A year after my knee cap replacement surgery calls for “GOODBYE, ARTHRITIS”

 

It must have been in early 2000s that I started suffering from knee pains. One of my colleagues observed that I did not walk straight and commented on my uneven walking. I thought it is due to continued sitting in one posture on chair for long time. Slowly, it dawned on me that I am regularly suffering from knee pain. A visit to the doctor confirmed it. He called it arthritis after an X-ray of knees.

Most Indians start suffering from knee pain from the age of 50 years onwards. In my case, it could be so plus minus few years. A friend of mine from Germany who himself happens to be physician thought its occurrence relatively early as compared to most Europeans, who he said, suffer from late 60s or early 70s of their lives.

Fortunately, it is osteoarthritis, suffering at knee joints. The other kind of arthritis is related to pains at every bone joints. I heard, it’s terrible and can occur at any age.

Knee pain is reportedly due to heavy weight that legs have to bear over many years of walking. Runners may be falling in this category of being most vulnerable. Probably it should be less so for those who are lean and thin and continue to walk regularly with balanced diet. I am not sure if this is due to genetic inheritance of some genes that might express in advanced age.

As age advances, calcium deficiency becomes common. Calcium is an important component of bones. Lack of calcium in bones accelerates knee pain. As bones impound over one another due to movements, cartilages, elastic muscles that are in between and attach to both ends thin out.

In my case, I was prescribed calcium as well as diacerein (proteoglycan synthesis stimulator) tablets to make up for calcium loss and encourage cartilage growth, which acts as sponge for joint movement. Besides, some also take glucosamine, a basic ingredient that helps. It is known to be precursor of chitin, a polymer of glucosamine found in insects and other arthropods. I did take glucosamine tablets for some days, but did not continue as I did not feel their usefulness. I did found some relief with these medications, but for a limited period or intermittently. So, I will continue diacerein and calcium for some months and then stop as I felt relief.

Occasionally, knee pain will be severe and so prolonged that I will not sleep. And hence, I will take pain killer tablets, ultracet tablets (a mix of tramadol hydrochloride and acetaminophen). Often, I will resort to use of dyanpar (diaclofenac/paracetamol) ointment to get relief. Over the years, this relief using dyanapar proved less and less effective. Pain killer tablets sometime led to increase in stomach acidity for which I had to take anti-acid tablets. Fortunately, I often drink cold milk in the morning on regular basis and hence, acidity was less of problem. And plus point for me to continue bearing with arthritis was that I did not have to walk long distances or stand for long time to perform official duties.

I suffered from this disease for about fifteen years. I had injections of Synvisc One (Hylan GF 20) at knee which were supposed to lubricate joints and provide relief for about 5-6 months. These are very costly. These cause swelling at injection site. I did not get any relief, as my case was too advanced, just two months before my surgery. Prior to that, may be 5-6 years ago, I had injections of some natural sea weeds, as per recommendation of orthopaedic in the RML Hospital, Government hospital in Delhi. I went in for consultation hoping for Synvisc One injection. The orthopaedic there was influenced by the medical representative and hence I landed up with this stuff, injected by my Orthopaedic doctor at BLK hospital. I did not work.

In December 2020, I was mentally prepared to undergo surgery. It had become virtually impossible to walk for more than 200 or 300 metres without pain and with normal walking style.  I gathered information of those who had undergone surgery. I found most talked of their positive outcome, I decided that it is time to undergo surgery.

Like any other patient, I had consulted about 5-6 orthopaedics for this problem over years. Some talked of surgery in the first visit. Others talked about surgery after medication as I consulted them a bit regularly. But it was in December, 2020 that I faced dilemma as whom to trust for surgery. Unfortunately, many doctors or hospitals do not have a good referral system to uphold confidence of patient. It is often left to the reputation of doctors or of the hospital that you hear about from acquaintances and friends.

I decided to undergo operation under Dr. Bhushan Nariani of BLK Hospital at Pusa Road. Dr. Nariani exuded confidence during my visits. Reviews of patients who have undergone surgery under his supervision are available at the hospital’s website. We had been to this hospital in the past in view of its proximity to my work place and its reputation. Further, this hospital is listed as approved for CGHS beneficiaries, which I am. And it is cashless too as my office provided us this facility.

I was hospitalized on 11 January 2021. I went through some tests like X-rays of knee from different angles. Earlier I had essential blood tests. I had surgery on 12 January 2021. I have talked about my hospital experience earlier in my blog at https://govindgujar.blogspot.com. And hence I will not repeat here. Fortunately, Covid-19 infection was declining, with few Covid-19 patients far off from my ward.

 

Photo a day before surgery

The surgery was successful. I did not need ICU, nor of additional blood from donors, although my associates had arranged for donors too. I have also talked about this ICU experience in my blog. I left hospital after six days stay during which I walked and exercised under the expert guidance of physiotherapists.

I was discharged on 17 January, 2021. After my leaving hospital, my stitches were removed after another week at my home by paramedic.

I often felt hungry in the initial two to three weeks of surgery at home and hence, I used to take high protein high oil diets like dry fruits and bournvita milk besides regular diets. Later, after about a month, I was fine. During night times, initially I had stiffen-ness of legs and hence, I will regularly exercise flexing legs and also walking at least 10-15 times during night when I woke up. It was stressful moving legs as I switched sides left or right from centre. I needed to keep pillows in between legs at knee joints.

 

Photo nearly three weeks after surgery showing my stitches.

After a month, I consulted my orthopaedic and complained about stiffness of joints. He prescribed muscle relaxants for a week. Medicines continued for about 1-2 months, not on regular basis, but as restricted as per needs. I will have stiffness at knee sometime more on left than on right. Sometime, I felt that muscle relaxants provided little relief. A month later after surgery, I stood for a long time about 15-20 minutes at the farewell function of our friend. Later, I used 15-step staircase to climb up on that day. I started physiotherapy for next four to five months under the supervision of physiotherapist at home. Later, I started doing exercises on my own as well as doing some using open gym instruments like standstill cycling, standstill walking etc. at ground floor. I started playing badminton after a month and continued one to two games for 4-5 days a week. Occasionally, I will climb up or down the staircase for 4-7 floors. This helped me gain confidence, helped in restoring my respiratory capacity and improved overall health.

Occasionally I felt stiffness so severe that I questioned utility of surgery. During sleep, it was painful to shift legs during first two months. I continue to feel stiffness and feel it even now when I am sitting or standing in one position. But positively, I felt over these months that surgery has helped me. I did not feel pain at knees after walking. Legs coordinated. My walk was just straight and more I walked, better I felt. So, I started with promise of walking 1-2 rounds after dinner and ended up doing more than 4-5 rounds in the society’s compound. Walking smoothens muscles.

I stopped doing physiotherapy exercises after about 6 months, as I believed walking and some flexing and contracting of legs are good enough, including open gym exercises described above.

I started driving car after one-half month or so. Of course, having DCT car helped me a lot.

We had planned a visit abroad long back. So, in the month of Oct, we visited Egypt. Prior to that, doubts crept in if I will be able to make it as we will be visiting monuments often on foot. I am told that if needed, I could stay in the bus itself. But that did not happen. On the contrary, I did occasional walking of 5-6 km in a day often climbing up or down staircases and walking straight on the ground during this visit.

Now, as the year is closing in, we started travel by road driving our car from 20 December. It has been daily drive of 200-300 km on every third day and occasionally my wife driving too. Driving 200-300 km with one or two breaks of 15-20 min is comfortable with some stiffness. But this stiffness does not last long as I relax.

I can on my own say that knee cap replacement surgery is a right course. It is up to you when you want to undergo through knife. It is up to you to decide what kind of implant you need. I did not go in for imported one and believed in one that my doctor felt comfortable with. I am of the firm opinion that most of our orthopaedics are competent to carry out surgery of this kind very successfully. Any hence, even in towns, these surgeries are being successfully carried out. A proper after care and physiotherapy can ensure that you are back on your legs as early as possible. I am on my own too. A year of medical care that I spent for my legs after surgery is not a high price to pay for as I bid “goodbye to arthritis”.