Mary Schaefer is a nurse who came to terms with her need for a total knee replacement. Read how she approached the operation, as well as recovery and rehabilitation.
When did your knee problems begin?
I first injured my left knee in a bicycle accident in 1995 and had arthroscopic surgery. It was okay for a while but then it started to bother me. In 2005, I was mugged and thrown to the ground on my right knee. Within six months, I was limping at the end of my 12-hour workday and crying in the car on the way home.
What made you decide to have surgery and what type of knee replacement did you receive?
In September 2006, I had a bilateral simultaneous total knee replacement. By this time, I was in severe pain with bone-on-bone osteoarthritis in both knees. I just couldn’t handle the pain anymore. On top of that, the NSAIDs (pain killers) I was taking induced primary hypertension.
I asked my doctor how long I would be out of work for one TKR and was told six months. Two TKRs (both knees) would also be six months. This was the determining factor in having both done at the same time. I am glad I had them both done on the same day—with the same surgery and same anesthesia. The post-op pain was so horrific that if I had only done one I would not have done the other.
How would you describe yourself at the point of your surgery? What were your top two fears about having a TKR?
I was 56 years old, healthy, working full-time, 12 hour days in an intensive care unit. I was scared. As a registered nurse, with 35 years of nursing under my belt, I knew all the bad things that could happen. I was afraid of infection, pain, the entire aftermath, and I was afraid for my job. Where I work, on family leave, if you’re out three months, your job goes up on the board. The employer must give you a job, but it might not be where you were working before.
Did you know other close friends or family members that have had a TKR? If so, did that impact any aspect of your choices around the surgery or recovery?
Both of my parents had one or both knees replaced. My mother wouldn’t have the second one done after the first.
Was your family involved in the decision to have a TKR? Did they play a role in your recovery?
My children were involved and very supportive of my decision. We discussed all aspects of the surgery, including financial, medical as well as the Living Will. My youngest son was my advocate. He was the one to handle my affairs both at home and in the hospital.
How did you select the surgeon who performed your TKR? What made the experience with your surgeon positive or negative? Did you have a role in selecting the hospital where your surgery was performed?
My primary care physician referred me to a surgeon. I met him and liked him. He was frank and respected my knowledge. My brother was seeing another surgeon, but didn’t like him. He came to see my doctor and liked him too. I had a choice of three hospitals. I went with the one that had the first opening.
Did you research the costs involved with the surgery before you made the decision to have a TKR? Did financial issues impact your decisions?
I had great medical insurance at that time. I also had short-term disability insurance that would kick in after two weeks.
Did you research the implant before surgery?
Yes. I researched via the Internet. I received one of the new “lady knees.”
Was weight an issue for you before surgery? Has it been an issue after your surgery? How has your behavior changed before and after your TKR?
I’ve put on some extra weight since the death of my son in 1999. Stress can do a real number on a person. My weight did not affect my physical therapy or my ability to walk or maneuver my knees. I don’t limp anymore. In fact, I went back to work full time, 12-hour days only six months after the surgery.
What pain did you experience after surgery and what was most effective in helping you manage it?
First off, I requested to be intubated during the 4-hour surgery. I was given bilateral femoral blocks. They lasted for at least 10 hours. The blocks were great for immediate post-op pain.
My first post-op day I remember the pain was worse than I had imagined. I was not prepared for it. I was sobbing so hard I was having laryngeal spasms. I had a combination of oxycontin every 12 hours, two percocet every 4 hours, and lorazepam every 8 hours. This combination was very helpful.
What was the most challenging part of your rehabilitation? What was your experience with physical therapy?
I wish I had been better prepared for the pain… I was not. The intensity took me totally by surprise. Also, I was told up front that since I was having a bilateral procedure I would need in-patient therapy. They worked me so hard that I wound up crying. But it was a good thing. I was up and down the stairs by the end of the week.
My home therapy wasn’t so intense. The therapist came three times a week for two weeks. He gave me exercises to do on the off days. I had outpatient therapy at the hospital where the surgery was done, since it was closer to my home. The outpatient PT worked me really hard and was pivotal in helping me return to work quickly.
How long did it take before you were fully recovered and active again?
It took me about three months to feel good again. I was back to work, full time in six months. Now six years later, I don’t even think about it.
What does it feel like to have an artificial knee? How does life compare to before TKR surgery?
The knee feels normal…like it’s always been there. I can’t feel it at all. My knees don’t hurt and I can run around that ICU without any problems. No more crying because my knees hurt!
Did you experience any complications and what advice can you offer others considering a TKR?
No, I haven’t had any complications. If you need to have both knees done, get them both done at the same time. Do not pre-donate your own blood for use after surgery. It will take your body too long to make more. You will need your blood level high pre-operatively for it will drop post-operatively. Make sure someone is there with you to speak with the doctor and nurses. You may not be able to do it.
Have your spokesperson make sure you have enough pain medicine and get it often enough. Physical therapy is your friend. The outcome you achieve is up to you. It hurts, but it’s important to push yourself and move those knees.