Last summer I penned a diary about a medical procedure that gave me back functioning knees and a new lease on daily life.
Unfortunately, the story has a less than happy second act.
I'm now just 36 hours post-surgery and wanted to catch you up on my multi-year knee odyssey in the hope that others will find a way to get themselves properly healed.
In 2001 I had allograft ACL replacement surgery in my left knee. The reason for the surgery was a self induced testosterone poisoning incident ten years before when I inadvisedly jumped off a very substantial cliff while skiing at Vail.
Bad idea. No, stupid idea. Big pop, big tear, big ouch!!!
I lived with the torn ACL for over a decade and was able to continue doing most sports (running, bike riding, soccer, skiing, etc.) by heavily over developing the muscles of my knee and leg. However, there came a time (in my 40's) when that no longer worked.
The '01 ACL operation was performed arthroscopically by Dr. Katz at Good Samaritan Hopsital in Rockland County (NY). After a multi-month rehab process that included quite a bit of crying and grimacing on the mats and machines of my local gym, the ACL and my knee came back to nearly full functionality. It now works almost as well as before the injury. Today I call that knee my "good" knee. The ACL is solid as a rock and the two titanium surgical screws (one implanted in my femur the other in my tibia) stand out in bright white relief whenever I get yet another x-ray. All the orthopaedists who I've seen since 2001 (and I've seen a lot) remark that Dr. Katz did one fine job. I couldn't agree more. Thank you Dr. Katz.
So far so good.
Unfortunately this story is about my right knee. In 2005, after suffering for over a year with swelling and stiffness and almost constant pain I had an arthroscopic menisectomy to repair multiple
tears to my medial and lateral meniscus.
Because I was fully alert and awake for the surgery (having been given spinal anesthesia), I conversed with the surgeon during the procedure and he showed me the damage to the articular cartilage. At that point he said there was nothing further to be done.
The removal of the meniscual tears and reduction of scar tissue did help my knee to functionally improve for several yeras. From 2005-08 I rode my bike, swam and worked out at the gym. However, the knee was never more than 60-70% and I couldn't run, ski or hike much beyond a gentle woodland trail. By the summer of 2009 the knee was even more dysfcuntional than it had been in 2005. That's when I started on my "journey of discovery and dissappointment" which eventually brought me to the operating room 2 days ago.
Last summer and fall I saw a many orthopaedic surgeons whose diagonostic and treatment approaches left much to be desired. As per my previous diary last August I received injections of Synvisc in both knees. For 2-3 months they were much improved and I went back to some of my athletic activities including hiking and even a bit of bike riding. However, within about 100 days the effects wore off and my right knee was making it difficult to do normal activities like walking, going up and down stairs, crossing the street and doing simple yard and house work.
I was miserable and could not find a doctor who had an answer. My age (52) is considered on the young side for knee replacement and besides, the doctors didn't see (on the x-rays) the level of damage usually associated with TKR.
Finally, early this year while doing my millionth hour of online research I discovered a doctor and a hospital that specializes in my particualr problem ... acute damage to the articular cartilage (aka osteoarthritis) due to multiple minor sports injuries and long term wear and tear over time.
Although it deserves a drum roll here is the link without fanfare, it's called the Institute for Cartilage Repair at the Hospital for Special Surgery.
In late March I had my first appointment and a rather long conversation with the institute's director,Dr. Riley Williams. After reviewing the MRI and talking further about my goals, Dr. Williams said I had several options and focused in on a procedure called Synthetic Osteochondral Reconstruction.
So after some discussion with Shanna to make sure it fit into our busy lives, I scheduled the surgery for April 28th. On the appointed date we drove to HSS (71st an York in Manhattan) and I was prepped for the operation. Because the procedure would start out as arthroscopy I asked to remain awake for the early stages of the operation. After getting the spinal I turned my attention to the video monitor and watched as Dr. Williams removed scar tissue and 3 meniscus tears.
Within about 15-20 minutes it was obvious from his comments that all was not right. The damage to my knee was considerably worse than the MRI had shown. Since I was awake he adressed me directly and said that the planned procedure would not be adequate to repair the damage. Through the arthroscope he showed me 3 large areas of damage to the distal articular femoral cartilage reaching down to the bone.
Operation aborted. I was devastated, but not as much as I would have been had I not been in on the discussion during my operation.
However, all was not lost. Dr. Williams said there was another procedure that would address the level of damage my knee had. It was called Allograft OATS and involved transplanting analagous sections of a cadaver knee into mine. He did say that it was impossible to schedule the surgery and that the would put my information into a registry to await a good match. It could take months or maybe even a year or more to find a good match (the right size).
Fast forward two weeks. I'm healing up from my menisectomy and have had 2 PT session. The knee is sore, but feels a bit better than pre-op because the scar tissue and meniscus tears have been removed. I'm actually able to do some work around the house and am up on a ladder when my phone rings. I answer 10 feet up in the air. All I hear is ..."
"This is Dr. Williams, we have a graft, are you in?"
For a momemt I'm struck mute. I have a major series of classes in early June and there are so many other things going on in our life right then that I know this will set things upside down. The recovery time for OATS includes 4-6 weeks on crutches with little or no weight bearing. This will be hard for my partner. What will she say?
"How long do I have to decide?"
"You have to tell me now. If you're a no go then we move down the list to the next best match and you fall to the bottom."
Gulp.
"Okay."
"Okay yes?"
"Okay yes."
"Good, my office will call you but be prepared for next Wednesday. The graft deteriorates over time and transplanting it in less than 10 days is best. See you next week."
"See ya."
Click.
Gulp.
So the next five days were very difficult. I had tons of work to do and there was disagreement about whether I should be doing it at all at this point. Truth be told I had my own reservations too. But, i had been waiting for over 5 years and now I had a chance. I was going for it.
So 2 days ago I repeated my trip to the city and checked in to the HSS ambulatory surgical unit on the 9th floor. BTW, the entire experience at HSS was pretty damn good. This si one corner of the health care system that seems to work (if you have insurance). Even though this was a more invasive procedure it was expected that I would walk (with crutches) out of the hospital that night.
Mine was the last operation of the day and the surgery started late because Dr. Willams had to squeeze in a "Tommy John" surgery in front of mine. This time I choose not to be awake for the procedure and when I came to in post-op it was already almost 9pm. It took another hour or more for my anaesthesia to wear off and I was still feeling pretty awful. It was generally decided that I should spend the night at the hospital. I didn't see Dr. Williams until the next morning when he and his PA (Melissa) dropped in to see how I was doing. He said that the operation had gone very well and that the grafts were perfect. He said that now it was up to me. I had to work hard and rehab so I could go skiing next winter!!!
So here I am in bed with my pressurized cuff icer (Game Ready) and CPM (Continuous Passive Motion) machine. The last few days have been rough (stomach problems from the meds, pain, etc.) but each one from here out should get better. I will be on crutches for 4-6 weeks and don't expect to be getting back to real sports until the late fall or winter.
I'll check in from time to time to update people on my progress and would be happy to discuss my experience in more detail for people who are having similar issues with their knees.
Cheers.
H57