New Knee vs. Old Knee

Having been released by Dr. Kerina three weeks ago to play tennis to my heart's content, I have been on the court every chance the weather has permitted.  My first team match was scheduled for last Tuesday in Gainesville, but after the team drove half way there, we got the call that the match was cancelled due to wet courts.  So my first "real" USTA match was Friday at my old club, Skyview, in fairly cool, very windy conditions.  It was great to be back in a competitive match.  Of course, playing against my old teammates was very difficult.  We didn't prevail, but wait until next time!

I'm trying to get a grasp on how to best describe the way this knee works on the tennis courts, as compared to the way the old knee worked.  Here goes:

The old knee hurt with every step.  I think that when you are playing tennis, the adrenaline helps to block the pain, since my old knee had always felt more painful walking, and doing normal things than it did on the tennis courts.  However, I never walked on the tennis court without taking 3 acetaminophen, in addition to the daily dose of Mobic.

The old knee could not go backwards.  I was always able to move forward, to some degree, but not backward.

The old knee would not push off in any direction.

The old knee could not bend very far.  OK, it could not bend at all.

Now for the new knee.

First of all, from the beginning, I have best described the feeling of the new knee as if there was a sock full of sand in there.  It's still there, but it is becoming smaller.

The new knee does not hurt.....at all.  While I still take Mobic, for other arthritic issues,  I do not take any other pain meds.

The new knee feels strong and it can bend.

The new knee can go forward, backward and sideways.

The new knee can push off.

From my first time hitting tennis ball, I have been in awe of the sense of balance I now have.  As I move around the court, it still amazes me that I am able to do what I can do, movements I have not been able to do for more years than I can remember.  I can now actually get a cardio workout on the tennis court.  It is an exhilarating feeling, and I am excited to be on the court every time.

 I have been playing with Bill for 20+ years, and he knows how I play.  Since I am on the inside looking out, I asked him for his view of the difference, new knee vs. old knee.  He said I am getting to balls I have not been able to get to; I can go back for overheads and up for short balls.  He feels my movement has improved 20%, but I feel it has improved more than that, but I'm on the inside looking out through my rose colored Bolles.

What are you doing on the court? What does your doctor say?

Since Christmas Eve, I have been on the tennis court here at Harbor Hills every chance I get, hitting with my backboard, Bill, and every time someone walks by, they ask if my doctor knows I'm playing tennis.  I'm been fudging the answer, but, truth be told, while he had given a reluctant OK to it as long as I didn't run, fall or twist my knee (as if you can control the latter two caveats), I have been a bit reluctant to actually play a match, even though I keep thinking my new knee will tell me if I do anything I shouldn't be doing.  So far, it is humming along.  I haven't been so pain-free or well-balanced on the tennis court for years, as I have been since this knee replacement.  

I wasn't scheduled to go back to Dr. Kerina for my final post-op appointment, where he really would turn me loose, until February 3, which is over three weeks away.  So I called his office to see if I could get in earlier, and, coincidentally, they had a cancellation for today.  Bill freed up his late afternoon schedule to go with me down to Leesburg.  But this morning, I had a date to hit with John, the pro, and that 40 minutes is quite a workout.  If the knee was ever going to swell, that would have done it.

The big guy (that would be Dr. Kerina) came in and said, "let me take a look at that knee before you tell me what you have been doing that you shouldn't have been doing."  He took a look at the new knee, and said, "Wow, that knee looks good!"  He said it was solid when I came out of surgery, and it is solid now.   Go ahead and play tennis; do what you want, but just don't fall or twist it, and I'll see you in a year.

So, nine weeks and one day from the date of the surgery, following a good-by hug, I have been released to do what I want, and my next appointment will be November 8, 2011, one year following the original surgery.

Back on the Court Ahead of Schedule!

Today is New Year's Day, 2011.  On December 24th, one week and one day ahead of my original wishful thinking date of January 1 (and one full month ahead of my doctor's prediction), I went out on the court and spent 35 minutes hitting tennis balls with my ball machine, Bill.  That was less than seven weeks after the surgery.  Dr. Kerina gave a reluctant OK to hitting tennis balls, as long as I don't run, so I have been out there getting used to this new knee.  It feels and it works differently than my old knee.  This knee, though it still feels as if there is a sock with sand in there, works well, if in a cumbersome way, and doesn't hurt.  My original knee, in the condition it was in pre-surgery, hardly worked at all, and hurt all the time.  So this is a great improvement.  I've been trying to hold myself back from hitting too long and too often.  Pain and swelling would be a warning to stop, but since there is no pain and being on the court doesn't make it swell up any more than the stationary bike or elliptical, and even that swelling is minimal, I continue to hit every day the weather permits.  I have been on the court four or five times since Christmas Eve with Bill and am none the worse for wear.  I'm resisting the urge to start playing doubles, and my better judgment is prevailing.

Six Week Follow-up with Dr. Kerina

So, yesterday I had my six-week follow-up with Dr. Kerina.  Bill and I went to the Lady Lake office,  where I received very positive feed-back on my progress.  I had an x-ray taken that shows the new knee in alignment with no instability or soft tissue problems.  He told me there is no reason to work on increasing the range of motion; 130 is higher than any expectation for six week post-op,  and any additional range will come from my normal activity level, which is fairly high.  I don't need any more PT, and he reluctantly said I can hit tennis balls "as long as you don't run."  He also reluctantly said I could use the elliptical machine, but hitting tennis balls is much more fun that that!

I  had previously picked up the Operative Report from Leesburg Hospital; the knee is a "Zimmer Natural Gender (cobalt chrome cast alloy) #1 femur, #2 tibia, 9-mm ultra condylar and tibial bearing, #1 patella."  The patella parts are "ultrahigh molecular weight polyethylene."  He chose that particular knee because I am a tennis player, and the "plastic" parts because the substance is stronger than some other choices, and can better withstand the usage that comes from playing tennis.  He said it should last 20 years of normal use, but my lifestyle is not considered "normal use."  The parts that are most likely to wear are the "plastic" parts, and they can be replaced if necessary.  The other parts are glued in and "aren't going anywhere."  The soft tissue, though, takes longer to heal, hence no running yet.

As for antibiotics and dental work, absolutely I must take antibiotics before any dental work, even cleanings.  "Don't listen to your dentist."  Dr. Kerina said the antibiotics are very important; the mouth is a dirty place, and any infection will seek out the parts that are alien to your body, i.e. the new knee.

And yes, I will set off metal detectors.

Physical Therapy #8: Graduation Day

"Today is graduation day."

It's almost six weeks post-op, and Forwen was working on my knee for the last time, preparing to take the measurement to include in the final PT report to be sent to my surgeon.

Range of Motion:  -3 to 130.

I was told this was an unusually good result for only six weeks out.  He has not had another patient do as well as fast.   It's bittersweet, though, since while I love the fact that I feel as good as I do and can do as much as I can do, I am really going to miss my 3x week at PT.  I think it is partly knowing that 3 times a week, I had an appointment to do something important (sort of like playing tennis?), and now I'm going to have to be disciplined and do the stuff by myself with no one standing over me.   That's no fun!  But I knew from the onset that, whereas tennis was my "job" prior to surgery, that rehabbing was my "job" post surgery.  Of course, I'm passionate about tennis, but, unfortunately, not as passionate about rehabbing.  Oh, well.  On to the next stage in the TKR recovery process!

Pleasant Surprises

So, I drove to Skyview to attend the tennis ladies Cookie Exchange, which I was pleased to be invited to.  On my way home three hours later, I realized that I had stood on my feet for almost the entire time I was there, and was totally unaware of any discomfort.  If anything, I was conscious of how well-balanced and solid I felt.  Last year, I needed to be sitting most of the time.

It's the little realizations like this that are so significant.

Physical Therapy #5 and #6

Today is five weeks since the surgery.  I will have two more PT appointments, and then I will be done.  The physical therapy plan is that you must reach certain goals before being released from PT, including range of motion, certain knee lift/bending with 5 lb. weights, certain balancing, certain level on the bike, etc.  I'm just about there.  My range of motion is  -1 to 127.   I'm up to ten minutes at level 7 on the bike; 5 lbs. on the knee lifts, and have the balancing part nailed, I think.  That's standing on the balance board tossing and catching three balls of ascending weights (one at a time, though), at a small trampoline.

I asked about using certain machines at the fitness center, and Forwen said go ahead.  He said he knows my legs are strong because I can walk up and down stairs.  I can pretty much do what I want to do, with the exception of tennis.  I'm being patient with that, because I am well aware of the damage I can cause if I do something stupid, and playing tennis would be stupid!  Serving, however, I have been doing.  I might as well try to keep one aspect of my game honed.  But I am still shooting for January 1 to be hitting tennis balls.  I see Dr. Kerina next Thursday, and we will see what he says.