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Author Topic: Arthrofibrosis Doctor  (Read 3962 times)

Offline Hyaldo

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Arthrofibrosis Doctor
« on: August 26, 2011, 05:48:40 PM »
Hello all,

I was just diagnosed with post-op arthrofibrosis. I had ACL repair 2 months ago. I am at -17 degrees extenstion and 113 degrees flextion. I have an appointment scheduled with Dr. Wojtys  in Ann Arbor, MI on September 6th and another one setup with DR. Eakin in California. I don't know what to expect. Has anyone here treated with this doctors before? I would like to know about your experiences.

Please help!

Thank you!!

This is a re-post in the correct thread.

Offline missmyknee

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Re: Arthrofibrosis Doctor
« Reply #1 on: August 26, 2011, 06:31:47 PM »
Hi Hanna

As posted to your same post in the General Knee Questions section:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=57264.0

Besides the one link to a Dr Wojtys user, also look search for threads by those names I gave you using the search box and also type his name to search.

Here is the link to the tutorial by Dr Noyes. It is excellent. Read it over several times plus the other info in the AF section I gave you the link to. Here is Dr Noyes link:

http://www.kneeguru.co.uk/KNEEnotes/node/633

Here is a link listing AF doctors

http://www.kneeguru.co.uk/KNEEnotes/node/427


To answer your question you posted in the other section, I am a patient of Dr Noyes. He is located in Cincinnati.I travel from Kansas to see him. I've been with him since 2004 and thru 6 surgeries. I trust no one else with my knee.

Dr Eakin is another excellent doctor to see for AF. One thing to keep in mind,if you have surgery with one of the AF docs, you want to use one who has his own on site PT facility. Their facilities have PTs specially trained in the rehab of AF and allows the Dr to check on you, usually 2 times a week ,to see your progress. If a problem does occur, the Dr is right there to access the problem early and make necessary adjustments. Most of us have made arrangements to stay in the city where the Dr is located, anywhere from 2 weeks to 6 or 7 weeks. The rehab is crucial to  a successful recovery.

Feel free to ask questions  ;D

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Hyaldo

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Re: Arthrofibrosis Doctor
« Reply #2 on: August 26, 2011, 09:23:15 PM »
Hi Pam,

Thanks again for the info!! This is really helpful.

I totally agree with having an onsite PT facility. That was one of the things that I asked Dr. Wojtys staff when I booked my appointment and they said they did but I don't know if he checks on his patients right there during the rehab. Staying in MI maybe a good option for me but I am still somewhat debating. I live 2 hours away from Ann Arbor and my parents only one hour away so it's a lot easier to travel!! I think I am on the right path, I just need to decide between the two  ;)

Thanks for all your help :D

~ Hanna

Juneau

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Re: Arthrofibrosis Doctor
« Reply #3 on: August 27, 2011, 07:58:53 PM »
Hi Hanna,

I had AF surgery with Dr. Eakin on July 6th. Dr. Eakin is very knowledgeable and friendly and I am very happy that I had surgery with him. I am still in the middle of rehab. I am dealing with some swelling issues right now and my knee has to deal with some damage from three previous surgeries but my knee is already quite a bit better than before the surgery. I did quite a bit of research after I found out that I had AF and also saw another OS in Seattle before I decided on Dr. Eakin. It was very useful to meet with two different surgeons and to get their perspectives.

There is a very modern PT facility on the ground floor of the same building where Dr. Eakinís office is. I saw one therapist that is very familiar with AF right after my surgery and I saw another one that specializes in Aquatherapy at their therapy pool to get some exercises a month later. Dr. Eakin does not visit patients at the PT facility. You go to his office for the visits.

I flew from Alaska to Palo Alto. One time into San Francisco and twice into San Jose. San Jose is a little closer and is much easier to access (particularly the car rental right next door to terminal) but there are more flights into San Francisco. After surgery, we stayed at the Creekside Inn, a very nice (lots of trees and gardens) extended stay hotel for 10 days so I could remain in the area for my first post op visit. Since then I returned one more time three weeks after my return for another post op visit (the one month post op)

I found the following two articles very helpful in my research into AF and I donít think that they are posted on the Kneeguru site.

This article explains the typical arthroscopic procedures that are done for AF. Reading it makes it easier to visualize the problem areas and understand the terminology that the surgeons use like Lateral Relases and Anterior Interval Release better.
http://miomed.com/cpmdoc/Arthroscopic_Treatment.pdf

This article is a good summary of the rehab that can be expected for AF. I have given copies to some of my therapists back home that were not familiar with AF because it provides a good overview and is concise.
http://drmillett.com/attachments/article/87/Rehabilitation%20of%20the%20arthrofibrotic%20knee.pdf

The rehab for AF is very specialized. Itís even more tedious than rehab for ACL re-construction (my ACL reconstruction was the culprit for AF as well) and has to be done very carefully. I overdid a bit PT last week and also spent too much time at work and I now have to take it extra easy to get back on track.

Itís very overwhelming and stressful to deal with AF but you are on the right path. You are doing the right thing to see two AF experts. This will allow you to make an educated decision.

Just remember, you donít have to make a decision about which doctor to receive treatment from right this minute. Do some research, speak to the doctors and then you can consider the alternatives and decide on the next steps.

Good luck!  :)

Offline Hyaldo

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Re: Arthrofibrosis Doctor
« Reply #4 on: August 28, 2011, 06:13:08 AM »
Hi Juneau,

Thank you so much for the reply! This is really helpful. I'll read through these articles and get familiar with the procedure! This has been very frustrating to deal with ever since I found out that I have AF. I am most likely going to see both docs then decide my next steps!

Did you receive pt while you were in Palo Alto and will you be finishing it back home?!? I am having a hard time finding a pt with AF knowledge in MI.

Hope your rehab is going well.

Best of luck to you too  :)

Juneau

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Re: Arthrofibrosis Doctor
« Reply #5 on: August 28, 2011, 07:51:56 PM »
Hi Hanna,

I stayed in Palo Alto for 10 days after surgery and saw a PT at their PT facility 3 times during that tiime. She gave me a bunch of exercises for me to do that included pictures. The doctor also made some suggestions on exercises.

I am continuing with PT back home in Alaska. My original prescription was 6 weeks 3 times a week but I will need longer PT because I am having to be extra careful because of weight-bearing issues. My PT at home is a very experienced PT but has limited experience with AF and I provided the information that I posted to him so he becomes more familiar with it. I am continuing with a lot of my original exercises plus a few new ones as I can tolerate to work more on strengthening.

I also provided a copy of the rehab tutorial that is posted on the knee guru site.
http://www.kneeguru.co.uk/KNEEnotes/node/263
It explains the fundamentals of the rehab protocol for AF:
In the initial phases of the disease and in the postoperative period, inflammation and joint swelling typically limit motion and contribute to further scarring. If this is not treated in appropriate and timely fashion, this can lead to permanent motion loss. Decreasing swelling and preventing inflammation is essential to maintaining and increasing motion. Weight bearing is also another important variable. When the knee is loaded by early weight bearing activities or aggressive strengthening, recovery from an inflammatory process will only be delayed or exacerbated.

It's quite common that AF patients have to educate their PT about AF unless you live in a location right next door to one of AF doctors. Some patients stay on location for a month but rehab is typically longer than that so we have to often deal with a non AF experienced PT at some point. It's important to get the principles of the required rehab but the most important thing is that we need to be willing to really listen to our knee. Work consistently on the exercises but not overdo it. If there is an indication of irritation, pull back and adjust exercises and activities of daily living as needed.

I was also very frustrated and scared when I found out that I had AF and what the implications were. But I am very glad that I did the research and found a doctor that I was very comfortable with. My ROM numbers were much worse than yours and I had it for a while so I had developed Patella Baja. 7 weeks after surgery I have almost full extension and I have much better flexion. I still have way to go on flexion and gain strength so there is a long road of recovery ahead but I am already doing much better than before surgery.

Let us know how your doctor visits go.

Offline Hyaldo

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Re: Arthrofibrosis Doctor
« Reply #6 on: August 29, 2011, 05:18:18 PM »
Hi Juneau,

Thanks again for the info.

I am currently receiving PT. My PT has been very gentle since we discovered that I have AF. I am feeling a lot better pain wise but my knee is still swollen and somewhat warm. I've been walking on it without crutches though and this doesn't seem to bother me. I walked about a mile yesterday and it felt ok just got a little sore so I came home and iced it and elevated it. I have PT later today.  My PT is not really experienced with AF and I don't know if I need to continue at this point or not...I started at -18 last week and he brought it down to -13 after PT so that's some improvement. We'll see if I can make more improvement today.

Hope your rehab is going well and I'll definitely let you know how the appointments go!!

Take care!

Juneau

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Re: Arthrofibrosis Doctor
« Reply #7 on: August 29, 2011, 08:06:06 PM »
Hi Hanna,

It's good that your PT is gentle now. Gentle hands-on is the key. If you have a lot of scar tissue, the PT might give you only a temporary ROM improvement because the scar tissue will tighten up again. You should probably continue with PT until you see the surgeons. Once you decide to have surgery, then you probably want to take a break from PT, because it has been decided at that point that it is ineffective, and just do gentle stretching on your own. You will do enough PT after surgery.† ;)

Most of the heat and swelling you can't control because it's caused by the AF, but you should watch your activities of daily life in addition to your rehab program and control those if you can to not cause further irritation. I recommend you take it easy on the walking even if it is not hurting if it causes more swelling and heat. It's important with AF to get out of the swelling cycles because that could make the AF worse. And it might be better to operate on a knee that is not anymore warm.

It's such a fine line of watching your activities when you have AF. I know from experience about the swelling cycles. I have been doing very well after surgery until a week ago when I overdid it and now I had to pull back on the exercises that I can do and go really easy.

Take care
« Last Edit: August 29, 2011, 08:48:44 PM by Juneau »

Offline captainruss

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Re: Arthrofibrosis Doctor
« Reply #8 on: September 02, 2011, 08:06:27 PM »
Hello,

Anyone have a line on an AF doctor in Florida?  I am in Saint Petersburg (Tampa).  I admire your ability to spend 6 weeks somewhere having surgery.  I was not prepared to be off work 15 months.  I have my wife working overtime because of no progress with my AF.  I had 6 weeks leave to have a TKR and ended up losing my job.  I can't afford to pay attention, let alone travel somewhere leaving my three children, one of which is full time in college at 15.

Do any AF docs consult long distance?  I really like my current OS....he has done my spine and shoulders.  He did not do my original TKR or the removal....that was OS #1 and #2.

Thanks all.

Russ
80 Shattered patella 5 surg
09† TKR†
09† MUA
09† MUA
09† Knee infected??
10† TKR† Scar Tissue
10† 2nd OS† Diagnosis Infection
10† TKR with antibiotic spacer, no joint
4/11† TKR
11† TKR PT
11† TKR
11† TKR† AF diagosis
12/11† HO diagnosed
2012† Intractable Pain
2012† OS split
amputation possible?

Offline missmyknee

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Re: Arthrofibrosis Doctor
« Reply #9 on: September 02, 2011, 11:58:01 PM »
Hi Russ

I've read all your posts on the other threads. You have certainly been thru your share of problems with your knee. finding a doctor with AF knowledge is difficult much less find one who also has knowledge of AF with a TKR. There are 2 doctors on the AF doctor list who deal with AF in a TKR. Dr Blaha in Michigan and Dr Noyes in Cincinnati. There used to be an AF doc in Florida , but we found out several months ago that he is no longer practicing. You can also try the Mayo Clinic in Florida for an OS who deals with your problem.

Your OS can probably consult with Dr Blaha or Dr Noyes long distance and /or they might be able to give the name of an OS in Florida.

Dr Blaha info

http://www2.med.umich.edu/pcdv2/provider/dsp_provprofile.cfm?individual_id=106305&um_depart

Dr Noyes info

www.cincinnatisportsmed.com

There have been a couple posters Named Janet, and JillM who used Dr Blaha with their AF and TKR. Dr Blaha did their TKRs  I used Dr Noyes for my AF and TKR.

another area to locate a doctor is from the knee society

http://www.kneesociety.org/members/public/pubfind.cfm

Dr Carlos Lavernia of Mercy Hospital , Miami Fl

http://orthomercy.com/about-the-institute/physicians/carlos-j-lavernia-m-d-f-a-a-o-s/

 wrote the following article

 Multimodal pain management of AF in a TKA

http://docs.google.com/viewer?a=v&q=cache:Pl3o1E4L320J:www.orthomercy.com/wp-content/uploads/2010/08/Multimodal-Pain-Management-and-Arthrofibrosis.pdf+arthrofibrosis+in+a+total+knee+florida+orthopeadic+surgeon&hl=en&gl=us&pid=bl&srcid=ADGEEShBNfIT9FNPGYoGtG57vSUJDgZiNQAmrAoDSL26o7W2b6YYWn3KC5PWttxBd1QNb5X1fFsO16Wil-T7zZBNY0RG1kasiGzSi7DhFiNqzxY_RWXg3m4Svp0LAtxRXu_-rsMYqYtG&sig=AHIEtbSuV_JbcCTAtkuD-x1beAra_UVLlg

In regards to your pain.....you might think about seeing a Pain Management doctor. Orthopeadic doctors handle pain in the immediate post op period , but with chronic pain , a pain management specialist should manage the pain. They can provide a custom program of different types of pain meds , a cocktail of meds, to handle your chronic pain.

Have you been tested to see if you are allergic to any of the metal or cement in your implant. That can trigger AF in a TKR.

Search for recent posts from starpolisher. She is currently doing Astym or her AF /TKR and is seeing real improvement after suffering for 5-6 yrs with AF in both TKRs. She's had revisions too. She mostly posts over on the kneegeeks facebook page to the right side of this website. Her name is Patty.

www.astym.com

Also ultra sound used in regards to AF will not break up scar tissue, but is used for 10 min, to warm up and soften tight tissues just before doing patella mobes and deep tissue massage. Dr Noyes uses this method in his PT room.

I tried to answer most of your questions in one post. Hope this helps some

Pam
« Last Edit: September 03, 2011, 03:36:09 AM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline captainruss

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Re: Arthrofibrosis Doctor
« Reply #10 on: September 03, 2011, 04:58:55 AM »
Pam,

I apologize for going crazy with the different theads.  I have had so many OS look at me like I am crazy when I tell them scar tissue is growing and I have pain from scar tissue.  They really don't get it and finally my OS #3 is starting to listen.  He is a great OS, but I can tell he doesn't have a clue about what I have read on this site.  I was so excited...maybe relieved is a better word when I actually found someone has similar problems and there is someone out there to talk to.

You have been very helpful.  I wish I could visit Ann Arbor.  I went to University of Michigan 28 years ago.  I have been out of work for 15 months and cannot afford to drive accross town.  I have always worked and debating on filing for disability.  If I could get my AF under control, I am healthy and willing to work. 

I have a pain specialist.  I went to two now to have the morphine pump implanted so that I could slow down the opiates.  They make me grouchy and I have a huge tolerance to them.  They are similar to OS as they give you so much and then announce that is all they can do for you.  At least my OS will give me anything I ask for.

I will look up the astym (my PT therapist said she would look it up also).  Even my PT specialist says she has not heard of AF.  Thank you for all of this.  I will send links to my OS and contact Florida Mayo clinic. 

I infer that I should only post in one thread?  I was not sure if everyone would look at it.  I am not the brightest computer bulb in the lamp!!

Thank you so much for your help.

Russ
80 Shattered patella 5 surg
09† TKR†
09† MUA
09† MUA
09† Knee infected??
10† TKR† Scar Tissue
10† 2nd OS† Diagnosis Infection
10† TKR with antibiotic spacer, no joint
4/11† TKR
11† TKR PT
11† TKR
11† TKR† AF diagosis
12/11† HO diagnosed
2012† Intractable Pain
2012† OS split
amputation possible?

Offline missmyknee

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Re: Arthrofibrosis Doctor
« Reply #11 on: September 03, 2011, 04:02:01 PM »
Hi Russ

You can post in as many threads as you want. It was easier for me to pick a thread, to answer. you.  ;D  One thing you can do , something we all have had to do, is print off Dr Noyes tutorial on AF and some of the articles there. This will help the Dr understand what you have been going thru. Here is a link to the tutorial

http://www.kneeguru.co.uk/KNEEnotes/node/633
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Hyaldo

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Re: Arthrofibrosis Doctor
« Reply #12 on: September 07, 2011, 10:21:18 PM »
Hello all,

So I had my visit with Dr. Wojtys yesterday and was somewhat surprised when he told me that I donít have Arthrofibrosis. I was really happy to hear that I donít have it but sad when he said that I do have to go through 2 more surgeries to revise the ACL. He said my lack of motion was definitely due to the ACL (he was 95% confident). My previous surgeon replaced the ACL when I was still lacking flexion and extension. He wants to do the first surgery to remove the ACL and clean out whatever scar tissue that might be there then do a ton of rehab to restore my motion. Once I get my motion and strength back, Iíll go through another surgery to replace the ACL. What a mess the first surgeon go me into!! Do you guys know what to expect with ACL revisions? Juneau, you mentioned that the ACL was the culprit to your Arthrofibrosis, has any of your docs tried to revise it? Dr. Wojtys seems very knowledgeable and he knew right away why I was lacking motion!! I am still thinking of seeking another opinion thoughÖ I am just too afraid that when I hear different things, Iíll get myself confused and not knowing what to do!! I appreciate your suggestions!!

Juneau

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Re: Arthrofibrosis Doctor
« Reply #13 on: September 07, 2011, 10:53:19 PM »
Hi Hanna,
I have heard that people can develop problems if the ACL is not attached properly and require a revision. That was not my problem. I am not sure what the cause of my AF was but I had a lot of bruising and I did not get a CPM because my OS did not do that typically - I found out in the meantime that many surgeons have a CPM ordered even for ACL surgery. My ACL was so scarred up when I had my scar removal surgery by Dr. Eakin that he had to take it out but I won't miss it because the remaining scar tissue holds everything in place.

I am glad that you are very comfortable with Dr. Wojtys. It's important to trust the doctor. I am sure he won't mind answering you any additional questions after you have seen another doctor for a second opinion. Surgeons are very used to people going to see multiple OS before they can make a decision particularly when it's something as complicated as AF. I saw a doctor in Seattle that proposed a different type of procedure before I saw Dr. Eakin and I called that doctor back with lots of questions after I had done some research and I did not ended up getting surgery from him.† ;)

It was scary for me too to find out about all those different options but the better informed you are the better decisions you can make. It's a wise thing to get a second opinion and then check back for more questions if needed. You don't need to rush into things.

Offline missmyknee

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Re: Arthrofibrosis Doctor
« Reply #14 on: September 08, 2011, 12:30:36 AM »
Hi Hyaldo

Here is another tutorial from Dr Noyes on ACL reconstruction failures and revisions. This might help you out.

http://www.kneeguru.co.uk/KNEEnotes/node/155

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions