Knee #2, my right, is scheduled for August 25!

The left one was first and occured on Tuesday June 2.

Total knee replacement is one of the most successful procedures in all of medicine. According to the American Academy of Orthopaedic Surgeons, more than 700,000 total knee replacements are performed annually in the U.S.

I have previously had orthoscopic surgery to remove a torn meniscus on my left knee.

This is an explanation of what is happening and why my manual left knee surgery was a little more complicated than the upcoming Mako Robotic right knee surgery.

Dashboard

Left Knee Countdown

Loading…

Tuesday June 2

Right Knee Countdown

Loading...

Tuesday August 25

Completed Milestones

✅ Saturday May 23 — CT scan completed
✅ Thursday May 28 — Pre-op appointment with Zachary Christopher Lum
✅ Thursday May 28 — X-rays completed
✅ Thursday May 28 — Labs completed
✅ Sunday May 31 — Chlorhexidine shower 1 of 3 completed
✅ Monday June 1 — Chlorhexidine shower 2 of 3 completed
✅ Tuesday June 2 morning — Chlorhexidine shower 3 of 3

Active Prep

🟢 Thursday May 28 — Wegovy hold started
🟢 Thursday May 28 — CoQ10 hold started
🟢 Thursday May 28 — Skin lotion hold started
🟢 Thursday June 18 at 2:30 PM — Surgical follow-up with Aleksandr Palenyy

Critical Times

🟠 Monday June 1 at 12:00 AM — GLP-1 no-solid-food plan should have started
🟠 Monday June 1 at 10:00 AM — Solid food stopped after corrected fasting instructions were discovered
🟡 Monday June 1 until 10:00 PM — Full liquids and clear liquids only
🟠 Monday June 1 at 10:00 PM — Clear liquids only
🔴 Tuesday June 2 at 10:19 AM — Nothing by mouth starts
🔵 Tuesday June 2 at 12:19 PM — Left total knee replacement

Upcoming

⚪ July 17 at 2:15 PM — Surgical Follow-Up with Dr. Lum
⚪ August 25 — Right knee surgery date

Clear Liquids After 10:00 PM

✅ Water
✅ Approved clear sports drink
✅ Ensure Clear
✅ Filtered apple juice or white grape juice
✅ Black coffee
✅ Plain black tea
❌ No lemon, milk, cream, plant milk, sugar, sugar substitutes, or creamer

Chlorhexidine Shower Plan

✅ Sunday May 31 night — Shower 1 completed
✅ Monday June 1 night — Shower 2 completed
✅ Tuesday June 2 morning — Shower 3 completed
✅ Full body, chin to toes

Vibe Updates

Monday June 1 evening

The night before surgery

Shower 2 of 3 is done. The fasting plan was more complicated than it should have been, but I clarified it directly with anesthesia and adjusted the plan.

Current vibe: focused, irritated by unnecessary communication failures, but still moving forward.

Tuesday June 2 morning

Surgery morning

Final shower completed. The plan is nothing by mouth starting at 10:19 AM, with surgery scheduled for 12:19 PM.

Current vibe: ready to get this done.

Tuesday June 2 ~ 9:45 AM

I'm here!

I have arrived at the hospital.

There were two hiccups by the orthopedic team, one of which I have resolved.

Start time: 6/2/2026 11:30 AM
End time: 6/2/2026 11:48 AM

Ropivacaine Nerve Block

Anesthesiologist: Chen, Amy, MD
Fellow/Resident/CRNA: Bernstein, Hunter, DO

Procedure Pause

Procedure pause and verifying correct patient, medical record number, allergies, medications to be administered, and current vital signs was documented in the Pre-procedure Flowsheet.

Preanesthetic Checklist

IV checked, site marked, monitors and equipment checked and oxygen available.

Peripheral Nerve Block

Patient position: supine
Prep: ChloraPrep
Block type: fem/adductor canal
Laterality: left
Injection technique: single injection

Procedure Details

Needle type: short-bevel
Needle gauge: 21 G

Hand-off

1. Patient status reported to RN and care transferred.
2. Post-procedure observation per protocol.
3. Patient condition: stable to the OR and good.

This is the ultrasound of the big needle inserted into my leg.
---

Ultrasound Evaluation

Using ultrasound, anatomic structures were evaluated as normal. Ultrasound was used to identify needle positioning and the spread of local anesthetic in close proximity to the nerve being blocked. Images are archived via PACS.

Assessment

Injection assessment: patient conversational and tolerated procedure well, incremental injection, local visualized surrounding nerve on ultrasound, negative aspiration for heme, injected with ease, no paresthesia on injection and patient tolerated procedure well.

6/2/2026 ~ 12:00 PM

On my way in to the OR right now, more later....

6/2/2026 ~ 3:00 PM

Woke up!

Everything went according to plan. YAY.

The hospital is doing a good job with pain management, including several injections of fentanyl.

First therapy session went well. I was able to stand up using a walker and take a step to the left and a step to the right.

The plan is to discharge tomorrow.

KNEE 1 OR 2 VIEWS, LEFT EXAM DATE: 6/3/2026 11:40 AM

COMPARISON: Prior examination done on 5/20 eighth/26

INDICATION: AP and Lateral, Post Total Knee arthroplasty

TECHNIQUE: Two projections

FINDINGS:

Status post left total knee arthroplasty. Hardware is intact. No acute fracture. Expected postsurgical changes with soft tissue edema, soft tissue and intra-articular gas.

Partially included IM nail. Chronic fracture deformity of the proximal fibular shaft.

6/2/2026 ~ 3:00 PM

The Big Reveal!

The doc says my left knee looks fantastic.

He said Dr. Lum still needs to decide when my right knee can be scheduled.

Here is a picture of my scar and my x-rays:

6/27/26

I want this behind me so I can get better and walk.

And cook. And fish. And mushroom forage all fall and winter long!!!
I really don't want to wait 58 days!
I really don't want to go back to Fort Bragg in a couple of weeks and then have to wait until August 25th to have my right knee done, so I have been messaging the nurse to see if it can be moved up.
Oh, and stay tuned. I am applying for a couple of jobs....

Fasting Instructions Documentation

UC Davis apparently provided the corrected GLP-1 fasting instructions to the SNF rather than directly to me. The SNF did not inform me or implement the corrected plan. I learned the plan Monday morning after LVN Michal returned the call. I then contacted anesthesia directly, disclosed that I had eaten breakfast, and stopped solid food at 10:00 AM. Surgery was not rescheduled. Going forward, all critical perioperative instructions should be communicated directly to me in writing, not verbally relayed through facility staff.

Anatomy

The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities.

The knee is made up of:

The lower end of the femur (thighbone)
The upper end of the tibia (shinbone)
The patella (kneecap)

The ends of these three bones are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily within the joint.

The menisci are located between the femur and tibia. These C-shaped wedges act as shock absorbers that cushion the joint.

Large ligaments hold the femur and tibia together and provide stability. The long thigh muscles give the knee strength.

Total Knee Replacements (TKA) Surgery

The Zimmer Biomet Persona Cementless Total Knee utilizes Trabecular Metal technology to provide stabilization and biologic fixation during complex primary and revision knee arthroplasties.

Pre-surgery X-Rays

The x-rays show why this is not a completely standard mechanical setup. The existing tibial rod and upper hardware were considered when the surgeon selected the appliances and surgery methodology for the left knee replacement.

Knee Implants

Specifications

Femoral implant interchangeability with Stemmed Precoat, A/P Wedge and Trabecular Metal tibial components
Up to 125°-155° Femoral ROM

Total Knee vs. Partial Knee

Total Knee Arthroplasty (TKA) is exactly the same surgical procedure as "total knee replacement," the patient-friendly name for the operation.

A TKA replaces the main joint surfaces of the knee: the femoral side, the tibial side, the plastic bearing surface between them, and the kneecap surface.

A partial knee replacement replaces only one damaged compartment of the knee.

An Important Difference

I received a TKA that retained the titanium hardware I already had inside my left tibia.

Dr. Lum decided to leave that hardware in place and selected an implant strategy that worked with it.

It's possible that the press-fit two peg system will have a shorter longevity (10 - 15+ yrs) than a long central keel. This will have to be monitored over time.

Zachary C (Zach) Lum, D.O.
Assistant Professor, Orthopaedic Surgery
Specialties: Orthopaedic Surgery, Orthopaedic Surgery - Joint Replacement for Hip and Knee, Joint Replacement

UC Davis Link: Zachary C (Zach) Lum, D.O.

Dr. Lum is a fellowship-trained, board certified orthopaedic surgeon who cares for patients with various musculoskeletal conditions. He is trained to manage sports medicine injuries, fractures, and conditions of the upper extremity. He has specialized expertise in hip and knee reconstruction and revision arthroplasty, and is trained in computer navigated and robotic hip and knee replacement.

Recent Publication

Lum ZC. Can Artificial Intelligence Pass the American Board of Orthopaedic Surgery Examination? Orthopaedic Residents Versus ChatGPT. Clin Orthop Relat Res. 2023 May 23. PMID: 37220190

UC Davis Medical Center is a nationally recognized academic medical center in Sacramento, California, serving as the primary teaching hospital for the UC Davis School of Medicine and offering comprehensive care in over 150 specialties, including a Level I trauma center, a comprehensive cancer center, and a nationally ranked children's hospital. It is known for its advanced care, research, and commitment to diversity, providing services from primary care to complex treatments for all ages.

Mako Robot

SmartRobotics™ is designed to elevate surgeon control and confidence and optimize implant placement by combining 3D CT-based planning and AccuStop™ haptic technology.

The Mako robot is a robotic-arm assisted surgical system that operates using a patient-specific 3D CT scan to guide orthopedic surgeons with extreme precision, potentially reducing pain and speeding up recovery times.

Personalized 3D Planning: Before surgery, a CT scan was performed to create a 3D virtual model of my exact joint anatomy.
The surgeon creates a personalized surgical plan, pre-determining the precise placement, sizing, and alignment of the joint implant.
AccuStop Technology: During the procedure, the robotic arm aids the surgeon in removing the arthritic bone and cartilage. Built-in haptic (tactile) boundaries prevent the surgeon from straying outside the pre-planned area, ensuring only diseased tissue is removed while healthy bone and ligaments are protected.

Benefits

Accuracy: Highly accurate implant placement that matches your unique anatomy.
Minimally Invasive: Smaller incisions, bone sparing, and less damage to surrounding soft tissues and ligaments.
Faster Recovery: Patients often experience reduced post-operative pain, less scarring, and quicker joint function recovery compared to traditional techniques.

Why the Mako Robot Is Not Being Used on My Left TKA

Robotic knee replacement systems depend on precise mapping, tracking, and mechanical planning. In my case, the tibial rod and nail/screw hardware are already occupying space in the bone.

Rather than forcing the robot into a situation where the existing hardware could interfere with the surgical plan, my surgeon is doing the knee replacement manually. Manual total knee replacement is still a standard surgical approach. The key point is that the surgeon is planning around the hardware that is already in my leg.

Smith+Nephew is a portfolio medical technology company focused on the repair, regeneration and replacement of soft and hard tissue.

The PICO 7 is a canister-free, single-use negative pressure wound therapy (sNPWT) system. It continuously delivers a targeted negative pressure of -80 mmHg to surgical incisions to manage exudate and promote healing.

Why I Have a PICO Negative Pressure Dressing

After surgery, the incision needs a clean, protected environment so the tissues can heal properly. The PICO system is a small negative pressure wound therapy device. Instead of being just a regular dressing, it gently applies controlled suction over the wound area.

That gentle suction helps pull the edges of the incision together, removes extra fluid from the area, and may reduce swelling around the wound. It also helps keep the dressing sealed and protected from outside contamination.

The main benefit is that the dressing is actively helping manage the wound environment instead of simply covering it. This kind of dressing can give the incision extra support during the early healing period.

The pump is small and lightweight, so I can move around more easily while still receiving the negative pressure therapy.

Helps protect the incision
Applies gentle negative pressure over the wound area
Helps remove excess fluid from the dressing area
May help reduce swelling around the incision
Supports a better healing environment
Allows more mobility than traditional larger negative pressure systems

The pump also has alerts for common problems such as an air leak, low battery, or a dressing issue. That makes it easier for staff and patients to know when the system needs attention.

TR CC Knee Brace

Full range knee recovery by combining motion, cold therapy, and compression

During the recovery phase following knee surgery, prioritizing the reduction of swelling and pain while preserving full range of motion is crucial.

The TR CC Knee is a patent-pending hinged knee brace that facilitates complete range of motion while concurrently administering cold therapy and compression.

By addressing swelling and pain effectively, it encourages patients to maintain a straight, fully extended leg, thereby preventing the occurrence of flexion contractures.

I want to give a shout out to Mario Ayala at Pacific Medical, Inc. UC Davis Medical Center should have set me up with this device before discharge and they didn't.

Mario drove it to me at the Skilled Nursing Facility on short notice so I could have it as soon as possible. ⭐⭐⭐⭐⭐

It has been a tremendous help with both the compression and keeping the cold compresses positioned properly.

I can keep my knee straight when relaxed as well as exercise it per Dr. Lum's instructions.

I have worked with Pacific Medical in the past to get knee braces and I highly recommend them.

Physical Therapy After Knee Surgery

The Training Room NOLAUC Davis Health offers comprehensive orthopedic care and physical therapy (PT) for knee replacement recovery. The multidisciplinary team focuses on pain management, joint mobility, and restoring function.

Rehabilitation typically spans 3 to 12 months, starting in the hospital and progressing to outpatient clinics or home health care.

Phases of Rehabilitation

Recovery is divided into distinct phases to help patients transition safely back to daily life:

Inpatient (Days 1–3): Begins shortly after surgery. Therapists focus on getting you out of bed, walking with assistive devices, and performing basic mat or seated exercises to prevent stiffness and blood clots.
Early Outpatient (Weeks 1–6): Focuses on regaining your range of motion, controlling swelling, and improving leg strength.
Advanced Recovery (Months 2–4+): Progresses to functional activities like stair climbing, squatting, and endurance training. Most patients return to normal daily activities within 6 to 12 weeks.

Key Exercises

Your UC Davis physical therapist will provide a customized home exercise program (HEP) tailored to your specific needs.

Common movements include:

Ankle Pumps & Quad Sets: Gentle contractions to promote circulation and wake up the thigh muscles.
Straight Leg Raises: Tightening the quad muscle to lift the leg, which prevents the knee from buckling when you walk.
Heel Slides: Bending the knee while seated or lying down to gradually improve joint mobility.
Gait & Stair Training: Practicing walking on level ground and navigating stairs safely.