This ordeal reminds me of the famous catchphrase “Da Plane,” “Da Plane,” which appears in the opening credits of the TV show Fantasy Island. My version would read “Da Pain,”” Da Pain!” in the context of total knee replacement surgery or TKA ( Total Knee Arthroplasty).
The immediate aftermath of the procedure overwhelmed the excitement of having it done. The long anticipation finally came true. There was a six-month waiting period. COVID had postponed many scheduled surgeries, pushing for a more extended than usual waiting period. As it turned out, post-COVID put me within just weeks of waiting.
I have a high pain tolerance, but I was not prepared for the excruciating torment that saw no relief from the heavy-duty painkillers prescribed, which included a nerve drip and opioids. The misery had the habit of showing up in the early morning hours, so I was not getting any REM sleep in the early part of the recovery process.
My knees have been bothering me for some time. Still, I have managed to carry on with physio, acupuncture, and every other OTC supplement. I even surprised myself by never using a power cart in the twenty years of playing golf, walking regulation courses of nearly 9 km. 5 times each week. Even in later years of shorter ( executive ) courses, it was still a feat, even in the heat of the day, to walk an entire 18-hole course almost every day in the heady days of this highly addicting game.
Unbeknownst to me, my downhill skiing activities in the late 1990s into mid-2000 had caused a meniscus tear on my right knee. I also have had a long history of physical activities that may have contributed to an early wearing down of my knee cartilage. Even before jogging became “de regueur,” I was already into it on the outskirts of town in my teens. My involvement with the martial arts throughout had put additional challenges, especially on the right side. Along with degenerative osteoarthritis in both knees, it was only a matter of time before I maxed out all the pre-surgery interventions available to me. TKA was only a matter of when.
Throughout this ordeal, my Rheumatologist kept me going with injections of “viscosupplements,” and a daily liquid, “Nutriflex,” that held my knees together. The injections worked wonderfully initially, lasting nearly two years in the first year until the annual needle only lasted less than two months. At $600 per knee (OHIP does not cover this), I felt it was not worth the money as the relief has come down to just a few weeks. Out comes knee braces and all kinds of knee supports. I started using a remote-controlled golf cart, foolishly clinging on walking a 3 to 4-hour course typical of a (short ) golf round.
It came to a head during our 2023 holidays in the Philippines when I couldn’t manage anything but a once-a-week outing with a power cart and (mandatory) caddy. And it was not much fun if you can’t put together a game well below a satisfying round. Severe pain became the highlight of each round. More problematic was the loss of balance and sometimes the sudden folding (“giving way”) of my right knee. The more I used a walking cane, the more I felt I was becoming dependent on it, and my balance became more compromised.
Knee replacement surgery has an excellent success rate of over 90% and a regret rate of only 6%. New technology has improved many aspects of the procedure, including quicker recovery, a shorter hospital stay (overnight ) and an artificial joint with a 25-year life span ( replacing the older 15-year variety ).
With this kind of reputation, all the possible downsides become just a blur; blood clots, infection, and bleeding are some that are uncommon. It was a no-brainer in my mind.
It was indeed, if everything checks out in the pre-op process, and there is the rub. During a routine EKG, it showed that I have A-Fib ( Atrial Fibrillation ), which never manifested in all my consultations with my cardiologist. He explained to me that it is one of those that can show up out of nowhere, especially among seniors. But it meant I was to consult my cardiologist to see if I could have a TKA. (A-Fib increases the chance of a stroke ) They put me on blood thinners and a heart monitor to make sure of my fitness for the surgery.
I was astonished at the number of medical personnel involved in the days leading up to surgery. In addition to the orthopedic surgeon, I met with a general practitioner, an anesthesiologist, a cardiologist, a pharmacist, and a slew of nurses and technicians to prepare me for the surgery. A day before, it was decided that the procedure would go as scheduled.
The actual procedure came and went without any problems. The anesthesia, which included an Epidural ( Spinal anesthetic), assured me that I would not feel any part of the process. So, I woke up with the procedure completed and ready for the recovery room. A piece of cake, I thought.
Well, not so fast! First, instead of being kept overnight, they decided to keep me longer, not because of the surgery, which went well, but more about cardiovascular monitoring ( echocardiogram ). I was saying to myself that all the talk about pain seemed overblown. The Tylenol and an opioid are doing their job. However, I was not paying enough attention to a “nerve catheter” inserted on my thigh until it ran out and was removed by the third day. Then, I started feeling the pain despite the intervention.
The success or failure of this procedure depends on a post-operative series of physical therapy to bring back the artificial knee to a range of motion ( bending and straightening ) of a normal knee. A series of exercises to strengthen and restore the knee function. A certain measure of angles determines the range of motion by the lower leg. With a strap, the leg is pulled close to the thigh ( similar to a leg curl ), increasing the compression time.
The Inconspicious Downside of TKA
When all else has been tried, there is no current alternative to a permanent solution to a normal functioning knee but to undergo a total knee replacement. Before the surgery, everything else had been provisional, some intervention to make the knees close to functional and pain-free. Osteoarthritis is a degenerative condition; the knee must inevitably be reconstructed. Current medical technology does not offer anything as successful as TKA. Despite the promise of regrowing the worn-out cartilage through PRP ( Platelet Rich Plasma ), OHIP has not approved it in Ontario. There is no clear evidence that it is a promising procedure for OA.
Like everything else, we all respond differently to medical intervention. Our level of fitness, other health challenges (co-morbidity ), and age can influence the success and recovery of every medical procedure. The thorough pre-op process determines suitability, even an elective procedure like TKA.
In my situation, all I heard was the high success rate and the promise of a normal knee in as little as six weeks. All the negs were a distant blur. But there are decidedly several other adverse effects besides pain and stiffness and many weeks of discomfort of going through physio. The lengthy use of acetaminophen and opioids for pain caused severe digestive disruption, i.e. constipation and hyperacidity. A liver enzyme (ALA ) indicates that my liver had taken a hit with a high amount of Tylenol during the recovery process.
The constant sitting and lying had also put pressure on my Sciatic nerve (causing Sciatica, a pain that runs from the right side of the lower back through my buttocks onto my thigh into the lower leg ), causing another layer of pain on my right side. It causes a limited ability to sit for more than 20 minutes at a time. Despite returning to driving after six weeks, the Sciatica and a sore right knee limit any driving more than half an hour at a time.
It’s been ten weeks since the procedure. Generalized pain and stiffness remain but are tolerable, and no pain medication is required. I continue with physiotherapy beyond the OHIP-mandated program. Chiropractic manipulation had put my Sciatica in remission. The constant physio-pressure on the knee had achieved the straightening progression necessary for regular walking.
Just as the knee straightens, the increased bend provides relief from using a commode, just as I scrapped the walker in favour of a cane. Balance is still challenging, and strength has not yet returned to the legs sufficiently to lower me to a chair without some assistance of an armchair. My appetite has returned, and I have regained the seven pounds I lost.
So there is progress, albeit a slow one. This whole ordeal has given me pause to reconsider getting my left knee done right on the heels of the right one. My sense is to give my body a chance to recover fully, play some golf again and get the other knee done before I turn 80. That’s another year and a half, and one never knows some medical progress that can improve the procedure and speed up recovery.
