July 15, 2014: The pre-op discussion day

Pre-op meeting with surgeon, Dr R. Cunningham of Vail-Summit Orthopedics, his assistant Matt Cain, and anesthesiologist Dr. Peterson. New Xrays were taken.

Dr C. says that, although it might be possible to treat my problem with a partial knee replacement, he thinks total is best in my situation. It will be somewhat preventative re arthritic issues related to the kneecap. He described the device he will install (Stryker Triathlon). It gets cemented to the bone. Metal is CoCrMo: cobalt-chromium-molybdenum; a plastic piece serves as the cartilage replacement. And there will also be patellar resurfacing: a plastic piece cemented to the patella.

Good news: my other leg shows no problem.

Current flexion on right is 125°–130°. Current extension was measured at about 4°.

Discussion of activity choices once recovery is complete is delicate. E.g., downhill running is strongly discouraged. But how to define "downhill":  Peaks Trail vs running down Quandary? And what about downhill skiing at ski areas? I do that rarely so probably it is not an issue, though hard and regular area skiing is likely discouraged. They will check the implant in the future to see how much wear there is. But Dr. C says that likely little wear will show at five years, and a check at ten is reasonable. But he is willing to see me after five!

Anesthesia choice is tricky. There are two choices. Anesthesiologist prefers a spinal block together with a drug that puts me to sleep. Reason: Morphine can be introduced; recovery is easier. But Dr C. just responded by email that he prefers the general because the spinal immobilizes the leg for longer and he wants activity and movement ASAP. So I will follow his advice.

The hospital stay will be one, two, or three nights, depending on progress (turned out to be three). The post-op rehab program is extremely important, as scar tissue will build, and it must be broken down by exercises. I will do my best. Also the angle my foot bends backward will likely increase by a few degrees. Of course, the main question is: After his procedure, will my current pain, caused by bone-on-bone on the medial side, disappear. One hopes so. That is part of the rationale for the total, since it would be sad if I had a partial done and the pain remained.

VSO is headquartered in Vail, but has a big office here at the Frisco hospital (St. Anthony Summit Medical Center, below), built in Frisco in about 2007. The hospital has about 35 beds.


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