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Author Topic: Arthroscope on Tuesday now Synovectomy!!  (Read 18295 times)

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Offline Kite_Buggy

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Arthroscope on Tuesday now Synovectomy!!
« on: February 06, 2004, 11:28:28 PM »
Hi All,

I was diagnosed with Ankylosing Spondylitis @ the tender age of 18 and suffer with a bad back, hips, shoulders and neck but my biggest nightmare over the last 8 years has been my left knee.
I have had sever swelling in the knee for at least 5 days out of every 10 for all this time. I have had x-rays and MRI scans over the years but no damage could be seen on these. I have also had 6 cortisone (sp?) injections I the joint which have offered good relief but I知 not allowed any more as I知 told in the long term they will damage the joint!!
Anyway earlier this year I saw an OS who had a look at my knee and told me that he would be happy to go in and take some nice pictures if that was what I wanted!! As a result I had an Arthroscope earlier this week (in fact I知 slightly worried @ the moment because the joint is quite hot! Is this normal or could it be infected??) Anyway the results were exactly what I was expecting..
According to the surgeons notes I have hypertrophied synovium +++ which I知 told means that 的 have yards of seaweed like tissue in the joint that is causing the swelling and it痴 to much to be got out through the Arthroscope so we will have to open it up
So my surgeon tells me that my next step is an open synovectomy in 6 weeks time and that it痴 a major operation HELP

Has anyone here been through anything similar?? If so what can I expect i.e. pain, recovery time, other options etc etc

Thanks in advance
Steve..

Offline LucyC

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #1 on: February 09, 2004, 04:56:00 PM »
Hi Steve,
I can't believe it, your symptoms are almost identical to mine! I thought I was the only one out there with strange knee swellings. For the past two years mine has been swelling for 6 days out of twelve and was so precise i could work out exactly when I'd have a "big knee day"!

I got diagnosed in 2001 with seronegative monoarthropathy of my left knee (basically inflammatory arthritis) however in addition to this I had two car accidents in 1998 and 2000 which caused severe whiplash injuries to my neck, back and right shoulder. these have never cleared up despite weekly osteopath treatment.I have since been examined by a leading surgeon who suggests this is because I have ankylosing spondylitis, but this is yet to be investigated since my knee has been so bad and they wanted to treat this first.

My synovium has been growing out of control and causing severe painful swelling, just like yours.
Last March I had a partial synovectomy carried out arthroscopically to try and trim back the inflamed synovium. But two months later it was back doing its swelling cycle.

So on 9th Jan I had an open knee synovectomy - I made the decision to go private as the NHS were taking too long despite saying I was a critical case. I have to say it didn't go exactly to plan.
Because the synovium had been left so long growing manically, instead of being in theatre 1 hour i was in there 4 hours. And as a result I didn't get the required pain medication before hand ( I should have had an epidural as well as the general anaesthetic and morphine)so I did wake up screaming, so they gave me a morphine pump but still it didn't make much difference.
Since they've already investigated your knee arthroscopically hopefully they'll know for you just how much they need to do so you won't be in the same situation as i was.

It took two days before I could straighten my leg onto the bed and only then was I allowed to try and walk but only with a straight leg splint on and crutches.
Now I'm learning to walk again and bend my leg ( I can get it to 65 degrees at a push). But i still can't walk without the splint as my leg isn't strong enough.
I was warned beforehand it would take a lot of effort to get the thigh muscles to work again and they meant it. When I tense my quad muscle you cannot see any sign of muscle movement despite me straining.and this was hard to take in it at first, i have literally had to teach my leg to work again. It was such a strange sensation at first but through time its coming back and now I have to concentrate on getting it to at least 90 degrees again.

I have physio every other day and they are confident i will get there it will just take time. I've been told it will be hard for me as i didn't have much thigh muscle to begin with (due to the constant swellings and the fact that I'm very skinny..so there's not a lot of fat there!)and also because of the immunosuppressive drugs I'm on to combat the arthritis: methotrexate (only started recently) and sulphasalozine. So the healing process in my knee will take a bit longer.

Are you on any medication?

I'm sorry if I've waffled on or worried you but I have to say this:my knee feels so so much better than it ever did when it was swollen. Even though I can't bend it as much yet and its taking its time I can instantly feel the benefits of removing all that bad synovium. It was worth all the pain and tears just after the op. I've finally got my old size knee back, and even though it has a long scar down it i don't care as long as its not swollen!

My advice to you is have the op, and in the meantime try to build up your quad muscles so they can cope after the op. (the easiest exercise is to sit with your leg straight on the bed and push your kneecap down into the bed while making sure the sole of your foot is at 90 degrees to the bed). If you had your arthoscope only a few days ago its bound to be hot as the synovium will have been agrrevated. If you can bear it try and cold pack it but I myself can't do that (think its because its an arthritis) so I try putting some heat on it to soothe it or have a warm bath.this may work for you. Sounds silly adding heat to to hot joint but it does work for me!

I have another month before i see my surgeon again for an update and he's hoping by then I'll be walking without the splint. In the meantime I'm having intensive physio. So hopefully my total recovery will be 2-3months.

I hope I've made sense and I hope I've answered some of your questions/worries. If you need to ask anything else contact me anytime I'll be glad to help.

good luck and take care

Lucy
Jan 01:swelling LK: arthoscopy,diagnosed - seronegative monoarthopathy. Symptom free 1yr. June 02 constant, painful, swellings.March 03 - partial synovectomy. Worse swelling. Jan 04 open synovectomy

Offline Kite_Buggy

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #2 on: February 10, 2004, 11:54:05 AM »
Hi Lucy,

So I知 not the only one after all!!

I have searched all of the Ankylosing Spondylitis forums for someone with similar knee problems but drew a blank every time. I must admit our symptoms do sound very similar to say the least.

When you say you knew when you knew when you were going to have a big knee day. I know exactly what you mean. It might sound strange but I have been keeping a diary of my knee swelling over the past 6 months and I can now accurately predict when my knee will be swollen upto a month in advance! I actually plan my life around this now.

Sorry to hear about the possibly that you have Ankylosing Spondylitis (AS) bought on by the car accidents :( . Although it痴 a painful and nasty disease I feel that it痴 a walk in the park at the moment in comparison to our knee problems.

I have been taking an NSAD called Mobic 15mg for 10 years to keep the pain down from the AS and it really does offer great relief and allows me an almost normal life (without it I cant even get out of bed in the mornings) . I hate to think what it痴 doing to my insides though!!

I have recently found another forum called Kick As (www.kickas.org/) where a lot of people claim to be controlling their AS with diet (The London AS Diet) and coming off the pills all together. I might try this after I get my knee sorted.

Your open synovectomy sound痴 very painful (they did warn me) and I didn稚 ever think that it could take as long as four hours in theatre or that we would be in a splint for so long!! But it sounds like you definitely have a big light at the end of the long tunnel now :)

I am also in a similar boat with the leg strength thing in that my knee has been swollen for so long that my left leg is now visibly thinner than my right and it looks like the muscles have all but wasted away due to lack of use. I will take your advice and try to get some strength back in the leg before the op as and when I can in between swellings. As for straightening it I haven稚 been able to do that for years so I think that will be very tough!!

Has you surgeon told you how long he expects the operation to last? My guy mentioned upto 14 years until the knee gets back to the state that its in now. I wonder if they can do the same procedure again in 14 years?

Oh well I think I am now even more determined to get this sorted and although what you have been through sounds pretty horrendous it will as you say all be worth it to have a normal knee (and life) again.

Thanks so much for your help and advice and good luck in the future.

Keep in touch :)

Steve..


Offline LucyC

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #3 on: February 10, 2004, 06:44:25 PM »
Hi Steve,

I too kept a diary of my knee swellings and planned my life around my predicted swellings! my family found it hilarious! I thought I was the only one who did that!

They're hoping for me that now all the synovium has gone, all the nasty drugs I'm taking can now get into the knee and build up a defence for future growths. So I don't think they're going to put a time scale on how long the synovectomy will last. I was told at least a year but they're hoping the drugs will keep things under control for a long time after and maybe even kill this disease. Now all the inflammation will hopefully be under control hopefully the drugs can take effect on the rest of my body too and allow my osteopath to get a bit more movement out of me. I'm only 24 and some days I used to feel so stiff I felt 94. I think though the methotrexate I'm taking is working well as its a disease-modifying anti-rheumatic drug and is working alongside the sulphasalozine to reduce the white cell count and beat the arthritis. So at the moment I'm not so stiff, I'm still restricted in some movements ( like turning my head) but its so much better and I think thats due to the synovectomy.

I too am worried about what the drugs are doing to my insides. I had to stop taking NSAIDS about a year ago as it was making me so ill and wasn't acting on the inflammation at all. Now the drugs I'm taking are a lot stronger on my stomach and liver, and I definitely notice it if i have a bit too much to drink. But if it works then I'll keep going til there's an alternative, so I'll check out that website, the diet sounds worth a try.

I have to say, although the op was extremely painful, it only lasted a few days ( the pain) and I've had to take hardly any painkillers recently despite pushing my knee a lot to get it bending. I don't know if the same is for you but when it was swollen it was horrificly painful as its more a pressure based pain thats not relieved until it goes down. In the early days my doc was able to drain the fluid out and give me instant relief and instant small knee but as the arthritis progressed they stopped being able to draw even 1ml out. So i hope that gives you some hope for less pain after the op. I used to take co-codamol 30/500 for the pain and if necessary pethidine, now I can get by on just paracetamol and sometimes co-codamol to help me sleep!

Another thing, if they offer a cpm machine to help get the movement back in your knee after the op:take it! I was on one for two hourly periods the day after my op and though it wsa painful, it helped get the movement back a lot quicker. I wish I could have taken it home! i now just get on the exercise bike to do some resistance work. Although I can't yet do a full rotation, two weeks ago I couldn't even support my leg long enough without the splint to get on it. So I'm getting there slowly!

Anyway, I hope this helps again, I've been a bit naughty today and walked downstairs without the splint as I was fed up with having to put it on all the time.I was a bit unsteady but I survived so I think I'll keep trying little walks!

Anyway good luck, keep me updated with your progress and I'll let you know how I'm getting on soon.

take care

Lucy
Jan 01:swelling LK: arthoscopy,diagnosed - seronegative monoarthopathy. Symptom free 1yr. June 02 constant, painful, swellings.March 03 - partial synovectomy. Worse swelling. Jan 04 open synovectomy

Offline Kite_Buggy

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #4 on: March 02, 2004, 10:16:56 PM »
Hi Lucy,

How are you getting on??

It's been a fair few weeks since we last spoke so I hope that you have come on in leaps and bounds (or at least small steps ;-)) hopefully you will be pain free for a good few years to come now.

How's the ROM??

Thanks for that advice about the cpm machine trust me I will grab it if I get a chance! The exercise bike sounds good as well as I was a very keen mountain biker until the swellings got to bad about a year ago and I gave it all up and got fat.. lol..

I have got my date for the open synovectomy..........14th March...........And..........Guess what...........My knee is the best it's been for years!! Don't get me wrong the swelling is still stuck in the same cycle but it hasn't been to painful since my arthroscopy.. TYPICAL..

I keep asking myself if im doing the right thing but im sure it will all be worth it in the end..

So whats it to be next year?? The London Marathon or London to Brighton Bike Ride??

Keep in touch.....
Steve.......... :D
« Last Edit: March 02, 2004, 10:19:29 PM by Kite_Buggy »

Offline LucyC

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #5 on: March 05, 2004, 08:11:43 PM »
Hi Steve,
Well I've come on so much since I last posted. I finally reached the magic 90 degrees that the physio's kept going on about and its made a huge difference as to what i can comfortably do now. I can sit in a chair go upstairs normally (just about) and almost get one rotation on the exercise bike if i pedal backwards! i still can't go downstairs or cycle forwards but I can feel it'll be any day now. In fact I'm between 90 and 95 and they said the next 10 degrees will be the hardest but once i get that it'll go all the way.

Its largely thanks to the fact that I've had hydrotherapy pool physio sessions instead of normal physio. i seemed to have come to a full stop and the ROM wasn't improving but after just two pool sessions i'd improved by 30degrees! The warm water really helped my arthritis and I found I could push it just that bit more without it hurting. I did put my hip out after the first session but that was only due to it not being used for so long! I also got to massage my knee under the pressure jet in the pool which has helped to shift some of the scar tissue.

I have to massage it alot to break down the scar tissue beneath and use a lot of aqueous cream to help the scar itself heal and this has decreased the sensitivity alot. one side is still numb but its better than before. Its so good i could finally wear my jeans again today, and the denim hasn't even been irritating it as much as i thought it would.

i also got the all clear to walk without the splint and only one crutch if i'm outside (just as a warning to others really) and thats strange to do, I'm a bit "careful" about that leg, but being able to walk without the splint has increased the muscle strength without me realising.

My surgeon is very pleased with my progress and I've still got to work hard and have more physio and hydro sessions but the end is in sight. He's signed me off for another month so i can conentrate on getting better.

So its all good thanks! am feeling so good about it, i feel like I've struggled up the hill but i'm at the top now (if that makes any sense at all) and i never thought i'd get here!its going to get easier from now on as long as i keep exercising!!

I know how you're feeling at the moment..just before my op I thought could i really go through with this, wouldn't it be easier just to put up with the swellings, i can deal with it. But thankfully i had a horrendous swelling episode two swellings before the op ( you'll understand that!) and i'd booked tickets for a big event in london i was desperate to go to and i was in so much pain at the event and could hardly walk that my poor boyfriend had to practically carry me that i became more determined than ever to beat this horrid knee whatever it took!It had ruined my night and i vowed it wouldn't ruin my life! so keep the date, if your swellings are anything as bad as mine were and as frustrating...it'll be worth it..trust me!

so good luck, and keep in touch, let me know how you're doing!

bye for now
Lucy
Jan 01:swelling LK: arthoscopy,diagnosed - seronegative monoarthopathy. Symptom free 1yr. June 02 constant, painful, swellings.March 03 - partial synovectomy. Worse swelling. Jan 04 open synovectomy

Offline Kite_Buggy

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #6 on: March 22, 2004, 04:43:32 PM »
Hi Lucy

I had my surgery last Monday .

I was in the theatre for two hours in total and woke up from the anaesthetic in very little pain. During the operation I was given a number of injections around the top of my leg which apparently suppressed the major nerves in the knee for when I woke up??. The pain came on a few hours post opp but the morphine seemed to help take the edge off  it. I stayed on the morphine until Wednesday morning and could straighten my leg to 0 degrees by this time.
I was then handed the cpm machine on Wednesday morning which I did 6 hours on straight away and got the knee form 0 - 45 degrees. Thursday then saw another 5 hours with 0 - 70 degrees on the machine and 90 degrees manually with a lot of pain and persuasion. Friday saw 92 degrees on the machine which I was told was very good so soon post opp :D I was then discharged from hospital on the crutches.
The thing that I cant get over  is that my quad muscle wont work at all and I cant lift my foot up from the floor without the assistance of others!! I have been told that I need to lay face down on the bed and bend my knee whilst trying to stop it with the other leg to build the muscle back up but this hurts like hell!! I am hoping that this will be easer when the 32!! Staples are removed this Wednesday.
My Rom seems to be stuck @ 90 degrees for now (at a push and with teeth well and truly gritted!!) but I suppose this might improve when the staples are removed ?? I too tried to peddle my bike backwards but that just caused way to much pain at the moment :o
I must admit I am getting fed up of the constant pain from keeping the joint moving but I have been threatened with manipulation followed by a 120 degree session on the cpm machine and a 2 day stay in hospital again if I don&#8217;t :o This I definitely keeping me motivated :o

So how are you getting on??

Steve :D

Offline LucyC

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #7 on: March 25, 2004, 11:44:44 PM »
Hi Steve
Firstly, I have to say i am well and truely impressed..90 degrees within a week of surgery! I wish I'd been that lucky! But I'm pleased for you.
secondly 32 staples!!! ouch! My surgeon was very lovely to me, he did one long "oversew" stich to minimise my scarring and keep everything very neat..it was only a pain for the nurse to remove it as she had to snip each individual overthread.
i too have to do that exercise lying face down, though i never had to do it with stiches in so am sure it will come a lot easier once your staples are out. Another similar one I do is if i sit on a table so my feet can't touch the ground, bend my bad leg under the table as far as it will go and use my good leg crossed over in front of it to resist against it as i try to straighten my bad leg.
Your quad muscle will come back to you, but it will take time and alot of "mind over matter" as my surgeon kept telling me, that was the one thing i couldn't get used to. One thing that helped was if i did the exercises that i did sitting on my bed with my good leg first and then transferred over to my bad leg my brain didn't have time to think..ooo watch out this is the bad one.
keep on with the exercises, even though it hurts ( can you get some stronger pain meds?) as otherwise scar tissue builds up and you're faced with having to break it down again..which hurts a bit more - its happened to me a few times.
Sounds like you're getting on really well though, when are your staples coming out? have you got physio lined up or do you have to do it yourself? I got told after a month I may need more surgery to manually bend it more but my physio worked me on a softly softly approach due to the arthritis and even though 3 months later i'm still only at 95 degrees, they won't manipulate it, they're just waiting for me to get though it to full ROM again.
I've had a few set backs recently, so I haven't been to physio for a couple of weeks - i've been on my exercise bike though and can finally cycle forwards and backwards no problems! I'm able to  now put some resistance into the cycling so I hurt quite a bit once I'm done but its a good thing!
I'm having problems with my arthritis drugs, because i'm recovering still from the op my blood counts are low and the day after i take my methotrexate i get a horrendous fever, cold, sore throat, high temp etc as my immune systme just shuts down. This week its been the worse and when I'm feeling this ill, i can't get on with my exercises as its just too much stress for my body, it can't cope..its horrid!
On the plus side though, my surgeon said the bones in my knee were spotless, no damage at all so once i can get over the op, my knee should be trouble free! (fingers crossed)
I find night times are the worse for pain as I always wake up when my knee's been bent for so long, so We're experimeting with longer term painkillers to help me sleep..not found a good one yet but will keep going!
Anyway, glad to hear your op was good and that you're practically beating me recovery wise!keep me updated as to how you get on.

take care
Lucy
Jan 01:swelling LK: arthoscopy,diagnosed - seronegative monoarthopathy. Symptom free 1yr. June 02 constant, painful, swellings.March 03 - partial synovectomy. Worse swelling. Jan 04 open synovectomy

Offline Jaci

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Re: Arthroscope on Tuesday now Synovectomy!!
« Reply #8 on: June 08, 2004, 06:33:21 AM »
Steve,

How interesting to come across this thread. I've been posting over on the soft tissue healing problems section since about the same time you started posting here.

I also have ankylosing spondilitis and developed arthrofibrosis (abnormal scar tissue growth) after an arthroscopic menisectomy in Dec 2003. I was originally diagnosed with AS when I was in my early 20's, although I had many unexplained back and neck problems in my late teens. I had severe AS and related inflammatory conditions through my mid 30's, but have been relatively symptom free for several years.

I had an arthroscopic lysis of adhesions and manipulation under anesthesia on march 1.  Started doing research on an AS and scar tissue connection, but never could find any info nor any other person who had the same problem. (Note: Some dr's use the terms synovectomy and lysis of adhesions interchangeably.) I'm 3 months post op and it appears that scar tissue has grown back again so I'm facing another surgery.

I hope you're rehab is going well.

Regards,

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS















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