It's been coming on for several years, and in the summer of 2016, it came to a head while hiking in Shenandoah National Park. I quit denying it and finally admitted to myself that something was terribly wrong with my right knee. I would frequently experience significant and persistent pain on the inside of my right knee, particularly while hiking. Ironically, it never hurt during or after playing pickleball, which I was doing 4-6 days a week.
Finally in October 2017 I visited a local orthopedic surgeon (let's call him Surgeon #1). He took X-rays and determined I had osteoarthritis on the inside (medial compartment) of my right knee. Images showed no soft tissue in that area: bone on bone. OUCH! On that visit my knee was quite swollen, and he extracted a ton of fluid. He also gave me a shot of cortisone. The cortisone didn't really help much and drove my blood glucose through the roof for several weeks. It was obvious that steroid therapy was not a viable solution. Several weeks later he prescribed an orthopedic brace designed to put pressure on the outside of the knee to reduce pressure on the inside of my knee and provide separation between the bones on that side. I began wearing the brace while playing pickleball, hiking, extended walking, mowing, etc. It was uncomfortable, but fairly effective.
 |
| Pre-op front view |
 |
| Pre-op side view |
A few weeks after getting my brace Dorcas and I attended a presentation about knee surgery, with specific emphasis on the
Mako Robotic Arm Assisted Technology. The presenter (let's call him Surgeon #2) uses this technology in full and partial knee replacements as a tool to aid in the precision of the cuts and alignment of the replacement components. We were impressed with both the surgeon and the technology. I asked a lot of questions during the presentation and also afterwards one-on-one with the surgeon. It was clear that I could benefit with knee replacement surgery.
Among other things knee surgery is just majorly inconvenient. Recovery from knee surgery is fairly difficult, relative to many other joint replacements. Recovery and rehabilitation usually takes about 8 weeks. When do Dorcas and I have 8 weeks to set aside without sacrificing our extensive travel schedule, not to mention my year-round pickleball habit? Finally, in late June, just before leaving for our Summer Rockies trip I met again with Surgeon #1, and scheduled surgery for September 24, the week after we returned from our summer trip. That would leave about 8 weeks to recuperate before departing about Thanksgiving for our Florida winter home.
While on our trip I began having second thoughts about the surgery. Surgeon #1 proposed complete replacement of the knee vs unilateral or partial replacement, and didn't use the Mako robotic arm. We never even discussed partial replacement even though the right compartment of my knee appeared to be healthy. We learned during the presentation the year before that the trauma and recovery from a partial replacement were significantly less than that for a full replacement. I sent Surgeon #1 a message asking 1) Why he recommended a full vs partial replacement and 2) What were the clinical benefits of Mako robotic assisted surgery vs conventional surgery. His response follows:
"Unfortunately, I am not able to fully address this matter via email. Please contact the office and schedule an appointment at your earliest convenience."
Well that's a kick in the butt. We wouldn't be home until a week before the scheduled surgery (9/24). Another appointment would likely mean a significant delay for the surgery, probably delaying our scheduled Florida departure. And why couldn't he answer my questions? I had seen Surgeon #1 twice, and he had taken x-rays both times. He had scheduled the surgery, so he should have valid reasons for his diagnosis and recommendations. Why couldn't he explain his reasons? At this point I had started to doubt my decision to go with Surgeon #1. Surgeon #1 also happens to be significantly younger and less experienced than Surgeon #2.
OK, we had 3 options: 1) schedule another appointment with Surgeon #1, 2) schedule an appointment for a 2nd opinion with Surgeon #2, or 3) wait until after we leave for Florida and visit the Mayo Clinic in Jacksonville FL, where I am already a frequent customer. Option 3 was not particularly desirable because I have already met my out-of-pocket expenses for 2018, and if I had surgery in 2018 it would be essentially at no cost to me. Surgery at the Mayo Clinic would likely be in 2019. I enter Medicare on January 1, and have no clue what expenses I would incur under Medicare. Option 2 was not very desirable, because I had lost confidence in Surgeon #1 and hated to delay the surgery and our departure to Florida.
Consequently, I scheduled an appointment for a second opinion with Surgeon #2 for Sept 17, the first work day after we returned from our summer trip and 7 days before my scheduled surgery on Sept 24 with Surgeon #1. Oh, did I mention that both Surgeons #1 and #2 are in the same practice? Anyway, Surgeon #2 took additional x-rays, including images with lateral stress placed on my knee, which Surgeon #1 had not done. He concluded that a complete replacement was not necessary or warranted. It happened that he had just had a cancellation and could perform my surgery on Sept 25, the day after my scheduled surgery with Surgeon #1. So, we can do a partial vs full replacement, we can use the Mako robot and the surgery would be only 1 day later than originally scheduled. There was a caveat that if, after making the incision during surgery, he found additional damage that was not apparent in the images, he would perform a full replacement. We have a go. Surgeon #2 would make the arrangements for canceling the surgery by Surgeon #1.
 |
| Mako Robotic Arm |
Click HERE or HERE to view videos that explain and illustrate the Mako Robotic Arm procedure.
Click HERE to view a rather graphic and gruesome animation showing conventional knee replacement technique.
During the week before surgery I had numerous pre-op calls and spent most of a day at the Novant Health Clemmons Medical Center, which is a new facility about 20 minutes from home and specializes in outpatient orthopedic surgery. Among other things, they performed a CT scan of my leg that would provide a map for the Mako device. Surgery was scheduled for 10:30 on the September 25th, and we arrived at the hospital about 8:00 for preparation. During pre-op I tried to change my mind and walk out, but Dorcas said it was too late. Surgery started on time and took about 4 hours. I was in the recovery room by about 2:30 and in a hospital room shortly thereafter. By late afternoon I was making laps around the ward with the aid of a walker. No moss on this stone! Amazingly there was very little pain. They told me they used a nerve blocking medication that would block the pain for about 2-3 days. Dorcas stayed until after dinner, and then went home to take care of Matilda, who had spent a long day at home alone. That night I couldn't sleep. I spent the much of the night completing the blog on our Boundary Waters trip. Then from 3:00 to 5:00 am I watched a very interesting Ken Burns documentary on PBS "
THE MAYO CLINIC: FAITH - HOPE - SCIENCE". The film features interviews with patients including John McCain and the Dalai Lama, and tells the story of William Worrall Mayo, an English immigrant who began practicing medicine with his sons Will and Charlie in Rochester, Minnesota.
 |
| It's too late to turn back now! Don't we need a hair net for my face? |
 |
| Shaving the surgical site |
 |
| The surgeon drew the cross hatches to make sure he properly aligned both sides of the incision before closing up |
The day after surgery I continued to walk and spent much of my time in a recliner with my leg up and attached to the "Ice Man". The Ice Man is essentially a cooler filled with ice and water that has insulated hoses conducting cold fluid to a plastic wrap around the knee. The Ice Man is my friend, and I got to bring him home. I met with some physical therapists, who made sure I could go to the toilet, put on my socks and negotiate stairs with a walker.
 |
| Ice Man cold therapy device |
Shortly after noon they sent me home, slightly less than 24 hours after coming out of surgery. By that evening I had abandoned my walker, finding it more of a hindrance than a help. I found I could move through the house quite well by steadying myself on furniture, walls and door frames. When I went outside I used a hiking stick.
 |
| OUCH! First physical therapy session 7 days after surgery |
 |
| Post-op front view |
 |
| Post-op side view |
 |
| Matilda is one of my two best support people |
So.... what happened? How did this happen and why was this necessary? Let's take a trip down memory lane.
I have been at least 50 pounds overweight most of my adult life. That obviously has to be tough on the knees. When I graduated from high school I was 5' 111/2" tall and weighed 185 pounds. At the end of my first semester at college I had ballooned to 235 pounds. During my first marriage from about 1985 to 1993 I had another growth spurt and jumped to about 275 pounds. After my diagnosis of diabetes and during my separation I dropped about 70 pounds and bottomed out at about 205. Then I met Dorcas. In spite of her healthy eating, and trying to entice me to eat better (didn't work) my weight climbed to about 235 pounds and has been fairly constant since the late 90s. Also I seem to have shrunk an inch or so to 5' 10". It also probably didn't help that my right leg is one inch longer than my left.
 |
| Skinny Myron during senior year in high school in 1972 |
After I graduated from college and starting work in 1978, I discovered that I loved the outdoors and have led a fairly active outdoor lifestyle since then, enjoying hiking, backpacking, cycling, skiing, canoeing, and, since about 2006 when I retired, pickleball. I'm sure all these activities contributed to the wear and tear that led to my osteoarthritis Following are some archival photos of some activities.
 |
| Backpacking at Mt Rogers in the winter |
 |
| Backpacking at Mt. Rogers in the summer |
I started paddling in about 1989 and joined a local whitewater paddling club. To paddle serious whitewater one must kneel in the boat. This kneeling causes stress on the knees and that too may have contributed to my osteoarthritis.
Following images show some backpacking trips. Always one to overpack, my pack usually weighed 60+ pounds. On a trip to the bottom the Grand Canyon my pack weighed over 80 pounds, mostly due to the need to carry extra water.
 |
| Don't look down! |
 |
| Hoh Rain Forest Olympic National Park |
 |
| Hoh Rain Forest Olympic National Park |
 |
| Hoh Rain Forest Olympic National Park |
 |
| Colorado Rockies |
 |
| Colorado Rockies |
 |
| Crossing a steep snowfield in the Colorado Rockies |
The week after I retired in 2006 I flew to Colorado to meet my friends Andy and Christy. That week we did a backpack trip and several day hikes, including to the summit 2 Colorado 14ers,
Handies Peak (14,058') and Rio Grande Pyramid (13,827'). OK,
Rio Grande Pyramid is not technically a 14er, but it's close, and it was a harder climb than Handies Peak, so I'm counting it.
 |
| Summit of Rio Grande Pyramid |
 |
| Above the clouds in the Weminuche Wilderness in the Colorado Rockies |
Since 1997 Dorcas and I have been venturing into the Boundary Waters Canoe Area Wilderness in northern Minnesota. These trips involve a number of portages as we travel overland from lake to lake. On each portage I carry a food pack that contain alls our food (and Matilda's) for about 14 days. The few times I have actually weighed the food pack it has been over 80 pounds. I also carry a dry bag containing camera, GPS, binoculars and miscellaneous other gear. That bag weighs 10 pounds or so. Hello knees!
On the second trip across the same portage I carry the boat and a net backpack containing PFDs, tarp, chairs, sandals, ropes, drinking water and other miscellaneous gear. That's another 20 pounds or so on top of the 55 pound boat.
During many canoe trips we find it necessary to drag the boats over trees and log jams. On day trips with empty boats, that's not too hard, providing you don't fall off the log. But on camping trips where the boat is weighted down with days of camping gear and food, it is much more difficult and strenuous stressing the back and knees.
 |
| Dragging a canoe across a downed tree. Megan, Wayne's granddaughter, is now married and has a son. |
So that's the back story. At the time of this post it has been 3 weeks since surgery, and things are going extremely well. The pain now is practically nonexistent, and I am walking normally and negotiating stairs easily. I had my first post operative followup yesterday and both the orthopedic PA and my physical therapist say I am doing great. I have a range-of-motion of over 130 degrees. They gave me the green light to drive, and in fact to do whatever I feel like doing, including cycling and pickleball. I will probably start going to the Y next week and using the machines and maybe even try to play a little pickleball.
All in all, while not particularly fun, it has been a fairly positive experience.
