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Author Topic: TruFit Plug Surgery 8 days ago  (Read 20012 times)

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Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #15 on: September 23, 2009, 06:57:53 AM »
13 weeks and Plug is doing pretty well.  I'm having more pain at end of the day if I've been on my feet too much, but it's still just an achey kind of pain.  Days I'm off the knee there's hardly any achiness. Had OS appt this morning, and he's still pleased with the Plug progress, and I am too.

I asked him about the warm spot I have over the Plug area, and he was not concerned. He feels the whole knee is pretty much inflamed from the patella cartilage problems. 

Although he thinks it's too early to call the MFX a failure, he doesn't hold much hope that it helped any, either. He feels my patella cartilage is too far gone, and I'm just bone on bone there and the groove.   After cleaning up all the fraying under the patella, he said there just isn't enough cartilage left. He gave me a cortisone (Kenalog) injection, and wants to see if that will settle the knee down. I asked him if the anti-inflammatory benefits of the injection would be counter productive to the MFX, and he said since it has been 3 months, he didn't feel it would hurt the MFX at this point, and he was more concerned about getting the inflammation and pain from the patella arthritis under control.  (I feel that statement confirmed his suspicion the MFX wasn't going to help).  He attributed increased pain I'm having radiate from top of tibia down my shin as inflammation, also. He didn't elaborate, so I'm not sure if it's bone pain or tendon pain I'm feeling. I'm also having a little bursa inflammation on upper top area of my patella, too. Feels like a quarter sized gel mass under the skin that slides around a little. More of a bruise type pain. Hope shot helps that too.

The patella / groove pain has steadily gotten worse. I'm in more pain now than post surgery. Absolutely miserable at night. I am taking Benedryl just to get 3-4 hours of sleep, then dragging through the day, trying to catch a quick catnap when I can, but most days can't.  I wanted something for the night pain, but after asking me if I had any drug allergies, I told him I can't take codeine. He just shrugged and said, "let's see what the shot does for you for now".  I stopped on the way home and picked up more Benedry.   ::)   This OS is definitely stingy on pain meds.

I like the benefits of a steroid shot, but usually have a miserable 24 hours after one. This one is no exception. Tightness in the joint and sharp broken glass in the joint feeling is the norm for me. I spent the afternoon and evening on crutches hoping tomorrow I'll start feeling the benefits of the shot.

I went to the appt with a lot of questions ready. My OS seems very reluctant about giving out much information (an understatement!), and doesn't offer much, unless asked specific questions. Even then it's hard to get answers from him. I persisted today, and kept asking questions and/or rephrasing them until I got an answer. My sister is a doctor, and even though orthopedics is definitely not her specialty (PhD and specializes in cancer/virology DNA research), she gave me some insight into how to get past layman's questions and get him talking. Besides stepping out of the room to get the injection stuff, and I'm sure to pop into another exam room and then back to mine, he actually spent 40 minutes with me.  :)

Justin.... how's it going?

Nan

Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #16 on: October 12, 2009, 07:25:42 PM »
16 weeks now.  A couple days after the cortisone shot my whole knee felt so much better. I could feel the slight pain from my Plug site more, but I think it was because the other inflammation pain was basically gone, and it wasn't over powering the pain signals.  It aches a little, but over all the Plug site is still doing great.

I had almost 2 weeks of pain relief from the arthritis and MFX. Very little swelling, and I've only had to ice once a day, or not at all if it was an easy day. I even got lots of sleep at night, too.  My knee 'almost' felt normal again. I only tried climbing stairs the proper way once. My quads aren't quite strong enough yet, and I didn't want to ruin my good day.  :D 

This last week I've felt the MFX and arthritis pain gradually start to come back. I've had to ice a couple times a day, and long bouts of standing seems to aggravate it.  Deja vu.  :'(
It's not as bad as it was a month ago, but DANG! I was hoping to get more relief than a couple weeks.

I have an OS appt on the 20th. Hope he has another backup plan.

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #17 on: October 18, 2009, 09:57:12 PM »
Hi Nan,

We have finally figured out the problem, which is a relief...I was starting to think the pain was in my head!  Work comp has been a pain in my ass and I regret that they are involved with my knee.  The low quality MRI they called for showed nothing in the knee and we proceeded with therapy and treatment with that information.  The OS at the Steadman-Hawkins recognized the crappy MRI and ordered a new MRI, which showed the blown out MFX still holding on by a thread and flapping in the fluid...under it is exposed bone which is starting to spur.  The OS in Denver is ready to go with an MFX in the groove and a minor Lateral Release.  I guess the after care of the MFX is biggest factor in success and my Doc then, my PT then (no experience), and myself failed to make the best of it.  I was back to work when I should have just started full weight bearing or phase 2 of post MFX PT.  I was also told that the OS needs to make a "bed" for the new cartilage to form and that was not done either.  The example I think works best is gluing something back together...for the glue to adhere correctly it is best to rough up the surface a bit. 

What really sucks is that now we know what is wrong and what needs to happen, work comp does not want to have it done in Denver (although they have worked with them before?).  My work comp OS 's (3 so far) seem intimidated by the S-H brand and want me to be seen in Denver, but Work Comp insists to have it done somewhere else...alll the while I have not been able to work (the longer I am out the less I get paid).  So my next appointment is at KU med on Nov. 2nd, so we will see what he says armed with the new information from the S-H clinic.  I guess the most frustrating part was not only a misdiagnosis based on bad evidence, but I am not even allowed to pay out of pocket to get this done (or they have threatened to take away all of my work benefits!) with a doctor that I trust will get the job done.

Sorry for the rant, I am just getting tired of the BS that is involved with an injury that occured in March.  I feel bad that your are having issues post surgery, but you are still in the Rehab portion of the MFX process.... http://www.steadman-hawkins.com/knee_microfracture/recov.asp ...and should be very careful until you are 6 months out.  Maybe you need to review the rehab protocols again with your PT?  Have you and your doc discussed the protein injections yet?  Even with the damage I have, I was still feeling great for almost 2 months once we started the shot process...

Have a great weekend!

Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #18 on: October 19, 2009, 04:08:30 AM »
Oh Justin! What a hassle you're dealing with.  Can your S-H doctors write letters on your behalf to worker's comp? Can you go up the chain at Worker's Comp and get someone to listen to you? Have you checked with your OS office, or S-H and see if there's a patient advocate that can get something happening?  What a bunch of crap you're having to deal with!

I go back to my OS Tuesday. My knee is still a little better than it was a month ago, but is still very painful, especially at night - and more so if I've been on it all day.  I'm taking the max doseage of Motrin or Tylenol during the day, and it helps take the edge off, but I need to resolve the problem - if there's a fix out there.    I'm sure he was hoping for the off chance that the cortisone shot would work, and since it didn't do much, I'm hoping he'll have another option when I see him Tuesday.   I'll post again after I see him.

Hang in there - stay strong.

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #19 on: October 21, 2009, 05:47:49 AM »
Hi Nan,

Fortunately I am a 15 yr exp manager at a major retailer, they have a ton of training $$$ in me.  I am supposed to be hitting the most productive years now and I am only 32.  Therefore my company supposedly has a strong interest in my return, so I called our HR dept and they are helping me wade through the BS...because our work comp is outsourced. My S-H OS also agreed to be paid from my work comp, so if they further deny him, we know it is about my case manager's ego at that point. The OS I see on Nov 2nd is versed on all of the latest and greatest when it comes to cartilage regeneration...so we will see.

How did your appt go?  The Docs at S-H go with Protein injections at a certain phase of the rehab of MFX.  They also fit you with a special brace to keep the load off the groove, along with orthodics as standard operating procedure.  Did/do you have or have to do those things as part of your rehab?  If you have the time you might look at the Jan 2009 sports medicine journal...it has some very interesting articles about MFX vs other procedures.

Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #20 on: October 21, 2009, 07:43:45 AM »
Hi Justin. I'm glad your employer and OS are working with you (& for you!) to get through that WC mess.  Hopefully it will all work out for you soon.

Today's OS visit was good/bad.  We are both pleased with the Plug. Pain is almost non-existent there now.  He feels the groove MFX is probably not good, and the almost non-existent patella cartilage is his main concern.  He showed me the photos he took during my surgery, showing the awful condition of the cartilage.The groove damage was pretty large, and he told me he really didn't hold out much hope since it was grade IV, but he did the MFX hoping it would work. He discovered it while in there for the Plug surgery.   We discussed my options.  He is recommending trying Orthovisc injections to delay TKR, although he has no guarantees that it will help.  Am waiting on insurance to approve the injections.

I'm 48 (for another 24 hours anyway  ;D ), and am not a candidate for ACI or any other cartilage repair procedures.  If I was younger, and the rest of my cartilage was in better shape, I'd be estatic about the Plug success.   Kind of bummed now.....

Hang in there.
Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #21 on: October 22, 2009, 01:45:10 AM »
Hi Nan,

If my cartilage was not good everywhere other than just the two spots I have, I would have definately pushed for a full or partial knee replacement.  Every one I have talked to and my family member (I got my crappy knees from somewhere) has LOVED their new knees.  I rehabbed a lateral release next to a 40 year-old TKR and he rehabbed as fast or faster than my then 28 yr old self. So do not dread them...think of them as a possible solution that can last up to 15 yrs!

I really think you will like the orthovisc shots, except when they are administered...ouch! I talked to the orthovisc drug rep in my area and she recommend that I stay off my feet for 24-48 hours. It is also recommended on the website and in the instructions that come with the shots, so if you can relax post-shot and let them set up in the joint.

Justin

 
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #22 on: October 22, 2009, 02:44:19 AM »
Thanks for the tip, Justin.

I agree with you about just getting on with it, and getting the TKR.  I know it's the right thing to do. The timing is just awful, though.  And the expense I'll have with a huge deductible and co-pays.  :o   Just now getting this last surgery paid for. 

So do not dread them...think of them as a possible solution     It is a solution.  Although I haven't had years of knee pain like a lot of people on this board, I have had 6 months of misery, and it's not giong to get any better.  That's the reality of it.

Tomorrow is my birthday, and my family is taking me out to celebrate (the demise of my 40's, lol!).

Keep me posted on your knee and surgery.  Hang in there...

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #23 on: November 04, 2009, 12:28:42 AM »
Hi Nan,

Unfortunately I am one of those who have been dealing with these issues for the better part of 4 years.  Pre-surgery in 2006, I was a runner, working toward a brown belt in Tae Kwon Do and I also playing inline hockey several times a week....it is amazing how things change as quickly as my 45 minute surgery in 2006. 

Well in seen the "approved" OS on Monday and without much examination, he decided that the S-H doc was right on the money.  I am being scheduled for a MFX of the groove (again!), a lateral release (again!!) and possibly a MFX of the lateral femoral condyle or Trufit plugs.  I asked about the Trufit in the groove, based on your experience and my previous failure of the MFX.  He said that the first thing is that once you do plugs, you do not go back...so much cartilage is removed to place them, if they fail, there are very few options.  Second, plugs in the groove have not been met with great success, so the MFX is a higher % success.  I think the scariest thing we talked about was the bone spurring that was starting to occur in no less than 3 spots...I know with my mom's struggle with spurring in her feet, that this is something that will dog me for the rest of my life.

The approved OS's office and staff were quite the step down from the quality of the S-H clinic, basically on extreme to another.  I hope that the quality of care does not reflect that difference, I mean I have already had one bad experience and never fully recovered.  Also the work-comp direction has been so poor and inefficient to this point (injury was in March!), I really do not trust their judgment...but although this is my body, they seem to have the keys to the car, so I do not think I have much of a choice without foregoing my benefits.......frustrating, very frustrating....

Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #24 on: November 04, 2009, 01:02:59 AM »
Oh Justin! I'm sorry to hear you are still dealing with so much frustration with worker's comp.  >:(

I had the Tru-Fit plug on my medial fem condryl. It's the only part of my knee that is doing well. I had MFX on my groove. My OS doesn't do plugs in the groove, and even if he did, it couldn't be done because the defect was a fairly large linear defect.  The groove MFX pain and the awful arthritis under my patella is causing a lot of problems.  I also think I may have blown out another chunk of cartilage in the area near the plug. Not at the same spot, but on that condryl.  I went from a sitting position and quickly got up and pivoted (this was when the cortisone shot was falsely making me feel like Superwoman). I heard a loud grinding pop and immediate pain. My knee popped with every step for several days.  Exactly what happened when I originally hurt my knee this spring. I didn't have nearly as much swelling as before, but again the cortisone shot was probably helping that.   

Now the cortisone shot has completely worn off, and I'm still waiting to hear from the insurance company. 

I'm not that familiar with lateral releases, but... it is it common to have to repeat it?

You're right about the Plug being a "no going back if it fails" procedure. For me it was my only option left. I'm really frustrated, because it seems to be a great success, while the rest of my knee has taken a dive.  Lot of good a successful plug is doing me now.  ::)

Do you have a surgery date yet?

Hang in there....

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #25 on: November 11, 2009, 04:49:23 AM »
Hi Nan,

I am still waiting for the surgery approval, but it seems to be eminent.  I was doing some research about your lateral release question and I found nothing really conclusive either way.  I did find a large research study involving long term results with microfracture.... http://www.eorthopod.com/public/patient_education/11922/does_the_microfracture_technique_for_articular_cartilage_repair_hold_up.html ....The great quote from the article is: "The final analysis suggests that microfracture helps improve knee function in the early months to year following surgery. But many patients experience deterioration over time. In other words, the benefit of the procedure doesn't seem to last so the durability of microfracture is questionable."

I also found good article that I used to help my family and friends understand what is going on in my knee without getting into specifics.  http://www.denverpost.com/nuggets/ci_4675594?source=email . The name of the article is "Micro surgery is risky business" and it contains some good information.

My only guess why I need another lateral release is due to scar tissue bounding the knee cap again (I scar something fierce!) and I really did not have a good rehab post MFX and lateral release in 2006.  I am sure since we were very aggressive with physical therapy after my injury in March 2009(bad MRI that did not show anything) that I traumatized the joint more than usual, since "there was nothing wrong" with the joint.  Another lateral release will hopefully take more load off my MFX repaired groove and decrease the friction that would have otherwise been on it. (at least that is what I am told)

Are you going to get a TKR soon?  Or will you wait for several more months to see if there is some improvement?  Were you going to try the Protein shots first?

Take Care,

Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #26 on: November 11, 2009, 05:29:03 AM »
Hi Justin, thanks for the interesting articles.

I am pretty aggravated today. I have waited 3 weeks to find out if I'm getting insurance authorization for the Orthovisc shots. I finally called my OS office today to check on it. After talking with a couple people, I was finally able to speak with the person handling it. (It's a very large practice with 14 Ortho docs, and they see hundreds of patients a day). The lady I spoke with had no record - literally NO medical record for me.  She put me on hold and when she finally came back online, she said she had found my records.  She had taken over the job from the previous employee who quit. When she quit, she had a stack of records to get authorized, and she "misplaced" the whole stack. Of course... luck would have it I was one of them.   ::)   

So now I am back at square one.... waiting for authorization. The gal said she would mark the file STAT and try to get an answer for me within a day or two at most.   

I have decided to go ahead with the shots, and give it 1 try (of a series of 3 shots).  Because of a big work project I can't even consider a tkr until the project is complete, and it won't be until mid-December.  That leaves me 2 weeks to try to get one scheduled. I dont think the stars are going to align to get it done according to my schedule, lol.   I have a $5K deductible that I've met this year, so delaying it until 2010 really bites, but.... hey it's only money, right.   :( 

MFX sure seems to be a "maybe" fix, doesn't it? I wonder how long the "long term" benefits of MFX really is.  OSs seem to be quick to do it.  It's hard to get a good picture of its success rate and long term outcomes based on postings on this forum. The majority of posts are from patients who are having trouble post-MFX.  Kind of skewers any data.

 Hopefully science will continue to have breakthroughs, and something more long term is coming soon.  You are young, so hopefully whatever it is will benefit you. 

How long until you have approval and a surgery date set?

Hang in there,
Nan


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Re: TruFit Plug Surgery 8 days ago
« Reply #27 on: November 15, 2009, 09:22:28 PM »
Finally got the authorization to get the Orthovisc shots.   First one is Tuesday.  Will keep you posted......

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #28 on: November 18, 2009, 04:47:49 AM »
Had the Orthovisc shot today.  So far, so good. I wrote about it in another post:
http://www.kneeguru.co.uk/KNEEtalk/index.php?action=post;topic=49272.0;num_replies=5

I've been feeling a bit more pain in the medial femoral chondyl area lately. I don't think it's the plug site, but can't really tell.  Just more of a deep ache going on.  It might be from the area nearby that i suspect I damaged some more cartilage a few weeks ago when I stood up and pivoted too quickly.  Just not sure......   

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #29 on: December 30, 2009, 02:36:38 AM »
Hi Nan,

I am glad that the shots are working for you, I just hope that the effects last longer for you than it did for me.  I think my OS has those shots as part of the rehab program for MFX. 

FYI, I am 14 days post-op right now and I no longer feel like I was ran over by a large vehicle.  What a great Christmas Present!  I had a MFX of the trochlear groove (again), lateral retinacular release (again), debridement and general clean out of large amounts of scar tissue and loose cartilage (again).  Rehab has been going well, but I guess I will not really know much until this summer. 

Have a Great New Year!

Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)















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