The knee is fixed. Hopefully. My patellofemoral structure now involves a certain amount of metal and plastic, following surgery for partial knee replacement on Tuesday. The work starts here, though, with rehab/recovery. I’m contemplating a 50k audax in late May …

The MRIs indicate that the rest of my knee is in good condition – there’s no point in only doing a partial if the scans suggest that more surgery will be needed before this replacement wears out. The rarity of this type of replacement means that there isn’t a great deal of information about how long PF replacements last; seems to be about 15-20 years but the sample size is small.

Anyway: so far – surgery was Tuesday. I wasn’t particularly stressed about it – sufficiently not stressed that I think I was more stressed about not being stressed, if that makes sense. I did have the usual ‘do I really need this?’ doubts – I could walk for hours without pain, as long as it was on flat ground. We’d been on holiday two weeks beforehand and had walked for hours; after a couple of days of 30k+ steps, it was a bit uncomfortable but nothing unmanageable. Stairs etc – yeah, those were painful as usual and served as a good reminder as to why surgery was needed – this was getting in the way on a day to day basis, as I wasn’t sleeping very well and my ability to exercise effectively was diminishing, and it was randomly painful whilst sitting or standing. Not great with the hypothyroid stuff going on as well. Oh, and the low iron count. That’s back (I don’t appear to have posted about it the first time – late 2022). I’m back on iron supplements and now awaiting a consultant appointment to try to work out why my ferritin levels aren’t great (given other symptoms, working theory is malabsorption of some sort, maybe coeliac).

Anyway – the last round of cortisone in August didn’t do anything. Another MRI scan showed the grade 4 getting worse in the PF area so surgery was decided on – no other useful treatment available with the amount of cartilage damage involved. There are one or two other possible injectables, but even those would give maybe three-four months respite if they worked at all. That seemed pointless – it wouldn’t repair anything and my ability to outstrength the damage has plateau’d.

So, Tuesday. Hospital, and a general anaesthetic (my first). The GA was ok, in fact. Weirdly uncomfortable in the hand when it goes into the cannula. I felt myself drifting off a bit, then woke in the recovery room. Waking was fine (no nausea, etc. Thank you to the anaesthetist!) and felt basically like waking up from sleep. The woman in the bay next to me had a rougher time of it, although that also sounded somewhat performative (not really meant to be that pointed a comment, but the tone of her voice wasn’t fear or distress, it was ‘look at me’).

Things that I didn’t read anywhere before hand … firstly, I had a nerve block into the knee as part of the anaesthetic. That takes about 24 hours to wear off. In that 24 hours, you can do all the rehab exercises easily and cheerfully. Raise your leg 20cm – yep, no problem. Bend it – yep, past 90 degrees, all good. etc.

Then the nerve block wears off. This next part is apparently not universal: I had quad activation failure. It’s not unusual, but apparently not universal. Essentially, the quad muscle can fail to activate when there’s pain/swelling in the knee. It’s a protective mechanism. I obviously have a swollen knee – the replacement surgery does involve quite a lot of moving/pulling around of tissue and it unsurprisingly objects thereto. The quad felt bruised (still does, somewhat). The knee itself is still somewhat numb.

So, the result of this was that around lunchtime on Wednesday I went from “oh, yeah, the rehab exercises are easy” to “wtf: I cannot lift my leg at all”. Not so much as a millimetre. The quad was moving, it just wasn’t able to move enough to move my leg. Bending the knee, even assisted, was limited.

I could (can) walk – I don’t even really need the crutches. It’s safer with crutches and stairs are definitely safer with a crutch, so I have been using them. This morning (Sunday), it’s easier again to walk. I can’t quite describe what the difference is – Michael suggested maybe improved proprioception, which it might be. It certainly feels more stable when I walk – still not bending the knee much. I can bend the knee more; indeed, this morning’s advance was being able to bend my leg and lift it enough to be able to slide my foot into my slipper boot (small wins, but they all count!)

Leg raises (seated and lying) are now possible again – I have to force them and it’s painful, but the quad does work. I can now do all of the exercises to a greater or lesser extent; the only one I cannot do is the kneecap mobilisation. This is not because it hurts but because touching the kneecap makes me nauseous. It’s not due to pain; it doesn’t really hurt much to touch or push it as the exercise requires. It’s something to do with the area being swollen/spongy that it badly hits some squick/ick centre of my brain. I’m aiming for kneecap mobility in other ways, because wanting to throw up when I push at my kneecap isn’t really helpful.

The exercise improvement isn’t all better living through medicine – I am taking tramadol (as well as ibuprofen and paracetamol) still but have reduced the number of times I take it each day. Other medication – aspirin, as a blood thinner against DVT (the injectable into the stomach flesh in the hospital was oddly painful until it dispersed); omeprazole, as anti-gut-rot with the NSAIDs etc. I have a laxative as well, as tramadol etc can cause constipation, but haven’t needed it. This may be because my symptoms of potential malabsorption re iron (as above) are such that any constipative effects of the tramadol may be countered by those symptoms!

All of this medication is set up with alerts on my phone, together with a tracker for the exercises. Each round of exercises (four per day) is followed by icing. As recommended by the clinic, I’ve rented an ice therapy machine for a month to enable proper icing of the joint to reduce swelling. I rented a physiolab machine – the options seem to be physiolab or gameready. The hospital uses the gameready machines. There’s not a lot of difference between them – I prefer the physiolab because the ice/water holder is removable and so it’s easier to empty and fill. The gameready requires the entire machine (it’s not that big, but still) to be taken to the sink to empty. That’s easier in a hospital room with a sink in the room, but less helpful when you have to take it through into the kitchen at home. Physiolab also do re-freezable ice packs, although you can just use normal ice. I’m using the equivalent of about 4kg of ice per day – it’s easy enough to buy from a supermarket (there’s a branch of Iceland nearby) but it does take up space in the freezer.

Other things: I’m moving my operated leg with my non-operated leg (tucking the good foot under the leg to shift it up onto a chair/bed, or down off the chair/bed) – not something I had really thought through beforehand, but logical. I can’t lift the leg (at all initially, not enough even now) to do that. Lowering the leg from the chair/bed needs to be controlled as well because if it drops without control it will pull hard on the quad etc and that is special and not in a good way.

… onward!