Gotta wait awhile for more days like thisThe deal is done. Commitment made. Time to get on with the business of healing and returning to normal. But first, I'll share my impressions with the surgical experience and the first few days of recovery.
I didn't sleep much the night before surgery. I was literally tortured with the graft choice decision. It wasn't an easy choice due to lots of pros and cons but ultimately, having younger tissue and sparing my hamstrings made the most sense for someone my age. My surgeon admitted after the fact that he'd never done an autograft on someone over 50. So, there it is.
Summit Center Surgery Center, Flagstaff, AZThe ambulatory surgery center experience was smooth. I was the first case so it was pretty quiet when I arrived at 0615. The intake for the nurse was easy as my medical history is super boring. Good way to be in this situation. I met with the anesthesia provider and he offered me some preemptive narcs and an adductor canal nerve block to help with the post op pain. Since a big part of my job as an ortho PA is taking care of patients' post op pain, I wanted to experience what this procedure had to offer in terms of unpleasantness. At the same time, I didn't want to be some sort of hard-ass douche bag either. So, I compromised and took one of the pre-op Norcos and deferred the block until after the operation. It's no biggie doing it after the fact.
I met with the surgeon and confirmed that I wanted a cadaver graft. He went to the freezer to pick me out a fat, young piece of tendon that would allow him to do the magic. They wheeled me back into the OR and were pushing the Fentanyl before I even wiggled onto the operating table. Man, that shit hit me like a ton of bricks. Hard to believe people main line that drug for fun. A couple of deep breaths followed, the Propofol went in and I was out. I have no recollection of the next 30-40 minutes. In addition to reconstructing my ACL with the new tissue, he also cleaned up and trimmed my degnerative medial meniscus. The good news was that my articular cartilage was/is healthy. No arthritis....yet. Below are some pics of the fun.
Dr. Moezzi in the throws of putting me back together
My new ACL, prepped and ready for implantation
Pulling the graft into positionI received general anesthesia and slowly came out of it once I was back in recovery. I had a bulky dressing on and a knee immobilizer to keep my leg straight. It would also allow me to weight bear as tolerated without my leg buckling under me. As the fog lifted, my friend Kristy was there with my morning latte. Most excellent. I've had general anesthesia a few times before and never had any issues with nausea. This time was no different. I'm lucky. I've seen patients barfing their guts out for hours after waking up. You simply don't want to be that guy.
My ticket punched for the pain trainOnce I was out of the clouds, the situation in my knee became clear....a bomb had exploded inside! Since everthing costs money, I inquired as to the expense of the nerve block. I vaguely remember someone coming back and saying $200. I pulled the trigger. The anesthesiologist came by with a long needle and the ultrasound machine. I got to watch as he guided the needle to the sweet spot and infiltrated the local anesthetic. Now, everyone of my patients getting a total knee replacement gets one of these and most of the time they're thankful. Quite often, the pain relief is both profound and immediate. For me, not so much. I was disappointed. Truth is, some of us are just wired weird. I like to think that it helped some but there's no way to know. The one noticeable thing, however, was that my shin was numb for 12 hours.
Once I was moving everything and holding down my coffee, I got my final instructions, shook my surgeon's hand and headed home. I crutched into the bedroom and plopped down. Now the fun begins. Holy shit. The ache coming from my knee was relentless. I remember my buddy Andy Dorais, who went through the same thing a month prior, saying he really had no pain. Never took a pain pill. I wanted to be that guy, too. But after squirming around for an hour I dropped my first Norco 7.5. I felt like such a wimp. After an hour of no relief I dropped the second one and 600mg of Ibuprofen. I waited and waited. After another hour everything got better and I passed out for a 90 minute nap.
Kristy was all over me seeing what I wanted, food, drink, etc. I managed some of her delicious dinner and got back on the couch, stuggling to find a position that was comfortable. The instructions were to leave the knee immobilizer on in order to keep from developing a flexion contracture where my knee wouldn't go straight down the road. But there was no way I was going to be sleeping with that thing on. Plus, the compression cold therapy machine couldn't do its thing with all that shit on my leg. I even unwrapped the dressings to remove some extra padding leaving the base dressing intact and rewrapping with the ACE bandage. I also brought some serial compression devices from home to help with Deep Vein Thrombosis (DVT - blood clot) prevention. I crawled into bed with all this on.
I took another round of Ibuprofen and two Tylenols but decided against the narcs just to see what happened. Of course, I feared that the block would wear off in my sleep and I'd wake up hating life again. But, thankfully, that never happened. I slept for an hour at a time, waking up to pee and stretch. Since I was being non-compliant with the brace I felt like I needed to be vigilant with the straightening several times a day and night to make the difference. It worked out fine.
The next day went alright. I spent most of the day in bed doing the full court press on swelling and icing. I got up a few times to stretch and test things. I still had a lot of pain with full weight and odd little moves. My quad was not really interested in doing much. No big deal. That night I decided to take one Norco in hopes of better sleep. I chased that with 400mg of Ibuprofen again. Slept fine.
Day two was better. My mobility was good and weight bearing tolerance was higher. I still couldn't trust my quad for shit so I continued to use the crutches. We opted for a dinner out since I was feeling up to it. My friends have a 4 and 6 year old so getting away for a couple of hours keeps the parenting psych high. I wore my brace to the restaurant and it was actually really nice having the support and security. One thing is for certain, you don't want to blow your graft tripping over the curb or something stupid like that. Once at the table I removed the brace and let my knee bend and stretch. All was good.
That night I only did the anti-inflammatory and Tylenol. No big issues aside from the bouts of stretching and peeing. One thing about being a sea level dweller and recovering from surgery at 7,000 feet, the diuresis of acclimatization continues. Up, down, up, down...luckily, the toilet is two steps from my bed!
Early goal is to get it straightThe next morning marked the 72 hour point from surgery and the green light to remove dressings. I wanted a shower and I wanted the cold machine closer to the action. I got a post-op appointment with the surgeon and his assistant. He told me that "nobody looks this good" at this point so that was encouraging. Of course, I'm sure he says that to everyone. But he seemed genuinely happy with everything. We did a couple of xrays to confirm hardward position. His exam suggested everything was nice and tight. He told me not to stress much about motion for another week.
3 days post-opToday, post-op day 4, all is good. I can actually take some steps with full weight and no pain. I can fire my quad a bit although not enough to trust my knee completely. I'll continue to have at least one crutch under me at all times. I think by day 8 when my flight back is, I'll be ready to travel. I have a pair of high speed, low drag compression panty hose (yep...sexeh as fack!) to wear for the flight in addition to the compression devices. I used miles for a first class seat so I hope for a smooth transition back to AK.