David, 67 “Two at a Time”

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David, 67, has been physically active his whole life: a skier, a gymnast, a scuba diver and cyclist. When he was 15 he broke my tibial plateau, tore both cartilages in the anterior cruciate ligament. By age 30, his knees were arthritic and unstable and his knee issues led to back pain. It got to the point where he could barely walk four blocks. David’s wife convinced him that he needed to have surgery.

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David, 67, has been physically active his whole life: a skier, a gymnast, a scuba diver and cyclist. When he was 15 he broke my tibial plateau, tore both cartilages in the anterior cruciate ligament. By age 30, his knees were arthritic and unstable and his knee issues led to back pain. It got to the point where he could barely walk four blocks. David’s wife convinced him that he needed to have surgery.

DAVID: My name's Dave. I'm 67 years old. I worked in government and private industry. I was a skier, a scuba diver, a cyclist. When I was younger I was a gymnast. So I was fairly active physically all my life. When I was 15 years old I did a vault, landed wrong on my left leg and it hyper extended backward. Broke my tibial plateau, tore both cartilages in the anterior cruciate ligament. So from that point on I was pretty well limited in what I could do physically. I couldn't run. But I could ski. I'd be skiing since I was a kid.

DAVID: By the time I was 18 I'd had both cartilages removed from my left knee. And I had arthritis in that knee. When I was 29 years old I tore the anterior cruciate ligament on my right knee. Developed some arthritis in that. So from about the age of 30 on my knees were arthritic and somewhat unstable. When I was 50 years old I picked up cycling largely because of wife who's a triathlete. I had to do something to keep up with her. And I couldn't run. We would cycle together. I did a number of century rides. 100 mile rides. And until probably I was in my 63rd, 64th year I was pretty avid both skiing and cycling.

DAVID: Things began to slow down, even though I'd had a lot of problems with my knees, it began to get worse and worse. I had gotten used to the pain over 40 some odd years of living with bone on bone in knees. But what was really the issue was the way my knees were positioned, uh, was throwing my entire alignment out. And I developed a lot of back trouble. And by the time I was about 64 I could barely walk four blocks.

DAVID: My wife finally convinced it was time to do something about it. As it turned out in November of 2012 I had bilateral arthroplasty. I had both my knees replaced. I had good strong upper body strength, which was one of the reasons that the doctor was willing to do both of my knees.

DAVID: With a knee surgery, there's going to be a period of time when the leg is simply not gonna work very well. And if you do both of them at the same time, there's gonna be two legs that aren't going to work very well.

DAVID: I actually went through my house and tried to do the things that I would normally do but without being able to use my legs to any great extent. I tried to simulate what it was gonna be like to actually have the surgery. And one of the things I found was the only way I could get up and down the stairs was to pull myself basically up the rail and then brace myself on the railing going down. You need a fairly good amount of upper body strength to be able to muscle yourself around. Now having said that I will say there was some muscles that got sore that I wasn't expecting in my arms and shoulders during recovery.

DAVID: There's an entire protocol that-that is laid out fairly well for-for joint replacements. I was asked not to take any anti inflammatories including aspirin for a period of a couple of weeks before the surgeries. I was asked to take iron supplements because of the possibility of blood loss. So I took over the counter iron supplements.

DAVID: At the time we only had one dog so that wasn't too much of a problem. We now have three so that was kind of a detour. My wife had her hip replaced in December of this year. So we had to board our dogs for the period of time leading up to the surgery in order to, uh, to try and keep things as-as clean as possible.

DAVID: For about three days before the surgery we used a special soap and frankly I'd advise anybody to-to just be aware that it's gonna dry out your skin.

DAVID: So I was scheduled for surgery at 8 am. Which meant I had to show up two hours early for preparation. I got out about 12 I'm told. I was still asleep. That was after having both knees replaced. Normally takes about two hours from what I understand for each knee. I was in recovery for about an hour and a half. And I ended up back in the room about 1:30. I was pretty well still sedated so I don't think I was in a great deal of pain. I believe I had a nerve block so my knees weren't bothering me that much. In fact I remember thinking, uh, I was kind of surprised that it didn't hurt more.

DAVID: About four o'clock physical therapists came in, stood me up, and had me move my legs around. Try and get some circulation going and to at least begin learning to walk on my knees.

DAVID: I was in the hospital for a total of four days. Um, every day I had physical therapy twice. And it was geared toward two specific goals. One, learning to walk with the walker. And then secondly, learning to go up and down stairs, which is something I knew I would need to be able to do. Normally for single replacements, people are told to, when particularly when going up and down stairs, um, go down with the bad leg and up with the good leg. I kept puzzling over which one was the good one and which one was the bad one. The good one in my case was the one closest to the railing. [LAUGH]

DAVID: I was able to walk entirely around the ward by the time I was ready to go home, uh, with a walker. It became increasingly easier as they took more and more tubes out of me till I was walking around with just a few monitors. And then learning the stairs I actually went up and down the back stairs of the hospital between floors.

DAVID: I was in the hospital about one extra day from normal because I'd had a fairly good amount of blood loss and so I had three units of blood transfused and I was somewhat anemic. By the time I was ready to get home I was, uh, reasonably mobile.

DAVID: So the nerve blocks probably wore off sometime, uh, early the second day after I got out of surgery. And I began to feel more and more pain. The first day was actually less painful than the second day.

DAVID: The pain level, uh, I'd have to say I was expecting it to be really, really bad, um, based on my prior experiences with-with knee surgeries. And it was bad. It was significant. But it was not as bad as I was expecting actually. I have a pretty high threshold of pain. One of the things I discovered being on pain medication is that I had to remember to eat because the pain medication just suppressed my appetite. I didn't feel hungry. And in fact I lost 10 pounds so that was a-a good news situation.

DAVID: I was kinda stubborn. My wife didn't like it. I would get up in the middle of the night and take myself to the bathroom. Use the walker. She always got irritated with me 'cause I made a lot of noise when I did that. [LAUGH]

DAVID: I tend to push the limits of things. A-and I knew that there was very little I could do short of falling down that was going to cause a problem permanently for the-for the replacements. So the limiter was what I could tolerate. And so I pushed things pretty hard because I wanted to get back to my life as quickly as I could. I started going out for walks outside. We live on a private road so I was able to walk up and down the road with not too much trouble.

DAVID: It was painful. But I had enough pain meds that it was pretty, pretty manageable. And if it got to be bad I'd take something and generally take a nap and then [LAUGH] wake up and feel like I was ready to go do something.

DAVID: My biggest limiter probably in the first few weeks of my recovery was the anemia. I'd walk for, you know, a half a block and be tuckered out. I have to go back and lie down for a while. So it took a while to build that back up. So I had to eat a lot of things with iron in it and take iron supplements and monitor that for a while. So that was the biggest issue for me.

DAVID: I had therapy I think three times a week. I had a woman named Karen. Um, so if you ever get somebody by the name of Karen, this was my advice. Be careful, uh, she's a self described physical terrorist. And she would push me pretty hard to do the-the exercises that I had to do. So it was a good 45 minutes to an hour twice a day in just doing the exercises. And planning for them. Taking enough pain meds so I could do them and push them.

DAVID: I also set specific goals for myself in terms of what I wanted to try and achieve. I kept close track of how much flexion I had in my knees. And how much extension. Whenever the-the therapist came over she would measure those and I kept pretty close track of-of how we were doing and whether we were making progress toward whatever the maximums were in those cases.

DAVID: The doctor told me to back off because I was reaching the limits of the prosthesis. I was probably able to drive after two weeks. The only real thing is being able to lift your leg up and from the gas pedal to the brake. And so I was able to do that. The real limiter is not so much, at least it wasn't for me, my legs but the pain medication that I was on. Whether I felt safe driving.

DAVID: I did a lot of core exercises which, you know, whether you got one leg or two that's some of the things you're gonna have to do.

DAVID: A number of exercises which I had once I became an outpatient rather than in home is proprioceptor exercises. That's not something that-that people talk about much but proprioceptors help you locate your body in space. And they help your sense of balance in that sense. You have to kind of know where your body is in order to stay upright. And surgery affects your proprioceptors so that was one of the things that-that my therapist very hard on was standing on one leg, moving my other leg around. Um, learning to understand again where my body was at and where my center of gravity was. You have to relearn to-to-to balance yourself because has been traumatized by the surgery and...

DAVID: I started working from home, you know, three to four weeks. And I went back to work after five weeks. Eh, requires a little bit of adaptation. I-it was hard to sit. Sitting was harder than standing actually. And so I had to move my legs around, put my legs up, put them down. Keep them moving in order to avoid getting stiff and sore.

DAVID: I continued to do outpatient therapy for several months. I kept working on strength and-and conditioning and endurance. My wife and I would go out and walk the dogs and we just kept building up, you know, one mile, two miles, three miles out walking back and forth.

DAVID: At the end of five months she said let's go climb La Tuna canyon. It's about a four and a half mile climb and about 2,000 feet of climbing. So we did that after about five months. Up and down. I don't know. Six, seven months.

DAVID: I started building back up on the bike. I wanted to be sure my balance was good because I was more worried about that than I was about being able to ride the bike. So I went out and we started doing rides and built up to about 60 miles. We'd ride from down to the beach and back. So did that for about a year and then got a pass to Mammoth and went up and did-started skiing again.

DAVID: If you've ever trained for a sport you'll know that it's not all fun and games. You don't quit when it starts to hurt a little bit. That's part of the deal. But that's how you make progress.

DAVID: I was surprised even fairly early on that it was working as well as it was. I mean even the first day when they came in and stood me up and I was standing there by the bed and I looked down and for the first time in my recollection both my feet were pointed perfectly forward. I hadn't been able to do that probably 20, 25 years. And suddenly I was able to do that. It was kind of amazing. I actually became a better cyclist because I could apply power more evenly to the pedals. So I could actually ride faster than I could before.

DAVID: I skied better 'cause I could drive better with my left leg than I could before. My turns were much more even and consistent. Everything actually just got better for me after I did it. I always a-assumed that when I had knee replacements that they would somehow feel strange like there was a foreign body inside of me and it wasn't me anymore. And it frankly doesn't really. It feels like knees. They do pop a little bit sometimes. I'm told that's normal. It doesn't end up being that drastic a change except that its' better.

DAVID: Well my legs simply just work a whole lot better than they used it. I was really bow legged especially my left leg. So now I'm having a few issues with plantar fasciitis and ankle issues and things like that that I'm dealing with. Because my body is just aligned differently. My ankles got used to my legs being in one place and now they're in another place.

DAVID: I have some fairly severe problems in my back. I have, uh, spondylolisthesis. So I have a vertebra that's about a half inch out of alignment with the rest of my spine. And it's sitting on the disc which is sitting on my sciatic nerve. And all of that sort of resolved itself as a result of getting these knees done and being properly aligned.

DAVID: I was fortunate my wife was-was very attentive and she really wanted to take care of me. You have to be cognizant of the burden that you're putting on the person who's taking care of you as well. 'Cause it is a lot of work. And it is a lot of stress. You gotta be aware of that and the people who are caregivers have got to-to understand that you're gonna sign up for something that's gonna be difficult. I think it's important to help the other person and push and she pushed me. And I would not have done those things probably on my own. She suggested that we go for a walk, go up the canyon, do this kind of thing. Let's try this, let's try that. She wanted to do the 10K and so I said eh all right, I'll give it a shot. [LAUGH]

DAVID: Having a partner who pushes you a little bit and also engaged in some of that stuff is very useful. So if you're not married to one go find a friend I guess. My advice to people is, you know, sit down and think about it. Figure out on this side of what are the pros and what are the cons and then try to identify how important they are to you and come up to a-with a conclusion based on the research that you did.

DAVID: You-you can worry yourself to death about things. Knees are gonna probably turn out pretty well. The odds are in your favor. Way in your favor.

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