By Janet Coulter, MSN, MS, RN, CCM

Have you ever stopped to think about how truly magnificent the knee is? As with most things, we sometimes take our knees for granted until they don’t work correctly or cause pain.  I know I had taken my knees for granted - until recently. Walking, running, sitting, standing, getting up from a chair was automatic with no thought about the work my knees were doing.

That changed when I experienced a complete radial root tear of the posterior horn of the medial meniscus with a moderate medial meniscal extrusion, a small area of full-thickness chondral loss in the medial compartment, and moderate patchy edema along the anterior rim of the medial tibial plateau. It was also discovered that I had an intermediate-to-high patellofemoral compartment chondromalacia with small to moderate joint effusion and a small 6 mm body in the lateral meniscal gutter inferior and lateral to the lateral meniscal body.

Although I have injured my right knee several times in the distant past (car accident, falls), there was no recent injury.  My right knee just started to swell, feel hot and become stiff after taking a leisurely walk one afternoon. I tried all the conservative interventions: rest, ice, physical therapy, anti-inflammatories, and Turmeric. After a few months of limping around and no noticeable improvements from the conservative interventions, I made an appointment with an orthopedic physician, who referred me to an orthopedic surgeon.

I thoroughly researched the orthopedic surgeon. He was the orthopedic physician for our professional baseball team for twenty-five years. He is the best orthopedic surgeon in my area (in my opinion). His specialty is sports medicine. After all, I had a sports injury. I was walking when all this started. Walking’s a sport…right? He recommended a total knee replacement. What?!  A knee replacement? Was that the best alternative? After researching, I had to agree that a total knee replacement was in my future.

Many years ago, when I entered my basic nursing education program, the nursing instructors emphasized that we need to take good care of our legs, back, and shoulders. That was very sound advice. Nursing can be hard physical labor with all the lifting, pulling, turning, walking, etc. Now, forty-six years later, I have “nursing knees” – a hazard of the profession complemented by a car wreck and a history of two falls landing directly on my right knee. Well, no matter the exact cause, this issue needed to be addressed, and a right total knee replacement was scheduled.

I started researching the surgical procedure and post-operative rehabilitation. Historically this procedure was inpatient with a stay in ICU and possible stay at a rehab facility before returning home. Pain medication was given IV. That was 8-10 years ago. Now it’s an outpatient procedure with physical therapy before you leave the outpatient surgical center and outpatient physical therapy the first post-operative day. Percocet or Vicodin are used for pain control. Things have really evolved.

After my total knee replacement, I had several bumps in the road, but I am on the path to recovery! Overall, I have learned so much. The knee, the largest joint in the body, is really two complex joints - one between the femur and tibia, and one between the femur and patella. It is a modified hinge joint that permits flexion and extension, as well as slight internal and external rotation. Sounds amazing, doesn’t it? I now appreciate both of my knees and everything they do for me (although I think my right knee is my favorite). I no longer take for granted everyday things like walking, getting up from a chair, or climbing stairs. Being able to walk pain-free is wonderful.

I hope to see you in June at the CMSA Annual Conference in Orlando!  Say “Hello” if you see me. I’ll be wearing a great, big smile and walking with a spring in my step!

Learn more about Post-Acute Care, Rehab, and Readmissions in the CMSA Educational Resource Library with “Improving Outcomes… after Patients Leave the Hospital”.

For the full course description and objectives, go to https://www.pathlms.com/cmsa/courses/36337

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