Introduction. Don’t go looking. I went looking. Progress at one week. Three. That amount of flexion. This amount of pain. Those miles of walking. These miles of cycling. Will my leg ever be straight. When to go back to work. How much weight loss is normal. What about fatigue. What does overreach even mean?
I don’t have the answers for these things. We are all different and comparing ourselves to others can be dispiriting. So this is a story with few numbers. No milestones to compare yourself to. It’s just my experience and how I approached some of the challenges of rehab and daily living after a lateral partial knee replacement in my right knee.
The anaesthetic. I was offered a spinal, accepted a spinal, and woke up in the operating theatre (don’t remember this) to complain of pain. Knocked out with a general anaesthetic immediately. Yes there was a lot of pain afterwards. No, I couldn’t control it. Not for the first few days. The great thing about pain is that it’s almost impossible to remember once it’s gone – and it will go. You just have to slog through it. I was in hospital for two nights but could have stayed longer if I’d wanted to. And yes, I did want to. But I hauled on my big girl pants and left on the Sunday evening – forty eight hours after waking up from surgery.
Painkillers. Left the hospital with paracetamol, codeine and some break through oxycontins. Never touched the latter. A good tip seems to be to take the painkillers for longer than you think you need them, always ensure you have pain cover for physiotherapy sessions, and taper down the stronger tablets first (codeine) and keep the paracetamol going. You can break the codeine tablets in half, and mix and match with different strengths of Co-codamol. I took paracetamol four times a day for a few weeks, then dropped down to just as required. If you’re taking codeine you’ll need to up the fibre in your diet, drink plenty of water and possibly add in a laxative. Happy times.
Sticks. I started on a walking frame, using it for a day immediately post-op, then progressed straight to crutches (the ones that you can hang off your arms). I live in a top flat (three flights of stairs) and had no problem going up and down once I got home (more on that later). At some point I moved to one crutch, and stopped using the crutch when I kept walking away without it. It was useful to take the one crutch out with me even after I didn’t need it. It felt safer, and was a good signal to bus drivers that they shouldn’t drive off until I’d sat down.
Going home. The first week was hard. Tiring, sore and difficult to move around. I stayed with friends for a week and would have struggled to manage at home on my own. I needed looking after. Having my meals cooked for me. A little help with the TED stockings for a couple of days. A hand into the shower. Some tender loving care.
Stocking up. I stocked the freezer before my operation, bought bulk food that was easy to prepare, and brought lots of fruit and vegetables home with me after a week away. Standing up to cook and do dishes was hard, but got easier quickly. Having a small kitchen was a godsend. I could swivel between the sink and the hob with little effort. I ate a lot of porridge and quiche (never together).
Sleeping. Getting comfortable in bed for the first few weeks was tough. I was advised not to sleep with a pillow under my knee (it would prevent my leg from straightening) and I managed that for the first couple of weeks but buckled eventually and used the pillow. Once I could turn over in bed and sleep on my side I put a pillow between my knees which helped. Sleeping on a fifteen year old concrete futon is not ideal post knee surgery.
Washing. I do love a bath board! The hospital team gave me a board to take home, but, while I was staying with friends I used their shower. The board and a non-slip mat in the bath were essential (my shower is over the bath) safety measures, and meant I could relax without worrying about slipping. The board has now moved on to the next patient – a friend who broke her ankle just before Christmas. I gave the board up when I had enough knee flexion to step in and out of the bath easily.
Staple removal. Not going to lie, it hurt. I booked the appointment with the nurse as soon as I left hospital (advice was to have the staples removed 10-12 days after surgery). It only took a few minutes but she did miss one (hard to see in amongst the swelling) and we spotted the silver glint just before I left. I should have taken strong painkillers in advance. Got a telling off from the nurse for not taking my dressings (provided by the hospital) in to cover the wound once the staples were out. REMEMBER TO TAKE YOUR DRESSINGS.
Physiotherapy. Physiotherapy wasn’t provided with my surgery so I arranged it myself. I found a local private practice two blocks from my flat (it was vital that I could get to physiotherapy on my own) and booked the first appointment for a few days after the staple removal (around three weeks after surgery). I wanted to get started quickly, and the sessions hurt – both at the time and afterwards. For me, physiotherapy meant goals, measuring progress (for example knee flexion and straight leg), having a professional on hand for reassurance and questions, and doing the stuff I couldn’t do myself (for example getting into the scar early to avoid the build up of scar tissue). I went every week until I was swimming and cycling, then dropped it to fortnightly.
Exercise. At home I already had a turbo trainer (my touring bike is on that), yoga blocks, therabands, ankle weights and hand weights. I bought a 6 mm yoga mat -the extra thickness made the physio exercises at home more comfortable. I had (and still have) a daily routine set out by the physiotherapist which he has changed every few weeks as I get stronger. This is a mix of stretches, strengthening exercises, and exercises to improve my knee flexion. Knee flexion has been relatively easy but getting a straight leg has proven much more elusive. As I write this (around week ten) I’m still around half a degree off that holy grail.
I started on the turbo trainer early on (ten minute sessions) and had to buy a step ladder to get onto it. I started off in an easy mode (spinning) and increased the resistance over time. I’m also lucky enough to live close to a swimming pool. I was in the pool soon after my wound had fully healed, doing gentle exercises before starting front crawl with a pool buoy between my knees, then progressing to wearing fins – and now I do a few lengths with fins, a couple without, a few with etc.
Walking. I’ve been advised to keep increasing the distance I walk but it’s been tricky in icy conditions. I started with a few steps in my street, building up to a block. My target was getting to the local Scotmid to buy supplies. Initially my leg felt stiff and sore, then I struggled with spatial awareness (standing on one leg is good for that, progressing to standing on a cushion to get a bit of a wobble.). The spatial awareness issue has resolved but I’m still conscious of my knee when walking. I was anxious on my first couple of trips into town on my own (using the bus) and tired afterwards. I was surprised at the level of fatigue even several weeks post surgery. Nobody mentioned that! I’m now able to walk further than I could when my knee was flaring (before the surgery).
Cycling. Before the operation I was advised to stay off my bike (outside) for around twelve weeks. This was for safety purposes. While I’d probably have enough flexion to cycle, the rough road surfaces and unpredictable drivers, dogs and pedestrians would be too risky. However, at my follow up with my surgeon around seven weeks, she advised I could start earlier. Again, I started gently, cycling off-road initially for ten minutes, with the second outing half an hour. I’m expecting to cycle to work next week.
Work. Going back to work will depend on what you do, whether you can work at home, and your employer. I am able to work at home, and have a supportive employer. I did a few hours of work in my fourth week post-op, had a two week break over Christmas, and then went back to my normal working pattern. The main challenge has been to remember to stand up every hour and do some physio to prevent stiffening up. As I work part time, I’ve been able to do more extensive physio on my days off, with lighter exercises on working days. And yes it was tiring going back!
Kneeling. Yep – it’s happening! Lots of people worry about this. I’ve been working on it over the last week, kneeling on a cushion and initially putting most of my weight through my unaffected leg. I’m starting yoga in a couple of weeks and I’ll be looking for postures that help my kneel confidently.
Aches and pains. Pain comes and goes in different places at different times. My main issues, outside the expected pain, have been pain across my knee cap during one particular exercise (leg raise off chair), and pain associated with a very tight ITB. I’m working on the ITB (stretches and spiky ball) and the knee cap pain will dissipate over time.
Cranial osteopathy. A few days before the operation, I had a cranial osteopathy treatment. Following surgery, I had a few more treatments. The treatments were calming and helpful in reducing pain as well as improving my mobility and stimulating the healing process.
So that’s it. As I write this, I’m just nine weeks post-op. The journey hasn’t been linear. Some weeks have been easier than others, and the seventh week was particularly unforgiving. There were a few tears in the first couple of weeks. I lost an astonishing amount of weight and am trying to put it back on. Chocolate and cheese is an ace combo. My friends have been superstars – providing emotional support and lots of shopping. I’ve stayed motivated, and worked hard. I have to make all of struggle worthwhile. If you’re starting out on this process, I wish you well. If you’re ahead of me, I hope your rehab is going as well as it can for you. It’s a long but fruitful haul.
SANDERLINGS 