“You should have your internist prescribe anti-depression medications,” my orthopedist told me.
My wife and I looked at each other, bug-eyed, in total disbelief. After all, I hadn’t gone to my one-month post-op clinic visit following a total knee replacement seeking psychiatric advice.
My knees went bad when I was a teenager because of a rare condition known as osteochondritis dissecans. The cause of this disease remains unknown, but its effects are clear. By the time I was twenty years old and heading to medical school, I had already had dead bone sawed off and extensive reparative surgery in both knees. Over the next forty years, I had to progressively curtail my physical activities, eliminating running, tennis, hiking, and elliptical exercise. Even walking became painful, despite injections of steroids and synovial fluid directly into the knee. And so at age sixty-two, I had my left knee replaced, one of the more than 800,000 Americans who have this surgery, the most common orthopedic operation. My orthopedist had deemed me a perfect candidate: I was fairly young, thin, and fit. He said the only significant downside was a 1 to 2 percent risk of infection. I was about to discover another.
After surgery I underwent the standard—and, as far as I was told, only—physical therapy protocol, which began the second day after surgery. The protocol is intense, calling for aggressive bending and extension to avoid scar formation in the joint. Unable to get meaningful flexion, I put a stationary bicycle seat up high and had to scream in agony to get through the first few pedal revolutions. The pain was well beyond the reach of oxycodone. A month later, the knee was purple, very swollen, profoundly stiff, and unbending. It hurt so bad that I couldn’t sleep more than an hour at a time, and I had frequent crying spells. Those were why my orthopedist recommended antidepressants. That seemed crazy enough. But the surgeon then recommended a more intensive protocol of physical therapy, despite the fact that each session was making me worse. I could barely walk out of the facility or get in my car to drive home. The horrible pain, swelling, and stiffness were unremitting. I became desperate for relief, trying everything from acupuncture, electro-acupuncture, cold laser, an electrical stimulation (TENS) device, topical ointments, and dietary supplements including curcumin, tart cherry, and many others—fully cognizant that none of these putative treatments have any published data to support their use.