Conformis iForma post-op (in UK)

[Osprey]

HI … op today, so thought I’d log my progress.

History –

I have had several arthroscopy on knee, resulting in removal of just about all meniscal cartilage.
Last one 10 months ago showed significant loss of bone off head of femur, and on lateral side significant loss of articular cartilage.
As a result of continuing bone on bone damage long leg x-rays show the line between hip to ankle my knee is now 27mm out of line ..

Knee has been graded as Grade 4 Osteoarthritis.

The 2 big issues I have is that if I kneel, I could not sit back onto my heels, pain is significant, and it just won’t bend backwards to allow this.
On sitting (car & train journeys etc) I have significant limping afterwards … which I can ‘walk off after 10 mins or so.
Any significant ‘work’ on ladders, stairs, or walking over rough ground causes swelling especially at rear of knee, and on outer side of joint.  Usually with prolonged pain afterwards.
Also after sports such as waterskiing, wakeboarding, kneeboarding  etc.

I purchased (a very expensive) Ossur Unloader brace, to reduce damage, and help with pain.

Consultant was initially recommending an oestomy realignment, but has now decided upon a Conformis iForma Inter Positional Device insert for lateral side, under controlled research programme - not yet recognised procedure in UK.

3 full sets of MRI scans done and Conformis in US, examined and confirm knee is suitable.


>>>

Day 1
Today went in for the surgery, in S.Wales, UK.
This was under GA …  full arthroscopy clean up of knee, wash out, removal of crud  etc. and then fitting of the iForma
There is a video of this technique at:
www.conformis.com/Physicians/ConforMIS-Patient-Specific-Implants/iForma-Interpositional-Device



Woke up with little pain, just low level ache, presumably due to anaesthetic/pain killer placed directly in joint … I know that Diclofenac was administered during the op.
The worse feeling at that point was my throat … from Intubation, feels like it had been sandpapered, very difficult to swallow even a glass of water.

There was a drain in the knee for first 2 hours, once this was removed – antibiotics injected via catheter (surprised by how much).

Exercise then started straight away with leg extensions, and this was measured as 100 degree to rear and full movement to front.
Some then walking full load bearing with crutches.

Another couple of hours waiting for effects of GA to be fully clear, and sent home with exercise plan from Physiotherapist and a bag of medication …

Aspirin (Dispersible)  - 150mg once daily
Omeprazole – 20mg once daily to be taken with the Aspirin
Ibuprofen    400mg  every 8 hrs
Tramadol    100mg every 6 hrs
Paracetamol  1000mg every 6hrs


Supplied with enough for 10 days at above levels.

Expected appointment with Physio in 2 weeks, and check up with Surgeon in 4 weeks.

At time of writing (12 hours after op) still no real pain, at rest and with full load bearing, soon be time to go to bed … and hope pain keeps off then   
Throat is still an issue though – can’t swallow food comfortably.

[cboden51]

This sounds wonderful and I am praying for continued good progress for you.  That is too bad about the throat- haven't had that happen except for a procedure many years ago and I remember it being just as you describe but it did get better pretty quickly, if my memory serves me and that is not always the case.

[Osprey]

DAY 2
OK had good nights sleep which surprised me, only work up once with pain spasm ... where I had tried to roll over, and twisted my knee.

Went for a walk this morning (on crutches) only about 1/2 mile  ... and later did a full set of  the Physio exercises .... and knee certainly aching afterwards.
However it's all about movement so will stick to it.
The lateral  moving of leg to the rear - i.e.sitting on chair and bending leg back as far as possible was the hardest, quite a lot of pain to get it to aprox 100 degrees.

Resting pain is much worse than yesterday, on 0-5 scale is probably around 3, hospital advised I can stop taking Tramadol if I want ... think I'll keep it going for another 48 Hrs.
It may be analgesia put in joint during op has worn off, or because of the exercising.

No stitches or staples to be removed, so won't be going back to see consulatant Mr. Chandratreya for 4 weeks, pleased with him, his approach & explanations.   

[cboden51]

Sounds like you are doing very well. I went to look at the video and see that you have an incision in addition to the small areas where they put the arthroscope in. How did they close that?

I am sure you are right about the resting pain level being increased in part due to the analgesia injected into the joint wearing off. I noticed the same thing ( I had a PKR Conformis type).

Keep up the good work!

Connie

[Osprey]

The insert site incision I have been told is closed with dissolving stitches.

it was marked out by surgeon just before op and at that time incision mark was about 3"

Guess I'll find out when I take bandages off on w/end   

[UK Girl !]

Good to see you are doing well !

Never heard of this before - hope it does a good job for you - very interesting!

As for the tramadol - get off it as soon as poss - I was on it after my TKR and had the most awful withdrawals from it - no one told me to come off it gradually and I just stopped - to my discomfort !!!!!!

[Osprey]

Day 3
Removed the crepe bandages and the layers of ‘padding’, leaving just the op-site dressings in place.
Knee is pretty swollen … circumference for example is 23” compared to 17” for other knee.
The removal of dressing made it slightly easier to carry out the physio exercises … have, 7 different exercises with 10 reps of each – full set repeated 3 times a day.
The ones that are difficult are –
# Lying on floor and slowly bend up the knee sliding the foot along the floor … using a strap to pull back on the foot to achieve a good ‘bend’
# Sitting on a chair and brining the leg back as far as possible, using the good leg to put pressure on the other to get a good ‘bend’

Both of these exercises cause a fair amount of pain … and a feeling like it’s pulling a band or similar inside the knee on lateral side, and more than once the thought in my head that the iForma might burst out.
Obviously my knee does not like being bent  backwards.

My throat has now returned to normal.

I’m still keeping with same mix & frequency of pain relief medication, I may start reducing this tomorrow.
Walking is a lot easier today, standing still though forces me to shift weight onto good leg.
Trying to use ice at least 4 times a day, and aiming for 2 sessions of 30min where lying down and raising  leg to be higher than heart  … both to try and reduce swelling.

[Osprey]

1 Week update

(late subission)

At 1 week point I dropped the Tramadol, bad move, about 1/2 day later serious continual throbbing ... so much pain I could not get any sleep that night.
Next day knee was really painful, and walking on it was much more difficult.

After 24 Hrs ... supplemented with Diclofenac, and that eased things ... while I ordered some more Tramadol.

After 48 Hrs back on original regime with Tramdol and pain is now manageable.

Removed dressings ... have 2 small incisions points (Arthroscopy) and a 4" scar down lateral side, sutured area is raised, and reddened, but looking clean and neat.
Put new op-site stick on dressings onto main incision area only.

Carrying out Physio exercise twice a day ... the ones where I have to bend knee backwards are certainly the most painful, but knee is definitely bending further.

[Osprey]

Op + 2 weeks

At this point started trying to get back to normal use, albeit with a significant limp.

Am able to ‘do things’, but resultant pain later in day is then significant, maybe it’s just a symptom of  getting back into using the knee.

On weekend - I did a little work which included a fair amount of stepping up and down (controlled with good leg first on way up bad leg on way down) on to and down from a 24” platform.  Certainly no kneeling.
 I used a Neoprene brace on knee to aid with warmth (-1degeee C today) and stability, seemed reasonably OK at the time ….. wow did I suffer that night.
From early evening worst pain since op, and stayed that way since … really painful when trying to get to sleep - continual ache.

So although I can do more … doing anything means it hurts like hell afterwards, not undertaking any ‘impact’ exercise so hopefully just needs time to get back in work mode.

Did experience sharp pain at arthroscopy incision site, for a couple of hours, but that has disappeared.

If pain does not calm down a bit by tomorrow – will need to think about asking for something else.   Still on:
Aspirin (Dispersible)  - 150mg  + Omeprazole – 20mg   …. once daily
Ibuprofen    400mg  every 8 hrs
Tramadol    100mg every 6 hrs
Paracetamol  1000mg every 6hrs

If I need something more for the pain not sure what would be next logical step up form Tramadol.?


The operation site now has no reddened area, so is healing well, there is a pronounced ¼” ridge along incision line, maybe that is where internal sutures are puckering things up, but all looks a healthy colour.
Swelling overall on knee is not reduced, looks like a large watermelon   

I am still putting on an ice pack twice a day.

[Plumb]

osteophyte removal  That alone can cause so much pain 

Looks like a rebirth of a unispacer. Did your OS explain why he rather have you try this than a partial knee replacement?  From reading this it is about saving the bone.  Go ask your GP to provide you something else for relief.  Its been a few weeks and your pain levels are not being met with tramadol.  Why sit and suffer..  Heck you look like your in for one of those long achey recovery's that last for a few months.

Take care you

[Osprey]

osteophyte removal  That alone can cause so much pain 

Looks like a rebirth of a unispacer. Did your OS explain why he rather have you try this than a partial knee replacement?  From reading this it is about saving the bone.  Go ask your GP to provide you something else for relief.  Its been a few weeks and your pain levels are not being met with tramadol.  Why sit and suffer..  Heck you look like your in for one of those long achey recovery's that last for a few months.

Take care you

Surgeon is not a fan of partial knee replacement, he advises they are not that successful, and often lead to a later full replacement.

In my case the medial side and patella were undamaged, but lateral side had category 4 OA.
At time of surgery told that knee looked in hell of a mess when they looked inside ... so only 12 moths after full arthroscopy clean out it had deteriorated significantly.

The OA had caused significant leg misalignment (27mm out of line, I think the figure was) ... the interpositional device allowed the corrcetion of this ... guess I will find out if it has been successful at check up time 1 month on (Jan)

Surgeon also advised that using the iForma IPD, does not remove any bone, and thus does not burn any bridges for any future developments in knees implants or corrections, or indeed a knee replacement at a future date.

So has all things going for it ... just hurts like hell     :-)

[TwoBadKneesUSA]

Looks like an interesting take on "repair".  If they took off the "spurs" of bone, they are going to be cutting or grinding the bone so it's bound to be quite painful.  They say there is no worse pain than bone pain.  Definately check with your GP about more pain medication.  If these iForms put your knee back into a better alignment you may be having pain from adjusting to a more normal alignment.  Hope your pain is getting better for you.  At least I hope you can get it to tolerance levels.

Milly

[Osprey]

Op + 4 weeks

Movement is considerably better, can now walk with an almost normal gait, until last week, my leg was tending to walk with foot pointed out to 10 o'clock position .... and it took significant effort to keep it straight.
Presumably this was me readjusting to leg alignment ... my knee was out by 27mm ... not sure exactly how much this has now been reduced, but it was the intent to realign.
For past 2 weeks walking more each day, as well as swimming a few lengths every other day.
The side effect is that my hip is now aching, again probably due to gait change.

Over last 2 weeks as I have been using leg more, pain during use has reduced considerably .... apart from standing still .... as I found out doing Xmas shopping with wife.   
2 mile walk is no problem, 2 min standing still is very painful.

The aching when at rest is becoming more pronounced, and at night sleep is very broken as I wake up every hour or so with very significant aching in knee & hip ........ temporary relief gained by direct application of Ibuprofen gel.

Today I met with my surgeon .. who seems pleased with recovery so far, op site is clean swelling reducing, and leg extension better than expected.  ...  my exercises must be paying off.  (had a sheet issued by physio on day of op)

To help with night time pain he has now prescribed 10mg Oxycodone (Oxycontin)  .... they also make you drowsy, so maybe I'll start getting some decent sleep.

[cboden51]

Sounds as if you are making good progress! I had the same issue with night time aching after my partial knee replacement with the conformis taking Advil at night before sleep until magically at 6 weeks it was not necessary any more. Hang in there.

[Osprey]

Thanks for the comments ... my surgeon has said that 6 weeks is the expected turning point .... although it can take up to 6 months !
My range of movement is pretty good ... full extension and 120 degrees flexion.
It does cause a lot of discomfort at 120 degrees though