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Author Topic: TTT (Open Patellafemoral Realignment)  (Read 762 times)

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Offline red1702

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TTT (Open Patellafemoral Realignment)
« on: October 19, 2010, 10:44:09 AM »
Hi all,
I just wanted to put my two cents in as to what to expect when having this procedure. I had mine on September 21st this year.

My first little gem of wisdom would be this Ė do not underestimate how painful this procedure is. Without wishing to scare anyone, my hospital ward-mate, Charlotte, had three children and said she would sooner go through childbirth again.
This is not something you will want to put off for long. The sooner you get it done, the better as far as I am concerned; I was told that had I had this operation a few years ago, my recovery would have been quicker and easier. I am only 22.
Ask as many questions as you want, as many times as you want, and donít be afraid to ask about pain relief options. In my pre admission appointment I made sure that it was common knowledge that I have a very low pain threshold and that, basically, I am a big wimp. It was better to admit this and have all of the pain relief options than try to be brave! I was given a femoral nerve block during my operation which is injected into your groin area whilst you are still under the anaesthetic, and keeps your leg numb for hours after you wake up. Keep this in mind though- when the injection starts to wear off, you will find yourself with a burning sensation on your kneecap which is unpleasant to say the least. Mine lasted about 12 hours, whilst Charlotteís lasted a good 24 hours; it depends on each person individually.
Because of the amount of bandages you will be wrapped in, ice isnít terribly effective but it is certainly worth having a big bag of it resting on your leg anyway. I was given liquid morphine which was taken orally every 2 hours and although it doesnít kill the pain completely, it does take the edge off slightly. Another thing to consider is that it will make you feel a little drunk, and many people find that sensation unpleasant. I also had codeine and paracetamol every 4 hours. I was in a leg brace straight away which was locked completely straight for two days, then was unlocked to allow a 30 degree bend. I am now at (almost!) 60 degrees. The brace allows the bend, but my muscles haven't quite grasped the concept yet† ;D

Be prepared for bed-pans and bed-baths† :-[ . Again, if you are used to being independent, it is a difficult concept to grasp, but you have just had major surgery and you will need help. Youíre not going to be getting out of bed on your own for a while, so be gracious and if you are offered help with washing, accept it. Having a bed-bath will make you feel a million times better.
I will tell you only about my experience, and give advice; this is not intended to be medical advice at all, just a few tips from one person to another.
I was in hospital for two nights and was pleased to be going home, but I made sure I was sent home with a bottle of liquid morphine and plenty of painkillers. I was very lucky to have someone at home with me constantly, as I was still unable to so much as go twenty yards to the toilet on my own. Everything is extremely difficult when you are on crutches, particularly carrying things, so I dug out an old backpack and made sure anything I wore had pockets in it. I keep my phone on my person at all times, because if someone has to pop out for even a minute, that minute is a really long time if you fall. I lost my footing a couple of times, which is very painful, and I needed help to pull myself upright again. I didnít fall completely down, but I did slip several times and my bodyís automatic reaction was to tighten the thigh muscle to help me stay up. It hurts.† :'( Sturdy footwear is imperative.
I spent a good chunk of my time crying after I had this operation, sometimes from the pain, but a lot of the time it was because I was frustrated with my lack of ability to do anything for myself† >:(. It helped to write down how I was feeling everyday in a diary, as it enabled me to look back and see the progress I was making. It was very slow, but still evident.
I went back into hospital just three days after being discharged because my leg was so swollen I couldnít even stand, whereas Iíd be making good progress up until that day. I was taken into A&E and shortly after being put into a room, my temperature soared through the roof and I started losing consciousness through the pain and panic. My whole leg was so swollen that it was agony even to lightly touch, and so it was assumed that I had an infection. I had to have a needle put under my knee cap to drain off some fluid for testing, which believe me was no where near as painful as I was expecting. In fact, afterwards, I felt relieved, as two syringes of fluid were taken out of the joint and therefore I didnít feel as swollen. Thanks to my low pain threshold, I was given a freeze spray on the area before he put the needle in. I had a five day stay in the hospital this time, whilst they figured out what was wrong, which was frustrating and boring. I had a total melt-down, threw a huge tantrum because I was so sick of being in the hospital and threatened to discharge myself† >:( :'(. That night, in an attempt to sedate me, I was given sleeping tablets and plenty of morphine, and I slept fairly well for the first time in a week. I felt better in the morning, and although a little embarrassed, everyone on my ward had admitted that they had gone through the exact same thing. More importantly, that morning I managed to have my first shower.
I havenít slept very well since the operation and I have only had one night where I have slept through. At first it was the pain keeping me awake, now it is being uncomfortable. Plenty of pillows and an elevated leg have helped, especially being as after surgery you must sleep in the brace. I am a side-sleeper, so sleeping on my back was hard, but as the weeks have gone on I have learned ways to sleep on my side. Itís not comfortable for very long, even with my leg sandwiched between pillows, but again, it shows progress.
Being on crutches is frustrating and difficult, especially when you start to get aches and pains in your back and shoulders. Heating pads and massage help, and if you donít have someone who will help, try to get hold of one of those electronic massagers. I got calluses and blisters on my hands eventually, so I recommend plenty of hand cream and getting some weight-lifterís gloves. They are slightly padded and will stop your hands from aching as much.
Another thing I wouldnít have been without is my grabber. One of those litter-picking looking things which will assist you in accessing things that are just out of reach. Invaluable.
I am exactly four weeks on from the op and my scar has healed well enough for me to start using Bio-Oil to minimise the appearance of the scar. With my leg straight, the scar is four inches long and a millimetre wide. At the moment it is vivid purple, but I have been assured that it will fade over time. I am already back at work; I returned last week (three weeks after op) as I have a desk job and the company I work for have made plenty of adjustments for my return, including moving me into a bigger office downstairs, giving me more room to manoeuvre. I am also right near to the toilets now and also to the kitchen, and it has been good for me to have something to focus on. I do get very tired very quickly and as soon as I feel that Iíve had enough, I am allowed to go home. Iíve been averaging 6 hour days.  :)
Be prepared for this. Have plenty of things to keep you occupied and ensure you have some really good friends around to keep your spirits up. It might just be a case of someone sitting and watching a movie with you, but it goes a long way in making you feel better.
Another thing is that I barely had an appetite after this surgery, which I am assured is quite common. Keep plenty of things to snack on as you might not be up to eating full meals. I had a mini fridge next to my bed with some cold drinks and snacks in it. It was another little thing that helped me to feel less dependant on others.
I went out a few times, with the aid of a wheel chair and a leg extension attachment which allowed me to keep my leg straight and elevated. Getting in the car was something I thought Iíd struggle with, but I just sat in the back of the car with my legs up on the seats. Itís not going to be easy in a two door car, but I had access to a four door car and I just sat on the edge of the back seat with my legs out of the door and shuffled myself backwards.
Itís little things that can make life a lot easier, such as the equipment from the occupational therapist. I had a frame that slotted over the top of the toilet which made life a lot easier. I also borrowed from a friend an over-bed table like the ones you get in the hospital, which was useful for putting my laptop on and for eating, as well as keep everything really close to hand.
Remember that every one is different, but being prepared for all eventualities will help make everything a little easier. I am an example of the extreme as I am now suffering from post-surgical traumatic stress, but I am getting better everyday and learning to look forward to new things and see the bigger picture. My surgeon has recommended that I get my other knee done in a few months...† :-\
Good luck, and please feel free to ask me anything!
[email protected] and mark it as urgent with something in the subject line so that I donít miss it in my junk folder.
Many hugs,
Red xxx

Offline duckie857

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Re: TTT (Open Patellafemoral Realignment)
« Reply #1 on: October 20, 2010, 12:19:40 AM »
Red,

You might want to consider coming over to the Post-Op thread and sharing your story there. You're more likely to find a lot of people over there that had the TTT. http://www.kneeguru.co.uk/KNEEtalk/index.php?board=6.0

Did you just have a TTT or did you have any other work done too? It sounds like you were in an awful lot of pain and had a few rough patches!

I'm 23 years old. I had a TTT on October 6th. No soft tissue work. My surgery was at 2PM. I had a femoral nerve block as well, but I was awake when they gave it to me. That part sucks for me every time. I spent 23 hours in the hospital on a morphine pump that I stopped using by mid-morning. I was on 20mg of Percocet (Oxycodone) for the first few days but found it it was too much and went down to 10mg and then 5mg. I'm 12 days post op, and other than at night for sleeping, I'm off pain medication completely.

I have little to no pain during the day, but my knee is a bit more swollen now that I'm getting around more.

I'm starting at-home physical therapy tomorrow. I have 45 degrees ROM as of today. I start outpatient physical therapy at my PT's office next Tuesday. My OS's goal is 90 degrees starting next Wednesday, full ROM by November 3rd. I'll be off my crutches on November 3rd and out of the brace by November 23rd.

Overall, the pain hasn't been nearly as bad as I would have thought. The first 48 hours were the worst for me!

Good luck and keep us posted :)
'04 - '10: Years of dislocations & subluxations

01/13/2010 - LR, MR, VMO Advancement
10/06/2010 - Fulkerson Osteotomy (TTT)
09/02/2011 - Scheduled MPFLr