Until just a year ago, Renee Cleaver had spent most of her life in pain. Seemingly simple everyday motions like standing up or walking down a flight of stairs were a struggle for the 52-year-old Harrisonburg resident. At age 12, Cleaver tore the anterior cruciate ligament (ACL) in her left knee while playing soccer, then tore her other ACL one year later. Over the years, the pain became nearly constant, affecting almost every facet of her life, and throughout that time she had been unable to find relief—until she went to Sentara RMH.
The ACL is the key ligament that stabilizes the knee. These days, patients almost always have surgery to repair a torn ACL, but several decades ago Cleaver used a combination of physical therapy and strengthening exercises in an attempt to rehabilitate her knees. When those techniques didn’t work, she underwent separate ACL surgical repairs at ages 17 and 18.
Unfortunately, the procedures didn’t provide the solution she had hoped for. She developed arthritis in her knees and had to wear knee braces when participating in sports and other strenuous activities, and the pain grew progressively worse. Traveling for her job as a salesperson was an endurance test. And although Cleaver is an avid music fan, she could no longer attend concerts, since they required too much standing.
“I had gotten to the point in my life where standing for 30 seconds was painful, and standing up after being seated was very, very painful,” she recalls.
She tried to compensate for the pain with large doses of ibuprofen, but she worried about what the medication might be doing to her body.
“I stopped living in a lot of ways,” she says. “I felt like my world had come to a screeching halt because of my knee pain.”
Exploring Her Options
Cleaver knew that if she wanted to lead a normal life, doing nothing about the problem was no longer an option. In talking with sports medicine physician Thomas Weber, MD, of Sentara Orthopedic & Sports Medicine Specialists in Harrisonburg, she learned she needed total knee replacements to help eliminate the pain.
“Dr. Weber started the conversation about next steps,” Cleaver says. “He was an integral part of my care leading up to surgery.”
To help move Cleaver’s treatment plan forward, Dr. Weber recommended that she see Sentara RMH orthopedic surgeon Frank Cucé, DO.
“I was so impressed with Dr. Cucé!” Cleaver says. “He was honest, upfront and kind. He made it very clear what my risks were, and that the recovery process was going to be extremely difficult.”
Cleaver wanted to have a bilateral knee replacement, meaning she would have both knees replaced at the same time—a less common surgical option for patients, according to Dr. Cucé.
“Most patients have one knee replacement surgery, followed by the second surgery three months later,” he says. “But it made sense for Renee because she didn’t want to take additional time off work. Plus, she didn’t have a ‘good knee’ to support her during recovery.”
Dr. Cucé agreed that a bilateral replacement was the best option for Cleaver.
“She had very bad knees, so operating on one knee and leaving the other actually would have inhibited her rehab,” he explains.
Preparing for Joint Replacement Surgery
First, Cleaver needed to get her body ready for surgery and recovery, so she began exercising before she even met with Dr. Cucé for the first time. Thanks to her persistence, she eventually lost 30 pounds.
“I knew it was going to be an extremely difficult rehab, and to have extra weight was going to make it that much more difficult,” she says.
Cleaver also benefited from the Sentara RMH team’s preoperative joint education class, where patients learn what to expect during and after surgery. The class covers everything from the preoperative to postoperative aspects of patients’ joint surgery, including preparing the home environment for their return from the hospital, making other discharge plans, learning about equipment such as walkers they will need in their home, and getting their muscles in shape for the recovery process. Class participants then have a question-and-answer session with staff and meet their physical therapists.
“Sentara RMH does a really good job of preparing you for what you’re facing,” Cleaver says. “They’re obviously very focused on making this a successful program for their patients, and ensuring that patients have as much knowledge and preparation as possible.”
Tonya Turner, BSN, RN, coordinator for the Sentara RMH joint and spine program, says most knee replacement patients attend the presurgery class and, ideally, are scheduled for the class with others who will be having surgery the same week. Six weeks after surgery, the hospital holds a reunion luncheon where those same patients can discuss their progress and share feedback. The group atmosphere promotes community and camaraderie among patients, according to Turner.
Even though she was already getting her body ready for surgery, Cleaver says meeting with the hospital staff and physical therapists before surgery still helped with her preparation and recovery.
“This surgery is very hard on your body, so you need to be as prepared as you can be, mentally and physically, for the procedure,” says Turner. “Renee’s weight loss prior to surgery really made a difference in her recovery.”
In fact, Turner adds, new guidelines recommend that hospitals perform total knee and hip replacements only on patients whose body mass index (BMI) is under 40, because a high BMI often contributes to complications and poor outcomes.
Knee Surgery and Recovery
Knee replacement is a major surgery, according to Dr. Cucé.
“Essentially, the ends of the bones are cut and resurfaced with metal and plastic in between, and often the patella, or kneecap, is also resurfaced,” he says.
At Sentara RMH, joint surgery patients like Cleaver stay on a designated floor, with a nursing and physical therapy team specifically trained to provide coordinated, specialized care for each joint surgery patient. These nurses understand the importance of physical therapy and how it helps a patient recover more quickly. They know how to handle the equipment used during patients’ recovery, and how to manage postsurgery pain effectively.
“The inpatient physical therapy team designated for joint patients is located on the same hospital floor as the nursing unit, which is a great convenience for both patients and staff,” says Turner. “Patients typically have group physical therapy together so they can encourage and motivate each other.”
Cleaver had her bilateral knee surgery in early November 2017. Having both knees replaced at one time is challenging, and Cleaver doesn’t hold back when talking about the recovery process.
“You have to learn how to bend and straighten your leg all over again, and your body doesn’t want to do it because there’s so much swelling in there,” says Cleaver. She used a walker to get around during her recovery, since she couldn’t rely on either leg.
“During physical therapy there were three or four days that were probably the most difficult of my life,” she says, “but the physical therapists were just fantastic. They knew just how to work with me for the best outcome.”
After she left the hospital, Cleaver continued with outpatient physical therapy, and the pain eventually went away after several months of perseverance.
“I’m very proud of Renee as a patient,” says Dr. Cucé. “She had to overcome significant obstacles, including major surgery and intense rehab. I often tell my patients that, when it comes to knee replacement, I do the ‘easy part’ and they have the ‘hard part.’”
New Knees and a New Life
All the effort was worth it for Cleaver, who is now living the life she had wanted for so long.
“Once you’re out of that pain zone, it’s amazing,” she says. “The impact was tremendous—just losing the mental stress and no longer having that looming over me! There’s lightness in the fact that I know I can hop up out of my seat to answer the door or pick up the phone. And now I can trust my knees to go down steps. I used to take one step at a time, but I don’t even think about it now.”
Five months after surgery, Cleaver traveled to London to visit one of her daughters who was studying abroad. Her new knees took her up the more than 1,000 steps to the top of St. Paul’s Cathedral, for breathtaking views of the city skyline. She has also attended—and stood for—three Dave Matthews Band concerts since her surgery. She rides her recumbent bike every day and looks forward to daily walks with her dog, Riley.
“Walking is my time to enjoy the outdoors and enjoy the fact that my knees work,” she says.
Knee replacements last an average of 15-30 years, says Dr. Cucé, so there’s a chance Cleaver will need surgery again when she’s older—but she’s more than willing to go down that path, if needed.
“Dr. Cucé is obviously an excellent surgeon,” she says. “He and his staff were wonderful. They’re a very good team, and they work well together. I really felt like I got great care at Sentara RMH.”
Is Joint Surgery for You?
If you’re wondering about surgical options for your knee, shoulder or hip pain, contact Sentara Orthopedic & Sports Medicine Specialists at 540-689-5500.