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Author Topic: DeNovo NT graft - Recovery and Post-op Diary  (Read 5171 times)

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Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #15 on: January 12, 2016, 01:47:58 AM »
Day 48:

Today I returned to work. It was only for a half-day, but it was a good start. My hour-long commute each way was uncomfortable, but not intolerable. I am using a cane (since about Thursday). I'll be using it for at least one more week.

I'm behind with the CPM. Per protocol I should be at 90 degrees as of last Tuesday, and 120 degrees by next Tuesday. But each time I get close (I've hit 90 degrees a couple of times in the last few days), I have to dial it back to about 70-75 degrees and work my way back up throughout the day to 90. Hitting the peak flexion is just extraordinarily painful because my knee simply will not bend that far.

PT was supposed to start today, but I faced some unexpected setbacks at my appointment. I'll see a new therapist starting Friday with hopefully more success. I tried a few exercises at home to see what my abilities are like with mixed results. The protocol calls for isometric closed-chain exercises... I still don't understand what this means except that my foot is supposed to be on the ground. That is difficult because I don't have enough range of motion or strength for any of the exercises I found. So ... I tried straight leg lifts and side leg lifts. Both are painful, but possible for a few reps. I'm hoping a PT will be able to improve these results as well as ROM.

CPM use continues until Week 8, I believe. Then I plan to replace it with a bicycle.

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #16 on: January 15, 2016, 03:07:16 AM »
Day 51:

Work has proven difficult. Mostly because sitting at a desk is extraordinarily uncomfortable. I cannot bend my knee enough to sit normally in a chair. I've been propping my leg up under the desk, but that hyperextends my knee, or requires me to twist my hip so that my knee is on its side, slightly bent. Neither is comfortable.

By the end of each day, my knee is swollen and very painful. The incision site has become inflamed - I expect from swelling. I've also made the stupid mistake of neglecting the CPM due to my own fatigue.

The dog jumped onto my knee last night as well. That pain was one I will not soon forget. It appears there is no *real* damage though, which is a relief.

My ROM is improving just by virtue of being mobile. Though I think I'll probably be using the cane for awhile beyond the 8 week mark.

So far, I am comfortable with my progress and actually pretty pleased with my pain and mobility levels. After 7.5 weeks, I feel like I would about 3-5 days after an arthroscopic debridement. It's really not too bad.

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #17 on: January 31, 2016, 08:56:06 PM »
Day 68: (Two months post-op)

I've been in PT for about two weeks, and back at work for three. The PT has been great for ROM - I'm finally at 118 degrees flexion (PROM). My AROM is still a paltry 80-90 degrees, but that is primarily due to quad weakness. The patella is stiff and a lot of scar tissue formed during the first 10 days post-op when I was locked in hyperextension. The therapist is working to increase flexibility and movement of the kneecap so that it will track properly as my quad strengthens. Exercises are basic leg raises, stretches, hip abduction. Anything to strengthen the outer quad for better movement. At week 10 we will start working on hamstrings and inner quads, per protocol.

Pain has increased significantly. Stabbing, sharp pains start at the top of the kneecap at the patellar tendon  and radiate into the patella. When this happens, my pain levels spike to a solid 8 and very slowly dissipate to a resting 4-5. It can take hours to get the pain back down. Ice helps, but it is a temporary fix. The CPM no longer has the pain relief effects that it once did. And pain killers are useless for this.

I still don't have full nerve recovery in my knee - there is a tingling numbness superficially, especially on the lateral side of the kneecap (outside of my left knee) which is the direction my patella was flipped during surgery. After a shower there is visible dark bruising on that side of the incision as well. I don't have any explanation for these symptoms and my OS seems just as confused as I am, which is disconcerting. Swelling has not gone down. My knee remains about 1.5 times the size of normal and consistently feels like there is an Ace bandage wrapped too tightly around it.

On a good day, I can make it a few steps without the cane, and even with a gait that mimics normality (hopping limp of sorts). But then my knee gives out and I'm apt to fall. The pain also increases in severity after I try walking without the cane. Driving or riding in a car seems to be the worst thing for my knee. The pain is unbearable after about 30-40 minutes.

The incision looks pretty good. The tips have started to heal beautifully (using Mederma daily may be helping) so that the incision appears to have shrunken to about 4 inches from the initial 5.5 (approx.) There is still some inflammation in the middle 3 inches - swelling of the scar so that it is raised over the rest of my skin - but I assume this is part of the healing.

Despite the pain and other odd, frustrating symptoms, I'm trying to increase my activity levels. The rehab protocol provided by my OS allows cycling as of Week 8. I can barely do a full rotation and my average RPM is embarrassingly low ... but it's movement. For now, the stationary bike is my salvation.
« Last Edit: February 08, 2016, 06:02:55 AM by stephlouise »

Offline 01

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #18 on: April 28, 2016, 08:18:00 AM »
How are you doing now, stephlouise?
04/2016 Denovo NT on LFC/trochlea

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #19 on: April 28, 2016, 04:41:16 PM »
5 months post-op:

Hi 01, thanks for asking!  I'm still recovering - but I'm optimistic that I'll be biking and walking by the end of the summer. Physical therapy has been tremendously helpful in regaining balance and strength. My quad is still very under-developed, but it's improving.

Walking is getting better, but I use a cane when I leave the house. Any surface that is sloped or uneven causes me to fall. I still cannot navigate the driveway of my house without doing a zig-zig to reduce the effect of the incline - I'm sure my neighbors get a kick out of it. But, I can walk about a block with the cane if the surface is flat. My continued use of the cane is likely a strength issue because my knee just gives out, and I can walk well around the house. Gait-training is really helpful, but if I don't focus on my steps I still have a limp (bad habits, basically).  I'm going to start light yoga and extend my time on the stationary bike over the next month in the hope that I can expedite the growth of muscle.

I'm hoping to have an MRI done this coming month. There is a click at times when I fully extend my leg after full flexion (my ROM is at 135 degrees). But this seems to have improved and could be due to my lack of quad strength causing my patella to track improperly. The MRI will hopefully confirm whether it's a muscle degeneration issue or a cartilage issue (I'm hoping for the former!) 

Nerve pain has been the biggest problem, but it is intermittent thanks to medications and creams. I'm finally allowed to use some NSAIDs again since the cartilage is (likely) finished growing. This issue is uncommon, but it doesn't rise to the level of CRPS (or RSD) thankfully, and is likely the result of having 3 knee surgeries within just over a year AND having had chronic pain for so long. It should be reversible with the help of PT and meds.

All in all, I'm pleased with my progress. My pain levels are, on average, lower than pre-op. When the pain strikes it is debilitating, but it's less common than before. My recovery is taking longer than the standard DeNovo recovery time, but that has been attributed to the nerve pain.

So, that's the status ... I'll update again after I get an MRI done. Hopefully with good news :)   Thanks again for asking! It was a good reminder to update my post.

Offline 01

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #20 on: April 28, 2016, 06:29:32 PM »
Glad to hear you are getting better! :) I hope the MRI will show good cartilage. Too bad that your recovery is taking longer than usual.
04/2016 Denovo NT on LFC/trochlea

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #21 on: January 08, 2017, 12:18:01 AM »
410 days post-op:

I intend to start a new thread with a summary of my impressions of the De Novo surgery, but thought I'd first post a follow-up here, just in case anyone is still checking in on this. My one year De Novo anniversary was Nov. 24, 2016, and this past Thursday, January 5, 2017, I had my first post-op debridement. This entire experience has been a huge roller coaster and extraordinarily educational on so many levels.  Having the added complication of what turned into full-blown RSD has made recovery one of the greatest challenges I've ever faced.

At one year post-op, I was walking better than prior to surgery, but still could not run, walk stairs, or ride the bike. I could walk more about 0.5-0.75 mile, but not without complications. When I did walk stairs, it was one step at a time and without bearing weight on my "implant knee." In July 2016, almost 8 months post-op, I was having a good day and "forgot" to be cautious while walking only three stairs into the backyard. My knee gave out, causing me to fall hard (luckily only three stairs!) and I ended up with a severely sprained right ankle, and with a mild sprain to my implant knee. It was a huge setback. About a month after that, I slammed my implant knee into a conference table (the bane of my existence, as anyone with knee injuries knows - those things are dangerous!) while seated and was set back about two months in my RSD recovery.

In May, I had an MRI that showed the surgery was - for all intents and purposes - a medical success. The cartilage grew in as desired, although it was a little uneven. Regardless, there was no longer any bone-bone contact at the patella. This was incredibly encouraging, but didn't change that I was still experiencing a painful "catching" when extending my knee and when I tried biking.

In October, my OS determined that another surgery would be the only way to (a) figure out the cause of the catching and thereby the true success of the implant; and (b) to fix any lingering issues. Due to the RSD, any surgery is a huge risk for me, but I'd seen quite a bit of improvement and had to weigh the cost of waiting too long before the next surgery and thereby delaying my mobility against the risk of making the RSD permanent by flaring the nerves. We scheduled surgery for January 5, 2017.

I am now two days post-op, following an arthroscopic debridement and chondroplasty. My OS is extremely conservative and warned me he may do absolutely nothing during surgery, as he would err on the side of preserving tissue. He made only two incisions (compared to the 4-5 during prior arthroscopies) at the base of my patella. He ended up doing significant debridement of scar tissue resulting from my implant surgery. There was minor chondroplasty needed due to the unevenness of the implant growth. The scar tissue is the likely cause of the "catching" and pain I was experiencing. The good news? The implant looks great. It nearly blends in with my regular cartilage. The only abnormality is that it is thinner around the edges of the implant, which isn't optimal, but is unlikely to cause any impairment to my mobility.

Right now, I am thrilled with the outcome of the implant and the most recent arthroscopic surgery. I am already starting to walk without crutches. I would have been walking yesterday, except three nerve blocks were done to control my nerve pain (one femoral pre-op and two sciatic post-op). Those wore off after a few hours and the pain was not controlled until today. Now, I'm controlling the pain with Percocet and Aleve. Ice is not the friend of RSD patients, so I'm limiting the cryotherapy as much as possible.

Already, I am noticing an improvement in my knee. I can do quad sets without pain, which is epic. My knee is weak and I'll likely need a cane for a week or so until my pain response has diminished again (causes my quad to give out randomly), but if my recovery progresses at this same rate, I am optimistic I will finally have the knee that I hoped for from the implant.

I think it is important to realize that the De Novo implant has an 18-month full recovery period. The RSD set me back quite a bit, but I will be 18 months post-De Novo as of Memorial Day 2017. That gives me a few more months to work through the kinks.

Physical therapy starts in ten days with aquatic therapy 3x a week to strengthen the quad and rebuild the muscles. My muscle development was stunted by the RSD, so the hope is the aquatic therapy will induce minimal pain response so that I can transition back to the bike.

The hardest, and least anticipated, part of the De Novo surgery has been the depression caused by both immobility, as well as disappointment from setbacks and lack of progress. It shocked me just how hard it was to persevere despite some serious obstacles, and despite progress that consistently and unavoidably fell below my personal standards of physical achievement. I've been lucky to have an amazing surgeon who has been an absolute cheerleader (seriously, at some appointments his only role was to tell me to keep trying and that, no matter what, we were going to get me riding the bike again). The power of a supportive physician should never be underestimated.

This has been somewhat rambling (I blame the Percocet), but hopefully all the details are there. 

Offline NewYorkDancer

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #22 on: January 14, 2017, 04:35:03 AM »
Hi Stephlouise!

Would love to talk to you privately about your experience with Denovo as I just has this procedure done in November 2016! Is there a way to message you privately?

All the best!
Professional Ballet Dancer here in New York

- Microfracture (3-29-16)
- Synvisc One Injection
- Supartz Injections

Getting ready to undergo Denovo procedure and meniscus repair

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #23 on: January 14, 2017, 05:31:51 AM »
Hi NewYorkDancer,

I just sent you a private message. Let me know if you didn't receive it! Hope your recovery is going well! Two months in can be a rough time, but hopefully you're back on your feet!

stephlouise

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #24 on: January 14, 2017, 05:32:48 AM »
 _
« Last Edit: January 14, 2017, 05:35:44 AM by stephlouise »

Offline Smys21

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #25 on: February 14, 2018, 06:34:01 AM »
Hi Stephlouise,  I am hoping you will see this ass I would really like to talk to you about your Denovo experience and how you are now after the debridment was done. I think I am in the same boat as you were; I am 4 1/2 mo post Denovo and am having almost exact same issues you had. Can you please message me so I can ask you some things? Please and thank you.

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #26 on: February 14, 2018, 06:49:04 AM »
Hi Smys21,

Thanks for reaching out. I just sent you a PM and am happy to talk to you about my DeNovo experience.

A brief update: Iím 26 months post-op and have a well-functioning knee most days. Occasional pain is annoying, but not debilitating. I can cycle, walk the dog, do stairs (cautiously, I admit), and even run for a few steps when Iím feeling bold. The RSD cleared about 90% after the arthroscopy to clear scar tissue. I got hit with the flu so I stopped riding, which I was doing weekly, and Iíve noticed stiffness and nerve flare-ups more in the last couple of weeks. I expect these to clear once I get back on the bike and moving my knee around. This has been an odyssey of truly epic proportions. No two experiences will be identical, but if my trial and error, and frustrations with expectation and disappointment can help make your journey any easier, Iím happy to share what Iíve been through, what has failed, and what has worked.

Stephlouise

Offline andreaga

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #27 on: May 15, 2018, 10:35:45 PM »
do you have any up-dates after your surgery? Last time you posted at 6 weeks post-op and I find your posts very helpful. I'm wondering how you're doing couple years after the surgery.
I'm 5 weeks post- op today. Thank you so much, looking forward to your up-date.

Offline stephlouise

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Re: DeNovo NT graft - Recovery and Post-op Diary
« Reply #28 on: May 16, 2018, 12:22:36 AM »
Hi andreaga,

Congrats on your surgery and being 5 weeks post-op! I hope your recovery is going well. Are you weight-bearing yet?

I'm really glad to hear that the post-op diary has been helpful. That was my goal in chronicling my progress because the surgery carried so much unknown for me. I wanted to reduce that uncertainty for others.  I did continue to post beyond 6 weeks, but the updates were far more sporadic. Check out replies #19 and #21 for more detailed long-term updates. I've also added another current update below.

I am now 2.5 years (30 months, almost to the day) post-op. Here's the good, the bad, and the ugly...

The good: I can ride the bike again (which was my #1 goal for this surgery, even more than walking!) and I ride 10 miles at a time multiple times each week. I can occasionally wear heels (I'll be wearing them for my wedding this fall) up to 3.5 inches high. I can walk the dog, do yard work, climb stairs (carefully), drive a manual, do squats, and climb around the house for DIY carpentry projects. Most days, I do not think about my knee or my surgery or my limitations because they do not affect my everyday life or my career.

The bad: When the pain hits, it's very unpleasant and it's usually unexpected. I'm probably about 85% ability. I will never be 100% - a fact I have slowly resigned myself to. But I'm 34 now and gained 25 pounds post-op (going from a very fit 115 to a soft 140 at 5'7"), so it's not surprising that it's an uphill battle to maximize my athletic ability and mobility at this point. I have to be careful using stairs, especially going down stairs. My body makes me pay for any physical excess - heels over 3.5 inches? I'm in pain and have knee weakness the next day; heels for more than a day or two? I trip and fall and am set back a week or two; too high a gear or tackle some hills on the bike? searing pain through my quad and behind my kneecap until I stop the activity; sit for too long with my knee at 90 degrees? my lower leg goes numb, I fall, and have painful pressure behind my kneecap. None of this is debilitating and it's all MUCH better than what I experienced pre-op. But it's a fact of life. As I write this, I have stinging pain behind my kneecap because I wore heels to work. It's a trade-off. Also note, I take zero pain medications. Not even Aleve (which would likely alleviate much of the pain but I hate pills so much after taking them so long, that it takes a lot more than non-crippling pain to get me to break open the pain killers).

The ugly:  Mostly, I walk normally and without a noticeable limp. On really bad days, my leg drags a bit, but not markedly.  People who meet me now have no idea that 2.5 years ago I was using a cane and barely getting around. When my knee gives out, I'm likely to trip, but can usually recover, and then have a limp until my body can shake it off. My quad has not built back up yet, so my legs are lopsided (my family swears this is noticeable only to me). And the muscle atrophy and long recovery resulted in a slower metabolism, so the athlete in me is screaming at the uphill climb to fitness.

In summary: I would do this all over again. Even if not allowed to change a few things (like getting the CPM sooner would've been helpful, or getting the debridement sooner), this graft has been life-changing. I had resigned myself to being crippled when my first surgeon told me I have zero options to fix my patellar defect, and then later when my 3rd surgeon couldn't convince the insurance company to cover the cost. I am still paying off the surgery (only one loan left!), but it has been worth every last penny. Now, I look forward to walking and hiking, I do not dread getting out of bed or panic when I cannot find a parking spot in the front row. I can go to baseball stadiums, snorkel, and walk on the beach (sand was off-limits pre-op). I do have to be more careful than anyone without the graft, but it's a small inconvenience for all of the freedoms I've regained.

Best of luck with your recovery. Patience and optimism will help you enjoy the tiny victories, and make the healing process so much more bearable.

-stephlouise















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