Brace yourself. I’m going to tell the truth about total knee replacement and pain. I’m not going to pull any punches. I’m going to be frank and honest. It was a grueling bitch.
But first, let me say:
- I’m five months out from surgery and I spent last Saturday night dancing for three hours at my niece’s lovely wedding. I felt terrific. The next morning, my entire body was tired and sore like I’d run a marathon, but my knee was just fine. Keep the knee! Replace the rest of me!
- In mid-September, four months out from my May 7th surgical day at the Mayo, I was boulder hopping on islands during a solo canoe trip in the Boundary Waters Canoe Area wilderness. It was nice. Euphorically nice.
- At eleven weeks out from surgery, I realized that it was all very worth it. Until then, however, I wondered often what the devil had I got myself into.
It is important to note: I’ve chatted with others who are veterans of this surgery and rehabilitation. Some people feel little or no pain. At all. Even the first days after surgery. Pain after surgery is a customed fit to each and every patient. Some folks, particularly women, don’t bear much post-surgical discomfort.
Not the case for me.
My post-surgical stay at Mayo Clinic’s Methodist hospital was two brief nights and the day in between.
The team of caregivers had me standing the same day as surgery. No big problem. I felt some aching, and my mind recognized that there was pain, but it was ‘over there somewhere.’ And it was clearly not the grueling pain of deteriorating, diseased arthritis! That old pain was gone! Tylenol and oxycodone worked well in tandem to keep the post-surgical pain from roaring. I thought, this is going to be a cake walk.
I was relatively comfortable the day after surgery—until a resident stripped the tubing that delivered blocking drugs to the bundle of nerves that normally transmitted pain signals from my leg to my head. In a surprise move, the young doc yanked that catheter like it was the pull cord on a lawn mower. It stung like a whip, but even then, the stinger receded after just moments. He eyed me with interest and his face expressed curiosity: Had he done me a service by pulling that tubing without advising me that it would sting like a bee with a ten inch barbed stinger, or should he have warned me in advance? At the time, I didn’t care. Now, in retrospect, I’m glad I didn’t know it was coming.
Without the nerve block, my leg slowly started to regain sensation over the next day – and that feeling was on the harsh side of 
positive. For me, the pain of TKR surgery and healing rolled in over the next couple of days and weeks in three distinct flavors.
There was the deep, aching insult to my leg bones that met to form my knee joint. During the surgical procedure, I was aware enough to recognize the drone of the drill, lower in tone and of a slower rotation than a dentist’s drill. Because of anesthesia, it didn’t hurt at all, but I knew from the sound that Dr. Trousdale was grinding away the diseased arthritic bone from the tips of my femur, tibia and fibula. Then, I heard and felt the pounding as the surgical team fit the artificial device into place. It sounded as though they were using a rubber mallet, and although the sensation was painless, I could feel the impact carry through my femur up into my pelvis. As the medicated nerve bundle regained function in the day or so after surgery, I recognized the deep, dull ache of healing, wounded bone. I’ve broken a number of bones in past years, and the ache of wounded bone is a sensation I know. It takes three to six weeks for bone to heal beyond pain. In my knee, the ache gripped to the marrow.
There was the sharp pain of the surgical wound itself. Dr. Trousdale’s signature incision spanned from several inches above to a point three inches below my knee cap. The cut was deep enough to bare the bones of the joint, and the surgical team used clamps to grip my skin and flesh and pull it back away from the work site where the alloyed metal and plastic device parts were installed in place of the degenerated bone. The seven inch cut followed the inside contour of my knee. Dr. Trousdale chose to enter my knee through scar tissue of an old incision—a previous surgery to remove cartilage almost forty years ago. I don’t recall that surgery being as painful as this replacement. Wasn’t I playing tennis just weeks after that earlier surgery?
The third pain resided in the back of my knee. At first, it was the most uncomfortable of the pains that would follow me home and become my constant companions during the weeks to come. I recalled just before surgery that Dr. Kopp, my anesthesiologist, explained that the block to the nerves that controlled the pain in most of my leg missed just a bit of my knee muscle and tissue—immediately behind the knee. I recall asking Dr. Trousdale about that pain when he visited the day after surgery. He may have said something about cutting a ligament that I no longer needed with the replacement device in place, and that may have contributed to the deep seated pain gripping the inside and back of my knee.
During the first week or so, that behind-the-knee pain controlled the wheel of the jalopy of agony that ruled the road of post-surgical recovery. The surgical cut on top of my knee patiently took the back seat, while the deep aching of my healing bones rode shotgun, waiting it’s turn as king of the road.
These three kingpins of pain were my major adversaries during the weeks from early May until late July, when suddenly one day after I’d returned to work, I wondered aloud: Wow, this was worth it!
My next posts will cover the drugs that got me through it, convalescing at home, and the exercises that got me to the point of feeling healed again – or well on the road to healing.