Advertisement - Hide this advert





Author Topic: ACI/HTO follow up Questions for OS 4 week Post Op Visit?  (Read 5874 times)

0 Members and 1 Guest are viewing this topic.

Offline zoeygrl

  • Regular Poster
  • ***
  • Posts: 53
  • Liked: 0
ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« on: April 25, 2008, 01:44:53 PM »
Hello everyone! I am so happy to have found this bb and really enjoy reading everyone's experiences.  I have an appointment on Monday April 28th for my 4 week post op visit.  I believe the OS is going to take xrays to see how the bone is healing.   I have been trying to think of a list of questions to ask him and I don't want to miss anything so I thought I'd ask you all for some help.  Here's what I have so far:

1.   How many more weeks of NWB?
2.   When can I drive? If so, can I get a disabled parking permit?
3.   Will I need to have the screws and plate removed from my leg?
4.   Do I need something to get through airport security when I fly in the future due to the metal in my leg?
5.   I'm up to 100 degrees in flexion, where do I need to be before I can walk?
6.   How much physical therapy will I need once I begin to walk?
7.   How will I know if I have overgrowth of the cartilage?
8.   Should I continue on the cpm?

Anything else you think I should ask? I feel like I'm missing a ton of stuff.  The OS I see is a great doctor but I do have to pull it out of him sometimes, he's very quiet and softspoken and I seem to find myself finishing his sentenaces.   

Any and all advice is greatly appreciated!   :-*

zoeygrl
1989 first arthroscopic surgery to clean up knee
1992 2nd arthroscopic surgery for clean up of cartlidge flakes
1/24/08 harvesting of cells for carticel transplant
3/27/08 HTO and Carticel transplant

Offline casey2291

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #1 on: April 25, 2008, 06:03:52 PM »
Zoey,

You might want to ask your OS how long you have to wear your brace for, when you get a new brace, if you get to unlock it or when you get to go to a smaller brace.  Also, once you are given permission to start weight bearing, ask if it is ok to weight bearing in the shower without a brace?   

I can tell you about my experience since I also had ACI/HTO on the medial femoral condyle (which if I remember correctly is also where yours was located) and respond to some of your questions based on my experience for you to compare to the answers that your OS gives you at your appointment.  Definately still ask your OS all your questions as they all tend to do things differently.  For me, I had to be NWB for 6 weeks and keep my leg immobilized for 6 weeks except for when I was doing ROM exercises.  At six weeks I was allowed to unlock the immobilizer brace and got to start weight bearing.  I had to continue wearing the big brace (unlocked) until around 10 weeks post-op (to protect the osteotomy)  At that point in time I got to switch to a smaller brace, but actually continued to wear the larger brace for several more weeks due to muscle weakness.  I don't believe that you need to get anything from your OS to get through airport security.  I also wondered that question and from what I read on the internet, airport security people are used to it.  You might have to show your scar and allow for a few extra minutes at the security gate.  I have plans to travel by air at the end of the May and I will let you know how it goes.  I also read that some hardware sets the metal detectors off and others doesn't.  I am interested to hear what your OS has to say about it.  As for PT, you should plan on being in PT for a good while, given that your insurance will pay for a lot of visits.  Often times, the amount of formal PT you get is driven by how many PT visits your insurance will pay for per year/per injury.  Regardless of that, you should at least plan on doing PT for at least a full year (an independent workout program at some point in time).   I am 6 months post op and I just reduced my PT sessions to once a week.  I am fortunate that my insurance pays for a lot of visits.  I do PT on my own twice a week at the gym and I plan on continuing PT on my own for at least one full year.  I work on my ROM everday.  I have probably been in PT a little longer than the average ACI patient because I had scar tissue which caused slow progress and I had to go back in for a scope.  As soon as I have full ROM, my PT will probably discharge me.   My PT told me that it would take at least a year or maybe a year and half to fully get my quad muscles back.  Also, from my own experience, you have enough flexion in your knee now to walk.  If I remember correctly, I was right around 100 degrees when I started walking.  Your biggest problem when you begin to weight bear is probably going to be muscle weakness.  Even though, I was given permission to ditch my crutches at 6 weeks, I didn't fully get rid of them until 10 weeks post op.  I just didn't have enough muscle in my leg to support me.  I really couldn't believe it when at my 6 week post op visit my OS told me to go ahead and try to walk and I couldn't do it without the use of crutches.  Hope this helped you some and that your visit goes well.   
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline zoeygrl

  • Regular Poster
  • ***
  • Posts: 53
  • Liked: 0
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #2 on: April 25, 2008, 06:16:29 PM »
Hi Casey, thanks so much, I totally forgot to ask about the monster brace, this really helps.  I have the unloader brace from before the surgery so I'll ask him about that too.  I have been doing all of my quad exercises and using my stim machine (even though I hate it so) and my slr's so I"m hoping my quad atrophy won't be too bad.   I feel like I'll have a little chicken leg after all of this!  My OS is very conservative so I bet I"ll be another 2-4 weeks NWB but we'll see.   Are you back to work? I can work from home but not if I have to be in the cpm for 6 hours a day.  My boss really wants me to come back on May 5th.    I will let you know what he says about the airport and hardware.   I hate the monster brace and can't wait to sleep without it.   Luckily I have 90 visits of pt a year from my insurance company (I also work there too!)  Thanks so much for your reply and your experience, it's good to know how you're doing.  We DID have the same surgery, so we should stay in touch to see how we're doing. 

thanks again!  I added a few more questions to my list! 
1989 first arthroscopic surgery to clean up knee
1992 2nd arthroscopic surgery for clean up of cartlidge flakes
1/24/08 harvesting of cells for carticel transplant
3/27/08 HTO and Carticel transplant

Offline casey2291

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #3 on: April 25, 2008, 06:53:51 PM »
Hi,

My OS wouldn't let me wear an unloader brace and made me keep the big one b/c of the osteotomy.  I hope that you get to ditch yours soon b/c I know how heavy and just cumbersome it is.  I too hated sleeping in it.  I did sleep in it for a couple of weeks after I was officially allowed to ditch it just because turning over in bed was extremely painful for me (I think due to muscle weakness and the scar tissue problem that I had).  It took me a long time to be able to sleep normally again and even today, when I sleep on my stomach I am aware of the swelling in the knee.  Thankfully though, the knee rarely keeps me awake anymore.  I had a lot of weakness in my leg and I didn't use a stim machine right away except at PT, so that is a definate advantage that you had over me.  I too hated that stupid machine and when I found out my insurance company wasn't going to pay for it anymore, I gladly sent it back.  I'm glad to hear that you have a lot of visits of PT.  I have 100 visits a year and I have not even come close to that, but it is nice to know that I have access to them if I need them.  My PT facility has the option to become a gym member once you are capable of doing your exercises independently so I may end up scheduling a once a month visit for the next several months with my PT so that he can tweak my exercises and to make sure I am progressing appropriately.  I've already hit my out of pocket max on my insurance for the year, so the visits would essentially be free for me.  I went back to work around 13 weeks post op.  I intended to go back to work around 10 weeks when I ditched the crutches but there was a mix up at the OS's office and I couldn't get clearance to return to work.  I work with small children so it was necessary for me to be off the crutches before I returned.  I had accomodations when I went back to work so that I would have to do a limited amount of walking.  I'm learning that this surgery requires a lot of patience.  I had a little set back this week and had to take a little break from exercise routine.  Overall the knee started to feel better and I started to get overly anxious to return to complete normalcy and worked out a little too hard.  Even at 6 months out, I am learning that ice is still my best friend.  It sounds like you are doing really well so far and are commited to your rehab.  I hope you get a good report when you see your OS.
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline MegTX

  • Forum Faithful
  • ****
  • Posts: 212
  • Liked: 0
  • With my shield, or on it.
    • Personal Website
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #4 on: April 25, 2008, 07:44:48 PM »
My "good" knee was covered in bruises from where the brace would hit it when I'd roll over at night & such.  I was so glad to get rid of that darned thing!  I ended up using my body pillow as a buffer between my two legs.   ::)

My insurance only covers something like 60 visits a year, so I'm a little worried about it lasting as long as I'll need PT.  But, I'm learning to take things as they come, yanno?  I'll be glad when I get full ROM and my strength up and can go back to a regular gym.  I used to HATE going to the gym, and now I can't WAIT to get back to one!!   :o

I always forget to ask for my pictures of the surgery & my operative report.  :-)
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

Offline casey2291

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #5 on: April 25, 2008, 07:55:28 PM »
Meg...I have had 52 visits of PT since my surgery and I am at 6 months post-op.  I think you will be just fine with the 60 visits a year that you are given.  I did take two weeks off at different times b/c I was out of town.  At some point, you will be able to do some stuff on your own and won't need your PT as much.  I slowly decreased to two sessions a week and now I am down to one.  I think I would have been discharged awhile back if I didn't have problems with my ROM.  Be sure to keep track of your visits b/c I have never been to a PT facility that does that for you.  I too now "enjoy" going to the gym!!   :)
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline MegTX

  • Forum Faithful
  • ****
  • Posts: 212
  • Liked: 0
  • With my shield, or on it.
    • Personal Website
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #6 on: April 25, 2008, 08:03:31 PM »
I hadn't actually figured it up, but I'm 11 wks post, I have only been going 2x/wk from the beginning, and missed 2 appts because of illness, so I've only had 18 of my 60 so far.  At 2x/wk, that's 30 wks covered, which is a little over 7 months.  I know once we have ROM & strength up, they'll drop me back to 1/wk so it'll be fine.  I'll find out next week if the doc is going to do the surgery to clear the scar tissue, since I'm only at 108 and I should already be at 130+ which will of course mean more work in PT.  :/
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

Offline casey2291

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #7 on: April 25, 2008, 09:20:26 PM »
Meg,
I hope you don't have to go in for more surgery and I know that I did everything I could to prevent it.  No one ever wants to go through another procedure and I dreaded having my knee operated on again and going through the anestheia and the nerves of another operation, but I know that I was extremely pleased that I had my knee scoped.  I don't think my PT agreed with me having it done until it was done and he saw how quickly my gait and ROM got better after my scope.  My ROM increased pretty quickly after my scope and so did my pain levels.  ROM work after my scope was still painful (still is), but the fact that now I see progress with my ROM seems to make it easier.  How is your gait at 11 weeks out?  are you still on crutches?
   
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline MegTX

  • Forum Faithful
  • ****
  • Posts: 212
  • Liked: 0
  • With my shield, or on it.
    • Personal Website
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #8 on: April 25, 2008, 09:56:26 PM »
My ROM was stuck for about 5 weeks at about 85 degrees, then I got a good pop on what had to have been a major adhesion, and it went up to 100.  We went back and forth between 95 and 100 for a couple of weeks, and now there's been a very slow, but steady progression for the last 2 weeks, I'm sitting at 108 now.

I've been 100% weight bearing since about 8 weeks, have been using a cane to keep from getting in the habit of limping, the last week or so I've quit using the cane around the house/office, and just use it when I'm running errands or going somewhere with variable terrain as a safety.  I can keep the limp to a minimum if I walk slowly and concentrate on it, if I don't it's pretty pronounced.  My PT says my gait is actually pretty good for where I'm at, and for me to just keep working on walking heel to toe and not limping as much as I can.

My PT is fine with doing a scope or not, he says I'll be fine either way but we'll get there faster with the scope.  I don't have issues with anesthesia now that I know to clue my anesthesiologist in about the nausea and use a motion sickness patch the night before.  So really, I don't object to the scope if the doc thinks it's best.  He's been on the money with everything else with my knee, so I'll trust him on this one... as long as he's talking a scope/LOA and NOT a MUA.  I will not agree to an MUA, but I don't think he'd do that anyway, he's too good at what he does.
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

Offline zoeygrl

  • Regular Poster
  • ***
  • Posts: 53
  • Liked: 0
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #9 on: April 29, 2008, 02:14:14 AM »
Hi everyone! I had my 4 week check up today and have good news! I can start pwb at 20% this week and work my way up to 50% in 2 weeks.  By June 1st I should be full weight bearing and switch to a cane if need be.  PT is 3x per week.  I can send the cpm back too but have to use the immobilizer brace for another 4 weeks, yuck.   :'(

Still no driving until June 2nd and that poses a problem for me and getting to and from work.  My boyfriend can take me sometimes but the rest of the time I will have to rely on others.   My boss is looking to seeing if I can work from home a few days a week to take the pressure off of getting a ride.  I checked into the bus schedule and it would take me 93 minutes and 3 transfers to get to work that would only take me 20 minutes if I were driving.  this is a huge hurdle for me to get over at this point, but I cannot jeopardize my job.   I will work it out with my boss somehow.   

I am excited to start the next process!  I can't wait to get a normal life back.  Although it's been only 4 weeks I am about to go stir crazy! 

Thanks everyone for your support and good wishes.   I will continue to montior these boards and provide feedback and updates! 

I'm happy now!   ;D
1989 first arthroscopic surgery to clean up knee
1992 2nd arthroscopic surgery for clean up of cartlidge flakes
1/24/08 harvesting of cells for carticel transplant
3/27/08 HTO and Carticel transplant

dileigh

  • Guest
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #10 on: April 30, 2008, 02:53:11 AM »
Does your area have handicapped public transportation? We do here, but they limit the number of days per week you can schedule it.  That may be an alternate way to get you to work at least a few days. 

Did you remember to ask all of the other questions in your first post?  It always feels good to get out of the house. 

Wow, PWB, I still don't have that ability and no PT until after the 6 week appointment, just some home exercises.  You're going to be ahead me quickly.


Diana

Offline zoeygrl

  • Regular Poster
  • ***
  • Posts: 53
  • Liked: 0
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #11 on: April 30, 2008, 03:31:57 AM »
Hi Diana, thanks for checking in.   Yes, I had a list of 12 questions to ask the doctor thanks to you and others!  Here's what he told me in no particular order:

1.  Hardware - most likely will have to have it removed next year (about a year from now) unless it doesn't bother me at all.  he said most people want it out because they can feel the screws
2.  No airport card needed, if the metal detector thing goes off just show them my scar.  weird.
3.  Work really hard at the weight bearing and pt to get my range of motion back.  I went today and I feel so beat up and sore....owie. 
4.  Since I can't drive for another 4 weeks he won't discuss the disabled parking pass.
5.  Overgrowth, he said that I will know in a couple of months if I have overgrowth from the catching and popping when I walk.  Then he will evaluate me to see if they need to go in and "shave" it back...yuck.
6.  He said I must wear the brace at all times except at pt.  I am really beginning to get annoyed with it, I put ice on my leg today and took a nap without the brace and my leg is really bothering me now.  I think it's from the pt though.

I think that's about it from all the questions I didn't answer in my follow up email.   I had to take one of my hydrocodones tonight as the pain is pretty intense from working out today.  This is the first one since I quit taking them 3 days after my surgery....at least I have a good supply to get me through the pt...tee hee. 

Hope you're doing well.   I think everyone is very different and every doctor has their way of doing things.    I may be ahead of you but I worry that I'm going too fast and I'll have issues.  We'll see, let me know how you're doing?  so nice to hear from you

Zoeygrl
1989 first arthroscopic surgery to clean up knee
1992 2nd arthroscopic surgery for clean up of cartlidge flakes
1/24/08 harvesting of cells for carticel transplant
3/27/08 HTO and Carticel transplant

Offline Army John

  • Regular Poster
  • ***
  • Posts: 138
  • Liked: 0
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #12 on: April 30, 2008, 03:41:11 AM »
Zoey-

  Good to hear things are going well.  I suspect you'll never set off an alarm at the airport because they are typically, if not exclusively, using titanium hardware.  I have never triggered anything and I have hardware in my shoulder and now I have even more in my knee.  My wife doesn't set anything off and she had a TP fracture and that joyful injury comes with an erector set of hardware-- she has something like 10 screws and some huge plate. 

I too hate my brace... with a passion.  I don't know if I am supposed to drive or not but I have been.  I had surgery on the left knee and I drive an automatic.

Finally, I sent that PDF file you sent me to the therapy department on Fort Drum.  I'm not pleased with how conservative they are being with me.  Now I'm not saying they're wrong it's just that I am not a very patient person and after reading it, I think I should be allowed to do more.  But again, this is a year long recovery so I'll bite my lip. 

Take care..... John
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline zoeygrl

  • Regular Poster
  • ***
  • Posts: 53
  • Liked: 0
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #13 on: April 30, 2008, 03:02:57 PM »
Hi John, thanks for your follow up.  My ex husband sold titanium maxiocranialfacial surgical equipment so I should have know about the airport thingy!  My xray showed 4 big screws and a plate, fun fun.  You sound like the million dollar man with all your pieces patched together.  erector set - that's funny! 

It's weird that your pt is so much more conservative but I think that's because you have multiple lesions right? Did you have Carticel? I was assigned a case manager from Carticel who would answer any of my questions.  While I never called them, that might be a resource for you to ask some more questions on the pt? 

Best to do what they say, although I am tempted to start driving in another two weeks as I have to take a cab to work and it's costing me $40 each time! take about ouch!  Since mine is my right knee I can see why they don't want the compression but I have got to get around!  I'm going to try it once I get to 50% weight bearing.   

Kentucky Derby is Saturday, I think my horse is Big Brown.  going to a party I hope.   Take care and hope your recovery keeps moving forward! 

I think it's a big aggressive that my pt is working me so hard! I am hurting today, I think I may have pulled a groin muscle, ouch!  or it's just that my muscles aren't used to working this much.  I go back tomorrow for another round of torture.   


1989 first arthroscopic surgery to clean up knee
1992 2nd arthroscopic surgery for clean up of cartlidge flakes
1/24/08 harvesting of cells for carticel transplant
3/27/08 HTO and Carticel transplant

Offline casey2291

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
Re: ACI/HTO follow up Questions for OS 4 week Post Op Visit?
« Reply #14 on: April 30, 2008, 04:29:46 PM »
Good info to know about the hardware, especially since I am flying at the end of May.  Thanks for the clarification on that John and Zoey. 

John...my ACI was on my left leg and I started driving at 3 weeks post-op.  I also had an automatic.  The biggest problem was keeping my leg straight while getting in and out of the car.  You mentioned your PT being conservative.  Be thankful that he/she is protecting your grafts and being conservative.  You can always mention to them when an excerise becomes easy for you and ask them if the protocol allows for you to increase/add to your program.

Zoey...sorry to hear that it costs you so much to take a cab to get to work.  Do you have any co-workers who might be willing to pick you up or take you home?  I would be very cautious if you start driving before your OS recommends.  If you happen to need to brake really hard, you might not have the strength in your leg to do so and it might also compromise your ACI or HTO.  This was a very expensive operation with a long recovery time.  I would just hate for some freak thing to happen while you are driving and it gets messed up.  But, at the same time, you gotta do what you gotta do to get to work...sometimes life doesn't always work out just the way we would like it to.   

I hope everyone is healing nicely and feeling good!

 
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05