The 6 Dollar Man - we have the technology

The title of this post goes back to Lee Major's TV series in the 1970's, adapted to reflect repairs to just one limb rather than the whole body! In other words, it's about a personal journey towards having a replacement knee fitted.  The procedure seems to be increasingly common now that ummm.... "mature" people are active for longer, yet the information out there can be overly technical, impersonal and not a little alarming.  I thought that documenting my personal experience of the process may assist others in making balanced decisions should they be in a future similar position.

A BIT OF HISTORY

I'm 75 now and still physically active but suspect it all started when I was at senior school in the UK.  I threw the discus for my school and province. The problematic left knee was the one which I used as an anchor when rotating in the throwing circle and it would occasionally flare up after competition.   It was shortly after emigrating to NZ in 1975 that I took up sailing at national championship level.  Hanging over the side of the boat to counterbalance it put a lot of load on the knees and this is when the problems became really apparent. 

1963 school team for county championships.  I'm middle row, 3rd from right

1980 - hanging over the side by my feet - heavily stressed knees

In 1981, I had my first surgery to stabilise a dislocated knee and whilst the decline was relatively slow, it was becoming more painful and less stable.  Like a true guy, I soldiered on until recent years when Jennie really started putting the heat on me to get something done about the problem.  As mentioned in previous posts, buying an e-mountain bike and covering some 2500 km on off-road trails in the last 15 months had some real benefits, as did losing 10kg from all the cycling exercise.

However, the time came when exercise alone wasn't enough and x-rays prompted a pronouncement from a local surgeon that they were "stuffed".  The NZ public health service is pretty effective overall but some regions have long waiting lists for particular procedures, including ours.  The surgeon commented that I'd done a lot to help myself and although he couldn't promise anything, he would see if the procedure could be carried out at a private hospital in another region.

THINGS MOVE RAPIDLY

A few short weeks later, I received a preliminary approval from the regional health authority,  then an email from Ormiston Private Hospital in the Auckland Region asking me to have new x-rays taken and to attend a preliminary consultation with an orthopaedic surgeon.  This was when the nerves really started but she really put me at ease with a no-nonsense description of the procedure.  Melissa also sails competitively as I once did, so that was a nice ice-breaker too.

The amount of pre-op documentation to be completed was substantial but efficiently handled by the admin team.  This is where things got interesting and may be of benefit to future patients!  The broad options for anaesthesia were a general anaesthetic or a spinal block, with additional sedative as appropriate.  Initially, being awake during surgery with all the sawing and hammering filled me with horror but this alternative offered a much faster recovery rate and without some of the known risks of general anaesthetic.  It was implicit that there would be absolutely no pain with a spinal block so that's the way I decided to go.  With an absence of pain, I also thought that minimal sedation would also be good.  Instead, the intent would be to play some music via my phone and earbuds as a partial distraction from noises which might resemble an engineering machine shop!  Fingers metaphorically crossed, I signed the paperwork and waited for the day, not without some trepidation.

HOW IT ALL WORKED OUT

An early check-in on the morning of the procedure, followed by visits from various members of the surgical and rehab team with yet more papers to sign.  Jennie and I were both impressed with how clearly explained it all was and delivered with grace and good humour.

Waiting to walk to theatre - more apprehensive than I look!

Just a couple of minutes walk to theatre to meet the near all-female surgical team.  The ones prepping me with the spinal block did their business, again clearly explaining how it all worked.  As I was laid down on the operating table, I experienced the one and only surge of genuine anxiety.  I was effectively paralysed from the waist down but the anxiety vanished as quickly as it had started.  The anaesthetist, Natalie; helped to get my music started at low volume - a mixture of favorite pop songs and Mozart, since you ask!

I was able to hear much of the conversations between the surgical team and the noises of surgery which were not off-putting because there were no accompanying sensations thanks to the block.  What impressed me the most was the relaxed, ego-free atmosphere and associated humour which is a hallmark of all genuinely high performance teams.  That culture is something I've been fortunate to be associated with for much of my working life and it's less common than you might think.  In what seemed like no time at all but was somewhere close to 1.5 hours, Natalie told me that they were suturing up and I'd be in the recovery ward shortly.  What a truly impressive team and being fully awake, there was the opportunity to thank them personally

With no side effects, the stay in the recovery ward was a very short one but the nurse looking after me asked if I'd like an iced lolly.  Wow, that lemon ice was the best ever and yet another example of the hospital team going the extra mile!

From there, it was to a private room with all mod cons including multi-channel TV, private bathroom and so on, with nursing staff making sure that I was completely looked after.  Within a very short time, I was sitting up in bed, eating a delicious sandwich whilst chatting with Jennie and some members of the surgical team. I guess the intent is to normalise the situation as soon as possible and having a spinal block certainly aids that.

Only an hour after surgery finished

Ice water circulating round my knee and pressure cuffs on my feet

All the meals were extraordinarily good, with an excellent range of options - something I wasn't expecting at all.

A beautiful fresh fish fillet and roast vegetable meal

After dinner, it was time to get out of bed for the first time, only a bit over 6 hours since surgery was completed.  A slightly worrying time but pain relief took care of that.  Just a short stroll up the corridor supported by a walking frame to build confidence.  The care by the nursing team at all hours of the day and night couldn't be faulted.

Not exactly elegant but pain-free!

After breakfast the following morning, I was disconnected from the pressure cuffs etc and allowed to visit the bathroom for a shave etc - another milestone.  Seeing the surgical dressing for the first time was quite a surprise. A very neat incision considering that it was a whole knee replacement.

A surprisingly small dressing

It was then time for a visit by the physiotherapist and walking the corridors with the aid of crutches.  Surprisingly tiring and walks were interspersed with naps and watching TV.  Helen, the physio; thought I'd acquitted myself well and we worked through the various rehab exercises that I'd need to do on discharge.  The photo below shows the use of a mini skateboard to improve knee flexibility - works a treat!

Skateboarding whilst sitting down!

Thursday was the day of surgery and it was now Saturday morning.  Before discharge, Helen needed proof that I could negotiate stairs, especially as we have a 2 storey house with both internal and external stairs.  She was a great teacher and going up and down the stairs between hospital floors was done safely, although I wouldn't be breaking any speed records.  With this last task accomplished, the paperwork was signed off and time to make the 2 1/2 hour journey home.  

THE REHAB JOURNEY

This brings us up to date.  Rehab involves exercises that can be uncomfortable, painful even but that pain can be managed.  After 3 days, I'm able to do without the stronger pain relief but they're available if required.  Exercise is tiring but I'm not sleeping particularly well, mainly due to lying in a position which is not my normal one.  Not a big deal in the scheme of things but this recovery phase is going to be tough. My wife Jennie won't put up with any slacking on my part which ensures that I stick with the plan.  She also regards it as payback for when the roles were reversed a few years ago when she had a hip replacement!

SUMMARISING

The entire team at Ormiston Hospital are worth their weight in gold.  Consummately professional, conduct themselves with humility and no egos on display - easy to relate to.  Systems and processes are absolutely top notch.  It was the American productivity improvement guru W Edwards Deming who said, "If you have great people and poor systems, the poor systems will win every time".  The Ormiston Team have got it right and I owe them a big debt of gratitude.

For anyone facing surgery now or at a future date, I hope that my personal experience shows that it doesn't have to be a scary process and that options like a spinal block for some types of surgery offers substantial advantages.

On the road to recovery - stair runs