Recently in Medicine Category
Tomorrow is the one-year anniversary of the rebuilding of my right knee by Dr. Andrew J. Feldman. The surgery involved a high tibial osteotomy, an ACL recision, and a microfracture. When I saw Dr. Feldman three months ago, he was very pleased with the result. The tibia, into which a wedge of cadaver tissue had been inserted, had healed perfectly; the ACL reconstruction was stable and strong; and the alignment was just what he wanted. He believes that we have staved off a knee replacement for a good long time. Unless I abuse it. (Apparently, Steve Yzerman, the former captain of the Detroit Red Wings hockey team who had the same operation, went back to playing hockey, knowing the the knee would only buy him a couple of years. Given the salary he was being paid, it was worth it to him, but now he will need the knee replacement sooner rather than later.)So I'm going to wear a knee brace whenever I do sports activities that are likely to put rotational stress on the knee. That includes ice skating, rollerblading, kicking around a soccer ball, and playing tennis. The brace is way cool, by the way. It's the official brace of the U.S. Ski Team, and it's manufactured by Donjoy and was custom-fitted for me by Gotham Surgical and Brace on 39th Street. I had my choice of colors, but chose a respectable dark blue.
I know it's hard to believe seeing just the pictures, but the brace is actually remarkably comfortable, indeed, much more so than the smaller fabric covered brace I was wearing a couple of months after the surgery. What's great about the brace is that there's no fabric on it, so it's cool and there's nothing to rub against the area where the plate was screwed onto the bone.
The knee feels strong. Here's what I can do now that I couldn't do before the surgery: run for the bus. I can go from standing still to running without a second thought and without pain afterward. The arthritis is still there on the medial side of the knee, but with the weight shifted to the outside of the knee, I'm rarely aware of it. Oh, there's a minor twinge every now and then just to keep me honest, but it's night and day from a year ago.
And the area where the plate was inserted has almost all of the feeling back. In fact, I think there's less numbness than there was after the first surgery twenty years ago.
To celebrate the anniversary, I bought myself a new set of CCM hockey skates, my first new pair in about fifteen years. My first time on the ice after the surgery was last weekend at Wollman Rink, though it was so crowded that it was hard to really get in good skating rhythm. So tomorrow morning, weather permitting, I'm off to the "The Pond at Bryant Park" first thing in the morning to put the knee through its paces. Bryant Park on a weekday generally has the advantage of being less crowded than Wollman and -- even better -- much less expensive: in fact, it's free.
Don't worry, Dr. Feldman, I'll be conservative!
Today marks the six-month anniversary of my knee surgery. All in all, things are going very well.
I had my last visit with my surgeon, Andrew Feldman, two months ago. At that time, he was very pleased with my progress, saying that I was ahead of where most patients would be after four months. He told me that there were four areas in which things might go wrong: the healing of the tibia, the stability of the ACL repair, the flexibility of the knee and joint, and the overall alignment of the leg. In my case, everything was working out perfectly.
He was particularly pleased with the alignment of the leg.The picture at right shows a recent picture of my knees. You can see that my "good knee" (the one at the right of the picture) is naturally a little bow-legged. The repaired knee, at left, is much straighter. In fact, Dr. Feldman over-corrected just a little, meaning that my right leg is actually a little knock-kneed. This assures that the weight is borne through the outer part of the knee, away from the damaged medial area.
For the last two months, I've been working out steadily on the elliptical trainer in the gym, trying to build up strength in my quad and hamstring. Last month, I began rollerblading again, which also gives those muscles a nice workout. I'm currently wearing a brace whale blading, to avoid wrenching the knee in the event of a collision or fall.
I'm still not supposed to be subjecting the knee to any significant impact, but I have been experimenting with a few minutes on a treadmill a couple of times a week, just to see what it feels like to run. It's feeling better and better. Clearly, I'm not going to be running a marathon at any point in the future, but I do hope to return to tennis and squash and to be able to play soccer and baseball with my sons. That seems like it'll be possible. Right now, I can kick a soccer ball pretty well, but I have more work to do before I can run after it gracefully.
The last four months have been a process of learning how to walk comfortably on the realigned knee. I still walk a little stiffly, and I limp a little if I've given the knee a real work out. My flexibility is good, though I can't yet bend my right leg all the way up to my buttock. The knee is a little stiff when I get up after sitting for a while. And there is a little numbness and an occasionally prickly sensation around the area where the plate has been attached to my bone (beneath the diagonal scar in the picture) and in the muscle lining my tibia (tibialis anterior). From my experience after my previous ACL-repair, I expect that I'll always have some odd sensations below the knee.
On rare occasions, I'll feel an arthritic twinge from the medial side of the knee, but it's nothing like the nearly constant pain I had before the operation. Indeed, for the most part I don't experience the knee as "painful."
So I'm pleased with my progress thus far, though I realize I still have a a lot more work ahead. Progress now occurs at a slower rate than it did during my intial rehabilitation. But all the time spent at the gym for the past four months is paying dividends beyond a stronger knee. My next visit with Dr. Feldman is sometime in September. I'm hoping for an equally positive evaluation then.
Now if only I could finish writing that book manuscript ...
It's now been ten weeks since my knee surgery, and everything is going beautifully. The x-rays pictured above were taken three weeks ago during my third post-op visit to my surgeon, Dr. Andrew Feldman. (At the left is a side view, at right a frontal view.) He was very pleased with the way that they looked, pointing out that the line where he made his cut (just to the left of the plate and equidistant between the screws on the righthand x-ray) was barely visible, indicating that the bone was healing perfectly. He said that the realignment of the leg was exactly what he wanted it to be and that the reconstructed ligament felt strong.
He cleared me to begin bearing weight on the leg, suggesting that I move to one crutch, then to a cane, and then to unassisted walking as I felt ready. My target was to be able to put 50% of normal weight on the leg after a week, and full weight a week after. I was able to shed the full-length brace at the beginning of week eight in favor of a much smaller brace, which I dont' have to wear at night. Lately, I've only been wearing it when I go outside.
As it turns out, I was able to progress more quickly, putting full weight on the leg with a week and moving to a cane shortly thereafter. I'm now walking around without the cane, and I try to minimize the limp as much as possible.
My physical therapy sessions have become more demanding, lasting between 1.5 and 2 hours. We've added riding on the stationary bicycle at low resistance for 10 minutes, isometric exercises for the quads, and some weight-training for the quads. Russian stim is no longer necessary. When I'm at the gym by myself, I'll usually start with 30 minutes of bike riding, followed by the complete leg routine and whatever upper-body exercises I still have the energy for.
Because it's being used now, the leg is sore much of the time -- not painful, just sore, with the occasional twinge around the area where the plate was affixed. My therapists started massaging the scar area a few weeks ago to keep the skin from adhering unnaturally to the tissue below, and it's made a difference. There's less discomfort in the area now, and the numbness has decreased.
I'm not due to see Dr. Feldman for another five weeks if all keeps going well. My goal is to be able to walk into his office without limping at all. Walking on the leg does feel a little strange, because I feel conscious that the outside of my knee is bearing more weight than it used to and that I'm a little knock-kneed. Whether I can actually feel that, or whether I think I'm feeling it because I know that's what the surgery was supposed to do, I can't say. It does feel, however, as if I'm re-learning how to walk properly.
Click on the continuation link, if you'd like to compare the present x-ray to the one that was taken before the surgery.
A representative from Empire Blue Cross Blue Shield called today. Apparently, they need to be convinced that the use of the EBIce Cold Therapy Unit is not an "experimental" treatment.
Finally, a glitch, though mercifully it's bureaucratic and not medical.
When we first scheduled the surgery, I'd been worried about bureaucratic problems, because the surgery was scheduled for early January, and we had switched our coverage from Oxford Health Plans to Empire Blue Cross Blue Shield, effective January 1. I was certain that the necessary pre-approvals wouldn't be processed in time. But lo and behold! My Empire ID card arrived before my final appointment with Dr. Feldman, and all the paperwork went through smoothly. The hospital visit, as I wrote before, was a breeze.
But then today I checked the claims section of my Empire account online.
I have a new knee brace. The old one (shown below at left) was put on in the operating room. It had stiff pieces of metal running along the sides and bottom, and it wasn't very comfortable.
The new one is much more comfortable -- and much bigger. Manufactured by Donjoy, the brace runs from the top of my thigh to my ankle, with foam padding around the thigh and calf secured by Velcro straps and adjustable hinges which are currently set to 0 degrees: no flex at all. We decided to keep using the EBIce cold therapy unit. Some quick research suggests that the EBIce has been around for about 12 years, and I think it's made a big difference for me. The knee, when it came out of its bandages, looked far less swollen than I remember it looking in similar circumstances in 1987.
Yesterday was my first post-op appointment with my orthopedic surgeon, Dr. Andrew J. Feldman. He walked into the room holding my charts and said, "You really made me work hard."
