Distal Femoral Osteotomy - Pre & Post-Op Diary

[KCuman]

Hi All, Chereb, I'm glad to hear you holiday was enjoyable.  But, sorry to hear you are still having problems and your physical therapist is not able to do any more.  I'm hopeful that your OS will give you some fairly good news.  As Aturpin has said, don't give up!!
I'm now at 3.5 months (I've lost track of the weeks now ).   Still doing PT 2 times per week and have started road bike riding about 20 miles a couple times a week.  I do use clipless pedals Tailwind and do not have a problem twisting out.  I do still notice my quad muscle is not sure how to do things.  Going down stairs I always hold on to a railing and kind of hoble down.  Also notice pedaling on the bike when it isn't right.  Other than that my progress seems good, I think. 
I tried a yoga class today and found for the most part I did OK.  I couldn't sit back on my heels, due to a pulling of the muscles just above the knee and I could not kneel comfortably.  I will ask my PT if I should push through this pain or wait.
I see my OS in about 10 days for my 16 week check.  I will ask what he thinks about surfing.  I'm still learning so fall ALLOT.

Take care all, Nikki, I will go to your post next.  Chereb, keep positive!!
Karen

[jumpi5d]

Hey everyone! Its nice to get updates on everyone.... I can update too!!  I'm at 18 week out and I'm doing good. I have pretty much all my ROM back. The rest I won't get back with the plate still in (about 10 degrees.) About three weeks ago my leg started bothering me a ton. Right in the middle back of my leg about 4 inches above the bend of my knee. I talked to the doctor and he said as long as I was able to walk on it not to worry to much it's probably just healing. I go back in on the 28th. (It's not as easy as it hurts lets get an appointment, I live 14 hours from my doctor.)  My IT band is tight and I can feel it sometimes rubbing on the plate, but other than that I'm doing good.

Chereb I hope the issues get figured out and you get to feeling better soon.

-Paige

[chereb]

Hi Guys, A small update from me.. Went to my GPs who had my last xray result through from consultant. The news was not good as i suspected. The joint where the weight was distributed to has collapsed. Effectively it seems the only option now is TKR sooner rather than later. I know now that the pain from the knee is caused by the collapse and no amount of physio ect will remedy it. Im quite upset as i was still hoping all would turn out ok. See the consultant next week and will update whats next now. 

[aturpin]

Chereb,

I am sorry to hear that your procedure turned out this way.  Did your Dr. say why the joint collapsed?  You said that the joint where the weight was distributed to collapsed...that means that the good compartment is damaged in addition to the compartment that prompted the surgery? I suppose that explains while the angle of the joint changed so dramatically.   

You have been through so much, you are such a trooper. Try to keep your head up even though it might be hard. Best of luck at your consult next week.

[chereb]

Aturpin....yes the good compartment collapsed. It was shifted to medial side and the medial side collapsed. Thats why the allignement has changed so much. Doctor said it was nothing anyone did or didnt do. Just one of those unfortunate things. Cried like a baby yesterday. Just seems so unfair. My consult for next week is now cancelled due to a bank holiday so waiting for a new date.

[Tailwind]

Aturpin and others. Hey, now exactly 4 weeks until my DFO. Getting a little nervous and excited. Preparing to start my own pre-op diary.

Quick question: Why the ROM issues post-op from the DFO? They don't really open the knee capsule and do anything mechanically to the joint. Is is becuse they have to cut through the quad to get to the femur? Adhesions form from muscle healing post-op?

[jumpi5d]

Hey Tailwind.

I think my ROM issues were mostly from swelling, the muscles/tenons adjusting to the plate and scar tissue. I was put in a CPM machine at 65 degrees the same day as my surgery but I seemed to be stuck at around 75 for several weeks. My doctor didn't cut through any muscle. It was moved to the side out of the way during the surgery. The only tissue that was cut was the Iliotibal Band. 

[aturpin]

Hi Tailwind,

My experience was the same as jumpi5d with respect to the cutting, only through the IT band. I find it interesting about the ROM too since there is nothing actually happening in the knee joint, as you said. The ROM symptoms, PT pain, etc. for the DFO were exactly like the experience I had with my ACL reconstruction which I also found interesting. Furthermore, after the DFO I carried swelling in my knee joint for at least a couple of months. My best explanation is that although the joint capsule isnt bothered, the entire purpose and outcome of the surgery impacts the knee joint by changing the angle so even though it doesnt seem like we are doing anything to the knee, a lot is actually happening in there. Great question though.

[Tailwind]

Thanks for the info!

Here's another question. I'm thinking of buying my own e-stim machine to supplement my PT. Of course I'll ask my PT and OS about this but has anyone had any experience with thier own e-stim gadget?

[jumpi5d]

***vent warning*** lol

I leave Saturday or Sunday for the big D to see my doctor. Hopefully everything looks good, and he can address the snapping issue from the IT band. I already know there's not much he can do for it.. It's so annoying!!!!!!! Tonight has been super rough. I did a lot of walking and now everything feels sooooooooo tight. Oh and my limp is back :-/

ugh!

[aturpin]

Tailwind,

I have never personally owned a stim machine but I used to train with a bunch of people who had them and our trainers would take them along when on the road.  At the time they were pretty portable (about the size of a walkman) and did the trick, I am sure they have only gotten smaller.... its pretty much the ab shocker thing they advertise on TV. I think the only reason I would personally consider owning one is for right after surgery when your quad has to learn how to fire again and you can use it for Russian stim to reteach the quad.  As for anti-inflammatory and use while icing, I felt the stim I got at PT was sufficient.

Hang in there jumpi5d and good luck at the Doc.

[Tailwind]

Aturpin

Thanks.

Ok, its been 8 mos +/-  how about a general update? How are you feeling? What is your pain level? Is the pain from your arthritis or the DFO? What types of activities are you able to do/not do?

[aturpin]

Funny you should ask, I was just thinking it would be time for an update.  SO in keeping with my usual format....

Post-Op Month 7 Day 22 (July 28, 2009) - it has been nearly 8 months since my surgery and I am still feeling great. If I had to sum up any differences or progress I have made since my last update or over the last couple of months I would say my knee is more consistent and I am more confident with it.  In the early stages of recovery there are bouts or relapse and pain followed by periods of comfort and gains.  As time goes on these ebbs and flows become fewer and further between and now I can't really remember my last bout of pain or weakness. Even as I increase my activity level, my knee has become harder to anger. I suppose it might be helpful to make a list of the most recent developments.

-most notably, I am no longer popping. Up until about a month ago I was feeling some catching along my medial joint line and then if I applied pressure there would be a pop and then the catching would stop.  I dont feel that anymore and it seems like the joint has kind of settled.  I dont know how much more settling I have left, I suppose I will only know in hindsight

-I was also have a decent amount of pain behind my knee, kind of at my calf insertion point, on the lateral side when I upped the activity level.  I dont experience that pain anymore.

-stairs keep getting better and better.  I am 95% confident with steps now. Simply walking up and down I am 100% fine.  Running up I am 100% but running down is a little tricky.

- I have begun to incorporate squats into my workout routine.  Granted I am doing very little, if any, weight (either kettle bell swings or mediciine ball squats with a throw) but my knee takes it really well.  If I do too much, I can tell the next day or if I do back to back days I will be sore but otherwise its pretty good. I think this is a positive commentary on the arthritis as well.  Squats used to really fire up the arthritis on my knee but now that my alignment is corrected, it can tolerate much more since there is less weight on the area.

- I have also incorporated the stair machine and the elliptical into my workout.  And, on the elliptical, I am doing sprint intervals where i try to go as fast as I can (not holding on to anything trying to simiulate running) and it does very well.  I have to stay conscious about the subject leg and make sure it is pulling its own weight though.

- I have tried to take a few jogging steps and this still feels pretty weird, kind of like I have a peg leg as there is very little push off power in the leg. I also think I am feeling the hardware in there when I land on the leg.  It will be nice to get the hardware out of there.  It doesnt bother me on a day to day basis or even during exercise but I just think it would be even better if I didnt have it.

-I am now clipping into pedals while I cycle and I have no pain or problems twisting out (can't remember who asked that before).

- I work out 6 days a week and am spinning 2 times per week... no problems there.

-I have been getting a little pain lately in my patellar tendon.  I will continue to monitor this as I am not really sure what is responsible for this.  I had an ACL reconstruction with my patellar tendon as the graft so it could be that.  It could also be overuse from cycling and or steps.  I notice it most on the elliptical so it could be an form thing.  I'll keep you posted.

-I continue to golf withouth problem although I havent played a full 18 yet (I usu. walk the course) so when this happens I will report back.

- I am also swimming from time to time, no problems.  However, I did a kickboard workout the other day and it really revealed how weak my hamstring is on the subject leg. This will be a focus for strengthening going forward.

All in all I feel that I have healed completely (my doctor might say otherwise, I am not sure how long it takes for the bone to be completely healed and the joint to settle but it feels healed).  With respect to strength I feel about 85% of my pre-op strength.  The last 15% is really in explosiveness which I am not in a real hurry to work on. I still have to stay conscious of the leg during excercise mostly to make sure it is working hard (I think that is mostly a subconscious mental compensation rather than the leg not being strong enough). Recovery is mental too, who wouldve thought.  ROM is 100% pre-op range, my quad is only a tad tighter on the subject leg but stretches to the same degree as the good leg. All in all, I can't complain. 

Lately my focus has shifted away from the DFO and towards the allograft procedure looming in my future. I am thinking I may try to do this in December again and then hopefully I will be done with knee surgeries for a long time to come (forever even? wishful thinking for sure). I will be having my hardward removed as well during the allograft procedure (2 birds 1 stone).

I hope everyone out there continues to make good progress, its a long road but so far for me, it has been one worth traveling.

[Tailwind]

Excellent update. Very complete. You touched on a lot of things I was thinking about. Again, key point for me is not to focus too much on any given day and take a long view of recovery and rehab. Also key: leg strengthening takes a long time with a  DFO. Pre-op, I estimate my subject leg is 60-65% as strong as the good one. It will take a long time and a lot of work post-op to match the good one.

[Tailwind]

Watching the CD of surgery vids from my surgeon and just realized the two surgeons on it are mine and Dr. Bugbee.