My December 15 Denovo NT with TTT

[kasia_ny]

Hello Everybody,

I  have been reading KG religiously for the past few weeks and  I thought it was about time to start my own diary. 

I  am scheduled for my Denovo NT chondral transplant  to repair a grade 4 chondral defect on the lower part of my patella.  I am also going to have tibial tubercleplasty (this is the same as TTT or tibial osteotomy in my understanding).   

My initial injury happened when I was in high school (about 15 years ago).  I was running backwards barefoot on a 1-inch thick mat and suddenly fell.  All I remember was a horrible crack and pain.  I was taken to emergency room and an x-ray was taken which did not show anything.  This had been before MRI or any type of similar imaging technology was available the country where I grew up. I had problems ever since.  The pain would come and go, sometimes I was fine for months or even years. It was not terrible, since I was even able to ski and play tennis, however, the more active I was the more the knee bothered me. 

Starting last year something changed.  I had more and more pain, especially on stairs.  Then on Memorial Day weekend this year, my husband and I went dancing to celebrate the end of my first year of graduate school.  I was dancing and having a great time, and suddenly felt a flash of excruciating pain... I had to sit down.  I did not fall or misstep, it just happened.  I thought that it will go away in a few minutes, but it did not.  I went home in tears and the next morning woke up with the knee swollen like a baloon.  The knee was blocked, I could neither streighten it nor bend it. 

On June 16 I had arthroscopy and the doctor removed two loose bodies from my joint both 10mm X 10mm.  I was told to try PT for a few months to see if the defect would cause me pain.  I did my PT and stationary bike for months without much success.  I am in constant pain and I limp.  I can walk no more than 5 blocks at a time. 

I scheduled my surgery a month ago.  Last two weeks I spent fighting with the insurance company, finally getting the surgery approved and funded.  I will spare you the details, but three days ago I almost lost hope... I was on the phone with them for hours and hours every day and finally get them to work with me. 

Now I am really stressed out about being unable to work.  I am in a PhD program, and I have tons of stuff to do.  I am on a winter break starting December 13 until the end of January (luckily) but during that time I am expected to write three big term papers.  Hopefully two weeks after surgery I will be able to start working on them.  Now I am scrambling to study for the finals, however, I cannot really concentrate.  I probably should spend less time reading KG     

[kasia_ny]

I have 10 days to my surgery.  I made a list of things I need to get beforehand, reading KG was so helpful with that:

raised toilet seat
shower chair
leg cover for showering
weight-lifter gloves (the skin on my hands gets blistered very easily)
crutch bag
bathrobe with large pockets

Do you have any other advice?  What do you wear after the surgery?  I was thinking loose shorts, the bedroom I will be staying in is pretty warm, the warmest room in the house. 
Also, I am going to be staying in the hospital for a minimum of two nights.  I have never been to a hospital as an adult.  Can you use your cellphone there? 

[kasia_ny]

I forgot to mention: After the surgery, I will be NWB for 6 weeks, no exceptions.  Also, I am supposed to use the CPM machine 6 hours a day beginning the next day after surgery.  PT is supposed to begin 6 days after surgery, hopefully I will find an available PT just before Christmas. 

[Snowy]

Hey there,

I don't have any personal experience with this particular surgery, but thought you might be interested in this KG member's blog:

http://10-hours.com/about-marc_rubin_blog.php

He had a DeNovo graft just over six months ago, and has been documenting his recovery in some detail.

With regard to your other questions, certainly hospitals here (Canada) don't mind you using cellphones; I was updating my post-op thread on KG from the recovery room about an hour after I woke up from surgery. (Priorities...) I had my surgery in July and lived in shorts for the first couple of weeks. Mine were just short (above the level of the bandage) rather than loose, but loose would be even better.

Make sure you've got a whole bunch of distractions available for the first little while...books, DVDs, laptop, whatever your personal preference is.

Best of luck with your surgery; I hope all goes well!

[kasia_ny]

Snowy,

Thank you for your encouraging message and  the link.  Marc does a great job describing the whole thing.  I am actually getting the surgery in the same hospital, (different OS) so it was very nice to read about his positive experience there. 

From what I understand so far, the TTT is a bigger part of the surgery for me.  My OS told me, that 10 years ago they would do just that. 

9 days to go.  Today I had my pre-op testing.  I walked to the doctor's office and freaked because the waiting room was full of sick people.  I cannot get an infection now!  I use hand sanitizer non-stop.  I really want the surgery to happen on schedule.

[annie5970]

Kasiany,

I know how you feel about the germs. I had TTO surgery three weeks ago today, and I was also worried about getting sick, causing a postpone in my surgery. However, I only had about a 5-day wait between the time I agreed to my surgery, and the actual date. I wanted it done by the end of this year, and my OS was totally booked. However, he had a cancellation, so I was able to get in early, but with very little prior notice.

I made sure I had my CPM delivered, and my post-op PT scheduled. I already had the shower chair, raised toilet seat, crutches, crutch pocket, and robe with pockets, so I was set to go. My husband made sure I had lots of small bottles of water in the fridge, so I could transport one when needed if he was at work. My mom took off the first two weeks, and my sister has been off since last week to help me out. I stocked up on easy-to-prepare meals, and froze some pre-portioned meals to make it easier on my mom and husband.

Will you be staying in the hospital for a couple of days post-op, or is your procedure outpatient? My OS kept me overnight, and I am glad he did. He keeps his patients 1-3 days for pain relief purposes immediately post-op.

It is a daunting surgery, but you will be just fine. I am still feeling my way through recovery, and have a post-op diary in process. The diary is titled "Annie's TTO Surgery on November 15, 2010"

All my best,
Annie

[cdubb]

Kasiany,
I'm going to be very interested in following your recovery, as I'm almost 5 weeks out from a patella ACI with the TT. My defect was 20 x 20 mm.   After my cells were already growing at Genzyme, I read about DeNovo and asked my docs PA about it knowing that I wasn't a candidate since my cells were growing for the ACI, but just out of curiosity and perhaps for my right knee that has a similar defect.  She said there wasn't enough evidence to support it's use in the PF joint, so they aren't them as often yet for patellas.  They are doing them though.  I know my doc does have a Denovo NT and ET clinical trial going though.  I may ask more when it comes time (hopefully not for at least a year) to do the right.  I do have a post op on Thursday, so maybe I'll start some light questioning then.

Funny your OS told you that the TT is the bigger part of the procedure and 10 years ago, that's all they would do.  9 years ago, the TT was broached briefly with me, but I shut the conversation down...now here I am in 2010 and just had a patella ACI/AMZ (AMZ is just what my doc calls it the TT- stands for anteromedialization).  I find that I actually worry more about the ACI graft when I feel twinges, but I would say pain wise that they TT is probably the more uncomfortable part.  Everyone on here will report very different experiences with the TT post op.  My procedure was outpatient and I was d/c an hour after waking up and other than the morphine given when waking up, I managed just fine on oral pain meds. I didn't have the femoral block either.  Other than the pain waking up, I'd say my pain in the first few days never reached more than a 5/10 (maybe??) I was diligent about taking pains med on a schedule for 3 days though to avoid severe pain.  Others can't imagine having to be sent home same night. 

So, good luck to you and I'll be following your recovery closely. 

[mightyjack]

Hi kasiany

I am 8 weeks post op. I did not have the same procedure as you are about to have but I was also NWB for six weeks and also in the brace 24/7. I wore loose comfortable clothing for the most part.  I stumbled a few times with the crutches and landed on the non weight barring leg which I worried about but my last O.S visit revealed everything was fine.  Just be as careful as you can while on the crutches. 

I also experienced problems with a very dry mouth due to the pain meds.  There are some over the counter products to help counteract that if it’s a problem for you.  On the day of your surgery, you may want to ask your O.S. for a medicinal patch for nausea.  I am prone to getting sick due to the anesthesia but didn’t have any trouble when they gave me the patch in advance. Good luck with your surgery and let us know how you are doing.

Regards 

[kasia_ny]

Annie, Cdubb and Mightyjack,
Thank you so much for your posts. 

Annie:  I was told by my OS that I will be in the hospital for two days.  However, this afternoon I got a note in the mail from my insurance that the approved me for 2 inpatient days, 15th and 16th of December.  So it means one night.  I will call the doctor's office tomorrow to verify.  I am getting the femoral block and they will keep it in as long as I am in the hospital.
I am staying with my in-law's the six weeks after the surgery.  I am lucky we really get along!  They were so kind that they offered me their bedroom, because it has a private bathroom with a large shower.  My husband will take a week off, and then my mother-in-law will be on winter-break (she is a teacher). 

Cdubb:  I have a grade 4 chondral defect on the lower part of the patella.  The OS explained that about 1/3 of the patella is affected.  I also have patella alta.  I actually had my June 2010 scope done by a different doctor (it was sort of emergency, since my knee was blocked entirely by loose bodies).  Both doctors suggested Denovo.  The first doctor told me he would only do Denovo NT (juvenile cartliage transplant) as opposed to ET (this is when they grow your own cells).  My OS said that I could do either one.  I chose NT since I did not want to have an additional scope.  OS also suggested that the younger you are the better the chances with the ET, because young cartliage has certain properties, so I decided that I am not that young anymore (almost 31) and I will be better off with the juvenile transplant.  Both doctors said that Denovo has to be done along with TTT.

Mightyjack:  I am sorry about your dry mouth, this sounds really annoying.  I filled my scripts today, I got percocet, zofran (anti-nausea) and keflex (antibiotics). 

Did you go to crutches training?  I got a script for it and I am planning to go on Friday.

Take care,
Kasia

[cdubb]

Kasia,
I am also 31!  I was told that I had to have the TT with mine too.  My kneecaps don't track right, but it also unloads the graft.    Our defects sound similar in location/size.  I was told grade 4 central, but my photos really look like the whole lower half of my kneecap is trashed.  It was about a third to half of my kneecap.  My defect was larger than my scope estimated it to be when it was fully debrided.  I also already had some spurring.  The deepest part was more central.  I actually have some op photos that my Dr. sent me.  One shows my kneecap/defect and the TT cut prior before it was screwed down and the other shows the ACI patch sewn on.  If you PM me your e-mail, I can send you them if you can handle op photos.  I like looking a them, but I know some people have no desire to look at op photos.   Since our ages and defects are similar, I even more interested in tracking your recovery!

Courtney

[kasia_ny]

Courtney,

I send you a message on FB (I joined the KG group).  I cannot PM yet, I must have 21 posts first. 
Your defect indeed sounds very similar to what I have.  I thought that the scope is more precise in estimating the size! 
Today the doctor's office confirm that I will stay in the hospital for two nights.  They also confirmed that the insurance confirmed that they will pay the OS's fee in full, which was not obvious at all! 

Take care,
Kasia

[Snowy]

Glad to hear Marc's blog was useful! I've been following it with interest; although my own surgery was very different, I'm always interested in cartilage issues (I was diagnosed with early stage OA in both knees at 28; now 34, and know that cartilage issues will be in my future) and he's recorded his rehab so diligently that it's a fascinating read.

Having spent time on crutches several times now, I can reassure you that the actual technique isn't difficult at all. The big challenges are a) carrying things; b) stairs: and c) use injuries. The first just requires use of a fanny pack, backpack or single-strap pack; I'd also recommend buying one of those no-spill travel mugs so you can make your own tea/coffee and carry it from the kitchen to wherever you're sitting when you don't have a helper around. The second is totally manageable if there's a handrail, but I would strongly recommend practicing getting up stairs with no handrail, where you have to push off on both crutches, before the op. It's not actually hard once you're used to it, but it's tricky if you haven't tried before - and definitely better to get the practice in at a point where it doesn't matter if you fall on the bad leg.

The third is tougher; elbow crutches definitely help (less risk of underarm rubbing) but your hands will likely still blister up and get very sore. Padding the crutch handle will definitely help, as will wearing the padded gloves that sports stores sell for weightlifters. (Definitely get a set of these - the more padded the better - before surgery!) If you have traditional crutches, make sure they're set at a height where you're not really leaning on them with your armpits; they're actually meant to be slightly lower, so supporting without actually taking the majority of the weight. If you have these crutches and your armpits rub or blister, it'll be pretty rough. This happened to me the first time I was on crutches, and the only thing that helped was wearing a backpack and letting the crutches rest on the backpack straps rather than directly on the skin.

Hope this helps. Will be thinking of you as your op approaches!

Kay

[kasia_ny]

Snowy, thank you for all the advice!

Three days to my surgery.  I am extremely busy trying to finish my exams and write some of my papers beforehand. 

Today I tried out the crutches.  Bummer.  I have a ganglion cyst on my left wrist (and I am lefty) which has not bothered me for a while.  I just tried the crutches for maybe 3 minutes in the morning and the wrist is now flared up and hurts.   I guess I will have to deal with this. 

The whole thing is getting to me.  I am so irritable.  One minute I am okay, the next one I get stressed and anxious about the surgery.  I would like to have it behind me.

Take care,
Kasia

[Rknees4]

Kasiany
The anxiety and moodiness is quite normal. Try and keep busy and the time will come.
It will be behind you soon enough.  Yes try and get some of those papers written because it will be a few days before your head clears after surgery and pain meds.  Good that the DR is keeping you in hospital as means better pain control.
Take Care,
Will be sending positive thoughts the day of surgery.
Rknees4

[Melissa S]

Hi Kasiany,
You have really found the right place to discuss knee problems.  There is always someone on here that will listen and give advice on what you are going through.  I will be anxious to follow your recovery too.  I am 5 weeks post op from a patella ACI surgery without TTT.  I didn't need the TTT because my alignment is good and my defect was caused by an injury.  I wasn't really aware of or offered the Denovo so I will be interested to compare our recoveries.
Good luck with everything tomorrow and let us know as soon as you feel up to it how everything goes.
I thought of one other thing that no one mentioned that you might need.  If you don't already have some get some sports bras or cotton bras with no underwire.  I have found that I can only wear my sports bras because the underwires on my others cut into my side from crutching.

Melissa