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 Partial Knee Replacement

Background

In 2010 whilst out running as part of my training for my next Ironman triathlon, I experienced sharp pain in my right knee.  I was several miles from home and with no other option ran back home despite the pain.  It transpired that the meniscus, a sort of fibrous spacer in the knee joint had disintegrated and allowing the two ends of the bones to come in to contact.  What followed was an operation to repair the damaged as much as possible along with the advice to stop running and protect the joint from further damage for as long as possible by keeping as fit as possible.

I continued being active and found that Nordic Walking was a marvellous replacement for the running.  However, I did have to give up taking part in anymore triathlons.  I was able to keep this going for nearly ten years until it became obvious that the joint was steadily deteriorating.  I found it increasingly difficult to remain active and was walking less and less.  I had to accept, albeit reluctantly, that the time had come where I was going to have to have further surgery.  To my huge relief it transpired that rather than having to have a full replacement I only required a partial knee replacement.  From that point it was just a matter of when the surgery would take place. 

Thursday 20.09.18 - Operation Day (OD)

Arrived at the hospital early in the morning all ready to begin life with a new knee or part of knee.  Having struggled for some time with with my right knee steadily deteriorating, it was with mixed feelings that I checked in at the ward before settling down to await my turn.

During the wait I spoke with the pharmacist about medication and the anaesthetist who explained her role and asked if I had any concerns.  Eventually I called to get changed into a gown and walked with one of the theatre nurses to the anaesthetic room for various needles to be poked into my arm and then everything going blank. Once fully awake in the recovery room I was transported to the ward where I would be looked after until ready to go home.

The remainder of the day was good as there was very little pain, no doubt due to the residual effects of the anaesthesia.  Late Afternoon I got up for a short time and with the support of a couple of sticks was able to move about and had no issues with weight bearing on the operated leg.  Once back in bed, I was able to perform straight leg lifts and had quite a good amount of flexion in the operated joint. With everything looking good it looked as if I was on track to head home the following day.

Friday 21.09.18 - OD+1

The initial euphoria from the previous day had definitely worn off.  The night had been long, interrupted by frequently having my pulse and blood pressure recorded and insisting on each occasion that my low pulse and blood pressure were perfectly normal; for me.

However, some sleep was possible and on awaking in the morning in became immediately obvious that the post op honeymoon period was over.  My leg felt very tight and swollen and movement which had been so easy the previous evening were now a great effort and accompanied by large measures of pain.  During the night the dressing had oozed slightly.  On the plus side, whilst straight leg lifts and bending the knee appeared to require some superhuman effort, actual walking and weight bearing was relatively straightforward and heading home that day looked a distinct possibility.

Mid morning and couple from the physio team roll up.to assess how I am progressing.  All is going well, straight leg lift gets ticked off together with moving up and down stairs.  It was all going so well until they insisted that I put my foot on a step and then try to bend the knee as much as possible.  At this point the oozing previously mentioned become more of a drip followed by a steady flow of blood at which point it was decide that I should return to bed and have a new dressing reapplied.  The remainder of the day was spent for the most part in bed with leg elevated.

Saturday 22.09.18 - OD+2

Having remained in hospital to allow monitoring of the wound site, it was anticipated that in the absence of any further issues I would be discharged later that day.  I still had the issue of the physios wanting me to achieve 80 degrees of flexion in the knee before going home.  Apart from the fact that achieving that with the compression bandage that had been put on my leg to prevent any further bleeding was going to be hard enough it was going to be very painful. 

My concerns were entirely justified all the other exercises that we ran through were not a problem but the flexion to 80 degrees was agonising but was achieved.  It only remained for the various discharge forms to be completed and I was heading home later that day.  Everyone involved in my care at the hospital had been wonderful but there was no comparison with the joy of being home.

Sunday 23.09.18 - OD+3

Since forcing the joint to 80 degrees it has remained very swollen along the length of the leg but particularly the joint capsule.  Slightly less first thing in the morning but as soon as I lower the leg any overnight improvement quickly disappears.  Taking note of the experience of others, I have decided that I will not worry too much about my lack of ability to bend the leg.  I will perform all the recommended exercises but only to the point of pain and not being in pain. Lack of flexion has the biggest impact.  It is not until you can no longer do something that you realise how much you take that action for granted.  

I have found using a resistance band to support the leg really helpful.  This was a tip I picked up from another person's experiences with partial replacement.  I use the band to support the leg when I have to lift or lower the leg to or from an elevated position.  I place the band around the bottom of the foot and then use it to support the muscles that are engaged when lifting the straight leg.  Prior to this I was experiencing considerable pain over the centre of the knee and below the joint on the medial side.  Now, using the band I can perform the action with minimal discomfort.  By increasing or decreasing the tension on the band I can vary the amount of effort that the muscles are required to do.

I have spent most of the day alternating between resting and walking.  A short spell of walking around, a couple of exercises then sitting down with the leg elevated.  At the moment the rest periods are much much longer than any periods of activity.  Hopefully, as the swelling decreases activity will become easier and less painful.

Monday 24.09.18 - OD+4

I am continuing with the exercises that have been given to me by the physios.  However, I find that this is painful, which is to be expected, and seem to exacerbate the amount of swelling in the leg.  This means that progress is very much two steps forward and one step back and I can't help feeling that by aggravating the swelling in the leg it is actually hindering the recovery process.  

During the morning I frequently go for walks round the garden.  I was given sticks by the hospital but find it easier to use crutches when walking outside as they provide a greater degree of stability.  As I am able to weight bear I consciously avoid leaning on the crutches.  When thinking of crutches, the typical image that a majority of individuals will have is someone with a broken leg, hopping along by moving the two crutches forward together then swinging the good leg forward.  To do that in this case would be counter productive.  The effective way is to walk as normal in the classic 'contra lateral' fashion that is employed when Nordic Walking, i.e. when the left leg moves forward, the right arm and crutch move forward as well and vice versa, the right leg and the left arm with crutch move forward.  By lunchtime using this method I have managed to complete several circuits of the garden and walked about three hundred foot and felt good.  The rest of the day is largely spent resting with the leg elevated.

Tuesday 25.09.18 - OD+5

Slept really badly during the night suffering with a lot of pain from both leg and back despite taking all my prescribed painkillers.  Lesson learnt!  It is very easy to overdo things and finding the balance is difficult.  Equally, remaining in one position for too long causes problems.  I am finding it very difficult to come up with a sitting position with the leg elevated that doesn't put too much pressure on the lower back.  However, it would appear that the source of the pain in the back originates from the knee.  It can best be described as having sciatica in reverse and the swelling in the leg as a whole appears to be linked also.  The exercise that involves flexing the joint increases the swelling in the leg.  This in turn causes pain in the thigh, hip and finally the lower spine which  combined with a less than ideal seating position makes for a miserable time.

In spite of all this I manage to walk outside a fair bit.  The weather at the moment is sunny and quite warm and being able to get out in the fresh air is a real tonic.  My main concern at this stage is the amount of swelling in the limb.  I had expected that there would be a degree of swelling, I didn't anticipate that the entire leg would be swollen from thigh to ankle and to such a degree that trying to flex the joint involves great effort.  I have found that using my trusty resistance band to help with the flexion exercise takes some strain off the muscles involved and enables me to flex a bit further with reduced pain.  I can adjust the resistance through the band to increase or decrease the amount of work that the relevant muscles are engaged in.

Wednesday 26.09.18 - OD+6

Apart from walking short distances several times during the day, I have taken it easy in an effort to reduce the discomfort and degree of pain that follows any activity.  The swelling in the leg remains a concern as, apart from the obvious discomfort, I feel that it is hindering performing the exercises effectively.

On the plus side I find that I am moving quite confidently and can manage with one stick only around the house using the second one when I go outside where the ground can be uneven in places.

Thursday 27.09.18 - OD+7

Week two.  I can't believe that a week has gone past already.  The days have become fairly routine with a pattern establishing itself of one fairly active day followed by a more sedentary day to recover.  The swelling still remains an issue however from the information I have been able to gather from various medical sources this can continue for some considerable time.  I am now monitoring it through a series of daily measurements.  From these measurements, I have been able to ascertain that there is definitely less swelling first thing in the morning which is to be expected having spent the night with the leg elevated.  At the end of the day there has invariably been an increase in the swelling despite regular periods with the leg elevated and the use of ice.

The other issue is pain.  I like to think that I have a fairly high pain threshold but there have been times that, in spite of taking the analgesia prescribed, I have struggled to keep on top of it.  It is not the pain that occurs whilst carrying out an activity or exercise that is the problem but the pain that follows later.  This was always an issue prior to having the operation.  It is similar in some ways to the difference between pain from reaching lactic threshold, i.e. 'feeling the burn' and the delayed onset muscle soreness (DOMS) that can be experienced a day or two after exercise.  Apart from a few twinges during the course of an activity there are no other real indications at the time as to whether or not I am overdoing it.  This comes afterwards when resting with the leg elevated it will feel tight from the swelling and considerable pain will track along the entire length of the leg.

Friday 28.09.18 - OD+8

Walking is improving all the time.  I have to be careful that I avoid limping along and use the right leg properly ensuring I put weight through the joint and use the sticks for confidence rather than too much support.  The weather at the moment is wonderful so it has been lovely to go outside regularly and stroll around the garden in the sunshine.  Frustration is setting in at the moment, so many things seem beyond me at the moment, not a problem when you are unwell and feel awful but I feel fit and well but realise that it would be very easy to try to do something that might be risky.  Particularly as I am less stable than I would like to think I am.  So for the time being I continue with little and often.

Saturday 29.09.18 - OD+9

As the weather continues to remain fine and sunny I continue to make the most of it getting outside as much as possible.  I am able now to walk about outside quite confidently with the aid of only one stick.  Around the house I can manage without a stick at all but find that I still use one at the moment just for that added degree of safety.  Swelling in the leg still remains an issue but it does appear to be dissipating albeit very very slowly.  I find that I can do a little more between bouts of resting with the leg elevated.  Recovery seems to be going in the right direction albeit slowly.

Sunday 30.09.18 - OD+10

Today I went out for coffee.  The difference in getting in and out of the car from the day I left the hospital was amazing and really brought home to me how much things are improving.  The walk from the car park to the cafe was accomplished without any difficulty and with the aid of only one stick as was the return journey.  Albeit the total distance to and from the car wasn't much more than 300 yards.  However, every little helps.  

I was also able to sit at the table in the cafe which in itself was something of an achievement.  Up to now being unable to flex the joint much has meant that sitting in a chair has not been possible without elevating the leg.  Now I find that I can sit in a chair, providing it is not too high, without elevating my leg but only for a relatively short period of time.  The limit in the flexion of the joint means that I have to sit towards the front of the seat to rest the foot on the ground.  Even so the edge of the seat presses into the underside of my leg so that after ten minutes or so it begins to get increasingly uncomfortable.  By the time I had finished my coffee I was ready to return home.

Having spent the afternoon resting with my leg up I was feeling really encouraged by progress and decided, unwisely, to test things a little further.  On my way upstairs I thought I would see if I could step up using my right leg.  I knew I could raise the leg sufficiently to place it onto the bottom step which is nice and deep and not too high.  To my delight I was able to do so without any noticeable pain or discomfort.  Of course the success of that meant that I had to try again on the next step and was successful once again.  The remainder of the stairs are not as deep so it meant bending the knee as as far as possible to place the foot on the step above.  I had decided that I would give it a go but if I couldn't achieve that comfortably I would not force it.  By the time I had finished I had effectively walked up the stairs alternating between each leg as the leading one and without any noticeable discomfort at all.  The downside, half an hour later the pain kicked with a vengeance.  Another lesson learnt!

Monday 01.10.18 - OD+11

Not a great deal to report today.  Yesterday's exertions took their toll somewhat so I decided to take it easy but struggled with finding a comfortable position, other than lying down, where I could keep the leg elevated without experiencing a lot of discomfort in the lower back. This particularly annoying as I was hoping to do some admin work which is clearly not going to happen today. 

Despite that my mobility is continually improving and I feel increasingly confident moving about without the support of a stick at all.  After my experiment with the stairs, I am going to try some stepping exercises using my step which is adjustable in height.  I shall begin with it on the lowest setting and see how I manage.  I have decided sensibly, to leave it until tomorrow before starting.

Monday 02.10.18 - OD+12

I felt a lot better today having rested for most of yesterday.  I have stepped up my exercises, excuse the pun, and I have added a stepping exercise.  With my exercise step on a low setting I step onto it leading with the operated leg. I then step down with the other leg leading.  This way the operated leg is used to lift me onto the step and then control the step down.  I do this ten times and repeated it three times during the day.  I was surprised at how well this went.  I had expected that I would start to experience some pain and discomfort whilst performing the exercise but didn't at all.

Later in the day I went out in the car to a local shopping centre here I walked the longest distance so far.  Whilst I had no issues with the walking, the ground being flat and level, it was the short car journey that caused me the most discomfort.  I have only been in the car a couple of times since leaving the hospital and up to now it has not been a problem.  With the seat as far back as possible and my leg extended I have not experienced any discomfort.  On this occasion although being in the car for a relatively short period of time I started to get a lot of pain and discomfort on the medial side of the knee just  below the joint.  This stopped immediately I got out of the car and started walking.  Yet again this highlights how difficult it is judging just the right amount of exercise.  However, I shall continue undeterred and repeat the exercises again tomorrow.

Tuesday 03.10.18 - OD+13 to Wednesday 10.10.18 - OD+20

I have continued with exercising daily but in the absence of any significant changes during the last seven days decided to combine everything into one entry.  The swelling in the knee is slowly decreasing and I am gradually able to increase the amount of flexion at the joint.  However, the determining factor at the moment is still how far I can flex the joint before it becomes it becomes unbearably painful, at which point it the knee becomes noticeably more swollen in a short space of time and the swelling then is both painful and limits movement.  So everything is still something of a balancing act which is just sooo frustrating.  

Each day I am walking slightly further and I am now able to manage without walking sticks but I continue to take one with me when out as there are occasions when my leg feels as if it as about to give way under me.  Having continued the step up exercises regularly, I have now progressed to walking up the stairs normally although at this stage I remain unable to come down them in the normal way.

During this period I saw my GP who was pleased with the way the wound has healed and extended my prescription for both the anti inflammatory and painkillers that I am taking.  I can't wait to reach a point when I no longer need these.  I am sick to death of popping pills.  I am struggling to avoid my impatience and my desire to to do things setting back my recovery.  I am able to sit in chairs more comfortably with my leg slightly outstretched for longer periods than I was able to before but I still have real problems with sitting in the car.  Despite setting the seat so that my leg is almost completely extended and supported I continue to experience a great deal of pain which starts within a very short space of time and which I seem unable to avoid whatever I do to adjust the position of my leg.

Taking a positive attitude, I have now placed my bicycle onto my turbo trainer.  This is a clever way of turning your bike into a static bike by holding it rigid with the rear wheel on a roller with variable resistance.  I wasn't quite sure how it would go but I was pleasantly surprised to find that I was able to get on and off the bike without too much difficulty.  however, that is as far as progress goes.  With my feet on the pedals I am unable to bend my knee sufficiently far to be able to get the pedals to go round.  This is now my goal, to be able to complete a full circle with both feet on the pedals.

Thursday 11.10.18 - OD+21

It is now three weeks to the day that I had my operation.  By way of a minor celebration and with such fine weather I went out to the Rococo Gardens at Painswick and managed to walk at least a quarter of a mile included some up and down slopes on uneven terrain.  I celebrated this with a cheese scone and coffee in their cafe before eventually returning home..

Unfortunately, the exertions of the morning took their toll and the afternoon was spent resting with my foot elevated and an ice pack applied at regular intervals.  During the afternoon, I kept experiencing a sudden sharp pain in the centre of the knee.  This would happen suddenly without warning and although it lasts only a couple of seconds it feels as if someone has suddenly driven a sharp spike through the centre of your knee.  What is particularly annoying is that I seem unable to prevent it as it does not seem to be attributable to movement or the position of my leg, the pain occurring randomly regardless of the position of my leg or the fact that it is not moving.  That said the enjoyment of getting out into the sunshine and fresh air made everything worth it.

Friday 12.10.18 - OD+22 to Thursday 18.10.18 - OD+28

Four weeks since the operation and this week has had both highs and lows.  Progress has been fairly consistent with the swelling around the joint continuing to diminish.  Consequently, I tried reducing the high dose of painkillers that I have been taking for sometime now.  Unfortunately, at the same time I began to have an adverse reaction to the anti inflammatory medication that I have been taking daily, suffering with mouth ulcers and skin sore and cracking.  I had suffered a similar problem with a previous prescription so the hospital had changed it to an alternative in the hope of avoiding these side effects.  As soon as the side effects appeared I stopped taking the medication and very quickly things have returned to normal but without the anti inflammatory I have had to resume the higher dose of painkiller.

On the plus side I am steadily increasing the distance I am able to walk comfortably and despite the joint being more swollen at the end of the day, the degree of flexion is increasing slowly but surely.  I had previously set myself a goal of being able to sit astride my bicycle on the turbo trainer and with both feet on the pedals rotate them through 360 degrees.  After four weeks, I am now able to do this.  With my feet placed upon the pedals I can just get sufficient flexion to rotate the pedals backwards and then forwards.  I have managed two full rotations in both directions but it is painful to do so and I am cautious not to overdo it and progress slowly.  I am now able to walk up and down the stairs normally albeit slowly and steadily which is another milestone.  Long may this continue.

Friday 19.10.18 - OD+29 to Thursday 25.10.18 OD+35

It is now five weeks since the operation on my knee and I am pleased with the range of movement in the joint and I am able to sit on my bike and rotate the pedals fully against moderate resistance.  I started with performing this exercise for one minute and I have now managed to increase this to three minutes.  I continue to experience some pain but less than when I first started.  However, I am concerned that there is a particular point when I bend or straighten the leg that is painful, albeit not excessively.  I have noticed that at the point at which it is painful that if I put my hand on the side of the knee it feels as if something clicks into place.  I am hoping that this is something that will eventually disappear.  I have an appointment next week with the surgeon and will discuss this with him but I am optimistic as I have read a number of accounts by individuals who have had knee replacements and they have experienced pain for three to six months after their operation.

I continue in the meantime to increase my walking distance and can walk comfortably without support although I use my trekking poles if on uneven ground just in case.  I am now working on improving the length of time I can sit in a chair or in the car with my leg bent before it begins to become to painful and I have to elevate my leg.  At present this is impacting on being able to travel as I can only manage short journeys still.  In summary, certain aspects of my recovery are ahead of what would be expected at this stage following the operation but some aspects seem to be behind.  However, overall the recovery is progressing positively but I believe that my initial assessment as to when I shall be able to my previous level of activity remains at this time.

Friday 26.10.18 - OD+36 to Tuesday 20.11.18 - OD+61

In two days time it will nine weeks since the operation.  Since the last entry recovery has been steady day to day with little of note happening day to day.  Seven weeks after the operation I returned to the hospital for a review.  I didn't see my consultant but a member of his team.  I had hoped that the appointment would have give me some answers to a couple of niggles but the review was over in that space of five minutes if that.  The fact that I no longer had any arthritic pain from the joint meant that the operation could be hailed as a success.  I felt that as the offending part had been removed, not experiencing any arthritic pain should be a given.  I expressed my concern that when flexing or extending the knee joint, I experienced some pain at a particular point when doing so and that I could feel a small amount of movement in the joint.  I was trying to ascertain whether or not this was fairly normal but this was dismissed  and I was informed that it should sort itself out in the next twelve months or it might not because it is an artificial joint.  Although I continue to experience some pain it does appear to be diminishing slowly so I am retaining a positive approach.

Last week, eight weeks after the operation, I went for my first Nordic walk.  It was slow and steady and it really brought home how much fitness I have lost since the operation.  The purpose of the walk was twofold.  First, to make a start on improving my fitness and secondly, to practice technique ready for our instructors convention the following weekend where my technique and my competency as a British and internationally accredited instructor would be assessed.  The walk went well, the weather was sunny and dry however, I hadn't taken into account how slow I would be.  The walk, which in normal circumstances would take me between 40 and 45 minutes, took me just under two and a half hours!  Whilst I felt no discomfort during the walk, I certainly did the following day.  Lesson learned and since then I have walked a couple of times over much shorter distances.

The British Nordic Walking Instructors Convention went well.  I am responsible each year for the opening address as well as a presentation or two.  So it was an early start and a long day by the time I returned home and I was certainly feeling it.  However, it was a good convention and I was pleased that I continue to be competent and capable to teach Nordic walking. Considering that, when compared to others, I looked as if I was doing everything in slow motion thereby making it easier to identify mistakes, I was really pleased with the result.

In two days time it will be nine weeks since the operation.  I will continue to exercise and walk on a daily basis to build up strength and fitness and feel confident that I shall be able to resume all my scheduled walks in the new year.  Therefore, my next post, which I anticipate will be last on this subject, will be when I am recovered to the extent that I can walk at a pace and distance that will ensure a full return to Nordic walking.  When I have reached this stage I will publish details of all taster sessions, lessons and led walks for the new year.

Wednesday 21.11.18 - OD+62 to Wednesday 19.12.18 - OD+90

Tomorrow will be exactly three months and one week since my operation.Since my last update I have been working to rebuild strength and fitness through a combination of cycling and walking.  I was really pleased on a more recent walk to record that I had managed to complete a hilly walk of 3.3 miles in an hour without feeling that I had exerted myself to any great extent.  However, I did find following that, and a more level walk of similar distance the following day, it caused some swelling in the joint which was uncomfortable and a little painful.  At the moment the joint has limited swelling first thing in the morning but this gradually increases during the day, so that by the evening the joint feels tight and uncomfortable but with some mild discomfort and pain.  Range of motion in the joint is good and will improve hopefully with further reduction in swelling as I feel that it is this that is limiting further progress.

This leads me to believe that recovery following exercise is slower than I might have hoped for and  may necessitate when resuming walks and lessons, initially limiting the number of sessions to per week.  However, in the absence of any further complications I intend to resume walking sessions and lessons on Monday 7th January 2019.  A big thank you to anyone who has followed this blog and I hope that if anyone is awaiting a similar operation that my experiences may prove helpful.