49 Days

49 Days. 7 weeks. Today marks that many days (and/or weeks) since I had my Total Knee Arthroplasty (replacement) surgery.  I updated my status after two weeks here, and described why I needed the surgery in the first place, here.

It’s been a ride, to say the least. When I was a kid, Disneyland had different kinds of tickets for different rides, ‘A’ through ‘E’.  ‘A’ tickets got you onto the carousel and the trolley down Main Street. ‘E’ tickets got you on the cool rides – Space Mountain and the Matterhorn. The tickets came in books when you entered the park. When we went, we’d always come home with leftover ‘A’ & ‘B’ tickets, and never had enough ‘D’ or ‘E’ tickets. I am not sure exactly the Disneyland ticket value I’d give to this ride, but some days it’s been an ‘E’. Most days it’s been an ‘E’.  A roller coaster. People ask me “how are you doing?”. The best answer I have is that it changes day-to-day, sometimes hour-to-hour, at times minute-by-minute.

DC-DL-Ticket BK AE 59 Ex (Sample)
1960s & 1970s era Disneyland Attraction Ticket Book

I knew it would be hard. My doctor never sugar-coated that.  But I had never had any surgery before, so “hard” was a concept I didn’t really know the meaning of. As I’ve progressed, I’ve come to learn that a TKA is probably the hardest recovery of any orthopedic procedure.  Imagine someone puts you to sleep, cuts your leg into three pieces, and takes the middle “bendy” part out and replaces it with titanium and plastic.  Every surrounding muscle, ligament and bone is affected – in the case of the bone, they glue the new parts to the bones themselves. The quad, hamstring and calves are traumatized.  There is significant scar tissue created. As I mentioned in the prior blog, I was home from the hospital after a couple hours.  But that was just the beginning.

Today (7 weeks later), after a lot of hard work and recovery I have made progress. I’ve been using a cane for 3 weeks, after the first four were spent on a walker, I even walk around PT and a bit at home without the cane at all. I am off of painkillers (with the exception of occasional Tylenol due to PT pain), so I can drive myself.  I was able to “move” back upstairs to my own bed, I can shower and shave on my own, heck I can even put on my own socks (well, only ankle socks, but still) and shoes. I can even tie the laces. I’ve been able to go to a couple Atlanta United games.

My first big outing was to an Atlanta United game. They helped us get accessible seating and the customer service was amazing. I also learned – just a little – how hard it would be to have a true disability that made this an everyday thing).

That said, after 7 weeks, I still have a long way to go, which for someone as impatient as I am is scary and frustrating. Recovery is a process of essentially 3 parts:

  • Strength. Regaining the strength in all those muscles and ligaments that are affected. And not just by the surgery, remember I wasn’t very functional for ~ 4 years prior, so there is a lot of atrophy involved.
  • Flexion. This is the range-of-motion of bending the knee backwards. My right (good) leg has 135 degrees of flexion. Three weeks post-surgery, my left had ~70 degrees (purposely, my surgeon restricts flexion to no more than 70 degrees for first 3 weeks). As of Tuesday I had 98 degrees. I have fluctuated between 86 & 93 for the past four weeks.
  • Extension. The goal is to have the knee lay flat. If you think about your own knee, you can likely go beyond flat (hyperextension) a bit. My knee extension also fluctuates. At times, after a lot of work, I can get it flat. Other times, I can’t lay it flat at all.

Something I have recently learned is that only a very small percentage of people have issue with both flexion and extension.  Most people can either flex further, or go flat.  I am part of that small percentage that has issues with both. Yay.  When I am doing PT, I spend less time on strength (that’s actually come back fairly well, all things considered), and spend much more time on flexion and extension. That means about ½ my work is spent stretching the muscles so I can bend, and ½ my work is spent stretching the muscles the other way, to get them to lay flat. Essentially I am doing really hard work that counteracts almost all my really hard work. The efforts to get more flexion are being offset by the efforts to get extension. A vicious cycle that makes my progress and recovery slower than some others experience.

My own personal pain cave. I spend a lot of hours here doing rehab.

I mentioned scar tissue above. Scar tissue has proven to be another big obstacle.  My quad had a lot of it, and it impedes stretching until it is broken up.  I had a lengthy massage on my quad that included scraping to help break it apart, and that has helped a lot.

I am continuing to try and stay focused on the long view. While it’s been 7 weeks, it’s only been 49 days. I never expected to be back to normal in 49 days. Onward.


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