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Author Topic: Patella Screw Removal, LR, VMO Advancement  (Read 8879 times)

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Offline kimmyxs

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Patella Screw Removal, LR, VMO Advancement
« on: January 19, 2007, 05:05:03 AM »
I thought that I might as well keep a diary on this lovely surgery.  On January 15, I had the 2 screws that were put in place for a vertical patella break removed.  This was because at least one of them was catching in the muscle causing quite a bit of pain.  In addition, my OS removed bits of patella that he didn't get to last time, and did a lateral release for patellar tilt.  I admit that once I realized that the hardware removal meant going back in through the original ORIF incision site, I was creeped out and a bit panicked.  I got over it though.  I figured, corrrectly, that at least this surgery I could prepare for.  I had my coffee maker moved upstairs, my crutches ready, my room with my laptop handy, plenty of reading material and cross stitching. 

On the day of the surgery we had a bit of a panic because the roads were really icy and we had to be at the hospital at 6:30 am.  Oddly enough we arrived right on time.  As we waited, my two children 18 and 20, another woman was sent home because her surgeon couldn't get out of his driveway.  Lovely Kansas City!  At 6:45 I went in and got my gown on and met with the anesthologist.  I did a general again this time.  The IV got running and they let my kdis come in.  I met with my OS.  At just before 8 am I was wheeled down the hallway.  I remember entering the OR and that was it until 10:15 when I woke up in recovery.  They allowed the kids to come back again.  I was surprised to find myself again in a darned brace at only 20 degrees ROM.  I wasn't really prepared for that.  I was a bit ticked, but heck, my OS did a great job with the original break, so he must know best.  I changed clothes about an hour later.  At almost one they let me go home. 

My first night was okay.  The next day however was rather painful.  At one point on the top of the knee cap, I must have a bit of the incision that was rubbing the wrapping or where the wrapping is for the polar care.  Did I say I love my polar care!  I had one before so now I have one for upstairs, and one for downstairs.  I had my old one ready and ice already in the fridge.  Little did I realize I would get another.  One will eventually end up at work.  That much is for sure. 

Wednesday, the 17th, my son had gall bladder surgery done.  Again, my son ended up at the same hospital at almost the same time.  My ex and I decided I would stay at home because of the pain I had on Tuesday.  A good decision.  The doctor released him at 7 pm and he is home and doing well also.  I found that I was able to sleep on my stomach and side so I slept a total of 10 hours.  Wow.  Even though I am taking at least 2 weeks off of work, I am thinking that so far this is going well.  Because of the brace, I am able to hobble around.  I have been downstairs several times, I can hobble to the bathroom and I am doing my ankle pumps and quad sets.  Today, day 4 they aren't painful. That must mean that the incision is healing enough not to rub the wrapping.  I am not noticing much swelling, but again it is hard to tell.

I have a follow up on Monday.  Hopefully he will open the brace.  I just hope that the incision site heals cleanly and that the LR works for the tilt.  Come to find out, my son has the same tilt that I do.  Humm... also the doctor cleaned up the back of the knee cap.  I am not sure what grade of damage, but apparnetly it was quite a bit.   My son recieved the screws.  Those babies are quite long and really sharp!  I was a bit surprised by that.

« Last Edit: February 04, 2007, 02:07:51 AM by kimmyxs »
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline kimmyxs

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Re: Patella Hardware Removal and LR
« Reply #1 on: January 24, 2007, 04:15:42 AM »
I had my stitches removed from the scope holes. Not bad at all.  I was a bit surprised to find out the incision across the top of the knee cap was put back together with what appears to be just seri strips.  It looks yellow, but the swelling isn't bad.  I supposed that is because of my polar care ice.  I love that thing.  I am supposed to do quad sets of 50.  Wow to keep the muscle toned and working.  Not a problem.  The SLR are a bit more difficult.  I am still in the brace - still set at 20 degrees.  Darn it all.  I also need to take another week off of work. 

At least tomorrow I can get the knee wet - a shower - oh heaven!  Hopefully next week I can start PT again.  I am pretty good at working on my own and my quads didn't atrophy much at all last time - mostly because I diligently did my quad sets even when it hurt to do so. My problem has always been a ROM issue.  3 weeks fully extended really kills the ROM. 

I suppose that with another week off I will get several books read and much cross stitch done!  Maybe even all of my cross stitch supplies inventoried.  We shall see.

I admit that I was on my feet about 2 hours last night.  I had a presentation for Toastmasters (a training session that lasted 1 hour and 15 minutes).  It was not bad at all.  I didn't have much more pain than usual when I got home.  Love that ice!
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline kimmyxs

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Re: Patella Hardware Removal and LR
« Reply #2 on: January 26, 2007, 06:50:28 PM »
Wow, all LR are all so different. I I am still in the brace set at 20 degree ROM.  I am assuming that this is to protect the patella right now.  The seri strips all came off last night.  I still have one stitch in that the nurse apparently didn't know was there.  It looks like it was the 3rd hole for the scope.  The odd thing is that is next to the original incision site.  The odd thing is that the incision (right over the original one used to put the kneecap back together) wasn't stitched or stapled - it was just glued and seri stripped.  It looks great.  I am finally using my scar cream and doing some massage to keep scar tissue down.

I cannot wait to get the ROM back - my quad already seems to be strinking - unlike last time.  The knee is swollen but isn't oddly colored yet.  We shall see!  All and all I feel great.  I will be on my feet most of the day tomorrow so I am assuming that I may have some swelling.  This time I will bring my lovely Ice machine and an extension cord.  I am not sure that I can handle all day otherwise!
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline peggy1

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Re: Patella Hardware Removal and LR
« Reply #3 on: January 26, 2007, 06:56:22 PM »
Hello,

Glad to see that you are doing well after the surgery. Hoping your son feels better too. I have a question. What is a polar care? I don't recall reading about this anywhere on these posts.

Thanks,

Peggy


Offline kimmyxs

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Re: Patella Hardware Removal and LR
« Reply #4 on: January 28, 2007, 05:11:22 PM »
Hi Peggy,  Polar Care is made by Breg.  It is essentially a small ice chest - almost the size of one that holds 12 cans or bottles, it has a motor that fits into the specially made lid and a long cord that attaches to a wrap around your knee.  It causes ice water to flow through continually.  I love it - I have two - one from each surgery.  I am glad I got another because a nurse at the hospital the first time around lowered my bed on the handle and broke it!  I trully think it helps with swelling and pain. 

Yesterday I spent too much time on my feet.  I had an hour and 15 presentation to give.  I actually was glad for the brace because at one point, the knee got weak.  I refused to sit because I do like to move and with 30 or so people and being video taped,  I felt it best to stand.  The presentation went great.  I think because I had been working registration for the leadership training and was on my feet for two hours before that my knee was screaming in pain by 2 pm.  I came home, took a hot bath and went to bed.  The knee was more swollen than usual, but this morning the pain is essentially gone and the swelling is down.

I am really not sure why I have a brace!  I did have a good deal of work done, but no one else who has had an LR and/or hardware removal seems to have one.  I am pretty sure it is because of the patella debridment (apparently the cartilige on the back was a mess) and the screw removal the doctor felt that I needed extra time to heal the patella.  I will be certain to ask at my next post-op visit. To be honest, I am chaffing at not being able to work out.  I am doing my quad sets, SLR, etc along with my ab and upper body workouts, but ...  I also cannot wait to get back into a pool! 

I know that a TKR is down the road.  Hopefully this will hold it off for another 7 or so years.  I really would like to make it to the mid 50s, but... The other thing is not being able to drive.  My mom who is a nursing home driector told me that for elderly Americans, losing the ability to drive it the hardest thing to get past because of the loss of freedom.  I can totally understand!
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline kimmyxs

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Re: Patella Hardware Removal and LR
« Reply #5 on: February 01, 2007, 12:23:43 AM »
Well,  I now understand the need for the brace.  My kids just don't get what the doctor says after surgery to help me out.  I had a medial reefing done at the same time.  Apparently the patella was all over the place.  While he already had me open, he tightened the VMO advancement. with strong stitches, hence the no movement.  He said the backside of the kneecap was a mess, but the mensicus didn't need repair at all and in fact look quite good. He is also amazed at how well I heal which is why he chose not to use staples this time.   The kids just told me he cut the muscle and restitched it!

I willl be starting PT next week and am finally allowed to go back to work.  Yeah!  Who knew I would say that.  I am so stir crazy!  All in all he opened the brace to 60 degrees even though I can only get to 30, but!
« Last Edit: February 04, 2007, 02:09:10 AM by kimmyxs »
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline OSuzanne

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Re: Patella Hardware Removal and LR
« Reply #6 on: February 01, 2007, 03:51:25 AM »
Hi Kimmy!

I too have never hear of polar care.  Did you buy it yourself?  How much do they cost?  I wished I would have had one after my LR.  Good luck working on your ROM.  I'm sure once you get back to PT next week and working out again that you will do well.  You sound very motivated.  Do you mind me asking how you fractured your patella?

Suzanne
Left knee: Lateral release, Medial meniscus repair & cyst removal - 03/05
Left knee: Medial meniscectomy - 12/06
Right knee: Lateral release, lateral meniscectomy, chondroplasty - 01/07
Right knee: ITBS - 07/07

Offline lilrosie06

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Re: Patella Hardware Removal and LR
« Reply #7 on: February 01, 2007, 05:10:25 AM »
Kimmy....I had LR/Debridement on 1-23, and no brace. In fact, they had an ace bandage on it, but told me to take it off the next day. But, I do have the polar care that you have. I LOVE IT!!!!!!!!! Its so convenient, and works so well.

Kids are kids. Lol. They mean well, but, if like mine, tend to fight over who is doing more, etc. But, overall, I cant complain. Everything is getting done one way or another.

Do you have any bruising? I didnt have any at all, now, a week later, I do have some. But not alot. I know some people get bad bruising with a LR. I, too, will need a TKR down the road. AM 42 now, so trying to postpone it. Has your OS mentioned a TTT, if the LR doesnt work well enough? I started PT today. Just very minimal stuff, and hurt alot. But thats to be expected, I guess.

Hang in there. Best of luck in your recovery.

DONNA

LEFT KNEE INJURY-1-05
SCOPE 4-05, LR 1-07, TKR 6-07, MUA 7-07, REVISION 10-07, INFECTION CLEANOUT 11-07, REVISION 4-08, EXPLANT 2-09 ANTIBIOTIC SPACER PUT IN, AND PICC LINE FOR 6 WEEKS
REPLACEMENT 5-09

BACK IN PT NOW....HIP AND FOOT PAIN, POSSIBLY SCIATIC

Offline kimmyxs

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Re: Patella Hardware Removal and LR
« Reply #8 on: February 02, 2007, 09:30:08 PM »
Hi everyone,  I actually have no clue how much the Polar Care cost, but I am sure you can find it on the Breg website.  Both of mine came home with me from surgery.  Monday one is going directly to work (the one with the handle that works).  My kids have been great, they are 20 (almost 21 - only 9 days away), 18, and I have an additional 20 year old living with us.  She is basically a member of the family and has been since she was about 12 - it just took until September before she finally moved in with us.  They have handled far more than they should, but all they could tell me was that the doctor cut a muscle - hence the brace.  I think I chose to ignore that.

If this surgery doesn't keep the knee cap in place, then off to have a TTT done.  He did the medial reef because they patella just wasn't stable or staying anywhere close to being in place.   I am  almost 4 weeks post surgery and I have had no brusing except on the lateral backside of my knee.  I thought that was weird.  I have little ROM so I am anxious to get started!  I am not feeling the VMO firing like I did last time even though I am doing SLR in all directions.  That is a bit frustrating.  Sadly, I was going down the stairs yesterday and  I guess my brain took over and thought I was fine.  I attempted to go down the stairs like a normal person and thank goodness for the brace.  I hit the stops at 60 degrees and landed on my behind.  I was shocked.  My son got me back to my room.  Other than some swelling I feel fine!

Suzanne, I broke my patella vertically (an unusal break) when my patella dislocated last June.  The shock caused my quad to contract and break it!  I had been working out with a trainer for the previous 10 months.  The strength of my quads was the ultimate cause of the break.  Hum, I lost weight - built muscle tone and now I am back where I started (although I haven't gained the weight back yet).  To be honest,  I have been motivated just to get back to my previous level of activtiy.  Prior to all of this I was an avid bowler (I haven't seen the lanes since the accident). 

I hope everyone is doing well!
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline kimmyxs

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Re: Patella Screw Removal, LR, VMO Advancement
« Reply #9 on: February 04, 2007, 02:12:41 AM »
I am at almost 3 weeks post surgery. I am actually finding that the brace gives me a level of comfort now - especially after almost falling down the stairs.  The VMO just doesn't seem to be firing at all these days.  Maybe because of the advancement of the muscle.  I will be sure to ask the PT guy next week.  I am ready to get back to work.  I forgot that the day I go back that I am a contest master for a club Toastmasters contest in the evening.  It will prove to be a really, really long day! 

I am trying to get back to a working sleep cycle.  I wanted a nap so badly this afternoon, but I read and played on the internet instead.  It kept me awake at least!  Getting up at 5:30 am will be problematic - especially since I have to catch the bus! 
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline kimmyxs

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Re: Patella Screw Removal, LR, VMO Advancement
« Reply #10 on: February 08, 2007, 12:00:35 AM »
I had my first PT appointment.  I am at 43 degrees ROM without pain and at 51 with pain.  The brace is set to 60 so we are trying to get there by my next OS appointment on the 14th.  He said not to worry about the VMO not firing yet.  As soon as the brace is opened up more we can work specifially on it.  In the meantime it will be quad sets and various SLR with various changes.  If we don't get firing by the 14th he will try the stimulation but would prefer not to if we can get there without it. 

Work is going better today.  I feel more awake all day and my group is being great at moving meetings so that most of my meetings are on the same floor.  Less walking!  Yeah! 

6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline peggy1

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Re: Patella Screw Removal, LR, VMO Advancement
« Reply #11 on: February 08, 2007, 02:56:36 PM »
Kimmy,

Nice to see that your group is working with you and you don't have to do all the running around. Rom will come, just have patience. Keep pushing!!

Peggy


Offline kimmyxs

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Re: Patella Screw Removal, LR, VMO Advancement
« Reply #12 on: February 10, 2007, 04:56:38 AM »
Hi Peggy, today at PT I was actually at 71 degrees without pain - actually farther than either of us expected, but past what the doctor wanted (he said not past 60 degrees.  Oh well, it was a miracle.  The VMO appears to be firing now with eSTIM which is great.  My PT says that I have great muscle tone.  He noted that my ROM is coming back pretty quickly - quicker than most.  Right now the lateral side is more painful than the VMO - interesting to me!

I admit that I cannot wait to begin driving again.  Getting anywhere means that one of the kids has to drive me.  I have a car less than a year old.  I believe I have put maybe 1000 miles on it!  That is scary to me given that it has 10,000 on it now. 

I am glad the first week of work is over.  Now I am hoping that the OS lets me out of the brace on Wednesday.
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline peggy1

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Re: Patella Screw Removal, LR, VMO Advancement
« Reply #13 on: February 10, 2007, 01:42:38 PM »
Kimmy,

Good for you getting that rom over 60. I know all about those wonderful braces that stop you from going further, Not only did that drive me nuts but just the funny feeling when my leg was in it, the leg wanted to move and the brace stopped it. My os finally just opened it up all the way, then told me to stop wearing it. I was glad to get rid of it, don't you find that brace a little heavy to manuever around in? I also know that the desire to drive, I haven't driven since the end of June and I miss the freedom. So who put all of the miles on your new car?

Glad to hear that your 1st week back to work went well. As far as the lateral side hurting, could it just be from the exercises at pt? My rom is 100 and that's where it will stay until I get the hardware out in April, I can't wait.

Well, enjoy your week-end and keep pushing at pt!!

Peggy


Offline kimmyxs

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Re: Patella Screw Removal, LR, VMO Advancement
« Reply #14 on: February 11, 2007, 09:27:15 PM »
Hi Peggy, yes, I hate the brace.  I hated the 12 weeks after the patella break and am hoping that he lets me out on Wednesday.  Or at least opens it up all the way.  Knowing my OS though, that is doubtful. 

My daughter and son have put most of the miles on the car.  My daughter's car died and she needed to get around to school and to take me to and from work.  I actually drove yesterday for the first time.  It was bliss!  Getting in and out is a pain, but...

I am going to ask about the lateral pain on Tuesday at PT and again at the OS on Wednesday.  To be honest, last night I slept so well.  Probalby the best night of sleep since  I was in the drug supor right after surgery!  All in all, things are looking up!
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl