Open Debridement and Proximal Z-plasty

[missmyknee]

Hi Janet

Thank you     Yes, it is good to be home !

Made it home safe and sound, all 10 hrs......the Fall leaves thru Hoosier Nat'l forest were beautiful 

I brought the power converter my kids use for their Playstation when we travel. It worked very well for my Polar care , so I iced most of the way home. Found another nifty use for my Polar care unit....while my knee was cooling down, I also had a pkg of lunchmeat, some cheese ( I didn't want to throw them away when we left) and 2 cans of soda cooling down it it too. 

PT session on Saturday included a long session of patella mobes and hamstring massage. Patella mobes produced another POP in scar tissue, where the PT said my patella moved alot easier after that POP.   

Tomorrow I start hometown PT at 8 am. 

Pam

[missmyknee]

Yesterday was my first PT session at home. I had to go over all the details of my therapy , with the therapist. My therapy has to be monitored closely for how my knee reacts. I am not supposed to push anything. I felt rushed on some things and the clock was being watched. Time was not a factor in Cincinnati. Patella mobes were done, but the quality was missing, as far as feeling inside the knee , the areas of catching, thickening, stiffness. Then came the passive overpressure flexion from the therapist. I had to explain several times I am to only stay between 90-100 on flexion. I was taken beyond my perameter, past 100, very painful and stiff. I am paying the price.....my knee swellled up, hot and became more painful 3 hrs after PT. Today it has not changed and it was difficult getting a shoe on. So a discussion with PT will be done tomorrow.

I also got a call from the doctor's nurse. She was asking me all sorts of questions about my knee. How the incision looked, any redness, fever, drainage. I thought this was alittle strange as I had never been questioned like that before. I found out they drew a fluid sample from my knee in surgery. The results came back and showed bacteria in the fluid. I did have some red areas and ran a low fever just days post op, but this cleared up. I also received 4 IV doses of vancomycin and was on Cipro for 10 days. Blood tests 4 weeks prior to surgery were neg for infection. I was told since it took 9-10 days to grow the bacteria out, they were leaning more to the sample being contaminated , rather than an infection. So now I am back to monitoring my temp and my incision site. I informed her of my PT session yesterday and how flexion peramemter was not followed. They were very concerned. She stated that they would prefer me to stay for a prolonged period of time in Cincinnati, to do my rehab. I would love to do that , unfortunately I cannot take that much time away from my family. I said my downfall is when I return home. She said if it continued, I need to call and have their PT call and talk to my PT.

We'll see what tomorrow brings.

Pam

[Janet]

Pam, I am so furious at your PT! Why do they think they know better than the instructions given by the OS? And especially with a patient like you who knows more about your own knee than they could possibly know? Very frustrating. After my TKR, I had a great home PT. She listened to everything I told her about walking the line between pushing and pushing too hard. Unfortunately, one session did push harder (with my approval....really trying to get it to bend) and by the next time she came two days later, I had lost flexion and the scar tissue was growing. But she was very interested in my story and how my knee reacted. Even dealing with lots of TKR patients who needed MUAs, she had never heard any of this kind of scenario before.

I hope your knee calms down soon and your PT will listen you now. If not, call out the "big guns" and have the people in Cinci call. As you know, you need to use every tool at your disposal!

Janet

[missmyknee]

Janet

Dr Noyes nurse was not happy to hear this news and asked why they would do this with the doctor's script for PT. She was pretty mad. That's when she said they would prefer I stay in Cinci to rehab for a prolonged period of time.  I told her I went over all my rehab , I pointed out the flexion perameters and verbally repeated them several times, but this person just went ahead and pushed me beyond 100  I've been working with this PT for a long time and he knows my problem. I even copied Dr Noyes tutorial and gave it to him. I don't know how many times I have to state that I have to keep my knee calm and not flare it up with PT progressed too fast. I'm not even allowed to use any of the exercise machines for several months. As for patella mobes, in Cinci they take the time to actually feel all around the knee for areas of tighness, catching, sticking, thickening or ropelike. They don't just limit it to moving the patella around. On Saturday my mobes lasted almost 20 min because there was an area where it was sticking, that finally popped. My knee is still quite irritated this eve. This is also my week to be off the Celebrex...as they alternate taking Celebrex one week and off the next.

Tomorrow is another session and also clipping my suture ends.

Pam

[skibum9]

Pam-

I'm starting to feel fortunate to have found a PT (second time around) with a clue in my home down. I don't agree with all their methods (fibrotic release with sharp instrumentation, and 2 on 1 for bending). They are very careful on my lateral side they can see and feel all the wires. Most of the exercises are for strength, good thing my home program provides for balance and quad control.

I doing the 2 weeks on, 2 off, 2 weeks on with the Celebrex. Is this something you should ask the doc about?

Sharon

[missmyknee]

I am now 2 weeks post-op

Today was my 2nd PT appt at home. Monday's appointment proved to be disasterous for my knee because I was pushed beyond my flexion perameters against doctor's PT script orders.

Today had a discussion with PT. I was asked how my knee was doing and I said not good at all. I told him how my knee reacted to Monday's session with big increase in swelling , so much so, that the swelling is down into my foot, which it has never done. I also said I had increase in pain and had to hit the percosets and it was hot. I iced down all day on the polar care. He asked what did I think caused that and I said the flexion going beyond the perameters set for me. I also mentioned the doctor's office had called to check on my knee and told them about the reaction to PT. He seemed very concerned . I explained again that my PT is very specific for my arthrofibrosis. I said right now I am in a critical time period of healing and rehab. My progress is not neccessarily measured in numbers , but how my knee reacts to therapy. Progress for me would be little or no swelling,pain and heat with my rehab. I can progress to the next level when that is under control. I said even though you think I can go beyond 100, I can't on the basis that my knee is reacting to this flexion in a negative and detrimental way. I explained that when my knee becomes swollen, painful and hot, it is inflammed and that is the condition that makes it ripe for scar tissue production. I said my PT is not like anyone elses in this PT room.  What I ended up doing is, I said, I'll hold the goinometer at 100 degrees on my knee while you do the passive flexion. That way you will know when to stop. So we did it that way. The rest of the exercises were done per script.

I hope I finally got across how my PT is to be done and why it is done this way. Hopefully he understands now. So far my knee has not gotten any worse from today's session. Clipping the suture ends was unenventful.


Sharon....I think they are doing my Celebrex this way is because of my Gastritis I have from yrs of Ibuprophen use. Two weeks for me would be rough on my stomach.

Pam

[missmyknee]

Cat

I sent you a PM

How are the hairy beasts doing ?     Did they miss you ?

Pam

[Janet]

Pam: I'm glad you were able to have a frank discussion with your PT. I hope you're right that he now "gets it." You go, girl, for sticking up for yourself! What was done can't be undone, but hopefully you won't have any problems with him in the future.

Janet

[missmyknee]

Had 3rd hometown PT session today. It took 4 days for my knee to come down from Monday's PT session . That session was not done per Dr's PT orders and went beyond my flexion perameters. The swelling has finally left my foot and pain levels are down to a 5-6. After today's and Wed session, I think I finally made headway on PT's understanding of my arthrofibrosis, although you can tell he just wants to take my flexion beyond 100 degrees, but is restraining himself . This morning he could feel how hot my knee was and remarked on the heat in my knee, before he did mobes. I think he was really surprised to feel that much heat. Monday I'm getting a different compression sock. This one will provide more compression for the swelling and allow me to take off the full ace wrap. This is being done because I am supposed to be in my Donjoy Defiance brace. I can't fit it over an ace wrap.

Pam

[skibum9]

Hi Pam-

How is your knee doing this week? Hopefully your hometown PT is still taking it easy with the flexion.

I think I finally have my hometown PT trained not to force my knee beyond it's limits. They do all their manual stuff and then let me provide overpressure by sitting on a stool. My active flexion is up to 125 and the passive is holding steady at 130. Extension seems to be within a couple of degrees of straight, but they have only measured it once in 5 weeks.

Sharon

[missmyknee]

Hi Sharon

I think I made headway with my PT's understanding. I hold the goinometer, while he pushes...gently. I also have pushed myself with my other leg, while he holds the goinometer. I got myself to 100, without too much pain. I am on the Celebrex this week , so we'll see if it helps. I did get the new compression stocking , but don't really care for it. The compression is uncomfortable, it falls down too easy and my brace slips off of it easily, too. I think I'll go back to the white tedhose.

I also tried the recumbant bike. CSM said I could try the recumbant bike as long as I just rock back and forth..no full revolution. I thought I would do 10 min, but only did 5, because the knee swelled right before my eyes. I don't think I am ready for that yet. The medial side is the worst. There is still alot of heat in the knee which gets worse with any activity.

I did hear from J again. I also emailed Tim to give him an update . 

I go back to Cinci for a Nov 27th appointment.

You sound like you are doing well and keeping your flexion very well. Are you doing formal PT, if you are , are they doing the instrumentation ? Keep up the good work. Any word on PT/ins issues ?  I did say "HI" for you, to J.

I have PT wed and friday this week.

Pam

[skibum9]

Hi Pam-

Glad to hear that the PT is starting to understand. Sounds like the new compression stocking isn't working out. When I was having the skin sensitivity issues along with minor swelling several weeks after the surgery, I cut the foot off the white tedhose. It worked out pretty good since I didn't have any swelling in my foot and it made it easier to get on and off.

In general I'm doing pretty well, but pain and stiffness are still a huge issue. I'm still doing formal PT twice a week and the gym 3 to 4 time a week. I tried dropping to once a week for PT, but could tell a difference. They use the sharp instrumentation periodically. Still battling the insurance issues. The CA wildfires slowed things down since our corporate office was closed last week and folks were evacuated.

My next appointment in Cinci is on Nov 15. I hope I can get a date scheduled for the surgery to remove the wire. I can see and feel the wire on the lateral side of the patella and patella tendon. It freaks people out when I'm rubbing my knee and they ask about it. I haven't quite figure out where the wire is on the medial side.

Keep up the good work at PT.
Sharon

[missmyknee]

4 weeks post-op

I am 4 weeks post op. This week I am off the Celebrex. My knee is some what better with regards to heat....so far. I am not hot 24/7 , only when I do any activity. I walk mostly around house with 1 crutch or no crutch. I still use 2 crutches outside the house. Hopefully as the week goes on, it won't get worse because of no Celebrex. This week added some changes to PT. I am doing,

Calf stretches
Hamstring stretches
calf raises
Quad sets
long arc leg extension
SLR with 3 lb weight
SLR, right side, with 3 lb weight on thigh
Patella mobes....lots of them, several times/day
over pressure flexion, I can now get to 105, without too much trouble. Extension is 0
recumbant bike, rocking back and forth, 5-10 min
pillow squeeze
E-stem
Ice ( I use a Game Ready unit in PT, this provides icing and compression together...I love this machine)

Last week patella mobes done by husband produced another 2 scar tissue "pops" on the lateral side. Today's mobes are producing a lateral click...haven't felt that before. Still swollen and very tender to touch below patella and medially. I am still wearing compression stocking for swelling. I had 3 episodes over the weekend where I got a very , very sharp pain, just below the patella while walking. When this same pain happened after May's surgery, I was developing scar tissue.   


Pam

[missmyknee]

6 weeks post op

Not too much change in the knee at this point. I still am getting quite a bit of swelling , heat and burning pain with any activity, but not 24/7. Trying one crutch. Have been on Celebrex for anti-inflammatory and icing. Still have tissue catch on lateral side of patella. PT at this point consists of :

calf stretches
hamstring stretches
patella mobes
SLR with 3lb weight
long arc leg extension
standing hamstring curl
standing one legged balance
mini squat
recumbant bike
ERMI...felxion is about 110 with work.
e-stem
ice machine

Have next post-op check next Tuesday. Will ask about this constant deep burning pain in knee. Ice calms it a bit but it comes back. Burns all under Pat tendon and whole medial side. It drives me crazy at times. Also have some topical skin sensitivity.

Pam

[Janet]

Pam: I also had that intense burning pain, especially in the patella tendon/fat pad area. I had to work through it at PT or I wouldn't have been able to do anything. I'm pretty sure I remember them saying it was tendonitis. It eventually went away, but I sure wish they would/could have done something to help the pain. I hope they can do something for you, since it will make your recovery easier.

Janet