Same, same but different

11 November 2016: One week after TKR replacement (left knee) - 9 months + 1 week after TKR (right knee)

This time last week I was heading into hospital feeling anxious and apprehensive. Although I had first hand experience of the surgery earlier this year, the risks of the surgery were still front of mind. Especially after being at the Cochrane Colloquium where many of the people I talked to were AMAZED I had a good outcome with the first surgery and gave me the very strong impression they thought I was nuts risking the operation - not once but twice! No matter how much you know in your heart that you have made a reasonable and evidence informed judgment that suits your own personal circumstances, it is sometimes really hard to describe or defend the reasoning to people who are primarily focussed on research.

Anyway - I am delighted to report that the surgery went pretty smoothly. But there have been some interesting similarities and differences between the two procedures.

The hospital check-in protocols were pretty much the same. 

The surgeon came in and marked up my leg and got me to tell him what procedure he was going to perform (it's a rather unnerving question - you think hasn't he got it written on his records?!)

This time there was also an ECG undertaken (nothing of interest to report) and a different anaesthetist. Many of the kind and friendly staff at Wakefield that I met last time were also there. The same people wheeled me down to theatre. Just as I was being hoisted onto the operating table, Peter the surgeon, introduced me to the team as a frequent flyer - "she loved the last knee we gave her so much, she's come back for another one", he said.

Surgery took about 2 hours and then I was back in the recovery room and given a very welcome lemon iceblock (ice lolly). This time however the nurses in the recovery room were very worried about my low blood pressure and called the anaesthetist in from home to come and check me out. Last time my blood pressure was low for about 24 hours and then was back to normal. This time, it took about 3 days to get back to normal.

Once I was wheeled back to my room I was just starting to get myself settled when the nausea started. Unfortunately there was no receptical in sight - and all I could see in front of me was my iPad and a plate of sandwiches. The nurse sprinted for a container from the next room and then came back lunging towards me just in the nick of time! Luckily - she brought two containers. If I hadn't been vomiting it would have been funny. Last time the vomiting volume was much less and certainly the delivery was less dramatic.

On Saturday morning my blood pressure had increased up to 97/66. When my partner Peter came to visit he was surprised at how well I was looking and how lucid I was.

I was delighted that the new knee wasn't too bloated and was also quite flexible.

When the Physio came to visit I was able to bend my knee to 100 degrees 

I was able to get up and wander down the corridor using a walker.

My time in hospital progressed well. Sunday I was able to have a shower by myself and get up on my crutches (BP 100/58).  There was some concern about my urine output (It is a bit creepy having people collecting you wee in jugs and measuring it). I was threatened with a bladder scan and recatheterisation unless I produced more urine. I was drinking as much as I could and when they decided to do the bladder scan they could only find 13ml of urine in my bladder. So I was let off the catheter hook (whew).

Monday (BP 103/60) I was able to walk up and down stairs carefully and slowly on the crutches and I had my knee X-rayed. The X-rays showed the operation had gone well and I was discharged on Tuesday morning (BP 127/73). 

My stay at Wakefield had been good and the permanent staff there are just fantastic professionals who know their jobs well and also go out of their way to make you feel cared for. However it seems that they must have a new policy in place, allocating their permanent staff to those with the highest need. So on Sunday/Monday as I was getting back on my feet (so to speak), I was allocated to 4 different agency staff across 4 different shifts. While the agency nurses seemed like nice people with good intentions, most had never worked at Wakefield hospital before and didn't do any of the automatic things I had taken for granted - like introduce themselves and tell me their names and their roles, or  bring ice for my leg every two hours, or close the curtains at night and turn off the light (all of which are pretty hard to do on crutches).

I also found that  some agency nurses didn't know how to use the equipment ef taking up to 4 attempts to take a BP reading with an automatic blood pressure monitor (yes - I did consider just doing it myself!!!) and they had a pretty casual attitude to dispensing medications. I ended up in an argument with one nurse telling him he had already given me the particular medicine only two hours beforehand - and that it wasn't due for another 10 hours and needed to be taken with food. In hospital, with the high volume of pain meds coursing through your body it takes a huge amount of effort to try and keep your head clear, so I tend to just take whatever pills are thrust at me on the grounds that they will probably be beneficial. As a safety management practice, nurses ask you to give your name and date of birth every time they hand over the pills. But this approach doesn't work as the patient isn't given a list of the medicines to cross match against. It just happens that I recognised the pill the nurse was giving me and remembered specifically taking one with my dinner two hours earlier. The next morning I reported the incident to the nurse manager and I guess I will have to write a letter about it when I have the headspace.

One of the differences between the two surgical events is that this time, the clear dressing on my knee wasn't replaced before heading home. Apparently they have decided against using the adsorbent dressing in favour of retaining the clear dressing applied in theatre. The impact of this is that after one week, while my surgical wound looks pretty clean, the oozy blood coming from the site collects making my leg look like a packet of supermarket meat marked for "URGENT SALE" or some kind of elaborate Halloween costume.

Other differences between this surgery and the last are:

- no trips to the Emergency Department. In February we were concerned that the right knee had developed an infection as it became hot, painful and engorged - like a sausage in the frying pan just about to burst its skin. This pain and swelling was caused by two large haematomas that had developed around the scar of the right knee. While the left leg is bruised and swollen, the skin has remained loose, and sore as opposed to horrendously painful and there are no haematomas

- my leg is much less touch sensitive. Last time I avoided covering my knee with trousers or sheets for about 6 weeks. This time, it is really easy to wear lightweight soft knit pants. There is none of the electric flashes of pain when the fabric touches my leg. Last time I couldn't cope if the dog accidentally touched my leg, for example.

- I can now sleep reasonably well. With my right knee it took about two months before I could sleep for more than a few hours at a time or sleep on my side. I am pleased to report that I am sleeping up to four hours a night and can comfortably sleep on my right side with my left knee resting on a pillow on top of my right leg. It feels comfortingly normal.

The last few days have been very sore but overall the left knee recovery has been much smoother. Apparently the wear and tear on the joints in each knee were comparable. The left knee has had the benefit of longer "prehab" exercises (12 months as opposed to 3 months) and is stronger and with a greater pre-operative range of motion and function.

Having been through the surgery relatively recently, I have been more aware of what to expect and how to respond and perhaps able to tolerate the discomfort more. But I think that the main difference has been that the left leg didn't swell up right from the beginning.

In any case, it will still be a long road to recovery, but at least this time I can sleep and I can enjoy the comforts of a small hairy companion hanging out with me as I go through the healing process.