KNEEtalk

The SPECIALIST'S OFFICE => Bone breaks around the knee => Topic started by: mjeffrey on August 09, 2014, 08:57:04 AM

Title: Early Hardware Removal
Post by: mjeffrey on August 09, 2014, 08:57:04 AM
Thought Iíd start a new thread for hardware removal as the other one was getting a bit long. I called it Early Hardware Removal because it is less than a year since the original  ORIF. MTB1 also had his hardware removed after 7 months this week as well and mine was after 6 months.

Quote
mtb1 on 7-Aug-2014

I am hardware free! Currently relaxing in a hotel before heading home tomorrow.  I think it took about 4 hours from the time I put the gown on till I walked out. I had general anesthetic. My OS said he'd go in along the original incision,  slightly shorter in length. The private clinic experience (I am in north central BC - always went to the hospital in the past) was a good one, aside from the early morning emergency which pushed the entire day's appointments back by 2 hours.
So far so good. I'm on T3s again for as short duration as possible, gonna ween myself of the nasty pharmaceuticals asap to avoid the side effects.
Good luck on Friday Mark, take 'er easy. It'll update in a few days.

Aaron.


Yesterday I had my wires removed. Not sure how long the operation itself took but it was over pretty quickly. I chose general anaesthetic over an epidural. The original ORIF was with an epidural and the MUA with a general. Both were OK but I didnít like the idea of a needle in the spine. I was waiting with 2 other people who both had epidurals in the past and each chose generals as well.

I was back in my room at about 16:30, expecting to stay overnight. I was supposed to stay because of a drain the OS planned to leave in. Apparently there was no need for the drain and so I was able to go home after I saw the OS at 18:00. 
He said the OP was more difficult than expected due to some inflammation. I need to ask more details about the difficulties and what that may mean for the knee. I didnít ask at the time but Iíll see him Monday to change the bandage for something waterproof and get some details then. My knee typically swells up in the afternoon after walking on it and it was a bit puffy before the op. The OS says the daily swelling was likely due to the large amount of ďmatťrielĒ in the knee due to the complex fracture. I hope he is right and it improves now.

The incision was on the same cut as before but smaller and the OS said he tidied up the scar (it was a bit raised). I have a compression bandage down to about mid calf.

I was cleared to walk with crutches and can put full weight on it. No PT or exercise for 2 weeks. Any angle of flexion is OK apparently, I was a bit surprised as I thought the incision could be pulled apart. Will ask again on Monday.

Pain in the recovery room was ok but then increased a bit and they gave me some tramadol through the IV, it diminished quickly and stayed constant the rest of the evening and today. I guess the closest description of the pain would be slightly more than ďroad rashĒ so quite tolerable and I had no problems sleeping on my back or side. The incision hurts a bit if I bend it and Iím walking stiff legged.

OS suggested I take paracetamol or ibuprofen. I'm taking 400mg Ibuprofen 4 times a day to try to reduce the inflammation.

I have plenty of time on my hands now ;) so will post updates regularly.

cheers
Mark
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 09, 2014, 11:23:01 AM
I was wondering if the ibuprofen was having an effect on the pain. Sometimes it works for me, sometimes not. So I stopped it for 6 hours. Bad idea. Much worse without the meds.
Also feel some internal ache as well. Before it was just the incision.
Aaron, how is it going with you?
Title: Re: Early Hardware Removal
Post by: mtb1 on August 09, 2014, 09:55:04 PM
Greetings Mark  :)
I am now well into Day 4 of hardware removal recovery. I have not had a T3 since last evening and I don't think I'll need any more. I'll manage with the occasional Ibuprophen/acetaminophen combo.
I typically have good results with Ibuprophen - I think most of my pain (not just with this injury, but overall) is caused by inflammation, so it targets the source. I have an active lifestyle, which means many strains, scrapes, bruises, and other results of excessive fun ;-). I have 2 reasons for getting off the Codeine - 1) constipation, and 2) can't drive or work while taking it.
I have 2 less staples than last time, the incision is pretty much like the first. I think I'll heal up much quicker though as it was a lot less invasive, and there was no trauma this time.
I was not given any restrictions by my OS. He pretty much told me I can do whatever I want whenever I feel I can. I walked out of the recovery room with the cane tucked under my arm, just to make the nurse shake her head. Lol. I have been walking around inside unassisted, and outside with a cane. It hurts more just after I have been sitting or laying down for a while, and gets better if I keep it moving. The incision is sealed up nicely and really has been since the morning after the surgery. I feel like I could move the joint a lot more, but I don't want to rip sutures/staples, so I'll take it easy for another week or so. If all is well, I don't have to go back to the doctor. I have a staple remover, high pain tolerance, and a strong constitution, so I'll likely pull my own staples in 4 or 5 days.
It feels so good to unwrap it, let it air out, and give it a good rub. The hard little lump that covered the end of an irritating wire is gone. I am 99.9% sure that this was a good thing to do and that I'll make a marked improvement as soon as the incision heals.

Watch out Gnar, prepare to be shredded!!!

The nurse in the recovery room told me that the first 3 days would be the worst. I'm done with them, and you will be soon too Mark. Hope you're doing ok, stay positive whatever the case may be.

Aaron.
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 10, 2014, 06:36:27 PM
LOL "walked out of recovery room" I'd have loved to see the expression on the nurse's face. You should have also told her (or him) you were going to DIY the staple removal as well :-).

Pretty surprised to read about staple removal is that normal in the US and where did you get the staple remover? I see there are some youtube videos showing it but still seems like a brave/crazy thing to do, but hey, why not?

Second day post op and things here much the same as yesterday, same medium pain all day up until an hour or so ago when it went away. Maybe it was the combination of drugs: (Ibuprofen and Italian red wine ;-)

I think the clunk on extension is still there which I'm majorly disappointed about. Will raise it with the OS tomorrow.


Title: Re: Early Hardware Removal
Post by: mjeffrey on August 12, 2014, 09:16:11 AM
Third day post-op and I saw the OS again  to change the dressing. Surprised to see that he had used stitches. I had asked him to tidy up the scar which was a bit raised after the incision of the first op was pulled apart a little.
I hadn't been able to flex my leg much in the compression bandage and so this was the first time I really tried and only got to about 70 which I wasn't too happy about.
The clunk on extension was much reduced and he thinks it will continue to improve with the time.
edit: I was doing too much too soon. Don't follow my example

On getting home I started to work on my flexion and got to 90 (with a bit of pain). It really feels like there are adhesions in there (can they start so soon?).
Not happy with this I got on the bike and had to put the seat up. With a bit of coaxing I made the first revolution and continued for a few minutes, each revolution hurt but less and less.
Put the seat down and repeated. I thought, if Aaron is going to remove his staples himself, I can man-up to a little pain as well and pushed it a bit.
Doing this I got to 105 after 10 minutes (I measure it with an app on my smart phone).
Not wanting to cause too much inflammation I stopped there, iced it and put a compression bandage on and went to bed.

On waking on day 4 I did 5 minutes at 105 degrees. Similar pain but a bit less. I plan to repeat throughout the day pushing a bit each time.

Hey Aaron, do you have any issues with flexion? I didn't really expect to be back to how I was 3 months ago :-(
 
Title: Re: Early Hardware Removal
Post by: mtb1 on August 12, 2014, 03:13:08 PM
Mark, you wild man - on the bike already, that's awesome!
It's day 6 for me. I'm still pretty swollen, and the area around the incision is sore. I have a little over 90 ROM, so not too happy about that either. I had hoped to be back to work soon, but it looks like I'll take the rest of the week off.
You've gone and inspired me Mark - I guess I'll haul the trainer back out today, get the bike set up, and try to spin. It'll feel good for the mind & spirit and that is really what this is all about. We have to keep reminding ourselves that we are in it for the long haul. We have had an 'oooooops' moment that will be with us for the remainder of our lives. Overnight improvement is always possible, but it may not be measurable or noticeable. With hard work, perseverance, and support from others, we will put several days or weeks together and have success that we will notice.
Title: Re: Early Hardware Removal
Post by: Twinkeelfool on August 12, 2014, 11:29:11 PM
Inspiring thread ( I just read the other one too :) ). I'm around 5 months post op. Walking and stairs is pretty normal, but rom is around 125-130, it doesn't so much hurt to go further, it just physically won't go. I'm seeing my surgeon tonight, and hoping to get the k wires out before Xmas or just after.

If I wasn't active I could get away with leaving them I guess, but I can't run and I can't surf. And as much fun as squatting 25 different ways is, I want to be able to do the things I could before. So I want the things out. I also don't think it's such a great idea to have a bunch of wire inside a joint long term.

My surgeon mentioned he wouldn't take them out unless they were giving me trouble, and that 12 months is the minimum they need to stay in. Realistically, it'll probably be a few months to get him to do it anyway ( like most surgeons he's always busy! ) so I think I'll be close to a year by the time they come out anyway.

People see me walking pretty much normally and think I'm fully recovered, but until I can surf, or run, I still feel restricted. I'm grateful for being mobile for sure, but I want to move freely, and at speed.

Title: Re: Early Hardware Removal
Post by: daihard on August 13, 2014, 06:18:47 AM
Doing this I got to 105 after 10 minutes (I measure it with an app on my smart phone).
Not wanting to cause too much inflammation I stopped there, iced it and put a compression bandage on and went to bed.
Hi Mark.

Quite a bit off-topic, but would you mind sharing with me the name of the smartphone app you use to measure your ROM? I always guess by looking, and I could use something more accurate.

Thanks! I hope you get your ROM back soon to where it was prior to the hardware removal surgery!
Title: Re: Early Hardware Removal
Post by: MDAL on August 13, 2014, 06:39:25 AM
Daihard:

There is a bunch of them in the market some free some paid, some of poor quality some of better quality, these are mostly developed by single individuals, so not really rocket science:

"iGoniometer smart phone application"

"Goniometer" (by Jinfra)

Knee Goniometer App (Ockendon©)
http://bonesmart.org/forum/threads/apps-for-bonesmarties.13725/

There are many more, some pages keep reviews of it.

Personally, I bought a manual 30cm goniometer, you can buy them from ebay for pennies...
Title: Re: Early Hardware Removal
Post by: MDAL on August 13, 2014, 08:00:47 AM
Still on this subject:

Manual goniometers (ebay list), you can find good deals for less than 5 dollars:

http://www.ebay.com/sch/i.html?_trksid=p2050601.m570.l1313.TR0.TRC0.H0.Xgoniometer.TRS0&_nkw=goniometer&_sacat=0&_from=R40

I believe the longer ones even a bit more expensive help giving a better measure, but you can perfectly do the job with a cheaper short one.
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 13, 2014, 09:40:57 AM
Interesting question daihard. I did a brain dump here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=64628.0

Title: Re: Early Hardware Removal
Post by: mjeffrey on August 13, 2014, 10:34:46 AM
Quote
Twinkeelfool
People see me walking pretty much normally and think I'm fully recovered, but until I can surf, or run, I still feel restricted. I'm grateful for being mobile for sure, but I want to move freely, and at speed.
I had the same comments when people saw me, if they only knew the reality. It was always clear I'd need my hardware removed,  since I have more than most people (4 k-wires and 2 tension bands) and 3 OSs told me the same.
But given how the wires and tension bands are placed (gory details here  https://www2.aofoundation.org/wps/portal/surgery/?showPage=redfix&bone=Knee&segment=Patella&classification=34-C1.3&treatment=&method=ORIF+-+Open+reduction+internal+fixation&implantstype=Tension+band+wiring&redfix_url=1285238823429 (https://www2.aofoundation.org/wps/portal/surgery/?showPage=redfix&bone=Knee&segment=Patella&classification=34-C1.3&treatment=&method=ORIF+-+Open+reduction+internal+fixation&implantstype=Tension+band+wiring&redfix_url=1285238823429))
I would have thought that it would cause problems for everyone. Since the accident I always had weakness on doing leg extension exercises due to pain at the top of the patella, and while its still early days I now feel that that pain less. I guess I'll know for sure in a few weeks.

cheers,
Mark
Title: Re: Early Hardware Removal
Post by: Twinkeelfool on August 13, 2014, 11:28:50 AM
My surgeon won't take them out til the 12 month mark, so march next year. I kind of expected that, and it sucks but at least I have a timeframe now. I'll have to suck it up and squat like a mofo til then. I'll hopefully be able to surf my longboard at least on small days to get my saltwater fix. In the grand scheme of life another 6 months won't kill me. I think...
Title: Re: Early Hardware Removal
Post by: jacobj on August 14, 2014, 05:37:46 AM
Hi all,
9 and a half months after fracturing my patella, the time has come to have the hardware removed. Only 6 sleeps to go in fact. My surgeon recommended early removal because it appears that the pins are shifting and causing me a fair amount of pain at the top and bottom of my knee. I went for my first bike ride (on an actual bike) last weekend to test out the knee so that I can have a point of reference before and after surgery. Cycling up hill was a definite no no, the pain was just too much. I'll add my removal story here once it's done!

Cheers

Jacob
Title: Re: Early Hardware Removal
Post by: Twinkeelfool on August 15, 2014, 04:57:41 AM
Good luck Jacob!. Let us know how it goes.
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 15, 2014, 11:50:26 AM
Yep, good luck Jacob keep us posted on how it goes. What do you have in the way of hardware?

edit: I was doing too much too soon. Don't follow my example

For me it's now day 7 post removal. I decided my early cycling was a bit aggressive and decided to stop for a while. I thought it might be contributing to the inflammation. Although I stopped the inflammation continued so maybe it did, maybe not. In the last few days I just did some gentle stretches.
I've also been working 3 days this week (from home at the computer) but could only comfortably manage around 4 hours per day: after sitting for a while, I get a throbbing in the knee and so prefer to lie down which seems to help.
 
Although it is swollen, the kneecap area now looks more like the other one, I think the cerclage was making it look bigger.

No real improvement in pain or flexion so I'm a bit disappointed at that but still early days.

Anyway not much to report. Just thought I'd record it so others would know what the experience could be like.

cheers
Mark
Title: Re: Early Hardware Removal
Post by: mtb1 on August 15, 2014, 03:01:10 PM
Day 9 update.

My recovery is significantly slower than I expected, but still pretty good compared to round #1. I removed my staples yesterday. After the first couple, I developed a technique which popped them out virtually pain free. I didn't even feel over half of them come out. It was much better than having someone else do it. I think my incision will be a little tidier than the original which is nice to see.

I may have gone off the prescribed pain meds a little early. The pain was nasty there for a few days, but I think I have it under control now. The areas around the k-wire entry points were particularly painful, and still are tender. I rubbed on some Arnica gel yesterday ( being careful not to get it on the incision) and it felt awesome.

Swelling really hasn't gone down much since day 1, but it's not like I have taken it super easy either. The incision itself has been tight and has restricted ROM, but is getting better daily. It looks like I'm over 100 today, so It's definitely time to get on the trainer. If it feels ok to pedal, I won't be there long....outside I'll go!

So Mark, it looks like we are on a similar trajectory. You seem to be having much the same experience that I am having, which is reassuring.

Good luck with your removal there Jacob, hope all goes smoothly.
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 15, 2014, 04:05:25 PM
Thanks Aaron, Yep reassuring to know we are similar. Lol with the staples , crazy :).
If you have knee pads like the DH guys use, i'd wear them outside for a few months just to be sure. Last thing you want is another break and the bone will still be more fragile than the original.

Cheers
Mark
Title: Re: Early Hardware Removal
Post by: mtb1 on August 15, 2014, 06:24:17 PM
Check...got these back in May - http://www.raceface.com/guards/legs/ambush-knee/
They're soft & supple, and go on & off easy. I was worried that they would irritate the hardware at the time, but they are actually fairly comfortable, non-restrictive, and somewhat supportive.
 
Suggest to me 8 months ago that I should ride xc with knee pads and I likely would have scoffed. I wear them now, no question.

I'm just livin' the new reality  ::)

Jacob - just re-read your post about pain while pedaling....my pain was opposite to you. I had none on the downstroke (extension), but plenty on the upstroke (flexion). I had no power, but no pain.
Title: Re: Early Hardware Removal
Post by: jacobj on August 18, 2014, 03:41:42 AM
Yep, good luck Jacob keep us posted on how it goes. What do you have in the way of hardware?



Hi Mark

I have two pins and a figure-8 tension band wiring. Only two more sleeps to go now. I just hope they don't ring me today to postpone the surgery (like they did last month) due to something more urgent coming up.

I must admit I'm a bit apprehensive, not so much the surgery itself, but the result. I'm going to be pretty disappointed if the pain is still there. It's really stopping me from doing a lot of things like running around with my kids etc.

Cheers

Jacob

Title: Re: Early Hardware Removal
Post by: fsugirl on August 18, 2014, 05:18:26 PM
Thanks for sharing, guys!
Everyone's experience (pre/during/post) is different, so it's always good to hear from different people in our 'tribe'. :)

Two things that stood out to me that I wanted to comment on...

No restrictions regarding flexion post-surgery - I, too, was very surprised by this - I don't know how many times.... and in different ways... I asked them (docs, nurses, anyone in earshot) to confirm that before I left.

Stitches, staples, etc. - related to my first comment - I was a little surprised I didn't have any real stitches or staples.  My OS put my incision back together this time with mostly glue and a few dissolving 'stitches'.  I thought for sure flexion would not be good for this!!  But it really was fine...
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 18, 2014, 08:52:12 PM
Hi Anne, hope things are still going well with you. I agree, it's amazing to hear the different approaches, they can't all be optimal which is a bit worrying. My stitches (last time staples) will only come out after 18 days, which seems really long given what I have read and Aaron's at 9 days.

I wan't really expecting to have to work so hard to get back the ROM though so that's disappointing. Stupid knee. I'm now only at 115 degrees assisted, still 25 (non-assisted) to go.
As Jacob says, it is the worry of it not getting better that is the main thing.

On the plus side, the pain I had in the quadriceps tendon (where the tension band(s) go through the tendon) is a lot less on extension and reducing and the pain I felt from one of the angled k-wires on the lateral side is on the way out as well. And before I hit the current flexion limits, the knee seems to move a lot more freely as well, before it used to "catch" a little at about 80 degrees and now that's gone.

edit: I was doing too much too soon. Don't follow my example
As for exercise I did 40 mins on the bike today in 10 minute chunks, the saddle is at the lowest now so I'm going to have to trim the stem or put on thicker shoes next :). I'm also using electric stimulation (NMES) but the VMO is still requiring a lot more stimulation than the other parts of the quads. Going up stairs is OK, going down I need the handrail.

Tomorrow is the 6 month anniversary of my accident - now that's a day I want to forget...
Title: Re: Early Hardware Removal
Post by: jacobj on August 19, 2014, 05:12:35 AM
Looks like surgery is going ahead tomorrow. Just got the call from the admissions office. Even though it's day surgery they want to keep me in overnight after surgery for some reason. I was hoping to jog straight out of there  :P

Jacob
Title: Re: Early Hardware Removal
Post by: Madyakker on August 19, 2014, 09:03:57 PM
Good Luck Jacobj
Hope it helps with the pain. Let us know.
Madyakker
Title: Re: Early Hardware Removal
Post by: mtb1 on August 19, 2014, 09:48:52 PM
Day 13 post-removal update.

I feel good.  :) There are still a few painful (to the touch) areas around the surgical site, mainly top & bottom - where the k wires used to protrude. Flexion gives me very little discomfort until I hit the limit of my ROM. Extension is quite painful still, but is improving. My ROM is approximately 120.

I got outside on the bike for a few laps of the neighborhood today, for about 1/2 hour. The legs felt surprisingly strong, but the last 2 weeks of inactivity has definitely had an effect. I'm gonna jump for joy when I can stand up and pedal again, but it looks like that is still going to be a while. If the week goes well, I think I might just be ready for a trail ride on the weekend with my wife though, so all is good.

I'll be returning to my welding job in 8 days....I should be ready for that too.

Aaron.
Title: Re: Early Hardware Removal
Post by: daihard on August 20, 2014, 02:45:31 AM
I feel good.  :) There are still a few painful (to the touch) areas around the surgical site, mainly top & bottom - where the k wires used to protrude. Flexion gives me very little discomfort until I hit the limit of my ROM. Extension is quite painful still, but is improving. My ROM is approximately 120.

I got outside on the bike for a few laps of the neighborhood today, for about 1/2 hour. The legs felt surprisingly strong, but the last 2 weeks of inactivity has definitely had an effect. I'm gonna jump for joy when I can stand up and pedal again, but it looks like that is still going to be a while. If the week goes well, I think I might just be ready for a trail ride on the weekend with my wife though, so all is good.

Aaron,

Can you pedal comfortably with a 120-degree ROM? If so, that's encouraging news to me as I'm currently 120 unassisted (though I'm 7 weeks post-op and still have my hardware). I'm supposed to get the green light to do some more vigorous PT the day after tomorrow, and one of the things my therapist wants to have me do is pedal a bike trainer. I know it's going to be a while before I can hop on a real bike, but being able to pedal anything would make me feel great.

Thanks,
Dai
Title: Re: Early Hardware Removal
Post by: charlottekatt on August 20, 2014, 03:27:48 AM
Daihard -

Ask your PT if you can do your warm-up on a recumbent stationary bike....the seats can be adjusted closer/further so flexion isn't an issue.  Plus you can scootch the seat an inch or two forward every visit n get a little extra flexing in.
Title: Re: Early Hardware Removal
Post by: jacobj on August 20, 2014, 06:02:04 AM
Hi all
It's about 3 hours post hardware removal op. I must admit that it's more painful than I had expected. I managed to walk unassisted to the bathroom which was good. It's weight bearing as tolerated are the instructions. Staying in hospital overnight. Not much more to report at this stage.

Cheers
Jacob
Title: Re: Early Hardware Removal
Post by: jacobj on August 20, 2014, 11:17:42 AM
8 hour update. Haven't had any pain meds since being in the recovery ward. It's sore but bearable. Standing up for more than a minute or so causes it to throb and sting.
Title: Re: Early Hardware Removal
Post by: fsugirl on August 20, 2014, 01:52:41 PM
Great to hear, Jacob.  Sounds like things are going as expected!
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 20, 2014, 03:54:28 PM
Hi Jacob

Sounds like you are doing OK, hope you feel better soon. I'm surprised they didn't give you any pain meds. 10 minutes after I woke it hurt like hell and they gave me some immediately. I needed something (Ibuprofen, nothing too strong) for more than a week.

Did you end up staying overnight? They planned to keep me as well to leave in a drain but in the end there was no drain and so I went home ;-).

Can you pedal comfortably with a 120-degree ROM?

Hi Daihard. 120 is plenty, 110 should be OK, but if not just put the seat a bit higher!!!
Personally I didn't like the recumbent bike but if you get a chance, no harm comparing. Do you have an exercise bike at home? I rented one initially but then needed it for so long I bought a turbo trainer http://www.evanscycles.com/products/minoura/b60-remote-trainer-ec024622 (http://www.evanscycles.com/products/minoura/b60-remote-trainer-ec024622) and a (necessary) special tyre for the mountain bike. Works pretty well and I prefer it to the exercise bike.
Title: Re: Early Hardware Removal
Post by: mtb1 on August 20, 2014, 06:18:20 PM
I would say 110 was minimum for me to pedal. I raised the seat as high as possible and scooted my foot forward on the pedal.
I have a Minoura trainer as well. I used it a fair bit during recovery round #1, but that was just to avoid ice & snow outside. For round #2, I was probably on it a total of 20 minutes before I decided to venture out. It will be hauled back to the basement today and stored away until next time ( ;) NEVER!).
Title: Re: Early Hardware Removal
Post by: jacobj on August 21, 2014, 07:43:27 AM
A bit over 24 hours update:

The pain from surgery has remained pretty much the same. Stinging from the incision coupled with general pain inside the knee that wasn't there before. I haven't taken any pain meds for it as the pain is bearable. Ended up staying overnight as I managed to score myself a private room. I probably would have pushed to be discharged same day if I didn't have my own room. No crutches or walking aides. I drove myself home from the hospital this morning. So far it's a walk in the park compared to the initial break.

As a side note, I was in the anaesthetic bay waiting for surgery and the surgeon came in to say hello, and basically told me "no time is a good time for hardware removal, i had a patient that had it removed 2 years after the fracture and 4 weeks later he stumbled and broke the patella again". All that has done for me is to make me a bit paranoid about breaking it again. When you're prepped for surgery it's probably to late to warn me about the dangers of hardware removal lol.

Cheers

Jacob
Title: Re: Early Hardware Removal
Post by: fsugirl on August 21, 2014, 01:40:09 PM
Glad to hear it's going so well for you, so far, Jacob. 
I didn't stay overnight & I did take pain meds for 24 hours & use my crutch a little, but those last two things were more out of precaution, I think.  I pretty much felt good quickly and was back to normal activities... though I did wait at least a week to start back with regular exercise.  I think I looked worse than I felt - was all bandaged up, using my crutch for extra support (or maybe it was sympathy? ;)).

Interesting last comment.  As I was trying to decide about having the hardware removed (2 years out from injury), my husband said, "whatever you think will make you less paranoid about re-injuring is what I think you should do."  Both of us wanting me to get back to living life more like I used to - without so much caution! - we discussed this very thing.  It held the most weight on the 'don't do it' side of the decision-making process... but I did it anyway.  So, thanks for the reminder! ;)  Though I know re-injury is very possible - for some reason - I DO feel like I have more confidence now... so I'm still glad I went through with it.  Here's to hoping I don't fall now!! :)
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 21, 2014, 08:20:50 PM
Hi Jacob,

Hi Jacob thanks for the update.

As a side note, I was in the anaesthetic bay waiting for surgery and the surgeon came in to say hello, and basically told me "no time is a good time for hardware removal, i had a patient that had it removed 2 years after the fracture and 4 weeks later he stumbled and broke the patella again". All that has done for me is to make me a bit paranoid about breaking it again. When you're prepped for surgery it's probably to late to warn me about the dangers of hardware removal lol.

I was interested to read what your surgeon said. I'm sure there is more risk of another fracture given the bones will be more fragile after the HW removal and for a while you're less sure on your feet and more prone to falls. On the other hand see this:
Quote
Tension-band wires ultimately will break.
from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048243/ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048243/).

So maybe if you have a wire tension band (I have 2!), the choice will be made for you.

It happened recently to someone on keegeeks:
I've never posted on here so apologies if this is in the wrong place!

In 2012 I fractured my patella in 2 pieces in a car accident and had surgery to have the figure of 8 wire tension band. My surgeon had told me its the best thing to happen for patella fractures and it would be fine to leave in unless it cause problems in the future. fast forward 2 years and here we are. I started exercising recently (jogging, running etc) and felt a sharp pain in my knee. I was unable to walk or even move it in the slightest without agonising pain. It swelled up to twice the size and I had an emergency xray where I was told by my doctor part of  the wire had broken off due to exercise and slipped into my joint - she would send the Xray to my surgeon and he would take it from there. Yesterday I got a call from the hospital informing me I will undergo surgery tomorrow morning to remove all hardware including the separate piece inside the joint.

I am 20 years old and completely confused. I cannot find online anywhere anyone having to urgently get the wire removed/ it snapping and going into joint. Does anyone know what I am to expect tomorrow? I just feel a little annoyed as I haven't been told anything about the surgery or recovery time. To top it all off I was given a lecture for jogging as I am apparently never supposed to do this after the original operation which I was also never told!


Personally I have a lot hardware and the 2 other OS I saw took it for granted that I'd need it removed.
Also if you look at how they place the tension bands (through the tendons) then it is no wonder there is pain. For me that pain at the quadriceps tendon on extension has now gone. Any ongoing knee pain/problems will tend to inhibit the quadriceps muscles so I saw no future in keeping the wires and decided to get them out as early as possible so I could start to recover properly.
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 22, 2014, 04:50:30 PM
Day 14 post HW removal.

Well quite a bit has happened since I last gave an update but I'll start with a warning: Don't overdo it!!!.  I did and am now having some consequences which I'll explain below.
I returned to work on Tuesday, Day 11 and it was OK, needed some pain meds during the day but nothing too dramatic. I decided I'd try to push my flexion a bit and got to within about 10 degrees of the good leg (using a 3kg ankle weight and gravity). Nothing too dramatic and it is by no means unassisted but I was reassured that I would get back the flexion - after the MUA I am more than a little paranoid about more adhesions. I also did 30 minutes on the bike.

The next day I paid for it with more pain and on changing the dressing the wound looked a bit red and inflamed. No fever but a bit of bleeding so I made an appointment to see the doctor for Friday (today). I thought he could also take out the stitches rather than wait till next week.

Thursday a bit better and Friday I was walking pretty well up hill to the hospital. The wound has closed ok but not fully healed below the knee and apparently I had been doing too much, so much for the "no restriction on flexion" line I got after the operation >:(

Anyway they cleaned it up, removed the stitches and the scabs and told me to come back in a week. The new dressing is gauze pads soaked in alcohol and closed with a compression bandage, I need to change it and clean it daily.
No PT, no flexion exercises, limited walking and no biking.
So an extra week of recovery, yuk.

I'm going to edit my previous posts and put a warning about the mistake I made.

see you
Mark
Title: Re: Early Hardware Removal
Post by: fsugirl on August 22, 2014, 07:04:10 PM
Hi Mark,

Thanks for the update... & sorry you had to learn a lesson the hard way.  As we're constantly reminded (and - I know - I say it ALL the time) - every situation really IS different.

So strange to me that I - who took FOREVER to recover & was on pain meds for MONTHS after the initial procedure(s) - recovered quickly (& had no flexion issues - though, of course, I doubted the instructions too!) and had virtually no pain post HW removal.  I'm sure there's a scientific explanation... & it involves a difference in procedures, but... on a very simplistic level, it's weird to me. 

Hope it's all down hill from here!

Anne
Title: Re: Early Hardware Removal
Post by: mtb1 on August 23, 2014, 02:42:35 PM
Well that sucks Mark, but hey, what's one more week eh?

It's the dawn of day 17 for me & I'm still doing good. Went for a 1km trail walk with the dog, then a 50 minute spin around town on the bike yesterday. Strength & ROM are still not back to pre-removal but I notice small improvements every day. Like Jacob, I seem to have pain inside the joint where there was none before. Extensions are still difficult, and I cant fully straighten the leg unassisted without significant pain. I have been dressing-free since I pulled my staples on day 7. I never had more than a dry non-stick gauze pad and elastic bandage. The incision is 95% healed, just a couple of small scabbed spots left.

I think that sometimes doctors will say 'no restrictions' knowing full well that the pain will naturally restrict most people. After round #1 I had no restrictions on flex, ended up overdoing it, and was told to back off & take it easy. I haven't been any more patient with myself this time, but at least this time there is no fracture to pull apart.  :)
Title: Re: Early Hardware Removal
Post by: Twinkeelfool on August 26, 2014, 03:08:22 AM
Sounds like some mixed results, although overwhelmingly positive guys.

About the bone rebreaking, I've heard some people claim a bone can be even stronger after being broken. I find it a little bit odd, like counter intuitive.

I've got til next May/June to wait ( surgeon wants to wait at least 12 months ). I'm back at work ( physical job, lots of stairs ) and it's pretty good for that stuff but surfing or intense activity ( besides excercise bikes ) is pretty much out at this stage. On one hand I'm very happy but it's like I'm in a holding pattern til the wires come out, just squatting like a mofo a few times a week haha

Good to hear all the post hardware removal experiences.
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 27, 2014, 08:11:38 PM
19 days post removal.

Today I stopped wearing a bandage and just used some gauze and tape so I could walk fairly normally. The incision is looking a lot better and it feels like it is back on track. Although I was meant to wait until the end of the week when I see the (backup) OS again, I went to the gym today and did some light weights. Flexion unassisted is about 110 and assisted I easily get to 120. I'm fairly confident that it will get back to full flexion soon, it just seems like it is not really blocked.
Still a bit inflamed but it already moves a lot better than before. The big thing is that the sharp pain around the quadriceps tendon on leg extension has gone and if I tried I could easily do more weight than before. Also no more pain where one of the diagonal k-wires came out.

I felt I could run on it if I wanted but didn't try and will wait a couple of weeks.
During patella mobilisations it moves more than before and almost as well as the good leg.
Muscles are still a bit stiff, weak and prone to cramping but I'm sure that will improve gradually.
Not perfect by any means, still some odd clicking at times but much better than before the removal.

cu
Mark
Title: Re: Early Hardware Removal
Post by: jacobj on August 28, 2014, 03:41:27 AM
Day 8 Update

Hi Guys,

It's now day 8 since surgery. Finally back at work today. I could have been back days ago, but the doctor gave me a letter saying I'm unfit for work till the 5th of September, so I thought I might as well take a few days off.

I've taken all the bandaging off including the steri-strips. The wound looks pretty good. My knee is quite swollen at the incision sites and I think the tendons must be quite inflamed because there are hard areas at the top and bottom of my knees. I'm relatively pain free, just a bit of soreness around the incision. Full extension is possible without too much pain. I can get flexion to about 120 degrees before it feels like it's putting too much pressure on the stitches.

Walking up and downstairs i a lot less painful now then before surgery! I just need to get some more strength back into the quad to make it comfortable. That will come in time. I haven't tried kneeling yet because of the incision, but I expect that the will too be pain free after the inflamation settles.

Overall, I'm pretty happy with my progress so far.

I have an appointment next Wednesday (3rd Sep) at the hospital for a checkup.

Cheers

Jacob
Title: Re: Early Hardware Removal
Post by: mjeffrey on August 30, 2014, 03:37:51 PM
Hi Jacob

Sounds like your recovery is much better than mine at that stage and great that even now you have less pain with stairs than before the op. Seems like a really positive sign to me.

For me it is now 3 weeks post op. I saw an OS yesterday (mine returns from holiday on Monday) and he was happy with the incision, he removed the scabs and redressed it. I am now "allowed" to do PT, gentle indoor biking and swimming, no lower body weights.
Since he removed the scabs, I didn't do any more flexion exercises until it closes again but I am confident there won't be a problem.

I commented that even now the knee moved more freely than before and he OS replied: "of course now the hardware has gone, that's normal!" Interesting.

He said I don't need to come back unless there is a problem. All a bit anti-climactic really :). I would have liked to say goodbye and thanks to the OS who I had the impression gave me some special treatment (maybe because I was interested and worked hard). I guess I'll send him an email once the recovery is complete, I bet they seldom find out what really happens to their patients.

Knee is still moderately swollen and hot in the afternoon and as for mobility, while improving daily, I am not yet at the point I was at before the operation. 

cu
mark
Title: Re: Early Hardware Removal
Post by: mjeffrey on September 08, 2014, 06:31:59 PM
4 weeks post removal and so just a quick update.

Started doing more serious gym work this week and was able to do leg extensions on the injured leg with 15kg on weight stack and no pain (before removal 0kg and pain). I am also able to do a martial arts style front kick with full extension and no pain, previously about 10 degrees deficit with pain.
I can go down stairs without problems e.g. carrying 10 kg of shopping in each hand - this would have been impossible before removal.
I did some intervals on the trainer during the week and it felt good, I was able to get out of the saddle without problems (impossible before).

Starting to see a bit more definition in the quads but the VMO is lagging despite a lot of work with the NMES machine and trying to work them on the leg extensions.

Flexion is back to where it was before the operation (or slightly better) and my heel is maybe 4cm further away from the glutes than the good leg.

However the knee is still hot and swells up, particularly in the evening and worst, the annoying clunk when walking is still there. I'm seeing the doctor tomorrow about that, just preparing my list of questions now :).

How are the rest of you guys going. Still positive?
Title: Re: Early Hardware Removal
Post by: mtb1 on September 18, 2014, 03:08:17 PM
Breakthrough!

I am 8 months out from my injury, and 6 weeks hardware (& hardware related pain) free. In the past week I have worked, gone for a couple of trail rides totaling over 30km, and cut hauled split & stacked 2 loads of firewood. On my ride last night, I stood up and pedaled a couple of times. I can do about 6 revolutions - not smooth ones, kinda herky-jerky, but standing revolutions no less. Perma-grin!

ROM is not where I want it to be, but I continue to work on it and I think I'm still making progress. There is discomfort in general at times, but nothing that has kept me awake at night, and I have taken very little medication. I have a click on extension, but I sort of expected that, and it is not painful at this time. There is still a little swelling, particularly at the end of the day. It appears that my pair of patellas will not match ever again - the injured one pulled apart a little in the first 10 days and is snow slightly larger than the good one. Muscle tone is good, strength is coming back, but there is still a vast difference in the size of my legs. I'm going up & down stairs fairly normally, with some effort. Same with vertical ladders onto scaffolding at work.

I'm happy overall with the recovery so far. I think I'm lucky in that I am an active person, so I don't have to really concentrate on exercises - they're just a part of normal life for me.

Aaron.



Title: Re: Early Hardware Removal
Post by: fsugirl on September 19, 2014, 04:20:46 PM
More of an update later, but a quick announcement...

I RAN TWO DAYS AGO!!! :D  It was only two intervals of about a fifth of a mile, within my regular walk, but... I RAN - with NO major pain.  There was some pain, but nothing more than what I expected - just from the heavy impact.  Yippee! :)
Title: Re: Early Hardware Removal
Post by: mtb1 on September 21, 2014, 10:25:10 PM
Here is a visual 'where I'm at'. Enjoy.

https://www.youtube.com/watch?v=PXK45TbJkdY
Title: Re: Early Hardware Removal
Post by: mjeffrey on December 10, 2014, 07:34:02 PM
Thought Iíd post my progress since Itís been so long since an update, It was great to see that Aaron is back on the bike and riding the trails again (check out the video in his last post). I think I could get out again as well but Iím still a bit cautious of riding on the road. Iíll probably wait until the new season now (itís wet, cold and muddy here atm).

After seeing my OS 2 months ago he said that I wouldnít need to see him again unless there are issues and that I could stop PT and replace it with the gym. PT was becoming pretty boring and I felt it wasnít helping so I stopped it.

Iíve been going to the gym 3 times a week since May and in the last  2 months Iíve been doing ďspinnngĒ classes on the indoor bikes. They last about 50 minutes and are pretty intense. After this I do some weights so itís a pretty long session. For the legs I do leg press, leg curl and leg extensions. The leg extensions show the difference in strength between the legs, uninjured leg 45kg and injured leg 30kg, so about 2 thirds as strong. The machine only goes up to 80Kg so with both legs Iím already at 75 which isnít too bad. I was starting to get a bit of pain with the extensions so Iíve stopped them for a couple of weeks now and may start again gradually or not at all - I donít feel they are essential and they do put a bit of pressure on the knee cap. I also do proprioception (standing on a bosu ball or one one-leg with the eyes closed) and stretching exercises while resting between sets. 

I started walking one-way to work once a week 6 weeks ago (4km). First day was great, no issues but the second time it hurt from the start. Not sure what made the difference. This week there was a metro strike so I walked both ways. It was uncomfortable about 1k from home on the way back but not painful. If I concentrate on relaxing my leg while walking and try not to overstride it is less uncomfortable (I tend to try to walk too fast). The walk to work takes 40 mins which is about the same as I did it before the accident.

I now walk up and down stairs and escalators in the metro and am trying to do the ďquick stepĒ while going down stairs. Not there yet since the injured leg doesnít react quickly enough but itís gradually improving.

Knee is still stiff and I feel it when walking. There is a painful spot on the outer lower side just below the patella. Before the hardware came out I thought it was a k-wire now Iím not sure what it is.

A patch of skin about 2 cm in diameter has lost sensation which feels a bit weird it may be permanent but it feels like it is improving or maybe Iím just getting used to it. 

I have patella-baja (patella too low), I guess from the arthrofibrosis of the patella tendon but it is not super bad. My kneecap seems to be bigger than before and the OS said it was due to fibrosis.

Flexion remains about the same, after warming up it is about the same as the other one but it needs more effort to get there. Pretty happy with that given the problems I had but then again flexion isnít everything.

Knee continues to be hot at times but not really swollen anymore (or maybe just slightly).

I suppose it is only 10 months since the accident and for a patella fracture it was pretty bad but I had hoped for better. I get the feeling that the stiffness will remain (it is not improving) unless I do something more radical about it. Iím considering seeing another OS about I but will wait for the new year.

Anyway, a (too) long post again and I can understand the TL;DR response but I wanted to write it anyway :).

I still read all the posts on the board and am following everyoneís stories. I wish you all speedy recoveries.

Mark
Title: Re: Early Hardware Removal
Post by: morgana on December 11, 2014, 03:06:00 PM
Great video mtb1  That was pretty cool footage, and even cooler that you were out doing it!

mjeffrey  Nice post.  Sorry you aren't where you want to be yet on certain things.  I know with the tpf that many things took me years to get to "normal".  It didn't mean that things were terrible or even just bad, but certain moves weren't as comfortable or as second nature as prebreak.  For me, the child's squat was a move I did daily for years.  I could get to that same height, but the bad leg was at a 90 degree angle instead of the butt touching heel position.  I am finally at butt touching heel, but my body weight is still slightly shifted forward to keep from falling on my butt.  Getting closer to balanced over time.  Which is to say, things can still change and improve.  I am 6 years past fwb and it's still improving, small amounts now, but...

That said, seriously reach out and ask your pt and os about leg extensions.  Again, I'm tpf, not patella - but, both told me repeatedly that I should NEVER (not just during healing, but NEVER) do leg extensions with more than 5#(2.2 kilos) because that angle would stress the knee and the tibia causing damage and a knee replacement much earlier.  Their indication was steps and other natural movements would stregthened the muscles without the overload stress that extensions put on the area.  I realize that our injuries aren't the same, and that OS/PT's the world over have different philosophies on the same injury.

Okay, off my soap box and back to you - Congrats on your gymrat status!  Some of the spinning classes in town offer videos to watch so you get the sensation visually that you are riding thru some cool territory.    Does yours?  (I get so caught up in the video that I stop pedalling, so I don't do well in those - lol)   Love the bosu ball.  And yoga helps to really focus on one side so you can feel what the body needs to do.   Again still seeing changes coming with that.  And I've been back to standing to pull on a wetsuit for years now, that was a great feeling.

Keep posting.  And I'll keep watching for Your Follow Ups too.

Hoping the healing continues and you do see and feel the improvements you are hoping for!
Title: Re: Early Hardware Removal
Post by: fabifrancisco on December 19, 2014, 12:52:40 AM
I am hopefully getting my hardware removed Jan 2015... keeping my fingers crossed.  I have to have a clean CT scan on my six month anniversary which is 12/26.  Please keep us informed on your progress!
Title: Re: Early Hardware Removal
Post by: Margorita03 on December 29, 2014, 08:07:51 PM
 Hi All,
I am new to this message board but thought i would ask a question.  I broke my patella over labor day weekend into 5 pieces. I had surgery back on Sept 10 wasn't able to start physical therapy till the beginning of November.  At this point i am able to bend it to 102 degrees still limping.My question is this my pt told me that I would be better off having my hardware removed just wondering if it seems to hlep the situation or actually make it worse?  This has been one of the most harrowing experiences of my life and i dont want to put myself any farther behind in progress any opnions appreciated  ???
Title: Re: Early Hardware Removal
Post by: mjeffrey on January 01, 2015, 11:02:16 AM
Hi Margorita

No one can predict the outcome of any surgical procedure. You always need to weigh up the risks versus the potential benefits. You have all of the risks of surgery, possibility of infection, anaesthesia complications etc plus extra rehab time. My surgeon said it would take me 8 weeks to get back to where I was. I would say he was about right, it was 6-8 weeks.

On the other hand the surgery is nothing like the original: much less post op pain, easier rehab etc. Most people who have had it done here on knee guru recommend it, there are several older threads about it as well.

There is also this study
http://www.healio.com/orthopedics/journals/ortho/2010-5-33-5/%7B1cded17c-0273-4f4a-b472-21baa2a7358f%7D/implant-removal-following-surgical-stabilization-of-patella-fracture (http://www.healio.com/orthopedics/journals/ortho/2010-5-33-5/%7B1cded17c-0273-4f4a-b472-21baa2a7358f%7D/implant-removal-following-surgical-stabilization-of-patella-fracture)
Quote
Nineteen of the 22 patients with implant removal had improvement in symptoms that varied from complete pain relief in 3 to moderate relief in 16. Three had no relief of symptoms following implant removal.

So if you're having issues with the hardware discuss it with your OS. He will first check that the break has healed fully (I had a CT scan) but it seems a bit soon, most OS's are reluctant to do it before 6 months and some insist on a year.

good luck,
Mark
Title: Re: Early Hardware Removal
Post by: mtb1 on January 16, 2015, 04:05:59 PM
Hi Everybody,

I am 51 weeks post-injury and 23 weeks hardware-free. Almost a year already, time seems to have accelerated.

Mark, it sounds like you're doing excellent. You are on a much different path than I, but we are having similar results overall.
 
I have not seen my OS or a PT since having my hardware out. I get enough exercise from work & from having fun on the weekend, and I have had no real issues. Flexion is still not where I want it to be but is continuing to improve ever so slowly. Strength is coming back, but is also below my expectation. There is little pain, only when I push it. Kneeling/crawling around is not easy, but I can. Up & down stairs is no problem, but we always have to be careful now don't we? I pack large heavy objects around at work and have do stairs one at a time in those cases. I can jog for short spurts. I can stand up and pedal reasonably smoothly up short hills. I have been snowshoeing & got back on the xc skis for the first time last week. We picked up a puppy in early December, so I am walking LOTS! Everything is done with a much increased level of caution than before, which is ok most of the time  :) Generally, I feel pretty good about where my recovery is, but that is only because I have read of so many other not-so-good experiences & horrific injuries on this forum.

Margorita, keep in mind that I am not qualified in any way to give medical advise. But I can say that hardware removal was total relief for me. I think I had k-wires rubbing on my patellar tendon, and once they were removed, the pain disappeared and I was able to make true progress on recovery & enjoy movement again. Mark's comment is pretty spot-on as far as the surgery is concerned. I was back at work welding in 3 weeks, and probably back to where I was pre-removal in 5.