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Author Topic: Post-op patella baja....  (Read 7837 times)

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Offline ~*Heather*~

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Post-op patella baja....
« on: September 05, 2003, 07:57:14 PM »
Hello everyone.  

I am back home now. I stayed one night for pain control which was very much needed.  :-/   I am getting along just fine at home with ice and pain meds now. My husband is here and actually extended his leave time so he will be with me for a few more days.

It turns out I didn't really have a TTT.  I had a tibial tuberacle osteotomy. SO I had a TTO if you will...lol. Another resident surgeon cleared that up for me. My kneecap was tracking poorly as expected because of the baja.  There was minimal debris under the patella and in the groove.  My OS did a scope to check things out first and took pics of the debris for me. He removed them as well.

He said I could bathe tomorrow (Saturday) as long as I didn't soak the knee. I have never gotten the knee wet that soon after surgery so I will probably not do that. I will wait the 7-10 days as I think I should.  He reused my incision from the quad tendon repair and just made it a little longer over the tibia to fix the baja.  I already peeked...I couldn't help it.  It's covered well by steri-strips. Curiosity gets to me  ::)

Here are a few issues I am having though, maybe someone could shed some light?  My ankle and foot is swollen badly. This happened with the quad repair but this time I can barely move my toes an there is a lot of pressure!  It went down after a night's rest but this morning it is starting again. It did happen in the hospital but they said it was "trauma" swelling.  It gets bad at times and ice doesn't really help.  Has anyone had this happen?  It's gotten worse after I left the hospital, but I also had a 3 hour car ride home and 3 flights of stairs to get up.

Also, at the incision site over the tibia, I have blisters forming on the sides of the steri-strips.  They itch like mad, but I have never had them before.  It is something I should call my OS for?  I see him the week of the 15th for my first post-op visit.  I have them covered well as I do not want them to burst and cause infection (is that possible?)

Also for anesethesia, I am horrible after general. I throw up for days and just feel horrible for quite some time so I didn't have it this time. This hospital offered me a sedative accompanied by an epideral.  Basically described it as breathing on my own and no tube down the throat.  I do NOT remember ANYTHING of the surgery. The sedative they gave me worked just like a general!  I didn't feel the epideral at all. I would advise anyone who does not do well with general to try this method. I was so much more coherent afterwards.

I am partial weight bearing and in an immoblilizer for 6 weeks. I believe I go to a hinged brace next.  He wants my bone and quad tendon to heal before I start PT.  I forgot to mention he also removed the previous OS's suture ties and redid them as well as tightening up the repair.

We  will know in about 9 months if this route was a good one.  Pain control is great right now.  Thank you all for wishing me well and taking the time to post your support.  Any comments or suggestions are always welcome!

Heather
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

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Re: Post-op patella baja....
« Reply #1 on: September 05, 2003, 08:49:40 PM »
Heather:
Just wanted to wish you a quick and painfree recovery.  I really do hope this is the answer to your prayers.  Take it easy and don't push yourself to much.
Sending you positive and healthy vibes.
-Kolleen

Offline Heather M.

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Re: Post-op patella baja....
« Reply #2 on: September 05, 2003, 10:12:04 PM »
Heather!

I've been checking every day for your first post-op report.  I'm so glad that things seem to be going relatively well--better than expected, certainly.

As for the swelling--gosh, you had so much work done.  It would be weird if there weren't any swelling.  I'm SURE the immobilizer makes it worse, because it's forcing all the pressure into your lower leg and foot--ask the doctor if you can  loosen the immobilizer when you are sitting still on the couch (NOT SLEEPING) and see if that combined with elevation helps. It will be swollen for some time, I'm sure.

The blisters are an unfortunate side-effect of the arthroscopy and all the work you had done.  The skin was probably retracted during the surgery and in general just abused.  I would definitely call the nurse and ask how to care for them, but rest assured they are pretty normal, too.  I was even told my arthroscopy could cause water blisters on the skin--the resident just cleaned them (OW) and kept them covered with a clean, dry dressing.

What does your doctor say about continuous motion or preventing further scar tissue?  Are you on CPM--I can't imagine doing that with what is essentially a broken leg!  I'd love to hear more of your home exercises, PT, etc--or is it that you are just to take it easy for the first few weeks?  Not even leg lifts or ROM stuff?

The news about the epidural is a relief.  I'm VERY lucky in that I don't respond badly to general anesthesia at all--they give me the anti-barf meds (I'm sure that's their real medical name) and I do just fine.  I'm terrified of the idea of an epidural, and my brother had an absolutely dreadful experience with one so I'd been very afraid.  You've reassured me.

I'm so torn about what to do, I just don't know!  I think I've decided NOT to do another scope in the fall.  The doctor said it wouldn't address the baja, and I really think it's part of the problem.  Besides, if I had an open repair they would also start with a scope and clean out any debris and scar tissue.  Sigh.  I'm just so messed up about this, so I'm eagerly awaiting your updates.  I really hope everything goes well for you.

I would guess your procedure wasn't really a TTT because it didn't move the tibial tubercle medially or laterally, right?  It was just moved proximally or up toward the kneecap?  Did you have a bone graft from your hip?  How does your quad feel?

I'm getting very worried about my quad and quad tendon--the pressure and traction there is so tight.  I honestly feel sometimes like it might just rip or something.  I don't know if that's normal, but it's become a big concern in the last two weeks since I started PT again.  My pain levels have gone up as well--today I'm going to have to cut out the eliptical (7 minutes on slow, no resistance) and leg presses (60 pound) because my pain levels have been off the charts, and those are the new exercises we've added.  2 steps forward and 3 back is what I feel like sometimes.  That is giving me incentive to get this dealt with.

Keep in touch, feel better soon!  And watch out on those stairs, I was very scared to hear you describe that!

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline ~*Heather*~

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Re: Post-op patella baja....
« Reply #3 on: September 06, 2003, 02:07:25 AM »
Heather,

The swelling in the foot and ankle is where my concern was.  The knee is swollen as it should be. Sad that I can tell that, huh? I just never had swelling in the foot where moving my toes took effort.  I looked again at the blisters and they look like water blisters and have gotten bigger.  Doesn't this always happen on a Friday at close of business when you don't want to be a pain in your OS's butt? They aren't painful just itchy so I'm not too worried. I also realized that my brace was rubbing in the approximate area where they showed up so maybe that is the culprit?

I do loosen the immobilizer while lying down because he had it tight and has a bandages along with an Ace Bandage wrapped and if I don't loosen it, the ice would never get to it. I did notice though when it's loosened that the swelling in the foot lessens.  I'm glad you pointed that out.

I really didn't have an issue with scar tissue or at least he didn't mention it to me or my hubby afterwards. He just mentioned the debris behind the patella. I was glad that I wasn't one of the ones who has that problem!  I'm not on a CPM machine as of yet.  He wants to wait at least until the first post-op (7-10 days) before I begin passive exercises at home. The more aggressive PT will have to wait until I have seen some progression within the quad tendon.  He wants to go slowly and let this thing heal up as much as possible before aggrevating it further.  He did tighten the quad so I'm hoping that this will be the last intervention to it. I'm all for waiting for PT too as we all know how bad PT can get!  :o

I get the anti-barf meds too, but they never helped much.  I just felt totally YUCK after all my surgeries and it was days before I could keep something down.  We had stocked the house with ginger ale and saltines and since I went the other route, I haven't needed them. My husband had asked about complications with the epideral and they reassured us that there are risks as with everything, but they won't do anything until they are sure it's 100% effective.  If it wasn't then they just do the general anyway.  One more reason I opted for it was because of the postop relief you get from it. You are still numb afterwards so it's easier to get on your pain meds and get in under control before feeling comes back. I was freaking out before the surgery because they gave my options for it.  I had never been given options before. Always did what I was told....hmmm?  Maybe another reason for my issues?

I am totally surprised at how well this feels.  Two days after the quad tendon repair I thought I was dying.  Maybe I've adapted to pain or something but I think this one was easier for me.  The recovery will be longer and harder though.  3rd surgery on top of atrophied muscle...Yikes!

My OS did move the tibia up about an inch and medially. He didn't mention about filling the bone, just securing it with screws. It was tracking poorly this entire time and I doubt it was totally due to the baja.  I think I had a bad repair done to the quad.  I am also worried about the quad and rebuilding it.  Mine would get tight like you described after any kind of activity, even stationery biking with no resistance.    

Even without knowing if this worked...it'll be 9 months he says. I would reccommend it.  At least I gave it a shot.  This was ultimately the last resort and also addressed the baja.  I know you had a scope scheduled, but I think you should consider this procedure.  You could always do the scope then wait the 9 months and I can finish being the guinea pig...lol. We don't have many choices here and this is a big deal procedure but when you look at it in the long run, it could be your last.  I mean you fix it and the scopes may never be needed again.  

You are up there in weight on quad sets though. I couldn't even lift my own shoe....seriously.  The lag in it was ridiculous and the pain was excruiating.  I was so unstable on the elliptical too. My workouts were dying slowly but surely. Another reason why I went ahead and risked having this surgery.  I can't live like that anymore.  

Feel free to ask as many questions as you would like about this surgery and my progression. I am always happy to share! Back to the couch and pain meds for now. I'll check back here later.  Feel free to email me if you would like, my email is listed.

Talk to you soon,

Heather

P.S.  Thanks for all your help with this. You are the one that found me on the other board and directed me here.  I really don't think I would have gotten to this point or gotten this surgery if you hadn't been here answering every question I had and explaining everything to me. I owe you big time!!!!!!!!

 
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Erin

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Re: Post-op patella baja....
« Reply #4 on: September 06, 2003, 02:47:41 AM »
Hey Heather, I hope everything is still gonig good. Hopefully this will help your knee issues. Good luck with the recovery!
Erin
7 years left knee pain/popping/giving out
10-20-00 L.knee surgery to tighten knee cap
2 years of right knee pain
9-13-02 Sprained right ankle
6-9-03 Brostrom-gould surgery on right ankle

Offline ~*Heather*~

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Re: Post-op patella baja....
« Reply #5 on: September 06, 2003, 04:00:23 AM »
Just wanted to add after rereading my post, sorry for the bad spelling, leaving words out and using the wrong words.  I'm sure it's these pain meds!! LOL! Let me know if anyone needs a translation :)

Heather
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline enuff81020

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Re: Post-op patella baja....
« Reply #6 on: September 06, 2003, 07:41:07 AM »
Hi Heather,

I might be able to shed some light on the swelling for you.  I had a lot of swelling and some bruising in my foot  and ankle and my ortho called it the natureal result of the surgrery and my foot being "down and dependent."  I have not yet gotten a good definition of that phrase, but every medical person I have said it to has agreed with it.  I guess it is a typical side effect of a major surgery on the knee.

You sound pretty positve--so I amhoping that is an indication that you are coming along pretty well from the get-go.  Keep it up, we are all rooting for you.

Take care, get better soon!  Sylvia
Both kneesOA.
Scope on rt knee,9/00;2/01
scope w/ LR and debridement rt knee 2/02
left knee same5/02
Patellar problems
LeftTKR12/16/02
Right TKR7/14/03
Complications MUA 8/14/03
R TKR revisio

Offline Janet

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Re: Post-op patella baja....
« Reply #7 on: September 07, 2003, 03:31:11 AM »
Heather:

So glad to hear your surgery went well and you aren't in too much pain! That's great, great news. We were all anxiously waiting to hear what you had to say. As for the swelling, I also had swelling in my ankle following my last scope. I had strict instructions to keep my knee above my heart and my ankle above my knee. Are you doing this?

I finally feel like I'm making some progress in PT. I guess making the change to five days a week was really needed. I've now been going 5 days a week for a month. I am finally able to do more weight on the leg press. We are working hard on gait training because I am not using my quad when I walk. My PT is hard and my knee really hurts all the time, but I hope it's worth it in the end. My doctor said 6-8 months before we'd know how successful this was, and it's almost 3 months, so I'm glad to finally see some progress!

Hope things keep going so well. Keep us posted. Good luck!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline ~*Heather*~

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Re: Post-op patella baja....
« Reply #8 on: September 07, 2003, 04:02:41 AM »
Janet,

That's wonderful about your scope and PT. I hope this does work for you.  I know how increasing PT can take the life from you though, so be careful!  

The pain from this surgery is getting worse or so it seems.  I spoke way to soon. I still have high hopes though! I think I will stay optimistic with this one.  I have to! I'm worried about when my husband goes back to work on Wednesday and the boredom and realization of knowing I'm stuck on the 3rd floor until he gets home sets in.  :-/

I can't seem to ever just feel good. I actually threw up lunch today and my appetite has gone out the window. I know I need to eat to heal so I am trying. Sometimes water doesn't even sit well.

I am elevating as you said but the swelling comes and goes... mostly comes right now. I'm sure it'll change it's only been 3 days since surgery. It just seems my whole body hurts now.  Some days it's hard to believe that I CHOSE this surgery....lol.  

Please keep me posted on your progress too.  I am very interested in learning about PT and everything else from everyone here.  The "PS" note I wrote in my post to Heather M was also for you as all the PM's and replies to me was so very helpful and much appreciated. I thank you  from the bottom of my heart!  


I go back for post op the week of the 15th. I have to call to get the appt still. I will definitely post back and let you all in on what I learn. Any thing I should be focusing on asking rather than the PT and healing process? Any questions about the procedure or stuff like that?

Heather    
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Laura_S

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Re: Post-op patella baja....
« Reply #9 on: September 07, 2003, 09:31:14 AM »
HEATHER!!

I'm so glad to hear from you.  I know I havent posted on here in a long time, but I definitely thought about you on the 3rd.  Sounds like everything went smoothly.  I'm glad for you.  Just keep up the good work and listen to what he says.  I'll let you know if I'm in the same boat as soon as I get home from Duke.  I leave tomorrow (Sunday) around 4pm for the appointment which is Monday at 10.  

Feel better!

Laura
"Never give up, for that is just the place and time that the tide will turn." - Harriet Beecher Stowe

Offline cat

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Re: Post-op patella baja....
« Reply #10 on: September 07, 2003, 05:02:43 PM »
Heather,
So good to hear from you. Hope the pain is not too bad and that you have a speedy recovery.
BTW, I love your icon. It's really cute.
cat
"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 Janet

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Re: Post-op patella baja....
« Reply #11 on: September 07, 2003, 07:07:24 PM »
Heather:

It's not unusual for the pain to get worse before it gets better again. Just stay on top of your pain meds. Take them on a regular scheduled instead of trying to catch up with the pain. I sure wish I had known that at the beginning. You've had a ton of surgery. No wonder you hurt!! It will get better.

I remember when I first tore my quad tendon. It was misdiagnosed in the ER. That was a Friday evening, so Monday I called the doctor, went to see him Tuesday and had surgery Wednesday. Before that, I never suspected I had a serious injury. One day I was fine, and the next I was down on the couch for the next three weeks. I didn't start PT until 3 weeks after surgery. It was my lifeline to the outside world. Since I couldn't drive and couldn't move around well and hurt so much, I spent my days on the couch. My dear husband would come home from work and "load" me in the car (literally) and drive me around just so I could get out. After a few weeks, I came to a certain peace about it all. I came to enjoy the fact that my life was less hurried and that I was home when my daughter got home from school. But it was hard to have my "normal" life come to such an abrupt halt. Because of all my complications, our lives still run on a much slower pace than the rest of the world. My hope is that some day I don't have to plan my life around how much I can walk and how much I hurt that day. Just think, maybe a year from now we'll both be living more normal lives! That seems like a long time, but after all we've been through, it's a drop in the bucket!

Hang in there! Try to keep your spirits up! You're in my prayers.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline ohiostatemel

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Re: Post-op patella baja....
« Reply #12 on: September 08, 2003, 05:10:35 AM »
Hey Heather.  
I have been keeping up with your progress since you got home from surgery.  I completely understand you being nervous with your husband going back to work Wed.  I was scared to death when I was left alone for an extended amount of time after my TTT.  Make sure you have plenty of "diversion materials" laying close by.  
It sounds like you are doing pretty well.  I am glad that all went as it should and hopefully, your pain will begin to decrease significantly in the next few days.  I'm thinking of you!

Take care,
Mel

Offline ~*Heather*~

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Re: Post-op patella baja....
« Reply #13 on: September 08, 2003, 05:43:45 AM »
These dang blisters that started at the edge of my steri-strips kept rubbing on the immobilizer and finally they burst...yuck!  It appears to be water though. It stains yellow smells like betadine.  I was looking for ANY signs of infection.  They itch like crazy but I am staying away from them. One ripped clear to the bottom and oozed minimal blood.  

I was cleared to wash the knee yesterday but opted not to since my OS is unaware of the blisters.  I am calling my OS tomorrow to schedule my first post-op and will inquire as to what caused these and proper care. Does anyone know?  Just a skin reaction?  Heather M. gave me a great reasoning but I am just so scared of infection. How long after surgery do most infections occur?  Am I in the clear after 4 days? I have never had this happen before with any surgery.  

I also noticed that the swelling is worse while I sleep.  I get up and my knee, calf and ankle are huge even if I have loosened the brace a tad. Also normal? Also the
last two days I have slept about 15-17 hours a day. That wasn't from the meds though since I am trying to ween them. They make me so ill that I can't hold anything down except liquids.  Hubby wakes me for ice so that's not the cause either...lol.

The blood rushing sensation when getting up is horrible too! OUCH!  :'( I'm so dramatic huh?  Sorry, I can't help it.  Any advise would be wonderful.  I'm just paranoid I guess.

Heather

   
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Jillian24

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Re: Post-op patella baja....
« Reply #14 on: September 08, 2003, 06:49:15 AM »
Heather,
    I am sooooo glad that you are home. I have been waiting to hear. I had the swelling as well. It went away in about 2 weeks. I had aweful bruising as well. Thats what hurt me the most.
It sounds like your recovery is going well and I am so happy for you. I hope that your progress continues and you have amazing results..best of luck to you sweetie and get some rest. I will be thinking about ya.....Jillian
ONE TTT LAST OCT
10 LR'S    ONE MEDIAL RELEASE
STAPH INFECTION.....MANY MONTHS IN HOSPITAL















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