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Author Topic: ACI/Osteotomy in 1.5 weeks and freaking out!  (Read 9890 times)

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Offline TaraAnn325

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ACI/Osteotomy in 1.5 weeks and freaking out!
« on: May 31, 2014, 02:25:13 AM »
Hi there.  Just maybe looking for some support and definitely advice.  I know recovery is different for everyone, but I'm thinking I might find comfort in getting experienced input. 

On June 11th, I'll be having an ACI and osteotomy.  The cell graft will be for a trochlear and patellar defect.

I live alone.  With five cats.  In a two story home.  My mom is going to drive up from where she lives (2 hours away) and help me out for the initial recovery.  I am HOPING, though, to be solo by a week post-op.  Just not that used to having another person around all the time.  Especially not my mom!!  ;)  Based on other people's experience, does this sound even remotely possible?

At what point have people been given the OK and actually felt comfortable to go up and down stairs?  I can certainly sleep downstairs for a while but would love to make it to the second floor before too long considering that is where the shower is.  Also, if my mom is here for very long, it would be nice to be able to be in my own bedroom and not in the wide open downstairs with no chance of escaping.

Speaking of showers, am I really gonna need assistance with that?  NO ONE has seen me naked in many, many, many, many years.  Not really planning to break that streak anytime soon!  I will have a shower seat.  Although my shower is the tub/shower and not a walk-in shower.  Should I just plan to hose off in the backyard, maybe, instead???

My surgery is on the left leg.  At what point is it reasonable to think I can drive an automatic?  I do have a neighbor willing to get groceries and help with upstairs litter boxes.  But I am just such an independent person and cannot imagine relying on others all the time.  What really stops people from being able to drive almost right away if their surgery is a non-driving leg?

Luckily for this situation, I work from home mostly on the computer all the time.  I'll be off for almost a month, and I think that should be reasonable.  I imagine I can work while using the CPM and can take regular breaks to throw in PT here and there.  Hopefully that isn't a delusional plan.  Anyone have input on that?

OK, I think that is all I have for now.  Very much looking forward to getting advice from others, so chime on in!!!    :)

Tara.

Offline MDAL

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #1 on: May 31, 2014, 03:03:04 AM »
Well, you will go for a surgery which requires a certain amount of care and patience so you don't break it all up, and yes those things do happen. It would be a bummer if while trying to be independent you slip and screw up your graft, or the bone itself and find yourself in a very s****y situation.

You will need a care giver for some weeks and even after you will need some special attention to what you are doing for up to 3 months.

About baths, you can't shower for 2 weeks at least so you don't get infections, you will need to wash in bed with a sponge. Someone should bring you water and washing materials.

It may suck to be dependent, I know that myself... but there is no point in screwing your life over a few weeks of patience...

Good luck.

Offline TaraAnn325

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #2 on: May 31, 2014, 03:41:16 PM »
Thanks, MDAL, for the response. 

Do you have any knowledge about going up and down stairs?  Is it totally contraindicated for many weeks or left up to the individual and what they can tolerate?

Offline MDAL

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #3 on: May 31, 2014, 03:58:37 PM »
TaraAnn:

I think you should be a bit better informed by now about the 2 procedures you will do and the risks you will take.

ACI:

They will place cartilage holding on almost nothing (there are several ways to do it, but none of them is held on cement), in the first weeks any brute force, fall or fast movement can rip it off, and let the new cartilage plug loose inside the joint, leaving you with a hole bigger than before. Most of these procedures rely on bone marrow to form the connective tissue between bone and the surrounding native cartilage, it takes a long time for it to connect, and it will be extremely fragile up to several weeks/months. There is a serious failure rate in ACI procedures, don't take it for granted! You will need to be extra careful with each and every move or you will end up worse than before!


Osteotomy,

They will make a partial cut through the bone in order to correct the alignment, new bone will form in between the cut, even though this procedure can be done to add or remove height. Can you image if you have a fall up or down stair, or if you slip with crutches when half your bone is cut, and not yet connected? Can you picture this image? Crutches are tricky, a bit of water in bathroom and you are in the floor. Going up and down stairs with a braced leg, crutches, full of pain and messed up with pain meds is a serious risk.

Now seriously, do some research about the procedures you will do, and think carefully about all the consequences that even a minor incident in the early stage can lead to... You need to be extremely careful, patient and you will need a caregiver in the initial weeks. What you will do is NO joke!


Offline Vickster

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #4 on: May 31, 2014, 05:04:08 PM »
This is a really good link to understand aci. It's a little old and from the uk, so bear that in mind, especially that every doctor's protocol and every patient will have a different surgical, post op pain and recovery experience, but it'll help you understand about the graft and possible rehab.  The description of the state of the graft is really interesting and to be borne in mind

http://www.kneeclinic.info/download/CKC_GNHFT_ACI_RehabGuide_101106.pdf



On the driving front, it'll depend on your surgeon, whether you are braced - never drive before cleared to do so, regardless of the leg/car type - at least here in the UK, if not cleared to drive, you could find yourself uninsured if involved in an accident, or stopped by the police etc.  After my left leg surgery (arthroscopy, rather minor in comparison), my first surgeon wouldn't let me drive for 3 weeks.  Second scope, 10 days, different surgeon

There are a fair few aci/tto diaries on here so have a search and a read, quite a few mention being cleared to drive, work etc

Good luck :)
« Last Edit: June 01, 2014, 10:52:43 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline ozzie

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #5 on: May 31, 2014, 05:04:59 PM »
Hi,  I am on vacation so can only write briefly, but I can give you more info at another time….I had ACI and osteotomy on both knees-right in March and left in December of 2013.  I am doing great and my ACI's were in same spot as you will have.  I did have help for about 2 weeks.  I did not do the stairs for 3 months according to my ortho and PT's orders, so I would recommend bringing the litter pans downstairs and staying on the first floor.  You should definitely speak to your doctor and physical therapist about what to expect and how to prepare and what limitations you will have.  The best Physical therapist is one who is knowledgable about ACI-there are many who are not since it is not as common-but your ortho has probably sent you to someone he knows and will be familiar.  I understand not wanting to have someone stay with you if you like to be alone and not have guests, but I found it helpful to have someone come visit daily and prepare my meals and do the stuff I could not tend to like animal care, etc for at least the first two weeks. 

Btw, I have 3 cats also!  and a dog!  I did not do the dog walking until recently of course-my two teenagers had to step up and take responsibility and they did…..

I am at 5 months post op from last surgery now and doing very, very well.  I am  taking long, fast walks, swimming, and have no pain.  If you want to read about my experience, I wrote a lot on my diary on this website-Ozzie's ACI and osteotomy….

Feel free to ask any more questions etc.
ACI patella and trochlea & Fulkerson on Dec. 26, 2013-Dr. Scott Gillogly
ACI patella surgery and Fulkerson with Dr. Gillogly June 25, 2013
Extensive cartilage damage in both knees due to misalignment of patellas

Offline TaraAnn325

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #6 on: June 01, 2014, 10:48:15 PM »
TaraAnn:

I think you should be a bit better informed by now about the 2 procedures you will do and the risks you will take.

ACI:

They will place cartilage holding on almost nothing (there are several ways to do it, but none of them is held on cement), in the first weeks any brute force, fall or fast movement can rip it off, and let the new cartilage plug loose inside the joint, leaving you with a hole bigger than before. Most of these procedures rely on bone marrow to form the connective tissue between bone and the surrounding native cartilage, it takes a long time for it to connect, and it will be extremely fragile up to several weeks/months. There is a serious failure rate in ACI procedures, don't take it for granted! You will need to be extra careful with each and every move or you will end up worse than before!


Osteotomy,

They will make a partial cut through the bone in order to correct the alignment, new bone will form in between the cut, even though this procedure can be done to add or remove height. Can you image if you have a fall up or down stair, or if you slip with crutches when half your bone is cut, and not yet connected? Can you picture this image? Crutches are tricky, a bit of water in bathroom and you are in the floor. Going up and down stairs with a braced leg, crutches, full of pain and messed up with pain meds is a serious risk.

Now seriously, do some research about the procedures you will do, and think carefully about all the consequences that even a minor incident in the early stage can lead to... You need to be extremely careful, patient and you will need a caregiver in the initial weeks. What you will do is NO joke!

Wasn't looking for a lecture.  You actually never answered any of my questions.

Offline TaraAnn325

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #7 on: June 01, 2014, 11:22:05 PM »
Hi,  I am on vacation so can only write briefly, but I can give you more info at another time….I had ACI and osteotomy on both knees-right in March and left in December of 2013.  I am doing great and my ACI's were in same spot as you will have.  I did have help for about 2 weeks.  I did not do the stairs for 3 months according to my ortho and PT's orders, so I would recommend bringing the litter pans downstairs and staying on the first floor.  You should definitely speak to your doctor and physical therapist about what to expect and how to prepare and what limitations you will have.  The best Physical therapist is one who is knowledgable about ACI-there are many who are not since it is not as common-but your ortho has probably sent you to someone he knows and will be familiar.  I understand not wanting to have someone stay with you if you like to be alone and not have guests, but I found it helpful to have someone come visit daily and prepare my meals and do the stuff I could not tend to like animal care, etc for at least the first two weeks. 

Btw, I have 3 cats also!  and a dog!  I did not do the dog walking until recently of course-my two teenagers had to step up and take responsibility and they did…..

I am at 5 months post op from last surgery now and doing very, very well.  I am  taking long, fast walks, swimming, and have no pain.  If you want to read about my experience, I wrote a lot on my diary on this website-Ozzie's ACI and osteotomy….

Feel free to ask any more questions etc.

Hi Ozzie~

Thank you very much for your response.  I guess my first post was a dud because it came off to some that I am uneducated/uninformed.  My hope for posting on this site was to get personal insight.  Not a lecture.   I really wasn't asking about what kind of surgery I was having!  So, again, I very much appreciate your response and support.

Even with the initial detailed post-surgical rehab steps that my doctor has given me and from what I've read from other educational websites, they didn't include, for example, reasons for why exactly a person would post that they couldn't get themselves out of bed on their own in the beginning (was it the nerve block that prevented this or did this person not have the arm strength to lift the leg or was this person just not used to lifting a leg with a big cumbersome brace or is it actually contraindicated to lift the leg for the first couple days?) or why someone else needed help with a shower three weeks out (were they being just very careful or was it actually contraindicated to not try to maneuver in a shower alone until maybe a month out or something?  And was this an actual shower attempt as in standing?  Would that person have been OK if they'd simply been assisted into a chair in the shower and then took it from there?  Or maybe that is what the person meant by help with a shower -- someone got them situated on the seat and then left her to do the shower...?) or why they didn't drive for 3 months post-surgery (because they were heavily medicated still or it was simply too hard to keep the leg protected trying to get in and out of a driver's seat and drive on own?).  Those were just examples of things running through my head after reading a bunch of blog posts...   

I am aware of the recovery and rehab for these procedures, although I admittedly never actually asked my doctor exactly when I could drive again (isn't a huge issue bec I live in a tiny town and work from home) or when I could go up the stairs again (that one didn't occur to me, although I assumed I wouldn't be doing stairs right away!).  I did email my doctor on the 29th listing those and a bunch of other questions, but I haven't heard back just yet.  That is when I started looking at the blogs to try and get a better vision of the post-surgical experience, and that is just what started to freak me out!

From what you wrote, it sounds like I have had an OK expectation.  My mom was going to stay with me for a week at least, at which point I was hoping to send her home and then have a neighbor and couple friends scheduled to come by daily to help out with groceries and cat stuff or just check in.  It is just that some of the blogs I read seemed to detail people having "hand and foot waiting on" for many weeks.  I wondered why it was necessary for that long or if it was just a convenience...

I will read your past posts and then let you know if I have further specific questions for you.

And thank you again for your response and support!!   :) 
« Last Edit: June 01, 2014, 11:31:23 PM by TaraAnn325, Reason: posted before done writing »

Offline TaraAnn325

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #8 on: June 01, 2014, 11:42:03 PM »
This is a really good link to understand aci. It's a little old and from the uk, so bear that in mind, especially that every doctor's protocol and every patient will have a different surgical, post op pain and recovery experience, but it'll help you understand about the graft and possible rehab.  The description of the state of the graft is really interesting and to be borne in mind

http://www.kneeclinic.info/download/CKC_GNHFT_ACI_RehabGuide_101106.pdf

On the driving front, it'll depend on your surgeon, whether you are braced - never drive before cleared to do so, regardless of the leg/car type - at least here in the UK, if not cleared to drive, you could find yourself uninsured if involved in an accident, or stopped by the police etc.  After my left leg surgery (arthroscopy, rather minor in comparison), my first surgeon wouldn't let me drive for 3 weeks.  Second scope, 10 days, different surgeon

There are a fair few aci/tto diaries on here so have a search and a read, quite a few mention being cleared to drive, work etc

Good luck :)
Thanks for the response, Vickster!  That link was interesting.  I like the details they included on actual practical things to consider after the surgery.  Interesting how long it was before you were cleared to drive even post-arthroscopic surgery.  After my meniscal repair and cartilage harvest, I was driving two days later!  Doctor was OK with that.  But I was off pain meds by then and essentially comfortable walking.  All different experiences, I guess!  :)  And thanks again for the response!
« Last Edit: June 01, 2014, 11:46:09 PM by TaraAnn325, Reason: posted before actually done with response »

Offline ozzie

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #9 on: June 05, 2014, 02:52:05 PM »
Hi Tara-I just saw you posted on my "journal"  and so glad if it was helpful!  I am now visiting family in FL-for my mom's 75th birthday. My daughter graduated high school-so we were busy with graduation and then we went to college orientation last weekend. Next week will be calm-no travel or major life transitions!  I am happy to help with info from my experiences. The only issues I have at this point is weakness in glutes -my right (first) leg is weak too and I attribute some of that to waiting too long to do stairs after my first surgery. I thought I had to wait 6 months and it is 3 months. My physical therapist is very professional, but did not communicate that I could do stairs.  This weakness does not affect my life at all, just feel it going down stairs, getting up from a low chair. 

Good luck and please update on how things are going.
ACI patella and trochlea & Fulkerson on Dec. 26, 2013-Dr. Scott Gillogly
ACI patella surgery and Fulkerson with Dr. Gillogly June 25, 2013
Extensive cartilage damage in both knees due to misalignment of patellas

Offline papasmurf1978

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #10 on: June 12, 2014, 08:09:50 PM »
Hi everyone,

There's lots of hype these days about new procedure called Chondro filler where a gel is inserted in the cartilage defect in order to regenerate the cartilage. Couple of results are posted on the web with excellent results but did anyone had it done and would like to share the experience?

I will probably need to have it done. My MRI revealed that I have 6 mm large x 4 mm high involving less than 50% of cartilage in the medial facet of my patella. I did squats in February of this year, got knee pain couple of days later and was diagnosed with beginner stage chondromalacia patella. I read that the sooner you fix the defect with Chondro filler the faster the regeneration and complete prevention of further degeneration of the cartilage. Also, I heard that it's best when it's done before 45 years of age to increase the chance of full recovery. I'm 36, male and great shape except for my knee which it has been now 3 months I'm dealing with. I really want to fix this problem. My knee cap pops once ever time I fully extend it without pain but it didn't do that before and it also cracks once as well gently without pain. This is really weird. My Ortheo told me my patella is not tracking exactly as it should so now I'm doing PT to get it back in proper tracking. One exercise I do is static wall squat. Really helps and it does not hurt my knee and I feel that my muscles get way stronger, especially quads which I think are important for proper tracking.

Any info would be appreciated as I'm sure there's lots of you out there having same problem.

Thanks,

Mariusz
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline ozzie

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #11 on: June 12, 2014, 08:17:23 PM »
I am sorry, I am not familiar with that procedure.  I guess just make certain that you go to an orthopedic surgeon who has lot of experience with cartilage replacement issues, so you can trust his/her advice!  Ozzie
ACI patella and trochlea & Fulkerson on Dec. 26, 2013-Dr. Scott Gillogly
ACI patella surgery and Fulkerson with Dr. Gillogly June 25, 2013
Extensive cartilage damage in both knees due to misalignment of patellas

Offline TaraAnn325

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #12 on: June 20, 2014, 06:08:19 PM »
Surgery was June 11th.  It hurt more than I anticipated, actually.  I was taking Percocet, 2 pills every 4 hours but was really in tears within 3 hours.  Once I was given stronger meds a couple days later, I've been able to keep on top of the pain.  Happy to say that I also contacted my insurance company about the CPM and was told insurance would approve it (no charge, no limitations) as long as my medical group approved it.  So I'm now on the CPM, 0-30 degrees, 8 hours a day.  I'd also recently started 90 degree passive flexion (basically having my mom control my leg as it slowly drops down from the bedside).  This activity has been off and on tolerable.  Sometimes I can just about make it to 90 degrees OK.  But a couple sessions have had me screaming out in pain, feeling like something was catching or snagging in my knee mostly when we tried to extend my leg again (all passive motion).

My fear about being reliant on others and why exactly I would need so much help for so long...  Well, my mom is still here although I can do many things on my own.  My biggest problem is the fatigue in my good leg/butt.  If doing this again, I definitely would get the rest of my body in WAY better shape.  I've used crutches many times before, and I've done it on pain medication.  So I was confused about why I would be so debilitated and reliant on someone else.  But I've never actually had the restriction of "no weight bearing" in one leg.  Wow, does that put a lot of strain on the weight bearing leg.  Getting to the bathroom and back would exhaust me!  I'm now able to do several different things, but I do come back to the bed in between to rest for a minute or so.  I even watered the backyard this morning all on my own!  :D

I really think if someone had posted like I had initially asking for insight on the experience, I would point out how surprisingly exhausting it is to walk on crutches with only one weight bearing leg.  That seems to be my biggest limitation right now.  I've not tried the stairs, although I've stood in front of them a couple times and considered it.  Maybe today I'll go up the first step and back down.... 

Showers...  I was given the green light to shower by day 2.  Of course, I was instructed to cover my surgical leg in a way to keep it completely dry.  I actually didn't bother with a shower until yesterday, 8 days post-op.  Yup.  So yesterday I went to the gym and used the handicap shower there since my shower is upstairs.  I even worked out at the gym doing the arm ergometer for 35 minutes to attempt some type of cardio.  Hard getting a workout with the arm ergometer, though.  Been doing leg lifts with weights on my good leg (is bilateral transfer still a thing?  I remember when I was getting my masters in exercise physio many years ago that some professors explained exercising one leg has actually been shown to transfer strength to the non-exercised leg...  one of these days I'll look that up and see what he current line of thinking is....)  and using dumbbells for upper body also while stuck in bed.

I climbed into and out of my own car yesterday just to see what the potential would be for me to drive.  Getting in and out is totally doable.  Not 100% comfortable with the sitting in the car position, but I didn't feel like it was a stress or strain -- maybe if I could put some small item at my foot to elevate the leg a little...?  Thankfully the surgery was on my left leg, so I imagine I can handle short trips of driving soon if need be.  Don't see any reason to drive but nice to know it is there just in case. 

My mom is planning to leave this Sunday.  I've been toying with the idea of sending her home sooner.  But she is doing such a great job keeping my place clean!  Cleaning is something I actually don't see myself being able to do ANY time soon.  Don't have a plan for that, but there's always the option of hiring someone.  Or just putting up with cat hair and a dusty floor for a while.

Cat care was really hard on my poor mom.  My cats are so spoiled and used to me being at their beck and call.  We've given up temporarily on trying to control their food and particular diets.  I keep certain food in containers by my bed for the picky one who prefers this crazy expensive stuff.  And all the others are just gonna have to eat the low calorie food because of the one overweight cat.  I have managed occasionally to pull out some wet food and feed as a treat to individuals.  -- OH,

that reminds me... something we got that has been very useful:  one of those hospital type of tables that has wheels and can swing over a bed or chair.  I use that to transport things around the house.  Like bringing myself coffee in the morning or ice packs back to my bed.  Definitely has been helpful.  I had imagined carrying things in a backpack, but I didn't really think about open drinks.  This table is definitely a must in me being self-reliant.  Another benefit is that I could put that table over my knee/shin when I sleep to prevent any cat from climbing on the surgical leg.

The 22 staples are going to be removed next week on Thursday.  I'll be getting right into the pool after that per doc's instructions.  Good time of year for this surgery, for sure!!   

Well, that's the update.  Off now to water the front yard and then do a whole lot more of sitting and waiting to heal!   8)

Offline GarethNeath

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #13 on: August 26, 2014, 04:28:52 PM »
Hi,

Any update on the state of your knee after the operation back in June? From what I gather, the recovery from ACI is a long process. has the oseotomy made much difference?

I'm sure the cats were very sympathetic to your plight - not (I'm a cat owner too)!
1996 - Meniscectomy - right knee
1999 - ACL reconstruction left knee
2002 - Meniscectomy - right knee
2004 - Meniscectomy - right knee
2011 - Debridement - right knee

Offline ozzie

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Re: ACI/Osteotomy in 1.5 weeks and freaking out!
« Reply #14 on: August 26, 2014, 08:51:00 PM »
I am doing very well. I still have a little weakness in my glutes and am doing exercises for that including those that get you to stand from sitting position.  I did not do that till my second surgery (or I did do it-but not as much as I was supposed to) because it hurt my pre op knee.  I just returned from a trip that was 10 days of walking-lots of hills.  Both knees were great.  I brought ice packs wih me and at night I put cold on them since I had a little swelling..I am happy with the surgery, had no complications.  As for the osteotomy-it provided immediate relief from pain for each of my surgeries. I only wish I had had osteotomies 10 years ago and had avoided the cartilage damage.

 I wrote A LOT on my own page on this site-"Ozzie's 2 ACI's and osteotomy" or something like that-but I don't mind at all answering questions or discussing here. 
ACI patella and trochlea & Fulkerson on Dec. 26, 2013-Dr. Scott Gillogly
ACI patella surgery and Fulkerson with Dr. Gillogly June 25, 2013
Extensive cartilage damage in both knees due to misalignment of patellas