On January 19th, 2010 I had a major knee surgery, two procedures actually. One involved attaching cartilage that was grown in a petry dish by Genzyme - grown from my own cartilage taken in a prior surgery's biopsy, and the other involved a surgical fracture of the top part of my tibia.
I am writing here to go over the procedure and, more importantly, the recovery. Like anything in life, if it isn't blogged about it really didn't happen. As I can attest by the 7 inch scar on my leg this did happen, and you're reading about it now (sucker). A bit of history in case you forgot, or don't know me. I have been an active person since I was 2. In fact, my first memory is of my father sending me out to shovel the driveway as I was learning to walk. The previous statement was complete hyperbole.
Anyway, my adult physical fitness activities of choice have never been exactly knee friendly - soccer, skiing, running, banging my knee with ball peen hammers... About 6 years ago I started to feel weak in the knee, and not after watching anything Tiffany Amber Theissen was in. Of course I ignored it as I was a young active 30 year old and still felt like an invincible youth. Realage said I was 19 so I couldn't possibly be broken. In fact, I pushed it harder. One day though, a few years later, I remembering going for a run and thinking that it was probably my last run - it just didn't feel right. But instead of having it checked out I ignored it again. I would simply do other, less painful activities, swim, bike, deadlifts, etc... Eventually, when I could no longer even walk up stairs without wincing I decided to have a look inside. Now, an x-ray won't show cartilage. And an MRI alone wasn't helping either but a CT scan (along with the MRI) showed a gross lack of cartilage where the underside of my patella (knee cap) meets my femur. I was rubbing bone on bone every time my knee passed a 30 degree bend (stairs) or downward pressure was placed on it (running). My doctor said he was surprised I wasn't crying like a little girl from the pain everyday. I guess I sort of was...inside.
So fast forward a tad to the actual surgery. As I mentioned the surgery was 2-fold. I'll talk about the cartilage implant first. It's a pretty cool procedure and has been around in the US only for a short time - since the mid-1990s. It is a more common surgery in Europe but is gaining momentum here in the US I'm told. You can read about the treatment here. Basically my own cartilage cells regrow on my bone and replace the lost cartilage, thus returning my leg movement to normal. The cartilage adheres to the bone via a small sac that is sewn onto the bone and dissolves after a few weeks. This part of the surgery is pretty vague in terms of success. I really won't know if it worked for a few months. My surgeon did a dry run on a pig the week prior to my surgery and that seemed appropriate as I was eating like one in the days leading up to the procedure - all healthy foods of course, quality was my concern, not quantity.
At the same time, my knee cap was slightly moved away from my femur by a procedure called "anteromedialization of the tibial tubercle". It sounds confusing but it isn't. It is painful however and it's what makes the recovery long, slow, and hurty. On the top of the tibia is a small overhang, it connects your patella to your tibia via the patellar tendon. That is the "tibial tubercle". Basically the surgeon gets medieval on my tibia and fractures the overhang, moving the knee cap slightly away from my leg (this is called "anterior displacement" of the tibial tubercle). This causes some discomfort at first as there's a fracture in my leg, an obvious source of pain, and the opposing ligaments, skin, etc... take a bit of time getting used to the new setup.
Upon regaining some level of coherence after the surgery my doctor assured me that all of his pig prep paid off and used a baseball analogy mentioning that he "hit a home run"...you want your doctor to be confident in what he or she does. He mentioned that if I followed the recovery steps as planned I wouldn't need to send my kids out to do the shoveling. Yay.
I've spared the most gory details of the surgery; the hemo-pack, the 28 staples, the peeing in a jar for 2 days. I have photos/video of these (not the peeing) but you likely do not want to see them. Anyhow the MPAA would never allow the blog's PG13 rating with such content. I like to keep it clean.
The Recovery (Phase 1) -
Preparing for such a surgery is not easy, and you can never really prepare for the change and discomfort that follows during recovery - getting addicted to oxycodone, the itching from the crutches and where my leg was shaved, how hard it might be to go to the bathroom or take a shower. I couldn't look at the scar the first time the bandages were changed, not because I was getting squeamish, but because there was something changed in me, a glitch in the matrix, and I couldn't grasp it.
Other than the intangibles mentioned above recovering from both of these procedures at the same time is a relative cake walk when it comes to level of effort. There is no active physical therapy for the first 6 weeks, other than catching up on all the movies I haven't watched in the last few years like watching Terminator 2 for the 30th time. For optimal phase 1 recovery I have to have my leg in a continuous passive motion machine for 8-12 hours a day for 6 weeks, incrementing the degree to which my leg bends every week or so. I can remember getting in the machine for the first time thinking that I was never going to reach a 45 degree bend. Then hitting 45 degrees thinking that it was as far as I would ever go. It's interesting to note how easy it is to lose sight of the big picture when you're in serious pain (maybe I should have taken the drug longer). There is also a weight limit for the tibia - 0. I can not put any of my body weight on my leg for 6 weeks. So you can imagine what being off axis for this long does to your back. Good times. Good times...
Anyway I am bending comfortably to 105 degrees and am slightly ahead of schedule. I can shit, shower, and shave without issue and I am actually looking forward to getting back to work in a couple of weeks.
The thing that sucks about the recovery though is that if you're an active person who can't stop doing shit, then are forced on your ass for 6 weeks, you get a little stir crazy. Luckily I have season 2 of Chuck and my wife and kids to keep me company.
The Recovery (Phase 1) -
Preparing for such a surgery is not easy, and you can never really prepare for the change and discomfort that follows during recovery - getting addicted to oxycodone, the itching from the crutches and where my leg was shaved, how hard it might be to go to the bathroom or take a shower. I couldn't look at the scar the first time the bandages were changed, not because I was getting squeamish, but because there was something changed in me, a glitch in the matrix, and I couldn't grasp it.
Other than the intangibles mentioned above recovering from both of these procedures at the same time is a relative cake walk when it comes to level of effort. There is no active physical therapy for the first 6 weeks, other than catching up on all the movies I haven't watched in the last few years like watching Terminator 2 for the 30th time. For optimal phase 1 recovery I have to have my leg in a continuous passive motion machine for 8-12 hours a day for 6 weeks, incrementing the degree to which my leg bends every week or so. I can remember getting in the machine for the first time thinking that I was never going to reach a 45 degree bend. Then hitting 45 degrees thinking that it was as far as I would ever go. It's interesting to note how easy it is to lose sight of the big picture when you're in serious pain (maybe I should have taken the drug longer). There is also a weight limit for the tibia - 0. I can not put any of my body weight on my leg for 6 weeks. So you can imagine what being off axis for this long does to your back. Good times. Good times...
Anyway I am bending comfortably to 105 degrees and am slightly ahead of schedule. I can shit, shower, and shave without issue and I am actually looking forward to getting back to work in a couple of weeks.
The thing that sucks about the recovery though is that if you're an active person who can't stop doing shit, then are forced on your ass for 6 weeks, you get a little stir crazy. Luckily I have season 2 of Chuck and my wife and kids to keep me company.
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