KNEEtalk

DIARIES => Post-op diaries (50-100 posts) => Topic started by: Yankee on October 19, 2013, 02:56:26 AM

Title: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 19, 2013, 02:56:26 AM
Well, after suffering with horrible, down to bone kneecaps for years, and a fall that tipped my right leg over the edge of bearable, yesterday I had my right knee fixed with patello femoral implants - I hope they do the trick. 

First there was the arthroscopy where the surgery notes said repairs were made to the medial and lateral meniscus where there were tears that did not show up on the MRI - I was surprised to find out there were tears there at all.  And disappointed that those hadn't been noted on the previous doc's MRI.  HMM.  Then the patello femoral implants - the knee cap is mostly polyethylene now, most of it was just down to the bone.  Not much damage to the trochlear area but it was noted that the condition of the bone there was 'poor' - no idea what that means or why, I've always had good bones, but possibly damage from being injured for so long.

My first mistake was agreeing to a femoral block.  I was told it would help with the pain, and make my leg kind of unable to follow directions.  Well, apparently I'm not able to deal with legs that don't hold me up. Even on crutches I fell twice after I got home, the first time my leg just buckled underneath me and I landed in my recycling bucket, my sister was able to pull me to my feet without damaging my knee, which was in a full leg brace.  The second time it buckled again without warning, I fell backwards, hit my head on the table (fortunately not in a bad place and no blood was spilled) and busted open the incision.  I was alone at the time, crawled my way to my feet, and when my sister came back we looked at it, bleeding, and called the doctor.  The most dreaded news.  "Go to the ER".  I knew that was going to be a long haul, and we sat there for four miserable hours before being seen.  I got lightly stitched up with instructions to go to the doctor the next day to get the incision looked at. We arrived home after midnight (we'd been up since five that morning for the surgery), I got settled and went to bed, and remarkably slept very well.

I'll never have a femoral block again and I don't recommend them, for me, even if there's more pain, I at least know that my leg will stay where I put it.  That's just my personal opinion, whatever pain it's blocking is nothing compared to the falls, which fortunately were not serious but could have been utterly disastrous, and the four hour agony trip to the ER.

Today another half day sojourn out to the doctor for some real sutures and a clean up of the wound.  Then home for a relaxing afternoon of ice, narcs, and rest and now antibiotics.  The pain on meds is bearable, tough but bearable, keeps me very aware of the med schedule and not to mess it up!  I can weight bear carefully, so I'm being very careful and slow in my walking with the crutches.  It would be really great to have a carer right now to get ice packs and things rather than have to get up for them, but I'm just here with my dog most of the time, so I gather things up to reduce the number of trips. 

I have to wear the knee immobilizer until Wednesday, when the sutures are supposed to come out, and then I'm supposed to go immediately to PT, which should be interesting after not bending my knee for a week. I'm stiff on the best of days, I expect the pain meds will be on board before PT or else.  Right now I am looking forward to a restful and hopefully uneventful weekend. ::)
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 19, 2013, 01:45:51 PM
The dawn of day 2 was not so bad.  I can put weight on my leg, carefully, and I almost do better without the crutches but I'm not ready to to do that just yet.  Going to the bathroom is the very worst  - (TMI! TMI!)  my loo is so close to my tub that I have to sit sideways and then lift and swing my splinted leg up and onto the side of the tub to keep it straight.  Damn my tiny bathroom.  If I do this again, I might need to rent a commode, as gross as that sounds.  I didn't know I'd have to keep my leg straight for a week so I figured that with the elevated toilet seat I'd be ok.  Oh well, live and learn.  Otherwise the dressing needs to be changed later, I'm almost afraid to look as I know it's bled through since it was sutured yesterday, and that should be the event of the day, besides lots of naps and TV, I'm going to be beating on the Amazon Prime.  I haven't finished Prime Suspect yet, and there are a couple of other British mystery series' that I need to watch too. 
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 19, 2013, 08:21:07 PM
Huh - Mid day, Saturday, getting around mostly without crutches.  Not a lot of pain when weightbearing but I'm careful, much less awkward without the crutches. If there's any one thing I would suggest for someone having this surgery who lives alone, or will be alone for periods of time, is to get a small freezer that can be kept close to where you sit- I'd be swapping out the icepacks much more frequently if I could just grab them rather than have to get up and go to the kitchen. 

Otherwise I'm surprised at how nicely and quickly the pain seems to be dissipating. Over the incision is still tender but that's to be expected till it closes over. I may survive this in spite of myself!
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 20, 2013, 02:01:03 PM
Day 4 - I woke up and got up at 5:30 because the knee immobilizer was just too uncomfortable to stay in bed. I basically have NO pain, just achy, and all I really want is ice.  I'm not going to take any more pain meds unless I'm really uncomfortable.  I'm able to get around without crutches, but I did take them outside with me so I could put the dog in his pen, he refuses to go potty in the temporary pen. It didn't hurt to walk that far at all. I'm very pleased that it's progressing so quickly, especially since I had two surgeries at the same time, the sooner I get this brace off, the better, I'm pretty sick of the stiff stays on the side and back and the velcro digging into my leg.  Patience is not a virtue of mine... ;)
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 23, 2013, 01:34:31 AM
Day 6 - I'm grumpy.  Don't have a lot of pain but aggravation with things "on" me that are uncomfortable. Had to check in at the Dr. yesterday to get the sutures checked, my first PT appt was postponed till Monday because he doesn't want the incision to burst open as they start moving my knee.  So they put a big thick bandage on it, said I could sleep without the immobilizer if I wanted to but to keep it on when I'm walking and don't touch the bandage.  The bandage is like a vise, I can't get it off fast enough.  I walked a little bit to my mailbox and up the road about 15 yards, but that was all I could take with the immobilizer on.  I'm hoping this bandage comes off tomorrow  so that I can at least start to bend my knee, which really wants to bend right.  It really wants to get in the shower as well.....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 25, 2013, 02:13:06 PM
Day 9 - big progress....  Finally got rid of the immobilizer and have been allowed to start bending it a little, (only a little so as not to disturb the sutures) and can start walking on it.  I'm as of this morning up to my usual morning potty walk with the dog, maybe 200 yards round trip to the end of the road and back.  I am walking with one crutch for support, and walking every step carefully. If I don't use my toes properly, the weight slams down on the joint itself and hurts.  I'm going to have to learn to walk all over again, I've been compensating for bad knees for too long doing anything possible to avoid using my quads. I'm doing lots of passive stretching - just sitting with my knee bent to the point where it hurts, and just sitting there at the edge letting it stretch.  It does help.

I'm not in a lot of pain, still only taking the narcs at bedtime, and yesterday after I walked I took one, because I was understandably sore.  I'm mostly painful where the arthroscopic scars are, the actual implants I don't feel at all, smooth as glass - delightful.

If the doc is happy with the healing so far, Monday I will start PT.  Thursday, I have to go back to work come hell or high water, presumably driving myself, so I have a lot of stretching and bending do do before that. Oh to be rich and have the luxury of "enough" time off to properly recover...
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 28, 2013, 04:20:56 PM
Day 12 - Mercury is definitely retrograde - nothing is actually going to plan.  Another appointment at the doc this morning to hopefully get my sutures out - NOPE.  He's still not confident that the incision is healed enough to take stress so now they're not coming out until Friday. GRR.  Friday when I'm supposed to be at work...  The incision is clean and no infection, he just wants to be sure, and neither of us need the complication if the incision lets go.  I'm on and off the pain meds as things get less and less numb, maybe one every other day.  Yesterday I did take one because walking with a limp has thrown my hips and back out and sore all over, so that soreness needed addressing.  I'm back to walking my dog on the usual route, and while it doesn't hurt my knee, the rest of me is being abused!   

The good news is I'm flexible enough now to DRIVE....wooo hooo, I'm free!  Free enough to drive myself to PT tonight for the first visit.  I didn't beat Elissa's record but for Day 12 that's pretty good. The most pain is coming from the arthroscopy incisions, there's no pain or stiffness whatsoever from the open knee implant surgery.  I'm in the home stretch....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on October 29, 2013, 04:14:28 PM
Dear Yankee,

I am so interested in your case.  I know this may sound very intrusive - so I will apologize right up front.  But I have so many questions.

You sound as though you are in Europe - are you?  May I ask your age please?  I am interested in a menicus transplant - but I am going on 60.  I am willing to take risks to keep from having a total knee replacement, so a menicus transplant is what I am going to be looking into.

May I ask what led to the surgery you had?  It does not sound like an injury. 

I hope that you continue on with the recovery as you have done so well so far.

Many regards,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 29, 2013, 08:50:54 PM
Hi Lee,
I thought the name would have been a dead giveaway - LOL.  No, I'm in the US, 56 yo. 

I did not have any kind of transplant - I had IMPLANTS, patello femoral implants.  You can read about them here:
http://www.arthrosurface.com/products/knee/patello-femoral-implants/
My original condition was the deterioration of the cartilage on the back of my kneecap, it was so severe that I could not get out of a chair without using both hands.  Then I fell, on my bended knee, and not only tore the quad tendon at both ends (mildly) but damaged the patellar cartilage enough so that surgery was necessary.  I now have a shiny new titantium implant on my femur, and a high density polyethylene button replacing the cartilage on the back side of my kneecap that glides over the kneecap. It's lovely......no friction or pain.  The worst part of the surgery was the arthroscopic before the open knee procedure, that's was causing me the most pain now, the open knee part is completely painless. They repaired some tears to my meniscus, but what I have is still intact.

 I'd say do your homework, find out success rates on the transplant procedure and talk to people who have had it done.  Good luck.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on October 29, 2013, 09:03:49 PM
Day 13 - Did some driving today, about a half hour each way, which is the distance to work, give or take.  It hurt, pretty much all the time, so I definitely need to do my exercises tonight and keep trying to loosen things up.  I decided to take the afternoon off with some ice, pain med and Whitechapel on tv.

Went to PT last night for the first time - absolutely fabulous place, practitioners who are gentle, considerate and don't subscribe to the 'no pain no gain' theory, which for me would be torture, given that underlying all this current stuff is some kind of myofascial/connective tissue pain syndrome that I've suffered with my whole adult life.  She gave me gentle exercises, considering I still have sutures in, and I have every confidence this might be the first time ever I'll enjoy PT to rehab my knee.  One day left, and I'm back work Thursday. Not a thought that fills me with joy....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on October 30, 2013, 04:32:03 PM
Thank you so much for your reply Yankee.  Many blessings on your continued recovery and your return to work. 

Sincerely,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: randoknee on October 31, 2013, 06:20:29 AM
Hi Yankee,

I appreciate reading your diary.  I'm 52 and scheduled to have my PFA surgery next Monday, so it's helpful to see what you're dealing with.    I too have a couple of knees with bone on bone P-F compartments.   I had my good knee scoped, and had a chondroplasty, synovectomy this last June where my doc confirmed the bone on bone in that knee.  My bad (left) knee has the same bone on bone in the P-F compartment but has enough other challenges that my Doc want my good (right) leg to be as good as he can make it before we screw with that one.

I'm sorry you had trouble with the femoral block.  I had one when I had my hardware removal two years ago and I thought it was the cats pajamas.

I'll document my experience with the procedure on knee geeks as well.  Wishing you tailwinds on your recovery.

Dan
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 02, 2013, 01:42:33 PM
Day 15-Back to work....If I had three weeks to use, I would have taken them.  My knee is more painful now than it was a week ago,  I think because nerves are reconnecting things and are becoming less numb. The night before work I barely slept at all, didn't want to take narcs the night before because the hangover from that sneaks up on you and I have found myself driving down the interstate with my eyes closed.  But I suffered for it, woke up every hour and couldn't get comfortable. It was a really sharp, pingy nerve pain, and there was no position that was comfortable, bent or unbent.  Finally got up and took some ibuprofen and an ice pack and got to sleep about 45 minutes before the alarm went off.  Work was uncomfortable, not easy to get any relief sitting at a desk, although I came well prepared with ice packs to alternate through the day, and put it up on a chair covered with bubble wrap for cushioning (I forgot to bring a pillow).  I still wished I could just take a nap!

Day 16, finally had the sutures out.  There's still a hole at the bottom that wasn't sutured completely that's draining-better out than in, I say, and it will heal from the inside out, I'm not bothered. Inexplicably, when all the sutures were removed, the nurse took skin glue and smeared it all over the ENTIRE wound, even what was already healed, (I said, alarmed, "what are you doing that for!") and then put steri strips over the whole thing.  Well.  Guess what I'm allergic to.... by noon the whole wound was one big red, itchy welt, and at the tip of each steri strip was a rectangular red spot that was almost blistered. If that's not bad enough, the glue made the skin very stiff, and inflexible, and when I bent my knee, it opened up a small fissure on the top, which was closed and hadn't drained for over a week.

To say that I am PO'd is an understatement.   I stopped and got some acetone on the way home and took all that crap off, am soothing the irritation with Benedryl cream and keeping it clean, and I will continue to care for it myself till it completely heals.  I have never had this much trouble healing anything, cranking that wound into a car where straight legs can't go every other day to go back to the doctor has not helped. Jeez, even my dogs and horses never had an infected cut, and they sleep in their own waste!  Shouldn't be this hard. I shall be cold hosing my leg this afternoon!

Physical therapy is wonderful - fantastic people that do what needs to be done, and do what I need them to do, like work on some very painful adhesions instead of just working on the bend.  They're the best part of the whole thing.  I'm going to enjoy the rest this weekend and gird myself for a full week of work.  Ugh.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 02, 2013, 01:50:21 PM
Rando, good luck on your surgery.  One of the most pleasant things is that at the top of my kneecap where I have only felt insane pain and friction is now smooth and painless.  I think I'm having the most pain from the arthroscopic surgery than from the open knee part.  It's a little odd as well, I can hear a faint 'clicking' when the two parts meet, if I tap my kneecap I hear it clicking against the implant but I suspect that once my muscles are back in shape and doing their jobs, I won't hear anything.

The end of the two weeks has definitely been the most painful - three days after surgery I was off the narcs for a couple of days, or maybe once a day every other, but as things have gone on the pain is sharper and more nervy, I'm sure that will pass in a week or so.

The femoral block - if you're going to be in the hospital with people helping you walk, maybe - but going home with that for me was clearly not a benefit! There is no amount of pain it can block that will make up for sitting 4 hours in the ER the night of surgery, LOL.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 04, 2013, 01:40:57 AM
Day 18 - I am having a real problem with pain below my knee, it's like an electric shock sticking in my leg.  Turns out it's the pes ansurinus, "The pes anserinus is the anatomic term used to identify the insertion of the conjoined tendons Sartorius, Gracilis, and Semitendinosus into the anteromedial proximal tibia. An occurrence of pes anserine bursitis commonly is characterized by pain, especially when climbing stairs, tenderness, and local swelling."  I'm not sure if the bursa is inflamed but it sure does hurt.  The therapist worked on it last week, she said if felt like an adhesion, and released it for a while but it was back with a vengeance the next day.  I've been icing it and rubbing arnica gel into it, it's easing somewhat but I have a feeling this will be with me for a while.  I never had this before the surgery, I would love to know what brought this on, maybe an instrument clamped on it or a tight bandage or something. The tight bandages gave me some mild phlebitis which I addressed right away by taping the bandages on, those kind of complications I don't need.

The rest of my knee is still stiff but it's getting easier to bend and stretch.  I'm walking more normally but my knee still feels like it's held together with rubber bands and it's a bit of an awkward gait.  Occasionally I hear a little 'clunking' sound, or tapping where the two implants meet, it's a bit odd but far preferable to the pain I used to be in.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 05, 2013, 02:12:26 PM
Day 18 - early Monday morning....  I woke up to a bloody mess.  After removing the surgical glue and using butterfly closures to keep the wound together but leave it open so it could dry, I woke up Monday morning to *wet*....my entire bed was soaked with bloody sero fluid, which was also running down my leg.  Apparently there was a sizable pocket of fluid around the kneecap that I knew was there but I assumed it would dissipate on its own.  Because the surgical glue made the wound crack, the fluid took the path of least resistance and exploded out the middle of my knee when I bent it in bed.  Back to the doctor first thing, with all kinds of half humorous accusations 'what did YOU do this time', which at this point I didn't find funny in the least since it wasn't anything that I did that caused this problem.  In fact, aside from my falling down under the influence of a femoral block, none of the problems I've had with this wound have been caused by me...  It was decided that the pocket was superficial, that it wasn't infected,  so I am to keep it bandaged, allow it to continue draining, cleaned every day in the shower and with peroxide and now that the fluid was out it is assumed that the pocket will close of its own accord.  Back on the Keflex as a precaution, the draining has slowed and I hope by the end of the week will be non existent.  I am beyond annoyed and discouraged.

The pes ansurine pain is still excruciating, I mentioned it to the doctor and told him how much it hurt and he basically didn't address it.  If the PT can't do anything to help it, we'll be having another chat to see about a lidocaine/steriod injection to calm it down.  It's like a lightning bolt shooting down my leg when I walk and it IS affecting my recovery, since that's the major source of pain that's holding me back.  I doubt he will even consider it if my wound has not closed, as steroids are going to affect healing.

Meanwhile I ice, ice, ice, and take the pain meds when I can't stand it anymore, but I"m back at work so that's not frequently.  On the positive side, the extreme pain from under my kneecap is gone, no more arthritis, but it would be nice not to have the other pes ansurine pain so that I could fully appreciate it. Note to self, never have surgery while Mercury is retrograde......
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 06, 2013, 04:34:36 AM
Day 19-Tuesday.  Thought I was out of the woods with the fluid in my knee, I had a compression bandage on it and sat with my knee bent for most of the day in order to put pressure on it and get it to drain.  Not much came out, so I figured I was over the worst.  While I was at PT tonight, the therapist bent my knee up while I was laying down and fluid shot out of my knee and half way across the room, all over me, all over my clothes, she said she thought she'd need a hazmat suit.  There's still a lot of fluid hiding in there, she soaked three surgical pads working it out, and I soaked a bunch more bandages after I got home.  It's not infected, but it easily could be with all those pockets in there. I suspect that the wound is either going to need revision or will need a drain, neither of which I'm prepared for.  Pretty angry, in fact.  This is not what I need. I have no sick time left, and I need to be able to drive. I should be doing stairs by now.  Very discouraged.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 08, 2013, 01:42:57 PM
Day 21-Thursday. Had to go back into surgery under general anesthesia for an incision/drain, clean up the wound and resuture.  They are going to culture what they took out and hopefully it's nothing bad.  It was superficial and didn't go deep enough to affect the implants, which says to me that the "infection" or whatever it was is from the very poor suturing job in the first place. Forgive me, I am an angry person right now.  As if having to go through this a second time wasn't bad enough, the surgeon who appears to enjoy causing me as much pain as possible once again (I say again because he pushed me back on the table during follow up visit and threw in some sutures without novocaine) didn't use novocaine when he sutured (sutures, not staples, again) so I woke up feeling EVERYTHING, stinging and burning and on fire, and it still is.  I'm told I can bend my knee to drive to work, except that when I do it causes excruciating pain because there's no anesthetic. 

As if I have not said so repeatedly, I HAVE to work, no more sick time, living hand to mouth, I cannot miss work.  So, how hard would it have been to be considerate and diminish the pain as much as possible so that I can get on with my life? I think all of the room taken up by that giant overblown ego has displaced the compassion for a patient a doctor is supposed to have. Definitely not happy with this surgeon at all, crappy bedside manner, would never recommend him, and it's very very doubtful that I would ever let him do my other knee, which was tentative for December.  He can't be bothered talking to me without his hand on the doorknob - he has zero personality, except that of a arrogant bully.  The OR nurses asked me if there was anyone the doctor should call after the surgery was over, and I said "Yes me, he can't be bothered talking to me otherwise!" After surgery he did grace me with two minutes of his time, not long enough for me to question him about the lack of novocaine. He was long gone by that time.  Bad enough that this surgery turned into a clusterf*ck through poor management, but to make it as painful as possible?  Whether out of ignorance or arrogance or just mean-spiritedness, not acceptable.

Sorry for the rant, I wanted this to work out and I wanted my life back by getting both knees fixed. Not going to happen, at least this year, and it didn't have to be like this.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 08, 2013, 11:14:07 PM
You have every right to rant - AND - to find yourself another doctor!!!  ASAP!!!
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 09, 2013, 05:46:11 AM
Day 22 - Friday - I cannot tell you how much agony I have been in all day.  The sutures hurt like they are on fire, all day long I have had like electric shocks that are so painful they make me gasp out loud. If I move, or the bandage moves, I want to scream, so painful.  I was driving to work (and no, that doesn't feel good either), so no narcs, although I did finally give in and take a half of one mid afternoon, I just couldn't stand the pain, but sadly they don't do much for it.  I had to sit quietly in my chair, not moving, I put ice on it but the cotton is so thick that ice is basically useless, and that's the one thing that might make it feel better.

The Nurse called today to see how I was doing, and I said "You can tell him this verbatim. If he was standing in front of me right now I'd probably punch him in the face. There is NO excuse for him not using any anesthetic for these sutures, it's cruel and it's inhumane when there's no need for me to be in this much pain. Unacceptable.  We'll have words when I come back, and they won't be nice ones".  I think the business end of that hospital is going to get some letters too, he should at least be forced into some kind of sensitivity training if he is incapable of judging what kind of pain he's causing. Not acceptable for a doctor to behave like that.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 09, 2013, 07:16:20 PM
Day 23- Saturday- Still in excruciating pain from these huge sutures, like electrical shocks up and down my knee.  If I thought I could tolerate the drive and the probably 4-6 hour wait in the ER, I'd go and ask them to at least numb it, but I can't.  Taking Norco every 4 hours since last night, which is doing pretty much nothing for the nerve pain.  I thought it would have calmed down a little by now, but it hasn't. I'm getting ready to remove the dressing and try to get some ice to the sore part without touching the sutures, something, anything to calm it down.  When will this be over, I wonder......
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: drmark on November 09, 2013, 08:00:47 PM
This sounds like an infected joint.  Were the cultures negative?
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 10, 2013, 12:49:05 AM
drmark, I was told the following morning that the cultures were negative, but I was also told by a nurse practitioner that cultures usually take up to 48 hours, so what they would have checked for was white cells first, and that supposedly was negative.  It did not feel infected, it was just full of fluid that was building up in pockets left from a lousy suture job (IMO) and because the skin had cracked from the surgical glue, it found an avenue out.  I was told it was superficial, it didn't go deep enough to get into the joint.  I will believe that when it's healed completely.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: drmark on November 10, 2013, 02:11:49 PM
People with a superficial collection of fluid, don't have very much pain.  Was the culture from the knee fluid, or from superficial?

Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 10, 2013, 05:13:11 PM
I don't know what they took, I assume it was from what they cleaned out when they opened it, not much was draining out at that point, it was building up inside again. I didn't have any pain per se except from the increasing pressure of what was collecting inside - if something is infected usually there's 'heat', and I didn't feel any of that - but I sure it would have headed in that direction if it wasn't addressed.  No fever or chills, and have been on Keflex since the day after the first surgery when I fell and blew open the steri strips.

I just talked myself out of going to the ER to beg someone to numb it, mostly because the drive and the probably four hour wait would be worse.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: drmark on November 10, 2013, 05:39:43 PM
 Antibiotics by mouth can mask an infection and make the symptoms somewhat less clear, and cause a false negative result from the wound cultures.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 10, 2013, 06:18:51 PM
Oh that's just super.  I'll try to comfort myself with the knowledge that the fluid that came out it was just clear, yellow/pinkish fluid, not cloudy or with pus.  And hope this doesn't turn into a mess.  The sutures (I have had to rebandage because the bandage keeps creeping down, dragging on the sutures and exposing them) look pretty tight, no wonder they hurt.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 12, 2013, 01:54:24 AM
Well, the news just gets better and better.  I called the doctor this morning because I'm watching this once dry wound kind of start to deteriorate - what last Friday was a clean 'seam', is now starting to degrade a little bit.  I want to CLEAN IT.....Everything this doctor tells me about wound care is exactly the opposite of what I know to be true from experience, and from what is published on the company website.  Keep it dry for 24-48 hrs then wash gently and keep it dry. I had a 2" wide and 1/4" deep hole in my leg from Mohs surgery for basal cell cancer.  Kept it clean for three months by cleaning and dressing every day, never had a problem.  He wants me to leave it covered for five days.  Which IMO is going to just make it rot, stuck in that moist wet dirty bandage for five days.  I insisted today (day 4) that I be allowed to bathe and clean it, and I did.  It's red, but hard to tell if it's red from irritation of the bandages rubbing, or the sutures are too tight (they are VERRRY tight) or if something else is going on. I'm icing now to cool things down. I personally hate the synthetic bandages made of poly and rayon, they extremely irritating to my skin friction wise, and they seem to just make everything wet.

Meanwhile I get the news that the culture of what was taken out of my knee has pseudomonas and enteroccus in it - I did not see the path report so I have no idea exactly what organisms.  I did especially like the accusatory tone by the doctor "That comes out of YOUR COLON!", as if I wipe my butt and smear it on my sutures.  I'm such a germophobe in real life it's not funny, so this insinuation I find very insulting.  It also comes from dirty hospitals, more than likely it DID come from a dirty hospital especially if it's a resistant kind.  I've been on Keflex for almost a month, I am a yeast factory, so I'm not sure what good that actually did except to exacerbate the problem.  Now I'm supposed to see an infectious disease doctor.  I'm trying not to freak out, because a) I was told it did not penetrate the joint capsule, it's superficial, and b) it's what was supposedly cleaned and flushed out with bacitracin - with any luck there is nothing left in there.  IV antibiotics during surgery, did they help or hurt, I have no idea.  I'm pissed. And scared. And wondering why the hell I ever thought this was a good idea.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: drmark on November 12, 2013, 03:29:51 AM
I am no apologist for anyone, but I have a hard time believing that someone would wipe their butt, and then use the same toilet paper to wipe their wound.  Beyond that I have almost never seen this combination of germs in an infected total (or partial) knee replacement. 

The AAOS's CPG for diagnosis of periprosthetic joint infections (aka PJI) requires the positive cultures to have occurred in more than one culture specimen, assuming that there were no other blood of tissue test that indicate infection.

The AAOS CPGs also warn strongly against the exogenous use of antibiotics absent cultures taken prior to the onset of antibiotic administration.  When I inherit an new patient with these problems, I stop the antibiotics, wait a week or two and then reaspirate the knee for culture and synovial fluid signs of infection.  Then I use the CPG for the diagnosis of PJI to determine my next step.  The CPG (Clinical Practice Guidelines) are available for free from www.aaos.org



Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 12, 2013, 03:31:45 AM
Yankee - I am calling your name into our prayer team tonight.  When my husband was alive - he was a double transplant recipient.  He was given a kidney and a pancreas.  He lived 4 years with those 2 transplanted organs.  He spent the last year of his life battling every kind of infection you can imagine.  They operated on him 21 times trying to save his life.  During that time there was a specialist that did nothing but handle those infections.  I am terribly sorry - but I do not remember the name of those doctors - but you need to find out what they are called and then find one.  You need to get on top of this situation now.  A specialist is what you need and if your doctor won't recommend one - then find one on your own.

May God Bless you Yankee.
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 12, 2013, 03:53:40 PM
Thank you all for the support - I have been told I need to see an infectious disease specialist, but no word as to when. I called the surgeon's office, got voice mail, then called the ID office, they said a request had been made for a recommendation for antibiotics, but the ID dr. hadn't replied.  I said "shouldn't I be getting blood tests or something to make sure I have an infection before I start taking more antibiotics?"  I was told I'd know more after the doctors had spoken to each other.  I would prefer not to attack my liver or my kidneys unnecessarily, I want to know if I have an infection first.  So now I'm just waiting. I asked for someone to send me a copy of the path report, I want to know what I am or am not dealing with so my brain doesn't explode with worry.  I actually woke up in the middle of the night and was relieved that I felt good, not sick, which is my fear, that this is going to be a systemic nightmare.  Here's the photo from this morning after I cold hosed. Sutures are TIGHT. With any luck they will be out tomorrrow.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 13, 2013, 01:01:48 PM
Surprise, it's still infected.  The infectious disease doctor wants to put me on penicillin, and levaquin. No blood tests, no appointment, just 'take this'.   That freaked me out, and I said no to levaquin.  It's a nasty drug that almost killed a friend of mine, bloody diarrhea after three doses, for months, in and out of the hospital for months, to this day she is affected by what it did to her.  And, in none of the articles I've read is levaquin even mentioned.  I predict a fight but I don't want to take something with permanent side effects if it's not going to do the job.  I don't need to have my insides destroyed and I don't need a ruptured achilles tendon either.  I'm going in to the OD in an hour, there will likely be fireworks because he doesn't like being questioned, and I don't like people making decisions for me with consequences they don't have to live with.  I don't know yet if this is the resistant kind of VRE, but I am assuming so.  Which means I was infected in the hospital in the first op....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: drmark on November 13, 2013, 02:18:35 PM
Treating patients who have prosthetic joint infection with oral antibiotics, rather than complete open debridement of the joint, possible temporary removal of the prosthesis, and IV antibiotics for at least six weeks, is like  threatening someone with a knife at a gun show.  A bad end is not in doubt.

It may be time for an opinion of an Orthopaedic surgeon with interest and expertise in treatment of problem total joint replacement.  Let him/her choose the ID person that regularly deals with these problems.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 13, 2013, 07:08:50 PM
I thought that the wound was red because it might still be infected. The doctor this morning disagrees, he says the redness is from the sutures, which will come out on Tuesday.  I was assured that the infection was only in the subcutaneous tissue, it did NOT affect the joint, and the joint fluid was sterile - so the joint is not infected, the patello femoral implants are not affected.  The wound was opened and cleaned out but not down to the joint.  I'm going to trust that is true, based on what I feel.  Then again, there's one spot on the incision that's still draining a bit, and I hope it's not a replay where it gets to be an exit for anything building up in there.

I had a comforting talk with the ID doc who hears my concerns about fluorquinolones, I will not risk that kind of damage, I don't think those should even be on the market, and I bet if given the choice most docs wouldn't take them for themselves if you paid them.  She is willing to consider all options, including IV or injectables, because fluoros are the only oral option and I won't take them. I will see her on Monday or Tuesday, and probably start 'cillins in the meantime.  Meanwhile I'm cleaning the wound with Hibicleanse and flushing with cold water for as long as I can stand it and hoping that this will not be a case of 'treatment was a success but the patient died'....

To add- according to the Path report the Enterococcus was light concentration, and it is not VRE, which worried me.  The Pseudomonas aeruginosa was very heavy, but is also not resistant to any but one drug.  Still, they're all IV or IM....and the chances that I will be compensated for any of this toxic s**t I'm forced to go through because of a dirty hospital??   
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 14, 2013, 02:54:12 AM
Well, something I said I'd never take is now in my stomach - Cipro.  I pray it doesn't kill me or maim me or make me sick.  When I got home tonight, I looked at the wound and it was much redder and much tighter than this morning, and I can see the edges of the wound starting to pull apart and starting to get weepy.  I had an appointment with the ID doctor on Tuesday (she is going away until then) but I know it couldn't wait that long, I'd be exploding all over the place again and it would be an instant replay of last week. 

I don't know how I'd manage IV or IM drugs anyway - the time involved away from my job going for infusions would probably get me fired, so everyone hold hands and sing and hope that this Cipro works and doesn't kill me.  Meanwhile I will continue swearing words that would make my mother wash my mouth out with soap, I am so angry that I even have to go through this for something that should have been so simple.  I just got a bill from the hospital for $1600 - I think we will be having a nice long chat about how much if any of that I'm going to be paying considering what happened in their nice dirty hospital.  This infection has cost me big time, my plan was to get my other knee done in early December and that would have been covered by insurance 100%.  Now that's not possible, and it's pretty doubtful I'm ever going to be able to afford to get the other knee done, given how crappy insurance is likely to be next year.  The bill for the surgery was something like 27K, I think that deserves  a little consideration. As if.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 15, 2013, 02:59:02 PM
Day 2 of Cipro - I'm surviving it, but the first night was not pleasant, multiple trips to the loo, and now, while I'm not in discomfort, I'm worried about coughing or sneezing, if you get my drift. I"m taking heavy duty probiotics between doses, which I'm not sure is enough to counteract the effects.  This morning my wound looks much less red, so I am hoping it is kicking in and by Tuesday when the sutures are supposed to come out, it will have healed over properly.  The skin was very dry last night, so after I washed it with hibicleans I dabbed on some bacitracin ointment and that seems to have helped as well.  Long may it continue to improve...

PS - it's actually starting to itch a little bit, like a healing kind of itch, instead of being just red and sore and inflamed.  That's a positive to me.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 16, 2013, 06:14:03 PM
Day 3 of Cipro - to my relief, the side effects have waned, and my knee is looking much more normal, and healing instead of weeping. The skin is not angry shiny red, it looks like it probably should have looked the last time, dull pinkish around the sutures.   These sutures needed to come out yesterday, I've had it, they have annoyed me every second of every day.

Someday I hope to find out if the implants actually work. Right now I'm sick trying to walk on one leg, back hurts, hip hurts, exhausted. Hoping for this to be over soon.....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 17, 2013, 08:18:40 PM
Dear Yankee,

I have been following what is happening to you and it honestly seems like a nightmare to me - so I can only imagine what it must be like to you.

I am not up to current on the knee language - but I can see from Dr. Mark's input that you have had some sort of knee replacement that has now become infected.  You have every right to be scared out of your wits. 

I know that the Cipro is one of the strongest infection meds available orally. But I hope on Tuesday that ID doctor schedules you for IV drugs.  It is really the only way that you have a fighting chance of getting to keep your new knee parts.  It may be that you have let them clean that area out once again - but even that would be better than losing the new knee.

You have been through so much Yankee. You are on our prayer lists Yankee. May God bless you.
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 18, 2013, 03:24:52 AM
Hi Lee,
I had patello-femoral implants - a polyethylene button on the back of my kneecap, and a titanium implant on my femur to glide over each other instead of the horrible bone on bone arthritis I was living with. I *think* that part of it is successful, but it's hard to tell because I got a hospital-acquired infection in the skin.  The doctor insists it has gone to the joint or implants, that it is only in the skin structure.  That's what it feels like to me, but I have no way of knowing, really.  I had a second surgery to open the wound and clean it out.  I had to go on Cipro last Wednesday, as it was still infected and was getting worse. 

The good news is that the Cipro seems to be working, as you can see in the photo below, the skin is much less red, and less swollen.    Itches something fierce and the sutures are starting mess with the skin, other than that I hope I'm in a better place than a week ago.  I am relieved and grateful (so far, it ain't over till it's over) that the Cipro has not caused any horrid side effects, that was my biggest fear.  I'm fearful of my system being wiped out of its defenses with all of these antibiotics, so I'm handling things with gloves and have even stopped feeding my dog his raw food - I can't take the chance of picking up something like salmonella now.  I'm not sure if IV antibiotics are necessary, or advisable at this point, but I have an appointment with the ID doctor on Tuesday, whether there are blood tests to tell whether it's gone or not, I don't know.  Would I let them operate on me again, at that hospital?  I shouldn't think so, there isn't much point if the hospital is that dirty that the infection remained after the I/D.

Considering  that I had this surgery as an outpatient and was probably in the hospital less than five hours, to get an infection of this magnitude is disgusting, I'm infuriated by it and am considering my options as to how I am going to deal with it, I still don't know that I will completely recover or that it has not damaged my joint. I'm trying not to think of that possibility, I'm just trying to be grateful for the improvement so far.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 19, 2013, 02:01:41 AM
Dear Yankee,

I remember that you were only in the hospital for a few hours.  They used a femoral block and let you leave.  Not Smart!!!

I hope that the Cipro causes your leg to do better and better!! 

I am falling asleep now and must go.
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 19, 2013, 02:30:32 AM
To my great relief, the sutures came out today, (at my insistence!), and I feel so. much. better. 

Unfortunately, my skin is so irritated from the sutures half growing in and being pulled at for ten days, and being constantly rubbed by bandages for a month that it's a little red and weepy now.  I'm not sure what to do about it, besides just makes sure it's clean and not dripping. Ordinarily I might use some cortisone cream on it but with the infection I think that would not be a good idea, so I dabbed on a little aloe and I'll just try to let it dry out without making it worse.  Damn the bandages, you just can't get anything but poly or poly/rayon and they're extremely irritating long term. 

I can't start PT till next week, so I'm taking advantage of 'doing nothing' and trying to rest and rest and rest because I haven't been comfortable in more than a month, i'm tired and I'm bitchy (!) and sick of being sore.  The whole right side of my lower back is pulled from walking crooked and stiff so that's a major pain in the arse, but now that I can bend my knee it should get better shortly.  I hope.  Maybe I'll actually get to enjoy what I suffered so long for.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 20, 2013, 06:26:34 PM
The gift that keeps on giving........

So with the sutures out, you'd think it would be clear sailing, right? No.....  I went to the ID doctor yesterday, to be put on penicillin to address the entercoccus, and we decided that there seems to be a fungal infection on the skin on the outside of the wound. After the sutures came out it became more and more weepy, and sore and red and blistery, almost looked like poison ivy. The doctor asked if I had been doing any nude weed whacking, I said not that I remember but I have taken a lot of narcotics lately.... she believes it it some kind of yeast/fungal thing.   Given that I had been on Keflex for a month, that my knee was trapped in hot damp bandages for a month, and then Cipro on top of that, I shouldn't be surprised, but I am.   It seems to have responded to miconazole, the most of the weeping stopped over night, it seems to be drying up and the redness has gone down, hopefully that will do it and I won't have to go on a third drug, an antifungal. This is how people die from crap like this. Wipe out their immune systems and their intestinal flora and compromise their livers and they're ripe for the picking.

I wonder if the doctor's office needs a good, sterilizing clean, this thing blew up completely after the sutures came out and I was bandaged there.  I keep it so clean at home, and I let it the air get to it so it won't always be moist, I find it hard to believe that I'm the source of the infection. If this is what five hours as an outpatient gets me, I'll be damned if I'll ever be admitted to that hospital for anything.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 21, 2013, 03:28:08 AM
I will say this to you Yankee, your entire situation gives me a reason to pause over a possible knee replacement.  It must be concerning to those taking care of you - at least if they want to know the truth as to what happened to you.  You have been through so much, but in the end - it will be you who will be paying this bill.  No one could blame you for looking for sme compensatioin to help with those medical bills.

I just hope that you are now on the mend Yankee.

Take care,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 21, 2013, 03:55:01 AM
I'll tell you Lee, I would never in a million years imagined that as an outpatient, there for five hours, that I would ever have contracted a hospital acquired infection that has become such a nightmare.  Two surgeries, months of antibiotics and God knows what side effects I haven't seen yet, not to mention the just plain pain and  suffering of being in this condition and having to deal with the pain AND trying to continue on with my life in the meantime.  My family has helped with getting me places when i can't drive and doing things I'm not physically able to do, but I'm pretty much on my own here, doing this by myself.   I expected a couple of weeks of downtime and I prepared well for it, but the rest of this, the second surgery, having to go drive myself to work the *next day* because I had no sick time left, that I did NOT expect, nor the infection and its side effects and multiple doctors appointments that I miss work for, and it has been excruciating at times. And I still don't know if this infection is gone, will stay gone, if the implants will be affected and God forbid if this goes to the bone.  I'm still trying to get my mind around what the hell just happened to me and why I am not yet using my new knee except one stair at a time.

If I can ever afford to fix my other knee, it certainly won't be at the same place.  I honestly would be terrified to be an inpatient for any reason now.  One you get an infection it just becomes a cascade to disaster.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 23, 2013, 05:47:18 PM
Things *might* be looking up.  I put some miconazole on it and it stopped the weeping, but then the skin would crack and it would start weeping again. It was an improvement though, so I called the ID doctor as she requested to figure out what to do next, and was told by her obnoxious, snippy staff that she was "unavailable, as in NOT AVAILABLE",  and that I could leave a message if I wanted "but I have to inform you that she will not get the message until Monday, because she's UNAVAILABLE!". The desire to reach through the phone and b*tchslap someone was overwhelming..... I asked if anyone was covering for her, and they said "no, we could try to contact someone else in an emergency, BUT THIS IS NOT AN EMERGENCY!".  Well, apparently it's not an emergency TO YOU....  So I hung up angry and the nurse called me back, wanting more info, she then "called someone", wouldn't tell me who, and "they" told her to tell me to "continue putting on the cream for the next few days".  Effing BRILLIANT, isn't it? If I wanted to do that, I needn't have wasted my time calling!  I have had it with the half assed help, there will be a conversation about that as well. The doctor herself is wonderful and responsive, her staff, far too obnoxious, and in case anyone hasn't caught on, I am not in a place where I intend to put up with more shoddy treatment - this experience has been bad enough.

So after that non-answer, I took matters into my own hands, we had talked about possibly adding a cortisone or steroid cream to the mix if the antifungal didn't do it.  I had some Temovate in my drawer that I use for PI and for painful lesions when I had lipodermatosclerosis, and I used it in conjunction with the miconazole.  It seems to be doing the trick, the inflammation is markedly improved, but the areas around each suture hole still feel hard and bumpy, literally like poison ivy does.  The weeping has stopped, the sloughing of the skin has stopped, and it is starting to look and feel like normal skin. I don't know what the hell it is, or where I got it, but it seems at least now to be going away.  The doc wants me on penicillin for 3 weeks, Cipro for a month, too long, IMO, I don't want to be on it that long because of the potential side effects that continue to show up after you stop taking it,  but we'll see how I feel after 3 weeks, might be safe to stop it then. 

My knee otherwise is painful, achy sometimes, really sharp, strong nerve pain sometimes, had shooting pains across my kneecap yesterday while driving to work that just took my breath away.  Once I got to work I took half a Norco and put an ice pack on it, that made it feel somewhat better.  I assume nerves are reconnecting and that's why things are so electric now.  Function wise, it's bending better and I should start PT on Monday. Right now both my knees are sore, so I feel a bit disabled and I walk like a 90 year old, I would like to think I am on the upswing but I don't like to assume, because you know what happens when you assume....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 23, 2013, 06:47:44 PM
My Goodness Sakes Yankee!!!   I know that there are mindless, wanna-be caregivers all over - but for whatever reason - they seem to be camping out in your neck of the woods!!!

You are being a very generous person by giving that doctor the benefit of the doubt - but you are 100% correct.  I did this type of work at the beginning of my career - that has been over 40 years ago.  But it was a hardnosed receptionist with a know it all attitude that caused me to choose another career path and I thank God each and every day for her.  She could be the devil incarnate when she got on one of her highhorses - and it was all those sick patients that beared her wrath.

I guess one of my main questions while I see you are still suffering without much help from anyone in the medical profession - is:  HAS ANYONE DIAGNOSED EXACTLY WHAT YOU HAVE CONTRACTED?  Yankee - how long have you been seeing this ID doctor?  Have they not done some sort of culture to see what it is that you have?  Yankee - it may be time for a change of scenery.  And yes - I know it is going to be hard to find someone that will take your case this late in the game - but you need some help here.  Yankee - even if you get that to clear up some with OTC meds - the chances of it coming back are greater than it staying cleared up.  I think that the ID doctor needs to do their job and figure out what you have contracted and what it is going to take to get rid of it.  Yankee - Dr. Mark is exactly right with his remarks - you need to be on some IV meds - and that should have happened a while back.

I will continue to pray for your knee to get better and that infection to clear up.

Warmest regards,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 23, 2013, 08:33:11 PM
I have always said about myself that for some reason I seem to be magnet for idiots- maybe most people tolerate them, but I am not one to suffer fools gladly or take crap from ignorant, officious and incompetent people, and those at the ID doctor's office desperately need to consider their career options, they don't belong in a service profession.  The doctor herself was wonderful, called me at home at night when I was worried and made sure she got the script called in before the pharmacy closed, because she would be away for the next three days.  I am sure she is not aware of the way her staff acts, but she will be.

When I had the second surgery, what was taken from the wound was sent to the path lab, along with aspirate from the knee joint.  The knee joint fluid was clean, nothing in it at all. The soft tissue of the wound under the skin was growing pseudomonas in high amounts, and enterococcus in low concentration.  The Cipro for the soft tissue infection, and the penicillin for the enterococcus is what I'm taking now. The path report came back with an analysis of what drugs the bacteria was susceptible or resistant to, so we know that I am on the right, most effective drugs.  Given that there was no infection in the joint, there was no need for IV antibiotics, or at least that's what I was told. 

As for what's going on with the SURFACE of my skin, no, that has not been sampled, I asked if she would swab it and she said she thought it was yeasty, but didn't think that she would get a very good sample,  what she has suggested is working, so she seems to have been right about the yeast part of it.  Prior to the 2nd surgery, I was on Keflex for a month, and if you're a woman you know what effects antibiotics have on yeast - I was probably growing it on my skin under the bandages.  It is greatly improved today, so I'm hopeful that I am headed in the right direction.

Change of scene? Oh definitely. I am done with this doctor, both with his attitude and his dirty OR.  This whole thing has been so poorly handled I don't know where to begin, from a massive infection from a five hour stay, to a nurse smearing surgical glue all over my wound and causing a horrible allergic reaction on the wound and making it split open, I can't think how the hospital would defend themselves. I'm going to make them, though.


Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 24, 2013, 04:26:32 AM
Yankee,

I will tell you this:  I have NEVER been a sue happy person.  My late husband and I never filed a lawsuit in our entire 25 years of married life.  When he died and I remarried it was to a man that kept an attorney on retainer just in case there was a law suit to be filed.  That marriage lasted 2 years.

However - in your case - I would absolutely make an exception.  You have been through so much - I cannot even begin to imagine the pain, let alone all the inconvenince and hardship that you have had to endure.

But even a lawsuit won will not give you back your health Yankee.  Only God can do that.  I will be praying for you sir.  None of this was your doing.  You were only trying to make a healthy decision to improve your quality of life.  Maybe this time you have gotten on the right track so the healing can begin in earnest.

Sincerely,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 24, 2013, 09:31:42 PM
Lee,
By the way, I'm a girl, LOL, perhaps I should have called myself "Yankee-ette", LOL.  I don't believe I would have a prayer of suing anyone, based on the fact that I may recover, no one cares about pain and suffering, if your leg doesn't fall off, you don't have a valid complaint.  Regardless, the hospital will be taken to task for what happened there and depending on what they do, or don't do, I'll have to decide what next.   Right now the wound is looking better, hopefully it will continue till it's normal skin again.  I'm still not convinced that it's going to recover.    Time will tell.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 24, 2013, 11:33:38 PM
Thank you Yankee - I really appreciate the information!!  I did think you were of the male gender - sorry.  I guess the most surprisng statement in you last post was about recovering.  Yankquette!!!  Why would you not think that you are going to recover?  That infection has not gotten into that joint and it really does sound like your knee and the incision site is responding to the oral antibiotics.

If you truly think that there is a chance that the joint is going to have to be removed - maybe you should seek medical attention now.  That is actually where I was going with that statement about a "change in scenery".  I meant maybe you need to find a doctor that gives a hoot about what he is doing and get some further input on what exactly is going on in that knee. 

You do not mention where you are located - or maybe I just have not paid close enough attention.  But if you are anywhere close to Sacramento - I know these people at U C would take a look at your situation and I bet they could help you.

Good luck to you Yankquette!!!
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 25, 2013, 08:49:22 PM
Does anyone have advice for how to deal with the sensitivity of my wound? It's looking good today, little redness or bumpiness, much flatter, but MAN it is so sensitive, I can't stand anything touching it, not sheets, bandages, pantlegs, nothing.  It's like having a sunburn and not being able to tolerate even breathing on it.  It has been like this since the second surgery that the doctor sutured without local anesthetic, and is only slightly better after three weeks. I don't have a bandage on it because it's dry, no weeping, and I don't want to irritate it more with tape and gauze. I'm sitting at my desk with my sweatpant leg rolled up because I can't stand it covered or being touched..

I've tried Lanacaine, did nothing, tried ice, did nothing, I don't know what else to do to it. Suggestions?

PS I love wearing sweatpants to work, there's no way I can even think about putting pantyhose on top of this knee right now.  And Lee, if I hadn't just told you that I was a girl, your head would be exploding right now with that comment, LOL.... ;D
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 25, 2013, 09:01:04 PM
In response to what you said Lee, I guess I'm just discouraged.  I don't feel that the infection has progressed, there is little or no swelling except for around the wound itself and that is decreasing by the day. But who knows what's lurking in there.  It hurts though, like my knees have just been beaten up with a baseball bat, and at this point I"m not feeling the benefits of the surgery that I SHOULD be enjoying right now.  I'm tired of it hurting, my left knee is on the verge of going, so right now I don't have a good knee and I'm just painful all the time.  It's getting old. For the umpteenth weekend in a row I basically did bugger all - walked the dog a couple of times (it's hella cold here on the east coast) and did some laundry, spent the rest of the time in my chair with ice and pain meds because it just plain hurt to move around.

I am going to PT tonight for the first time since the 2nd surgery, which I hope will start improving things.  I have pretty good flexibility, I'm well over 90 degrees, but it's weak, I still can't do stairs.  At least now I am fairly certain that when the therapist starts to move my knee it will not explode all over her room again!
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 26, 2013, 12:31:31 AM
YankeeGirl - That knee looks like it hurts - it looks plain bad.  I am not a bit surprised that it hurts to the touch.  I am happy to hear that you are seeing someone tonight in the medical profession, maybe they will have some thoughts about what is going on in there.  I will be waiting to see your post about how the PT goes tonight.  I am not so concerned about the erupting as I am about how that knee is going to respond to PT.

Good luck Yankee - make sure you ice when you get done.

Lee
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 26, 2013, 01:15:33 AM
Fortunately the PT woman knows what she's doing. She did some very gentle stretching, massaged around the kneecap a bit, did some desensitizing on the sensitive skin, and then iced it.  The wound looks worse in the photo than it does in real life, it's less red.  I just looked back at the photos with the sutures in where it looked like a tufted pillow - THAT hurt.  This is just screaming sensitive, the nerves are on fire.  Ugh....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 26, 2013, 10:13:21 PM
THANK YOU GOD!!!  For putting at least one person in Yankee's situation that knows what they are doing and cares about her patients.

Yankee - have you seen or heard from that ID doctor?  Just wondering.

Lee
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 27, 2013, 06:43:03 PM
Hi Lee,
NO, I have not heard from the ID doctor, I expected she might call this week since they *should* have told her that I called, but I have heard nothing.  Since the wound is completely closed over now, not weeping or draining, not swollen, I think my combo of medicines worked and I didn't bother to call.  I have an appointment on the 6th,  I think.  The only thing is the sensitivity - it's driving me mad.  I wonder if I've been giving myself frostbite with the ice packs, even the ones that say you can put them directly on skin - I can't think of any reason why it would feel 'burned' and sore.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 28, 2013, 01:52:43 PM
So here's what I'm thankful for - a knee that finally looks and feels like it's turning a corner.  No weeping, closed up, just the top at the part that looks a little redder than the rest.  I could do without the 3:30 or 4 AM wakeup calls from the sharp nerve pain, however. Wonder how long that's going to last. 

I am beginning to think that what I thought looked like poison ivy WAS poison ivy, as it's responded to the Temovate so well.  Where  walk the dog, there is PI, only now there are no leaves on it, so conceivably I could have gotten some of the oil on the cuffs of my pants brushing through it and swiped that on my leg when I pulled my pant leg up to clean the wound.  More careful now not to go there, worst case of PI I've ever had was from the vines, not the leaves.

Hope everyone has a nice Thanksgiving!
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 28, 2013, 07:41:47 PM
Dear Yankeequette!!!

Wow - what a difference a week has made huh???  The knee looks like it belongs to a human again!!!

And I know you are happy about that.  How goes the physical therapy?  Slow and steady girl - you will be back to where you should have been with slow and steady.

Pretty strange about the Poison Ivy.  My son had it a couple summers ago.  Ended up on steroid shots because of such a reaction to the stuff.  He was pretty sick.

Let me know how the physical therapy is going.  Then when you have time - could you please put into layman's terms exactly what you did have done to that knee?  I have read your diary and I thought you had grafts put in - but from what Dr. Mark said you had a partial knee replacement.  Since I am looking at a total knee replacement I am interested in this sort of discussion.

Regards,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on November 29, 2013, 12:08:24 AM
Hi Lee,
Yes, it is looking better.  I wish it felt better, it's still quite sore and weak, this week was especially bad since there was a big low pressure system of crap weather passing through and I am severely affected by weather, low pressure systems cause me a lot of pain, I can barely move. It's called predicting the weather with your bones....

PT again on Saturday, I have the utmost faith in my therapist - it is a wonderful practice, all women and they are all so caring and compassionate, I feel well served by them so far and I know that I won't be pushed too hard too fast.

I am deathly allergic to poison ivy, I only need to look in its direction to get it.  Several years ago, I was picking apart an old dump I found in the woods (decades old glassware, etc., I love that stuff) and unbeknownst to me, it was covered with PI, but there were no leaves so I just thought the vines were forest vines.  You can get just as bad a case of PI from touching the roots, both arms that were not covered by my coat were affected, and then I took my jeans off and sat on them, and had it all over the backs of both thighs.  Steroids for me too, and Temovate, which is a life saver. 

I had patello-femoral implants, you can see the procedure here:
http://www.arthrosurface.com/products/knee/patello-femoral-implants/ (http://www.arthrosurface.com/products/knee/patello-femoral-implants/)
I had severe arthritis on the back of my kneecap, bare spots of bone, which caused excruciating pain, but I didn't have any damage to other surfaces, so this was a perfect, minimally invasive (ha ha) solution.  A polyethylene button was glued to the back of my kneecap with bone cement to replace the cartilage deficits, and a titanium implant was put into the end of the femur, and the two components glide over each other to eliminate the horrible arthritis I had before.  That part seems to have worked, it feels smooth but it's hard to appreciate when the rest of it still hurts.  I think/hope it will get better as the soreness diminishes.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on November 29, 2013, 03:31:24 AM
Dear Yankee,

I cannot thinik of anyone that deserves a break more than you.  You are in caring, confident hands for your PT - and that is where you need to be right now.

If that is poison ivy - you should be over it soon.  Maybe all of this is behind you now.

Before my son was born - when I was about 7 or 8 months along with him - his dad and I drove up to the mountains after swing shift to meet some friends for a camping trip.  We threw out our sleeping bags into a patch of poison oak or ivy.  We came home with it all over us.  So when my son gets it - it is really bad. 

I am hoping that whatever it is - it is getting well quickly for you.  You sound like you are on the mend and that is what I am praying for you.

Happy Thanksgiving Yankee,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on December 02, 2013, 02:29:57 AM
Another *yawn* update. The wound is looking better, less red, I'd like to say it hurt less and was less sensitive but it's not, really, I'm starting to wonder if I had some kind of chemical burn on the skin from whatever they used to clean the wound, aside from the absence of any kind of anesthetic which only made a bad situation worse.

I'm discouraged about function - no matter how much I stretch, it feels like a bunch of spare parts chucked together, tendons snapping, clunking (I can hear the two implants touching sometimes), my knee feels like it's put together with giant rubber bands that snap back in place when stretched, so far I'm not feeling much if any improvement.  I did a little bit of time on the bike at PT, then some sustained bending along the wall trying to exercise my quads, and the wobble board back and forth  It's still quite sore, any extended standing or walking (I think twice about whether I REALLY need something in the back of the grocery store) is still very hard, so I'm trying to be careful.  I'd feel better if I could take Ibuprofen, I'm sure, but I can't while on Cipro - another week or two of that to go.  Can't take my usual sleep medicine (trazodone), so I'm still taking Norco at bedtime, and every night like clockwork I wake up when it wears off at 3:30 or 4 AM with some serious pain because I've tried to move in bed and it has all gone rigid again.  That's getting old.  I think (hope) I'm out of the woods as far as any infection, there's still some swelling in my knee but no fluid, the skin is vastly looser than it was, not being stretched tight. 

Hoping to get some function back soon.....still can't do steps, and the longer I delay that the worse off I'm going to be, I think I will suggest that we at least start low ones this week to see how it goes.  Anyone who's had this operation, and has some info to offer about recovery and why this feels so weird, please chime in.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on December 02, 2013, 04:01:42 AM
Wow Yankee, it really does look better.  I am sorry that the function is not what you need/want it to be - but with continued PT maybe it will get there. 

Personally I think anything that includes being able to walk on the leg is such an improvement that I would take it right now.  But I am half way through those 6 weeks of non weight bearing - so I will not complain.  3 more weeks and then my hard work begins too.

Good luck to you Yankee, glad to see you are at least improving!!!
Lee
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on December 14, 2013, 11:56:43 PM
Well, long time since i last posted (at least for me).  The week following the last post, my knee started to fill with fluid, for no apparent reason, but both the therapist and I looked at each other and said the same thing - "this isn't right".  It was so filled with fluid that just bending it enough to drive was enough to practically make me cry by the time I got to work, the pressure was just brutal.  So, I call the surgeon's office and tell them I think something is growing in there (given the unhygienic way they removed my sutures I would not be surprised at an infection under the sutures). and that I wanted it aspirated and cultured. I ended up with an appointment with a PA, who was quite officious and told me he could not sleep at night if he stuck a needle in my knee, it just wasn't warranted, it's not bad enough QUE? Did you miss the part about the NEW pain just from driving, and the fluid of unknown origin?  Nope, I argued with him for 15 minutes but he'd taken his position and wouldn't budge.  He wanted to do some blood tests for inflammation markers (namely CRP) and I said no - that my PCP and I have been monitoring my CRP for a year or more and it was and still is SKY HIGH (the range is 0-3, mine was over 12) because of the inflammation and pain in my knees, so that would be nothing more than a waste of my money.  So I went home, still in pain and the next day called my previous ortho doc (who would have done this surgery had his staff been able to pull their fingers out and get information before 2 months went by).  As I told him all that had happened to me, he sat there with his chin on the floor, "you've got to be kidding"...., no sadly, I was not kidding.  He did xrays and checked it out and agreed that it was full of fluid, by that time the heat had gone down somewhat, and said that he wasn't comfortable aspirating it YET, but wanted to watch it carefully as I came off the antibiotics (the following day) to see if there was anything that would explode.  He told me to let him know and if nothing happened then just make a 1 month follow up. 

I voiced my discouragement with my recovery and lack of progress, and he gave me more information about what went on inside my knee during the I/D than I ever got from the surgeon who did it (you remember him, he's the one totally unfamiliar with the use of anesthetics...).  Given what I had gone through, he thought my progress and range of motion was nothing short of amazing, "but I know why, because you're tough and you powered through it".  Like I had a choice.  Anyway, he gave me some peace of mind that I might eventually recover, and said one month post op, of the SECOND op, after he cut through scar tissue that would now take even longer to heal, I was doing better than I thought. 

Given that after that very unhappy appointment with the PA where nothing was resolved, I never got so much as a followup phone call from the surgeon's office, I done with him, not going to bother going back.

The next day, I was cleared by the infection doctor to stop Cipro (1 month) and I had finished the penicillin as well.  She thought the wound looked great, after what she saw last time, weepy and disgusting, anything would be an improvement.  That also meant that I was cleared to start taking Advil again, and oh my GOD, how I have missed my Advil.  Tylenol does nothing for me, it's a waste of my liver cells, and the swelling has diminished slightly this week with the antiinflammatories on board.

The recovery is still very slow, annoyingly slow in exceptionally tiny increments.  I still can't stand for more than 20 minutes without wanting to lay down.  I had to walk around BJ's twice last night looking for ice melter - that did me in.  I was outside today moving things around getting ready for our big snowstorm, and after an hour I just felt like my knees had turned to lead, starting having really sharp pain especially in the backs of my knees, so that's when I know it's time to go in. I still can't do stairs, although I occasionally try it it's not more than one or two. Extremely frustrating.  My usual Christmas baking marathon ain't happening, I just plain can't stand up to cook, I feel successful that I actually managed to make soup today, but that's the end of it for the day.

As an added irritation, my employers decided to change health plans, and because they dangled a shiny little discount at them, they cut my insurance off a month early, so all of the benefits that I had worked my way up to, (I had met deductible and out of pocket, so everything in DEC. would be paid 100%), all those benefits are gone and replaced with an even higher deductible. And they made this decision when I was hobbling around 1 week after the 2nd surgery and clearly nowhere near recovered ( I didn't have any sick time left to take off and recover).  To say that I wish them all to be infested with nests of fire ants in very private places is an understatement.... Happy Holidays!!  :D
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: drmark on December 15, 2013, 12:19:35 AM
After an antibiotic holiday of at least two weeks a caring doctor should aspirate that knee for culture and sensitivity.  Squirting some joint fluid on a common urine dipstick that is used to diagnosed a urinary tract infection is a down and dirty way of learning what is really going on.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on December 15, 2013, 01:36:18 AM
Well, knocking on wood, it doesn't seem to be getting any worse, but it's only been a few days.  What will the urine dipstick tell you - does it measure pH or bacteria levels or what?
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: drmark on December 15, 2013, 05:04:09 PM
Protein and bacterial byproducts.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on December 18, 2013, 05:49:09 PM
Dear Yankee,

I have been looking for your posts, wondering what is going on with you.  I thought you were out dancing and had moved on without a good bye!!!

I am so sorry that you are still having issues.  I am hoping that this is your body adjusting to those new parts of the knee they gave you.  And then to add insult to injury - your bosses change insurances.  That happened to me too this year and I am paying my out of pocket expenses yet again for 2013.  This is the 2nd time they have done this to me.  But as long as it is not them - they don't seem to care.

I have your name on our prayer list and will leave it there.

Good luck to you Yankee - hang tough girl!!!

Lee
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on December 24, 2013, 03:42:15 AM
Hahhaah Lee, dancing......I'm lucky if I can walk for more than ten minutes.  It still hurts, things are still waking up and becoming sharper, enough to wake me up at night but it dissipates with some pain meds or advil and an ice pack.  I have undefined rheumatological "issues", meaning I can tell the weather forecast with my bones - this week I couldn't stand the pain anymore with the weather, all my joints were inflamed so I took a small course of medrol, also hoping it would help my knee as well.  It did, a little but it still hurts.  What's frustrating is that the improvement is in such small increments it feels like I will never get better.  Therapy is helping, I'm on the bike but doing one legged exercises stepping down, my knee/quad is weak to barely functional.  Still a ways to go. It bothers me that the one place I should not have pain, I still have pain - maybe because everything else isn't working right together yet, I don't know.  I'm not convinced this was a good decision, yet.

Hope y'all have a Merry Christmas!
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on December 26, 2013, 05:58:34 PM
So Yankee,

You are at least riding a bike - which I cannot wait to be able to do.  I want to be riding my own bike by April.  That is my goal.  When I can ride my own bike, I will be back to where I was at last summer.  But first I have to get started with PT. 

how is your wound?  Has it healed completely yet???  Are you still seeing the other surgeon or the one that did your actual knee work this time around? 

I hope that things improve for you quickly - but I know better.  In the knee world - this stuff just takes time.

Lee
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: simondelalto on December 31, 2013, 08:00:56 AM
LEE TIPTON, I WOULD GREATLY APPRECIATE IT IF YOU COULD EMAIL ME BC I HAVE SOME QUESTIONS FOR YOU IF YOU DONT MIND? [email protected] HAPPY NEW YEAR!
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on January 03, 2014, 11:44:20 PM
Hi Lee,
Hope you're kicking it and I'll check your diary in a second.

My wound has healed, finally.  I'm seeing my original doctor who was to have done the surgery but didn't, I'm supposed to see him again next week.  The pain is very gradually lessening, but still my whole knee (both actually) stiffen up horribly when I stand or walk for a while.  I don't get that.  There's a huge lump of scar tissue where the top of the wound was which would wake me up in the middle of the night like there was a drill in the middle of it - the therapist worked on that  and seemed to loosen it up a bit which helped.  The improvement is glacial, quite frustrating, I'm carefully doing stairs but it's not pretty, I'm just not strong enough yet, and I think the 2nd doc was right - that cutting through the scar tissue for the 2nd surgery was going to make everything take twice as long.  I have pain when I try to go down stairs too, where I shouldn't have pain.  Frustrating.....  I managed to shovel and snowblow this morning and did so without seeming to cause much extra pain so I'm relieved about that - I find myself hating snow more and more each day (14"....)`

I filed a 7 page complaint with the hospital and the medical group, detailing the entire mess.  The patient relations person called me this afternoon after she read it and was completely mortified, apologized all over the place.  She said that she had contacted billing and asked them to put my account on hold until this is resolved. They have to do their internal review and so does the physician group (and i know that another patient has also recently filed a complaint against this doctor with similar issues) so I think they have a lot of investigating to do.  I just want my life back.....
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on January 29, 2014, 03:53:58 AM
Dear Yankee,

At least you are not in as much pain as you were in the beginning.  Honestly - I am just glad that you did not have any worse reaction to what ever that doctor did when he re-sutured that incision than you did.  And if all you do is file a complaint - that place should be grateful.  A lawsuit is not out of the question Yankee - and I am not a sue happy person.  You have been through a lot.

I hope you continue to get better.  But you better leave that snow alone until you are much better -  that is a tough job for anyone - let alone a knee patient!!!

Warmest regards,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on January 29, 2014, 04:18:32 AM
Dear Simon,

I have left you an email and you are welcomed to email me back.  I am exactly 11 weeks out from surgery today and I am doing well.  I am also a soon to be 60 year old woman that is not 6'4" - and a bit on the heavy side.  I am active - but I will not be doing any dancing anytime soon. 

I had a motorcycle accident 40 years ago.  In those days they did not repair the menicus - they took it out.  I had a medial menisectomy when I was 19 - I am 59 now.  I guess several years ago my knee gave way and in the process my femur followed the path of least resistance and took a sharp turn to the left - which left me knock kneed on my right leg.  My OS did not get it as straight as he wanted - but I can almost straighten out my leg which I have NOT been able to do for about 2 or 3 years.  I am just now started physical therapy for it - so we will see.  The surgeon in dead set on replacing my right knee this year - but that is not happening until I cannot stand the pain any longer.

You are 19 huh?  Have you had an injury or is this a deformity from birth? I will tell you this: my left femur is a little curved too - and my mom had a tibia that was curving before her death.  Her leg hurt her to the point that they were considering amputating it - then she got pancreatic cancer and it killed her.

You will be able to stay on your parent's insurance until you are 26 - that is plenty of time to get your leg fixed.  It only takes a year to get thought this surgery.  But you have to find a good doctor.  Then ask them to do a sonogram of your femur.  If you get the right doctor - he will know what to do.  That is how they found my curve - which was close to 20 degrees - right before my knee.  that is why he could not get it as straight as he wanted - the location was just too close to the knee.  I have a steel plate and 8 screws.  He does not do open wedge - he just cut my bone - then screwed it together and left a space in there for it to grow back together.  Evidently I am healing because I am walking without a walker and without a brace and have been for about 3 weeks.

Simon I am so sorry that I did not see your request before now.  But you are welcome to email me anytime.

Warmest regards,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on March 11, 2014, 12:24:06 AM
Well, it's been a while since I've posted.  I wish I could say the news is good, but it's not.   I am four months post op, and while I can walk (for a limited time) I still can't do stairs without relying heavily on a railing.  I'm in pretty much constant discomfort, but pain on the stairs for sure has not improved. I stopped PT because I could not do the strength exercises, every time I put pressure on my knee to use my quad,  the pain is enough to take my breath away.  I've been to the new doctor, and based on the xrays he's done, (he wants me to have a CAT scan, a bill I don't want to run up right yet, and it has to be the right kind of CAT scan, to get it while it's causing me pain), he believes that the implants are not lined up correctly, which is why I'm feeling so much impact when I stress it.

My letter to the hospital ended with a reply so obnoxious I could barely contain myself, twisting my words and taking responsibility for NOTHING.  Didn't offer to reduce the bill for all the hassle that two surgeries cost me, not a penny.  Basically "we did nothing wrong, tough sh*t if you don't like it".   

I have not received a reply from the doctor's group (and they bear the lion's share of responsibility since they employ the physician and his idiot assistant who smeared surgical glue all over my wound, embedded steri strips in it, and causing burns and the skin over the wound to split open, which then spewed infected fluid.  I did get a bill from them again today, again no adjustments made for my trouble, not even a "sorry", just a big bill for over $900, for two surgeries, the second of which should never have happened.

My answer to that is to write to them again and correct their misstatements, to send letters of complaint to Arthrosurface and to the state medical board and hospital board.  Other than that, I have no recourse, and apparently they know it.  I still have my leg, and therefore there is no injury.  In this state, you have to go through a tribunal to be vetted and make sure your case is not frivolous, and unless there is a lost limb, death, brain damage or permanent disability, there is no case. So, someone can maim you and walk away laughing all the way to the bank. Do I sound angry?

I am trying to find information on the standard of care, especially for the closure of wounds.  My open knee wound, 5-6 inches long, was originally closed with nothing but internal sutures and steri strips, which of course didn't hold under pressure when I fell down after the femoral block. Is there some manual online that gives the standard method of wound closure? I can not believe that steri strips would be an acceptable method, especially since the surgical booker, the assistant and the doctor himself all insisted that I would have a knee full of staples.  That never happened in either surgery.  Thanks for all the help, if anyone can point me in the right direction I'd be grateful.
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on March 11, 2014, 12:43:53 AM
Hi Lee,
It sounds like you are making great progress, cheers to you, it's been a tough winter. 

The truth is I am in as much pain if not more than I was before this mess, the pain going up and down stairs is very 'nervy', literally takes my breath away.  If the implants were hitting each other in the wrong place then that might explain it.  You can see above where I'm at.  Or rather, where I'm stuck......  The snow has not helped, we've had pretty much a storm a week, it seems, and another six inches or so on the way for Wed.  I"m icing my knee at the moment because I fell on the ice twice this morning, (it had snowed and covered it) so it's nice and bruised and sore, and I'm sure it will be even worse tomorrow.  Oy, can this winter never end!!  Keep on truckin'...

Dear Yankee,

At least you are not in as much pain as you were in the beginning.  Honestly - I am just glad that you did not have any worse reaction to what ever that doctor did when he re-sutured that incision than you did.  And if all you do is file a complaint - that place should be grateful.  A lawsuit is not out of the question Yankee - and I am not a sue happy person.  You have been through a lot.

I hope you continue to get better.  But you better leave that snow alone until you are much better -  that is a tough job for anyone - let alone a knee patient!!!

Warmest regards,
Lee Tipton
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lee Tipton on March 27, 2014, 04:46:18 PM
Dear Yankee,

I seems that you guys just cannot catch a break.  I have a boss that is flying out of CA on Sunday (3/30) to head for DC.  I told him that I thought he was nuts - but he is going.  Even the President is getting out of there for a while.

I am so sorry about your issues Yankee.  And honestly, if it were me, I would find the best lawyer I could find that would take your case for a percentage of what is won - and let them go to it.  I have only filed 1 lawsuit in my life and it was my 2nd husband that caused me to file it.  We won it, and then I filed for divorce.  He keeps an attorney on retainer just in case he needs to file a lawsuit.  My first husband died in 1997, we were married for 25 years - and we never sued anyone. 

But in your case - I would make an exception.  That doctor is dangerous Yankee - and it is obvious that he has NO care about what he does to his patients.  He should have to pay the bill for having that knee repaired - and all the tests that go with it.  Even if you don't get a settlement - he should have to repair the mess he made.

I know you have no choice but to keep on truckin' - but truck easy on that knee please.

Lee
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lilalu on April 26, 2014, 07:45:28 PM
Hi Yankee,

your story is very interesting, because doctors suggested for me to get the same/almost the same implant you have (for it would be the hemicap wave - the bigger one). I´am very sorry, you had to go through so much pain! And of course I´am terrified be your story! I think my hospital and the doctors are really good, but anyway your story is not very encouring for me of course.

Hope you are improving by now! What about the thing with the implants not being implated the right way? Did they have to change them? Hope everything will be o.k. for you! Good luck and all the best!

Lila
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: wofford99 on May 09, 2014, 12:58:41 AM
I am so glad I found this thread.  I had a patello femoral arthrosurface in June 2013 and it has been a disaster. Have a history of about 34 surgeries on both knees due to patellofemoral problems. I am age 37. 

My incision is still open despite 3 debridements and we can't find anyone that will help us get it closed. I just had a scope 3 weeks ago due to severe swelling and pain after the arthrosurface. he found extensive synovitis, arthrofibrosis and cartilage thinning all since the arthrosurface. I have underlying rheumatoid arthritis and think I should have had a total knee opposed to an arthrosurface as it has caused diffuse inflammation. I am still in a bledsoe brace from June and I can only walk a few feet without significant pain.  I have almost no quad muscle despite good efforts with PT.   I fell after my 2nd debridement due to my leg still being numb from the femoral nerve block and split my incision open and it had to be derided again.  I had to do IV antibiotics at home during several months.  Now the incision is still open. my surgeon doesn't know what to do and has sent us to multiple specialists who keep punting me off.

 I wanted this thing converted to a total but my surgeon insists that it won't help me.  I have contacted the arthosurface company to see if any surgeon can convert this to a total but am not getting much response. just to ask my current surgeon.  We travel 3 hours to see my orthopedic surgeon and are getting tired of this especially because he is not all that helpful now.  My knee has been left in quite a state due to arthrosurface. wondering if I will ever be able to walk again with some regularity.  What a mess. Am so glad to find this thread! Margaret
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Lilalu on May 09, 2014, 10:41:10 AM
Hi Wofford,

wow, what a story! I´am very sad, this did not work for you and you are in so much pain! 34 surgerys - you had one almost every year of your life!

I´am sitting at the sofa at the moment and can hardly walk - but when I read such stories, I really think, I should not allow any surgeon to do anything to my knee! Maybe I should just take painmeds and doing all the exercise I can and never start with surgerys - now I´am in pain, but what if I have even more pain afterwards?

To the PFR: I´am sure, I read in the arthrosurface flyer, that their product is contraindicated, when you have rheumatoid arthritis. On the other hand your surgeon might be right and a total knee would not help you much either. You never know and I have spoken to people, who have similar problems with their total replacement also (e.g. arthrofibrosis). I guess your surgeon choose the hemicap, because you are very young and he hoped to gain you 10 years. Anyway I guess first of all, some expert has to see your incision and why it is still open. I´am not an expert - but I would not allow another surgery on my knee, as long as there are still so many unsolved problems with the previous surgery. The actual problem might not be the implant but the underlying rheumatoid arthitis or any other problem, that does not allow you to heal. If this problems are not solved first, another surgery may not give you the sucess and relief you are hoping for. But I´am sure, someone will be able to help you! Do you maybe have a university hospital or anything like this near your area?

As I said: I´am not an expert - I may be wrong with my ideas.

All the best!
Title: Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
Post by: Yankee on July 04, 2014, 04:06:38 PM
Hello folks, it’s been a long time since I posted an update.  I wish I could say that I have been doing well and recovered, but this surgery has been a complete and utter disaster.

The specialist I just saw said that he believes the patellar implant is both too small and too thin, so that the edges of the bone hit my femur and that’s what’s causing the constant pain on the outside of my knee, and the fact that I really can’t put much pressure on it at all. He says he “might” be able to revise it with a bigger implant, but I must agree to go into surgery with the knowledge I could wake up with a total knee replacement, if he thinks that will give me a better outcome.  He is a well-respected surgeon and university professor as well, my doctor’s mentor, so I trust that what he’s telling me is what he feels is right – however it’s not what I can deal with right now for something that shouldn’t be this god damn complicated.

I neither want nor need a TKR, the cartilage that would replace is perfectly fine, it’s my patella and has always been just my patella.  Worse still, since June 4 I am unemployed, so the chances of me getting anything revised are between slim and none now.   So now I have to look for work in this less than perfect state and hope I can find something where my knee won’t be a detriment.  It’s not easy, because it affects everything I do.

I have met twice with the hospital and the practice managers about what they did to me, and not only have they behaved in a way so stupid it defies belief but they have now stooped to flat out bald faced LYING about what happened to me.  They take responsibility for NOTHING.  They lied about the nurse removing my sutures from the first surgery and smearing my leg with surgical glue, claiming that IS the way it’s supposed to be used (it is not, any 4th grader can read the directions). They also flat out lied saying that the nurse never embedded steri strips into the wet glue which not only caused burns but broke open the incision which four days later started spewing infected fluid.  The fact that I have pictures of the resulting burn marks means nothing to them, nor does the fact that they reference the steri strips they supposedly never used in the office notes.  They just caught themselves in their own lie, which should sit well when the Board of Medicine takes up my complaint.  The doctor continues to reiterate his surgical procedures and how they can’t possibly be wrong, because he followed directions.  Really?  How does that explain the poor outcome, if you did it so well?

They claimed no responsibility for the Pseudomonas infection I got there, nor did they seem to be aware that it is THE most common hospital acquired infection, and that it is spread by poor hygiene.  I handed them a printout from the CDC which they didn’t seem to be familiar with. 

All of this has been compiled and sent to the state board of medicine as a formal complaint and request that they be investigated for their procedures and their complete lack of documentation, not to mention the doctor’s lack of familiarity with anesthetics.  Meanwhile, I am still in agony and trying to continue a normal life – I have a house, and gardens and things need taking care of, so I get to do it in pain. Every time I get up out of a chair, the pain is different – today it’s pounding on the top of my tibia for some reason, along with the usual throbbing on the outside of my knee.  It is brutal.  I did call an attorney, three times, and he wouldn’t even call me back, so I guess the prospect of getting any kind of relief is nil.  I know of someone who had a routine colonoscopy and was punctured – suffered through peritonitis, the whole 9 yards, lost work, sick for months.   She sued the doctor (who had done this to ten others but that wasn’t admissible in court) and she LOST.  My state has a tribunal that decides whether your case has merit and can proceed to malpractice or not, so you basically have to pay to prepare a trial twice.  No lawyers will do that unless there is a MASSIVE payoff at the end, i.e., brain death, permanent injury, blatant malpractice.  I’m going to continue to attempt to get some resolution out of them to cover fixing this, and if they fail to help me then I guess I go to the media and give them a little more bad press, beware patients, you need to know what you’re getting into with this hospital, they don’t give a s**t whether you’re happy or not.