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Different Perspectives on a TKR Surgery

It is always interesting to me to hear stories about someone’s experience while undergoing a total knee replacement, or any joint replacement – for that matter. This is due to the fact that there are anesthesiology options available for one undergoing a tkr. You find this out when meeting with the anesthesiologist. The two options are: general or spinal.

Patients can get a general and be put right out. Recovery time is longer with this method. It is said to poison the entire body. Then, there is the less severe method of numbing one from the waist down. And, the patient is given the option of either staying awake or having varying degrees of an altered state. Upon hearing what would happen during the surgery, I decided to be put into a deep sleep. I did not want to hear saws or anyone talking. Nor did I want to feel any pulling on my leg or anything like it. Don’t get me wrong. I am not as big of a chicken as you may think. I have seen other total knee replacements done, and hip replacements done (I worked in orthopedics for years)– but there was something different about having it done on me.

Fast forward to a couple days ago on NHL Live! Mike Milbury was being interviewed by Bill Clement. Both are former NHL players. Milbury has had a total knee replacement, while Clement has had a shoulder replacement. Both stayed awake during the surgery. Gutsy! Milbury mentioned how he heard the saw, watched the operation on television, and felt the tkr knee being popped into place. Clement mentioned how there was a partition between his head and shoulder area. He heard the saw and mentioned how strange it sounded. “Crazy, huh?” asked Clement. “Yeah, all that was missing was the popcorn and coke,” replied Milbury. Their viewpoint struck me as very interesting and insightful.

You had to hear the entire conversation to appreciate it to the fullest extent. It was inspiring, yet funny, to hear about someone going through these joint replacement surgeries while being awake. It just blows me away.

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Leg Length Inequalities & A TKR

As I mentioned in a previous post, one of the findings during my yearly post-tkr appointment was the fact that I needed to wear an external shoe lift. It turns out that my leg lengths were greater than what was originally thought.

Three weeks after my total knee replacement, I was given a 1/4” wedge to put into my shoe since there was a slight discrepancy between the length of my two legs at the time. There were no measurements taken at the time, only an estimate. I thought that was great. When I questioned my surgeon about it, he stated that there was no reconstruction nor realignment surgery done during my tkr surgery. The decreased amount must have been due to my leg just being straightened out when the bionic knee was put into place. See, prior to my surgery, I was bone on bone for so long that my leg was bow-legged. X-rays looked like my knee was falling out of joint. Not a pretty sight. 😕

Prior to my tkr, I was wearing a 1” shoe lift for 32 years. For as long as I wore that (it was on the bottom of my sole, not inside my shoe), I was sensitive about it. It never ceased to amaze me how 99% of the people would look at my lift, then up at me. Even with me looking at them, this happened. It may seem an exaggeration, but that has been my experience. When I met the 1% that saw me first, I knew I was on to something good. (Maybe I’m just too sensitive in this area).

Anyways, as time went on throughout my first year post-tkr while using that ¼” wedge, my opposite side hip and knee started to hurt. They were hurting so bad that it was getting to be painful to walk. Could have been much worse, but it took the fun out of walking much. My bionic knee was doing great. 🙂 So, when I had my yearly follow-up, I was thinking maybe it was because my shoe lift was not big enough.

My questions were answered when my legs were measured and I found out I needed to wear that 3/4” lift. Now I don’t have the opposite side pain and discomfort like before. Cool.

Funny thing about it? My first day out while wearing my new lift, I noticed someone directly in front of me staring at my shoe. Then she looked up at me.

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Using Benchmarks During a TKR Recuperation

Throughout my recuperation process from a total knee replacement, having benchmarks has played a role. Here is one of the first benchmarks I have used during my fun times of tkr recuperation (humor attempt):

My first week after having a tkr (also known as post-tkr), my benchmark was the hashmarks on the kitchen linoleum floor. How is that? Well, my exercise involved sitting in a chair with my feet on the floor. I was to slide my foot back as far as I could. This exercise had a purpose of increasing my tkr joint’s flexibility through strengthening my quadricep on my leg containing the total knee replacement. At the time, strengthening my quadricep was of prime importance.

I set my eyes upon a line/hashmark on the floor. Then, I gently slid my foot back to meet that line. The line was my benchmark. Believe me, that is not an easy exercise. In fact, it took everything I had to do it. I had to hold on for dear life to the chair seat in order to budge my foot a whopping 1/4”. Sometimes I needed to use my “good leg” to gently ease back my bionic leg. It’s a tough exercise to do.

One does not appreciate how the leg muscles work, and how lucky they are to have them work, until recuperating from a surgery such as a tkr.

Hope this helps someone else going through the same thing.

This is one example of how using benchmarks is necessary for a proper total knee replacement recuperation. (The search engines will like that sentence. 🙂 )

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An Interesting Perspective between Sports & Business

After having been in the working field for more time than I’d care to remember (30+ years), something struck me today as being curious. It happened after I heard Jim Dowd state he had been with 10 teams throughout his hockey playing days.

In the business world….When one is going on interviews for a new position, resumes are one of the most important tools to have. In fact, you need them. As they are perused by the potential employer, suddenly the questions start coming.

“Hmmm…I see you have had quite a few jobs. What is the reason for that? How do I know that you’re not going to leave us, since you have a hard time staying in one place?” is what an interviewee hears.

Job, or position, hopping (going from one position to another) is seen as a definite deficiency – by both the applicant and interviewer. It does not matter if one is fired, the place closed, layoffs abound, or circumstances were not conducive to one’s productivity. The main concern is the fact the applicant can’t (in the potential employer’s eyes) hold a job.

In the sports world…Listen to athletes talk about their versatility, skills, and playing history. There is a sense of pride and accomplishment in the fact that numerous teams are on their resume. They do not seem to be confronted with the “can’t keep a job” mentality found in business. At least, that’s what I pick up when listening to athletes, coaches, general managers, and other sports personnel being interviewed regarding one’s athletic history.

Why is that?
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Don’t Post Your Unwanted Ads on this TKR Blog!!!!!!!!!!

With the growing popularity of my blog, have come across some ridiculous and unsolicited actions. People, representatives of companies, have been posting comments about their products with claims about how great they are for patients of total knee replacements.

Just so my legitimate, and welcomed, readers know….I delete these comments. I do not endorse any product, company, or health claim. However, sometimes these comments will appear before I have a chance to delete them. That’s the irony…these people posting are not brave enough to contact me first to get approval for such comments. Gets my blood boiling!

Anyways, I wanted all my beloved readers to know that I appreciate being made aware of such comments. Anyone legitimately going through a total knee replacement recuperation knows the amount of downright hard work, pain, and time it takes. It does not involve gimmicks.

Tom Renney Fired as New York Rangers Coach

Here is some NHL hockey news which I learned about on NHL Live! – a few minutes ago. The article is taken from Newday.com:

In the midst of a late-season tailspin and with the strong possibility of missing the playoffs, the Rangers dismissed head coach Tom Renney Monday after more five years behind the bench.

No replacement was immediately named.

A team spokesman said assistant coach Perry Pearn also was fired, but fellow assistant Mike Pelino and goaltending coach Benoit Allaire remian.

Ending weeks of media speculation, Rangers president and general manager Glen Sather ultimately decided to fire Renney, who led the Rangers to three straight playoff appearances after the NHL lockout in 2004-05.

Renney, 53, was named interim head coach on Feb. 25, 2004 and the 33rd head coach of the club on July 6, 2004. The British Columbia native — who coached Team Canada to a silver medal in 1993 and junior teams to championships — ends his tenure fourth on the Rangers all-time coaching list in wins.

Widely considered a literate, thoughtful coach whose game preparation couldn’t be questioned, Renney had a formidable task this season without Jaromir Jagr, Martin Straka and Brendan Shanahan as the team transitioned to a younger team without strong personalities.

But his personnel decisions and failure to get the most out of underachieving, highly-paid veterans and prospects cost him, although supporters say he did the best with the hand he was dealt. Inconsistent all season following a 10-2-1 start, the Rangers have slid to eighth place in the Eastern Conference and lost 3-2 in overtime last night after a banner-raising ceremony for Harry Howell and Andy Bathgate that honored the tradition of the 82-year-old franchise.

In his first 20 games during the 2003-04 season, when Renney replaced Sather behind the bench, the Rangers went 5-15, but led the team to three straight playoff appearances after the lockout and was 128-83-35 coming into this season. Renney was the head coach of the Canucks from June 1996 to November 1997, when he was fired and replaced by Mike Keenan.

In 2007-08, the Rangers went 42-27-13 and were ousted by the Penguins in the second round of playoffs.

In 2006-07, they were defeated by the Sabres in second round. In 2005-06, they amassed 100 points, the sixth-highest in club history.

Four other NHL coaches have been fired this year. Chicago’s Denis Savard four games into the season at (1-2-1), Barry Melrose 16 games into his Tampa sojourn; Peter Laviolette, whose Canes missed the playoffs in 2006-07 and ’07-08 and Craig Hartsburg (17-24-7) after 48 games with the circus in Ottawa.

At least four NHL coaches have been in their posts longer that Renney: Lindy Ruff (11 years), Barry Trotz (9) and Jacques Lemaire and Craig MacTavish (8).

Exercise after a TKR Is Critical

One of my readers sent me this article about the importance of exercising after a total knee replacement. I thought it was interesting and wanted to share it….

Exercise after knee replacement critical..

It may be uncomfortable at first, but doing exercises to strengthen your quadriceps after you’ve had knee replacement surgery due to osteoarthritis is critical to your recovery. In fact, it can boost the function of your new knee to nearly that of a healthy adult your age.

That’s the finding of a University of Delaware study published in the February issue of Arthritis Care & Research.

The authors include Lynn Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at the University of Delaware, Stephanie Petterson, clinical faculty at Columbia University, Ryan Mizner, an assistant professor at Eastern Washington University, Jennifer Stevens, an assistant professor at the University of Colorado at Denver, and Drs. Leo Raisis, Alex Bodenstab, and William Newcomb of First State Orthopaedics in Newark, Delaware.

“It sounds logical that exercises to strengthen your knee should be a component of your post-operative physical therapy after a total knee replacement, but it’s not the convention at all,” says Snyder-Mackler.

“There are all of these old wives’ tales that strength training is a detriment to the patient and that the new knee should be treated delicately,” Snyder-Mackler notes. “Our study demonstrates that intensive strength exercise as outpatient therapy is critical to begin three to four weeks after surgery.”

Nearly 500,000 knee replacements, also known as total knee arthroplasties, are performed every year in the United States to treat severe knee osteoarthritis, the loss of the cushiony cartilage padding the knee. The joint disease leaves its sufferers with persistent pain and limited function, resulting in an overall diminished quality of life.

While knee replacement alleviates the pain of osteoarthritis and improves function, patients exhibit impaired quadriceps strength and function for such activities as walking and climbing stairs, and the levels remain below those of healthy people of the same age.

In a randomized controlled trial at the University of Delaware’s Physical Therapy Clinic conducted between 2000 and 2005, 200 patients who had undergone knee replacements were given six weeks of progressive strength training two or three times a week starting four weeks after surgery. Half of the group also received neuromuscular electrical stimulation (NMES).

Their function was compared to that of 41 patients who received conventional rehabilitation and home physical therapy. Quadriceps strength, knee range of motion, and gait were measured in such tests as timed up and go, stair climbing and a six-minute walk.

The group in the progressive strength-training program showed significant improvement in quadriceps strength and functional performance. They also demonstrated substantially greater quadriceps strength and functional performance after 12 months than the group that underwent conventional rehabilitation.

“This study clearly demonstrates the importance of surgeons encouraging their patients to be compliant with progressive quadriceps strengthening during their rehabilitation to enhance their clinical improvement and function post-total knee replacement,” notes Dr. Leo Raisis, a total joint surgeon and adjunct associate professor at the University of Delaware.

“Why undergo a $25,000 elective surgery and then not do as much as you can to get the most out of it and improve your quality of life?” Snyder-Mackler says. “Older people are incredibly motivated—they hurt after the surgery and they want to be better. They need to do this.”