The SPECIALIST'S OFFICE => Bone breaks around the knee => Topic started by: Bella Gamba on June 07, 2018, 06:08:22 PM

Title: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on June 07, 2018, 06:08:22 PM
I did not see any threads on this topic and wanted to share my experience.

I survived my metal implant removal surgery after tibial plateau fracture
I went into outpatient surgery to get the metal implant (quite big!) and eight screws removed from my leg.  These were causing a lot of pain when I did any standing activity and the Dr. decided to get them out.   At the same time a scope was done on my knee to remove scar tissue and fix any issues with my meniscus. I was put under general anesthesia and when I woke up I had already been given some local anesthesia on my leg for pain management.  Was able to go home after an hour in the recovery room (was given one opioid pain killer while recovering).  I am to be NWB for 2-3 weeks and thereafter I will be allowed to put weight slowly (25% to start and increase each week until I am full weight bearing by week 6) depending on outcome of x rays.

In comparison to my first surgery, it seems like recovery will be much easier

One week update

Some differences that I have noted so far:

The pain levels are much lower and seem to be associated with the incision and not the pain associated with bone healing. 

I do not have the terrible cramps that I had during my TPF surgery recovery (then my whole leg would fall asleep and this continued several months into my recovery).

I am not as swollen as I was when recovering from my surgery to fix the fracture.  After my first surgery, my foot was twice it’s size and I remember my whole leg changing colors and being very swollen.  This time my foot looks normal and I can put on shoes and socks by myself!

I weaned from opioid pain killers by day 5 as it did not seem like these were helping

I am using a Donjoy cool therapy treatment instead of ice packs and I think that this has made a huge difference in my recovery.

I am able (and encouraged) to do heel slides, quad sets, and straight leg rises to keep my flexion (in spite of being wrapped up with bandage I can reach over 90 ROM, my extension may be off a bit – has not been measured).  When out of bed I must wear a brace set at 0 flexion and extension.

I will try to do weekly updates...
Title: Re: tibial plateau metal removal surgery recovery
Post by: Douglas Firs on June 14, 2018, 11:51:54 PM
I will be following this thread with great interest, Bella. Great start. Very informative.

The surgeon I saw yesterday said I could have my metalwork (1 plate, 6 screws) removed if I wanted to do so, and that it MIGHT (just MAYBE) improve my extension. I think you yourself said extension was never a problem you faced, but I will nonetheless be curious how you rate the experience of having the metal taken out. I have read mixed reviews on it, but i am tempted to do it, just to try SOMETHING.

Though my surgeon said it was unlikely in his opinion to improve ROM, he seemed enthused about the idea of taking the metal out, because it's better in the long run to have 'virgin bone' (his term) in the event that some other work needs to be done to my knee when i am older. this is completely opposite of what my other surgeon recommended. very confusing.

I am eager to see what your results will be, as weeks/months go on.
Title: Re: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on June 16, 2018, 07:04:53 PM
Hi Douglas,

I cannot say yet that I will be better after the metal implant removal as I am still NWB. 

I was told by my OS, that taking the metal out would be needed in the event I ever need a knee replacement. Of course I do not want a knee replacement but really wanted the metal out as it was causing so much pain and irritation. I also was told that the more time is waited to take the implant out the more difficult it would be (mine was out one year after my TPF surgery and appeared to be really easy).  My OS took the opportunity of doing some “clean up” of my knee (arthroscopic) during the surgery.  This was minor  “shaving” of some scar tissue and microfracture to encourage cartilage growth/repair/ flushing of pieces of broken cartilage and bone.  I think that the OS was thinking my knee would look much worse than it was and at the end only needed “minor repair”!

I really have not had problems with extension but my flexion was very difficult from the get go.  This time around things appear to be progressing much better so far…

I will make this my two week update

Measured over 100 ROM at OS office

Continue to use cold therapy and do gentle PT exercises

Continue to heel but have not had my stitches removed yet. Pain levels are lower.  I have been putting my foot (operated leg) down to rest in preparation for putting partial weight next week.  Started going out for short daily walks (1/2 city block) on flat surface and moving more around the house doing some easy chores (light cooking) and trying to keep bending my knee.
Title: Re: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on June 30, 2018, 09:10:21 PM
Four week update:

Stiches were removed and I was fitted with my old brace set at 90 Flexion and  extension on my follow up doctor’s visit (2 and ½ weeks post surgery).

X Rays looked OK so I am allowed to progress to FWB, 25% weekly (not that easy to figure what I am doing!!)

I continue doing ice therapy and rising my leg quite frequently.  Do ROM and quad strength exercises 3X day

Starting to walk a longer distance (still with walker but hope to transition to cane) as I am putting more weight on operated leg (but still not 100%)

Stared PT and measured ROM: about 120

Incision appears to be totally healed and still feel (Internal)  pain in the arthroscopic incision sites when bending knee

When I wake up my operated leg is stiff and have pain in knee while trying to bend and do flexion exercises but eases up throughout the day as I move more

My leg skin is peeling off but not as bad as it was after my first surgery

I feel tingling on the left side of my right foot when I wake up but goes away as I move around
Title: Re: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on July 29, 2018, 11:42:11 PM
Almost Two month update

My ROM is still improving but not as good as my good leg (not measured at PT as this does not seem to be the focus - I am doing so much better than the first surgery)

I started moving around in bed and sleeping on my sides and able to bend my legs while sleeping but I still wake up stiff in the morning

I need to continue using my protective brace to go out but can take it off when wondering around the house

I still feel pain in the back and side left of knee (one of the arthroscopy sites) and stiffness when walking but feels good to be on the bike (no resistance)

I can walk a longer distance (about one mile on flat surface aided by cane)

When indoors I keep forgetting my cane in different places (a sign that I may start walking without it soon!)

I have increased exercises to do heel rises to help build up calf muscles (my operated leg measures 4 cm less than good leg) as well as standing balancing exercises as I am FWB.  Doing more time on stationary bike (no resistance)

Sometimes my knee feels warm in comparison to the other one but seems  to be cooling (not as warm  as previous weeks)
Title: Re: tibial plateau metal removal surgery recovery and three month update
Post by: Bella Gamba on September 01, 2018, 07:06:51 PM
Three months update

Pain is localized in the knee and near the arthroscopic incisions (so does not have to do with metal removal but more with the work the OS did there: microfracture, meniscus shaving)

I am still very stiff in spite of doing a lot of PT and stationary bicycle (continue to increase resistance every week).  I have reached about 140 ROM (better than before surgery)

I go for longer and more challenging walks (steep path, soft sand at beach, lots of stairs).  No cane or walking sticks.

Cannot go up or down stairs the “normal” way (but could not do this prior to surgery either)

Scar is looking better as I continue massaging with Vit E oil (does still feel tight around it)

The arthroscopic incisions look better, but in two sites it is clear that there is scar tissue I continue to massage

Continue to use the ice therapy machine (but only 20 min after exercising)
Title: Re: tibial plateau metal removal surgery recovery
Post by: KeithPow on September 20, 2018, 07:32:27 AM
Hi Bella

Thanks for your reply and I will follow your progress with interest, from your experience it would seem the whole healing process starts again following the removal but perhaps a little quicker. I was hoping for a miracle cure but that seems unlikely from others experience. I have my own business and its very difficult financially not being able to work for more than a few hours a day so I was hoping for a solution that wouldn't set me back another few months but guess i'll just have to continue as is.
Title: Re: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on September 26, 2018, 12:49:50 AM
Hi KeithPow,

I understand, I am also self-employed and the sole bread earner in my house and our income suffered last year.   My recovery has been much quicker although not without bumps (I had to slow down PT as I am having a lot of unexplained pain).   To put things in perspective, it took me 11 months after surgery to do my first international trip and I am leaving for same type of business trip in one week (about four months post-metal removal surgery).

Everyone’s TPF is different, and each of us has a different tolerance for pain and recovers differently.  I think my recovery is taking more time than normal because my surgeon did some knee “tightening and clean-up” and not everyone needs this treatment.

Seems like you still have time to decide to take your hardware out.  So far I am happy with the decision but know that I still have a long road to recovery.

Take care,

Title: Re: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on December 06, 2018, 06:11:11 AM
Six Month update
Does not seem like things have changed much since last update.  However, I am reminded that I am walking more “normally” and my gait has improved.  Perhaps, I am not able to see the “gradual” improvements but seems like I am making some progress.  I recently got dismissed from PT (something different from last surgery that I had to quit because the insurance refused to cover more sessions although I still needed help)

I am going about doing more things (travel, work, etc.) but I still have trouble with going up and downstairs, especially downstairs and continue to work on strengthening exercises. I find it’s hard to start walking when I get out of my car after driving for over an hour.  Generally, I need to stretch and go slowly as I cannot move with ease but soon after I can walk “normally”.

I am still stiff and have pain at one of the arthroscopic incision sites where scar tissue has built up (I frequently massage the area to break the scar tissue little by little but it is still painful).   

I definitely think that removing the hardware has been helpful as now my pain is confined to around my knee incisions and perhaps related to the strengthening of my leg muscles.   

Something that I made a conscientious effort this time was not to take pain meds.  After my first surgery I was encouraged to take a lot of opioid meds around the clock.  Literally, two different opioids were prescribed and available to take.  The reality is that I do not think it helped relieve my pain.  Even when I had talked to the doctor about weaning out of the meds, he insisted that I needed to take at least one before my PT sessions so that I would make progress.  I understand that recovering from a metal implant removal is much less painful than recovering from a fracture so maybe then I needed to take the meds (have no idea how it would have been without them!).  But I really think that doctors overprescribe these meds and the side effects are horrific (not to mention potential addiction).  So my guess is that at present I chose to live with pain, and perhaps taking meds would make me feel a bit better. 

It has been a while since my last update, and I know that there is still a long way to recovery after a TPF.  So you will probably see more updates on my recovery every now and then.
Title: Re: tibial plateau metal removal surgery recovery
Post by: Douglas Firs on December 13, 2018, 08:29:21 AM
Thanks Bella, for this informative thread. Very good to have this data for those of us in similar situations.

I too have about 6 or so screws, plus a small plate. I do not think I have ever been conscious of 'feeling' the plate or the screws. Unless the general tightness and 'obstructed' feeling in my knee can be partly ascribed to the plate/screws. But maybe this will change with time? I do not know.

Also, my last surgeon (i've consulted 3) said the same thing about the desirability of having the metal out in case Knee Replacement is needed down the road. My LATEST surgeon (#3) said "you don't need it out. There are people with much more metal in their legs who never even notice it."

Sigh. So confusing when doctors all contradict each other.

It sounds like it has been a lot of recovery for you.  More than I was led to expect by some other people's descriptions.

I'm very glad you are doing better now. Will check for updates.
Title: Re: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on July 05, 2019, 01:45:39 AM
One year update

It has been over a year since my metal removed surgery and two years post tibial plateau fracture. 

Since my last update, I have continued to heal and am more active.  I am able to walk longer distances and faster and doing more challenging walks.  However, I still cannot go up or down stairs the “normal” way and have a hard time walking in steep hills (especially downhill).

The good news is my OS is not talking about the potential of a TKR anymore.

For those who have just suffered a TPF fracture you will learn that you will have a long way to go to recover.  Although all of us will recover at different rates, I had a hard time believing that it would take so long to recover.  Accepting your new “normal” sooner than later will help put things in perspective and adjust to your new life (easier to say than to do).

Title: Re: tibial plateau metal removal surgery recovery
Post by: HobbledGirl on July 31, 2019, 12:35:48 AM
Wow, Bella, you went through a lot! Just for comparison:

It’s been 14 months since I had my plate & 7 screws out, so maybe I’m not remembering totally clearly, but I think I was up and walking pretty much right away. I wasn’t allowed to weight bear for 3 months after first operation, but I had no restrictions after the HW removal almost a year later.  I almost had to relearn to walk after the first surgery, and everything was scary (roads are so uneven!), but the hardware removal was pretty much a cakewalk for me. I was really glad to get it out as it was irritating me.

After the first surgery I did my own PT watching YouTube videos and reading (with OS-set limits, but he said I didn’t really formally need it if I could meet flexion & extension goals). After the second op I mostly continued doing lots and lots of dog walking hoping not to irritate the plateau irregularities and encourage cartilage rejuvenation. I may have done a little flexion work, but it’s part of my lifestyle to push it and I can now squat way down quite well.

Your mileage may vary, but for some people it’s pretty simple - at least if they have three big dogs that drive them crazy without their exercise!  ;D

My OS still predicts a TKR as without lateral cartilage and the irregularities scraping away at what is there, it’s just too likely to cause me problems. But for now, I often don’t think too much about it!

Title: Re: tibial plateau metal removal surgery recovery
Post by: Bella Gamba on August 07, 2019, 06:23:42 AM
Hi HubbledGirl,

Looks like your initial injury was around the same time as mine.  It is amazing that you are able to do all these activities.   My injury shattered my bone to the extent that my OS said this was the worst he has seen (Type V). I have to say that I still do my PT activities and hope that one day I will be able to squat and do stairs the “normal” way but think I have a long way to go.

Wow, walking big dogs!  Since my injury, I have been afraid of walking my dog alone in fears that she will get tangled with other dogs and cause me to fall…

Take care,

Title: Re: tibial plateau metal removal surgery recovery
Post by: HobbledGirl on August 08, 2019, 01:59:15 PM
Everyone is so different in how they break and heal. I could well imagine just a little change in some angle of anatomy or injury creating a vastly different experience in healing.

I’ll tell you how I got my extension-flexion: I used to do Bikram yoga, and the heated stretching allowed me to get past some scar tissue that had been in my hips bothering me for years. So when I was allowed to go for my flexion and extension, I wrapped a heating pad around my knee, set it to high, and let the area get nice and toasty. I then used a strap to pull at my ankle and push my knee to maximum flexion. I would take “knee selfy,” and push until my knee flexed at least as far as the day before. Similarly with extension. Heated knee, foot up on cushioned bed tray, weights on knee pushing into extension. I would distract myself and stay there for 10 minutes. It hurt like the dickens, especially coming out of it. At times I worried I was doing permanent damage (the knee could really swell up), but luckily my gamble worked for me.

I’m not sure I should be recommending this method, as I could well-imagine it creating problems. But I really didn’t want to be limited in my ROM and decided the risk was worth it for me.

I fell over one of me dogs a couple of weeks ago and bruised my ribs which still really hurt when I breathe deeply, bend down, or cough. They’re a menace, but I wouldn’t trade them for the world!

Best of luck, Bella!