Bone breaks around the knee :
progress, questions, and soon to be metal-free - - Posted by Xanthipe (xj), 2 July 2003
Hello,
I visited the OS last week and I wanted to give a brief progress report after having surgery (nearly 5 months ago) to fix my fractured patella.
The OS was happy to see that I was walking and even without a limp (I was so focused that I must have looked really uptight while I walked). The X-ray showed that at 20 weeks post-op the bone was all healed, which great news is; at 12 weeks it still had not filled in yet. It is crazy to think that bones can take so long to heal, even when they are screwed and wired in the proper geometry.
My passive ROM is 150 degrees, which this is by no means comfortable, but I can sit Indian style now. Still can't watch a movie at the theatres without propping my leg up at the 45 minute mark, but I have been trying hard to tolerate the sitting discomfort for longer before resorting to propping it. Today, I started working on going down/up stairs and so far the down is much harder than expected. My leg fatigues quickly so I won't even think of trying stairs yet at the end of the day.
For me, the leg (particularly the quad) strength is much harder to get back than ROM. I continue to go to the PT clinic T/R and to aquatic therapy M/W/F and do my exercises everyday at home, but my quad is still so skinny. I am wondering if I am giving my leg enough time to rest to build muscle. Do you know how often to strength train with weights at 5 months after this type of injury? How often did you knee fracture folks do strengthening exercises like straight leg raises, short quad arcs, and wall squats? I use the elliptical trainer (when I manage to get to the gym), the stationary bike (at home) and the treadmill (at PT), but I wonder what your favorite (or what is the most effective) quad strength training activity? Also, can the strength in my bad (with respect to the good) leg actually be quantified?
While at the OS, I decided to ask about why my pain was so persistent even at 5 months post-op. I continue to have: intermittent (and unpredictable) sharp pain across/on the side of the knee cap, pain after standing for more then 30 minutes, and consistent pain in the mornings. He answered with "you should think about getting the hardware out" as if that was the only possible culprit. I really hope some of this pain and discomfort will be alleviated once the hardware comes out. I do not have a date yet, but it will probably be scheduled within the next month or so.
Do I need crutches for the hardware removal surgery? I will travel from NY to LA for the removal and I would rather not have to bring the crutches, particularly since I don't ever want to see them again! Since the removal is so VERY MUCH easier than the first one (I know this thanks to my fellow knee geeks), I figured I could brave it. I do have a cane, so I can bring that if everyone thinks I need something for support. After my first procedure, I had a sensitivity to morphine, delaudid, percaset so I was wondering what other pain meds that you have used post hardware removal?
Trying hard to keep my spirits up,
XJ
Posted by dwalsh (dwalsh), 2 July 2003
Hi XJ.
I am now 9 months from my original patella fracture (severe) . At 6 months I had the hardware removed. As far as that goes my pain significantly decreased and i was able to work on quad/leg strength much easier, much more often. For me removal of the hardware solved a multitude of problems (inlcuding ROM that was only at 100 degrees pre-hardware removal now up to 140).
At the point you are at now I was in PT three times a week, doing the bike, treadmill and weight machines. Are you doing any weight machines? Also they had me working on the step for about 15 minutes, going up, down over etc. I also walked a lot (I live in nyc) and feel that in itself helped build up the leg strength, and have five flights of stairs to my apartment which definitely was a challenge. Going down the stairs is much harder. You place an incredible amount of weight on your knee when you are steppin down. I still sometimes cheat and take the stairs slightly sideways and even when concentrating have an uneven limp going down.
I would suggest hardware removal sooner rather than later. I think you'll be surprised how much it helps with your leg strength. I was at a plateau before the surgery and since have been able to make great gains working with the weight machines, step etc. (so much less pain). I also began going back to the gym taking body conditioning classes and yogo doing only what i could do but at least moving, working out. I saw the OS last week and he said 4 more weeks of PT and he doesn't need to see me again.... hurray! It still doesn't feel right or as strong as the other knee but I've resigned myself to this fact.
You will need crutches for a day or two. The surgery is so easy compared to the first time around and recovery time very quick but you are off your feet for a few days. I had vicodin prescribed for pain. I took it for 2-3 days and then was fine. Question: why are you traveling to LA for the surgery? I had mine done here at the hospital for special sugery in nyc. Great doctors, great hospital. First surgery was upstate NY not such a great hospital, not such a great doctor.
Hope all goes well ..keep us up to date.
Doreen
Posted by Pat_A.E. (Pat_A.E.), 3 July 2003
I am also 9 months post injury, 81/2 mos. post surgery and 5 months post hardware removal. At 5 months I was in PT 2X per week, but I was in a strenuous strength training program 2 days per week and went to a gym 3 days per week to work on the treadmill, stationary bike and weight machines. I don't think I could have done that kind of work with the hardware in place.
I quit PT this past March, but returned two weeks ago to find out what was causing hip pain. The therapist measured the strength in the right leg compared to the good left leg. He found I had regained 98% of the strength in the leg, but not in the hip. Also the quads were short. So now I am working on strengthening the hip and stretching the quads. I can already notice a difference.
Stairs generally are not much of a problem. That is not to say that I often pause before taking the first step down. While in PT I worked on stairs alot. I can recall thinking I would never do them normally again. Now I can't remember when they became routine.
Some days are better then others. A few days ago I could hardly believe that my knee barely felt different then the good one. Next day it was stiff and achy for no known reason. It still bothers me most when I stand in one place for more then a minute or two or don't change positions (like in the movies), and after walking a mile. It nevers keeps me awake and I haven't used pain meds since right after the hardware removal.
You will probably be instructed to use crutches for a few days. I used them all the time for 2 days and then periodically for 2 more days. I think this is mainly to keep pressure off the staples. I hardly needed pain relief, but took torodal when needed (I am allergic to narcotics). I had the removal on Friday as out patient. Was home after a few hours and on the sofa the entire day. Sat. I went shopping for a party and hosted 40 people that evening. Sun. went to church and did my normal routine. By Monday I was back to work. I didn't go to PT or my exercise groups until the staples were removed because they made bending the knee a little uncomfortable. The day the staples were removed I resumed PT and exercising which may have resulted in the incision scaring more then the first one did, but not too bad. I noticed an immediate improvement. The sharp pains were gone and I regained full ROM and muscle strength. In the beginning my PT thought I would never get much ROM because I was so locked in place. I am confident you will be happy with the results.
In spite of all the progress we make I'm not so sure we can ever expect to be as good as pre-injury. Maybe you younger people will be, but at 55 I am darn happy with my progress. Last week I rode my bike -- it was actually easier then walking! I am planning a walking vacation to British Columbia in September. Life is good. 
Let us know when you surgery is scheduled so I can offer a prayer for you that day.
Posted by Xanthipe (xj), 4 July 2003
Kathy and Doreen,
I am so very appreciative of the feedback I get from the great people on this site - much thanks and a 
!
The only weight machine I am doing now is the leg press. Maybe my PT has not given me any more strength building exercises on machines because the leg press gives me a fair bit of pain across my patella. As you both say, when I am hardware-free, it will be easeir to do the full gym curcuit of lower body machines. It is great to know that my pain level will decrease after the hardware removal. I look forward to resuming my normal exercise routine: biking to work, jogging, aerobics, or doing something other than "rehab." Of course, I am very grateful to have gotten to this point in the recovery. Life is not always a joy, but it always a blessing!!
Doreen:
Wow, five flights of stairs to get to your apartment sounds daunting. Way to go!
I am doing the procedure in LA because I trust him and he started it so I will let him finish it. I bet your NY OS is just as good if not better than my LA one, but my folks are in LA so I get some homemade Greek food for a couple days. I live in upstate and came to the same realization that you did.
Pat:
I will have to ask for Torodal because my stomach can't handle the narcotics: thanks for the tip. Many congratulations on riding your bike. 98% strength in your surgical leg is also great news...your hard work has paid off. Also, how exactly do they measure the strength?
Posted by mtshaw57 (mtshaw57), 4 July 2003
This is my first time posting here, although I did some lurking over the past few months, as I was trying to decide on hardware removal.
Well, two weeks ago -- 10 years after the original fracture -- I finally had the hardware removed. Since it had been in there so long, I thought they'd have to do a lot of digging which might slow down my recovery, but I was amazed at the actual outcome.
I was sent home the same day on crutches. The instructions said "weight bearing as tolerated" for the bad leg. Five mintues after I got home, I found that I didn't need the crutches! I was able to hobble around for limited distances without them just fine! Two days later, I was going about my business as if I hadn't just had surgery (albeit with a limp).
It's been 14 days now since the surgery, and my knee looks almost normal, except for some residual scabbing along the nicely healing incision and a little bit of a limp. I suspect that the limp is partly psychological.
While my bad knee will never look like the good knee, due to the nature of the fracture and the way the patella grew back together, it certainly looks much more normal than it has in 10 years, as I no longer have those irritating and unsightly little bumps under the skin from the hardware.
I wish I'd had the hardware removed years ago.
Posted by Pat_A.E. (Pat_A.E.), 7 July 2003
XJ, The PT measures strength with a physical test. For instance he has me lay in my left side (unaffected side) and raise my leg at 45 degrees. Then he pushes on it as hard as he can to determine when he can move it. Repeats the same test on the right side. Does the same type of test with knee bends, leg raises, etc. There is also a machine that can be hooked up to the quads which measure the muscle strength electrically.
It was very obvious when I did the hip test how much weaker the right side was. The leg tests were very much at the same stength and this was easy for me to determine, so I don't think it is too difficult for a trained professional to make a valid judgement.
Good to read another positive about hardware removal even after all these years. I personally think that doctors should suggest this surgery much sooner and more often with knee patients.
Posted by Xanthipe (xj), 8 July 2003
Thanks for the feedbak Pat. My OS asked about strength and I could not estimate it and it had not been measured; instead I told him my functional limitations: stairs, full ROM, standing and sitting for over 30 min., etc. I'll ask my PT to perform some of these types of tests.
Welcome to the board MTShaw! Thanks for sharing your hardware removal story. It is good to know that they didn't have to do too much digging to get it all out. All in all, everyone has reported such great results after hardware removal that I am now looking forward to getting this metal out!
I'll be back and post when I get an actual date!
Posted by Xanthipe (xj), 16 July 2003
Hello All,
Well, my 2nd (and hopefully last!!!!) surgery on my knee (to remove my hardware) is scheduled for July 29th! From what everyone has said, I am confident this will help! Can't wait until I can run, jump, hop and maybe even stand again comfortably!
XJ
Posted by Pat_A.E. (Pat_A.E.), 16 July 2003
I'll pray for healing and a speedy recovery on 7/29. Have you asked your surgeon about an anesthestic? I had an epidural (both times) with very good results. Quick recovery after the surgery. Used torodal for pain for a couple of days because of allergy to narcotics. Make sure whoever administer the anesthestic knows about your reactions to narcotics. Don't assume they know this. This is my spouse's profession so I can speak with some authority on the anesthesia part!
Posted by mtshaw57 (mtshaw57), 16 July 2003
I have a progress report that those of you still awaiting hardware removal might find encouraging:
Last Saturday, only 22 days after my hardware removal, I was feeling energetic and had a bad case of "cabin fever", so I decided to make a day trip to New York City. I thought I would walk around Manhattan until my knee started to ache, and then I would switch to taxicabs.
As it turned out, no cabs were necessary. I walked for miles, over the course of 4 or 5 hours that afternoon. By the end of the day, my knee was starting to ache a tiny bit, but not nearly as bad as my feet felt!
This recovery was so much easier than the original fracture.
Posted by Maz (Maz), 17 July 2003
xj,
Just don't have Toradol for too long or if you have a sensative stomach - it can errode your stomach lining! I still found it good combined with Percocet when I had my original knee surgery. If Ibruprofen works for you then Toradol is the same type of thing but better.
My advise on gaining quad strength if you were happy with water exercise, is to swim.... but with 'zommers'. You can order them off the web from worldwide aquatiocs. They're shortened fins and they are used specifically for fitness training and help the upper leg muscles gain strength really quickly. I found them excellent for that (though the strength hasn't helped me rid myself of pain... I need more help for that).
Hope that helps.
Maz
Posted by Maz (Maz), 17 July 2003
mtshaw57,
I'm so pleased to hear your hardware removal went well. It is encouraging for me. I'm so worried about mine - currently scheduled for 14th August. I imagine a huge leap forward one minute, then worry about a rebreak the next.
Maz
Posted by Pat_A.E. (Pat_A.E.), 17 July 2003
Maz, Don't spend time worrying about the hardware removal. Do a search on this board and you will find overall the results of this surgery are very positive. I am extremely pleased with the results. The surgery was done out patient with an epidural. I was home in 3 hours with crutchs & partial weight bearing for 3 days. I could have gotten rid of the crutches sooner, but was being cautious. I only used torodol for 2 days and had no difficulty sleeping. Can't say this enough "This is nothing like the first surgery!!!"
Updated Thu Apr 29 2010
