A Guide to your Parent's Knee Surgery

Yesterday Mom set the wheels in motion for her next knee replacement, so it seems like a good time to cover the first go-round.

I suppose we waited too long in the first place. She had gotten to where she was in so much pain that it was really affecting where she went and how much she did, and she had a lot of days that were just miserable. She did get some physical therapy, and cortisone shots a few times, but they were only temporary helps, and her orthopedist told her flat out that there was nothing else he could do for her--she needed to get surgery. The x-rays showed bone grinding on bone in both knees, so there's a limit to how much you can mask that.

Our first appointment was November 14th, and the surgery was scheduled for December 21st. That's a bit of a wait, but at least where we did it (which was through OHSU, with Doctor Huff), they do an MRI to get precise measurements and then a firm custom makes the implant, which takes about a month.

The other thing we needed to do was a pre-surgery appointment where a doctor not involved in the surgery assesses whether the patient is a good candidate for surgery--so questions about previous reactions to anesthesia, testing the heart rate, looking at overall medical history, etc. I found out, which I had not known before, that Mom did have a bad reaction to anesthesia the last time she was in the hospital. However, that was 1977, and the field has changed so much since then that those results were probably irrelevant. On the same day Mom met with a physical therapist to talk about after-care, and a physician's assistant to cover any last minute concerns.

One thing we have been asked a lot is why we did not do both knees at the same time. We did ask about that in the first appointment, and there is a really good reason for it. Your biggest risks with any surgery are infection, breathing problems, or clots/stroke. It turns out that your risk for all three is more than doubled by doing both knees at once. It's a huge strain on the body, you are under anesthesia longer, and you have more entry points for infection. Also, it is very important to get the patient moving around soon after surgery because the new joint needs to be used to get it working well. Having one good leg makes this a lot easier.

We knew the day of the surgery more than a month in advance, but you don't learn the time until right before, because there could be cancellations or reschedulings, and actually, even with our 1:00 time when we got it, someone else cancelled that day and we were called to see if we could get in earlier.

The time change was not a big issue, but perhaps just one more area of uncertainty. That being said, we are now at the really grueling portion of the story. So, if you have something like this coming up, this part may be the most helpful.

All four daughters had the day off. Maria and Julie had dental appointments, and then were going to go watch the dogs. This is not a frivolous thing. A major part of Mom's worry was leaving the dogs alone, and she kept saying not to visit her but to just take care of the dogs. She thought she meant it, but she also got very lonely in the hospital, so it was just something we needed to balance, and I knew it would be that way. Misty was the driver, of course, but she hates hospitals and did not want to come in, so I was the only one there. I thought that this was fine, because some company can be worse than no company depending on the situation, and just waiting around the hospital for several hours seemed like enough of a waste of time that you should not have multiple people doing it, but, yeah, I did not know what it would be like.

Much like surgery times, they don't assign a room until the surgery is over, so there is nowhere to put the stuff. I had really not thought about this part.

I had my coat backpack with me, and in my naive mind I imagined myself dividing my time between writing out Christmas cards, reading, and taking little walks through the halls. However, I ended up also having Mom's coat and cane, the bag we packed for her, and the bag the hospital gave us for putting all her clothes in. It was a lot of stuff, and carting it around was not really practical, so I ended up being glued to the waiting room. I left once to go to the bathroom, asking the concierge to watch the pile, but that was it. I would have needed food, but Julie and Maria had thrust a bag of mint meltaways at me as a backup, and I ended up having, I guess it was two or three an hour, just to keep me going. Yes, I realize that was less than ideal. If you have someone else with you, you can all take turns watching the stuff.

I did not take any walks or write out any Christmas cards. I did read, and I was lucky that I had a gripping new book (If You Really Loved Me, by Ann Rule). Starting it in that room, and going on through hours of surgery interrupted by worry and phone calls, I read close to 300 pages. I don't think I actually got over 300 until I was on the train.

The other thing I was not prepared for, and where company could help (the right company, anyway), is the emotional toll. Mom was really scared, and once she was prepped for surgery--covered only in a thin gown and with the drugs starting to take effect--she was very vulnerable, and I had to leave her, and wonder about her. That was followed by hours of waiting (two more hours than planned, actually), and every time my phone went off someone was asking for information I did not have, because I had not gotten any updates (incidentally, cell phone use in hospitals is okay now, except maybe in cardiac wards), and when the doctor finally did come and tell me it was done and Mom was okay, despite the fact that I had no reason to think it would not be okay, and was totally expecting it to be okay, I burst into tears.

Still, seeing my mother be weak and vulnerable was not over. She was very groggy in the room, and looking very frail. It was so late by then I could not stay long, and she was not that alert anyway, but at least I was able to drop her stuff off.

I was completely drained, and somehow I still needed to get myself home and get myself some food. The cafeteria was long closed, as well as the gift shop. It occurred to me that my easiest route was to take the tram to the streetcar, get off at the MAX line, and eat somewhere right there so I did not have to do any more transfers or walking, which is why I ate at Maya’s Taqueria.

Getting some solid food, and protein, into me did help, but I was still really tired. My emotions had been through the wringer, and somehow the fact that the surgery is very normal and went fine did not help.

Let me tell you, the emotional toll does not stop there. For one thing, there was waiting to find out when we would get Mom back, and making sure she got a visit and phone calls every day. This was partly our misunderstanding. We had originally heard 2-3 days, but they will only do the 2 days if the patient is going to a rehab facility. Since we were going straight home, they needed to be sure that she could do various things, and for a while it looked like it might be four days. As it was, we brought her home on Christmas Eve.

Then there was the recovery period. Your parent will have a lot of residual pain. An associate doctor predicted that six weeks after, Mom would be really mad at him, but by eight weeks she would wish she had done it sooner. That was pretty much how it went.

There is also a continuous round of icing, elevation, and exercising. Our mother was not a good patient for this. We reminded her, we wrote up a schedule, and yet she only really started taking it seriously when I got really mad at her and gave up on her, and then she was going to show me. I did sort of do it because I suspected it would work that way, but I was also sincerely mad.

You do need to have realistic expectations. The surgery is for taking away the pain, but generally does not improve flexibility. Most patients have a greater range of motion than our mother did, who has been carrying herself stiffly for some time. Getting rid of the pain was wonderful, but the visiting therapist was really ragging on the range of motion.

That is one thing that I think we should have done differently. After several weeks of home visits, we switched to outpatient physical therapy, which was more helpful. I think we should have done that sooner, maybe after three weeks.

I do think the second knee will go better. First of all, it is familiar this time. We know what we are getting into, what it looks like, and what we need to do. In addition, the weather is warmer and the days are lighter, which should make things less gloomy. We did the first one around Christmas because, of our two choices, that was the one where everyone had time off. It did work, but Christmas feels like it didn’t happen, and also, Mom was cold all the time. Also, the first time Mom’s recovery was hampered by the other knee being bad, but this time all joints should be working (unless her hips or shoulders start going out).

I’m pretty sure I will end up alone at the hospital again, so all I can really do is pack lighter. She did not use a single thing in her overnight bag that night, and don’t think she used it the next day either, so maybe it can be brought the following day. She should not need a coat. The cane will be necessary, but I will not bring anything but my purse and a book. I am planning on Green River, Running Red (Ann Rule again).

For Mom’s clothes, the family does not have to keep the bag, but it improves the odds of nothing getting lost or stolen. I will probably keep it with me, but if that is all I have it should not be so bad.

For the emotional aspects, I am just hoping that familiarity will make it better this time. There are a few less stressors in my life than there were then, and I have learned some things about my ability to handle it all, but that is actually going to be another blog post. Being able to plan helps, and that’s why I share. Well, it’s one reason anyway.

35 minutes walking outside
1 Nephi 16-21