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Author Topic: LOA & MUA round 2  (Read 19482 times)

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Offline Stasha83

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LOA & MUA round 2
« on: August 26, 2011, 09:47:22 AM »
Hi everyone

Last Friday I had my second surgery for AF. Pre-op my ROM was flexion of 110-115, lacking 15-20 degrees of extension and a fixed flexion deformity.

The surgeon said that the scar tissue was worse this time than my last LOA in February this year. My patella was totally scarred down and the front of my knee was full of scar tissue. This was all released. He also released some scar tissue from the posterior but not a true posterior release. My posterior compartment has also contracted. The remainder of my fat pad (some was taken out in my original surgery in June 2010) was fibrotic and has now been totally removed so I no longer have a fat pad.

Interestingly, my scar tissue had developed its own blood supply (I cannot remember the medical term for this). My surgeon said he had never seen anything like it. I think that explains why we knee was purple and why my veins had become very prominent, I guess they were feeding that area.

Post op my ROM was 0 extension and with help from the physio, 140 degrees of flexion. I had a femoral nerve block put in while I was asleep but when I came round I could still feel the pain so it was decided to give me an epidural. My blood pressure and heart rate were a bit up and down so I spent the first 24 hours in the high dependency unit which was a little scary.

On Saturday afternoon I was moved down to my room but the epidural remained in place until Monday. I also had a fentanyl PCA which I found I needed despite the epidural.

I had physio 3/4 times a day and we worked purely on ROM. My extension began to slip after a few days and my leg no longer lies straight without force. It seems determined to spring up and have a deficit of about 10 degrees. I am obviously disappointed but the fact that it can still go straight with some force gives me some hope. Perhaps it has just sprung back because the compartment has contracted and needs a lot of stretching out? My flexion is still going well but my surgeon has said that the extension is what is more important right now.

I came home on Wednesday and have continued my routine with the CPM and extension and flexion exercises. I see my own physio today so will see what he thinks. My medication at home is pretty much the same as pre-op, Gabapentin, Celebrex, Fentanyl patches and Paracetamol. We have also added some local anaesthetic patches would are applied directly to the knee.

I think that is about it from me at the moment, I hope all of your knees are doing ok.

Stasha
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Decruz

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Re: LOA & MUA round 2
« Reply #1 on: August 26, 2011, 04:34:04 PM »
Dear Stasha,
if I may ask, who's your surgeon of your previous and just done LOA & MUA?
By the way how did he explained the situation was even worse that the last time he went in? I mean, if the past LOA & MUA in February aggravated the situation why he think a new one should end up better and not aggravate again the situation? Obviously hope the best for you, just to understand this point as I always wondered about this specific situation...
Bye
 
Decruz

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Offline Decruz

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Re: LOA & MUA round 2
« Reply #2 on: August 26, 2011, 04:38:30 PM »
Dear Stasha,
if I may ask, who's your surgeon of your previous and just done LOA & MUA?

I realized just after posting you already answered this question in you previuos thread about your February's procedure, sorry for double-asking..
Decruz

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Offline Stasha83

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Re: LOA & MUA round 2
« Reply #3 on: August 26, 2011, 05:01:50 PM »
Hi Decruz

It was Mr Rahul Patel who has performed both of my AF surgeries. Both were at The Wellington hospital in London.

In terms of the situation being worse than last time, I meant the amount of scar tissue that I had. I am not totally sure that the op in Feb caused this, I did very well for a few months after that surgery and then things began to go wrong. I think this was a combination of things, maybe I pushed it too hard, didn't do the correct rehab- I just dont know why the scar tissue returned and nor does my OS or Physio.

My OS had made no promises that this will fix me but he thinks that by removing the remainder of the fat pad it may help to stop the knee being so irritated and inflamed. To be honest I couldn't have carried on as I was and am willing to take a chance no matter how small it is.

At the moment I am feeling positive, I have minimal heat and swelling and my knee seems to have tolerated this op pretty well. It's very early days though, as we all now AF can return much further along the line but I am certainly going to give it my all in the hope that I can beat AF. Fingers crossed anyway!
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline missmyknee

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Re: LOA & MUA round 2
« Reply #4 on: August 26, 2011, 06:53:49 PM »
Hi Stasha

Glad you are doing well after surgery.  ;D  Extension is more important to work on right after surgery. Are you propping your ankle up on a towel , about 4 inches?  Stretch out those hamstrings several times a day and doing patella mobes with tissue massage several times a day. A freely moving patella is crucial.

Positive thoughts for a successful recovery !

Decruz

AF surgery is not a guaranteed success. Using an AF doc gives you the best chance of a successful surgery and recovery, however , there is still a chance it will not work. There are other factors that enter the recovery including patient compliance to rehab and how the patient's body reacts to the surgery.  Some people have one surgery for AF and have complete success and go back to an active life and others have to have several surgeries to recover back to an active life, and some don't recover to an active life at all.

Thar's the chance you take on this rare condition.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Lottiefox

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Re: LOA & MUA round 2
« Reply #5 on: August 26, 2011, 07:36:44 PM »
HI Stasha

So good to see you posting. I was thinking about you this week. It sounds like you had a tough recovery with the HDU and stuff. You were in good hands though down there. I bet it was great to come home!

I can only echo the positive thoughts of the others. Pam has personal experience of AF and her suggestions sound sensible. I have all fingers and non fused toes crossed for the AF staying under control this time. As you say, you couldn't have carried on as you were so making the decision is the right thing, even without the guarantees. Nothing is ever guaranteed when you have surgery. I hope that extension starts to behave - I know you'll work hard on it (within the right constraints!).

Good luck and keep us posted,

Sending hugs from rainy Warwickshire to probably rainy by you!

Lottie xxx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Stasha83

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Re: LOA & MUA round 2
« Reply #6 on: August 26, 2011, 08:49:07 PM »
Hi Lottie and Pam

Thank you for the well wishes. It's good to be back! ;D

I am working hard on my extension. I do an hour on the CPM and then an hour working on various exercises for extension. My physio has shown my mum all the exercises that she can help me with at home which is a real help.

The current schedule includes heel slides, hanging my leg (propping my ankle up on a towel), patella mobes (sideways and up and down), raising the leg with a towel under the knee, lying on my stomach on the bed with my legs hanging from the knee down (this is an interesting one!) and my mum lifting the ankle to encourage those last few degrees of extension. Rehab is pretty much a full time job for the next 6 weeks!

My walking is still awful even with crutches, I just can't get away from walking with a bent leg but to be honest I am not too worried about this right now, I think we can work on that further down the line once I am a bit stronger. Obviously I will keep trying to get it right but the lack of quads and VMO doesn't help.

It is raining here too which makes being stuck indoors a little bit easier although it is still pretty tedious. I feel like I have gone back in time by 6 months and am right back to square one. Hopefully it will be worth it in the end.

Hope you both have great weekends and your toes and knees behave ;)

Stasha
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline mouk786

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Re: LOA & MUA round 2
« Reply #7 on: August 27, 2011, 02:29:43 AM »
2 exercises I found good for getting my leg straight as recommended by the surgeon (I see you are doing both anyway to an extent).

- lie on the bed with stomache down, leg hanging off and have some ankle weights on your ankle - this will get your leg straight. I find a firmer surface works better - I sometimes use a piece of wood on the mattres and put the duvet over it, so its a hard surface underneath but soft enough to lie on.

- the other way is the opposite - get somesort of box and put your heel up on it - then get some weights (start at maybe 2-3kg and work up) and put on your thigh - this will force your knee straght - I found this REALLY helped me - I was using upto 15 kg at one point.

I found doing the first one takes the pressure off your leg and allows you to relax but doing the second one really forces a good leg straightening.

Also my surgeon said my leg always wanted to bend a little because of the knee capsule - apaprently it was so used to being in the bent position - hence you need to work on making it go back to straight and it doesnt happen overnight - perhaps the same for you?

You are having a lot of meds - all i got was some paracaetamol and codeine and got sent home the same day! I spose that is the NHS for you, lol.

0-140 is pretty much perfection isnt it? So annoying that it has gotten slightly worse. What did you have immediatley post op last time?
« Last Edit: August 27, 2011, 02:37:15 AM by mouk786 »

Offline Lottiefox

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Re: LOA & MUA round 2
« Reply #8 on: August 29, 2011, 09:54:10 PM »
Hi Stasha

How are things going? Hope the long weekend hasn't been completely full of physio and rehab work....although I suspect a fair chunk of it was taken up....hope you got to relax and rest up a little as well.

Keep us posted, sending positive thoughts,

Lottie xx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Stasha83

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Re: LOA & MUA round 2
« Reply #9 on: August 30, 2011, 09:31:27 AM »
Hi Mouk786 and Lottie

Thanks for the tips, I had thought about adding weights to these hanging exercises but the physio said to hold out at the moment but we will be introducing the weights in the future. Not sure I would manage 15kg though?!

My OS said something similar about my capsule too, he said it, along with my posterior compartment, has contracted due to being in the wrong position for so long. I think its going to take a long time to stretch these out/correct them.

I think if I could maintain 0 to 140 I would be very happy but I am not at 0 anymore. Think the deficit is about 10-15 degrees although it can still be pushed straight so I think this is a good sign. Just got to keep working on it and trying to force home the idea that the leg does want to be straight rather than bent! Last time he got me to the same in theatre, but realistically (ie when awake!) it was -5 and about 130.

I have had all 3 of my op's privately (I've got BUPA), but I didn't get any decent meds after the original op either, just the same as what you were given. I have been on most of these meds since February now but slightly increased after this op. I do find this condition pretty painful, Im still in pain even with all these meds so I don't know how you managed? The other side is that my OS wants me to be as pain free as possible so that I can tolerate the rehab too.

It's not long until your next op is it? Do you know exactly what is planned for you? As you're NHS i'm quite interested to hear who your OS is if you don't mind sharing? It's just that there aren't many OS's in the UK that seem to know how to deal with AF successfully.

Lottie - my weekend was indeed full of rehab :( I am learning to bake though when I'm not on the CPM or doing home physio, I've made 2 batches of cupcakes so that was a good escape for me. This week I'm going to try chocolate chip muffins and some lemon cupcakes. I honestly can't cook to save my life so this is quite an achievement for me! I hope your weekend was good and your toe is getting better?

Stasha
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Lottiefox

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Re: LOA & MUA round 2
« Reply #10 on: August 30, 2011, 10:14:17 PM »
Hi Stasha

Choc chip muffins???? I need to hit that A41!!!  8)  Baking is an excellent distraction therapy - I am addicted to the Great British Bake OFF on BBC as like you, I am not a very accomplished cook. I can do decent roasts, pastas, chilli, casserole type things but cakes or pastry - not a clue!

Good to see you posting. Sorry the pain is still hitting hard. There are so many facets to pain. I find it hard still to know what is RSD pain and what might be normal for having had my foot sawn in half and pinned together at the pin toe. I do know I get sick of my pill container rattling.But as you say, you need to have pain controlled enough to cope with the exercises. It is good that the leg goes flat with work. I guess the compartment is really contracted after all this time and its a long process of balance to stretch it but not inflame things. How are you doing in terms of swelling, heat etc?

Thanks for asking about my toe. It is OK. I worked today and drove to Surrey and back and battled the M25 which was hideous both ways round. Sitting with my foot on the accelerator pedal all that time makes it throb. (is that RSD or normal?! Who knows!). I have made myself a little sock that is filled with Epsom salts. I wet my foot, stick it into the sock, and then make the sock slightly damp. It is so soothing and also brings swelling right down. I sit and read with my soggy salt packed sock on for 20 minutes!  ;D I am also going for my first reflexology session this week. She is going to work on my other foot and the hand of my right side, rather than directly on my RSD foot. I find self massage on it soothing but am wary of someone else manipulating it about, and also worried that the foot may see it as a trauma and react badly with more spread. I have got it really contained at the moment - I don't want it any bigger!!

Keep us posted,

Hugs xxxxxxx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Decruz

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Re: LOA & MUA round 2
« Reply #11 on: August 31, 2011, 12:03:08 AM »
Hi Decruz
It was Mr Rahul Patel who has performed both of my AF surgeries.
In terms of the situation being worse than last time, I meant the amount of scar tissue that I had. I am not totally sure that the op in Feb caused this, I did very well for a few months after that surgery and then things began to go wrong. I think this was a combination of things, maybe I pushed it too hard, didn't do the correct rehab- I just dont know why the scar tissue returned and nor does my OS or Physio.

Hope the best for you.
So Dr.Patel didn't have a real answer why, even after the 1st surgery in which he removed some, the amount of scar tissues when he came in the 2nd time was even more.
I'm trying to understand, only thing I can figure is your body hyper-reacts reproducing even more scar tissues if a procedure is performed in order to get them out (like you had "10" in terms of amount of scar tissues prior 1st surgery then your OS came back in with the recent 2nd procedure and found "12"), so did you asked your OS, following this logical thought, why this 2nd surgery should end up differently than having even more scar tissues again (like that "12" becoming a "14")?
I'm just trying to understand myself what is the OS' view in this specific situation..
Best wishes
Decruz

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Offline Lottiefox

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Re: LOA & MUA round 2
« Reply #12 on: August 31, 2011, 08:39:13 AM »
I'm not sure any OS could answer specifically "why" the scar tissue may have increased/started in the first place. There are many theories underpinning AF but I think Stasha was faced with the choice of live with what she had or else take a chance that another surgery (with all its associated and well explained risks) to free the joint and to try and put in place a program that works to minimise the reformation of AF this time could bring her better function. I think even with the risks and no guarantee I would do the same. I got RSD in my forefoot after a standard foot surgery this year. No one can tell me why - or how it will pan out. Evidence/anecdote indicates it never goes away. I'm certainly reducing my symptoms and level of the condition. What if I need surgery on that foot again or somewhere else? I am at a higher risk of RSD happening again in that foot, but apparently not in the rest of the body - according to the surgeons. But not according to anecdotes!

I guess what I'm saying is that we never think serious complications will happen to us. When they do, it sucks. And very often there is no definitive answer as to why or how to improve them. We just have to take the route that brings us the best hope and do what we can to make it work. Underneath that involves all of the research and analysis that we all do - but we can never bring a guarantee.

Stasha I hope the baking went well....my smilies went wrong, I meant to put choc chip muffins  :D :P 

Lottie xx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline mouk786

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Re: LOA & MUA round 2
« Reply #13 on: September 01, 2011, 01:12:34 AM »
I'll PM you the name of my as I don't wanna put his name up as I am still a current patient. I am on NHS as mentioned - the main frustrating thing is waiting for Ops and appointments. On my follow ups I don't always see the main consltant surgeon and I have had a falling out with one of his deputies who wouldn't take my scar tissue issues seriously (in my opinion).

He is an experienced knee surgeon and he didnt really make a big fuss of the scar tissue, both times just said he would go in there and cut it off - our sessions are not massivley long because it is the NHS but there you go. I think maybe he didnt go too technical to save time but also because I indicated I have done my own research anyway.

To be fair I didnt need much in the way of meds and my post op periods were relativley pain free,

This time I will be having an LOA and MUA again but staying in hospital overnight on a CPM and 'aggresive physio'. I have decided this time I won't walk on the knee to maybe prevent irritation - see how that pans out. Hopefully the hospital physio wont force me to try and walk on it.

Are you sleeping in the CPM?

Presumably the CPM doesn't put pressure on getting ROM it just does what comes naturally? Or if you put in 135 will it keep trying to push you knee back to 135 or will it just go as far as the knee goes and stop?

Offline Decruz

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Re: LOA & MUA round 2
« Reply #14 on: September 01, 2011, 01:34:42 AM »
Are you sleeping in the CPM?
Presumably the CPM doesn't put pressure on getting ROM it just does what comes naturally? Or if you put in 135 will it keep trying to push you knee back to 135 or will it just go as far as the knee goes and stop?

I used to sleep in the CPM, a bit uncomfortable but not too bad.
CPM just make Continue Passive Motion of your knee, your set it when you start as directed by your OS or as much as you can tolerate; usually is set to full extension to the max flexion you can get with no pain/too much resistance.
If you put 135 and you can bend 90 the CPM will keep bending but you'll stop it using the remote and restarting the opposite extension movement.
Basically, otherwise directed, you set 0-70 (just an example) and try, if you see you get 70 with no problem then you move up to 71-72-etc. until you figure out what's the flexion limit (let's say at 111 you feel stiffness, resistance and pain then you set it 110 and use it for 30 min, then re-try 111 as it should be better, if yes you keep 111 and go ahead increasing day by day, always following the flexion limit your knee tells you and trying to play around that limit increasing it).
You can increase by 1 degree at the time, so it's very easy.
Decruz

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