Four-month post-op check-up

Knee-plus-17 weeks, 2 days, Friday, 28-Jan-2005:
Today was my 4 month check-up. Interesting conversation with the surgeon. First of all, he is extremely pleased with my progress. I got to the office a little early, and was sitting in the exam room with my right leg crossed over my left, knee bent. He looked down at my knee and grinned.

I rolled my pants legs up over each knee, and he again grinned. Little swelling in the right knee, nice scar formation. And we began to chat about how I was feeling.

He felt my right knee and was pleased to note that it was not hot, and indeed, was barely warmer than the left one. I told him that I had noticed that the right knee did occasionally get warm. This is apparently both normal and expected, that the inflammatory process of healing will continue for months. If the knee were to swell and get really hot, that would be a sign of post-op infection. But warm, especially after exercise, this is normal and healthy.

He asked me if I could kneel without pain. I indicated that I could, but that it was not yet really comfortable. Again, he was pleased that I could do this at 4 months, but that it might take a year to get comfortable, if at all.

The incision scar has begun to stretch, mostly above the patella. This is normal, as is the itching that accompanies the stretching.

The device continues to make noises sometimes as I walk. Rattles and pops. This, too, is normal but should diminish with time. I asked why it would diminish. Apparently, a combination of scar tissue regressing, and tendons tightening will allow the replacement knee to better integrate into normal motion and activities, and the rattling from things being a little loose will begin to go away.

I continue to be restless in my sleep, at least according to my wife. When I sleep on my left side, right leg bent over left, there is stretching of the joint as I relax. This will wake me up if I am not deeply asleep, and make me twitch and be restless if I am more deeply asleep. The surgeon indicated that this should diminish with time, too.

Overall, the surgeon is happy with my progress, and indeed, indicated that if he did not know the date of my surgery, would guess from looking at the scar and swelling that surgery had occurred 8 or more months ago, rather than 4. We talked about the “why” of this observation. I told him that I was convinced that pre-op exercise helped a lot, and that multiple at-home rehab exercises a day got me through the initial recovery phase as quickly as I did. He nodded politely and said “Yes, but ...”.

His perspective is that yes, it might be exercise, yes it might be determination, but he has patients my age who do all of those things and still have a slower recovery than I did. He told me a story of a 56 year-old woman who --- 10 months after surgery --- is still taking pain meds, still has serious knee swelling, and still has a very hot/inflamed knee. Muscle tone pre-op was good; rehab exercise regimen was good.

He thinks that it is a combination of genetics and attitude.

The surgeon indicated that if my experience were the norm, his job would be easy. He drew a bell curve, and said that my recovery was way up in the tail of the curve.

We discussed antibiotic prophylaxis. I was surprised to only see two post-op doses by IV. He indicated that this is the current recommendation from “the Academy”, that his practice switched to this more than a year ago, and has had zero incidence of post-op infections. Irrigation of the surgical site during the surgery is with a Waterpik-type device that flushes the wound with an antibiotic solution. Then, two systemic doses post-op, and that’s it. Apparently, longer term prophylaxis carries with it its own series of side effects, and to no benefit.

We discussed antibiotic therapy pre-dental work, pre-colonoscopy and ANY time outpatient surgery or dental work could allow bacteria to enter the blood system. I have a scrip from my dentist for amoxicillin, taken an hour before dental work. The surgeon indicated that this would be fine, but that it would be something I would have to do for the rest of my life. He told me of a patient who developed a joint/device infection 18 years after implant, and following a root canal.

I asked about symptoms of infection. He said “You’ll know”. It would be a systemic infection: fever, swollen knee, hot and inflamed knee, an inability for the joint to support weight, severe pain.

My swollen sublingual lymph node did indeed return. It’s on my list to discuss with the dentist next week. I’m probably being paranoid, but ...