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state of the knee
May. 8th, 2013 10:01 amIt's been almost two years to the day since I had my left knee arthroscoped. Not that I was aware of the precise date, but I found out when I went back to the orthopaedic surgeon yesterday. Something deeply amusing about that, in a not-at-all-funny kind of way.
The surgeon immediately sent me for an x-ray, and told me to bring it straight back. Things inside that knee were, if possible, even worse. There's no joint space at all on either side between the femur and the tibia, and marked narrowing of the space behind the patella. In other words, the knee is totally fucked. Not that I needed to be told that, but there's a cold sort of comfort in having it recognised.
After pointing out the salient details, he said bluntly, 'The only operation I'm prepared to discuss with you is a total knee replacement'. That was a surprise; I'd been expecting him to suggest another arthroscopy, to delay the replacement until I was older. Apparently, though, there's just no point; it would simply be a waste of money and an unnecessary risk.
Okay, so knee replacement. I'd always known it would come to this. But ... then he told me the risk factors.
Leaving aside the usual risks from a major operation - respiratory infection, wound infection (including deep wound infection), adverse reaction to anaesthetic - there are some specific possible complications. Knee replacements have a 1 in 100 failure rate. If a really deep wound infection sets in, 1 in 1000 need to have the implant removed and live without a knee for six months (wearing a brace and unable to bend the leg), then undergo an operation of up to six hours to try again. Assuming the infection is cured, which isn't a given when you're talking about bone operations.
And the happy news is that all of these risks are doubled in my case. My weight can cause pressure on the chest, increasing the possibility of a respiratory infection. The amount of fat on my leg means greater 'excavation' (don't you just love that word?), so higher possibility of infection there. And the fact I can neither fully flex nor extend the leg makes it harder to get at the tibia.
Oh, and there's always the possibility of even worse consequences.
(Oh, just by the way? The operation itself is incredibly gruesome. My leg would be sliced open down the front, the various layers of fat and muscle released' and retracted, and a metal cup fitted over the end of the femur - held on with screws. Then the tibia would be bent forward until the end protruded well clear of the rest of the leg, a hole drilled down into the end, and a metal cup with some kind of removable, shock-absorbing pad screwed in and secured. Everything would be shoved back in place, drains inserted, and the leg would be sewed up. Ugh. So, yeah, you can see how it would be more difficult to do all of that with a large amount of fat and muscle in the way.)
Naturally, I am less than calm about this. In fact, it would be fair to say I'm fucking terrified.
In order to try to mitigate some of the risks, the surgeon's referred me to a physio for some 'pre-habilitation'. (wince - what a word) The idea is to improve my flexibility, and to build up muscle stamina in both legs, especially my quadriceps. So, I trotted along for an evaluation today.
I came away with a list of twice-daily exercises, an appointment to be assessed for hydrotherapy next week, the threat of gym work to come, a recommendation that I have a knee brace made, and an urgent need for painkillers and warmth. At this stage, I don't know how long this 'pre-hab' is going to take, but the physio seems confident he can get my knee to a point where the flexibility, at least, is no longer a major risk factor.
Other risks are less easy to mitigate. Losing weight is fucking difficult when I can't do any form of cardio exercise, and there's only so far I can cut down my eating before my body decides I'm starving and starts laying down fat as a defensive measure (contrary to popular fucking opinion and shithead reality TV/advertising claims). Add to that the tendency to weight gain as a result of my bipolar meds ...
The surgeon, at least, recognises this. Back in 2011 he told me that losing even 10 kilos would make a big difference. Well, I did that. I don't expect to lose much more quickly. He's willing to do the op, as long as I'm aware of the dangers. That's somewhat reassuring - he definitely wouldn't do it if he thought the risks were too high.
And honestly, 2% failure rate, or 2 in 1000 isn't very high. I keep telling myself that to balance my inner hysteric. Not that this will stop me freaking out while I make out my will, and living will. (And even the thought of that is frightening.)
I haven't fully committed to the idea of the replacement op, but realistically, it's either that or end up in a fucking wheelchair. And that I won't do. It's bad enough having to borrow mobility scooters, or ruling out having dinner at any upstairs restaurant, or even go to a market or festival with my family. I won't spend the rest of my life being left behind and disappointing them.
Update:
I started the physio regime last night. You know how medicos ask you to rate your pain on a scale of 1-10? Well, in the words of the immortal Spinal Tap, 'this one goes to 11'. In a word - excruciating. Have to keep telling myself it's worth it.
The surgeon immediately sent me for an x-ray, and told me to bring it straight back. Things inside that knee were, if possible, even worse. There's no joint space at all on either side between the femur and the tibia, and marked narrowing of the space behind the patella. In other words, the knee is totally fucked. Not that I needed to be told that, but there's a cold sort of comfort in having it recognised.
After pointing out the salient details, he said bluntly, 'The only operation I'm prepared to discuss with you is a total knee replacement'. That was a surprise; I'd been expecting him to suggest another arthroscopy, to delay the replacement until I was older. Apparently, though, there's just no point; it would simply be a waste of money and an unnecessary risk.
Okay, so knee replacement. I'd always known it would come to this. But ... then he told me the risk factors.
Leaving aside the usual risks from a major operation - respiratory infection, wound infection (including deep wound infection), adverse reaction to anaesthetic - there are some specific possible complications. Knee replacements have a 1 in 100 failure rate. If a really deep wound infection sets in, 1 in 1000 need to have the implant removed and live without a knee for six months (wearing a brace and unable to bend the leg), then undergo an operation of up to six hours to try again. Assuming the infection is cured, which isn't a given when you're talking about bone operations.
And the happy news is that all of these risks are doubled in my case. My weight can cause pressure on the chest, increasing the possibility of a respiratory infection. The amount of fat on my leg means greater 'excavation' (don't you just love that word?), so higher possibility of infection there. And the fact I can neither fully flex nor extend the leg makes it harder to get at the tibia.
Oh, and there's always the possibility of even worse consequences.
(Oh, just by the way? The operation itself is incredibly gruesome. My leg would be sliced open down the front, the various layers of fat and muscle released' and retracted, and a metal cup fitted over the end of the femur - held on with screws. Then the tibia would be bent forward until the end protruded well clear of the rest of the leg, a hole drilled down into the end, and a metal cup with some kind of removable, shock-absorbing pad screwed in and secured. Everything would be shoved back in place, drains inserted, and the leg would be sewed up. Ugh. So, yeah, you can see how it would be more difficult to do all of that with a large amount of fat and muscle in the way.)
Naturally, I am less than calm about this. In fact, it would be fair to say I'm fucking terrified.
In order to try to mitigate some of the risks, the surgeon's referred me to a physio for some 'pre-habilitation'. (wince - what a word) The idea is to improve my flexibility, and to build up muscle stamina in both legs, especially my quadriceps. So, I trotted along for an evaluation today.
I came away with a list of twice-daily exercises, an appointment to be assessed for hydrotherapy next week, the threat of gym work to come, a recommendation that I have a knee brace made, and an urgent need for painkillers and warmth. At this stage, I don't know how long this 'pre-hab' is going to take, but the physio seems confident he can get my knee to a point where the flexibility, at least, is no longer a major risk factor.
Other risks are less easy to mitigate. Losing weight is fucking difficult when I can't do any form of cardio exercise, and there's only so far I can cut down my eating before my body decides I'm starving and starts laying down fat as a defensive measure (contrary to popular fucking opinion and shithead reality TV/advertising claims). Add to that the tendency to weight gain as a result of my bipolar meds ...
The surgeon, at least, recognises this. Back in 2011 he told me that losing even 10 kilos would make a big difference. Well, I did that. I don't expect to lose much more quickly. He's willing to do the op, as long as I'm aware of the dangers. That's somewhat reassuring - he definitely wouldn't do it if he thought the risks were too high.
And honestly, 2% failure rate, or 2 in 1000 isn't very high. I keep telling myself that to balance my inner hysteric. Not that this will stop me freaking out while I make out my will, and living will. (And even the thought of that is frightening.)
I haven't fully committed to the idea of the replacement op, but realistically, it's either that or end up in a fucking wheelchair. And that I won't do. It's bad enough having to borrow mobility scooters, or ruling out having dinner at any upstairs restaurant, or even go to a market or festival with my family. I won't spend the rest of my life being left behind and disappointing them.
Update:
I started the physio regime last night. You know how medicos ask you to rate your pain on a scale of 1-10? Well, in the words of the immortal Spinal Tap, 'this one goes to 11'. In a word - excruciating. Have to keep telling myself it's worth it.
