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Author Topic: Return of the Gimp - Cartilage Implant Surgery  (Read 30087 times)

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Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #15 on: August 29, 2012, 01:07:24 AM »
Post OP - Day 6

Almost 10 hours of sleep last night...

I am almost out of my original pills and received a refill today.

I had my first post-op appointment today. They took out the 15 staples. I have a slew of internal stitches that will dissolve with time. The staple removal was relatively painless. The middle of the incision still had flesh that looked pretty fresh and was still healing, so the removal was a little more painful there. The assistant put on the butterfly strips that will be in place the next two weeks or so. The wound still needs to heal quite a bit, so the doctor asked me to take it easy the next three weeks. I will progress from 30 degrees to 70 degrees on the CPM machine over the next two weeks. I will also start on-site rehab two times a week next week. The focus of the rehab, initially, will be on strengthening the quad. With six surgeries now, the quad isn't as strong as my right quad. I can start migrating off crutches over the next week or so. I need to wear the immobilizer whenever I stand or walk. This will occur at least until my next appointment October 4.

It is still very difficult to get around and the pain is moderate. My wife has to help me with almost everything I do. I am still working from home and likely will the rest of this week.

CPM rehab is going well, and I may increase from 30-35 degrees tomorrow.


Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #16 on: August 30, 2012, 12:57:25 AM »
Post OP - Day 7

Bad night of sleep for the first time in 3 nights, and I do not have an appetite today.

The pain is better, but still lingering. On the doctor scale of 1-10, it is hovering around 5-6 with shooting pains around 8. I have fewer shooting pains today than previous days.

Today was the first day that I have been able to consistently get up without assistance. I set-up shop in my family room, so it is the first time I have ventured outside (in the house) of my bedroom in a week. It is good to be out of bed. The leg is elevated without the immobilizer. I wear the immobilizer when I am up and about but do not need to wear it when resting. The swelling is down a lot today. The knee looks good, especially since the wound is covered by the butterfly strips. The bruising is still developing on the knee cap in weird shapes.

I increased the range on the CPM machine to 35 degrees this morning. There was no pain increase. I did some minor leg raises, ankle exercises, and hamstring stretches to compliment the CPM machine.


Offline randomlife

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #17 on: August 30, 2012, 04:19:10 AM »
Thank you for keeping this record of your recovery. I'm three weeks away from having a similar surgery, so I've been reading everything that I can find on the matter. These personal experiences are very helpful! Sorry it sounds like you had a bad night last night; I hope you only have positive improvements from here on out!
03/10: Lateral tibial plateau fx
05/11: Chondroplasty of lateral tibial plateau and patella w/ extensive synovectomy
02/12: Grade III lesions on patella, new Grade II fissure on medial femoral condyle
09/12: DeNovo and Elmslie-Trillat TTT
01/14: Hardware removal and arthroscopy

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #18 on: August 30, 2012, 08:07:31 PM »
Randomlife

Good luck with the surgery. Where are your defects? The surgery and subsequent recovery seem very different based on the area of the defect or defects. If it is a weight-bearing area, you may be on crutches much longer but the surgery may not be as intense, depending on the location. I will be interested in hearing how your surgery goes.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #19 on: August 30, 2012, 08:19:10 PM »
Post OP - Day 8

Sleep was rough again last night, but tolerable. I am trying to ween myself off taking pain medication every four hours or so. I still have about 40 pain pills left but would like to get down to taking 1-2 a day, including one at night before eventual sleep. I have been off the pills for 15 hours or so.

The pain is weird. There is a stetching and pulling sensation in the knee when I am active; either in the CPM machine, or up and about. It may be the internal stitches that are dissolving. It may just be the external incision would healing. There has been some additional, minor bleeding from the external incision where the staples were. Nothing major, but some bleeding that was cleaned up with a singular Kleenex.

The swelling was very minimal last night and I was reminded that I do have a knee cap on my left leg. The swelling increases very quickly if I am active, which means showering, using the CPM machine, etc., but I can get the swelling down with rest and icing. I am still icing the knee quite a bit. The doctor said to ice it as much as possible the first couple of weeks. The only awkward area of swelling is still on the external top part of the knee cap. It comes and goes, but tends to be harder than the other areas of swelling. The knee is very warm after rehab and melts the ice packs quickly.

I increased the range on the CPM machine yesterday to 35 degrees. There was no pain increase. I hope to increase the CPM machine to 40 degrees tonight. It looks like I will be on the CPM machine to September 12 or 13.

Some photos:

Offline Cherokeegal

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #20 on: August 31, 2012, 02:22:20 AM »
Thanks for posting the diary.  I have surgery tomorrow that sounds similar to yours.

I'm really frightened about post-op pain and hoping I can deal with it. 
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #21 on: August 31, 2012, 04:40:33 AM »
Cherokeegal

Don't be frightened by the surgery you are scheduled to have. I am sure you will do great. Be confident and positive and know that you will come out of this procedure in better shape than you are in now. Make sure to have a good support network around you to assist in your recovery. The pain can be difficult at times, but knowing the positive end goal will make the surgery and recovery worth it. Best of luck!

joseph

Offline randomlife

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #22 on: August 31, 2012, 04:55:50 AM »
Thanks for the good luck wishes! The plan for me, as it stands right now, is to perform a De Novo transplant on the underside of my patella along with an Elmslie-Trillat tibial tubercle transfer. I have another defect on my medial femoral condyle, but my OS does not plan to use De Novo on that portion. I have deep Grade III fissures in the cartilage of my lateral tibial plateau, but nothing is to be done with those right now either. In fact, my OS has indicated there may be nothing that he can do with the tibial plateau, but he'll at least take a look when he's in there repairing the rest of it.

I'm planning to start a diary when I'm a little closer to the surgery, and I'll do my best to keep it up through recovery. Again, I really appreciate that you're keeping a record; I really appreciate all the post-op diaries and having this site as a resource. I hope you continue to see positive improvements!

lk
« Last Edit: August 31, 2012, 04:58:22 AM by randomlife »
03/10: Lateral tibial plateau fx
05/11: Chondroplasty of lateral tibial plateau and patella w/ extensive synovectomy
02/12: Grade III lesions on patella, new Grade II fissure on medial femoral condyle
09/12: DeNovo and Elmslie-Trillat TTT
01/14: Hardware removal and arthroscopy

Offline Lottiefox

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #23 on: August 31, 2012, 09:46:12 AM »
Joey

All looking good there, you can see the difference already in the swelling and the wound looks nice and tidy. Its a really interesting read so do keep posting. I am glad you're already helping some others! I hope that sleep is easier over the weekend and you keep making the progress on the CPM.

Take care!

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 #24 on: September 01, 2012, 02:51:00 AM »
Post OP - Day 9

Anxious...

Anxious to bend my leg. Anxious to walk. Anxious to swim... to play basketball... to play with my kids... to hang out with my wife... to shower without a chair and crutches..... to go to work without being driven. Having been on crutches for a 3.5 month period and a 2.5 month period previously, I understand there will be days like this. Must be patient.

Sleep has been tough the last three night, but it is largely because I was working late each night. I will catch up this weekend.

There is still some weird shooting pains, but not as much as yesterday. I was able to have my wife drive me to work so I could sign some documents. It was good to see some folks and act normal again - for an hour. Trying to do more things by myself but almost took a fall yesterday for being stubborn. I sat on the back patio next to the garden for 30 minutes last night, which was nice.

Swelling is down. It looks good. 

No issues at 40 degrees on the CPM. The first few times up and down it feels like opening a door or window that hasn't been opened for a few years. Otherwise there is minimal discomfort and pain. I hope to go to 45 degrees tomorrow. My first offsite rehab appointment to compliemnt the CPM work is Tuesday.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #25 on: September 02, 2012, 06:23:55 PM »
Post OP - Day 11

Much better sleep the last two nights. I am almost able to sleep on my side-partially, which helps with sleep. I never sleep on my back except following knee surgeries. Being able to lay on my side without discomfort helps immensely. My appetite is almost normal again, but I still trying to limit carbs and any fattening foods since my exercise is minimal.

I was able to shower with little assistance yesterday, other than the assistance provided by the shower chair. It may sound minimal but it is a big step to be able to get in and out of the shower without help. The shower is a stand-up two-person shower. I cannot bend my leg enough to close the door all of the way but hope to do so this coming week.

The pain is down to a 3-5 level when stationary. There are still shooting pains in which I am audible. They are shooting pains that don't have a pattern. I am down to two pain meds a day. Typically, i am taking one in the afternoon and one in the evening. I still have 30-35 meds and want to get down to one a day, at night, since my rehab will increase on Tuesday. The pain is somewhat frustrating and tiring but I have to remind myself that it is only 11 days since a major surgery. The pain was pretty strong this morning. Icing and elevation helped relieve the pain, as well as three kids climbing all over me. Yesterday, I did some exercises in which I was putting weight on my left leg while walking on crutches. I did 20 reps of about 15 feet each. I am hoping to be off crutches later this week. I will still wear the immobilizer for the next month. I have to figure out if I can effectively wear the immobilizer on the outside of pants once I return to work this week, because the brace is so damn big.

I am now at 45 degrees on the CPM, with a plan to go to 50 degrees on Tuesday. The pain with the CPM machine is during the first few minutes after starting and the last 30 minutes of the two-hour session. It is more painful at the beginning and discomfort at the end. Swelling was down yesterday but the knee was very swollen this morning. Again, the swelling, as expected, is on the kneecap and inside of the knee, but there is an area of swelling that continues on the outside, upper part of the knee. I can get the swelling relieved with rest and ice.

I have been downstairs more the past two days, including sitting on the back patio for some time yesterday morning. I am anxious to water my garden and harvest some of the vegetables. I was able to lean in and pick some tomatoes. Being downstairs creates a diversity of locations that helps morale.

My first offsite rehab appointment is Tuesday when i will submit my next post.


Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #26 on: September 03, 2012, 09:48:51 PM »
Post OP - Day 12

I drove myself to the office today and did some work. No issues with driving since it is my left knee that is recovering. It felt good to get out by myself and force myself to do some additional work. I also am trying to put more weight on the knee while using the crutches and in the brace.

I am at 50 degrees in the CPM. I decided to go with the increase a day early.

My first offsite rehab appointment is Tuesday when i will submit my next post.

Offline Joeybiscuits

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #27 on: September 04, 2012, 09:20:32 PM »
Post OP - Day 13

It has been a rough couple of days. There is continued progress with the knee, but the anxiety about the road to recovery is strong. I have been reading a lot about recovery time on blogs, websites, and medical journals. Once I reach my next milestone of shedding the crutches, I think I will be better. My kids and wife have been amazing.

I am able to shower with little assistance. I still cannot bend my leg enough to close the door all of the way but hope to do so this coming week.

The pain has increased at bit in the afternoon and evenings. This is likely due to me trying to put more weight on my left leg, the increased work on the CPM, and other activities I am doing independently. It has kept me up the last two nights, until the pain wins and I end up taking a pill to sleep. I am taking two pills a day, later in the day.

I had my first offsite rehab appointment today. I was able to leave the house and drive myself without any assistance. I was so happy to hear that I have the same therapist that I had after my microfracture surgery 4-5 years ago. I really like working with this therapist and he has been around for two of my previous surgeries. There isn't much we can do at this point, being less than two weeks since surgery. He evaluated the knee. The swelling is about right for two weeks out, maybe a little on the high end. I am going to begin weekly appointments, that for the next four weeks, will be primarily progress meetings. The wound takes 4-6 weeks to heal, so I won't be doing anything too intense until after six weeks. My therapist provided additional compression sleeves to help with the swelling. The exercises he wants me to do daily (3-4x daily), in concert with the CPM are:

- Leg raises: 10x, 2-3 sets
- Hamstring stretch: 30 secs, 3-4 sets
- Quad flex: 5-10 secs, 10 sets
- Knee flex using a towel: 15-20 secs, 5-6 sets
- Hip/knee flex using a towel: 20 secs, 3-4 sets

Having been through seven surgeries, I was already doing a number of these exercises but not as consistently as outlined above. I am now at 50 degrees on the CPM, with a plan to go to 55 degrees on Wednesday. My therapist did show me some gnarly photos of the surgery. He was only able to print in black and white, so I hope to get the color photos at my next doctor appointment, October 4. Pretty cool stuff. The wound seems to be healing nicely. He was a little bit surprised that the staples were taken out at 6 days. He said it is usually 7-14 days, with 10 days being more of the norm.

My therapist said he only gets 2-3 cartilage implant patients a year. Without an extensive set of data and existing literature, although there is some, he said they take it slow with cartilage implant patients. From what I have seen, the rehab plans seem to emulate a microfracture rehab. Since my microfracture was on a weight-bearing surface and my cartilage implant non-weight bearing, I do expect some modifications from my microfracture rehab plan.

I will be working at the office tomorrow, which will be nice, and at meetings for work Thursday-Monday.


Offline Lottiefox

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Re: Return of the Gimp - Cartilage Implant Surgery
« Reply #28 on: September 04, 2012, 10:20:45 PM »
Joey

You are doing amazingly. I cannot believe you are driving about (left leg or not!) and working and stuff. Fabulous. I wondered about the site of the implant and how you were able to be weight bearing (partially!) so soon...non weight bearing surface of course....I guess the road to recovery is going to be long with this. I know from following Marc Rubin's blog he felt exactly the same, and at 6 months then 9 months and then onwards he has kept making huge gains and eventually got back to proper function. It isn't a fast one this, but the rewards at the end will be SO worthwhile. De Novo has great results and you have a great team from the sound of it plus the right attitude. I was equally amazed they took your staples out so early! I kind of felt a big.....squeamish at the thought!!  :P ::)

Keep up the great work, hope you get some sleep tonight! You are US based yes? behind us, sleep time in the UK for me.

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 #29 on: September 05, 2012, 02:54:55 AM »
Thank you Lottie.

I need to take it day to day and continue to focus on getting stronger and better each day. As you know, some days will be better than other days.

I tried putting weight on the leg with one crutch yesterday, wearing the immobilizer, and it wasn't a pleasant result. Too soon. I am thinking I will be on crutches for about three weeks. The current defects were under and on the shoulder of the patella. The OCD and microfracture surgeries did a pretty good job of addressing the defects on the weight bearing surfaces.

I am able to drive because I have tremendous leg room in my car that allows me enough room to keep my leg straight.

The first two surgeries were in Chicago, Illinois, where I grew up. The rest, including the two recent surgeries, have been in Albuquerque, New Mexico.