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Author Topic: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect  (Read 10081 times)

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Offline TheFonz

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Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« on: January 12, 2013, 12:56:44 AM »
Post op - 1week 2days.

Click the URL to see my background information. 
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61152.0

This is my first post since my January 2nd 2013 Denovo NT procedure on my left knee lateral trochlea. i am typing on my ipad so i apologize in advance for typos and poor spelling/grammer (laptop is huge so hard to use while laying down. It's more like a portable home computer).

I have been surprised and pleased thus far with how minimal the pain has been.  I stopped taking Vicodin after day 2 and only take 2 Tylenol at nigh before I go to bed so I sleep better.  I'm still taking the NSAID they prescribed me and will be on it for the next 3 weeks. 

Surgery day-nothing significant to note.  This is my 5th knee surgery on left knee and like 10th surgery overall.  So i had a good idea of what to expect.  the 9 years of high school and college football has taken a toll on my body. According to the doc, everything went really well.  I had about a 3.2cm x 2.8 cm defect on the lateral trochlea.  All 4packs of denovo nt were used. The doctors fellow said its one of the biggest defects he had seen.  Both the doc and the fellow thought the procedure went really well.  (I always take this with a grain of salt.  What's he going to say, "sorry we only brought our B game today.  I wish it would have gone a little bit better??)

Pain was minimal. Was expecting it to be more.  I took Vicodin for the first two days (1 about every 3 to 4 hours).

My leg was in a knee brace that keeps it locked a straight.  I am suppose to keep it straight for the first 7 days, no cpm until then.

Post op day 1 - saw the doc at at 745am.  He showed pictures and gave me a DVD of the procedure.  (I will post the pics later for you to view when I get on my laptop).  Said to come back in a week to take the stitches out.  He said to try some leg raises.  I did 2 was really painful and the doc said to stop.  I do try and do a few quad sets each day but I can only flex about 50% until I get pain so I don't push it any further then that.

Other thing to note is that I had very minimal swelling.  This was unusual for me.  My knee was much more swollen on my previous surgeries.  I was pleasantly surprised with this as well.

Post op day 2 - nothing significant.  Pain was surprisingly minimal.  I was sure to stay ahead of the game with Vicodin.  I do a few quad sets here and there and watch a lot of tv.

Post op day 3 - this was really my only tough day.  It was actually the night that was rough not the day.  At about 8pm I started to get a headache and my back and neck were really stiff.  Prob from laying on back all day and night.  I slept very little. Was up most the night mainly bc my body ached soo much and I had a pounding headache that would not go away.  The symptoms were flu like without throwing up and minimal fever if one at all.  I'm not sure if got dehydrated, took too much Vicodin or if it was simply my body reacting to the procedure.  I never experienced this kind of achynees with my previous procedures. 

Around 9am when I woke up my ankle and foot were really swollen and still didn't feel great but definitely better.  Kind of like a nice hangover.  I called the doc thinking it might be a clot as I have never swelled before in the ankle and foot after knee surgery.  He said that sounds normal not to be too concerned.  If I was concerned about it, I could come in and he would look at it.  I decided to wait it out and the swelling went down after I elevated it again for couple hours.  I had minimal knee pain through this. Just your basic post op aching.

I'm pretty sure the swelling was due to the fact that I did not elevate it while I was sleeping.  The first two nights I propped it up on a pillow.  On the third night I didn't use a pillow to elevate it.  Note to those out there-keep your leg elevated for the first couple days or until the swelling is substantially reduced.

Later on in the day my body started to feel normal again.

Post op day 4- nothing significant.  Stopped pain killers.  Only take Tylenol at night to help sleep better.

Post op day 5 - nothing significant. Pretty much zero pain so long as knee/leg is relaxed.  I still get pain if I do quad sets with more the about 50% contraction.  So I only flex for excercise until just before I hit that pain.  My leg is atrophying fast.

Post op day 6- nothing significant.  Same as day 5.

Post op 1 week- same as day 6.

Post op 1 week 1 day- met with the doc to get stitches out.  After looking at it, he said it was to early.  Come back in a week to get them out. He took off the first piece closing the incision and it kinda of re opened it.  So he wanted to wait another week.  He said to start the cpm for 6-8 hrs a day and don't go past 30 degrees until the stitches are removed. 

After looking at the pictures the doc had shown me of the procedure, I had a concern about how much the defect got filled. When you see the pics I post later it looks like there is a spot on the right side that did not get filled.  His fellow ( doc was not in the office) who was present during the procedure said he vividly remembers there being total fill and that it was simply blood covering the graft.  He sounded very compelling.  he said to ask the doc when he gets back next week if I did not believe him.  After speaking with the fellow I felt much better about my concern.  I still plan on raising the concern with my doc next week to see if he has the same response.

I went home and started the cpm machine at 10 degrees.  I was expecting some good pain.  Pleasantly surprised, the pain was almost 0.  Every once in a while I would get a very focal and fairly sharp pain above my knee cap. I would scale it as like a 6 or 7 on a 10 point scale.    It would occur like ever 4th or 5th cycle.  This pain went away the next day.

Post op week 1 day 2- nothing significant.  Sitting in the cpm now at 15 degrees.  Pretty much 0 pain while in the cpm and out of cpm if knee is relaxed.  If I do quad contractions, I can still only go about 50% percent contraction until I start to feel pain.  I don't even bother with leg lifts at this point.  Leg is too atrophied and pain is too much. 

I will post pics of the procedure showing the size and severity of the defect and what the denovo nt graft looks like once I get access to my laptop.  Sorry for the typos, poor spelling and grammer.  I'm on an iPad so typing takes forever.  Lastly i definately will not post every day, more like weekly for the first month.  After that I will prob post month to month or if there are significant changes.

i will do my best to remember to tell everyone when it's my last post when all is said and done so you will have closure on my status.  I've noticed people post less and less as time goes on and then just disappear not knowing if the outcome was successful/worthwhile or not.
« Last Edit: January 12, 2013, 02:24:31 AM by TheFonz »
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #1 on: January 12, 2013, 03:55:58 AM »
I uploaded the pics my doc gave me of my denovo nt procedure.  Below are the links to them.

https://www.dropbox.com/s/bpxt2s6kw89uqm3/IMG_0005.JPG
https://www.dropbox.com/s/actovz8iitt9llc/IMG_0004.JPG
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #2 on: January 17, 2013, 10:36:44 PM »
Post op week 2 day 1

Nothing changed much over the past week.  Did cpm each day for about 6 hrs.  Up to 30 degrees now.  Doc said no more then 30 degrees until stitches are out.

I saw the doc today.  He took the stitches out.  Said everything looks very good at this point.  He wants me to progress to 90 degrees on cpm by the next time I see him in 3 weeks.  He also gave me a few exercises to do to strengthen quad.  Leg lifts on side, quad sets, etc.  very basic rehab stuff.  I still can't do leg lifts on my back, but while on my side it's no problem. 

My pain is still pretty much 0 when my leg is static.  I have minor discomfort in cpm if I try to push it too much, so I try and go just to the point before pain.  At this point no clicking or locking in cpm.  Feels pretty smooth.  While doing quad sets, I get a little pain if I try and flex 100%.  So I do them until I start to get some discomfort, about 70% of my contraction.  Last week,  I could only contract quad to about 50% until pain.  So I think it's getting better, but slowly. 

I guess that's it.  Back to Netflix!
« Last Edit: January 17, 2013, 10:41:15 PM by TheFonz »
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #3 on: January 23, 2013, 01:48:04 AM »
Post op week 2 day 6.

I thought I should update since I've had a little set back.  I've been doing the cpm and quad exercises since my last doc visit.  However, I've been developing a steady burn that gets worse the longer I am on the cpm.  The burn got so bad I stopped the cpm yesterday.  The pain/burn feels like its located just above the knee cap  (or bottom of the femur, like at the Top of The Trochlear groov) and pretTy deep inside tHe knee, not at a superficial leVel.  It's really hard to pinpoint the location since its more of a burn rather then a sharp pain.  As the burn intensifies, it radiates, making it harder to pinpoint.  It feels similar to what a pinched nerve feels like.  The burn occurs throughout the entire range of motion, so reducing the range doesn't help much. 

I've never had pain/burn before in this location.  My problems in the past has been pain underneath and on the lateral side of the knee cap.  This is more in the middle of the knee slightly above the knee cap.  Excluding this new burn/pain the rest of the knee feels pretty good.

I called tHe docs office today.  I have an appointment set for Thursday. I amto stop the cpm till then.  I will update Thursday when I get back.  Sorry for the typos. Still using an iPad to update.

Back to Netflix!
« Last Edit: January 23, 2013, 01:49:58 AM by TheFonz »
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #4 on: January 24, 2013, 09:46:23 PM »
Post op week 3, day 1.

Met with the doc today about the burning pain above my knee cap.  He thinks it might be nerve related caused by my incision since the pain is more of a burning sensation rather then a sharp pain.  When he took my dressing off, The incision did not look great.  It looked very red with some dark old blood around it.  It knid of looked like a burn.  He thinks the constant irritation of the incision is what is causing my burn slightly above my knee cap even though the incision is off to the side.

He changed the dressing and said to tone back the cpm until the incision gets healed a little more.  Otherwise I will just continue to rub the irrated incision.

I'm still doing my strength excercises.  Rest of the knee feels pretty good, so hopefully this burn will go away.  It's really what's holding me back as of now.

I'll post again in a few days with an update on my burning pain above the knee cap.

Back to les misrables!
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #5 on: January 26, 2013, 05:41:47 AM »
Post op week 3, day 2

The burning sensation is still a problem.  At this point, I'm pretty sure it's not due to the incision being irritated like the doc thought.  The incision looks much better today and the burning pain I'm getting has become worse even though I have cut back considerably on the cpm. 

Because the burn is so intense I have not been able to progress much on the cpm.  At this point, my gut is telling me that the pain is a result of the defect not being totally filled with the denovo tissue.  If you look at the pics I posted, you can see an area on the left side that does not appear totally filled in (the bloody area).  Im fairly sure this is the location that the burning pain is located.  I asked my docs fellow who was present during the procedure about it.  He assured me that it was totally filled in and that the blood is covering the denovo graft.  Looking at the pics and the video many times, I'm not convinced at this point that it was totally filled.

I called the docs office today to let them know that I was fairly confident that the pain was not due to the incision irritation.  I did not hear back from them (I think today is a surgery day for them).  I will call them again first thing Monday to express my concerns since I cannot progress much at this point.  Both the cpm and leg excercises cause the burn to intensify significantly.  So I'm cuttin way back on the cpm.  I dont want to make the situation worse.  I'm still planning on continuing the leg excercises.
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #6 on: January 30, 2013, 04:49:11 AM »
Post op week 3, day 5.

I met with the doctor today about my concerns regarding my burning pain under the knee cap.  His office has been very good about getting me in immediately.  I called them today and they worked me in the same day.  He still believes that my nerves are doing funny things due to my incision not being totally healed and thats what is causing the burning pain.  He prescribed an anti biotic for the incision.  It still doesn't look great but it's getting better.  He said to go back to the cpm and excercises but not to push it to hard.  He still thinks the burning will pass as the incision gets cleaner and more fully healed.  Time will tell.

He also said to start physical therapy.  I'll be giving the therapist a call tomorrow to set a pt schedule.  I have a follow up with the doc a week from this thursday. 

Anyone else have the burning in the knee post knee surgery? 

i may or may not post before then.  I guess that's it. 

Attempting to learn how to play the piano in the meantime.  Back to my intro lessons!
« Last Edit: January 30, 2013, 04:50:46 AM by TheFonz »
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #7 on: January 31, 2013, 04:20:16 AM »
Post op week 4.

Here are some pics of my knee incision.  I just uploaded them to my Dropbox.  Click the links below.  These pics were taken yesterday.  The incision looks a little worse then it actually is because of the reflection of the lighting from the neosporin I put on it.

https://www.dropbox.com/s/cvmasy4bnyhnpgo/IMG_0006.JPG
https://www.dropbox.com/s/h32hcfthjlc52sf/IMG_0007.JPG

I got back on the cpm today for about to hours.  Up to 35 degrees.  Feels a little better then the past week.  Still a burning sensation but less the it was a couple days ago.  I'm shooting for a 5 degree increase each day.
I plan on pushing through the burn unless it gets extreme.

Back to watching the Lakeshow.
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #8 on: February 02, 2013, 01:14:38 AM »
Post op week 4, day 2.

The knee is doing better.  Most of the burning sensation has passed at this point.  I still get it some of the burning when I get to my max range in the cpm, so not pushing it to hard.  I'll also get some of the burn when I do my leg lifts and quad sets.  Im currently at 45 degrees on the cpm.  Still trying to increase 5 degrees each day.  It's definitely better then it was 5 to 7 days ago when I could not even go 20 degrees on the cpm without having an extremely intense burn.

The incision is not full healed yet and I still cover it with neosporin.  I'll be on the antibiotics for 2weeks.  Hopefully the burning will be completely gone by that point.

I don't have much swelling left.  Looks pretty good in that respect.  Given how little my knee is swollen, I should be able to bend my knee to 120+ degrees.

Last thing to note.  When I get toward my max range of motion on the cpm, it feels like someone is pushing a pen (the opposite side that you would write with) into the bottom of my femur.  The closer I get to my max ranger, the harder it feels like the pen is pushing against my femur.  If I continue the cpm for too long at the max range, the burning sensation begins to kick in. 

The knee is doing better, but I'm probably behind schedule in regards to range of motion and strength.
« Last Edit: February 02, 2013, 01:26:29 AM by TheFonz »
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline Dadof3

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #9 on: February 05, 2013, 05:32:46 PM »
Thanks a ton for sharing your experience so far.  My son just had the Denovo graft done.  Your experience and story is helpful.

Hope everything goes great for you

Thank you

Offline sune

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #10 on: February 06, 2013, 08:35:36 AM »
Hi.
I had the same burning sensation you are describing over several weeks at about the same time , but it's gone now. Doc thought it was mainly nerve and skin issues, but said to take it easy to avoid chronic pain. You can check out my diary in this forum if you like.
Cheers,
Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #11 on: February 06, 2013, 11:35:46 PM »
Post op week 5

Dadof3- no problem.  There is not much information on this procedure.  Hopefully journaling my experience will help others dealing with a similar problem. 

Sune- Thanks for your response.  The burn is getting less and less.  It's still there a little when I get to my max range of motion on the cpm, which is currently about 55-60 degrees.  I did nothing but let the knee rest on sat and Sunday and that really helped with lessening the burning sensation.  I still do the cpm but am not pushing it at all.  I'll prob take a break from the cpm for another day to try and let that burn completely go away.

The other thing I've noticed is that I don't get great blood flow in my leg.  When I stand up, my leg has a darker coloring then the good one.  It's kind of a light purplish looking.  Plus, each time I stand up after being on the couch for more then 30 mins or after I've been up on my feet for more then 30 mins, my foot begins to tingle.  Similar to the sensation you get before your foot " falls asleep".  The tingling and discoloring comes and goes.  I've found that getting up every hour and moving about then laying back down helps the coloring in my leg to look normal.  Plus it helps make the tingling go away.

I'm still on crutches.  My leg has atrophied so much I suspect it will prob take about 3 to 4 weeks from the time the doc says i can start full weight bearing before I start walking again.  Still doing the leg raises and quad sets daily.  However, I still can't do the front leg raises.  I ride the bike for about 30 mins a day with my good leg only to maintain muscle.

I still have this same problem stated in, my previous post "When I get toward my max range of motion on the cpm, it feels like someone is pushing a pen (the opposite side that you would write with) into the bottom of my femur.  The closer I get to my max ranger, the harder it feels like the pen is pushing against my femur.  If I continue the cpm for too long at the max range, the burning sensation begins to kick in.  The burning is most intense at the location where it feels like the pen is pushing into my femur."

My incision is looking better, but still not great.  it still bleeds from time to time in 2 different areas.  I'm hoping that once it fully closes, the burn will completely subside.  I have my first pt appointment scheduled for Monday.

I have an appointment with the doc tomorrow. It's just a routine post op check.  I'll update again after I meet with him.
« Last Edit: February 06, 2013, 11:45:32 PM by TheFonz »
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #12 on: February 08, 2013, 04:35:41 AM »
Post op week 5, day 1.

Met with the doc today.  Said the incision looks better, still not fully healed though.  He also said that I really need to wrk on my range of motion and that should be my primary goal for now.  He wants me to get to 90 degrees by next Thursday.  So long as the burning sensation remains low, i think i should be able to reach 90 degrees by thursday.  In addition, my leg atrophy is pretty bad.  He and I both agree that my leg atrophy is behind schedule mainly because I was way behind the curve before surgery.  My knee has been so bad for so long that it was already severely atrophied prior to surgery.  I could not do a single leg extension with no weight and I could not ascend/ descend stairs without a handrail prior to surgery.  He also mentioned a few weeks ago that I had the biggest defect that he has performed denovo nt on.

I'm currently at 60 degrees on the cpm.  I get glimpses of the burning pain, and when I do, I take a brief break.  That pain is a game breaker in terms of progressing so i really try and avoid it.  Other then that, I feel pretty good in the cpm.  I get the typical sensation/discomfort that goes with the cpm, which is The knee feeling like its going to burst like a water balloon from over pressure as you get to your max range.

On a side note, I received a billing statement from my insurance provider (blue cross blue shield PPO) and found out that the surgery is considered "experimental" and therefore will not cover the surgeon, surgeon assistant, anesthesiologist and equipment bills.  I was immediately irritated when i saw this.  I was told by the billing department at the hospital that they had checked with my insurance and that I would be responsible for paying 10 percent of the surgery cost under my current health plan.  They broke down the surgeon, surgeon assistant, anesthesiologist, and equipment costs. The only thing that would be out of pocket was the denovo nt packets at $4500 a pack.  The denovo nt packs need to be paid prior to surgery and that it was likely, but not guaranteed, that I would be reimbursed by my insurance for about half the cost of the denovo nt packs.  I was told the same thing by one of the doctors assistants.  Needless to say, I am very irritated.  I will be calling the billing department tomorrow.

That's it for now.  I'll post again in another week or so unless something worth noting comes up.
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline TheFonz

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #13 on: February 09, 2013, 01:18:48 AM »
Post op week 5, day 2.

Toady has been one of my better days in terms of knee progression.  I hit 70 degrees on the cpm.  For the first time, the burning pain is not what kept me from going further on the cpm.  I'm hoping this continues and that the burning will totally subside in the next week.  I still get flashes of the burning pain from time to time, but it did not limit my progression like it normally does.  Today is the first time I did not put neosporin over the incision while I was on the cpm.  Perhaps that may have helped.  Normally the incision drains a little bit of blood and puss which is why I was using it.  So far, the incision has not leaked at all today.

Last night, the burning pain flared up.  I noticed my knee felt very hot and it was very warm after putting my hand over it right were the incision is.  it was draining a little bit of pus and blood.  Not much swelling though.  I iced it for about 45 min.  The burning sensation immediately got better after the knee cooled from the ice.  Over the past couple weeks I was very skeptical whether the incision was causing the burning pain.  As the incision is healing and leaking less puss/blood, the burning seems to be getting less and less.  It's just taking a long time.

That's it for now.

« Last Edit: February 09, 2013, 01:21:08 AM by TheFonz »
Check out the link below to see my journal of my Denovo NT procedure.  3cm x 3cm defect on the Lateral Trochlea of the left knee.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61437.0

Offline jco

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Re: Denovo NT on Lateral Trochlea Lft Knee. 3cm x 3cm defect
« Reply #14 on: February 10, 2013, 01:57:30 PM »
Fonz my doctor used staples for some reason first postop mon the 25 .I am hoping to get the rest of exactly what was done as he told my motherinlaw and wife that he fixed a tear also while he was in there.Pain so far has been manageble i am learning to take them a little bit ahead of when i start to feel the pain.I wil follow your progress and hope your knee continues to do better
11/25/11right knee debridement  meniscus repair                                       11 /11/12mri defect rightknee cap                
2/8/13 arthroscopic patellofemoral debridement excision of suprapatellar plica denovo cartilage implantation to patella