My parents had many droll and irreverent friends, among them their orthopedist, who declared (most likely after a few belts at one of their circa 1950s cocktail parties) that the human knee was God’s little joke on humankind. Unfettered by PC standards far in the future and unafraid of offending someone within earshot who might today feel that the comment trivialized or even mocked the lofty concerns of the Deity, the doc’s comment moved swiftly into the annals of family lore.
Who hasn’t had a knee problem? Consider the lowly knee, limited in its range of motion and uniquely exposed to all manner of jarrings, accidents, and even to the inevitable ravages of age itself as decades of faithful use pound its cushioning pads thin, ultimately surrendering its suffering host to the orthopedic surgeon’s scalpel.
Americans today have options to head off the limiting effects of their bad knees. Unlike the cane-leaning, Ace-bandage-wrapped oldsters in our moldering photograph albums, these days we’re signing up for knee replacements in record numbers. According to the American Academy of Orthopedic Surgeons total knee replacements are expected to grow to 3.5 million per year over the next decade, a 673% increase over current rates.
America’s medical culture today is a weird hybrid culture of ever-evolving jaw-dropping technical advancements and, paradoxically, greater individual patient responsibility for both pre- and after-care details: for example, scheduling and getting x-rays, EKGs, and other tests on the front end and scheduling regular appointments in the torture chamber (otherwise known as physical therapy) on the back end. What follows is a brief overview of my own recent knee replacement (my second) for the benefit of hobbling readers who may be flirting with the idea of undergoing total knee replacements themselves.
My own surgery took place at my local East Bay hospital, and some procedures doubtless differ from hospital to hospital and surgeon to surgeon. But yet…as God’s little joke on humankind, a knee is still a knee is a knee…So here’s the story.
Unless you’ve suffered a traumatic accident requiring immediate knee surgery, your road to the OR is typically a long and twisting affair marked by common signposts and wishful thinking before final surrender to replacing the knee itself. Along this road you’ll hear all about exercises that (might!) delay the inevitable, illustrated in colorful detail in brochures stacked in racks in your orthopedic surgeon’s office. Ah, why didn’t I think of that, you chastise yourself, maybe if I just plant my feet differently when I climb stairs, replace knee-unfriendly high-impact activities with low-impact ones (sleeping and reading in your favorite chair don’t count), lose weight, wear Earth shoes, take this supplement instead of that one, you get the idea.
When none of these helpful hints work, the next step is the needle, delivery system for steroids or different forms of lubricant injected directly into your aching joint. Having opted for several of these myself over the years, my advice is to fully embrace the thrill — while it lasts. This pain-free interlude is oh-so-intoxicating and promising until it gradually drains away, in some cases leaving you worse off than before since you probably further damaged your knee by romping around on it when it didn’t hurt so much.
Then there are the naturalists. I can already hear the howls of protest from marketers and users of the virtual cornucopia of “natural” salves, wraps, shoe inserts, supplements, and the like, Cannabis formulations have now entered this already-crowded market in a big way, adding an additional layer of non-invasive “miracles” to wash that knee pain right outa your hair — without surgery. Some do help and I’ve tried dozens of them. Beware the cost, especially for cannabis-infused creams, salves, and pain sticks that can set you back fifty bucks or more a pop. This is America, marketing capital of the world, where hundreds of messianic sellers stand poised to deliver their miracle products to a susceptible aging population with aching knees. (No Shipping or Handling Cost! Next Day Delivery!). And so on. When you’ve tried as many as you can afford and they’ve circled the drain after your shower enough times, you’re still left with the structural problem of that pesky knee.
Once you decide to replace your knee surgically you enter a countdown of sorts that’s kinda like what happens when you file for divorce. The clock starts ticking. If you tell yourself from the outset that the insurance industry runs everything and just make peace with it you will be less pissed off as you move through the process.
It took three months to get on my surgeon’s surgery schedule. During that time I received reams of paper about equipment to buy so it’s ready to go when you stagger home from the hospital, usually after just one night. My clinic used to lend out walkers, toilet lifts, wheelchairs, canes, angled Styrofoam pillows for leg elevation, circulating ice wrap (one thing insurance did cover) and the like – but no more. You’re on your own, now, Baby, and there’s a new sheriff in town.
The surgery prep room is truly a trip. You are on a bed surrounded by machines: IVs, anesthesia preps for your upcoming spinal, antibiotics and gods knows what all, all preparing your unsuspecting body for the major assault soon to come. One final stop before the OR was to an empty, other-worldly room full of what looked like draped furniture á la Miss Havisham for the spinal, where a nurse held me securely in a bent-over cannonball position while the anesthesiologist applied what felt like tiny needles up and down my spine, kind of like a weird fairy dust. I was already out of it by OR time so didn’t get a look at the room, though for an earlier procedure I was rolled by a wall of saws, hammers, and other carpentry equipment that reminded me of the shop room in my junior high school. For in its essence, doesn’t orthopedic surgery have much in common with a building project out in the garage? We may think of ourselves as unique combos of knowledge and experience, but it’s all supported by a physical framework, just made out of bones instead of two-by-fours. I couldn’t resist asking the physician’s assistant for my first knee replacement what it was like during the operation. He pretty much confined his description to lots of flying bone fragments. I forgot to ask him how noisy it must be as the old knee is blown and chipped away to make way for its shiny new bionic replacement.
Finally, in a time warp unlike any other, you wake up in the recovery room like nothing ever happened. No pain. Enjoy this initial bliss but don’t make the mistake of trying to hold onto it because it’s neither real relief nor euphoria; it’s just that your knee was packed with steroids and pain meds that haven’t worn off yet. Ah, sneaky interlude, it will end soon enough.
Then it’s home, where for the next month you will spend every minute of every day cursing your decision to have the surgery as you helplessly try to beat back the pain that even your prescribed narcotics can’t touch.
No knee replacement experience is complete without the final act: physical therapy, aka the torture chamber. In my case this took place in a cavernous room reminiscent of a high school gym, ringed by mobile computer stations operated by a platoon of twenty-something physical therapists tricked out in no-nonsense t-shirts and expensive-looking high-end athletic shoes. Various sporting events hang, muted, from TV screens throughout the space. (Work hard enough here and this could be you!). Then, of course, there are the sufferers, almost all old enough to be the grandparents of the perky young PTs serving them, all straining against broad rubber bands, stretching out inflexible, post-surgery knees and hips, all trying to eke out a little more time before inevitable decrepitude finally makes it all impossible. Ah, modern medicine has delivered this ability to bargain with the unstoppable clock. For just a little more time, a little more time to hike familiar paths or walk the putting greens or go back to your folk dancing class or do whatever it is that makes you feel like part of the living instead of firmly on the inevitable downhill slide.
Early on in the pandemic I chatted with a guy in front of me who was, like I was, waiting in a long line to get into the grocery store. He spoke of how grateful he was to be a baby boomer, to have come of age in a time of great opportunity and secure employment in a field of his choosing. For at least the thousandth time, I wondered what I might have ended up doing if I were eighteen and starting out today. Reflecting on the armies of mostly young professionals who ran the hospital apparatus throughout my knee replacement experience, I understand the medical profession’s appeal. According to salary.com, physical therapists in California earn an average annual wage of $101,905. Physician’s assistants earn even more at $122,591. Registered nurses earn an average of $71,500. Contrast these earnings with those of the state’s lowly journalists, who earn an average of $46,634. Given the state of our profession today I’m not even sure if that salary even comes with job benefits or even any meaningful opportunities to write anything. I doubt that many high school counselors today are encouraging their students, as mine did, to follow their passions and the work will come.
Everybody has to eat.