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Author Topic: Yankee's Arthrosurface Patello-Femoral Implant Diary  (Read 20598 times)

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Offline Yankee

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Yankee's Arthrosurface Patello-Femoral Implant Diary
« on: October 19, 2013, 02:56:26 AM »
Well, after suffering with horrible, down to bone kneecaps for years, and a fall that tipped my right leg over the edge of bearable, yesterday I had my right knee fixed with patello femoral implants - I hope they do the trick. 

First there was the arthroscopy where the surgery notes said repairs were made to the medial and lateral meniscus where there were tears that did not show up on the MRI - I was surprised to find out there were tears there at all.  And disappointed that those hadn't been noted on the previous doc's MRI.  HMM.  Then the patello femoral implants - the knee cap is mostly polyethylene now, most of it was just down to the bone.  Not much damage to the trochlear area but it was noted that the condition of the bone there was 'poor' - no idea what that means or why, I've always had good bones, but possibly damage from being injured for so long.

My first mistake was agreeing to a femoral block.  I was told it would help with the pain, and make my leg kind of unable to follow directions.  Well, apparently I'm not able to deal with legs that don't hold me up. Even on crutches I fell twice after I got home, the first time my leg just buckled underneath me and I landed in my recycling bucket, my sister was able to pull me to my feet without damaging my knee, which was in a full leg brace.  The second time it buckled again without warning, I fell backwards, hit my head on the table (fortunately not in a bad place and no blood was spilled) and busted open the incision.  I was alone at the time, crawled my way to my feet, and when my sister came back we looked at it, bleeding, and called the doctor.  The most dreaded news.  "Go to the ER".  I knew that was going to be a long haul, and we sat there for four miserable hours before being seen.  I got lightly stitched up with instructions to go to the doctor the next day to get the incision looked at. We arrived home after midnight (we'd been up since five that morning for the surgery), I got settled and went to bed, and remarkably slept very well.

I'll never have a femoral block again and I don't recommend them, for me, even if there's more pain, I at least know that my leg will stay where I put it.  That's just my personal opinion, whatever pain it's blocking is nothing compared to the falls, which fortunately were not serious but could have been utterly disastrous, and the four hour agony trip to the ER.

Today another half day sojourn out to the doctor for some real sutures and a clean up of the wound.  Then home for a relaxing afternoon of ice, narcs, and rest and now antibiotics.  The pain on meds is bearable, tough but bearable, keeps me very aware of the med schedule and not to mess it up!  I can weight bear carefully, so I'm being very careful and slow in my walking with the crutches.  It would be really great to have a carer right now to get ice packs and things rather than have to get up for them, but I'm just here with my dog most of the time, so I gather things up to reduce the number of trips. 

I have to wear the knee immobilizer until Wednesday, when the sutures are supposed to come out, and then I'm supposed to go immediately to PT, which should be interesting after not bending my knee for a week. I'm stiff on the best of days, I expect the pain meds will be on board before PT or else.  Right now I am looking forward to a restful and hopefully uneventful weekend. ::)

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #1 on: October 19, 2013, 01:45:51 PM »
The dawn of day 2 was not so bad.  I can put weight on my leg, carefully, and I almost do better without the crutches but I'm not ready to to do that just yet.  Going to the bathroom is the very worst  - (TMI! TMI!)  my loo is so close to my tub that I have to sit sideways and then lift and swing my splinted leg up and onto the side of the tub to keep it straight.  Damn my tiny bathroom.  If I do this again, I might need to rent a commode, as gross as that sounds.  I didn't know I'd have to keep my leg straight for a week so I figured that with the elevated toilet seat I'd be ok.  Oh well, live and learn.  Otherwise the dressing needs to be changed later, I'm almost afraid to look as I know it's bled through since it was sutured yesterday, and that should be the event of the day, besides lots of naps and TV, I'm going to be beating on the Amazon Prime.  I haven't finished Prime Suspect yet, and there are a couple of other British mystery series' that I need to watch too. 

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #2 on: October 19, 2013, 08:21:07 PM »
Huh - Mid day, Saturday, getting around mostly without crutches.  Not a lot of pain when weightbearing but I'm careful, much less awkward without the crutches. If there's any one thing I would suggest for someone having this surgery who lives alone, or will be alone for periods of time, is to get a small freezer that can be kept close to where you sit- I'd be swapping out the icepacks much more frequently if I could just grab them rather than have to get up and go to the kitchen. 

Otherwise I'm surprised at how nicely and quickly the pain seems to be dissipating. Over the incision is still tender but that's to be expected till it closes over. I may survive this in spite of myself!

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #3 on: October 20, 2013, 02:01:03 PM »
Day 4 - I woke up and got up at 5:30 because the knee immobilizer was just too uncomfortable to stay in bed. I basically have NO pain, just achy, and all I really want is ice.  I'm not going to take any more pain meds unless I'm really uncomfortable.  I'm able to get around without crutches, but I did take them outside with me so I could put the dog in his pen, he refuses to go potty in the temporary pen. It didn't hurt to walk that far at all. I'm very pleased that it's progressing so quickly, especially since I had two surgeries at the same time, the sooner I get this brace off, the better, I'm pretty sick of the stiff stays on the side and back and the velcro digging into my leg.  Patience is not a virtue of mine... ;)

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #4 on: October 23, 2013, 01:34:31 AM »
Day 6 - I'm grumpy.  Don't have a lot of pain but aggravation with things "on" me that are uncomfortable. Had to check in at the Dr. yesterday to get the sutures checked, my first PT appt was postponed till Monday because he doesn't want the incision to burst open as they start moving my knee.  So they put a big thick bandage on it, said I could sleep without the immobilizer if I wanted to but to keep it on when I'm walking and don't touch the bandage.  The bandage is like a vise, I can't get it off fast enough.  I walked a little bit to my mailbox and up the road about 15 yards, but that was all I could take with the immobilizer on.  I'm hoping this bandage comes off tomorrow  so that I can at least start to bend my knee, which really wants to bend right.  It really wants to get in the shower as well.....

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #5 on: October 25, 2013, 02:13:06 PM »
Day 9 - big progress....  Finally got rid of the immobilizer and have been allowed to start bending it a little, (only a little so as not to disturb the sutures) and can start walking on it.  I'm as of this morning up to my usual morning potty walk with the dog, maybe 200 yards round trip to the end of the road and back.  I am walking with one crutch for support, and walking every step carefully. If I don't use my toes properly, the weight slams down on the joint itself and hurts.  I'm going to have to learn to walk all over again, I've been compensating for bad knees for too long doing anything possible to avoid using my quads. I'm doing lots of passive stretching - just sitting with my knee bent to the point where it hurts, and just sitting there at the edge letting it stretch.  It does help.

I'm not in a lot of pain, still only taking the narcs at bedtime, and yesterday after I walked I took one, because I was understandably sore.  I'm mostly painful where the arthroscopic scars are, the actual implants I don't feel at all, smooth as glass - delightful.

If the doc is happy with the healing so far, Monday I will start PT.  Thursday, I have to go back to work come hell or high water, presumably driving myself, so I have a lot of stretching and bending do do before that. Oh to be rich and have the luxury of "enough" time off to properly recover...

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #6 on: October 28, 2013, 04:20:56 PM »
Day 12 - Mercury is definitely retrograde - nothing is actually going to plan.  Another appointment at the doc this morning to hopefully get my sutures out - NOPE.  He's still not confident that the incision is healed enough to take stress so now they're not coming out until Friday. GRR.  Friday when I'm supposed to be at work...  The incision is clean and no infection, he just wants to be sure, and neither of us need the complication if the incision lets go.  I'm on and off the pain meds as things get less and less numb, maybe one every other day.  Yesterday I did take one because walking with a limp has thrown my hips and back out and sore all over, so that soreness needed addressing.  I'm back to walking my dog on the usual route, and while it doesn't hurt my knee, the rest of me is being abused!   

The good news is I'm flexible enough now to DRIVE....wooo hooo, I'm free!  Free enough to drive myself to PT tonight for the first visit.  I didn't beat Elissa's record but for Day 12 that's pretty good. The most pain is coming from the arthroscopy incisions, there's no pain or stiffness whatsoever from the open knee implant surgery.  I'm in the home stretch....

Offline Lee Tipton

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #7 on: October 29, 2013, 04:14:28 PM »
Dear Yankee,

I am so interested in your case.  I know this may sound very intrusive - so I will apologize right up front.  But I have so many questions.

You sound as though you are in Europe - are you?  May I ask your age please?  I am interested in a menicus transplant - but I am going on 60.  I am willing to take risks to keep from having a total knee replacement, so a menicus transplant is what I am going to be looking into.

May I ask what led to the surgery you had?  It does not sound like an injury. 

I hope that you continue on with the recovery as you have done so well so far.

Many regards,
Lee Tipton

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #8 on: October 29, 2013, 08:50:54 PM »
Hi Lee,
I thought the name would have been a dead giveaway - LOL.  No, I'm in the US, 56 yo. 

I did not have any kind of transplant - I had IMPLANTS, patello femoral implants.  You can read about them here:
http://www.arthrosurface.com/products/knee/patello-femoral-implants/
My original condition was the deterioration of the cartilage on the back of my kneecap, it was so severe that I could not get out of a chair without using both hands.  Then I fell, on my bended knee, and not only tore the quad tendon at both ends (mildly) but damaged the patellar cartilage enough so that surgery was necessary.  I now have a shiny new titantium implant on my femur, and a high density polyethylene button replacing the cartilage on the back side of my kneecap that glides over the kneecap. It's lovely......no friction or pain.  The worst part of the surgery was the arthroscopic before the open knee procedure, that's was causing me the most pain now, the open knee part is completely painless. They repaired some tears to my meniscus, but what I have is still intact.

 I'd say do your homework, find out success rates on the transplant procedure and talk to people who have had it done.  Good luck.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #9 on: October 29, 2013, 09:03:49 PM »
Day 13 - Did some driving today, about a half hour each way, which is the distance to work, give or take.  It hurt, pretty much all the time, so I definitely need to do my exercises tonight and keep trying to loosen things up.  I decided to take the afternoon off with some ice, pain med and Whitechapel on tv.

Went to PT last night for the first time - absolutely fabulous place, practitioners who are gentle, considerate and don't subscribe to the 'no pain no gain' theory, which for me would be torture, given that underlying all this current stuff is some kind of myofascial/connective tissue pain syndrome that I've suffered with my whole adult life.  She gave me gentle exercises, considering I still have sutures in, and I have every confidence this might be the first time ever I'll enjoy PT to rehab my knee.  One day left, and I'm back work Thursday. Not a thought that fills me with joy....

Offline Lee Tipton

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #10 on: October 30, 2013, 04:32:03 PM »
Thank you so much for your reply Yankee.  Many blessings on your continued recovery and your return to work. 

Sincerely,
Lee Tipton

Offline randoknee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #11 on: October 31, 2013, 06:20:29 AM »
Hi Yankee,

I appreciate reading your diary.  I'm 52 and scheduled to have my PFA surgery next Monday, so it's helpful to see what you're dealing with.    I too have a couple of knees with bone on bone P-F compartments.   I had my good knee scoped, and had a chondroplasty, synovectomy this last June where my doc confirmed the bone on bone in that knee.  My bad (left) knee has the same bone on bone in the P-F compartment but has enough other challenges that my Doc want my good (right) leg to be as good as he can make it before we screw with that one.

I'm sorry you had trouble with the femoral block.  I had one when I had my hardware removal two years ago and I thought it was the cats pajamas.

I'll document my experience with the procedure on knee geeks as well.  Wishing you tailwinds on your recovery.

Dan
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #12 on: November 02, 2013, 01:42:33 PM »
Day 15-Back to work....If I had three weeks to use, I would have taken them.  My knee is more painful now than it was a week ago,  I think because nerves are reconnecting things and are becoming less numb. The night before work I barely slept at all, didn't want to take narcs the night before because the hangover from that sneaks up on you and I have found myself driving down the interstate with my eyes closed.  But I suffered for it, woke up every hour and couldn't get comfortable. It was a really sharp, pingy nerve pain, and there was no position that was comfortable, bent or unbent.  Finally got up and took some ibuprofen and an ice pack and got to sleep about 45 minutes before the alarm went off.  Work was uncomfortable, not easy to get any relief sitting at a desk, although I came well prepared with ice packs to alternate through the day, and put it up on a chair covered with bubble wrap for cushioning (I forgot to bring a pillow).  I still wished I could just take a nap!

Day 16, finally had the sutures out.  There's still a hole at the bottom that wasn't sutured completely that's draining-better out than in, I say, and it will heal from the inside out, I'm not bothered. Inexplicably, when all the sutures were removed, the nurse took skin glue and smeared it all over the ENTIRE wound, even what was already healed, (I said, alarmed, "what are you doing that for!") and then put steri strips over the whole thing.  Well.  Guess what I'm allergic to.... by noon the whole wound was one big red, itchy welt, and at the tip of each steri strip was a rectangular red spot that was almost blistered. If that's not bad enough, the glue made the skin very stiff, and inflexible, and when I bent my knee, it opened up a small fissure on the top, which was closed and hadn't drained for over a week.

To say that I am PO'd is an understatement.   I stopped and got some acetone on the way home and took all that crap off, am soothing the irritation with Benedryl cream and keeping it clean, and I will continue to care for it myself till it completely heals.  I have never had this much trouble healing anything, cranking that wound into a car where straight legs can't go every other day to go back to the doctor has not helped. Jeez, even my dogs and horses never had an infected cut, and they sleep in their own waste!  Shouldn't be this hard. I shall be cold hosing my leg this afternoon!

Physical therapy is wonderful - fantastic people that do what needs to be done, and do what I need them to do, like work on some very painful adhesions instead of just working on the bend.  They're the best part of the whole thing.  I'm going to enjoy the rest this weekend and gird myself for a full week of work.  Ugh.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #13 on: November 02, 2013, 01:50:21 PM »
Rando, good luck on your surgery.  One of the most pleasant things is that at the top of my kneecap where I have only felt insane pain and friction is now smooth and painless.  I think I'm having the most pain from the arthroscopic surgery than from the open knee part.  It's a little odd as well, I can hear a faint 'clicking' when the two parts meet, if I tap my kneecap I hear it clicking against the implant but I suspect that once my muscles are back in shape and doing their jobs, I won't hear anything.

The end of the two weeks has definitely been the most painful - three days after surgery I was off the narcs for a couple of days, or maybe once a day every other, but as things have gone on the pain is sharper and more nervy, I'm sure that will pass in a week or so.

The femoral block - if you're going to be in the hospital with people helping you walk, maybe - but going home with that for me was clearly not a benefit! There is no amount of pain it can block that will make up for sitting 4 hours in the ER the night of surgery, LOL.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #14 on: November 04, 2013, 01:40:57 AM »
Day 18 - I am having a real problem with pain below my knee, it's like an electric shock sticking in my leg.  Turns out it's the pes ansurinus, "The pes anserinus is the anatomic term used to identify the insertion of the conjoined tendons Sartorius, Gracilis, and Semitendinosus into the anteromedial proximal tibia. An occurrence of pes anserine bursitis commonly is characterized by pain, especially when climbing stairs, tenderness, and local swelling."  I'm not sure if the bursa is inflamed but it sure does hurt.  The therapist worked on it last week, she said if felt like an adhesion, and released it for a while but it was back with a vengeance the next day.  I've been icing it and rubbing arnica gel into it, it's easing somewhat but I have a feeling this will be with me for a while.  I never had this before the surgery, I would love to know what brought this on, maybe an instrument clamped on it or a tight bandage or something. The tight bandages gave me some mild phlebitis which I addressed right away by taping the bandages on, those kind of complications I don't need.

The rest of my knee is still stiff but it's getting easier to bend and stretch.  I'm walking more normally but my knee still feels like it's held together with rubber bands and it's a bit of an awkward gait.  Occasionally I hear a little 'clunking' sound, or tapping where the two implants meet, it's a bit odd but far preferable to the pain I used to be in.















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