Life is often like that, the best balancing on a knife edge, with the worst. ~ Laurell K. Hamilton
Eleven years.
That is how long my astoundingly patient orthopedic surgeon has cautiously suggested that I might enjoy a knee replacement… or two.
However, like most in medicine, I love medical care, so long as it is not directed at me. Avidly I had been following the research into plasma, platelet and/or stem cell injections into knee capsule to grow new articular cartilage in osteoarthritic joints—it seemed a great fad, one all the cool kids indulged in. However, on a telephone consultation with a blue-ribbon institution doing the research (rather than the freestanding clinics happy to take your platelets or butt fat and inject it in various locales without scientific oversight) the researchers acknowledged that the data was that cartilage could grow, just not in a well-organized or durable fashion. By the way, did you know that it is fairly unregulated to have someone take your own tissue and inject it into yourself? Truth.1
This fall, while prepping for a West Virginia hiking trip with friends (that preparation included steroid injections in both knees so that I could keep up) I threw in the metaphorical towel. The cartilage regrowth advocates had moved on to investigate a new technique—that of building a scaffold of material similar to resorbable suture material, inserting this pad into the knee space, and then trying to get cartilage to grow there with exercise-stimulated piezoelectric charges before the scaffolding dissolved. In rabbits.2
Yeah. Not gonna happen in humans anytime soon.
Time to move on so I can get a move on.
A wise doctor does not mutter incantations over a sore that needs the knife. ~ Sophocles
I had gone down swinging. Boswellia, turmeric, strawberries were all researched. Stretching, resistance exercise, Pilates, yoga, weight management techniques were all employed. And a serious ton of ibuprofen.
It was simply time for a new knee, a knee that would enable me to walk without restriction, to climb and descend stairs with an alternate gait, without discomfort or unease. Time to have the tool I needed to best enjoy my retirement of travel, gardening and physical exertion and long-term health.
This December I took a “trip of a lifetime.” Invited to attend an international women’s rights conference in Thailand, I followed that two-week amazing opportunity to meet remarkable women with a nine-day guided tour of Japan and a brief trip to Cambodia and the Angkor Wat temple area—all adventures included extensive temple and historic relic tours with their integral stairs, and seemingly random boulders. The trip was a month long and tested my ibuprofen supplies and walking sticks to their limit.
Yes, it was indeed time. I had scheduled my surgery prior to departure for January 2025, to take advantage of both my high-deductible pre-Medicare health insurance and my garden’s off season.
I’m not the sharpest knife in the drawer, but I do know how to count. ~ Mickey Gilley
So here I am, at 14 days remaining pre-op. (By the time-travel miracles of publishing, I should be done with my six-weekish home recovery and be walking with a cane as needed by the time you are reading this, although all well wishes are appreciated). Which brings us to the heart of this article.
I am counting down the days, off my NSAIDs, off my supplements (as most might lead anesthesia to put a last-minute kibosh on my procedure), on acetaminophen alone and creaking like the pre-lubricated Tin Woodsman … but there’s still time to enhance my post-op outcome.
I’m stretching, beach walking, doing exercise class, yoga, gardening, eating a vegan/vegetarian diet. I am also engaging in knee “PREhab.”3
What’s that, you might ask? Studies indicate that starting your knee rehab in the PREperative period has a positive effect on pain and function out to six months postoperative, although the non-prehab group catches up in a year. Prior to visiting Asia, I had an intake visit with my local physical therapist, as the exercises in the pre-op brochure from my surgeon seemed elderly-level wimpy to me.
While doing my walking of Asia, I did my prehab exercises with bands in the hotel. With two weeks to go, like an athlete training for a marathon, I am kicking my prehab into high gear. I will do my prehab exercises three times daily, although I’ll be fair and substitute a round of prehab 1:1 with water aerobics, exercise class, and hauling loads of the mulch mountain inhabiting my driveway.
So, even though my management plans have changed to embrace the knife, in both pre- and post-op I play a major role in determining my knee outcomes.
“A knife is a humble tool that can create wonders in the hands of a skilled craftsman.” ~ Unknown
Know when to move on—when it’s time to embrace going “under the knife.”
