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Author Topic: Daughter having Fulkerson procedure  (Read 5328 times)

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Offline heidi63

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Daughter having Fulkerson procedure
« on: December 20, 2008, 02:16:03 PM »
My 17 year old daughter is having surgery on 12/22.  Fulkerson procedure is what is being performed and I am anxious about the recovery - it's her senior year of high school and started off with a severe dislocation of the knee cap, 3 months of PT, but she was still left with pain, sublexes and swelling.  It's outpatient surgery and seems like such an invasive & involved surgery.  I'm confident with the Doctor - just a Mom worried about how she will be right after the operation & that first  week or two.   :-\
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline mes489

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Re: Daughter having Fulkerson procedure
« Reply #1 on: December 20, 2008, 05:12:23 PM »
hello... I had a fulkerson when I was 19 in jan of 06 and getting ready to have it again here in a couple of weeks since I am on break for college.  It is a good idea that she is having it done on winter break because the first week is a bit rough, nothing that isn't manageable but it is best to be prepared.  I had a femoral nerve block right before surgery, the pain pump, and med management staying overnight at the hospital, but it was still painful.  I had the nurse coming in right after surgery asking me to bend my knee a bit which was painful. 
I would recommend making sure you have a shower seat for her and if possible one of those hand held shower heads, that worked best for me.  Make sure she stays on schedule with her pain meds because once you get behind it is so much worse trying to catch up.
Although the fulkerson was my second knee surgery on my knee, the first one being a patella reconstruction because I broke it due to dislocation, this post op was a bit more tricky.  I also got it on my break from school and ended up not wanting to crutch around campus all the time so I invested in a wheel chair, which would be difficult for high school, but was super nice for college. 

If you have any questions please feel free to message me!! Good luck to your daughter with her surgery and I hope she has a great and rapid recovery!!
 :)

Offline heidi63

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Re: Daughter having Fulkerson procedure
« Reply #2 on: December 21, 2008, 02:05:47 AM »
Thank you for replying to my email.  I appreciate your honesty about what it was like after the surgery.  She will have a femoral block right before surgery too - but won't have a pain pump - will have pain meds (vicodin) and will be coming home the same day (that does make me nervous!).  She had arthoscopic surgery last year on her other knee (totally unrelated) and was in a knee brace for 2 weeks post surgery & we did the shower/wash the hair thing then.  Good point about keeping up with the pain meds .. she learned that the last time, but I know this is going to be worse because it's a much bigger surgery.  She did have a wheelchair for 2 weeks the last surgery to navigate the high school - couldn't crutch back & forth from one side of the school to the other for classes as we have a large high school & the swelling/pain necessitated her leg be up too.  I just hope this works!  She was a dancer for 10 years  until the severe dislocation (7 dance classes/week) and has been upset & depressed that she had to give all of that up in her senior year.  I am hoping that the 13 days off of school for winter break will give her a good head start in her recovery for when she goes back to school after the first of the year.
Best of luck with your next surgery - wow, you've been through a lot!  Thank you for helping others! :)
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline heidi63

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Re: Daughter having Fulkerson procedure
« Reply #3 on: December 26, 2008, 10:37:06 PM »
Surgery was postponed for my daughter until January 14th.  She came down with a nasty stomach virus less than 24 hours before surgery & they wouldn't operate with her system compromised already.  Ugh.  Now we have to wait again ...... she was upset - she just wants to get this over with and move into the recovery stage.  I am still very anxious about this surgery --- should we really be doing this?  The tibia tuberosity procedure is making me very nervous!  Any thoughts by anyone???
 :(
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline cat

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Re: Daughter having Fulkerson procedure
« Reply #4 on: December 27, 2008, 02:37:19 AM »
Has your daughter been evaluated by a patella femoral specialist?? Not all surgeons are able to offer appropriate options. A true knee cap specialist would be better able to offer a correct diagnosis for WHY the knee cap dislocated- what structures may be stretched, torn, or inadequate, whether or not the bone structure is at fault- ie shallow grooves or even torsion of the long bones and then be able to offer or at least refer you out for proper treatment. If in doubt, another opinion couldn't hurt.
 ;D cat (who had a TTT and wished she hadn't)  ;D

"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline dimples3887

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Re: Daughter having Fulkerson procedure
« Reply #5 on: December 27, 2008, 03:28:24 AM »
I'm sorry to hear that the surgery was delayed.  I know the waiting was the worst feeling for mine and then I got scheduled for a 2pm surgery so that didn't help at all.  I'm about 5 weeks post-op right now so the suggestions are fresh in my mind.

Have tons of extra pillows to prop the leg this way and that way.
Drink tons of water.  Although the trips to the bathroom may be agonizing, the pain meds mess with every other bodily system.
Keep up on the pain meds for the first 4-8 days every scheduled dose whether she thinks she needs it or not.  Being ahead of the pain is KEY.
Have lots of ice to keep the swelling down.
Have lots of blankets ready around the house because shorts work best with the brace but you never know when you want to warm up and take a little nap.
Have a footstool or something for the toilet because its really hard to hold your straight leg while on the toilet.
Have lots of books, magazines, laptop, game books, whatever to keep her busy while she's laid up.  There's nothing worse than being in pain, tired, or bored...and all three is just that much worse. ;)
Just make sure she takes everything slowly and follows her surgeon's protocol.  If you read around on this site there are a ton of us who have had this procedure done and there are a ton of different rehab protocols.  Make sure to follow exactly what they say and if you have questions, call and ask them.  It never hurts to ask. We're all here to help too. 

Good luck with everything!
21 yrs. old
LK: 6/02-LR(fail)
     9/05-MRI shows patella bone bruise
     12/15/05-Medial reefing, LR, patella debridement (fail)
     TTT to be scheduled after RK TTT rehab is done...
Pain, clicking, and crepitus in both knees now...
RK: 11/19/08 - TTT

Offline heidi63

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Re: Daughter having Fulkerson procedure
« Reply #6 on: December 31, 2008, 04:20:06 AM »
Thank you for the responses!
We are with a knee cap specialist - the best in this area who has done 2 fellowships in this area and is also a friend and neighbor (our kids are the same age and friends).  He's a physican for a semi-pro sports team in the area and is known for not only his knee specialty in orthopedics, but also for being conversative with surgical options.  He has given all of the appropriate reasons for doing this surgery and we've had several frank discussions as to why this is his recommendation.  It's just sounds like such an involved surgery and she's faced a lot in the past months - has had to give up dance after 10 years (and 7 dance classes a week) and I just want a good outcome from all of this.   ??? 
The suggestions for her recovery are GREAT!  I will make sure that I have everything you suggest to make her as comfortable as possible.  She had arthoscopic knee surgery last year on her other knee (totally unrelated to this) so we're at least a little knowledgeable about some of what is ahead, but that was a walk in the park compared to this upcoming operation.
My daughter's point of view is to try whatever it takes now, before college, so she doesn't look back & say she didn't try everything possible.   She just wants to be a normal kid again .... and not have this hanging over her when she starts college next fall.
Ugh -
Happy New Year!
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline heidi63

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Re: Daughter having Fulkerson procedure
« Reply #7 on: January 03, 2009, 10:40:31 PM »
Is this surgery mostly outpatient or inpatient surgery?  I've read posts of both & I see many have had the morphine pump .... I'm concerned that my daughter is outpatient & will have a femoral nerve block and oral pain meds.  If the pain is so bad after this surgery, why is she staying overnight at the hospital?  That first night is making me very nervous   :'(
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline KW

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Re: Daughter having Fulkerson procedure
« Reply #8 on: January 04, 2009, 04:36:56 AM »
She shoud not feel anything for the 1st 24 hrs or so with the Femoral nerve block....that is the point of the nerve block.

I was not given the option of a nerve block and was made inpatient with a PCA (pain pump)...It was not necessary to stay overnight...I would have been fine at home on oral pain meds all 3 times.

The best advise I can give you is to make sure you follow a schedule with the oral pain meds for the 1st week or so...If the script says every 4 hrs that means ever 4 hrs...even in the night she needs to wake up to take a dose.  It is much harder to catch up when you are in pain then to stay ahead of the pain.

Karen
« Last Edit: January 04, 2009, 04:39:53 AM by KW »
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline heidi63

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Re: Daughter having Fulkerson procedure
« Reply #9 on: January 04, 2009, 02:01:57 PM »
OK, thanks for the input!  I feel better about her being outpatient surgery now. 
Yes, I've heard to follow the exact Rx for the pain meds.  I've also heard that ice, ice, ice & elevation above the heart is imperative too.
Just wish the date would hurry up and get here ... the waiting & anticipating what it will be like is unnerving!

 ::)
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline dancer44644

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Re: Daughter having Fulkerson procedure
« Reply #10 on: January 05, 2009, 12:51:20 AM »
Hi heidi63
This is a little unrelated but, I read about your daughter and she sounds a lot like me. A dancer for many many years until I dislocated my knee, did therapy for a year, started running, and then reinjured my knee. I would like to know what exactly a fulkerson procedure is and I am very interested in how it works out for her. I am a junior in high school (17 years old) and would do anything to get better and be able to dance again.
Let me know how everything goes!
Thank you,
Taylor

Offline heidi63

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Re: Daughter having Fulkerson procedure
« Reply #11 on: January 06, 2009, 04:13:49 PM »
Hi Taylor,

Yes, you & my daughter have a lot in common. To learn about the fulkerson procedure, following this link:

 http://www.kneeguru.co.uk/KNEEnotes/node/771

I found this website to be very informative & I even emailed Dr. Greslamer and he emailed me back & was helpful in understanding my OS was recommending.  I almost took my daughter to him for another opinion but the distance was too far and based on what I had learned from him, his website & my own research, I called my daughter's OS and had a frank discussion with him and was satisfied with his reasons for concluding that this surgery is the best option for my daughter.

One thing I did not understand completely is her anxiety related to the constant "what if" about dislocating, sublexations, the constant pain, swelling, etc.....  It finally hit me when she said "this is my knee and my life" .... it has been a tremendous burden for her to never trust her leg and always wondering if something will happen.  She wants this surgery more than anything just to feel 'normal' again & hopefully dance again!

I feel so badly for you .. you guys are so young to be dealing with this but it is not uncommon and the median age for this surgery is 17!  I've learned a lot from the people on this forum ... also check the forum on "patello-femoral joint" -- same website, just one of the specific forums just for the knee.

I just showed this website forum to my daughter last night, so she is going to bet on with her own user name & post as well .... I will make sure she finds you and I think you can help each other!

Any more questions, just ask ..... ;D

Heidi
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline dancer44644

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Re: Daughter having Fulkerson procedure
« Reply #12 on: January 06, 2009, 11:29:34 PM »
I know exactly how your daughter feels about the "what if." I thought my knees were improving and becoming more stable until i dislocated my left knee the other day simply bending down, a movement i do many times a day. Now I am hesitant about bending and moving because i am afraid it will happen again, or even in public. After over a year in physical therapy and starting it up again, I am losing faith in the pt. I really want surgery but my mom doesn't understand. Also she thinks I am too young.

I have my next appointment with my OS at the end of the month.. we will see what he says. I am thinking about finding one that specializes in knees, but am hesitant to because this OS knows my whole history. Anyway, I would really like to know how this works out foryour daughter! Also, I'm guessing you are in the US, where if you don't mind me asking? I'm in AZ.

Offline heidi63

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Re: Daughter having Fulkerson procedure
« Reply #13 on: January 07, 2009, 12:44:46 AM »
Hi again Taylor,
We are in PA. 
As a Mom, I know how she feels, especially because you did not have a traumatic event like my daughter's.  Seeing her being transported by ambulance & then in the ER with her knee cap on the lower outside of her leg (her knee area was actually concave and you could've held an egg in the 'hole') was terrible ... but it did make me appreciate what can happen with an unstable knee!  She told me that her every movement is never without the thought of what the implication of that movement may be.  If she is willing, have your mom look a the www.kneeguru.com website.  I have done an exhaustive search of everything related to knee caps, dislocations, PT, surgery, etc...... My daughter says I am way overboard (she has had no hesitation about the surgery), but I want to be as informed and comfortable that this is the best option for her.  I am comfortable and confident that it is.  Yes, you both are young, but her OS said this is her best shot at being normal again and he said she is too young to have this type of worry & difficulty with a leg!  I agreed.  My daughter's PT is oustanding!!!!!  He has been her PT for 6 years (she had another knee issue unrelated to this with her left knee) and has been extremely supportive & invaluable with his guidance and encouragement to her.  He was the one who sent us back to the OS because he wouldn't release her to a home therapy program because of the continued instability.  He wouldn't let her do any weight bearing exercises without him watching and as needed guided her knee cap to keep it from sublexing or dislocating - at one point he even got on the floor to watch the tracking of her knee cap.  He's been great and is an important part of the whole picture. 
I would see what your OS says at your appointment this month.  Educate yourself & ASK questions at that appointment.  If your mom would ever want to ask me questions about any of this, I'd be glad to chat .....  :)
Daughter's History:7/96-LL:broken tibia,disloc KC8/07-LK: arthro surgery-remove part synovium 9/08: RK: severe KC dislocation9/08-1/09: RK: sublexes,maltracking,patello alta,weak collagen1/09: RK: TTT, MPFL,5/09: Fractured right knee cap - immobilizer for 7 wks,continued pain-12/09 hardware removal

Offline dancer44644

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Re: Daughter having Fulkerson procedure
« Reply #14 on: January 07, 2009, 12:54:24 AM »
Thank you soo much for all of the information! Sounds like your daughter has some great people helping with her knees and the support is awesome. I will have to wait and see what my OS says. Keep us updated about how she does with surgery! thanks!