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Author Topic: Return of the Gimp - Cartilage Implant Surgery  (Read 30086 times)

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Offline Joeybiscuits

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Return of the Gimp - Cartilage Implant Surgery
« on: August 22, 2012, 04:34:09 PM »
Heading over to the hospital for patella cartilage implant surgery using juvenile cartilage implants. It is surgery number seven on my knees and the sixth surgery on my left knee. My left knee history includes reconstructive surgery related to OCD when I was 17, three arthroscopic procedures, and an additional microfracture via arthroscopic surgery. This will hopefully be the last surgery for a while. I hope to provide updates regarding pain and rehab after the surgery to assist others who may go through the procedure. I found very few descriptions on the personal recovery of individuals following such a procedure.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #1 on: August 23, 2012, 12:16:42 AM »
Day 1

DeNovo process completed as I had surgery midday today. The doctors suggested a nerve block. I reviewed mixed results on-line from others regarding nerve blocks. They said to start taking oral pain meds in concert with the nerve block since the nerve block would wear off in 12-16 hours.  Nothing to fear with the nerve block, thus far. There are side effects, so I will list if they occur. The surgery went well. There were two Grade IV "potholes" that needed to be filled. One was under the patella and the other on the inside of the knee on the shoulder of the patella. Both were relatively large with one measuring 2.5 cm X 2.5 cm and the other about 3 cm X 3 cm. The doctor did not need to completely detach the patella and turn it over to implant the cartilage. He completed a partial detachment. The incision, originally thought to be as large as five inches, is supposedly 3-4 inches. I will be able to check Day 4. I required more IV-administered pain meds than with my other surgeries even with the nerve block. In addition to those meds, I was provided a Percoset. Between pre-op preparation, surgery, and recovery, I was at the hospital six hours.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #2 on: August 23, 2012, 07:08:38 PM »
The procedure was Denovo, using juvenile cartilage instead of harvesting my cells. The doctor thought this would be the way to go versus a Carticel procedure, or one that harvested my cells.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #3 on: August 23, 2012, 07:19:04 PM »
24 Hours After Going Under

It has only been 24 hours but feels like three days. The pain after the nerve block wore off late last night was almost unbearable. This has been the worst pain I have incurred since my original left knee surgery in high school. The pain is also chronic. There are shooting pains intermittently, but the pain is a constant. Of course it is on the inside, around the knee cap, and behind the knee. The worst part is getting up to use the bathroom. Any relief I may have from resting is eliminated when I get up. The leg needs to remain straight and it is a challenge with my wife's assistance to get up and down from bed. Sleep has been elusive. I have slept in 30-60 minute increments other than from 330-600 this morning. Some of the informed side effects from the nerve block are now evident. I have muscle spasms throughout my left leg and around my knee, and my hands and feet have been falling asleep. The pain medication helps somewhat, but not nearly as much as I had hoped. I have almost no appetite but need to force food down since I am taking the pain pills.

Offline Lottiefox

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #4 on: August 23, 2012, 10:32:41 PM »
Good to read about De Novo. Sorry the pain has been so rough, hang in there. Have you read the blog by a guy called Marc Rubin who had juvenile donor De Novo on a lesion in his knee a couple of years back? he is a triathlete and its been a long road but he is doing amazingly well. His blog is here:

http://www.10-hours.com/

It is very motivational!

Lottie
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 Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #5 on: August 23, 2012, 10:41:10 PM »
Lottie

Much, much appreciated. I have already read through Mark's blog. Although I am not depressed about my condition and recent surgery, I am not extremely positive about getting back to running or playing basketball after six surgeries. I am excited to start the rehab process and the road to recovery.


Thank you

joseph

Offline Lottiefox

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #6 on: August 24, 2012, 07:43:48 AM »
I think after a lot of surgeries you'd probably settle for decent walking about and low pain! Hope you managed to get some sleep and that the pain is settling down. From what I hear this is a very painful surgery in the first few days because of the amount of "poking" and "attaching" and stuff they do..let alone the fact its an open surgery. ACI was mooted for my kneecaps but I have too much diffuse damage...it would be like darning a very worn out sock in the words of one doctor who I trust! I've been lucky things have settled for me. Does your damage all stem from OCD in these areas? I think the chances of success are much higher for something like that as its such a focused area.

Keep us posted. Glad you found Marc's blog, I remember him posting on here 2 years ago and now I am reading about his Ironman results. Fab!

Lottie  ;D
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 Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #7 on: August 24, 2012, 03:56:19 PM »
Post OP - Day 2

Lottie - thanks for the encouraging words.

I expereinced better sleep night two, but sleep is still constrained to 60-90 minutes at a time. Last night I was able to fall back asleep with more ease than night one. The pain is slightly more manageable, but I am taking many more pills to combate the pain than I thought I would. The pain at times is so great that sound (from my three kiddos) pierces the knee. I am still icing the knee a lot. I am not allowed to take the bandages off until tomorrow afternoon, but I feel the swelling has gone down. I am able to wiggle my toes and foot without too much discomfort, but need help from my wife anytime I adjust my leg on the pillows or get up to use the bathroom. The muscle spasms, a side effect of the nerve block, have greatly diminished. I am confined to my upstairs bedroom but hope to get downstairs at some point early next week.

I still don't have much of an appetite. I forced down two meals yesterday: egg whites midday and a chicken breast and salad at night. I do snack on pretzels during the day. My fluid intake is insane. I am consuming quite a bit of water.

The CPM machine will be dropped off later today or tomorrow. I start at 30 degrees tomorrow afternoon/evening. Because of the location of the defects, I may be able to get on an exercise bike in two weeks and off crutches in ten days. My post-op appointment is Tuesday, so I will know more then. The CPM plan is 4-6 hours a day, split into two sessions.

I am able to intermittently work from home. I have a work station set-up adjacent to my bed. Mentally, this is a tremendous help to my sanity. My wife has been great - she has been around for every surgery so she knows the drill, and my kiddos have been loud but understanding.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #8 on: August 24, 2012, 04:38:46 PM »
History

I had knee problems growing up but the doctors generally called it tendonitis and osgood slaughters. I went to the ER when I was 6-7 years old with knee problems but they couldn't find anything wrong. I played soccer, football, baseball, softball, and basketball almost every year, year-round, from 9-16 years old. The pain was extreme the summer before my senior year in high school. I quit football and went on a road show with different doctors. I remember one doctor telling me I needed to be more active! I finally received the right diagnosis from a doctor who my girlfriend's mother worked for at the time. I ended up marrying my girlfriend and the surgery was likely a big part of us getting close. The diagnosis was osteochondritis dessecans (OCD). in October of 1994, the surgery was performed in Chicago. Two pins about 2' long were pinned into the bone during the procedure which included an open incission and arthroscopic surgery. I was told I would have problems walking up stairs even after I recovered and sports like basketball were out of the mix. This surgery was followed up with another outpatient procedure to remove the pins. Note to folks who may have similar surgery - do not watch the doctors slice open the scar to remove the pins. I can still visualize it.

I ended up being on crutches for about four months my senior year of high school. I was highly inactive and my weight grew to 229. I am 6'0" tall with an athletic build. The next year, my freshmen year in college, I worked really hard at rehabbing and lost 51 pounds to get down to 178. I maintained a weight between 180-190 during my 20s. I also ran competitively, played basketball, and biked a lot during this time. My knee gave me problems but i figured I would get as much mileage out of the knee as possible.

In 2007 I was having a lot of problems with the knee and now lived in NM. I had a 2004 right knee surgery. The doctor planned on going in and cleaning the left knee up but did a microfracture surgery. I didn't know I had a microfracture surgery until three days after the surgery. I was on crutches for 2.5 months with the surgery. I had a lot of problems with the surgery and the doctor had to go back in during 2008 to clean out pieces that broke off and were floating around. The prognosis from my doctor was that, at 31 years old, I needed to realize I couldn't squat down and play with my kids, play basic sports, and garden without pain. I obviously didn't like the suggestion. I was able to run short distances and play half-court basketball but with moderate to high-levels of constant pain.

My first two surgeons thought I was either born with minimal cartilage in my left knee or that the cartilage wore away from bone-on-bone because I was so active while growing up.

My weight during this time, 2004-current, was 205-215 as I entered a cycle of losing weight, having increased pain, and then gaining it back.

I went to see other doctors before connecting with my current doctor, who I like very much. He reviewed my history and suggested I was a likely candidate for cartilage implant surgery. He wanted to conduct an arthroscopic surgery first to evaluate if I was a candidate and if my own cells or DeNovo would be better. The last arthroscopic surgery was in June 2012 and obviously I was definitely a candidate. So, after almost 18 years and six surgeries, I hope this is the right procedure to get me to minimal pain and back in the correct weight range. I am looking very much forward to rehab and starting that next chapter.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #9 on: August 25, 2012, 03:51:28 PM »
Post OP - Day 3

Improved sleep last night. I had trouble falling asleep but once I did, I slept for five hours straight. I didn't nap at all yesterday so i was surprised I had problems falling asleep. I received a call yesterday from the surgery center nurse. After some discussion, she summarized that I was being too liberal with my pain meds and recommended I take two Percoset whenever I needed to sleep and take at least one every four hours. I would go seven hours at a time without taking pain meds and would often take one. I also received a prescription for hydrocodone to compliment the oxy and tramadol. Thus far today, I have taken one pain med as I want to limit the number of meds in my system, but also keep the percoset in my system as recommended.

My appetite is getting slightly better. I am still not hungry for the most part, but ate parts of three meals yesterday. Perhaps related to the lack of naps I took yesterday as well.

I tried to do too much yesterday when my wife went to pick up two of the kids from school. I went to use the bathroom and then couldn't lift my leg high enough to get back into bed. I had to call her to come back home to get me into bed. Not the greatest moment. The knee, otherwise, feels pretty good. There are some shooting pains on the interior of the knee and under the kneecap as expected. The pain is more tolerable thanks to a Chicago Bears victory. I also received calls from good friends and my sister.

Later this afternoon, I will be able to take off the dressing for the first time and shower. I am excited and anxious to get a look at the wound. The CPM machine will be delivered today as well. I can start using the machine tonight, but may wait until tomorrow depending on how the knee feels after showering and moving around more.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #10 on: August 26, 2012, 01:41:26 AM »
Post OP - Day 3: The Start of Rehab

We took off the dressing off this afternoon. The picture was too large to post, but I may shrink it later. Fifteen total staples along the incision with no evidence of an additional arthroscopic procedure. I was able to take a quick shower and wash my hair for the first time since Wednesday, which felt good to shower. It hurt quite a bit. My wife bought a shower chair but I didn't use it. I didn't know where to put my leg and it was killing me.

I used the CPM machine for two hours at 30 degrees. It was uncomfortable with only intermittent pain. It was good to get going on rehab. I was also able to start doing some hamstring and calf stretches from bed. I just finished the CPM machine, so it will be interesting to see how the knee responds. Tomorrow, I will begin the two hours in the a.m. and two hours in the p.m. on the CPM machine.

My appetite is descent and I took a 30-minute nap this afternoon. The pain is very manageable at this point.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #11 on: August 26, 2012, 01:56:48 AM »
With photo...

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #12 on: August 26, 2012, 01:58:54 AM »
Second photo...


Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #13 on: August 26, 2012, 07:41:20 PM »
Post OP - Day 4

One error I had from a previous post was that I was taking meds too liberally. In fact, the post should have said too conservatively. The nurses thought I wasn't taking enough meds on Day 2 post op, so I increased the number of meds I was taking.

Very good sleep last night. I slept from 1000-1100, 1200-500, and 600-715. The most sleep in at least a week. It was good sleep, too. I kept waking up thinking my leg was bent or had fallen off the stack of pillows, which it didn't, of course. I am still taking one percoset every four hours. I have not complimented the percoset with hydrocodone, but will this afternoon.

My appetitie is still waning as I haven't eaten in about 16 hours. I will force something down shortly. I am drinking lots of fluids, though.

I am still in my upstairs bedroom and plan on staying here until Tuesday when I go in to get the staples out. It is enough of a challenge getting up and to the bathroom that I will wait a couple more days before moving downstairs.

I did my two-hour CPM rehab this morning. It was more painful than the rehab yesterday afternoon. The knee swelled quite a bit during rehab. It was iced for a good part of the rehab. My doctor has requested four hours a day on the CPM machine, broken into two hour segments in the morning and two hours at night. When I had microfracture surgery I did the 6-8 hour regiment. I am at 30 degrees for the foreseeable future. The pain, as expected, is primarily on the inside of the knee (where the incision is) and under the patella.

Lots of calls, texts, and emails from friends, which helps.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #14 on: August 27, 2012, 07:52:42 PM »
Post OP - Day 5

Great sleep last night. I slept from 1100-330 and 400-730. I could have slept much longer this morning as well.

I am still taking one percoset every four to eight hours. My supply of percoset and hydrocodone is down to just a few days. The nurses said to start pulling back a little bit today.

My appetitie is good today. I had to force down food much of the last few days. I have an appetite today. My diet is still heavy on egg whites, salads, and a piece of meat with dinner. I am drinking lots of fluids.

I showered for the second time since surgery this morning. I still haven't used the shower chair as intended, but did use it to prop myself up while showering. The shower was less painful today than the one on Saturday. I was also able to get out of bed by myself, although very difficult, to use the bathroom this morning. It was more difficult getting back into bed, but I was able to make it work.

I did my two-hour CPM rehab this morning. It was more painful than the past two days. Yesterday afternoon, the pain increased the last 30 minutes on the CPM machine. Today the pain was consistent the last 90 minutes. The knee swelled quite a bit during rehab, and it was iced for a good part of the rehab. Some of the bruising on top of the knee cap as well as the exterior is more noticeable.

I have my post-op follow-up appointment tomorrow. They will be taking the staples out and discussing rehab. My next appointment will be one to two weeks after the appointment tomorrow.

A couple of photos from this morning...