PreHab Pioneer Goes High-Tech for Double Knee Replacement
Jim’s an English professor by trade who taught for over 35 years in Cincinnati, Boston, and (mostly) western Pennsylvania before retiring to warmer, sunnier Austin, Texas. An avid tennis player, Jim has played tennis for even longer than he’s been a teacher. Jim attributes one of his lifelong passions to destroying his knees. Hint: it wasn’t the lecturing that did his knees in.
” I played tennis for over a half-century and paid a price for it. I’ve had knee problems for a long time,” explains Jim.
When it comes to Jim, “knee problems for a long time” is an understatement. The 64-year-old’s knee troubles stretch back more than 30 years. What started as stabbing pains during tennis matches led to pain off the court, and eventually spiraled into multiple meniscus tears, knee scopes, and cycles of injury and healing.
Throughout Jim’s decades-long cycle of injury and recovery, one thing remained a constant: his dedication to keeping active.
Jim: A Pioneering PreHabber?
The self-described “exercise addict” rarely spent a day down for the count. As he says, “If I don’t do some kind of exercise every day—even just a little bit—I feel kinda ‘blah,’ like I never brushed my teeth that day.” When Jim wasn’t able to play tennis, he was using exercise to heal. Whether it was running through preventive and rehabilitation physical therapy or gently working out in the swimming pool, Jim’s no stranger to the idea of “PreHab.” In fact, with the water therapy and preventive exercise Jim’s been doing for decades to heal from injury, he may just be one of the original “PreHabbers.”
Jim’s perpetual “PreHabbing” to heal and prevent himself from knee injury led to his “record-breaking” recovery from his first knee scope at his physical therapist’s clinic.
Jim explains light-heartedly, “In physical therapy, after my first meniscus-trim right-knee scope 18 years ago, I set a record for fastest ReHab. This was really only because I was a big chicken about having that surgery—not realizing how comparatively easy it is for the patient to recover from arthroscopic surgery—so for more than 3 months I tried to fix my knee with physical therapy instead."
Jim elaborates, "I stumbled on ‘prehab’ by accident. I’d never heard of that word then; I don’t know if it even existed back then. It strengthened my muscles, but it didn’t fix my meniscus tear or my knee pain, so then I got the scope, and right afterwards I went back to physical therapy for 1 week. Because all of my muscles had been strengthened from the PreHab, my physical therapist pronounced me cured in just 1 week, and I was back to tennis just a few weeks later.” He adds, “I’ve hurt many things and been to physical therapy many times over many years. I have become close friends with my physical therapists for all of the wrong reasons!”
Today, the idea of “PreHab” where you optimize your health before surgery to set yourself up for an easier recovery is becoming commonplace. However, Jim was of this mindset long before the idea of PreHab was receiving any airtime.
Push Came to Shove
Despite years of becoming “close friends with physical therapists for the wrong reasons,” it wasn’t until summer 2014 that a knee replacement was really put on Jim’s radar screen. By then he’d had 2 more knee scopes—a left-knee scope in 2007 and his second right-knee scope in 2011. While playing tennis in summer 2014, Jim had a “big attack” on his left knee that left him in pain and limping around New York City during a trip to watch the US Open. He explains, “After the attack, I went to a doctor in Pittsburgh who said, ‘Yup, you need knee replacements.’ With that, I stopped playing tennis and I was in a way always PreHabbing, but I focused on physical therapy and hitting the swimming pool.”
Jim went back to playing tennis in spring 2015 once his knee felt better enough to do so. Things were manageable enough for a tennis addict for about 15 months—though he was playing injured the whole time—wearing knee braces and getting a lot of deep-tissue massages—until he had his “second big left knee attack” in July 2016. He explains, “The second time I couldn’t sleep. I thought, ‘This is no good.’ I hung up my racket totally. I knew I would have to get a replacement.”
In the fall of 2016, Jim describes that things were getting “worse and worse” for both of his knees. To buy more time, Jim had cortisone shots done in both knees—the last in his right knee in August—to combat inflammation and pain. With this, he describes what happened next as a series of events that “dovetailed nicely together.” After cortisone injections, most orthopedic surgeons enforce a policy that you must wait 3-6 months before having a joint replacement. Jim’s insisted on waiting 6 months after the cortisone shots. Around this same time (late 2016), robotic arm joint replacement surgery was being rolled-out across the US and making headlines, but Jim had to wait until it was available to his surgeon.
Jim wasn’t sure if he could hold off long enough to take advantage of the cutting-edge robotic-arm joint replacement. However, he wanted to try.
Jim began obsessively researching what he and his renowned surgeon—Dr. Shelby Carter, Director of the Center for Hip and Knee Replacement at St. David’s Medical Center in Austin—deemed to be the future of joint replacements: robotic-arm assisted surgery. Jim recounts, “I became like Sherlock Holmes, trying to find out when it would become available. I saw that Dr. Robert Marchand in Rhode Island had done a series of the first MAKO robotic total-knee surgeries beginning in late June 2016.” Jim went back to Dr. Carter, who had already done many robotic hip and partial-knee robotic surgeries, with his research and asked if he could be his first patient to have a robotic total-knee replacement. That surgery, on March 3rd, 2017, was the first MAKOplasty® robotic‐assisted total-knee-replacement surgery in Austin and one of the first couple, if not the first, in the whole state of Texas.
Jim describes his recovery as “rapid after the first week,” adding “I really started to improve and just got better and better.” He wasn’t down for the count long before he went in for a replacement on his other knee. “It was 8 weeks to the day, on April 28th, that I went in for my second,” he recounts. “There’s no way my knees could have been done as successfully together; that would have been really hard in my case,” he adds. “From my surgeon’s point of view, he was doing something new, and understandably wanted to take his time and not do 2 at once and keep me under anesthesia for a long time. Then as it happened, my knees reacted in opposite ways. My first one, the right knee, bent well right away but took a few weeks to straighten out completely. The second, left knee was straight but took a few weeks to bend well. So the first couple weeks would have been bizarre and difficult if my knees had been done at the same time! 8 weeks apart was perfect. Each recovered really well separately."
"Altogether, these were my fourth and fifth knee surgeries and I’m thrilled to know that, with any luck at all, they were my last,” explains Jim.
High Stakes? Go High Tech!
Right before his first surgery, Jim discovered PeerWell. He became an active member of PeerWell’s online community and was the first to do a trial of of PeerWell’s first-in-the-world smartphone range of motion assessment tools. Jim explains, “I didn’t find out about PeerWell until the time of my first surgery. I just stumbled upon it and then found out about the range of motion app. I immediately wanted it. On a smaller scale to the whole robotic arm thing, but in a similar ‘tech’ way, I just wanted it.”
And just like that, despite describing himself as “not a techie” and someone who has “no particular computer aptitude,” Jim volunteered to trial test PeerWell’s in-app range of motion tool.
Jim became one of the first people in the world to test and record his range of motion at home with just a smartphone. Jim admits to becoming “fixated” with measuring his range of motion with PeerWell’s in-app tool. “I used it every day for 2 weeks. I used it at the same time as doing physical therapy and was pretty obsessed. I even showed my physical therapist the app and she was very excited,” he recounts.
Making a great analogy, Jim equates trying to improve knee range of motion after surgery without PeerWell’s ROM assessment tool to “trying to lose weight but not having a scale at home.”
Jim is a fearless advocate for his own health and well-being. He refuses to let injury and even surgery derail his plans for an active and full life—even If it means stepping outside of his comfort zone and leaning on new technology. Jim volunteered to be the guinea pig for a new surgery method and tested range of motion mobile technology.
Jim is living proof that regardless of age, adopting technology and facing discomforts head on can pay off big time. For these reasons, it’s no surprise that as of this writing, less than 3 months after a double knee replacement, he’s playing tennis again and hiking in Rocky Mountain National Park.
Rapid Fire Questions
1. What advice do you give people preparing for a replacement?
J: Do the Prehab. Do the research. I saw the people who said they didn’t do any, and that’s fine, but it’s not me. I wouldn’t be able to do that. Find a high-volume surgeon—somebody who does replacements all day long. That’s the most important thing. And go robotic if you can.
2. What is something that caught you off-guard about knee replacement surgery?
J: The left was the opposite of the right.
As noted above, Jim described in our interview that his left replacement behaved in an opposite way to his right: “They reacted in opposite fashions. The right bent right away, but had more trouble getting straight. The left one was flat as a pancake.”
3. Describe your replacement in one word.
4. Rate your entire joint replacement experience on a scale from 1-10 (1 being the worst thing ever and 10 being the best thing ever).
5. If you could tell yourself something at the beginning of your journey, what would it be?
J: I would say there’s no need to be scared. It’s not as bad as you think. The excellent surgeon’s assistant said, “In the first 2 weeks afterwards, you’ll be wishing you hadn’t done it.” This was not true for me. It wasn’t as bad as I thought it would be, and I knew it would get better. And a tennis player I traded emails with said, “Those first 2 weeks will be the worst 2 weeks of your life.” My reaction to this is that “Oh my God, he must have had a pretty seamless life. I have had many worse weeks than that. Those ones didn’t even come close!”
If you do everything right, including being careful, and do everything they tell you to do, there’s no need to be scared.
Are you getting ready for a joint replacement? Sign-up for PeerWell and start PreHab today. To talk to those recovering from knee replacements, like Jim, join our supportive Facebook community for joint replacement recipients!