My December 15 Denovo NT with TTT

[kasia_ny]

Melissa,

I had an injury too. However, my knecaps are anatomically too high (patella alta).   

Thank you for the bra tip.  I have a bunch of VS wireless ones, they are pretty comfy. 

Tomorrow is the big day!  Hopefully I can get some sleep tonight.  I have to be in the hospital at 10am tomorrow.  I am my OS's last patient of the day.

Kasia 

[Snowy]

Best of luck! I hope all goes very smoothly tomorrow, and I'll be sending you good thoughts.

[Rknees4]

Kasia,
Thinking of you and hope all went well.
Rknees4

[cdubb]

Hoping all went well and you are resting comfortably.

[kasia_ny]

So I am back!  I am at home, discharged yesterday.   This is my story:

Surgery day:  I was told to check in at the hospital at 10 a.m. on December 15.   I followed a standard routine – nothing to eat and drink since midnight the night before.  Non-eating part does not bother me that much; not drinking for so many hours is difficult.  The surgery was initially scheduled for 1.30 p.m., but got delayed and it eventually started after 5.30 p.m.  I was put under general anesthesia and also getting a femoral block.  
I woke up in the recovery room around 10 p.m.  I was very sick from anesthesia and was in a great lot of pain in my leg when I woke up.
I was initially told that I will stay around 1.5 hours in the recovery room.  However, the hospital could not find anybody to clean the hospital room for me (that is what my husband was told) and I spent almost 6 hours there.  It was no fun, since that room is very cold and the beds are hard and uncomfortable.  Finally I got transported to the hospital room at 3.30 a.m. on Thursday.

Day 1:  
After I was in my hospital room, my pain got duller and duller.  They told me I got a clinical dose of the painkiller into the femoral cateter.   My OS came to see me first thing in morning, together with his resident.  They explained that the chondral defect in the lower part of my patella was 3 X 1.5 cm.  They implanted the juvenile cartilage and used a patch to hold it in place.  They also performed a TTT.  According to the doctor, everything went as planned.  
The pain management unit visited me and explained that I am hooked to two automated pumps:  one for the medicine that goes in the femoral block and the other for the general painkiller, for that one I was getting a button to press when I am in discomfort.  I did not think this button did anything, pressing it did not change my pain sensation at all.
On the first day, I was put on the CPM two times for 2 hours each.  I was also hooked to the Gameready ice machine.  The CPM actually felt good on the knee, however, gave me a terrible back pain.  I thought it was strange that I had so much back pain being on all those meds, but none of the nurses seemed concerned.  The knee pain was there, but dulled out.

Day 2:
The resident came to see me in the morning.   He checked the incision and pulled the drain out (that was exciting – felt like a lot of progress to me).  He also asked me why I was not pressing my button the whole previous day and night.  I was like “sure I was, it did not seem to do anything for me though”.  Then they discovered that I was given the wrong button.  Yes.  They gave me the one that went to the femoral catheter and pressing it did not have any effect since the dosage was set.  So they fixed it and felt much better when they finally gave me the drugs.
I saw my OS in the afternoon and he told me I will be discharged the next day around lunchtime.  He also said that they will take out the femoral block shortly beforehand so that I can get home and get settled comfortably.  So they left the femoral catheter and the pump, converted me from the general painkiller pump to oral Percocet (5-325), two tablets every 4 hours.  Once on Percocet I began feeling nauseated and lost my appetite entirely.  I am also on Zofran (anti-nausea) but it does not seem to help much.

Day 3 – discharge
In the early morning, the pain management team paid me a visit and said that in order for me to be discharged; they have to assess my pain level after they remove the femoral block.  Otherwise they cannot let me go home.  I said that that was not my surgeon’s protocol; however, they said that they are the ultimate decision makers.  They basically took it out without my consent. Then nobody came back to check if it indeed wore out and about 3 p.m. I made a nurse page them and found out that the doctor responsible for taking it out took off for the day and is not reachable.  They sent somebody else that clearly did not care and said I could go home.  It did not wear out yet.  I was terrified that it will start wearing off on the way home.  
When you need to leave a hospital, you cannot just walk out of there, they have to assist you.  Should be easy enough!  We let them know we were ready at 4.30 p.m.  At 5.30 p.m. they bring a very small transportation chair that does not have the support for my leg in full extension.  I said that they have to bring me a regular wheelchair with extendable leg support.   The transportation person said that they do not have such a thing and offered that they will make a loop out of a sheet and my husband can carry my leg in front of the transportation chair!!!  At this point my husband went to complain to the attending doctor and then the doctor himself, some nurses and my husband started roaming the hospital to find a wheelchair.  It took two hours to find one – they actually had to borrow a private one from a patient.   We finally left at 7 p.m.
 
I was home in bed at 8.30.  The femoral block started weaning out an hour later, so I consider myself lucky.   Now the pain is not too bad, the problem is the nausea – I cannot seem to keep any food down.
Today is Day 4 and boy, it is great to be at home!
Thank you for reading this, I realize that this is very long.
Kasia
   

[Melissa S]

Hi Kasi,
Glad to hear from you and that everything is going OK.  Surprised that you stayed that long in the hospital.  I was in and out in one day as are most that have the ACI done.  Do you think you would have rather been home or in the hospital?  I was glad to be home and in my own bed.
I also took Percocet as my painkiller the same dose as you and I found that I had to space my pills out because of the nausea and vomiting.  Instead of taking two every 4-6 hours I would take one pill and then about an hour or two take another.  It seemed to help me a little not taking two at a time.  You might also ask if you can take vicodin instead of percocet.  The percocet seems to cause me more stomach problems than vicodin.
Do you know yet when you will start any physical therapy?
Take care and keep us updated on how you are getting along.

Melissa

[kasia_ny]

Hi Melissa,
I was supposed to stay in the hospital for two nights, but because the surgery was delayed they kept me for an extra night.  I had a drain in the wound and they said they would not release me with it.  I also could not urinate for almost two days as a side effect from the anesthesia and needed a catheter.  I was glad I stayed in the hospital, somehow it made me feel safe - although there were some problems, the nurses were really great there.  They also allowed my husband to stay with me almost all the time. 
Thank you for the tip about spacing out the pills.  I will try it.  I also just spoke to the doctor and he will give me a different anti-nausea and if it does not work, different pain pills.
I am doing some mild excercises all 4-5 times a day - knee hyperextension with a towel under heel - 10 min; quad sets - 10 times; ankle pumps - 20 times.  I am supposed to start with straight leg raises today - 10 times and knee flexions to 30 degrees - 5 times.
I am totally NWB until my first visit with OS - January 4th, then he will decide.
My forst PT appointment is this Tuesday. 
Kasia

[Melissa S]

Kasi,
Yeah, I didn't have a drain or the urinary problem but there is another poster on here that had that and had to go to the ER to have a catheter in after she was already home.  So it was good that you were there and they could take care of that for you.
All of those exercises are pretty standard.  Don't be surprised if you are not able to do a straight leg raise for a while.  For some reason that muscle just won't fire when you want it to and they are really painful when you can do them at first.
Good luck with your PT on Tues. and hopefully that will work with your pain pills or they find something that will.  I know how miserable it is not to be able to eat from the pain pills and that also doesn't help in your recovery because you have no energy.

Take care,
Melissa

[cdubb]

Hi Kasia,
Sounds like you've had quite a busy few days.  Glad you're home now.  I'm the one that had urinary retention and had to go to urgent care. That was more of a nuisance than anything.  They left the catheter in and I had to go to my primary care to get it taken out the next day.  So, I was up and about crutching longer distances on days 2 and 3 post op than I would have liked to have been.    My surgery itself is equally invasive as yours with the TT and patella ACI (instead of Denovo) and my Dr. does them outpatient and I discharged an hour after waking up.  I didn't have a femoral block either and actually fared just fine on oral pain meds.  I didn't have nausea though, so I lucked out there. I did take the promethazine for about 2 days though to prevent it.   I don't know why my doc does them outpatient, but knowing that a lot of other docs do the TT/ACI's inpatient did have me a bit nervous heading into surgery.  Especially when I woke up at 5:30 pm and was being loaded up into my car at 6:30 pm.  Since I didn't have a femoral block though, I wasn't nervous about what I would experience when it wore off.  They said that my pain wouldn't get worse than where it was at and I could manage it where it was at...and they were actually right...it didn't get worse. 

Also interesting on the drain in the wound? I wonder why some docs use that and others don't? 

If the nausea continues, you may want to ask for promethazine or compozine or some other anti-emetic. 

Good luck and let us know  how PT goes. 

[martialartist]

Kasia and others:

Thanks for sharing this thread. I hope this works for you and I will be following your recovery. I wonder though... would you mind sharing the name and city of your doctor? I am trying to find someone who is in network who has done this surgery before and who will also call me back... Its challenging. I also would be interested in your type of insurance and how you eventually were able to get this covered. I will be fighting the same battle shortly. Thanks.

[Rknees4]

Hi Kasia
Hope the nausea is settling down for you and the pain isn't to uncontrolable.  Heavy duty pain meds can do that. So can the surgery itself.  Remember they did the equivelant of a bone break and screwed it back together. That is enough to make anyone nauseous.
Just wanted to let you know I was thinking about you.
Take Care,
Rknees4

[kasia_ny]

Thank you all for your comments! Today I feel pretty good, the knee does not hurt much.  I like being in the CPM, the movement feels good.  

Melissa,
Yesterday they switched my anti-nausea and it did not help so much.  Today I followed your advice and spaced out the percocet pills (instead of taking two every four hours, I took one, then after one hour the next one).  It worked for me!  Thank you so much for this tip.  For the first time since the surgery I was able to have breakfast, lunch and dinner.

Courtney,
I would be terrified to have this surgery outpatient.  I also suspected that I might have urinary issues, since I had problems with that even after my scope - I react badly to drugs.   I am sorry to hear about your experience - that must have been really awful.
As far as the drain goes, the doctor explained it is because of the TTT - it is the bone that causes this.  I had it for two days and it was draining a lot at the begining.  

Martialartist,
If you PM me your email, I can give you all the info.

Kasia

Kasia

[Melissa S]

Kasia,
Great news, I am glad I could help.  You will start to feel better when you can get some food in you.

Melissa

[cdubb]

Kasia,
Gladl to hear that Melissa's suggestion help with the nausea.  Being sick after major surgery just adds insult to injury.   Really, other than the urinary retention issue, I fared fine at home and pain was completely manageable on oral pain meds.  Prior to the surgery, I remember my Dr.'s PA saying that the way he does the TT he doesn't move some muscle, which helps with post op pain??  That may also have something to do with why no drain necessary?  I really have no idea...just speculating.  My Dr. does a lot of these and they're all outpatient, but it is fascinating that so many other docs do them inpatient.  I guess I'm lucky that I managed okay at home (except the whole urgent care to be cathed issue). 

Take care and rest up.   At your point, the only time I had knee pain was when I would first go vertical and would experience the blood rush, but even that was manageable.  I had actually started weaning off the pain meds about 5 days out..until I had an ankle issue(inflammation of the periosteum from blood tracking down the lining of the bone) that flared up that actually hurt more than the knee did the first couple days.  I was pretty much completely off pain meds a little over 3 weeks out (I'll be 7 weeks tomorrow).  I would have been earlier if it wasn't for the ankle issue. 

[martialartist]

I attempted to send a PM but am unable for some reason.. Ill keep working on it. Sorry to hijack the thread. I assume you are unable to PM me either..

Thanks to the other person who sent me a PM with their doc  info. I will be following up. Much thanks..

Dan aka martialartist