Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the world of health. Nutrition. Exercise. Diet. Supplementation. If there’s something in the news, I look at the science behind it, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
The day began at 5:00 AM. The primary order of business was to take a shower with a special antiseptic soap on the legs, dry off, put on the loose clothes, and get in the car. It just so happened there was an ice warning but the roads were fine. Destination? The surgical center of an orthopedic group. Purpose? Total knee replacement on the right leg. Patient? My wife Paula. Check in at 6:00 AM. They take Paula back to prep her for surgery. Once she's ready they bring me in for a few minutes. The number of people involved in the surgical procedure stops by one after another to say who they are, what role they will play, and finally the anesthesiologist who's going to administer the nerve block. I leave for a couple of minutes, go back to the room, and in walks guy in street clothes. Neither Paul nor I recognize the surgeon who's in his street clothes as everyone else was in scrubs. He marks up the knee that he's going to replace, puts his initials on it and says it's time to get dressed for work, and says he'll see her in the operating room. A couple minutes later, I give Paula a kiss, and off she goes.
Less than 90 minutes later, they bring me into the consultation room and in pops the surgeon. He's a lot more recognizable now in his scrubs. He said everything went like clockwork, the procedure was successful, and I could see Paula in a couple of minutes in the recovery room. About 5 minutes later, they bring me back. Paula is sitting in a recliner, drinking a soda as well as eating some crackers. She's tired but alert. The nurse goes over what she can and cannot do as well as what I should do for the next 72 hours. Basically, all I have to do is wait on Paula hand and foot. Her job is to relax, because at some point there will be some pain. We know this because Paula had her left knee replaced six months before. Still, with the right combination of pain and anti-inflammatory medications, as well as rehabilitating the knee, she should make a relatively quick recovery. They ask if she wants to get checked out so that she can go home.
They put a belt around her chest, and she walks with a walker for about 30 feet. Because we have steps to get in the house, they have her walk up three steps and then down three steps in a very precise fashion. Good knee first on the way up. Surgical knee first on the way down. She continues to walk back to her chair, they do one last check of her vitals, give me some paperwork to understand exactly what I'm to do, and off we go. From the time we checked in at 6:00 AM, we left the facility at 10:30 AM and we're home by 11:00 AM.
I don't know what it’s like wherever you live, but that's the state of joint replacement surgery here in Michigan. That process isn't the same for everyone. Age, weight, heart disease, diabetes, and so on can impact things. The reason this went this smoothly is because of all the work that happened beforehand. And that's the purpose of this STOH. How to get a good outcome if you need to have a joint repaired or replaced.
It all began months earlier before, Paula’s first knee replacement. A few months before that knee was replaced, she asked the surgeon how best to prepare for the surgery. Her knees were in extraordinarily bad shape and it was difficult to move very much. But what he suggested was working the muscles of the knee and hip to the extent that she could before the surgery. In other words, prehabilitation. We've been using the same physical therapist for years for other issues. He knew exactly what was necessary to get the best outcome. But even more than the PT at the facility, it was the exercises he recommended that she do at home to strengthen the muscles of the knee and hip. While it was painful, she did the best that she could given her limited mobility at the time.
But that wasn't the only thing. She talked to someone during PT who had had the exact same procedure done. What he told Paula had a significant impact. He said that even though the exercises are going to be painful, don't do them until your muscles get tired. Do them until you hurt enough that you want to cry. That's when you know you're getting ready for surgery. I say it that was because that's what Paula told me and I observed her hard work.
The first surgery went well. I could tell from the minute that they had her stand up that her entire stature was different. Complicating the first procedure was that her left leg was at least 5/8 inch longer then her right leg. With the surgery, the knee had straightened out completely which added even more height to her left leg. What she did then was to meet with a specialist who modified a shoe that had a thicker sole to make up for the disparity in height. She wore those constantly.
And that contributes to a very basic concept in bone physiology. Structure determines function. By getting those legs even, she was training her legs in the rehabilitation, which then became the prehabilitation, for the right knee replacement now with no pain in her left knee. She was able to improve her stamina because that leg did not hurt. And because she trained both legs the same way, the rehab on her left knee became the prehab on her right knee.
One of the things that the physical therapist didn't think would happen was one of the things that Paula worked on a great deal. She always limped because her left knee before the surgery was always at about a 12 to 13° angle as sort of a compensation for the increase in the leg length in her left side. She worked at doing the exercises until just before the surgery on her right knee she got extension to -1/2 degree. What that means is that every time she did any exercise that required her to be on her feet, she was training the muscles at precisely the correct angle. All of that contributed to why the entire process took just four and 1/2 hours from entry to exit.
But she's still not done. Her first physical therapy session at home happened the next day. When she's done with those 6 session, she'll go back to her physical therapy sessions at the facility. The pay off is that when it's finally time to go to a theme park with our grandson, she'll be able to walk anywhere she wants by summer time.
Those are the key elements to have a successful outcome: get exercises from the surgeon or the physical therapist you will be working with after the surgery and do them at home. Have as much PT as your insurance allows working with the physical therapist before the surgery. Then, don't quit your rehab until you have the function that you're looking for now that the pain is gone. Do them all and then continue to do the exercises when you get home. That's how you're going to have a successful outcome from joint replacement surgery.
But there's still one more thing. The orthopedic group that Paula used send her home with the precise schedule and pain medications to keep the pain levels in reasonable points. Understand that it's going to hurt because what they're doing is cutting open your leg, cutting out bone, hammering and/or cementing parts into your body, and then sewing you back up. You better believe that's going to hurt. But if you can control the pain earlier on a schedule, you can get your rehab started sooner.
Those are the elements that should be a part of the process of joint surgery, whether replacement or tendon/muscle repair. Prehab. Pain management. Rehab to restore function. Keep that in mind if you need that done in the future. But as for time, I’m all out. Thanks for listening. This is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
