MS and Knee Surgery: My Total Knee Replacement Adventure, Part 1
Symptoms of multiple sclerosis are rarely fun or enjoyable. Many times they can be downright debilitating. One of my more worrisome MS symptoms in recent years has been spasticity in the legs. Sometimes it can make my legs feel as though the muscles are trying to pull the knee joints in opposite directions. The pain down deep in my muscles has been so severe at times that tears have escaped these blue eyes.
Problems with spasticity
I know that my knee pain has not been caused entirely by MS. Osteoarthritis is truly to blame, but I still wondered how much spasticity might make it worse. When the muscles are more relaxed and supple, particularly the hamstrings, my knees can move more freely. When my hamstrings are tight, it is harder to straighten my legs. That has been my normal for awhile.
MS and total knee replacement surgery
In the last few years, knee osteoarthritis progressed to the point that total knee replacement became my only real option to reduce the pain and dysfunction. My orthopedic doctor and I tried less invasive approaches first, such as steroid injections, physical therapy, and viscosupplement hyaluronic acid gel injections.
A year ago, the pain became so intense that I couldn’t even stand long enough to scramble eggs. I had also forgotten what it was like to walk up and down the stairs like a normal person, alternating steps. Never mind that weakness in the legs from MS sometimes made stairs difficult as well.
My surgery decision
After stating for years that I was too young for surgery, the orthopedist finally said surgery was the next step. The only option really. But when I asked when would it be time, I was told it was up to me to tell him when I was ready for total knee replacement (TKR) surgery. Last summer I decided it was time.
Prepping for surgery
In preparation for surgery, I talked to both my neurologist and my rheumatologist about surgery. I asked about surgeons in the area who had worked with their patients. I asked about any concerns I might need to have regarding current medications. I also asked about recommended timing of surgery since I use an every-6-month monoclonal antibody therapy for my MS and RA.
Working with my orthopedic surgeon
The orthopedic surgeon I chose (who was not the same orthopedist I had seen for over a decade) agreed that I was a good candidate for TKR. Since both of my knees needed surgery and each one was basically as bad as the other — my knees were quite symmetrical in their own crooked, deteriorated way — I got to choose which knee went under the knife first.
Evaluating MS symptoms
My surgeon evaluated the level of my spasticity (in a medicated state) and didn’t think that it would present increased challenges for surgery in my personal case. That was reassuring.
Scheduling around medication
Based on the recommendations of my rheumatologist and my neurologist, I needed to make sure that surgery was scheduled at least 5-6 months after my most recent dose of rituximab, a b-cell depleting monoclonal antibody therapy that can increase the risk of infection. If surgery went well without any complications, I could schedule the next round of rituximab at least one month following surgery.
Planning for extra assistance
My surgeon’s assistant and I compared calendars and I chose a surgery date that would allow my husband to be home with me in the days following surgery. I knew that I would need significant help with food preparation and trips to physical therapy at a minimum.
Always the one to be extra prepared, I obtained a walker to use after surgery (which I only used for one week), “bedside commodes” to temporarily raise the height of toilet seats at home, and long “reachers” to help with tasks including putting on my socks and shoes. I have friends with MS who have used these same tools at various times when needed.
Staying in shape
Prior to surgery, my doctor recommended that I continue to be active, but not risk injuring myself. I continued to ride my bike outdoors but was a little more cautious to avoid falling. I’m glad that I did so because being more physically fit — at least physically fit by my own standards — definitely helped during recovery.
In Part 2 of my total knee replacement adventure, I’ll share details of recovery from surgery, physical therapy, and the feared spasticity factor. Spoiler alert: I’ve experienced less spasticity after surgery than I did before surgery. I believe that physical therapy has helped in more ways than one.
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