A day after surgery is the worst, but if they give you the dope in timely intervals (every 4 hours in my instance) it's more than manageable. From the third day on it's Hallelujah times. Rocky, you want those conformis knees, stick with the peterbilts. I wrote an article after my episode, conformis people and my surgeon had a belly laugh.
Engineers, Doctors and Borgs.
I’m in a celebratory mood, brought upon by a change in venue. The trio of physicians, who have been ministering to this old carcass I’ve been carrying around for 74 years, came to a conclusion that the condition that postponed the February surgery has been sufficiently beaten down to try again on June 14th (knee # 1) and June 17th (knee # 2). Whenever I’m in celebratory mood I feel a need for literary output in the language of William Shakespeare and Ernest Hemmingway which I learned in my late youth. So here it goes.
I always thought that doctors were like engineers. Obstetricians are like manufacturing engineers making sure the “product” leaves the “factory” on time and meets the essential quality standards. Primary doctors are like product engineers keeping track of the product in use and in the field, informing the clients on the latest tweaks, pointing out things that could cause the product to fail because of misuse or abuse. Emergency room doctors are like service engineers sent out to make the product work again after abuse and failure. Surgeons are like the “super techs” usually involved when everything else fails and without their help the product will have to be junked. The equivalent of the design engineers would be the transplant guys, microsurgery guys, drug designers etc.
When I see 3D, I know that the essential work and repairs on the product at hand will be done well, accurately and with forethought. The product at hand is a pair of diseased knees which reduced their owner to resort to this alternative form of locomotion instead of walking.
As some of you may know the owner of the aforementioned diseased clunkers is big into computer generated 3D design work, therefore, when he saw this
he knew he was in the good hands. Why, because the trial and error, fitting and futzing, etc., would be done virtually and on a computer screen and not on the said diseased pair while their owner was in a la la land and in the hands of “another engineer”, this one capable of “turning off” and then cranking over 74 year old carcass laying dormant for an hour or so.
So why am I so excited? The following is a perfect symbiotic example of medicine and engineering in perfect harmony. First your truly was subjected to an MRI-like x-rays from hips to toes, that info was sent to Massachusetts to create a 3D model of the existing skeletal model from hip to toes. Why hip to toes? The plan is not only to install new knees but to also realign things away from the old bowlegged cowboy look to the more youthful and straighter self. Once those parameters are set the computer goes to work again.
It figures out how much stuff has gone missing and needs to be added to achieve straightness and full J curve motion from straight knee to bent knee (0 to 90 degrees). Current techniques only take into considerations those two extremes and one in five patients is not too happy with what happens in between those angles.
The computer then figures out the shape and size of the actual implant for each side.
The next step is truly revolutionary and pure engineering. The computer is connected to a 3D printer to manufacture plastic templates to be used in surgery to precisely cut, bore and shape the bone to accommodate the new prosthesis.
Once the bones are exposed the templates are placed in succession to drill (through holes) or cut (through slots) to shape the bone for the implant.
Once all that is done the surgeon reaches into the same kit to retrieve a pair of beautiful and new “spare parts”.
Let the making of the new Borg begin.
All kits are patient specific, clearly identified (the 3D printer makes kits for several patients on each run) and come pre-sterilized to the surgeon. A pair of mine has been patiently sitting in his office for a couple of months now.
Although the article was meant to “entertain”, it also meant to inform as I am sure there are many “candidates” for this surgery in our neighborhood. What I found surprising was that this advanced medical procedure is available right here in our Port St. Lucie community. Dr. Edward Rosario from Coastal Orthopedic has been doing this procedure for a number of years and has been training other surgeons in its use. He performs the operations at Port St. Lucie Medical Center and the facility that has the proprietary software to generate the initial 3D images of the knees is located in St. Lucie West at iCARE Radiology.
Edit (and progress report):
After hospital stay and rehab at Health South standing and walking on “straight” legs at home on July 2nd 2016 (15 days after the second knee was done).
Full disclosure here, I was still using walker at this stage, which the PT people "strongly recommended", but for the purpose of the picture (hero complex) walker was placed outside of the picture frame.
The first “look and see” with Dr. Rosario’s office was on July 14th. X-rays were taken to help with the “look and see”. Seeing the pictures on the computer screen (and being an engineer) I just had to have them.
And I was no longer bowlegged, which was the condition from my teenage days. Cautionary tale there, I had to see a foot doctor, after about a year the ankles were getting screwed up, turned out I had to "re-train" my ankles how to work with straight legs and walk right. Note that the knee cap is preserved; it is modified on its backside to glide smoothly over the prosthesis. Also note the distinct difference between the left and the right prosthesis, again the “beauty” of the conformis system which designs the new knees not only for each patient but also for each knee.
Comparison of the “originals” to the healed new pair (Sept 7th). Original were full of fluid, the surgeon said, "no, we are not going to fool around and drain them, they'll drain when I start working on them".
Fully functioning, able to work almost full days on one’s feet in the shop. Atrophied muscles and strength also coming back.