My day out at the Manchester Orthopaedic Centre

Why do it mate?

In a previous post, Time to sort out my Knee!, I detailed the need for surgery on right knee because of medial compartment osteoarthritis. As part of my travels, I want to do a variety of adventure travel activities but my right knee is shot. So I had to make the decision to undergo major elective surgery to get me in shape. I went into this with my eyes wide open, understanding the risks but satisfied it was the right operation for me and better than a knee replacement at my tender age! The article in this link concisely sets out the rational and I fit the ‘ideal’ patient profile. http://www.cjdonline.com/knee.php/high-tibial-osteotomy-knee-arthritis

The night before!

Well, I didn’t have too bad a night’s sleep, the night before my planned surgery. To be honest, I’d not slept well the previous 2 nights, as I was worried about all that could go wrong. I think as a doctor, we have a jaded view of normality, expecting and planning for the worst.

We did have a good drink with dinner, so that might have helped with the sleeping! The Penderyn was out. We had a great time round the table in the kitchen; good food and company with the family and partners. Culminating in a game of cards because Lucy wanted to play ‘cards against humanity’ with its expected debauchery. A fun night and a welcome distraction for me.

The day of admission

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I won’t bore you with the details about the surgery; suffice to say, my care was exemplary, from the admission ward through to the theatre staff and on the overnight stay facility. Not to mention Jon Borill (Orthopaedic Consultant) who explained everything very thoroughly and did the job. Taking 4 hrs in the process.

Click on this link to a previous post, which details the operation and what is involved – Time to sort out my Knee! What is not in the previous post about the High Tibial Oestotomy procedure is what the exact degree of open wedge, I was to undergo. Pre-op planning using leg alignment x rays and good old fashioned trigonometry determined the open wedge would need to be 10⁰ for a neutral/minor valgus alignment. Using donor bone from femoral heads removed during joint replacement surgery fashioned into a wedge to fill the defect.

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Funny thing however, was that my gas man (anaesthetist) was a great guy called Adam Dobson. We recently did the Prudential Surrey 100 together in 2019. A good man, for sure. A friend from Liverpool Medical School, we’ve shared a beer or two over time. But alas, not as frequently as we could or should but then again, I’m sure you have friends who you admire but never see. Something we can all relate to, I suspect! I will be making sure I make the effort to get him, and a few others, a beer or two sometime soon.

The poignant thing is, we even worked together at Wythenshawe Hospital in the mid-90’s when I did anaesthetics before moving into Obstetrics and Gynaecology. I have Pierre Martin-Hirsch to blame for that. A story for another time perhaps. The truth be told, I couldn’t see myself as an anaesthetist, so decided to train as a GP. Something Christina said I’d be crap at given how impatient I am. And she was right, I didn’t like waiting for surgeons and I certainly can’t cope with whinging patients. I suppose that’s why anaesthetics appealed initially. The only other option being a career in pathology perhaps. I just didn’t factor in what a pain in the ass some surgeons can be. So I decided to become one, and so a gynaecologist was born.

Anyway I digress. The funny thing about Adam being my gas man, was that I actually supervised his first ever anaesthetic case. I was an experienced SHO (Senior House Officer) having already done a year in Liverpool and 6 months at Wythenshawe. So there I was in theatre with my anaesthetist, highly regarded, I might add, who I had helped train!

I arrived back on the ward at about 2pm feeling ok but clearly looking a bit ropey as you can see! Later I sat out and enjoyed some tea etc. So there I was, feeling fine, pain free enjoying myself!  I mobilised using my crutches and pottered about the ward every hour or so. Later at 11.30pm, I joined my three night nurses; Jeanette, Nimmy and Jiju for a chat at the nurse station. I had a good laugh with them while waiting for the inevitable pain to kick in, but the Oxycontin seemed to be doing the trick.

Time for bed, I trotted back to my single room which was very nice and gave me the privacy I needed. My nurse for night offered to ‘tuck me in’ but I respectfully declined with a rue smile that she acknowledged with a subtle raising of the eye brows.

I did not sleep well. Not that I was in pain, on the contrary I was remarkably pain-free. I’m just not a good sleeper at the best of times. With the 4 hourly observations round and random noise on the ward, I had no chance. I got up around 6am, washed, cleaned my teeth and had a shave. Dressing was a bit of a struggle but I managed it and settled down in the chair by the bed to do some writing. Shortly after 7am the nurses popped in, surprised to see me sat with my laptop open writing this blog. Tea and toast was served and all was well.

I left around 2pm having waited for my take home medicines. Emily picked me up from the same entrance I’d arrived at the day before and I was soon home. I was kept busy on the phone, talking to numerous well-wishers amongst family and friends before a peaceful night. Aided no doubt by the vast cocktail of drugs I’d ingested in the last 24 hours and shortly before bed.

The following day was 48 hours post surgery and was now time for the external compression dressing to be taken down leaving the direct wound dressing in place until my clinic review 10 days later. My foot had become noticeably swollen and was now bruised, a purplish black with some numbness on the inner aspect.

I wasn’t overly concerned as I was able to mobilise and was pretty much pain-free on my opiate/paracetamol and Ibuprofen regime, only needing the occasional swig of OxyNorm, a liquid morphine. Sickly sweet, it quickly puts you in a better place!

I decided to undress the leg on my bed with Christina for help, with others randomly wandering in to see what was going on. Joe had aimlessly meandered in, as they all like to do. Privacy is something they all insist upon for themselves and their rooms but for Christina and I, it’s seemingly unnecessary. Our bedroom is an overflow room for chats when someone wants something or counselling suite when any of them are upset. Offending them frequently, as on occasion I’m partially clothed in my own room. God forbid! Anyway, I asked him to film the affair on the new Go Pro as he was there and it saved me the job..

The unwrapping was awkward, but progressed relatively painlessly. With each successive layer my leg whilst still very swollen got thinner and thinner. As we neared the final layers of bandaging and compression dressing (flat sheets of a ‘cotton wool’ type consistency) it was obvious all was not well.

By now, every Tom Dick and Harry had arrived for the show. Slowly the final layers where pulled free, somewhat uncomfortably as they were sticking my leg. Now visible, initially from the knee downwards, and progressively lower and lower with each turn of the loosening bandage. The bruising was a deep purple, the skin so tense it had split in places and in other areas blisters had formed. So delicate, the slightest touch would tear the surface with a yellowish blood stained serous fluid dripping where gravity took it.

It was quite a dramatic scene, with some obvious shock and awe from the gathered crowd in the bedroom, scattered with occasional nervous giggling. By this time Joe was in full swing, having decided he was now Stephen Speilberg taking 360 degree and close up shots for full cinematographic effect. Please feel free to watch the attached Go Pro footage where I’ve decided not to edit out the expletives particularly from myself. In part, because it’s real and actually quite funny in parts. If you are easily offended or worse still one of ‘those people’, I cannot stand, that like to be offended so it gives them something to whine about then please do not watch. I can’t be arsed with small minded people with nothing else to do!

I myself, was not expecting the degree of swelling, bruising and associated blistering, having said that I was not initially worried. Accepting everyone’s concern we made a quick trip to ED to get further advice. They concurred, the blistering was likely to be related to the gross oedema and there was no sign of infection. My wound was re-dressed, with instructions to keep the leg elevated as high as possible with cold compression if possible.

I had contacted Jon and sent a picture as a courtesy and he did ring back suggesting antibiotics as a prophylactic measure, and he contacted the on call team to organise a script.

I’m glad to say things have steadily improved, whilst still very bruised, the swelling has reduced significantly and pain is well controlled.

We’re now 10 days post op and hopefully over the worst of it acknowledging there is still a long way to go with physio and rehab, which will take at least 3 months. Possibly 4-6 months, to get back to full strength. One step at a time and taking it easy, til next time……

Three months of rehab is going to put a serious dent into this countdown!