Orthoglide medial knee implant 6 wks post op

[lcfuller]

So background first I guess. 2 years ago I had arthroscopic surgery due to a meniscal tear, during the surgery they discovered that I also had very little cartilage left in my knee. This was unusual because I am only 26 years old.  At this point the only option was knee replacement and no doctor would do a replacement on an otherwise healthy 26 year old so I was out of luck. Fortunately for me a new technology became available in the US about 16 months ago now. This was a small implant that fits between the femur and the tibia. There are no screws, no glue and no bone cutting.  There are still very few docotrs in the US that do this procedure and I was lucky enough to live in an area with one.

The problem with such a new procedure was that I couldn't find much information on what to expect post op and my doctor wouldn't tell me anything beyond everyone recovers differently (no kidding).  So while yes, everyone does recover differently here is the story of what I have gone through so far.

December 18th surgery day. In preop I was given a femoral nerve block, unfortunately due to my age and the muscle mass of my leg they had a hard time getting the block in the right place. Even with drugs to make me not care I remember the entire thing and I did care. Getting the block was not fun, in order to check the placement they send electrical impulses to make the muscles contract. Normally this isn't a big deal because they don't have to do it very many times. However in my case it took many, many tries.  Eventually they did get it in the right place and I was off to surgery.

Post op approximately 3-4 hours later. As I woke up in the recovery room I was very happy that they had gotten the nerve block in place.  I had no pain in my leg at all. When they moved me to my room where I would spend the night they also gave me a PCA (Patient Controlled Anesthesia). With my PCA I could give myself one dose every five minutes as needed for pain or discomfort.  Thankfully due to the nerve block I didn't need to use the PCA very much.

Decmber 19th Day after surgery. I was to be discharged from the hospital today.  The first order of buisness was to turn off my nerve block since I wouldn't be taking the pain ball home with me they wanted to make sure I could get around when I got home without this pain control. It was today that I realized I was wearing an immobilizer on my knee. I hadn't been told that I would have an immobilizer on after surgery.  I also became aware of a machine attached to me knee which circulated cold water over my knee to keep swelling down (I had been told about this).  Several hours after my nerve block was turned off a physical therapist came to see me to see if I was ready for discharge. In order to be discharged I had to get out of bed on my own, walk down the hallway on crutches, walk up a flight of stairs and then back down and get in a mock up of a car.  Lucky for me none of this was a problem, I think I was still feeling pretty good from the drugs I was on.  I was cleared by the physical therapist and now just needed to get the paperwork from my doctor.  So far things had been going along too well I guess because just before my doctor came in to discharge me my blood pressure dropped and I got very, very nauseous. I was given three differnet kinds of nausea medication and when I woke up about an hour later I was feeling much better.  Finally I was ready for discharge!  They gave me a bolus of nerve block before they removed it and I was off for home.

For three days post surgery I was not allowed to walk except to go to the bathroom and I had to keep the machine to circulate cold water attached to my knee as well.  After the third day I could remove the machine, but not the immobilizer and begin to move around.  I was told by my doctor that I could do whatever pain allowed.  For about the first four weeks I was using two crutches to get around.

January 2nd Post op doctors appointment.  I returned to the doctor to have x-rays, get the staples out and hopefully remove the immobilizer.  Everything was going according to plan the implant was still in the right place and my incision was healing nicely. I got out of the immobilizer and my doctor gave me a script for physical therapy.  His recommendation was for 3 times a week for 6 weeks.

January 15th first day of PT. At this point I was still having a very hard time bending my knee and was still walking rather stiff legged (like I still had the immobilizer on).  We measured the extension of my knee approximately 0°, my good knee was at 8° hyperextension and flexion, this was less than 90°( I can't remember the exact number but I couldn't pedal a bike all the way around) my good knee about 140°.  My physical therapist had to teach me what walking normal meant, though I couldn't quite do it yet, .  He also noticed that I couldn't engage my quad.  This would be a struggle to regain control of my quad.  He gave me several very painful exercises to do and told me to try using only one crutch.  He also promised aquatic therapy at my next session with him.

January 16th Day one of one crutch.  I decided to give the one crutch thing a try except for walking long distances. It worked well and I was begining to be able to bend my knee to sit normally in a chair.

January 17th Day two of physical therapy.  Success, I could pedal the bike all the way around a couple of times!  We also electrical stimulation therapy on my quad to reeducate it. I can't do a straight leg raise on my own, but I'm working on it. I am beging to be able to see my muscle in my quad contract at least a little bit.

January 22nd and 24th Week 2 of physical therapy.  Aquatic therapy is great! I can walk around in the water and try to relearn what it means to walk normal.  I can now pedal a bike like a normal person for 10 minutes.  If I don't let my foot touch the table I can do straight leg raises. Walking is getting a little bit better.  Extension of my knee 3°, Flexion about 90°.

January 28th week 3 physical therapy. Time to get rid of the crutch!  My walking is still not normal, but it's getting there. I can sit at a desk like a normal person again!  I can now start a straight leg raise by myself. Flexion has increased to 105°.  I am starting some exercises balancing on my bad leg and Wednesday I will begin doing body weight squats.

So I am 6 weeks out of surgery and things are going well. Each week I seem to be making progress toward returning to my normal life.  There is still a long way to go, but all in all I am very glad that I had the orthoglide surgery.  Hopefully I still feel that way in a few months when all the surgery pain is gone and my knee is as normal as it's going to be.

[biloxikat]

It was interesting reading about your surgery.  I remember seeing this procedure on the news.  I was very interested in it but my Dr didn't do it.  It wouldn't have worked for me anyway since I had so much damage behind my kneecap.  I hope it takes care of your knee problems.

[fitnesskitty]

This does sound very interesting I am going to go do a web search on it!  I hope you are still feeling good and progressing in PT!  Keep up the good work and best of luck to you!

Take care!

Sarah

[kimt]

Oh goodness -- I do hope this works out for you. I had the orthoglide put in last February 9th. It was a nightmare -- I finally had to have a TKR which I did January 3rd. Not once could I find anything on the orthoglide before I had that surgery. I searched sites like this and the internet etc. Only found info from the company that manufactures it and it was great news. It was the worst thing I did in my life. I pray yours is one of the few that works out. Only about 2 of the 30 that  were done in my area are happy. I thought it got better but one night in October it went out and was awful. I ended up with 3 different opinions and all were negative towards the orthoglide. I do so hope yours works out. They did mine as outpatient which was a nightmare from the beginning. Sounds like your surgeon had the good sense to keep you in the hospital. please keep us informed -- I am very interested to see how yours gets along. I wish you the best -- I had so hoped mine would be a good story. I am 47 and was 46 when they did the orthoglide -- like you, although older, they were hoping this would work so I wouldn't have to have a total knee.

[lcfuller]

 How did your orthoglide displace?  What kinds of activities were you doing?

[kimt]

It didn't displace or anything. One Dr.'s opinion is that it still shifts around even with that small lip that is supposed to keep that from happening. And another Dr. confirmed that as well. I am a failry active woman -- working as an accountant, shopping trips, and the workouts I get are at Curves, which is a woman's gym based on hydrolics. Nothing athletic though. I went to PT for three months, they never could get my leg straight. And I still had pain with every step I took. Three different OS took x-rays and were all in agreement that the orthoglide was the correct size and in the correct space. It just didn't work as hoped. I must say I hated it! The head nurse on the Orthopaedic floor of the hospital where I had my TKR said they had seen many orthoglides turn into total knees the past few months. I think there were three surgeons in my area who were doing them.

[jathib]

....Not once could I find anything on the orthoglide before I had that surgery. I searched sites like this and the internet etc. Only found info from the company that manufactures it and it was great news...

Just for future reference, never trust what you read on the manufacturer's website or on any website that will make a profit from the product. They are certainly not going to say anything bad about their product. The only thing you can really trust is an independent study. If you can't find one then in my opinion you shouldn't use the product unless you're willing to be a guinea pig. I'm certainly grateful for the doctors and patients that are will to experiment with something new but I'm not willing to be one of the first to try something. The Orthoglide certainly sounds promising but it will be years before there are any long term results. Every failure will mean more improvements.

[kimt]

Exactly!!  I knew better than trust the manufactor but it was all I could find. So I had to trust my surgeon. And I looked into the references of all the other surgeons doing this procedure and they were all first rate. I guess the only thing I would have done differently would have been to get a 2nd opinion at that time. But hindsight is 20/20 -- and it was promising and I hope one day will work. But not yet. Evidently this was done years ago and called a "unispacer" but  this time it was supposed to be improved. Anyway -- all's well that ends well and in the end I would have had to do the total knee eventually. The only bad thing is the year I went through so miserable and that I had to have two surgeries in an eleven month period!!

[jathib]

Oh yeah, I remember the unispacer. It was a total failure and disappeared from the market. I would imagine that most of the surgeons trying the experimental stuff are topnotch. Somebody has to do it and eventually they'll get it right. For now though, knee replacements are probably the best option. Some day they'll get ankle and shoulder replacments perfected as well.

[kimt]

You are right with the improvements. And that is why I have hope for the future -- hopefully when I have to have it re-done they will be all the more perfected!!! 

[lcfuller]

So it's been 10 weeks now since I had my surgery. I've been in PT for 6 weeks and it looks like that is going to be extended at least another 4 weeks, which is really frustrating because I wasn't supposed to be in physical therapy at all.  I have to say I am a little worried, things seemed to be going really well at first, but now I am having quite a bit of pain where the orthoglide is located. I'm still hopeful that it will go away with time and as I build strength in my quad.  The good news is I am off crutches completely and have been for about 2 weeks now. I still have a limp which is being referred to as my pimp stroll or my hip hop walk, but it's not too bad.  My ROM has really improved, we haven't measured it lately so I'm not sure of the numbers exactly but I can sit indian style, kind of, for a short period of time.  Right now we are really focusing on strengthening my quad and on regaining the extension in my leg. I feel like I'm making progress, but then sometimes it seems like I am back sliding.  I'm trying to stay positive and am still hopeful that this will work out for me.

[kimt]

I am pulling for you. You do sound like me at that point though. I never got full extension which resulted in a constant limp. And the pain would wax and wane where the orthoglde was. I would ask my OS about it and he woudl shrug and say it would get better. At the six month mark I went on a 5 shot program of Supartz in the hope it would help lubricated my knee until the orthoglide settled in. It would help for a few days after each shot but that was usually it.

I don't mean to sound negative -- I had a bad experience. I am really pulling for you! Please keep us informed as to your progress!!!!  I pray it will settle down and work well for you!!!!

[lcfuller]

So it's been a while since I've posted, to say the least. I have been fighting an uphill battle with my orthoglide implant and have finally thrown in the towel. It's been 10 months since my surgery and the pain has gotten worse and worse. I have met with several surgeons of the past couple of months and am scheduling a PKR probably for January. Some days I wonder if I can wait that long, but I'm trying. The idea of a PKR scares the crap out of me. I am 27 years old and incredibly active, or at least I was before all of my surgeries started. I'm worried that by 40 or 50 I won't be able to walk anymore, of course it's not like I'm walking so well currently.

So I guess that's the end of my orthoglide story, unfortunately it didn't work for me.

[Plumb]

I hope your upcoming surgery provides the pain relief you need.   Keep us posted. 

[Julie]

Hi there....I am 3 weeks post op for the orthoglide and I can tell you I am not having fun yet. I had the original unispacer put in 6 years ago and I think I am the only patient my OS has not had to remove it and do a TKR. Although it was an extremely painful procedure I guess it has saved me from having to have the TKR. However time made me forget just how awful the recovery was and when my doctor told me the orthoglide was a new and much improved version of the unispacer I agreed. I am still taking pain meds every 4 hours...sometimes they work and sometimes it still feels like there is a raw nerve being pinched under the orthoglide. I am still using a walker or crutches. The doc said to start using a cane this week, but i believe he is out of his mind. He also said no physical therapy because he does not want the therapists in there "wrenching" on my knee. I'm trying to be optimistic but its hard when I'm hurting. Although I have a desk job at work, there is still no way I am remotely ready to go back to work. Don't listen to anything they say on their website...the manufacturers of Orthoglide make this surgery seem like a simple walk in the park...and I am here to tell you it is not!!