Faster, Stronger, Better – Getting A New Knee

“Able to leap up curbs in a single bound”

My life journey has included quite a few skiing injuries, a back fusion, a life-changing broken leg, and extensive arthritis. Before we set out on our nomad life, I had my left knee replaced, which came after five surgeries over the previous 25 years. The results have allowed me to travel the world, climb numerous towers in Europe, ski, and generally do whatever I wanted. Fast forward to two years ago when I popped my ACL on the other leg. Things were ok for a while but arthritis developed very rapidly, last fall I could no longer climb stairs. Not ok. It was definitely time to get it fixed. I have climbed the tower in Sevilla and the steps to the church in Amalfi, I want to be able to do that again.

Choosing the Doctor

Here is where I have to admit that I’m a chicken. I really didn’t feel good about having my knee replaced outside of the US. So, when considering where to go for this knee replacement, Scottsdale came to mind.

Six months after my ACL replacement, I stubbed my toe at the Chicago O’Hare airport and it really scared me. So as soon as we arrived in Scottsdale (our next stop), I found an orthopedist in our neighborhood. I wanted an MRI to confirm that my ACL was still intact. For that, I wasn’t looking for anyone special, just someone nearby to order the MRI. It turned out that I really liked Dr. Gruber at Integrated Orthopedics and he was pretty frank about the state of arthritis in my knee.

The next time we visited Scottsdale, I saw him and he drained my knee. We went through that routine once more until last summer. That’s when he said I needed a full knee replacement. He also mentioned something about doing a case study because he uses a Mako computer-assisted technique and he knew my other knee was done the traditional way. I told him that I would have the surgery after ski season, which he understood. I have to say that I was very fortunate to find this great doctor completely at random.

Moving Things Up

Our ski season was supposed to include a week in Tahoe, 2 weeks in Utah, and 3 weeks in Colorado. At the time we made this plan, I wasn’t sure if I could ski this year. In December, we (the whole family) decided that I shouldn’t try to ski this year. That seemed okay at first, but as three weeks in Colorado loomed, I started getting really antsy and depressed. So after much discussion and compromise on Mike’s part, we decided to move up my surgery. It was originally scheduled for mid-February but we decided to move it up by two weeks to the first week of February. At this point, we already had all of the pre-op scheduled and our accommodation set.

As luck would have it, I was able to move everything up by two weeks. What a relief. Talk about stress, as if the knee replacement isn’t stressful enough.

Arranging Lodging

In the past, we had always visited Scottsdale in the summertime, when lodging was reasonably easy to come but pretty cheap. Now we were looking at February and March and to complicate things further, I wanted a ground-floor unit. Getting upstairs with a walker gave me nightmares. The timing of our stay overlapped the “snowbird” season, Superbowl, a big golf tournament, and baseball spring training. All of that made finding accommodations difficult and expensive.

We booked a place last summer, while we were here, but then we learned they couldn’t guarantee a ground-floor unit, so we canceled that. The next place I booked was a standalone two-bedroom townhouse on one level and it was expensive. We were supposed to arrive in mid-February. In mid-January, the owner canceled our reservation. Needless to say, I was pretty panicked. Our lifestyle isn’t all happy-go-lucky, we do need to plan transportation and lodging in advance most of the time. As I started researching lodging again, there was a lot less to choose from and it was still expensive.

I decided to reach out to Pure Suites, a corporate housing company that I had seen on a few Airbnb/booking.com listings. They seemed to have a bunch of properties in Scottsdale. After talking to them, I was able to negotiate for a ground-floor apartment in a large complex, with amenities, fairly close to where I was having physical therapy. We were able to lock in the apartment for our original stay and when I called to see if we could move up our arrival by two weeks they said okay. I was thrilled. At least we would have a roof over our heads and I wouldn’t have to move right after surgery.

Pre-op Challenges

If you have had surgery, you know that you need pre-op approval from your regular doctor, lab work, and with the knee surgery, I needed a CT scan. All of that was also scheduled to work with the mid-February surgery date. When we decided to move everything up by two weeks, I had to change all the appointments. Fortunately, in the Phoenix metro area, there are plenty of doctors, labs, and imaging places so it was pretty easy to move everything up.

The only tricky part was the imaging. They called the day we were traveling to Scottsdale to tell me that the location I made the appointment for couldn’t do the type of CT that I needed. So while we were in the lounge waiting for our flight to Phoenix, I was working with a scheduler to get another appointment for late that afternoon at an appropriate location. The result was a bunch of running around after we arrived in Phoenix to get the labs done and the CT scan on the Tuesday before my Friday surgery.

It is unfortunate that the medical community only reviews their schedules at the beginning of each week. There have been numerous times when I’ve made my appointment months in advance for a day I know I’ll be in that town only to have it canceled a day before. Often, they just leave me a phone message asking me to call and reschedule. The bane of my existence.

Clearly, the medical community isn’t designed to support our nomadic lifestyle. Fortunately, my surgeon has been very accommodating.

The Day of Reckoning

Fast forward to the day of surgery. Because of issues I have with IVs, the staff decided that I should have a PICC line put in for the surgery for however long it was needed. I was very relieved and the PICC process seemed much easier and less painful than a regular IV. This way, I didn’t have to go into surgery really mad, like I have a few times in the past. I’m sure my pleasant mood made the pain control easier. I think they drugged me up pretty quickly because I barely remember the doctor coming in and signing the knee they were going to work on.

Dr. Gruber had originally told me that they do most knee surgeries as outpatients and I was a little taken aback. With my first knee replacement, I stayed in the hospital for two nights. So, I figured it would be overnight with this knee. Mike wasn’t looking forward to dealing with me right after surgery, so he was relieved when I did stay in the hospital until the following morning. I was only able to leave after proving to the physical therapist that I could get up and walk with the aid of a walker.

Recovery

It has always amazed me how fast I could forget the details of such a memorable experience. With the first knee, I was grossed out by the process and there were significant issues with pain control. Both made the experience memorable. This time was a breeze in comparison. Far less pain initially, but days 3 to 8 were pretty bad. Overall, I think the knee replacement hurt less and is requiring less PT than the ACL replacement. That is pretty amazing considering the mechanics of replacing a knee joint. Yuck.

The PT routine is three times a week, starting 4 days after surgery until we leave Scottsdale about eight weeks later. PT involves some hands-on work with the therapist, but most of the time is spent doing a whole bunch of painful exercises. Just as one exercise gets easier, they give you more to do. Most of the exercises are designed to make your quads strong again. The funny thing is that it isn’t really the surgery itself that makes them weak, of course. They are pissed off, no doubt, but the period of inactivity after surgery weakens the muscles, too.

Progress Report

I spent the first two weeks using a walker and this really great, cooling machine. The machine is completely self-contained and circulates cold water and can perform compression on the knee and/or your lower legs. I must say, that was one of the better things I’ve spent $400 on lately (not covered by insurance). The machine was so much easier than ice and I could sleep with it at night because it would cycle the cold on and off as you would with icing.

Two weeks after surgery, I graduated from the walker to the cane. But the process from that point on has seemed like two steps forward and one step back. I would feel better, then I’d overdo it a little. Followed by spending the next two days with my leg up taking more pain pills. Clearly, the process isn’t linear.

I am now six weeks post-op and am walking on my own most of the time. The cane comes with me to activities that I know involve a lot of walking like baseball games and going to dinner in Las Vegas. Everything in Vegas is at least a mile away even if it is in the next hotel over. I know that I’ll have to continue with the exercise program forever. Over time the stiffness will dissolve and my knee will function normally. But PT and massage always help speed up the process.

What’s Next

As with my ACL surgery a few years ago, our lifestyle allows me to sample physical therapy in many parts of the world. In addition to doing my exercises, I am planning to continue physical therapy at our next stop, Mexico. By the time we head to Europe, I will be more than three months post-op. I remember being pretty much back to normal at that point with my last knee replacement. I’m confident that my new knee will provide many years of walking up and down curbs in a single bound. Faster, stonger, better!

 How would you feel about being the subject of a case study?