Second Knee Surgery is in my Future but trying PRP First

Those following along on my journey know that about a year and half ago I had a partial knee replacement on my left knee.  At the time of the replacement my other knee was in pain as well but not nearly as much as the one that I had replaced.   Arthritis is progressive.  You may be able to slow it down but its not ever going to get better.

May 2013 X-Ray

While its still not nearly as bad as my left knee, the right knee is getting worse and I can't walk now without limping and its starting to cause my hip, ankle and back on that side to hurt.    I had xrays taken last May and then again on March 30th and there is definite progression.   Besides the narrowing of the space, my leg is collapsing on the inside so I am getting more bowlegged which is causing some of the limping.

I'm also including an xray of a normal knee so you can see what it should look like without arthritis.

When there is this much damage there are very limited options available.  My doctor said I could try the unloader brace but I tried that on the right knee and it only caused bruising and ripped the skin off my knee and didn't improve the pain any  Not trying that again.

March 2014 X-Ray

I could also try OrthoVist again but it generally does not work well when there is so little cartilage left.

And there is knee replacement which has a fairly extensive recovery process but was very successful on my right knee.

But there is ONE other option that is fairly controversial at this point but has shown some promising results -- PRP or Platelet Rich Plasma injections.  PRP is where they remove blood from your arm, remove the platelets from the whole blood and then inject it directly into the knee with the hopes of stimulating growth and healing.  Despite it showing some decent results, its not currently covered by insurance and there are not many doctors who are using it for arthritis.  I had been reading about the studies using the technology so when my doctor mentioned it was something he would like to try, I jumped at being his first patient.

Being his guinea pig wasn't as risky as it sounds.  He has been using the process in surgery for soft tissue repair quite awhile with very good results.

Normal Knee

So last week I became his first arthritis patient to receive PRP.  He removed 30 cc of blood from my arm, centrifuged it, and then injected the resulting 7 or so cc of platelets into my knee using ultrasound to guide the needle.   The injection itself was not painful but about halfway through the pressure of all that liquid behind my knee WAS painful.  Not unbearable though and well worth it if I get good results.

Its been a few days now and it may be just having more fluid in there but I do feel there is less pain so I am hopeful.  I know my knee is pretty far gone though so the chances are lower but one can hope.  If it works then I will get another injection in about six weeks and potentially one more.

Crossing fingers and toes that it works.

Partial Knee Replacement Healing and Rehab

In recovery a few minutes before
they told me to walk.

While you may not consider my knee replacement a "horse" or "dressage" topic to me it is ... because it was the day I realized that I was not enjoying or able to ride my horse that I knew it was time to head under the knife. I tried to make it work by finding new ways to get on and off and taking pain meds but in the end it was just too painful to tack him up and ride and I was riding less and less.  It felt like a chisel was permanently installed in my kneecap.

<Warning up high in this blog entry… I put some pics of the knee as it is healing at the bottom.  If you are squeamish you may want to stop halfway through.>

I know many riders face this same decision so perhaps a log of how mine went might be helpful to someone.

My surgery was eight days ago last Monday. I arrived at the hospital at 8 am for pre-op, bloodwork and to confirm for the second time that week that I was not pregnant. (No chance of it but they didn't believe me.) The lack of fluids through the night made the IV difficult to place but by 10 am and with the help of the anesthesiologist; I had an IV and was bent over so they could place an epidural in my spine.  I remember bending over and the stick and that must have been when they knocked me out because the next thing I remember was waking slightly during the surgery to have them tell me that it was nearing the end of the surgery. 

I had an epidural so I could very lightly be put under (making it easier to come out of anesthesia).  I woke up a couple of times during surgery but it was like being VERY drunk.  I didn’t care in the least that I was in the OR. 

By 12:30 I was in the recovery room and by 2:30 I was walking with a walker to the bathroom.  I have to admit I was a little terrified when they asked me to walk and put weight on a leg they had just chopped but it turns out the pain meds were still working well and I did pretty well getting there. 

I had what is called a partial knee replacement which means that they replaced only the joint on the inside of my knee – the area of my knee with the majority of the arthritis and the cause of my pain.  The recovery is generally faster and there is much less blood loss.

By a little after 3 pm I was in the passenger seat of the car and heading home.  The surgery was a little over an hour away from our house and I rode all the way home with my eyes shut praying I wasn’t going to throw up.  (I didn’t but I had a bag ready.)

We had to pick up my son from school on the way.  As he approached the car, “Mom, what is wrong with YOU?”  

“I just had surgery… I don’t feel well.”

“Oh… well you look like you are dying.”

Thanks.  You can always count on teenage sons for the truth.

The first couple of days were not fun.  I had physical therapy the first day and they spend most of it trying to see how far they can bend your knee.   I was sure the stitches barely holding my swollen knee together were going to burst in the therapists face.  I couldn’t believe he wasn’t ducking.

Each day gets better though.  You have a decent day and decide that sure… you can go to work for a couple of hours.  I mean all I do is sit -- its not like I work construction.  What’s the difference between sitting there and sitting at home?   I tried going for two hours on Tuesday and paid for it all night.  No sleep because the pain meds just couldn’t keep up.

I haven’t seen my horse since the night before the surgery.  I hope he remembers me.  I am hoping that next week I can start driving again and can stop relying on wonderful friends who are currently caring for my horses.   Until I wean myself off the pain meds I can’t drive.  Right now I am down to a little less than half the dose I was on the first week so I am getting there.

The good news is that although my knee hurts its completely different than the hurt before the surgery.  Instead of getting worse every day … its getting better every day.  I have high hopes that I will be riding soon and will be doing it pain free.   The goal is to be able to bend my knee at least 120 degrees and extend it completely flat at 0 degrees.    At my therapy session yesterday I was at 108 degrees flexion and 2 degrees extension.

I can’t wait to  post the entry about my first ride after surgery.  The sooner the better.

The picture to the left is the day after surgery.  The word "Yes" I had to write

on there to make sure they replaced the correct knee.  The knee to the right

is a week after surgery.  The bruising didn't start showing up until

about day three.