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Martha Nelson


To Knee or Not to Knee: Three Things to Consider Before You Say, 'I Want a Knee Replacement'

Posted: 04/26/2013 4:32 pm

For twelve years I walked with constant pain. A victim of osteoarthritis, my right knee was bone-on-bone at the joint. The mitigating cartilage had disappeared over time.

I remember what started it all: The skiing accident at 16, and a year later, the high jump competition where I took my final jump in terrible pain. I remember my Uncle John, a medical doctor, shaking his head as he gingerly touched my swollen knee. "You'll hear from this in your 60s," he said. He was right. Only it started in my 50s.

At first the pain was unpredictable; it came sharply, without warning. By 2006 the pain was daily, my knee swelled up once a week, and I was walking with a funny limp. I would deny the limp when my best friends pointed it out. "You need to get that knee replaced," they'd say. I refused to consider it. I was managing the knee just fine.

By managing, I mean my life was scheduled very carefully. I used a well-known over-the-counter, nonsteroidal anti-inflammatory drug every day. I could count on moderate pain coverage if I took two pills in the morning and two at night. I planned outings and shopping to be no more than 90 minutes of actual walking. I clung to shopping carts as walkers. I exercised our two dogs and myself early in the day, managing the two-mile walk around the lake. Because I could do that walk everyday, I thought I was doing well.

I'd probably still believe I was doing well if my knee hadn't slid out of place while I was dog walking. On the final stretch to home, I had been (no kidding) actually thinking about how well my legs felt. Like the universe slapping me into real time, I was struck with a debilitating pain, far worse than any before. I could not put any pressure on the right knee. I could not walk.

I massaged the knee, stretched it, walked three steps and could go no farther. Finally I discovered I could walk six or seven steps by doing it on my tiptoes. What normally would take me five minutes to get home, took 35. I realized my knee was now totally undependable.

I made a doctor's appointment, got his recommendation on the best joint surgeons in the greater Nashville area where I live, and moved ahead with my decision to have that knee replaced. The X-rays showed my condition to be "severe." Absolutely true, and I knew it.

When I told a neighbor, he said, "It's about time. Watching you walk those dogs was very painful. We often wondered how you did it." And I had thought I was managing so beautifully.

Now on the other side of the decision, here are the three things I think are important to understand as you decide whether to have knee replacement surgery:

1. It is a harsh surgery. "It's one of the most violent surgeries to have," said the night nurse at the hospital. I think she's right. One woman told me she was considering it because she was starting to feel knee pain when she played tennis. "I think (a replacement) could improve my game," she said. Trust me, it is not a surgery to improve your tennis game. They cut your knee down the middle, put it in a sling, cut off the edgy bone (and my knee cap, too, since that was cartilage-free they discovered during surgery), and then work like highly expert carpenters screwing and nailing the titanium ledge, followed by the plastic cover, which takes the place of the lost cartilage in softening the joint-on-joint action. They staple you shut. It is not like "pulling a tooth," as one gal said to me, encouraging me to get it done.

2. Don't wait too long, but don't do it before you have to. I don't think I waited too long; some friends would disagree with me. My orthopedic doctor encouraged me to wait until I could wait no longer. That's what I did. Do it when you know it is the right time for you. Don't be pressured into it. You'll know when you're ready.

3. Your life will change in the short term, and hopefully, for the long haul. The post-surgery recovery is painful, hard, and your life will not be yours again for weeks, and months. It takes a full year, doctors say, to be completely healed. I've heard stories in the physical therapy (PT) room (where you will spend lots of time) of people driving in a week or ten days, walking with a cane and resuming their life after a very short time. I guess that can happen. I don't really believe it. The recovery takes time, painful PT work, and many long nights. All good reasons to pay attention to #1 and #2.

Coming next: The Post Surgery Recovery: What I Experienced. What happened, how it works, and what you may expect. It's neither all good, nor all bad. It's a process.

Martha Nelson is an award-winning journalist and a former educator, nonprofit executive, chef, and musician. Her first novel, Black Chokeberry, was published in April 2012 and is available on and from her website,