dissatisfaction, you can design a treatment plan to address the deficiencies.
My surgery in September 2022 was an almost standard procedure. I received the same mild anesthetic or sedative that most colonoscopy patients receive – along with a spinal nerve block to relieve the pain. The surgeon relied on “robotic assistance”, a computer that provides real-time data. Research shows that the technique minimizes incision length and soft tissue damage, and guides surgeons in making more precise bone cuts and implant placement to work optimally with the specific anatomy of the patient. ‘a patient.
Two hours after the operation, my husband helped me to the car. (Most patients need to take their first steps within a few hours of surgery, which, like mine, can take place in outpatient surgical centers.) At home, I ate a light dinner and walked up a flight of stairs. to sleep in my own bed.
The first two to three weeks were painful and arduous due to the severity of the operation and the numerous physiotherapy exercises that patients perform several times a day. But my pain management plan worked and my early progress was as expected. At my two-week check-in, my surgeon asked me where the walker or cane I had been prescribed was and laughed when I responded that I kept forgetting them.
Short-term warnings, but little medium-term advice
About three weeks into my recovery, I realized I wasn’t prepared for what was going to happen over the next few months.
Before the operation, I received the standard warnings about rare but potentially serious surgical risks, such as blood clots and infections, as well as specific precautions to avoid them. But I received little guidance on the issues many patients face as they continue to recover.
“The research carried out generally focuses on the short-term experience of patients, the length of hospital stay, the rate of complications or the very long term: how long will this “implant” last? » Rickert said. “There is very little research into the actual experience of patients in the medium term.”
I suffered from sleep disturbances for about two months. Many patients have trouble sleeping for weeks or even months due to pain and their inability to get into a comfortable position.
Another common problem is depression fueled by pain, lack of sleep and long recovery that limits mobility and independence. One in five knee replacement patients suffers from depression, while 15 to 20 percent struggle with anxiety triggered by the procedure, Riddle said. Although I was not clinically depressed, I had severe anxiety as the surgery date approached, and it remained high as my rehabilitation wound down.
I was often exhausted from near-total physical deconditioning because, like many patients, I was partially incapacitated for the first two to three months. Surgeons and physiotherapists estimate that full recovery can take 12 to 18 months. My mantra became, “I’m so tired of being so tired.” »
The physical therapy I underwent was difficult, largely due to a little-understood neurological response called “protective muscle guarding” that plagued my rehabilitation. This happens when the brain, trying to protect the injured knee, “locks” the leg muscles, preventing physiotherapy exercises. To overcome protective muscle guarding and get my muscles to cooperate with my physical therapy, I have undergone several tested therapies that have helped me, including lymphatic massage, extracorporeal shock wave therapy, aquatherapy, and cupping.
Seventeen months after my surgery, the sometimes dull, dull pain of arthritis in my knee was gone. I’m back on the pickleball court and generally sleeping well. My knee extension – the ability to fully straighten my knee, which is important in a healthy walking gait – is better, but my balance and flexion – the extent to which I can bend my knee – are slightly worse.
Many people are surprised when I offer a half-heartedly exaggerated assessment of my knee replacement surgery. My rehabilitation and recovery was much longer and more arduous than I had prepared for.
Without my understanding and accommodating employer, an office job, and full private insurance, I don’t know how I would have done it. I spent about $7,000 out of pocket for surgery, coinsurance, deductibles, co-pays, medical devices, and other types of care to overcome muscle guarding.
I am now taking steps to avoid or delay the replacement of my other knee. I lost about 35 pounds. Weight loss, specific exercises and other physical activities have helped patients forgo surgery, according to patient educational programs in the United Kingdom, Canada and Australia, Riddle said. Research presented at the 2023 meeting of the Radiological Society of North America showed that strengthening “the quadriceps relative to the hamstrings may be beneficial.”
But if I have to replace my other knee, I will focus as carefully on choosing my physical therapist as I would on my surgeon. “The surgeon performs the surgery, makes sure the implant is properly placed, and then releases the patient onto the PT,” Smith said. “The physiotherapist accompanies the patient for months, two to three times a week.” Many for-profit practices require physical therapists to work with two to three patients simultaneously. My progress accelerated when I moved to Johns Hopkins, which uses the model of one physical therapist, one patient per appointment.
After experiencing it once, I will also be better prepared for the challenges that surgery can bring and will be better able to advocate for myself by asking questions of surgeons and physical therapists about treatment changes and surgical advancements since the replacement from my first knee.
I will also do better to advocate for myself by asking tough questions of surgeons and physical therapists about pain management, poor outcomes, sleep problems, and other negative aspects of the recovery process.
My replaced knee will never be as good as it was before the arthritis, but arthritis is a progressively debilitating and irreversible disease…
News Source : www.washingtonpost.com
Gn Health
