Double Knee Replacement and Double Manipulation Under Anesthesia
“Everything you didn’t know was coming your way.”
By Tim Booth
VIRGINIA BEACH, Virginia — My name is Tim. Let’s first start with my background, which centers on my career in the U.S. Marine Corps. I joined the Marines in 1975 as an enlisted Marine. I was stationed in many locations in the U.S., overseas and at sea, of course. I achieved the rank of a Marine Corps Captain although I would have been able to last longer and retire at a higher rank had it not been for my knees. I first injured my knees in a training drill. I subsequently had many surgeries on my knees which made things ever more challenging.
Marines lead from the front and with two bad knees that was just no longer possible. So in 1999 I retired.
What follows here is my story of Double Knee Replacement and Double Manipulation Under Anesthesia… and my work towards a full recovery.
My Time in the U.S. Marines
I served half of my 24 years in the Marines working on aircraft. I took a commission as a warrant officer and then as a limited duty officer. I worked on logistics helping the Navy build ships to carry the Marines. I was part of the ships company at sea (called “sea duty”), I taught amphibious warfare, I served on staffs and joint staffs, and have done many different operations and training in the Marine Corps. My daughter (she and I at a Marine Corps Ball, picture on the left) served in the Marines in logistics, and my youngest son is currently an M.P. (picture on the right) in the Marines and is stationed in Iwakuni, Japan, coincidentally a place where I was stationed during my career.
The Booth’s are a happy Marine Corps family.
Just a little place setting to start my story (or my journey actually), toward recovery from Bilateral Knee Replacement. For those out there that don’t understand the Bilateral part that means I had both knees done at the same time. After surgery while still in the hospital I realized just how rare it is. I talked to nurses at the Sentara Leigh Hospital all about it. One nurse in particular worked this ward for seven years; she told me she could count on two hands the number of bilaterals she had seen. And this is a big hospital. They have a special ward just for hip and knee replacement recovery. In other words, they do lots of them.
Dr. Louis Jordan (The Jordan Young Institute) performed my bilateral surgery on July 24. They are the best known/recommended doctors in the area who perform the surgery. The surgeries went well.
Once bandages were removed everyone (professionals) remarked on how great the scars looked; to me I thought they looked ugly. However, upon leaving the hospital I only had a range of motion of about 50º on the left and 42º on the right. While many looked at that as alarming others simply said one day at a time, one degree at a time. Some said full range of motion for someone starting off where I did could hope for high 80s to 90º by eight weeks, and maybe get to 100º after full recovery. Something you quickly find is that almost everyone tries very hard (very, very hard) not to tell people what to expect or even what is normal or even, average for recovery. Many try very hard to tell you each person is different and each knee is different. In other words, no one wants to give you a number to compare yourself to for fear of destroying hope afterwards.
One day in my post-operative therapy there were 20 patients in the room during my designated therapy session. They had two or three sessions twice per day. As a pre-op patient, I was active (some would say very active at 60 years old) prior to surgery. I am not over weight, and I did preparatory exercises prior to surgery so that I could enhance my recovery chances. My patient history was also unique or peculiar depending on how you look at it, I had one orthoscopic surgery on the left knee and three on the right knee. I tried every non-surgery treatment known (including stem cell treatment). Prior to surgery I had a range of motion of 87º on the right knee and 89º on the left knee along with every arthritis symptom known. As a reference point when you are sitting in a chair with your foot straight down on the floor that is a 90º bend. In other words, I was well past due for this surgery I had been told as long ago as 10 years to have it done, and 15 years ago that I would need it done soon. In fact, I had a relatively early retirement from the military (24 years versus 30) because of the damage to my knees.
Time to go home and start my recovery. Did I mention I am sensitive to drugs. Yes, allergic to a lot and even the anesthesia requirements are less than would be normal for my body weight. The anesthesiologist called me a light-weight and I am OK with that. My recovery got stalled because of an allergic reaction to the blood thinner. In fact, I had almost every side effect listed for the drug I was taking. I finally had to tell the doctor that I refused to take it anymore and stopped; once I stopped I was able to start making progress. What progress you ask; well by week three I had a whopping 80º on the left and 60º range of motion on the right. A huge difference and I knew something was wrong, something in my treatment needed to change. I started to do lots of research, and then more research, then anything I could find online or anywhere to help.
Here I learned the physical therapy ‘motto’ I adopted in order to get through my recovery. “If you are not crying; You are not trying. If you are not screaming; You are just dreaming.” Yes, the part no one will tell you in advance is that recovery is very painful, some of the most pain I have experienced, even worse than before surgery. BUT not to fear this is only temporary in order to get back all of your range of motion, and possibly even more.
This is where the X10 machine came into play. In my research, I discovered a couple of videos online, and decided this was for me: therapy with less pain; driven by me. I was the one who could adjust the degree of straightening and bending (Extension and Flexion are the medical terms) and how much pressure I would allow the machine to use on me.
I had some good therapists, I had some, o.k. therapists and I had some great therapists, but all were there to ensure I carried out my motto in spades. No one including my doctor had heard of or recommended the X10; back to my place setting. I had been through therapy a lot in my life. I am also a person who does research and then when armed with information I make decisions.
I contacted the X10 people and less than a week later I was on my X10 machine.
Six weeks after surgery I started the X10. I started the X10 at a range of motion of 78º bend on the left, and 58º on the right. At this point, everyone involved in my recovery were starting to worry about my progress, and believe me I was trying. Doing as many as three therapy sessions a day some with a therapist and others on my own. I was pushing myself as best I could (additional place setting; I said military I am a Marine). Still it was only until I got the X10 and could really get in the driver’s seat and take up to 30 minutes per knee to get to the place the therapist would get to in one or two tries; that is when I started surpassing where therapist could push my knee. I had one therapist just scoff at my numbers on the machine only to show me his dismal results.
Expectations and Mental Fitness
When most people hear mental fitness they probably think of a person ready for the phycological ward; here I mean are you tough enough (mentally) to handle the surgery and recovery. This goes hand in hand with expectations. Whenever you read or hear about recovery from Knee replacement they are usually talking about a single knee at a time, and then they go on to talk about “What to Expect” how to prepare etc. Let me tell you for bilateral knee replacement they don’t come close. I may be scaring some people away from doing bilateral; and I am ok with that. Why? Because even though I think of myself as fairly tough both mentally and physically I was nowhere near ready for the mental side. Sure, I thought I was ready, I even did some extra exercises to get ready. Pre-surgery classes gave some good advice. When both legs don’t work, the upper body, strength is all you can bring to the table. Good that I was ready for that even though pre-surgery class exercises would not have prepared me; I was already there to begin with. This is where the mental fitness comes in.
Once you realize you can’t do anything without someone’s help your psyche takes a hit. Then you get double the pain from the single knee; again, the psyche takes another hit. You are on drugs that take care of the pain BUT slam the brain, and yes again another psyche hit. If that is not enough you may or may not be reaching your own personal expectations for progress, and progress means being able to do things on your own. The blood thinner that many doctors use is especially hard on the psyche (one of the side effects) and soon all you want to do is quit.
For me; for the first time in my life I REALLY needed a cheerleading team. Sure, my wife was fantastic, but she was just one of at least five voices involved in my recovery (Nurses, Physical Therapist, PT assistants, Doctor, Doctors assistants) I needed at least a couple of positives to survive and many people need more than that. Many days it was hard reaching my meager goal of two positive voices because of my progress, and the difference between the two knees. So, it was really up to me to just keep pushing and advancing one step at a time. Going for the Gold (bilateral)? Get your head in the game early. The good news is I don’t have to get myself ready to do it all over again for a second knee; I am done. I have heard those who have difficulty with the first knee sometimes don’t go back for the second.
Double Manipulation Under Anesthesia; a Fresh Start This Time With the X10
After one week I had made major progress. The start of week seven I was at 102º bend on the left and 82º bend on the right. Now people started saying the expectation was to be at least at 90º by week eight. Suddenly there was a number I should hit. But I wanted more, so I took the plunge and did the Double Manipulation Under Anesthesia. I was to have it on a Friday and was sent home over a holiday weekend and scheduling issues for back to therapy (6 days on my own). The doctor was very concerned that there would be about 5 or 6 days without any therapist. I reassured him I had my X10 machine and I would be just fine.
Tim’s Story in his own words in this 3:00 minute video–
After Double Manipulation Under Anesthesia with My X10™
Post MUA therapy at home and all alone, doing only what I could with my X10 and other exercises I remembered from therapy sessions. Moving constantly. Four hours after leaving the hospital from my MUA I hit the X10 machine (yes, I was very sore). But back to my motto if you are not crying you are not trying and if you are not screaming you are just dreaming. There it was Boom 90º on the left and 91º on the right. Progress for the right and regression on the left “What the *&^%!!”. Then that evening on the second session a pair of 97º; now I am feeling better. I was on my way.
By the time I got through my home alone phase I was at 112º on the left and 118º on the right. All thanks to the X10.
By the way, with the X10 support personnel, you are NEVER truly home alone without help. The support people came through in spades for me I even got to talk to a physical therapist very knowledgeable in double manipulation under anesthesia recovery (thanks to her and her support). I decided at this point I also wanted a different local therapist one a little more in tune with the whole X10 experience. I needed someone who would work together with me, my machine, and my supervised PT sessions. My new therapist studied my X10 log book, I showed her my videos of the machine in action, and of course an up close and personal look at the machine.
In order to get a closer grip on the whole process (setting it straight in her mind) we decided the machine was doing a great job both getting passive Range of Motion (ROM) and maintain my active ROM. I used the machine to expand my potential, and she focused on getting my muscles tuned up for the active ROM.
Leading from the Front: Finally Full Range of Motion!
At the end of week nine I had achieved 130º on each knee on the X10 (maximum range of motion is 0º to 130º), and 0º for extension. I also had achieved 120º on the right knee (active; or what I can make my knee bend using my own muscles and a little pushing) and 116ºs on the left. This is already better than I was hoping for before surgery and I still have some recovery to go, at least another 4 to 6 weeks. Most people claim that 3 to 4 months for full recovery should be expected. Oh, and I am almost completely off the prescription pain medication. All this after a double manipulation under anesthesia.
Throughout my whole X10 experience I had my own personal X10 Recovery Coach to reach out to. Todd Zegras kept me informed, discussed different options on using the machine and so forth.
I truly have become a believer in the X10 machine and believe there is no way I would be where I am now after a Double Manipulation Under Anesthesia without it.