An Unusual Knee Surgery
November 8 marked the year anniversary of my surgery to remove my infected left artificial knee.
The preparation for the surgery took so much more effort than we thought it would, but we ended up being glad to have been so thorough and take some extra steps. I had visits with my rheumatologist and family doctor. My surgeon, Dr. G., also suggested that I schedule a visit with the anesthesiologist. I had some complications with a previous surgery and it could help to look at my mouth and neck to see if the intubation tube would fit because of my limited range of motion due to the rheumatoid arthritis.
We had hoped to use an epidural because it would help manage the pain for days after the surgery. The anesthesiologist agreed with this plan, but also looked at my neck and mouth in the case I would need intubation. I also asked about his suggestions for an IV line because it is extremely difficult to access my veins. After a childhood filled with blood tests and previous IV lines collapsing my veins, it was next to impossible to do a blood draw, much less insert a large enough needle for an IV. As an alternative, he suggested that I have a PICC line installed.
A PICC line is inserted into a deep vein, typically in the upper arm, using ultrasound under sterile conditions. If it is well maintained the line can be used for many months, maybe even a year, for both removing blood for testing and administering medication. Not only could this line serve as an IV during the surgery, we could use it post-operatively for blood tests and administering the course of antibiotics needed for treating my knee infection for the following two months.
So the day before my surgery, I left early from work and had the PICC line put into my right arm. Even with the team’s experience and using the ultrasound, it was difficult. My vein kept rolling away from the needle no matter how much I told it to stay still. (Sorry, a little vein humor.) But finally, they got it and threaded the guide wire up the vein, almost to my heart, and secured the tube to the side of my arm.
One worry beyond the medical issues I had to contend with as I prepared for the surgery was extremely practical—what about my job? I loved my work, plus my paycheck and health insurance were obviously important. After Dr. G. determined that I would need two surgeries and would be out for several months, I went to my employer and explained my condition, the need for immediate treatment and how long we expected it to take. I wanted to work from home during periods when I was capable, but I would also need extended leave and time for my recovery.
Thankfully, my employer was very understanding and supportive. I arranged to use my remaining leave and then would go on short term disability. When I felt ready, I could contact my employer to take on some work from home. In the meantime, my husband would keep in touch with them to update them on how I was doing. Going into the surgery with these arrangements made took a huge weight off my shoulders and helped me to focus on the top priority—my health.
My parents drove down to help after the surgery. The night before we ate a big lasagna dinner with salad and garlic bread to hold me over during the pre-surgical starvation period. We woke early the next morning because I had to be at the hospital by 6 am. I wore my pajamas under my winter coat so that I would be comfortable. My last shower for awhile had been the day before because I couldn't get my PICC line wet. I remember sitting under the pounding water, looking at my knee and wondering what it would be like after the surgery. I took my time and enjoyed the hot water, knowing it may be months before I was able to get in the shower again.
After arriving at the hospital I had to wait awhile before they took me back to the preparation room. I kept grabbing the arm rests of my chair, willing myself to stay and not run away as every bone in my body was telling me to do. But they called me back and I put on the gown, fluffy hat and took the medications from the nurse to help with surgical pain. Dr. G. and the anesthesiologist both came to check in before the surgery.
We didn’t know what we’d find but the plan was to take a sample from my knee as they removed it and culture it for bacteria. Then Dr. G. would remove the old knee and implant a spacer, which is basically a cement block infused with antibiotics. It is not meant to be a functioning knee, but allows for some weight bearing and holds the physical space so that a new knee joint could be implanted later.
When I woke I learned the surgery went as well as possible. I needed to stay in the hospital a few nights until the results of the culture from my knee came back. And because I was a potential infection risk, I was kept in a room by myself, which was one small positive to the experience.
At first my left leg was numb, but feeling gradually came back along with throbbing in the area where my left knee formerly resided. I had to take pain medication, but it wasn’t too bad to manage and was better than I had expected because of my previous knee replacement pain from 20 years ago. The challenge was to manage ambulating so the physical therapist came in to help show me and my family how to get me up. I practiced using a walker to bear weight through my arms while walking.
Thus began my life without a knee, which thankfully lasted only a couple months. Living without a knee is certainly a bizarre concept and I wouldn’t recommend it or wish it on anyone. In a few days we learned that my knee had definitely been infected and I would continue on twice daily IV doses of strong antibiotics through my PICC line. With the support of my family I was able to go home and spend my treatment in greater comfort.
Has having RA put a hold on your ambitions?