Taking foul shots six weeks post-op. No playing, of course, at this point!
My left knee received a total knee replacement January 7, 2014, compliments of Jared Roberts and his team at Capital Region Orthopedics. My post-op rehab has been overseen by Mark Garcia of Kingston Plaza Physical Therapy and Dr. David Ness, Sports Medicine and Chiropractor in New Paltz, NY. Mark provided exercise guidance for 8 weeks while David assisted with stretching the knee post-op with various deep tissue manipulative techniques while assuring I maintained proper skeletal balance. Rob a personal trainer at the MAC Fitness Gym in Kingston Plaza has further assisted with great advice as to what exercises to use to strengthen my knee and core!
BACKGROUND:
For those not familiar with my journey towards a new knee, I severed my ACL completely and tore much of my medial meniscus in 1975 playing hoops in college. Back then, repairing the ACL and saving the meniscus were not the norm…and as a result, my surgeon then removed most of my medial meniscus and did not repair my ACL. I’ve accordingly been without an ACL and most of my medial meniscus for the past 40 years while running daily, and competing in hoops at the highest levels available.
PAIN PRE-REPLACEMENT:
I had little pain until I turned 50.
Up until then, I wore a Lenox Hill brace to play hoops whenever I wanted and ran regularly without a brace. My normal run was between 3 and 6 miles/day.
11 years ago, however, while running full-court in the Senior Basketball League in Albany, I began to experience knee pain after games requiring ice and ibuprofen. When I turned 55, I was fitted by my orthopedist- Max Alley, partner with the Capital Region Orthopedic Group- with an “unloader brace” which transfers one’s weight especially upon impact from running or jumping from the inside to the outside of one’s leg (or vice-versa). This actually provided a lot of relief for a few years. My pain medication cocktail was changed from ibuprofen to a more potent Naproxen to the even more effective Celebrex (NSAID’s).
Using these meds, and working out religiously, I was able to compete in the National Senior Games- basketball in the summer of 2011. I played well but knew my knee was not 100% and was leaning towards a knee replacement at the end of 2011, rehabbing during 2012, and being able to play in a qualifier at the end of the summer of 2012 for the 2013 National Games.
At the start of 2012, I was introduced to Play Again Now, a pleasant-tasting oral gel. In layman’s terms, this product is a hyaluronic acid (HA) that is taken orally; HA is made by the body naturally…but less as we age. It provides joint lubrication and reduces inflammation of the joints and ligaments. Shortly after starting this product, I found that I was able to stop using glucosomine/condroiten which I had used for 10 years, and reduce my intake of NSAID’s.
Also at this time, I told Max Alley, my orthopedist, that I wanted to seriously begin discussing knee replacement. Max introduced me to Jared Roberts, one of his partners who specialized in total knee replacements.
Jared asked if I had ever had any professional physical therapy. The answer was “no”. Jared prescribed 8 weeks of PT which was very beneficial, providing me with many exercises aimed at strengthening my core and knee stabilizers which I continue to do today. He also suggested I add a topical NSAID, Voltaren, in addition to or in lieu of the Celebrex. (Nicola PT in East Greenbush is the PT outfit I used for Jared’s prescribed PT and they were great! I learned exercises I had never before even heard of!)
After the PT, I told Jared that while I felt better, I still thought a replacement was in order. He suggested one more idea aimed at deferring replacement for another 6 months – 2 years. He recommended cortisone shots before each upcoming tournament. I tried these shots, and they enabled me to play my hardest without any pain, up to and including the senior games in Cleveland in the summer of 2013. I am not recommending nor endorsing such shots…but in my individual situation where I was bone-on-bone and needed some help for 3-4 months…they worked great!
After the Cleveland games, my pain had worsened, regularly waking me up from my sleep. We agreed on a knee replacement at the start of 2014.
PRE-OP PREPARATION:
- I continued to work out daily, focusing on knee strength, core strength, and knee stabilizing exercises. (If I had it to do over again, I’d go to the PT I’d be using post-op and learn the regimen to be used post-op and start the regimen 8 weeks prior to surgery. I didn’t have the foresight to do this but did work out equally as hard…perhaps just not as efficiently as I could have.)
- 14 days prior to surgery, I stopped all NSAID’s and supplements including Play Again Now.
SURGERY:
- I was taken to the operating room of St. Peter’s Hospital in Albany, NY at 10:30. Within minutes…or so it seemed, I was out, awakening at about noontime, wondering when my surgery was going to start!
- My knee was in a Continuous Passive Motion (CPM) machine. This machine gently straightens one’s leg out, then flexes it to 90 degrees, then back to straight.
- Once I could wiggle my toes and seemed awake and alert, I was transferred to my hospital room.
- Percocet was administered along with ice with the CPM machine running continuously.
- Once I could feel my leg, the CPM machine was removed (about 3 hours) and a PT instructed me on 7 exercises aimed at stretching and straightening my leg. I was also shown how to get out of bed with crutches and walk. I was asked to walk down the hallway about 150 feet.
- My job was to do these exercises and walk 150 feet as often as I could.
- The pain the first night was pretty rough, with percocet being administered every 4 hours and some morphine provided intravenously around midnight. That took the edge off!
DISCHARGE:
- On the second day, I was discharged at 11AM.
- I was taken via wheelchair to my buddy, Andy George’s waiting van. I walked from the hospital doorway to Andy’s van without crutches…and never used the crutches again!
- I was scripted with Percocet, Celebrex, asperin, and some stool softeners and laxatives.
- I immediately resumed my Play Again Now, taking 3-4 tablespoons per day to help with swelling and inflammation.
CAUTION:
My biggest issue was with the side effects of the Percocet…namely constipation, nausea, and confusion. I misunderstood my discharge instructions and was taking the Percocet regularly on an empty stomach. After 10 days, and in real stomach agony, I stopped the Percocet cold-turkey, took whatever my GP recommended to clear out my intestines, and felt much better. Jared prescribed a milder pain killer called Tramadol which works effectively.
Please make sure you eat before taking Percocet and follow any/all instructions regarding stool softeners, etc.
It was my experience that I should have weaned myself off the Percocet at once, substituting the Tramadol from the outset. Everyone will have different experiences with painkillers. One friend who is rehabbing a TKR now, has no side effects from the Percocet and uses every night to assist with sleep!
POST OP RECOVERY:
- I worked diligently every day on my exercises, fighting through the pain to straighten out my knee and bending my knee as far as possible. (The harder I worked, the more pain I seemed to be in at the end of the day…but the stronger my knee felt the following day.)
- The hardest exercises were ones that focused on stretching the knee…especially the incision in front of the knee and anything else in front of the knee that was stretched during the operation such as the patella. These exercises brought tears…but were instrumental in my quick recovery.
- On the sixth day after my surgery I went to my first physical therapy session at Kingston Plaza Physical Therapy under the watchful eye of Mark Garcia.
- At the first session, I had 120 degrees of flexibility in my knee without assistance and was able to make a full rotation on the stationery bike riding it for 10 minutes with minimal resistance.
- I was given exercises each week leading up to some pretty aggressive stabilizer knee exercises. I was also asked to do single-leg seated leg presses with 100 pounds. I could do 4 sets of 15 reps with my new knee. Amazingly, pre-surgery, my arthritic pain limited me to only being able to press 70 pounds 20 times with my bad knee!
While I’m sure I am working out as hard as anyone during my post-op rehab, I’m sure my buddies who are going through or have gone through the same procedure and rehab are or have worked out just as hard. I’m also sure they’ve iced their knees regularly. The only variable is that I’m using Play Again Now “joint juice” as I call it…and they are or have not.
My swelling is shown below in the following pix taken 30 days after my knee replacement:
In summary, there is only a 1/2″ difference in my knee swelling between my new knee and my right knee. I attribute this reduced swelling and my ability to exercise at an advanced level so quickly to Play Again Now
My surgeon, Mark Garcia, and Dr. Neff claim my knee swelling has come down more quickly than any they’ve witnessed to-date. The only variable or difference between my post-op regimen and those of buddies who have had the same surgery is that I used Play Again Now.
Future blogs will describe the exercise routines I was provided and which have enabled me to again run in competitive full-court basketball games…within one year of knee replacement!
Happy New Year and if anyone wants to talk about custom clothing…my “day job”…just contact me!
Regards,
Vinnie Rua- Founder, Christopher’s Custom