Press-Republican

February 27, 2010

Surgery gets Reiner back on his feet

Knee surgery, recovery can be lengthy process

By ALVIN REINER

PHYSICAL THERAPY just as VITAL

Total knee replacement involves not only surgery but physical therapy.

Full recuperation might take as long as a year.

The surgical procedure itself replaces the diseased or severely injured knee joint with artificial material.

As important as the surgery is the physical therapy that follows. This is comprehensive and lengthy, as there is much more involved than the actual joint. Muscles, tendons and ligaments from the foot to the back are involved with the processes of bending the knee and walking.

A typical physical therapy session involves electric stimulation, laser therapy, ultrasound and manual stimulation. The patient also does a variety of stretching and muscle-building exercises.

According to Elizabethtown Community Hospital PT and Sports Rehabilitation Clinic's physical therapist Bill Doherty, "Often with injuries, the body compensates and patients are not aware of this. We try to change the neuromuscular pattern to make it consistent with normal joint balance and movement. We use these (electro, laser, ultrasound) with movement; it's not just passive."

As he works, Doherty explains what he is doing and the rationale for the treatment process.

"A key aspect of physical therapy is follow-through at home, as most of my patients only come two or three times a week," he said.

I recently joined the ranks of those needing a total knee replacement.

My knee started its process of deterioration in November 1965 as I maneuvered through a bayonet assault course at Fort Jackson, S.C.

Taken to the base hospital, I was told that I "strained" my knee, and a cast was put on for two weeks. My sister, Jeannie, who at the time was a physical education major, told me that I probably tore my anterior cruciate ligament (ACL). This was confirmed six months later by a civilian doctor. In 1972, due to continued problems, I had surgery that repositioned my tendons to provide stability to my knee.

About 15 years ago, I was informed that I was a candidate for a knee replacement. But due to the technology at the time — which was only good for about 15 years — it was best to hold off from surgery as long as possible. So I wrapped my knee and continued to play basketball with guys less than half my age (I'm 65) — until recently.

With almost daily issues of soreness and swelling, as well as at the insistence of my wife, Vivian, I decided the time had come. This was confirmed by Dr. Eugene Byrne of Lake Placid Sports Medicine and a series of X-rays that showed no spacing and much bone deterioration.

SURGERY A SUCCESS
The day of surgery had an inauspicious beginning, when my name couldn't be found at first in the hospital computer base.

From there things ran more smoothly as the hair on my left leg was removed by "clipping" — not shaving.

I also received an "Adirondack tan," as the leg was coated with rust-colored Betadine.

I was relieved when both Dr. Byrne and his physician assistant Lauren Crowl autographed the leg that was to undergo surgery. Although I'm not a Boston or Cincinnati baseball fan, the non-surgical knee was fitted with a red full-length stocking to indicate "hands and scalpel off." I was also relieved that I would be anesthetized with a spinal to circumvent any complications from anesthesia.

The three-hour operation was a success.

Dr. Byrne informed my wife that my bones were "shiny" from wear and three pieces of something had been floating around. The next day, they had me walking down the hall, and the journey to recovery began.

The first day or two, I experienced a lot of pain — around 8 on the pain scale that tops out at 10. I had a morphine drip connected to an IV, and I pushed the button to activate it quite regularly.

The pain subsided considerably the next few days, and the morphine was supplanted by OxyContin and related pain killers.

Upon returning home, I was given a continuous passive motion (CPM) machine that bent the knee through adjustable degrees of motion for hours while I was supposed to relax. Along with OxyContin and other assorted medications, I also took the blood thinner Coumadin that required biweekly blood tests to make sure my blood didn't get too thin.

I had to stop using it for a week or so at one point — it is a rather dangerous drug, but it stops blood clots that can form after surgery.

Though I obtained a handicap-parking sticker, I haven't used it. In addition, I was given a card to carry that will identify my artificial knee if I ever need to pass through a metal detector.

Now, six weeks after the surgery, I can bend my knee more than 90 degrees and do daily tasks, including carrying firewood.

I'm well on the way to recovery.

E-mail Alvin Reiner at: rondackrambler@yahoo.com