Contractorarsenal's HTO (2nd August 2011) Post -Op Diary

[Contractorarsenal]

Hi,

Thought I would get my page set up before my op.
History: 3 ops on my medial meniscus and my OS decided it was time for a HTO or HKR. Due to the lack of cartilage in that area its now bone on bone with the onset of arthritis.

After a year of wearing an unloader brace, I finally opted for the HTO. I know its a brutal operation but at least I'm keeping my own bones, I tell myself.

I've been told I will be in hospital for two nights assuming there's no complications.
I've bought a Cryo Cuff icing machine and arranged for the hire of a CPM machine so, hopefully, I'm all set and ready.
With a bit of luck I will be compiling my first post-op entry on the 5th.

Mike

[Contractorarsenal]

Hi All,

I had my left knee HTO done on Tuesday 2nd August under GA with a nerve block to the groin.
This procedure was carried out in the UK under the NHS and my OS was Col Peter Hill.

Day 1.
No real pain because of the nerve block.
The physio had me up on crutches partial weight baring.
I managed stairs up and down.
The cricket bat brace was removed prior to physio and I was fitted with a 0 - 90 degree movement brace.
After my first session walking with crutches and doing a set of simple exercises my movement was up to 80 degrees.
Seemed too good to be true and I was reminded that the nerve block was probably helping movement because of the lack of pain.

Day 2.
The nerve block wore off during the night and initially, I had quite alot of pain.
I was administered Morphine tablets and all was fine.
When I woke up in the morning there was little pain but I was topped up with Paracetamol and Codeine.
I was fortunate enough to have a GP in the bed next to me (slipped disc op) and when I mentioned that the lack of pain was down to the Morphine, he told me it would have worn off hours ago!!
Another visit from the Physio who, after a few exercises said I was fit to go home.
My OS turned up later in the morning and said that the post-op X-rays were okay and that I could be discharged.

Once at home the first thing Gill, my wife, did was set up the Cryo-Cuff icing machine.

Day 3.
Pain is very manageable and I'm now taking Paracetamol & Codeine every 6 hours.
Feeling very tired.....you don't realise how much an operation takes out of you.
I'm sticking to the exercise plan I was given although I haven't been able to achieve the number of exercises in each set yet due to soreness and tiredness.

Day 4.
Bad night's sleep due to my stomach. The Codeine plays havoc on your system.
I've taken laxatives and that has helped.
I've decided to come off the Codeine asap.
So far I've only taken 2 Paracetamol today and I can't believe what has happened to the extreme pain everyone including my OS was promising me.

I'm having to sit at my PC to write this so, I will probably update every couple of days.
If you have any questions, please don't hesitate to ask.
Mike

[Contractorarsenal]

Hi, With every operation, major or minor, you are going to experience highs and lows.
Late Saturday evening (Day 4), my lower leg and foot started to itch and then swell up.
A phone call to my GP and I was off to A&E.
At 4am Sunday morning I was finally admitted onto a Truama ward with a suspected infection.
I eventually, was allowed home on Tuesday (Day 7) after a course of anti-biotics and a bit of TLC.
Days 8 - 10
I'm using painkillers still (2 paracetamol and 2 Codeine) but I'm gradually getting more movemement (60 degrees) as the swellinggoes down.
The Cryo-cuff icing machine has been brilliant and I really missed using it in hospital.

Day 11 (13th August)
I've reduced my painkillers and am only taking 1 codeine tablet with the 2 paracetamol now.
The swelling has gone from my lower leg and foot but the bruising is now evident. It runs from the base of my lower leg up to my knee and then contines up the back of my thigh and is yellow in colour.
I've managed to get myself out on crutches for a short walk of about 50 metres.

Day 12
The day started really good. Walked for about 100 metres and then removed my brace and relaxed on the sofa.
After 3 hours of friends and family visiting, I was feeling tired and decided to have a doze on the sofa.
Unfortunately, I experienced a big sleep twitch which sent a massive pain through the operated area.
Due to the pain, I was back on 2 codeine!!
Despite the Codeine I found it very difficult to get to sleep until Gill came to the rescue - a foot massage!!

Day 13 (15th August)
Woke up feeling a bit battered but after a session with the Cryo Cuff its started to settle down again.
Gill has been icing my knee and lower leg 5 times a day. This I believe it has speeded up the healing process by reducing the swelling and bringing out the bruising quicker than if it was left to naturally heal.

In my pre-op note, I mentioned that I was going to hire a CPM (Continuous Passive Motion machine). It was decided, due to the good range of movement that I already had, that it was not required. This has saved me £130.00 in hire costs.
I'm seeing the nurse tomorrow who will check out my wound and confirm whether it needs to be dressed anymore.

[Contractorarsenal]

Hi All,

16th August (Day 14) - the area around the break is very sore after Sunday's sleep twitch incident. I'm hoping it will settle down soon.
The nurse was happy with the wound but it will still be dressed for now as the brace rubs on it however, at last, I'm allowed to have a shower and get the scar wet.

The pain around the break has increased and spread across the leg. Have I fractured the hinge? There doesn't seem any point going to hospital at the moment as my OS told me pre-op that if the hinge did fracture during or after the operation, the 'Tomofix' plate would hold the leg in place.

17th August (Day 15) - after a pain disturbed night I have woken up feeling alot better.
The knee is settling down again.
I have my first physio session on Friday and hope that it won't trigger too much of a reaction.

[Contractorarsenal]

Hi All,

19th August (Day 17) - my leg has settled down and I'm off to see the Physio today for the first time since leaving hospital.

Physio session went very well. She was pleased with my range of movement which I got to 100 degrees.
She has given me another set of exercises aimed at strengthening the surrounding and supporting muscles.
I've been shown how to walk properly using my crutches and she has given me confidence to put more weight through the knee.
My next appointment is in two weeks time.
I've been told to wear my brace whenever up on my feet. This is okay however, I take the brace off at bedtime and it will be a real slep to put it on in the middle of the night if need to get up to go to the loo. Still, better that than falling over and damaging my leg!!

Pre-op I was concerned that with a lack of activity, I would put on a bit of weight. Thanks to this web site, Gill has taken up some recommendations and given me plenty of healthy meals that include oily fish, fruit and vegetables. I've been limited to a small dessert and/or chocolate plus I have'nt had a beer for nearly three weeks - gasp!!

Counting the days/weeks when I can get my season ticket back from my mate and get along to an Arsenal game!

[Contractorarsenal]

Hi All,

23rd August (day 21) - I've spent the last four days religously doing the exercise programme.
They say there's no gain without pain and some of the exercises leave me with quite alot of soreness along the line of the osteotomy plus very tired.
I've managed to get out for a couple of walks which have also been very tiring but so uplifting just to be out in the great outdoors!!

My scar is healing very nicely however, the absorbable stitches are still there and I know that I'm going to have to bite the bullet and make an appointment to have them removed, sooner than later.

I have alot of dry skin on my leg so, twice a day I'm applying E45 cream to improve its condition.

I'm starting to do more things myself now. This morning, I got myself into the bathroom, onto the seat and enjoyed a shower. Its one step at a time, but its great to have a little bit of independence back!

[Contractorarsenal]

Hi All,

August 25th (day 23)

After carrying out my first set of exercises this morning I experienced some pain around one of the stitches.
These should have dissolved so, a trip to the practice nurse was arrangedfor their removal.

Stitches removed with a bit of pain and a small amount of bleeding but it now feels really good.

I've been out for a short walk of 100m with no reaction.
I'm starting to feel more strength in the knee and the swelling and bruising is going down daily.

According to my discharge sheet, I'm supposed to be seeing my OS for a post op X-Ray and review between 6 and 8 weeks after the operation.
Unfortunately, today, I was informed that he will be on military duty over this period and my appointment has been arranged for nearly 12 weeks post op.
I'm disappointed that I will have to wait so long but this is just another thing where I will have to rein in my enthusiasm and get on with it.

[Contractorarsenal]

Hi All,

August 30th (Day 28)

Carrying on with the exercises and getting out for short walks.

Getting a full night's sleep has been problematic as I seem to wake up around 4am every morning with slight discomfort in the knee.
I'm used to sleeping on my side or stomach so, being restricted to sleeping on my back hasn't helped.
I've been able to sleep on my left side without too much discomfort during the last two nights which has helped me sleep better but trying to sleep on my right side is too painful.

The scar is healing very quickly and is getting very itchy.
I'm continuing to use the Cryo-Cuff as my knee is still very swollen and there is slight swelling of the leg just below the plate. I'm sure it will take time for the bruising on the bone to settle down.

My leg/knee is very steady with the brace on but if I walk with without it, my leg feels weak. I think a lot is in the mind and a confidence thing.
I've got my next physio appointment on Friday and will find out then how well I'm progressing.

[Contractorarsenal]

Hi All,

4th September (Day 33)

I went along for my 40 minute physio session on Friday and left after 15 minutes.
I was asked to do all the exercises I had been shown on my last visit two weeks earlier.
I went through my schedule and the physio told me that I was ahead of schedule compared to most people and that I now had to up the number of sets I was doing each day and to hold them for at least 10 seconds.
My next appointment is in three weeks time.

Over the last two weeks I have tentively put weight of my operated leg and if there had been any mis-timed placing of the supportiing crutch, it would result in a short shooting pain through the sawn area.

The physio has encouraged me to put more evenly balanced weight through the knee as this will put pressure on the break and aid healing. I'm doing this and I'm gradually getting more confidence about what I can do.

Yesterday, I tried walking around the house with the one crutch with an element of success. I need to do this as Gill is back to work on Monday and if I want a drink or food, I need to be able to carry a cup or plate.
Initially, I was a bit wobbily on my 'bad' leg but that improved with confidence.

I think my main worry about trying these things is the thought of something going wrong and sending backwards in the healing process however, I do feel a need to push myself a bit when my leg 'feels right'.

I'm totally off pain killers now and have found with various degrees of shuffling that I can lay on either side in bed (hurrah!!).

I'm also able to sit with my leg bent for longer periods of time which has allowed me to sit with everyone at the dinner table for meals.

So far, mine has been a good news story, but I cannot emphasise enough the importance of pre-operation exercising and strengthening of both legs.
Post-operation, it is important to have that good diet of fruit, vegetables with balanced meals. Although I have been reasonably sedentary compared to my normal life style, I have lost 6lbs in weight!!

[Contractorarsenal]

Hi All,

16th September (Day 45)

Since my last posting, recovery has been steady.
I seem to have days when I'm full of energy and I've learnt on those days it is important to just continue with the exercise regime rather than try too much.

On one occasion I walked 400m, done 3 lots of exercise, walked a further 100m and then was taken out for the evening for a meal where I spent a few hours with my knee bent under the table - far too much and I paid for it.
It took me two days to fully recover. My knee was sore to bend and the scar was angry where my brace had been rubbing on it.
Little and often is the best form of exercise.

Despite all the exercise my leg although stronger has not regained much muscle. I think as my movement is still restricted by the brace to 90 degrees a number of muscles are not getting the required workout to maintain any definition.
I'm still icing my knee once a day and generally do that shortly after having a soak in the bath. I'm hoping that the hot-cold thing will speed up the recovery.
My OS told me that I could not bend my knee beyond 90 degrees for the first 6 weeks. Well, that time has now passed and I'm starting to bend the knee a little bit more whilst in the bath.
This is definitely a gradual thing until I receive further advice from my physio who I'm seeing next Friday, or my OS who I won't see until the 20th October.

The long wait to see my OS is playing on my mind and I've started to question my level of recovery
Is the break healing?
I've hardly had any pain compared to some 'Geeks' and have started to wonder if thats because the bone hasn't carried out the 'knitting process' which I'm told can be very painful.
Should my knee still be swollen?

Can anyone other than my OS on the 20th October, help with these questions?

Regards

Mike

[Contractorarsenal]

Hi All,

21st September (Day 50)

Leg continues to improve.
Yesterday, I managed to walk just over 500m on my crutches non-stop.
To think back in May I walked 18km up and down 8 peaks in the Snowdon range and now I'm getting equally excited about walking 1/2kkm!!!

Whilst in the bathroom last night, I forgot I had put my crutches down and took two steps. NO Pain!!
I'm not going to do that again if I can help it until I've had permission from my OS.

Its getting easier to sleep on my sides now but lying on my stomach is a bit weird.
I can feel the plate along the upper shin so I'm assuming there's still some bruising and healing going on there.

I'm driving myself to the physio on Friday and I'm hoping to be told I can lose one of the crutches.

Mike

[Contractorarsenal]

Hi All,

Had a good trip to the physio.
Still ahead of schedule and the physio is contacting my OS's secretary to see if an X Ray at least, can be done before my appointment on the 20th October but she is also pushing for me to see a different OS sooner.
My leg is feeling stronger by the day and we need to know how much we can push the recovery process without doing any damage.

Five weeks ago, I was concerned that I wouldn't be able to accompany Gill when she took Andy up to his Medics Pre-Fresher week at Leicester University.
Not only did I manage to go with them but I drove both ways!!
2 hours there and 2 3/4 hours back - thank God for automatic cars!
It was great to see Andy off on the first day at Uni and very emotional.

I'm waking up every night around 2pm.
I think my knee stiffens up after it has been in one position for too long and when I've woken up it takes me a while and alot of shuffling about to get comfortable, much to the annoyance of Gill who is longing for a night's uninterupted sleep.
Looks like I'm going in the spare room for a couple of nights until I can shake off this particular sleep pattern.
I'm not sure if there is anything I can do about the stiff knee other than be patient.

Waiting to hear from my physio or the hospital about an appointment for a X Ray later this week.

Mike

[Contractorarsenal]

Hi All,

5th October (Day 64)

I've had my X-Ray and yesterday my Physio phoned me to say that in the absence of my OS, a registrar had looked at the results and I now have the go-ahead to remove my brace.
A new Physio appointment has been arranged for nwext Monday and I think, then will start the real Phsyio on the leg.

My leg is feeling alot stronger and I'm able to walk for longer on my crutches now.
The exercises I had been given was to maintain and increase the strength in my buttock muscles which are important for stability.
Some of the other exercises have helped with muscles around the knee but because they have all been carried out in a brace, I have been restricted in my movement.
Now that I have removed the brace I have realised how weak many of the knee supporting muscles are especially with any that isn't straight ine movement.

I'm being very careful to stick to the sets of exercises I've been given until I get new sets for strengthening without the brace.

Sleeping a bit better now.

I think its important to always set goals in life and the two I have set myself are as follows:

1. To be fit enough to play in the charity golf event I organise next March. I'm going to be a reluctant spectator this Friday in my charity golf day.

2. To be fit enough to go hiking/climbing with the lads in May.

Will report back after my Physio appointment next Monday.

Mike

[Contractorarsenal]

Hi All,

10th October (Day 69)

Went to the physio today.
I can bend my leg over 100 degrees and was asked to carry out a number of walking exercises without my crutches. These included walking backwards, sideways and sideways with one foot over the other.
I carried these out wqithout any problem and was told that I can now come off my crutches - brilliant.
The physio cut a walking stick to size and told me to try and use it only when I needed it.
I was also told to keep my crutches in case I might need them on the odd occasion.

It feels very weird not having the brace or the crutches but I'm gaining confidence

She also booked me into the rehabilitation class dealing with leg and knee injuries.

14th October (Day 73)

Attended my first rehab class.
initially, I was put through a series of exercises away from the main class.
The physio told me I was ahead of schedule for this type of operation and that I could start using all the aparatus straight away.
She informed me that within 5 - 6 weeks they would have me walking with a good degree of confidence.

October 17th (Day 76)

I've been out and about using my walking stick.
I've been able to watch a football match without having to sit down and I'm walking about 1/2 a mile at the moment.
Whilst indoors, I'm not using my stick.
I'm able to walk up and down stairs normally (not one step at a time) and I've managed to bend down onto my knees a couple of times but it does feel weird because I'm sure I can feel the plate.
It feels strange not having your brace and crutches and, at first i lacked the confidence and some strength to walk properly.
The most noticable thing was the lose of strength in my supporting muscles, tendons and ligaments.
One slight knock on the side of my foot and it felt as if was going to dislocate.

The physio gave me a new set of exercises to work on in addition to the ones I'm already doing.
One complete set now takes me about 20 minutes and I try to do at least two sets a day combining them with walking with and without the stick.
Since putting down the crutches, I haven't needed to uses them however, my leg does get tired and sore towards the end of the day but you know what they say "There's no gain without pain"

I've got my first post-op appointment with my OS this afternoon. I will report back tomorrow.

Mike

[Contractorarsenal]

Hi All,

20th October (Day 89)

Attended my first post-op consultation with my OS today.
On arrival, I was told to get a full leg X-Ray.
My OS was happy with the X-Rays and told me to continue with everything I was doing except I was to ditch the stick and concentrate on walking normally.
Ive got another appointment to see him on 26th January 2012.

21st October (Day 90)

My leg feels unstable towards the end of the day but I'm enjoying walking around the area without people asking me what operation I have had.
Very nice that people are concerned but a bit too much when a) you don't know them and b) its the 3rd time in a 15 minute walk!

27th October (Day 96)

I've been walking a bit further each day and two days ago, managed to walk 2km. My leg ached in the evening but when I woke up the next morning it had settled down.
I opted to do a day of exercises rather than another long walk. I think it is good to mix and match the exercises and walking and hopes it helps to build up strength, stability and endurance.

I'm still having to sleep with a pillow in between my legs if I sleep on my side. There's no pain but it feels as if I'm rubbing the plate with my other leg. I'm sure its just a case of getting used to it.
Everyone on here talks about the pain but its things like getting used to touching the skin over your plate that also needs a mention.

I'm attending my third rehab class on Friday and hope to start some off loaded twisting and turning exercises.