As I write this I am three weeks into recovering from a double knee replacement. I think that name makes it sound worse than it is. You don’t get your knees replaced, it’s really about slapping some titanium in where your cartilage has aged out. Rehab takes a long time and while it has been described as painful it is more about being uncomfortable. All the time. And I’m getting a little bored. (If you’re a hacker following my social media accounts to find out when no one is around, you’re out of luck. I’m here 24/7.)
Prior to the surgery I had osteoarthritis in both knees for about 3-4 years. It is apparently more common than I would have guessed, at least judging from the vast array of relatively worthless cremes, lotions and roll-ons you can find at any drug store aimed at the knee pain sufferer. The hospital where I had the surgery does 60 knee replacements a week. I half expected them to load me up onto a conveyor belt, but if that happened they apparently did it after they knocked me out.
Since this seems so common I thought some might be interested in what I learned along the way. But first one warning. I am the last person you should look to for medical advice. Prior to my recent knee episode you could measure my time between doctor visits in decades. I know nothing about medicine. Nothing about pharmaceuticals. And subjects like anatomy and biology are blank spots for me.
Doctor #1 – My first venture into getting some professional help for my knee problem is when I mentioned it to a general practitioner who I was visiting for a long-overdue physical. He asked if it was keeping me awake. No, it wasn’t keeping me awake and in fact never did. His advice, “Don’t go to an orthopedist until you can’t sleep at night.” No idea why he said that but I suspect it was bad advice. Had I started to get some sort of treatment early on it likely would have saved me some painful times.
Orthopedist #1 – Why are doctors seemingly so distrustful of other doctors? One of the first things this guy told me is that I was lucky I didn’t go to a university hospital because if I did they would send me straight to surgery. Not sure the rationale behind this advice either but I’ve never wanted much to do with hospitals so I readily accepted it. This visit set me on the strategy of trying to avoid surgery, of doing everything possible before going that route. He gave me cortisone shots which usually but not always relieved the pain for 3-4 months. Three times over a period of two years he gave me three-shot treatments of orthovisc. This stuff is supposed to strengthen your cartilage. It did nothing for me. He prescribed naproxen, which is prescription-strength Aleve. At one point my right knee, which had been my good knee, suddenly became my bad knee. My orthopedist diagnosed a torn meniscus. I had arthroscopic surgery to repair. I felt great for a week. Then the painkillers wore off and I discovered I was no better off than before the surgery. Not long thereafter I came across a story in the New York Times about how this surgery is likely the most often performed unnecessary operation there is. I suspect that I did have a torn meniscus, but that isn’t what was causing me the pain. Instead it was what the professionals refer to as “bone on bone,” another way of saying your cartilage is gone. I asked about physical therapy and was told “it won’t help you.” Another piece of bad advice.
Orthopedist #2 – I thought it was time for a second opinion. But without so much as looking at an x-ray, this guy’s opinion was that I was going to need surgery and since he didn’t perform that surgery he lost interest in me as a patient right away. In fact the guy spent his whole 5 minutes with me talking to his tag-along intern. I might as well have been one of the posters on the wall that shows deteriorated joints. I did, however, prevail upon him to give me a prescription for physical therapy.
Physical therapist #1 – Physical therapy helped me more than anything I had done to this point. (Except for maybe buying the Hoka sneakers that I wore everywhere for two years.) Two weeks before she started treating me, my physical therapist was a full-time bartender. But she never chose to put my knees on ice. Instead she taught me how to exercise and what I was able to do on my own in the gym afterwards. The PT loosened me up to the point where I felt better than I had in a while. I had a prescription for eight weeks of therapy and then I renewed it for another 8 weeks. I spent a full hour twice a week with my physical therapist as opposed to 5 or 10 minutes per shot with all of the doctors. So I felt she knew me and my knees better than anyone I had been treated by.
Acupuncturist #1 – Determined to try absolutely everything, I decided to see an acupuncturist and ended up doing about eight treatments with him. We got along great. We had similar tastes in books and music and common political views. So we had a lively conversation while I laid on a table with needles stuck in me for an hour or so. Not a bad way to break up the day. As for my knees? It did nothing.
At this point I was maintaining myself on quarterly cortisone shots, working out in the gym four or five times a week and taking naproxen daily. I was uncomfortable continuing with the medication because of warnings about prolonged use making you susceptible to other things, like strokes or heart attacks. And while I could do most things, I had stopped playing tennis, I couldn’t run, I didn’t take my dog for long hikes in the woods anymore, and I found myself avoiding anything that involved a lot of walking. It was time.
Orthopedist #3 – This time I went for the best surgeon I could find. This was a guy whose waiting room walls were adorned with New Jersey Nets and New York Giants jerseys, apparently worn by guys who had their knees done there too. No question in this guy’s mind that I should go for the surgery and that I should get both knees done. (One of my knees was much less painful so there was some question in my mind about doing one or two.) This guy I had confidence in. For one thing, he looked at my x-rays and determined that I also had had a stress fracture of the fibula in my right leg. That explained why one leg felt worse than the other even though the knee cartilage looked equally decrepit on an x-ray. Why didn’t any of the other medical professionals or radiology shops notice this? So I took the plunge. That was three weeks ago.
So here are some of the issues you might think about if you are in a similar situation:
To operate or not? All the other things that are offered to people with osteoarthritis in their knees, the creams and ointments, the braces, the shots, are intended to make a bad situation tolerable. (The only crème I found that helped was some Tiger Balm that my wife brought back from Thailand. But it also smelled so strong that even my dog didn’t want to come near me.) You won’t get better! The best case scenario is that you reach a point where you are not that troubled by the pain and are not limited in what you want to do in life. Not being prepared to accept that, I went for the surgery as what I perceived as the only cure. There are some stories out there about people who had a bad experience and had to have the surgery repeated, in some cases multiple times, but everyone I talked to who had the operation or knew someone who had it was glad they did. Some even described it as life-changing.
One knee or two? I’m not sure why you would have the cartilage deteriorate in one knee and not the other but I guess that happens. As I said up front I really know nothing about this stuff. A case can be made for doing one knee. The recovery is no doubt much easier and much less limiting if you are operating on one good leg. I also had one knee that was considerably worse than the other so in that way the one-knee option made sense. Ortho #3 talked me into the dual remake. I came to the conclusion that I didn’t want to go through this and then find I had to do it again a couple years later. The decision to have surgery a second time is likely even tougher than doing it once.
Now or later? As described above I had followed a plan, in concurrence with doctor #1, orthopedist #1 and physical therapist #1, of doing everything possible before submitting to surgery. While it made sense to me at the time, I would urge some caution in following this. I’m probably a little younger than the average knee preplacement patient and don’t have any other health problems. How otherwise fit and healthy you are has a lot to do with how well you are going to recover from this. So there is some risk in putting off surgery and finding yourself in a less advantageous position to deal with it further down the road.
At this point I’m happy with the decisions I made to have the surgery and to go for the double. The rehab, which some described to me as brutal, isn’t really. But it is tough and long. All and all, I’m doing alright. I doubled my time in the gym for the weeks prior to surgery. I think that helped with the recovery. I was walking after a couple weeks and only use a cane for stairs.
Don’t expect me to update this anytime soon, because I’m thinking of getting out of here and doing stuff on my new knees.