DECISION TO CONSIDER KNEE REPLACEMENT
The decision to seriously consider total knee replacement was not an easy one to make, nor did it come quickly. As a 'polio child' and now a post-polio adult, I experienced many physical changes primarily in my legs. Gradually these changes amounted to diminished ability to function at the same level I had and a significant increase from nagging discomfort to real pain. After years of denying that knee replacement might be needed, I found myself face to face with my doctor one day, armed with a written list of questions:
How much pain will surgery relieve?
Will the replacement be firm or will my knee still be prone to instability and shift?
Will replacement aid balance and prevent buckling?
Will walking be easier or stay the same?
Would replacement mean my leg will be straight again? Do I have the muscle and tendon strength to hold it in place?
How long does a replacement joint last?
What are the risks of infection and blood clots?
And, most important, Will I have an MD Anesthesiologist knowledgeable about the unique problems polio survivors can have with anesthesia?
Fortunately Dr. Dunlap and I have a background spanning over twenty years when I first noticed the twinges of new weakness primarily in my legs. At a time when so little was understood about the late effects of polio, he was the only source of help and hope for many like me. He suggested this surgery several years ago, but typical of many 'polio people', I thought I could just buck-up and handle it like countless other times. However, the pain only intensified until it was constant, around the clock.
Dr. Dunlap gave me straight answers; most, but not all pain should be alleviated, no to the shift question and yes, about buckling and balance. He didn't think my ability to walk would be improved except that the pain when I did walk would be much less, the joint would be stable and, in the process, the replacement would mean my valgus leg would be straight again. I could expect about twenty years use out of the new joint. The risk of infection was a factor he said, but one where extraordinary precautions would be implemented including antibiotics implanted with the knee joint. I knew from a past newsletter, there were many drugs post-polio patients should avoid, so we also talked about my concerns regarding anesthesia.
The process toward Total Knee Replacement officially began several weeks before the actual surgery with the usual pre-surgery tests; EKG, chest x-ray, blood work, urinalysis, etc. There was also an in-depth interview by the counselor on staff. This gave me an opportunity to personally talk with the Anesthesiologist about the choice of anesthesia he would administer. I truly appreciated this. Next in the process were several trips to the blood bank for analogous blood drawing to assure I would receive my own blood back by transfusion if needed. I was glad latter, since I experienced very low blood pressure after surgery and needed the two pints back.
Surgery day came in early September, between two of the four hurricanes we experienced. The five-hour procedure went pretty much as anticipated. There was a significant buildup of scar tissue from two previous knee surgeries I had in childhood which required extra effort to remove. But after that a Stryker Scorpio total knee system was successfully set in place. The hospital stay was uneventful except for needing the transfusions. Pain for the first couple of days was a factor. In hind-sight, I wish I had asked for a medication pump to be used to administer pain medication. That way I could have gotten the medication before the pain level escalated. Even though the staff was excellent, they did not always deliver the pain pills soon enough. As soon as my blood pressure stabilized PT began with the unheard of task of standing up beside the bed! PT gradually got easier and continued for two weeks after I got home. The only thing I was not prepared for was an injection of Fragmin each day to guard against infection. Before I was dis- charged after four days, I learned to give myself the injection, which I reluctantly did every morning for several weeks. I never did get used to that procedure and was very glad when it was no longer needed! Knowing the Fragmin would greatly lessen the possibility of infection, a serious risk with surgery of any type, especially orthopedic, made it tolerable.
Therapy came by way of three very professional and wonderful individuals; an RN, Occupational Therapist and a Physical Therapist. They each came to my home three times a week for several weeks. The RN took care of normal issues of BP, temp, etc, while the OT helped with the practical day-to-day functions like how to maneuver in the kitchen without tripping over the walker etc. It was my Physical Therapist who helped me and my new knee to begin to become friends. She pushed, pulled, rolled and rubbed, bent and stretched almost to the point of exhaustion. But every uncomfortable effort is paying off now, big time. At the beginning the knee literally would not bend beyond an inch or so, now I have a bend of about 110 degrees!
Today I am almost four months post surgery and with the exception of a set back due to a bad slip and fall in November, things have gone very well! I am so glad to have had this surgery! From the beginning I knew for post-polio patients healing can be a very slow process, and so far, that is true. Total healing could be anywhere from three months to a full year. Periodically there are problems with painful swelling when nothing but ice brings relief. There are times of aching for no apparent reason but this occurs with less frequency as time passes. Although I depend on my little green Jazzy for shopping and part of the time at home, when I do walk, it is definitely with much less discomfort, increased stability and greater confidence. For that I am so very thankful.