Fulkerson Osteotomy - What to expect?

[birdmommy517]

Hello all. Thanks for reading. I'm scheduled for a Fulkerson Osteotomy with medial reconstruction and maybe more (or something like that!) in just 2 weeks.

So, I'm 30 years old, and I think I typically heal pretty fast. I drink a lot of milk for calcium since everyone told me to after I broke my neck in 8/2007 in a rollover car accident where my C6/C7 vertebrae fractured, but no surgery was needed. I guess I'm in pretty good shape for someone who has had zero athletic inclination since age 14. (For fear of re-injuring this knee again!) I just walk for exercise, and sometimes cycle at the gym but not for several months now. Turns out just walking home from school and the ice on the sidewalk 3 weeks ago was all it took for that dreaded injury that I'm so overly careful about to happen. 

I'm pretty scared, especially after reading the little that I could find online. My Dr. described it as a "major knee surgery" but with fairly minimal (common) risks and a high success rate. When they told me the prognosis 16 years ago, it wasn't so good, so I decided to just live with it. It was only this recent re-injury, the current stability in my life, and the desire to no longer live in FEAR of this injury every day of my life that gave me enough courage and motivation to go in to the Dr. at all.

The original problem is apparently an incorrect Q angle between the tibia and the femur/quadriceps. My legs bend outwards at the knees, and my left knee has dislocated 8 times in my life (it pops to the outside of my leg), with the first and the most recent injuries resulting in the kneecap getting STUCK and having to be physically pulled hard to get it back into place. This happened the first time when I was 14 years old, and then the bad one just 3 weeks ago. Once the Dr. pointed it out to me, it was glaringly obvious how crooked my legs are! I had never noticed before, and the Dr. when I was 14 did not notice. The left is much worse than the right, and they said that's probably why the right one has never gone out all the way- only strained and pulled in that direction, only to pop back where it should be before anything majorly ripped or tore.

So, the Fulkerson Osteotomy is supposed to make the force on my kneecap between the quadriceps muscles and the patellar ligament (I think) "anatomically correct". They might "borrow" my hamstring to attach to the patella from the inner side of my leg to help keep that patella in place, and they also for sure have to do a bunch of medial reconstruction. (I think that's what it's called... fixing all the torn connective tissue that ripped when the kneecap pulled way too far the wrong way.)

Frankly, as the surgery date gets closer (Jan 14, 2009), I am feeling more and more frightened and anxious. (I take Xanax for General Anxiety anyway...)

I guess I just want to know what to expect from all of this... What's it going to be like? I've never had a surgery before! How long until I can walk safely? Run again? I am a 7th-12th grade substitute teacher, which requires a lot of up and about in the classroom, so when will I be able to return to work safely? They said I'd be bearing weight in a brace within 24 hours, but then I read online that bearing weight that soon is a bad idea because of risk of fracturing the tibia.

The Dr. told me that it would be hard to know exactly what to expect... I apparently also have very "loose ligaments" all over my body, which he said didn't help any of this.

Any insight or ideas at all that anyone might have will be greatly appreciated. My husband says that I'm "just poking around and making yourself anxious for no reason." Am I though? It would just help so much to hear other people's thoughts and ideas.

Thank you so very much,

Charlotte

[KW]

First – If you tend to be a anxious person let me remind you of one thing….you are going to find more horror stories on the internet then you are going to find success stories…a lot of people come here for initial information on procedures or they are here looking for information when things go wrong but people don’t seem to hang around when things go right…they get on with life.

Your OS should have given you an idea when you will be allowed to return work.  I have a desk job (accountant) and I was back in my office 11 days after my 1st  and was working from home the day after I was released from the hospital with my last 2 Fulkerson’s.

As for the weight bearing…I have always been weight as tolerated right out of the hospital…My understanding is that being weight bearing actually encourages the bone to heal.  I have never been told that there is a increased chance of fractures with bearing weight.  Your OS gives you instruction for a reason…and you should follow everything they tell you.  If you have a concern give them a call and ask for some more information.

Best of luck,
Karen

[birdmommy517]

Thanks, Karen, for the reassurance! It sounds like you had a pretty good experience with your surgeries. It is encouraging to know that you were able to go back to work so soon... Were you able to walk then?

Thanks,

Charlotte

[KW]

Hi Charlotte,

I did have a good experience with my surgeries.

I was full weight bearing directly out of the hospital with all 3 of my Fulkerson's.  I only used crutches for balance.  I was up and around (in a Post Op ROM Brace) rather quickly.  My os is fantastic with pain controll so I am one of the luck ones that had very little pain. 

Now when you say "Walk".....don't think you will be up and walking normally in 11 days...that is not going to happen.  I was up and around with a brace that locked my knee straight.   I was in that brace for 4 weeks.  Slowly I was allowed to regain my flexion when sitting then with the help of the PT I started working on walkign normally again.  The rehab from this surgery is long and alot of work.

Best of luck,
Karen

[birdmommy517]

Karen,

How did you happen to have 3 Fulkersons done? I guess I thought that they would just move that little bone bit once and that was it...

Charlotte

[KW]

Charlotte,

I guess I thought that they would just move that little bone bit once and that was it...

99.99% of the time you are correct....I was the .01% that managed to break a piece of hardware and the bone did not heal correcty.   It required a revision that started the entire process over again (Fulkerson #3).  This is a very rear complication...my OS kept telling my "I have never seen this happen before".

Karen

[hexcat]

Hi Charlotte,

I had this procedure on December 16th.  I have only posted once prior to my surgery but have read many different post's in regards to this surgery and have found many helpful tips.  I too had a similiar situation to yours with knee's dislocating since the age of 13 (now 37) and the anxiety that goes along with it.

I currently am in an immobilizer as of post op day 14.  I just returned from my 1st OS visit post surgery.  I must continue to wear my immobilizer for 4 more weeks and still am only allowed toe touch weight bearing with crutches. Yuck!.  I work as a nurse in a hospital with alot of up and down and walking.  My OS told me I may be off work anywhere from 4 to 6 months!  We shall see as I met another nurse who had the same procedure and was back to work in 12 weeks. 

Some important things that I read online and found to be true. Stay on the pain med schedule the first week or two.  Set an alarm and take even if you are sleeping. 
If your OS hasn't suggested or offered get an ice machine (mine was called polar iceman) I had to pay out of pocket for mine but it was well worth it.
If your able, have someone home with you the first few days, I tried to be by myself around postop day 3 and it didn't work out.  Very difficult to manage things with crutches.
As much as I didn't like the thought of exercising,  I started PT postop day 2 and I really do feel better after the exercises and movement.

I hope some of these tips have helped.   I too have always lived with the fear and anxiety of my knees pulling one of their tricks at anytime.  I can say that since my surgery I do feel more stable and am keeping my fingers crossed. 

I dont get on this site much but if you would like you can email anytime [email protected]    I hope your surgery is a success.  You made the first step going to the dr's and you will make it through!

Good luck!
Kay

[heidi63]

Hi Charlotte,
My daughter has a very similar situation as yours - severe dislocation of the right knee cap in September, PT for three months but didn't work, now having fulkerson osteotomy on 1/14/09 as well (she was supposed to have the procedure on 12/23 but came down with the stomach flu & they wouldn't operate so it was rescheduled).  She has loose collagen, a malaligned tracking , a high Q angle & patella alta (tilted knee cap).  She will have a fulkerson osteotomy, a MFPL reconstruction and the pseudo-tendon across the knee cap for added stability.  She will have a 10 mm incision and a 5mm incision plus 2 or 3 arthroscopic incisions.  Post op she will be in an immobilizer & crutches for 6 weeks with weight bearing as tolerable.  Her first PT appt is scheduled for 8 days after surgery.  Her PT is a gem and the best in this area and has given her quite a lot of encouragement and says he will help to get her through this.   Her OS is a friend and neighbor and his son is a good friend of my daughter's, so I know he is treating her llike it's his own daughter.  BUT, I am still anxious because this is controversial surgery and it seems like such an invasive & major thing.  I worry about her handling everything - she's on meds for anxiety already and this is just really stressing her out (and therefore stressing me out).  Part of me wants to just postone it all ... let her get her senior over and done but she will hear nothing of it -- she wants it all over and done and to be close to normal by prom and graduation.  She doesn't want this to interfere with her last summer with her friends before going to college.  She, like you, just doesn't want to have to be continuously of every step taken & dislocating it again or worse..........
I hear ya -- wish I could give you (and our family too) a crystal ball and would know more about what to expect.  Best of luck -- keep in touch as we'll be going through the same things at the same time.  Her pre-op appt is Jan 6th and I expect we will be firing a lot of questions again to the doc! 
Hang in there ... we will too!

Mom in PA

[dileigh]

I'm one of the success stories.  I had an ACI with my Fulkerson so that changed the post op situation some, but without the ACI I would have been healed a while ago.  I'm currently 9 months post op.  My knee tracks perfectly now.

Take your pain meds, I got a shower seat to help out with having to keep the leg straight once I was allowed to start showering again.  I had a straight brace for several weeks and an adjustable brace after that.  Help and ice are a must.  I had an Iceman that I bought off ebay.   They use a temperature controlled ice and water system to be able to keep it on longer than an icepack.  It's a matter of preference as to which way you want to go, and there are many different kinds available.    It is very difficult to carry things like food and drinks with the crutches. The weight bearing part is also partly up to your OS,  I'm in my late 40's and overweight so I was NWB for 6 weeks.  I progressed to FWB pretty quickly after that  ( a couple of weeks)

How long it takes to go back to work is up to your OS.  And what leg you are having surgery on.  Needless to say, surgery on your right leg will take longer since you won't be able to drive for a longer time than if it was on the left.  I'm also not sure about the running since the ACI changes those time frames as well.

You should have one more pre op visit to be able to ask the OS some of these questions.  Write them down or you will forget to ask.  More people are better off with the surgery and it currently has a pretty high success rate.  Good luck!


Diana 

[birdmommy517]

Everyone....

Thank you sooooo much for sharing about your experiences. I DO feel better at least just hearing and knowing what others have been through.

And Mom in PA- I'll have my laptop in bed, so we'll have to stay posted on my and your daughter's progress! Honestly, you might want to try Xanax for your daughter. I know how debilitating anxiety can be, and if it worsens, it can spread to seemingly unrelated things like migraines, muscle spasms, and just nondescript pain that can be mistaken for fibromyalgia. But fix the anxiety, and alllll the rest of it miraculously gets better. It's crazy... Xanax is one of the milder drugs for this purpose, and you can take an incredibly low does as I do, but if the Dr. feels she is too young for that, there is an herbal remedy that is safe for someone younger. It's called "scullcap herb", and you can get it at most health food stores just loose/bulk. It makes a pleasant tasting tea, and doesn't make you sleepy. I would say for me, it is about equivalent to 0.25 mg of Xanax. Just DON'T do St. John's Wort or Kava Kava, as they might not be safe for her young brain!

About the invasive part though... She will heal faster now than any other time in her life, for what it's worth. Also, my OS is not doing the little incisions. Apparently because of all the reconstruction of connective tissue (or whatever other reasons that were not clear to me), there will be a 6-8" incision for mine.

Anyway, thanks again for talking with me about this, and I still hope to hear if anyone else has a story to tell or anything else to add.

Charlotte

[heidi63]

Hi Charlotte -
Well, so much for my keeping up with this thread ... I've been too busy keeping my own thread going & posting on it.  Visit "Daughter having Fulkerson on 1/14/09" for more indept discussion about my daughter's operation & post op.  She's doing really well!  How are you doing?  How did your surgery go?  I hope to hear from you soon & hope you are doing ok with your recovery .... it's a hard one - especially that first week!

Best wishes 

Heidi

[birdmommy517]

Hey, thanks Heidi... I look forward to reading your other thread about your daughter. I'm glad to hear she's doing ok!

My surgery recovery has been AWFUL, but it's not because of the Fulkerson Osteotomy. That part- well the bone sites are still a little sore, but that's the worst of it. They did a nerve block, but it numbed my mid-shin to ankle instead of my knee. I had forgotten about this, but I learned at the dentist that my nerves are not where they should be... It's always so hard to numb me up for that. This NEVER OCCURRED to me until a few days ago, after going through agonizing bone-crushing pain for about 4 days... That's a freak thing I'm pretty sure... But then the percocet made me really sick, so I was just in hell for a few days. Thankfully, healing took over and the pain started to subside naturally.

They also ran into problems with the ligament reconstruction part with me. They said when they got in there, there was nothing left to work with, so they had to harvest a LOT more of my hamstring, which meant more pain down there and many more little attachment sites for that, which you can feel too.

As a result, they have had me bed-bound for 2 weeks now, not even allowed to let my toe touch the floor. Pre-op, they said I'd be bearing weight within 24 hours, but the issues with the ligaments and tissues changed things...

Since Monday, there has been a circulation issue which makes it incredibly painful if I let my leg down for anything. Minutes up on the crutches directly correlate to how bad it gets... Feels like my calf and ankle and heal will explode like a water balloon, though there is no swelling. The only visual evidence is my leg turns purple from mid-thigh to the tips of my toes. I thought I had a blood clot, but they think it's because I've been sitting up too much, and need to lie flat more with my leg elevated, for at least another week until my post-op appointment, and maybe even longer. Not what I wanted to hear...

Personally, I think this was exacerbated by the fact that I stopped drinking my medicinal tea since the Saturday before... I was taking a blend I made to help improve leg circulation and prevent blood clots post-op for leg surgeries. My husband was making it way too strong and it tasted pretty bad, so I just kind of stopped. So far, the elevation and lying on my back nonstop has not alleviated this problem yet, so I'll post again if the tea seems to work. If my theory is correct, I should see a big improvement in 24-48 hours. It just doesn't make sense to me that I was not up any more than I had been all along, then BAM this huge new pain all the sudden.

Having said all that, I should point out that Sunday (Day 11), I was almost pain-free all day, not even needing Advil. The pain was maybe a 2 or 3... kind of an annoyance that I could live with, you know?

So, that's my update. If anyone's interested, here is what they told me to look out for a REAL blood clot, and said to call ASAP for any of the following:
-swelling or redness
-any weeping or oozing from the incision site
-tissue hard/hot
-fever
-pain that's concentrated to one spot, usually the calf. (mine was widespread, not a spot)
-sharp, stabbing, or piercing pains

As for the tea, I did a lot of research to find herbs that would aid in improving circulation especially to the legs, bone healing, tissue or wound healing, surgery recovery, a bit of immune support, and general nutritional support, all while avoiding anything that would cause an increased rick of bleeding. I also looked for things that could be taken daily for at least a few weeks without risk of side effects. I'll try to include a hyperlink on each herb where I can find more info online... I personally use a book.

Here is the blend I came up with:

-butcher's broom (cut herb) http://www.ageless.co.za/herb-butchers-broom.htm
-oatstraw (cut herb) http://www.ageless.co.za/oat_straw.htm
-milk thistle (cut herb or seeds) http://www.ageless.co.za/herb-milk-thistle.htm
-hawthorne (cut herb or berries) http://www.ageless.co.za/herb-hawthorn.htm
-yarrow (cut herb) http://www.ageless.co.za/herb-yarrow.htm

If everything is cut herbs, use equal parts of each to make your blend. If you have to use seeds or berries, use 1/4 the amount of that. (like if 1 cup each everything else, use 1/4 c of the item you have to do a seed or berry on.) Then us 1/2 teaspoon of your blend + 1/2 teaspoon of your favorite tea for flavor and steep 5-10 min in water just shy of boiling. (Like boil then turn off for a sec before brewing... too hot and the tea will taste too bitter.) All of this is to be done AS A TEA ONLY. Eating the herbs whole can stress your liver and kidneys and dehydrate you, hurting instead of helping.

After you have healed some, you can add marshmallow root, which is excellent for reducing inflammation and pain, as well as preventing bladder infections that might be caused by inability to empty your bladder completely when you're wearing a crazy leg brace. Just use with caution at first, as it contains salicylic acid, which is very close to aspirin. Basically introduce after highest risks of bleeding have passed. After that, it is my favorite herb for so many things! This herb, along with milk thistle, can also help offset the constipation associated with narcotic painkillers.
http://www.ageless.co.za/herb-marshmallow.htm
http://www.dickcontino.com/marshmallow-root-herb-remedies-side-effects.htm

I buy everything at the local health food store, and we also have a tea specialist in town where you can get almost anything rare. But start with the bulk section of a health or natural food store. If they don't have it, ask them to order it!

DON'T GO CRAZY ON HERBS WITHOUT DOING HOMEWORK! Some of them can make you SICK AND HURT YOU if you use too much or for too long. If in doubt, ask an expert. There is a lady here in town who taught me a lot and she can order anything for you, and she loves making "custom blends" for people. I trust her, and would be happy to pass her contact info along to someone if they need it. (Please ask.) The ageless website I linked to above is pretty good for info, along with precautions. They do not list *all* the uses for everything though. It's best to consider information from a variety of sources, but I used this site because it is the most well-rounded in one spot, and has been accurate and consistent in what they put as far as my own research has revealed.

Charlotte

P.S. Should I post the tea recipe and info as its own thread with an appropriate title so people can find it? Thanks...