Melissa put together the perfect recovery for herself by doing the right things before and after her bilateral knee replacement surgery. She provides us with an update four weeks after bilateral knee replacement in her own words, and in the videos below.

My name is Melissa. I’m 47 years old and I had bilateral knee replacement surgery four weeks ago. I used the X10 the day that I returned home from the hospital. And now four weeks later I’m able to walk without the aid of a cane or any other device. I’m looking forward to having my new knees.

I started having knee problems at 35. I had been doing a class at the gym on a treadmill and the next day my knees just blew up and I figured I tore something. So I saw an orthopedist and was told that my knees were ‘twice my age’. And that I was ‘way too young’ right now, but someday I’d need a knee replacement. And I was advised to take Ibuprofen and just deal with it. So over the years I saw an orthopedist and a rheumatologist looking for help.

I had injections and shots and all of that to try to manage the pain. At that age I was quite active, but I wasn’t able to run anymore. I had pain just standing up from a chair because my knees would be so stiff. I would have pain during the night. There was a period of years when I felt like I was managing it quite well. I wasn’t seeing any doctors or having any injections at that point. But I would have copious amounts of Ibuprofen. I was able to do most of the things I wanted to do, but certainly not everything that somebody my age could do.

Then about a year ago they started getting fussier and I was experiencing significantly more pain. I sought out another orthopedist. And I was fully expecting to just get some shots and to be told again that I was not a candidate for total knee replacement.

By this time I was 46. On my visit with Dr. Winakur I said, “look, I know I can’t have a knee replacement, but if there’s something else I can do…” He had taken my x-ray and he said, ‘oh no, you are a candidate. If you want a knee replacement you just let me know, but it is completely your decision. You’ll know when the time is right’. That was kind of a revelation to me.

Nonetheless. I did go through a series of cortisone shots, which helped for a time. And after having more conversations with Dr. Winakur about what was involved with knee replacement, I decided to go ahead with the surgery. He said to me it’s a quality of life issue, and that the implants are getting better and better every year.

I said, ‘you know what? I’m done. I’m done being this constrained at this age. I want to be able to be more active and just walk my dog pain-free.’ So I thought, okay, I’m definitely gonna do it. Then the question was, do I do one or both knees? Dr Winakur felt very strongly, given my age and fitness prior to surgery, that I was an absolute candidate for bilateral. And to me that sounded like a more pragmatic approach. Anyway, it’s one and done. So I went for it and I’m glad I did it that way.

One of my big surprises is that, at least in my experience, it wasn’t this horrible, painful, awful thing that so many people warned me about. Prior to surgery I was a little nervous because so many people said I was crazy. But St Joseph’s Medical Center was great. My pain was managed well in the hospital, and by the time I got home I was able to keep track of it. And like I said, I got on the X10 immediately. I think just having something that I could do for myself, to move toward healing, was great psychologically. In fact the machine promotes a reduction in swelling. I think I just put that together, and it ended up being a pretty painless process.

I had the help of the physical therapist at home who helped me to fire those muscles up. We started doing work there and then we moved on to the Dynamic Strength exercises on the X10, primarily the Pump Test. This was where you’re pushing down against weight to get the quadriceps muscles back in the game.

What worked best for me was two X10 sessions of 45 minutes on each leg. That’s a big chunk of time when you’ve got two legs. I did toy around trying three 30 minute sessions once. I just preferred a morning and a late afternoon session.

So I did 45 minutes on one leg, ice the knee, then 45 minutes on the next leg and then ice. And after a 45 minute time I felt like that was enough time to really get the joint loose and push my range of motion a bit.

And I would feel it a little bit, but not to where I was screaming out in pain at all. I mean, it’s just that like ‘breathe through it kind of pain’ is all, nothing. And if that’s too much, you can back off.

In fact, one of the most surprising things to me through this whole surgery was what happens to your muscles. It was crazy. It was almost like they were paralyzed at first. I was somebody who had most of my strength in my legs. And to have them turn to mush was extraordinary and disconcerting, to say the least.

The big turning point for me came at the end of week two when my PT moved me from a walker to a cane. That made me feel like I had a lot more freedom and could get around better. And at that point I was able to start driving too. That was another big game changer. You start to feel a little bit more like yourself when you can have independence. I was excited by that.

I started cooking and doing laundry and being on my feet a lot more, probably even a little too much a couple of times. I would feel the tightness and the stiffness come back. But fortunately I still had the X10 at that point, so I could loosen up my joints by doing a session, with the range of motion on the X10, which, kept me limber.

So now that I’ve finished up with the X10, I’m lucky that I have a Peloton bike to turn to. That was something that I was avid about prior to surgery. I have already started using it a bit. And so I will just fall into that pattern. Now that I don’t have the X10 my daily routine will be to take a class on my stationary bike. And of course, doing the physical therapist’s exercises; they give you plenty to work on, so I’ll do that too.

Editor’s Note: To learn how to use a stationary bike after knee replacement, click here:

To read more about Bilateral Knee Surgery and Recovery click here.

We call it a “Meta-Blog.” We step back and give you a broad perspective on all aspects of knee health as with this article on ‘Four Weeks After Bilateral Knee Replacement’.

In this one-of-a-kind blog we gather together great thinkers, doers, and writers. All our work is related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. This is for you if you have a surgery upcoming, or in the rear-view mirror. Or maybe you just want to take care of your knees to avoid surgery. Executive Editor: PJ Ewing

To subscribe to the blog click here.

Two resources for you below. Both are email series that we created to help those who need some additional thinking for pre-surgery and post-surgery.

The Continuous Passive Motion machine (CPM) does not increase a patient’s range of motion or strength. It does not or shorten recovery. It doesn’t help, and can even hurt a patient’s knee.

The CPM machine is a story of failed early research and technology. If you are interested in the enormous body of research about the Continuous Passive Motion machine click here (as compiled by orthopedic surgeon, Dr. David Halley).

Robert Salter (MD) and John Saringer (an engineer) commercialized the CPM in 1978. The original idea was to stimulate cartilage production in knees, at which the machine succeeded extremely well in rabbits, but not for humans. Human knee cartilage has no blood supply and consequently cannot grow back.

Soon patients began using the Continuous Passive Motion machine to increase knee range of motion. Most research studies, before 2005, compared the range of motion of patients who used the CPM to patients who had only bed-rest. When that comparison was made it looked as though the CPM had a tremendous effect. However, after 2005, the experiments on the CPM evolved. These studies compared people who used the CPM to those who did not use the CPM, but who also were not confined to their beds. The non-CPM control group could move about.  None of these studies showed that the CPM could increase range of motion better than those who simply moved about. The results were remarkably clear: the Continuous Passive Motion machine failed to increase knee range of motion.

In the early 1970’s most civilian knee surgery patients had their knees in a cast for six weeks, and were largely confined to bed. The military not only did not cast injured knees, they immediately got patients up and moving. At that point in time the research showed that some movement was superior to no movement. Dr. Salter reasoned that if some movement was better, continuous movement would be better still, and hence the invention of the CPM.

Basically, the CPM flexed a patient’s leg through a prescribed arc. In order to work properly, the patient was to lay absolutely still for up to 20 hours a day. The purpose behind laying still was to preserve the alignment between the patient and machine. However, simply moving a patient’s head disrupted the alignment, and to make matters worse, the machine itself moved over the surface of the bed. Even bolting the machine down did not solve the alignment problem. Because of the alignment problem patient’s legs only experienced 68% of the prescribed arc. And the CPM was painful for most patients. Lastly they were not very compliant.

Surgeons who have kept abreast of the research, as a rule do not prescribe the CPM, though some will admit that they offer it if patients ask for it.

How the CPM failed (the research) – Read More

Click the Play button above to listen to a full analysis of the CPM including recent research by hospital, surgeons, and therapists from the U.S. to The Netherlands to China. We welcome your feedback in the comments below.

We call it a “Meta-Blog.” In these articles we step back and give you a broad perspective on all aspects of knee health. We explore surgery and recovery and such subjects as ‘How the CPM Machine Failed.’

This is a one-of-a-kind blog. We gather together great thinkers, doers, and writers. And it is all related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, and patients. And as many smart people as we can gather to create useful articles for you. You may have a surgery upcoming. Or in the rear-view mirror. Maybe you just want to take care of your knees to avoid surgery. In all cases you should find some value here. Executive Editor: PJ Ewing ([email protected])

Leslie Harrington shares her profound journey of overcoming multiple knee surgeries and the valuable lessons she learned along the way.

Leslie recounts a significant turning point in October 2022 when a freak incident caused her knee joint to fracture, leading to a pivotal surgery to remove debris obstructing her range of motion. We discuss her initial recovery from that surgery and how it quickly devolved into new challenges when her knee began to float in the joint, resulting in excruciating pain.

Leslie Harrington

Throughout her journey, Leslie highlights the mental battles alongside the physical pain—struggles with muscle guarding and psychological hurdles that compounded her recovery experience. After discovering the X10 Knee Recovery System™, Leslie began to see a significant improvement in her mobility and pain management, emphasizing how crucial it was to have the right tools and support throughout her recovery process.

As we explore her sessions with the X10, Leslie shares uplifting insights on achieving newfound ranges in her knee, the correlation between distraction and progress, and the importance of patience in the healing journey. With laughter and vulnerability, she offers advice to others undergoing similar struggles, reminding listeners to stay true to their own recovery pace and not compare themselves to others.

Leslie’s reflections culminate in a sense of hope and excitement for her life moving forward. She articulates her goals not only to regain full physical functionality but also to embrace activities that bring her joy, such as dancing and fitness. Her story stands as an inspiring testament to resilience and the transformative power of self-compassion and support in overcoming life’s challenges.

Bilateral Knee Replacement and Recovery and golf in the spring. Now that’s a bilateral knee replacement story you want to hear.

In this episode of The Bee’s Knees Podcast, we delve into the inspiring recovery journey of Kevin, who has experienced bilateral knee replacement surgery within a brief timeframe. At 64 years old, Kevin shares the challenges he faced due to chronic knee arthritis for nearly eight years, which ultimately led him to decide on surgeries for both knees—first in late August and then just 11 weeks later.

Kevin’s choice to undergo the procedures sequentially, rather than simultaneously, stemmed from a blend of apprehension and the desire for a timely resolution to his debilitating pain.

Kevin Boggs

Kevin discusses the pivotal role the X10 therapy system played in his rehabilitation. After his first surgery, he faced a concerning delay in accessing traditional physical therapy. However, with the X10 available in his home, he was able to facilitate his own recovery processes. His commitment to using the device consistently helped him achieve significant progress, much to the delight of his physical therapist during his first official appointment a week post-surgery. Kevin’s diligent work ethic, aided by the expert guidance of his coach Halima, contributed to his remarkable outcomes. Through a structured regimen of physical therapy, he focused on restoring flexibility, strength, and addressing scar tissue, all while engaging rigorously in exercises that accelerated his recovery.

Reflecting on his experience, Kevin expresses how his actual recovery trajectory far surpassed his expectations. His confidence in the X10 was reaffirmed when he opted for the same therapy approach following his second surgery. Four weeks post-operation, Kevin is driving without assistance and reveling in a newfound freedom from the pain that once confined him. He emphasizes the importance of taking charge of one’s health and views his investment in the X10 as a crucial step toward achieving a vibrant lifestyle again.

Kevin’s story serves as a powerful reminder of the significance of health and the lengths one should go to regain it. His journey illustrates the critical nature of timely medical interventions, informed choices about rehabilitation, and the potential of technological advancements in physical therapy. As he looks forward to resuming his everyday activities, including golf and travel, it’s clear that the hurdles he has overcome have only fortified his resolve to enjoy life to its fullest. This episode encapsulates not just a personal victory, but also serves as a beacon of hope for others grappling with similar challenges, encouraging listeners to prioritize their health and pursue the most effective recovery paths available.

by PJ Ewing

We define ‘good flexion’ as a minimum of 110º bend. A lack of full knee flexion is a problem that can linger forever after a knee surgery if not solved somewhat quickly after surgery. Watch this short video to get a handle on what we’re talking about with range of motion, and why flexion/bending is a crucial part of knee surgery recovery:

We care about flexion because it greatly impacts our overall mobility and activity levels. Mobility is crucial to our overall well being. John McKay (RN) writes in great detail about how important mobility is in his article:  Want to Live Longer, You May Want to Start from the Ground Up.

You need good flexion to do basic things like walk up stairs, enter/exit a vehicle, play sports, garden, kneel down to play with your grandkids. Here are some benchmarks:

If you do not get “good flexion” what are the implications?

There is a decline in muscle strength and other factors as we age. Being mobile helps put off the impact of those conditions.

For those facing surgery, your pre-surgery flexion is predictive of your post-surgery flexion as demonstrated in this research by Natarajan, Narayan, and Vijayaraghavan.

In the study it is shown that “pre-operative flexion significantly influenced the post-operative flexion”. Pre-operative flexion “is a good parameter for predicting the post-operative outcome.” 2

“There was a positive correlation between pre-operative and postoperative flexion; the better the pre-operative flexion, the better the post-operative flexion. However, good flexors tend to lose flexion while the poor flexors tend to gain some. TKR can produce a predictable result, not totally dictated by poor pre-operative flexion. Interestingly, restoration or even improvement in ROM for those with good pre-operative flexion may be limited by implant design and soft tissue tension.”

Just think about that for a second. “Good flexors tend to lose some and poor flexors tend to gain some,” meaning that even if you have good bending before surgery you might lose ground. And if you have poor flexion before surgery there is an opportunity for gains. With a knee replacement surgery, it is not simply the new mechanical joint that can be the determining factor. Rather, it is the ligaments, tendons and muscles that you have had all your life that may impact how well you can flex your knee.

And just for the record this is news for all of us as the study points out: “Other factors such as age, sex, etiology, type and kind of prosthesis did not show much evidence in influencing the outcome on postoperative ROM at the end of one year follow up interval.”

That said, the question becomes which pre-hab program should you go through? For a definitive comparison between a rigorous eight week “boot camp” pre-hab program, and a short prehab program using the X10, listen to this interview with Dr. Carl Freeman. Or just know that you can get more done in 10 days on the X10 than eight weeks of hard core pre-hab using conventional methods.

To read research about pre-hab before knee surgery click here: The Value of Pre-hab Before Knee Sugery

To hear patient accounts about their pre-hab see below:

First look at this quick guide to knee flexion/bending:

Now let’s explore your options depending on where you fit into one of these categories.

If your flexion is ‘very poor’ (<80º) you may need a procedure like MUA/Arthroscopy or even TKA. See a surgeon to discuss your options. If you have already had a surgery there is the option to consider using the X10 to help your ability to bend your knee.

Frank had poor flexion two years post surgery and was still able to fix the problem. You can watch Frank speak about his recovery here: Frank’s Story.

If your flexion is ‘poor’ (80º – 95º)

If your flexion is a concern but ‘manageable’ (96º – 109º)

Nan struggled after her total knee replacement for many months until she finally got to her goal. You can read (and listen to an interview of) her story here: Nan’s Story

For those with flexion over 110º

For more on how to use a stationary bike to help with flexion click here: Using a Stationary Bike After Surgery. An alternative to stationary bike is using a rocking chair which can help you work from 90º to 100º. Another technique is to sit on a dining room table (or better yet a massage table), wrap a TheraBand around your ankle and gently pull back to the point of tension, but not pain. Do this as often as you can for increments of 10 seconds.

Flexion is the number one challenge for most patients after any knee surgery including ACL, MCL, PCL, LCL, Patellar Fracture and Total Knee Replacement. A lack of full knee flexion is the number one reason patients call us six weeks after surgery looking for an “X10 Intervention”

Suffice it to say about knee flexion: “If you don’t got it, you want it. If you got it, keep it!”

This is Part Four of a series of articles on threats to a proper knee surgery recovery. I encourage you to explore the other articles in the series which you can find by clicking on the links below.

This is a free 15-part email series that runs for 30 days. We give you a broad perspective on all aspects of knee health. And we are highly prescriptive on what you can do right now to solve a tough knee recovery. We explore surgery and recovery and such subjects as ‘Lack of Full Knee Flexion’.

Executive Editor: PJ Ewing ([email protected])

by Kimberly Hayes

If your feelings of depression and low energy tend to peak in the winter, you may think you are suffering from Seasonal Affective Disorder (SAD), but it could also be something else. That’s why you need to know the most effective ways to combat SAD and the best methods for determining the source of your feelings in the first place. Here are some wonderful tips that can help you get through your winter blues, no matter the cause.

Exercise is an incredibly helpful tool for countering the symptoms of SAD. If you normally get exercise with an after-work run or a morning bike ride, shorter days can be a real downer. Having a small home gym can negate the effects that a lack of exercise has on your mental health during the darker, winter months.

A sedentary routine tends to lead to more feelings of depression and anxiety. So, if you have an extra room, some space in your garage, or an unused basement area, consider creating your own workout area at home to maintain your regular fitness routine. These distraction-free spaces can be more effective than keeping equipment in your living room or bedroom.  Consequently you only need a few tools to get a really great workout. To keep yourself from getting bored, you could use YouTube workout tutorials to mix up your workout. There are workout videos online for every kind of exercise, from kettlebell strength training to calorie-burning Pilates. You’ll always have a new way to burn those calories and keep your symptoms in check.

The effects of SAD can be physical and mental, with your energy levels dipping and feelings of depression taking over. The source of these symptoms, however, usually has something to do with the state of your mind and mental health. Researchers have found a link between inflammation in the brain and an increased risk of mental health issues, including the anxiety and depression that often accompany SAD.

One natural way you can manage your mental health is to add CBD to your health regimen. CBD has been proven to relieve inflammation and reduce feelings of anxiety and depression. The side effects are typically minimal, but you should definitely do your homework before you start using this potentially helpful supplement. It’s also a good idea to consult your healthcare provider to address any mental health concerns. Sometimes, it can be difficult to distinguish between SAD and a deeper rooted mental health problem. So do not attempt any self-therapy until you have officially been diagnosed with SAD. If you are diagnosed with SAD, you may need to look into these kinds of treatments, including supplements and light therapy.

Taking better care of yourself is the key to combating the effects of seasonal affective disorder. However, that entails so much more than exercise and mental health management. SAD can impact all aspects of your physical and mental health. So your efforts to contain it should be just as comprehensive. Start by cleaning up your diet, which is a vital source for energy and overall health. When those winter doldrums creep in, it can be all too tempting to reach for those comforting, carb-loaded foods. The refined carbohydrates found in your favorite winter and holiday foods, such as cookies and rich desserts, can actually cause more intense feelings of depression. It’s just one of the connections between your diet and your health. So try to limit these sugary, high-calorie foods, even around the holidays. Sleep is another crucial tool for fending off SAD, so start taking steps now to improve your bedtime habits.

To learn a lot more about sleep click here: Upgrade Your Bedroom, Improve Your Sleep. Or just click on the picture.

You will be hard-pressed to find a more complete look at sleep, the importance of your sleep environment and ways to adjust your own space to get better sleep. And learn a new concept called ‘Sleep Hygiene’ along the way.

Here is another article that you may find useful: Recognizing Depression.

Whether your feelings are a result of Seasonal Affective Disorder or some other issue, taking better care of yourself should always be your first step to pick yourself up. Either way, be sure to consult a healthcare professional and take the measures you need to improve your mental health.

We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery and such subjects as “SAD (Seasonal Affective Disorder).”

Voted Top 10 Knee Blog of 2018.

In this one-of-a-kind blog, we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success, and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here. Executive Editor: PJ Ewing ([email protected])

Elizabeth solved the problem only after finding X10 to recover from her MUA. Ligament Tears were just a part of the damage done to her knee years ago. It is exactly what we were able to do for Elizabeth that gets our whole company up in the morning. Listen and read below.

In this episode, we delve into the recovery journey of Elizabeth, an active-duty Air Force member who has bravely navigated the challenges of knee injuries and multiple surgeries. Elizabeth shares the significant impact her injuries had on both her physical health and her emotional well-being over the past two years. Her story begins with a devastating knee injury sustained during deployment, leading to the unfortunate “unhappy triad” of torn ligaments, which ultimately resulted in her first surgery. Solving Ligament Tears.

Elizabeth Amos

Elizabeth details the frustrations of rehabilitation following her ACL repair, particularly the stability issues that persisted, compelling her to pursue a second surgery. The second surgery, which involved a more complex reconstruction and rerouting of her IT band, was significant. Elizabeth describes her dedicated commitment to physical therapy, attending two to three sessions a week while facing ongoing challenges with knee flexion and stability. Despite her efforts, improvement was slow, leading her to consider further interventions, including manipulation under anesthesia.

Throughout our conversation, Elizabeth candidly discusses the emotional toll that her recovery journey has taken on her. Amid the setbacks and difficulties, her determination to regain her pre-injury lifestyle shines through. She expresses how important it is for her to return to running and her daily activities, highlighting the internal struggle of maintaining motivation while dealing with physical pain. Elizabeth’s resilience is remarkable, providing listeners with insight into her mental strength during this challenging time.

Following her manipulation procedure, Elizabeth faced further frustration with her progress, which led her to seek out alternative options for recovery. It was during this search that she discovered the X10 rehabilitation system. Skeptical but hopeful, she decided to give it a try, curious about how it could facilitate recovery without intensive pain — a stark contrast to her previous experiences in physical therapy.

Elizabeth shares her initial expectations around using the X10 and the resulting positive outcomes. In just a couple of weeks, she reported a tremendous increase in her knee flexion from 95 to an impressive 126 degrees. She discusses how the pain-free nature of the therapy was a game changer, allowing her to incorporate it seamlessly into her daily routine while continuing to engage in life and work without feeling constrained by her past injuries.

Our conversation culminates in Elizabeth imparting valuable wisdom to others facing similar challenges. She emphasizes the importance of exploring all options for recovery, urging those who may be hesitant to invest in their health to consider the significant benefits that come with regaining mobility and functionality. Through her inspiring journey, Elizabeth highlights not only the physical aspects of recovery but also the profound realization that one’s quality of life can vastly improve with the right support and interventions.

Elizabeth’s story serves as a powerful reminder of the resilience of the human spirit, illustrating the dedication required to reclaim one’s life after injury. Her journey underscores the message that recovery is often not a straight path, but with persistence, innovation, and the right mindset, a brighter future is within reach.

Join us for this inspiring episode that emphasizes resilience, the power of modern rehabilitation, and the endless adventures life has to offer even after major surgical interventions. Elizabeth’s journey is proof that with determination, the right tools, and a supportive community, one can indeed reclaim an active and fulfilling life post-surgery.

by Mary Elliott (The Bee’s Knees Podcast)

In this episode of the Bee’s Knees podcast, Mindy shares her experience with knee replacement surgery and discusses the challenges and benefits of using the X10 machine for physical therapy. We explore the importance of emotional well-being during recovery and highlight the convenience and precision of the X10 machine. Mindy’s story emphasizes the need for individualized solutions and proactive muscle strengthening.

Don’t forget to subscribe and review our podcast to help others find us.

Mary Elliott

In this episode of the Bee’s Knees podcast, we have a special guest, Mindy, who recently underwent knee replacement surgery. She shares her experience of living with knee pain for several years and trying various treatments before deciding on surgery. Despite her apprehension about her age, Mindy chose knee replacement and discusses the challenges she faced during her recovery, including swelling and difficulty achieving flexion.

Mindy also discovered the X10 machine, an alternative to manipulation under anesthesia (MUA) that provided a more gentle and accessible form of physical therapy. Mindy emphasizes the importance of finding a solution that works for each individual’s unique circumstances and highlights the convenience and precision of the X10 machine.

We discuss the importance of emotional well-being during recovery and how the X10 machine helped Mindy find a sense of relief and improvement within days. The ability to track progress and have support from both the X10 coach and her physician was greatly appreciated. Mindy continues to manage swelling through elevation and icing. As a nurse, she found the X10 to be a valuable tool and would consider doing physical therapy beforehand to strengthen her muscles in the future.

We express gratitude to Mindy for sharing her journey with us and assure her that we are honored to be a part of it.

We call it a “Meta-Blog.” In these articles we step back and give you a broad perspective on all aspects of knee health. We explore surgery and recovery and such subjects as this on one ‘Mindy Avoids Manipulation Under Anesthesia.’ READ OUR BLOG.

This is a one-of-a-kind blog. We gather together great thinkers, doers, and writers. And it is all related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, and patients. And as many smart people as we can gather to create useful articles for you. You may have a surgery upcoming. Or in the rear-view mirror. Maybe you just want to take care of your knees to avoid surgery. In all cases you should find some value here. Executive Editor: PJ Ewing ([email protected])

A story full of heart, dedication and making the most out of a tough recovery.

I was born in Cuba, and moved to Miami at the age of five, where I grew up. I have lived here all my life. I studied psychology and political science in college and became a paralegal. I was always active and athletic as a kid. Although it wasn’t my major, I was on the modern dance team in college.  Because I live near the water, I have always enjoyed all forms of water activities such as swimming, boating, snorkeling, and kayaking. During my marriage, my ex and I also used to go skiing quite frequently. In addition, I enjoy running, dancing, biking, crossfit and boot camp.

About 15 years ago I tore the meniscus in my right knee and had arthroscopic knee surgery to clean it out. No one ever explained to me that this surgery would ultimately have repercussions as I got older and continued an active life style. After my pregnancy I gained a significant amount of weight, and then lost it. I started running 5k’s during and after my weight loss, and continued dancing which was always my passion. The first few years my knee was fine, but after a while it started swelling up and started causing me tremendous trouble. I seemed to always be in pain. I became a regular at the orthopedic doctor’s office. I did endless therapies, took cortisone shots every 6 months, iced the knee, stretched it, did yoga, you name it. But the knee kept getting worse and worse, and the cortisone shots were no longer helping. About three years ago I practically blew out my knee during a 5K run. I had several medical opinions telling me that I would ultimately need TKR surgery, but for the time being it was just “elective” surgery. I finally met my surgeon, Dr. Carlos Alvarado, who gave me a third and final opinion. He ordered an MRI, and when he read the results, he was shocked to see that not only was I bone on bone, but I had also torn my ACL and MCL. He advised that surgery was no longer an option or elective for me; it was mandatory.

Dr. Carlos Alvarado is my guardian angel. I found him through a mutual doctor friend who advised me to see him. It was the best medical advice I ever received. Dr. Alvarado is young, extremely knowledgeable, and well-schooled in the latest technology. He has great bedside manner, and in my opinion, is a brilliant surgeon. My surgery was state of the art and used a new technique. It went very well, and in fact, Dr. Alvarado kidded with me the next morning about how I broke the blade of his saw during the surgery. I was up and walking around just hours after my surgery.

While I was physically in need of the surgery, I was not mentally prepared for what I was about to endure. I really don’t know how anyone can be prepared for this life changing event if they’ve never personally experienced total knee replacement surgery. That said, everyone and every BODY heals and recovers differently. I went to 90º flexion painfully, and sweated every minute of every therapy session. My extension wasn’t much better, as I was between -11º to -8º. I was going to therapy 3x’s a week, every week for an hour. I took five weeks off from work, so I had to take advantage of the time off to recover as quickly as possible. I made it to the 90º mark between the second and third week, and then progressed to about 113º, where I seemed to linger longer than the therapist wanted. The protocol is for a patient to reach 120º flexion and 0º extension by the 6-8 week mark, or an MUA (Manipulation Under Anesthesia) would be the next recommended step.

I didn’t know what an MUA was, let alone what it entailed, but the mere mention of the word sent me in a panic. And my therapist wanted to make sure that I knew what it was. So I got home, depressed, hopeless and frustrated, and got online to do some research. It’s what I do. In an MUA they put you under anesthesia and manipulate (aka “crack”) your knee to 120º. The goal of the MUA is to break up the scar tissue to allow the joint to move freely. With the exception of having a new surgical scar, you are basically starting at almost ground zero all over again, and with new pain and swelling. I saw my surgeon at my four week follow up and he told me he expected me to be Gumby, to which I replied I’m neither green nor made of clay. He said I was one of the youngest patients he had, and because I was in such good physical shape, he had very high expectations of me. I knew what that meant, and I saw where I was headed if I didn’t take immediate action.

During my research on MUA’s I saw the X10 machine kept popping up and without hesitation, I booked a phone conference with PJ Ewing, the developer’s son.  I was in a bad head space and was very depressed. I had so many questions and concerns.  But after talking to him for over an hour, he put me at ease and I felt like this machine was sent from heaven and would be able to get me to my end range quickly and with relatively little pain and discomfort. I really needed to get to my end range by my next post op appointment. I was terrified of getting an MUA, and to make matters worse, I had heard of two cases (friends of friends) who had to have it done. I spoke with my surgeon about the X10 and although he had not heard about it, he read the literature I brought him and he signed off on the medical consent, giving me his blessing. The only caveat is that he required me to do BOTH traditional therapy along with the X10 machine. At this point I was very far from dancing two months after knee replacement as he had promised.

I received the machine a couple of days after I sent in the paperwork. I continued doing therapy, but also started working with the X10 machine. I worked with the machine diligently 3x’s a day, seven days a week. On the days I had therapy, I would do the machine only once or twice, depending on how I felt. Every time I left therapy I was sore and my joint was super tight and I needed to ice my knee. I even used the X10 on those therapy days although I was sore, I would simply adjust it accordingly. I will elaborate below.

I starting using the machine at intervals of anywhere from 30-45 minutes. I pushed myself both up (extension) and down (flexion) with each session. While it was not as painful as therapy, it was uncomfortable because I pushed myself sometimes 5º, 10º or more per session. But it was definitely less painful than therapy. I only told my therapist about the X10 a couple of days after I started using it, because I wasn’t sure how she would react to it. When I mentioned it, she said that Passive Action Machines had been around for decades, but none seemed to be very effective. I told her all about this machine, with its advance technology, and  its many added features to strengthen the muscles and break up the scar tissue,  and because of all the research I had done, I knew the difference between the x10  and its predecessors, so I could make a valid argument in its favor. This machine is state of the art and has a lot of built in added features that speed up the recovery process.

The machine itself is comfortable and very user friendly, and it doesn’t take up a lot of room. I only had to relocate an IKEA size arm chair temporarily to fit the machine in my small two bedroom apartment. Once the set-up was complete, in the comfort of my home, I was given detailed instructions from Dave on how to use it. Then I simply sat on the chair, and pressed the ON button to get started. I had mine placed in my living room in front of my television, so that I could watch TV, read, work on the computer, answer emails, visit with friends and family, or even have a cup of coffee while the machine was doing its job. While it has many amazing features, one of my favorite features is that as the machine is going up and down in its range of motion, it slows down when you are at 10 degrees from your pre-set end range in either direction so that you can brace yourself for the final push.  (It really is a mental thing).

It adapts and adjusts to your body accordingly. If the machine feels too much pressure is being exerted to get you to the next degree, it automatically stops at the furthest degree it could comfortably get you to, and continues the up and down movement while slowly pushing you further along. As you move the joint, it will naturally loosen up and you get a better bend. This is very different from having a therapist bend your knee while you’re in therapy and “tapping out” to no avail. And you can also manually adjust your end range in either direction while you’re in the middle of a session so that you can push yourself comfortably to the next level, or pull back if you feel any discomfort. You are given an instruction manual on how to use the X10, it has all the pertinent numbers to call, and a grid where you keep track of your own progress. Since you are always in control, it is in your best interest to push yourself forward as frequently as you can even if you feel some discomfort. Kind of like the old gym adage: “no pain, no gain.”

I began using the X10 machine at about week six. After a few sessions on the machine, my therapy sessions started getting easier and far less painful. Prior to the X10, whenever my therapist would bend my knee while I was on my stomach, I would brace for the pain, and tap out while tears streamed down my face. Within a few sessions on the X10, the therapist’s manipulation got easier and easier to bear. Even my therapist noticed that my knee was bending more easily. She saw the swelling and inflammation starting to go down, and felt the muscles waking up, while the scar tissue started to break down. My therapist mentioned how she could totally feel a huge difference in the anatomy of my knee joint and the surrounding tissues, and how impressed she was with my improvement. By the eighth week (two weeks after starting the X10) I saw and felt a remarkable improvement overall in my mobility, strength, and flexibility. I only had the machine for 2 weeks, but I achieved my end ranges, and went from a starting point of 5º extension/90º flexion to 0º extension/130º flexion within that small time frame. I never felt more than a discomfort during the entire process.

With the X10 you are assigned Tricia, your X10 coach. She is your coach, virtual therapist and a Zumba instructor all in one. She is amazing and has a great personality. We had our first virtual phone therapy a few days after I started using the machine.  And from that point on we would text each other almost on a daily basis. She was a burst of energy and super inspirational. This was especially helpful on those days when I needed the “quit feeling sorry for yourself” speech. Since the machine has readings that are recorded and automatically sent to her for monitoring, I would frequently get texts messages from her, out of the blue, cheering me on. I even got emojis, which totally made my day!!! Thanks Tricia!

She was my biggest cheerleader and motivator. She kept me grounded and hopeful.  And she always brought a huge smile to my face.  Actually, the whole team is amazing.

My surgery was on April 3, so I am now just over 12 weeks post-surgery. I am beyond thrilled that I was discharged from therapy almost 2 weeks ago, at almost 11 weeks. My therapist said that I was off the charts and had exceeded all my milestones. I did a total of 26 therapy sessions at just under 11 weeks. I’m walking without a limp, and I’m dancing again. I take public transportation to get to and from work, so I walk over  3-4 miles a day just commuting. I have to go up and down escalators, and many times the escalators are broken, so I end up having to walk up and down the stairs. I’m slow and careful, but I can do it.

The therapist started transitioning me to regular gym equipment at eight weeks post op, and by the time she discharged me, I was doing leg presses/extensions of over 60 lbs with my surgical leg, leg curls at 45 lbs, I am also doing 20 minutes on the stationery bicycle at a low seat level, with high resistance. I’m using the elliptical machine and I’m doing wall squats with a medicine ball on my heels and on the balls of my feet.  I’ve also been cleared to do aquatic exercises.

Knee replacement surgery is a long journey no matter what your age or physical ability is prior to the surgery. It is as much mental, as it is physical. You have to mentally prepare yourself for this temporary setback. You will have a new metal joint in place of where you had your knee joint, and your muscles are cut during surgery. You will have little to no strength where you once had some or alot. You have to re-learn how to walk and “wake up” the quads, glutes and hamstring muscles. You had the surgery in the hopes of a normal life going forward with your new knee joint.

If you can, get the X10 machine. For me it was a great supplement to my therapy, and it helped transition me to the next level in a short period of time and with little discomfort. I don’t think I would have gotten so far so fast without it.

Don’t give up mentally or physically. It is not an overnight process. It will take time and you have to have patience and faith in yourself and your team.  Keep working at it and you will get to your happy ending.  I’m not completely there yet, but with continued hard work I know I will get there.  I have already overcome 100% of my worst post-surgery days. For now, I’m thrilled to be walking, dancing, swimming, biking, and gymming. And I look forward to many more milestones.

Thank you X10 and Team!!!

Every day will present you with a new challenge, especially at the beginning. You will wake up with pains and stiffness, and you’ll curse the day you had the surgery. It is up to you to rise up to the challenge.  At first it will be painful, it will be difficult, but with hard work and a positive attitude, you will get through it. Just when you think you can’t go any further, you keep pushing forward and within a few days (maybe even a week), you will see your hard work pay off. Get out of your head and stop telling yourself you can’t do it.  Even baby steps are steps in the right direction. The difficult and painful moments are only temporary.

We call it a “Meta-Blog.” In these articles we step back and give you a broad perspective on all aspects of knee health. We explore surgery and recovery and such subjects as ‘Dancing Two Months After Knee Replacement?’.

This is a one-of-a-kind blog. We gather together great thinkers, doers, and writers. And it is all related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, and patients. And as many smart people as we can gather to create useful articles for you. You may have a surgery upcoming. Or in the rear-view mirror. Maybe you just want to take care of your knees to avoid surgery. In all cases you should find some value here. Executive Editor: PJ Ewing ([email protected])

Quick Summary

Donna reached out to X10 in the spring to talk about using the program for a single total knee replacement planned for later in the summer. She did some exploration on doing both knees at once and ultimately went in that direction. Donna discusses deciding on bilateral knee replacement and her recovery here.

One Highlight

This was one of the best decisions I’ve ever made ever. If I had known then everything that I was going to have to go through, everything that my family was going to have to go through, I would have thought harder about doing two knees at once from the beginning.

Favorite Quote

“When I go to physical therapy now the therapist is like, “Oh my goodness, you are our star patient,” because my flexion is at 120º and my extension is at 0º. I’m walking with a cane now instead of a walker. And they’re like, “We wish everybody could be like you.” So I feel successful.

Is this for you?

Listen to the podcast or read the text below if you are considering knee replacement and want to make sure you know about the latest recovery technology. The audio interview provides a very detailed explanation, from a patient’s perspective, about how the X10 can make quick work of a bilateral knee replacement recovery.

An interview with Donna Groce by PJ Ewing

Donna had bilateral total knee replacement surgery. What follows is an interview with Donna conducted by PJ Ewing from X10 Therapy.

My name is Donna. I live in Winston Salem, North Carolina. I am 65 years old. I have a son and a daughter and am a grandmother of four.  I have three granddaughters and one grandson ranging from ages nine down to three. They are the joys of my life.

I am a born-again Christian. Praise the Lord for watching over me, taking care of me during this process. He’s been so good to me. That’s probably my number one praise, and I think that’s why I’ve been able to do as well as I have.

I’m exactly four weeks out from bilateral surgery, four weeks ago today. I was in the hospital for four days and came straight home. I am doing wonderfully, wonderfully well. I have been able to rest and relax, do some things that I’ve been wanting to do. I’ve done a lot of reading in the last four weeks, a lot of studying and things like that I don’t usually have time for.

This has kind of slowed me down somewhat and giving me a little bit of personal time to do some things that I wanted to do. I am very thankful for that. So even though it has been quite a journey so far, not being completely pain-free, but it’s not been an unhappy or bad journey, that’s for sure. And I’m super-glad that I’m four weeks on this side of the journey instead of four weeks on the other side.

Life was very painful. I had two really bad knees, bone-on-bone, both of them. One was a little worse than the other. I had meniscus tears in both knees, arthritis in both knees. Every step I took was a jolt of pain. I endured it for probably two years. It gradually got worse and worse. I have done everything possible that I could have done leading up to the surgery. I’ve had physical therapy. I did cortisone shots, two different sessions of the gel injections, everything that I could to prevent having surgery.

Finally, it just got so bad the doctor said, ‘you just have no other choice. You’re going to have to live with this pain, or you’re going to have to have it replaced.’ At the time I was only going to do my left knee, which was a little bit worse. I went into all the preparations. At the very last minute, I decided to do both at the same time and get it over with.

I had done a lot of research. I’ve done a lot of reading about the surgery, about what was going to happen, about the recovery, and about the physical therapy. I am not the type of person that likes to go into something without my eyes being wide open. So, I knew that there were things that I needed to plan for. There were things that I needed to do ahead of time.

Actually, this is kind of funny. You, PJ, were the first one that mentioned to me that maybe I should look at bilateral surgery instead of just doing one. It was in a conversation that you and I were having one time. You said, ‘well, have you ever thought about doing both knees at once?’

It kind of opened my eyes a little bit because I never had even thought about it. And, I said, no, not really. But after we hung up I talked to my husband about it and I thought, ‘Man, what do you think about this?’

I realized that it would make a difference. I would need more help, I wouldn’t have a good leg to stand on, so to speak. I did a little bit more research on the bilateral process. Fortunately, I had the perfect situation as far as coming home after the hospital. My mom lived with us for 10 years before she passed away earlier this year. My husband made her an apartment downstairs on the ground level of our home. So everything was already set up. We have a handicapped bathroom and a bedroom and a little kitchen all on the ground floor.

Then I went to the doctor for my pre-op visit. I told the PA that I was speaking with that I want to do both legs. And he quite frankly said, ‘No, we won’t do that.’ And I said, ‘well, I want to do both legs. I want to get it over with.’ And he said, ‘well, your surgeon will not do that. He doesn’t do both legs at the same time.’ And so I just said, ‘well, if I have to change surgeons, if I have to change practices, I want to do both legs at one time. I want to get it over with and do what I need to do and be well and not have to repeat the process in six months or a year.’

So at the very last minute, the week before my surgery was scheduled, I switched surgeons. People told me I was crazy, but it’s what I wanted to do. I had prayed about it and I had peace about it and I’m looking back now, would not change it for anything. I know it was the right decision.

When the PA told me at my pre-op visit that my original surgeon would not do two knees, he said, ‘let me speak to one of the other doctors here in the practice. We really normally don’t do two knees at one time, but let me speak with him.’ So he went and spoke with Dr. Calvin Maxwell McCabe. Dr. McCabe looked at my history. Fortunately, praise the Lord I am, other than arthritic knees, very healthy. I am not diabetic. I don’t have problems with my blood pressure, my sugar. I don’t have anything else wrong with me other than my knees. So Dr. McCabe took a look at everything and said, ‘yes, I’ll do both knees for her.’

I actually only met him the Friday before. He did my surgery on Monday.

He was wonderfully patient. He explained why he chose to do both knees when it’s something that they normally don’t do within their practice. He said, ‘the only reason that I’m going to do your surgery is that you are as healthy as you are’. I felt quite confident with him.

One of the maybe more humorous things is that my sister-in-law actually works for that practice. She was on vacation and I called her and said, ‘are you sitting down?’ And she said, ‘Oh my goodness, yes.’ And I said, ‘I just talked to Dr. McCabe and we’re going to do both of my knees Monday morning.’ And she’s like, ‘have you lost your mind?’

I left the office that day. after speaking with a PA but before talking to Dr. McCabe. By the time I got home, which was a 20-minute drive, they had already switched my surgery date to two weeks later so they could be on Dr. McCabe’s schedule. All my physical therapy already switched all of my other appointments. They took care of everything for me before I could even get home.

I’m telling you they were phenomenal and have been ever since. I can’t say enough about the care I’ve gotten from them. His physician’s assistant, oh my goodness, phenomenal. Her name is Laura. She came to the hospital several times. I have absolutely no complaints, none whatsoever. I couldn’t have asked for anything any better.

He did my left knee first, which was supposedly my bad knee. He told my husband after the surgery was over, ‘I am so glad she decided to do this because her right knee was just as bad as her left, if not worse.’ He said, had I not done both knees I would have had more problems with the other knee, possibly affecting my hip and my ankle. It could have done a lot of damage. And then we’re talking about other surgeries down the road. In the x-rays, my right knee did not look as bad as my left knee did. He said so. But when he got into the knee, it was as bad if not worse than the other.

Well, praise the Lord. I made the right decision.

Yes, definitely. When we spoke that day, you said to me, now, don’t take my word for it. Let me get you hooked up with this bilateral knee group, and you did that same day. And, oh my goodness, I’ve read everything there since then. It’s been so very helpful. And I hope that the comments that I’ve made there make sense about my surgery, I hope that I’ve been able to help somebody else. When people go on there, pre-surgery, they’re nervous and they’re afraid and don’t know what to expect. And it just so very helpful to have somebody say, okay, I’m a week out or two weeks out or six months out or whatever… and this has been my journey. It’s just been so very helpful to have had somebody literally walk in my shoes.

The people there have gone through what you’re getting ready to go through. I think this gives you the peace and calmness that you need knowing that they’ve gone through this. They’re doing well. They got past this. This thing helped them. This other thing didn’t help them. Maybe I should do that. It was just so very helpful, and it still is helpful. I check it four or five times a day.

My recovery has been really good. I’ll just start that way. Of course, not pain-free, but pain-manageable. I was in the hospital for four days; a wonderful hospital, by the way, Clemmons Hospital here in Winston Salem, North Carolina. And I felt like I was in a four-star hotel. They took such great care of me.

They kept my pain under control, kept me comfortable. Of course, I had two Iceman machines constantly going. The nurses and the doctors there were phenomenal. I felt like the queen of England or something.

I came home to the perfect setting, on a Thursday with all kinds of medicine. I had pain medicine, an iron supplement, nerve medicine, so my surgeon kept me quite comfortable. I wasn’t pain-free. I don’t want to give anybody false hope that you can do something like this and not have any pain. But it was quite manageable. On Friday morning, David delivered my wonderful X10 machine and set it up for me, educated my husband and me on how to use it and what to do. I got on the machine immediately that day and started using it. I used it two to three times a day.

It really helped with my flexion and extension, and it was completely pain-free. It felt really good to be able to move my legs like that. I had a friend that stayed with me, to give my husband, some relief from the 24/7 care that I needed. She stayed the first couple of nights here with us. And, my wonderful church family has been delivering meals to us every other day since I’ve been home. So that’s another blessing. Dr. McCabe had physical therapy come here to me for the first two weeks and then I started going outside for physical therapy. So I’ve done my X10 machine, my physical therapy, and the exercises that they have given me.

X10 sent me a lot of information about exercises to do. I’ve tried to keep up with doing all that. I think that’s one of the reasons why I’ve done so well. Movement is so very important. After you get home, you have a tendency to want to sit or stay in bed, but you’ve got to get up and move your legs. And I have done that. So when I go to physical therapy now the therapist is like, “Oh my goodness, you are our star patient,” because my flexion is at 120º and my extension is at 0º. I’m walking with a cane now instead of a walker. And they’re like, “We wish everybody could be like you.” So I feel successful, yeah.

I give the praise to the Lord, that’s for sure.

Yes, I did. She is such a joy. Oh my goodness. We had the best conversations. She would call to check on me and find out how I was doing. She would look at my results on the machine and things like that. And then we would end up staying on the phone for an hour just talking to each other. Yeah, I feel like I’ve got new friends. She and David are jewels.

So I’m very, very involved in my church, doing different activities, I work with our children at church. I work in a hospice ministry where we deliver food to hospice. My husband used to say to me, ‘Donna, you are going to have to slow down.’ But I have slowed down. These four weeks have been slow. So like I say, I’ve been able to do a lot of reading. I’ve been able to get into my Bible and do some Bible studies that I was really interested in that I hadn’t had time to do before.

I’m not doing steps yet. I haven’t gone upstairs yet. They’re not allowing me to do steps. I do walk without my cane, as long as I have something to hold onto or as long as I’m close to something. I’m being very careful. The last thing I want to do is following through with any damage, but I am practicing walking on my own. So, I do have a ways to go. When I go to physical therapy now, we’re working on my walking and my gait. I do strengthening work at physical therapy and at home. I have a band now and several exercises that I do. Before I get up I do exercises in the bed, and once I get up and I do exercises in the chair. And then I’ll walk. It keeps me busy.

Christmas is my goal. I realized it is a slow process. I do kind of push myself sometimes and I have over-done it and have paid for it a couple of times. I just had to back off for a day or two. The reality is that this is not a quick process. It is going to take time This time next year when I look back and I’m completely recovered and completely myself again, I’m going to look back on it as a year-long experience.

This was one of the best decisions I’ve ever made ever. As much as I say I researched it and had decided to do one knee, I think going back and doing the other knee would have been difficult. If I had known then everything that I was going to have to go through, everything that my family was going to have to go through I would have thought harder about doing two knees at once from the beginning.

This has not been just Donna’s journey, this has been my family’s journey. It’s taken time and effort on their part, and willingness to come and help me. So, I’m glad that I don’t have to put them through that again. We’re past that.

We call it a “Meta-Blog.” We step back and give you a broad perspective on all aspects of knee health as with this article on ‘Deciding on Bilateral Knee Replacement.’

In this one-of-a-kind blog, we gather together great thinkers, doers, and writers. All our work is related to Knee Surgery, Recovery, Preparation, Care, Success, and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. This is for you if you have a surgery upcoming, or in the rear-view mirror. Or maybe you just want to take care of your knees to avoid surgery. Executive Editor: PJ Ewing

To subscribe to the blog click here.

The link to the research study as presented in the blog episode is here: Conversion to TKA from UKA Risk Factors.

Two resources for you below. Both are email series that we created to help those who need some additional thinking for pre-surgery and post-surgery.