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Offline mjeffrey

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Early Hardware Removal
« on: August 09, 2014, 08:57:04 AM »
Thought I’d start a new thread for hardware removal as the other one was getting a bit long. I called it Early Hardware Removal because it is less than a year since the original  ORIF. MTB1 also had his hardware removed after 7 months this week as well and mine was after 6 months.

Quote
mtb1 on 7-Aug-2014

I am hardware free! Currently relaxing in a hotel before heading home tomorrow.  I think it took about 4 hours from the time I put the gown on till I walked out. I had general anesthetic. My OS said he'd go in along the original incision,  slightly shorter in length. The private clinic experience (I am in north central BC - always went to the hospital in the past) was a good one, aside from the early morning emergency which pushed the entire day's appointments back by 2 hours.
So far so good. I'm on T3s again for as short duration as possible, gonna ween myself of the nasty pharmaceuticals asap to avoid the side effects.
Good luck on Friday Mark, take 'er easy. It'll update in a few days.

Aaron.


Yesterday I had my wires removed. Not sure how long the operation itself took but it was over pretty quickly. I chose general anaesthetic over an epidural. The original ORIF was with an epidural and the MUA with a general. Both were OK but I didn’t like the idea of a needle in the spine. I was waiting with 2 other people who both had epidurals in the past and each chose generals as well.

I was back in my room at about 16:30, expecting to stay overnight. I was supposed to stay because of a drain the OS planned to leave in. Apparently there was no need for the drain and so I was able to go home after I saw the OS at 18:00. 
He said the OP was more difficult than expected due to some inflammation. I need to ask more details about the difficulties and what that may mean for the knee. I didn’t ask at the time but I’ll see him Monday to change the bandage for something waterproof and get some details then. My knee typically swells up in the afternoon after walking on it and it was a bit puffy before the op. The OS says the daily swelling was likely due to the large amount of “matériel” in the knee due to the complex fracture. I hope he is right and it improves now.

The incision was on the same cut as before but smaller and the OS said he tidied up the scar (it was a bit raised). I have a compression bandage down to about mid calf.

I was cleared to walk with crutches and can put full weight on it. No PT or exercise for 2 weeks. Any angle of flexion is OK apparently, I was a bit surprised as I thought the incision could be pulled apart. Will ask again on Monday.

Pain in the recovery room was ok but then increased a bit and they gave me some tramadol through the IV, it diminished quickly and stayed constant the rest of the evening and today. I guess the closest description of the pain would be slightly more than “road rash” so quite tolerable and I had no problems sleeping on my back or side. The incision hurts a bit if I bend it and I’m walking stiff legged.

OS suggested I take paracetamol or ibuprofen. I'm taking 400mg Ibuprofen 4 times a day to try to reduce the inflammation.

I have plenty of time on my hands now ;) so will post updates regularly.

cheers
Mark
« Last Edit: August 09, 2014, 09:33:40 AM by mjeffrey »
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #1 on: August 09, 2014, 11:23:01 AM »
I was wondering if the ibuprofen was having an effect on the pain. Sometimes it works for me, sometimes not. So I stopped it for 6 hours. Bad idea. Much worse without the meds.
Also feel some internal ache as well. Before it was just the incision.
Aaron, how is it going with you?
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mtb1

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Re: Early Hardware Removal
« Reply #2 on: August 09, 2014, 09:55:04 PM »
Greetings Mark  :)
I am now well into Day 4 of hardware removal recovery. I have not had a T3 since last evening and I don't think I'll need any more. I'll manage with the occasional Ibuprophen/acetaminophen combo.
I typically have good results with Ibuprophen - I think most of my pain (not just with this injury, but overall) is caused by inflammation, so it targets the source. I have an active lifestyle, which means many strains, scrapes, bruises, and other results of excessive fun ;-). I have 2 reasons for getting off the Codeine - 1) constipation, and 2) can't drive or work while taking it.
I have 2 less staples than last time, the incision is pretty much like the first. I think I'll heal up much quicker though as it was a lot less invasive, and there was no trauma this time.
I was not given any restrictions by my OS. He pretty much told me I can do whatever I want whenever I feel I can. I walked out of the recovery room with the cane tucked under my arm, just to make the nurse shake her head. Lol. I have been walking around inside unassisted, and outside with a cane. It hurts more just after I have been sitting or laying down for a while, and gets better if I keep it moving. The incision is sealed up nicely and really has been since the morning after the surgery. I feel like I could move the joint a lot more, but I don't want to rip sutures/staples, so I'll take it easy for another week or so. If all is well, I don't have to go back to the doctor. I have a staple remover, high pain tolerance, and a strong constitution, so I'll likely pull my own staples in 4 or 5 days.
It feels so good to unwrap it, let it air out, and give it a good rub. The hard little lump that covered the end of an irritating wire is gone. I am 99.9% sure that this was a good thing to do and that I'll make a marked improvement as soon as the incision heals.

Watch out Gnar, prepare to be shredded!!!

The nurse in the recovery room told me that the first 3 days would be the worst. I'm done with them, and you will be soon too Mark. Hope you're doing ok, stay positive whatever the case may be.

Aaron.
fractured r patella into 3 pieces 2014/01/23
surgery - k-wires, tension band, screw 2014/01/24
sent home, no cast/brace/immobilizer same day
follow-up with OS 2014/02/04
2nd follow-up 2014/03/11, ROM 90
3rd follow-up 2014/04/08, ROM 130
HW removed-2014/08/06

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #3 on: August 10, 2014, 06:36:27 PM »
LOL "walked out of recovery room" I'd have loved to see the expression on the nurse's face. You should have also told her (or him) you were going to DIY the staple removal as well :-).

Pretty surprised to read about staple removal is that normal in the US and where did you get the staple remover? I see there are some youtube videos showing it but still seems like a brave/crazy thing to do, but hey, why not?

Second day post op and things here much the same as yesterday, same medium pain all day up until an hour or so ago when it went away. Maybe it was the combination of drugs: (Ibuprofen and Italian red wine ;-)

I think the clunk on extension is still there which I'm majorly disappointed about. Will raise it with the OS tomorrow.


2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #4 on: August 12, 2014, 09:16:11 AM »
Third day post-op and I saw the OS again  to change the dressing. Surprised to see that he had used stitches. I had asked him to tidy up the scar which was a bit raised after the incision of the first op was pulled apart a little.
I hadn't been able to flex my leg much in the compression bandage and so this was the first time I really tried and only got to about 70 which I wasn't too happy about.
The clunk on extension was much reduced and he thinks it will continue to improve with the time.
edit: I was doing too much too soon. Don't follow my example

On getting home I started to work on my flexion and got to 90 (with a bit of pain). It really feels like there are adhesions in there (can they start so soon?).
Not happy with this I got on the bike and had to put the seat up. With a bit of coaxing I made the first revolution and continued for a few minutes, each revolution hurt but less and less.
Put the seat down and repeated. I thought, if Aaron is going to remove his staples himself, I can man-up to a little pain as well and pushed it a bit.
Doing this I got to 105 after 10 minutes (I measure it with an app on my smart phone).
Not wanting to cause too much inflammation I stopped there, iced it and put a compression bandage on and went to bed.

On waking on day 4 I did 5 minutes at 105 degrees. Similar pain but a bit less. I plan to repeat throughout the day pushing a bit each time.

Hey Aaron, do you have any issues with flexion? I didn't really expect to be back to how I was 3 months ago :-(
 
« Last Edit: August 22, 2014, 04:55:03 PM by mjeffrey »
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mtb1

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Re: Early Hardware Removal
« Reply #5 on: August 12, 2014, 03:13:08 PM »
Mark, you wild man - on the bike already, that's awesome!
It's day 6 for me. I'm still pretty swollen, and the area around the incision is sore. I have a little over 90 ROM, so not too happy about that either. I had hoped to be back to work soon, but it looks like I'll take the rest of the week off.
You've gone and inspired me Mark - I guess I'll haul the trainer back out today, get the bike set up, and try to spin. It'll feel good for the mind & spirit and that is really what this is all about. We have to keep reminding ourselves that we are in it for the long haul. We have had an 'oooooops' moment that will be with us for the remainder of our lives. Overnight improvement is always possible, but it may not be measurable or noticeable. With hard work, perseverance, and support from others, we will put several days or weeks together and have success that we will notice.
fractured r patella into 3 pieces 2014/01/23
surgery - k-wires, tension band, screw 2014/01/24
sent home, no cast/brace/immobilizer same day
follow-up with OS 2014/02/04
2nd follow-up 2014/03/11, ROM 90
3rd follow-up 2014/04/08, ROM 130
HW removed-2014/08/06

Offline Twinkeelfool

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Re: Early Hardware Removal
« Reply #6 on: August 12, 2014, 11:29:11 PM »
Inspiring thread ( I just read the other one too :) ). I'm around 5 months post op. Walking and stairs is pretty normal, but rom is around 125-130, it doesn't so much hurt to go further, it just physically won't go. I'm seeing my surgeon tonight, and hoping to get the k wires out before Xmas or just after.

If I wasn't active I could get away with leaving them I guess, but I can't run and I can't surf. And as much fun as squatting 25 different ways is, I want to be able to do the things I could before. So I want the things out. I also don't think it's such a great idea to have a bunch of wire inside a joint long term.

My surgeon mentioned he wouldn't take them out unless they were giving me trouble, and that 12 months is the minimum they need to stay in. Realistically, it'll probably be a few months to get him to do it anyway ( like most surgeons he's always busy! ) so I think I'll be close to a year by the time they come out anyway.

People see me walking pretty much normally and think I'm fully recovered, but until I can surf, or run, I still feel restricted. I'm grateful for being mobile for sure, but I want to move freely, and at speed.

No, a snapped knee cap is not the same as a TKR for the 3rd time!!!!

Offline daihard

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Re: Early Hardware Removal
« Reply #7 on: August 13, 2014, 06:18:47 AM »
Doing this I got to 105 after 10 minutes (I measure it with an app on my smart phone).
Not wanting to cause too much inflammation I stopped there, iced it and put a compression bandage on and went to bed.
Hi Mark.

Quite a bit off-topic, but would you mind sharing with me the name of the smartphone app you use to measure your ROM? I always guess by looking, and I could use something more accurate.

Thanks! I hope you get your ROM back soon to where it was prior to the hardware removal surgery!
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline MDAL

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Re: Early Hardware Removal
« Reply #8 on: August 13, 2014, 06:39:25 AM »
Daihard:

There is a bunch of them in the market some free some paid, some of poor quality some of better quality, these are mostly developed by single individuals, so not really rocket science:

"iGoniometer smart phone application"

"Goniometer" (by Jinfra)

Knee Goniometer App (Ockendon©)
http://bonesmart.org/forum/threads/apps-for-bonesmarties.13725/

There are many more, some pages keep reviews of it.

Personally, I bought a manual 30cm goniometer, you can buy them from ebay for pennies...

Offline MDAL

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Re: Early Hardware Removal
« Reply #9 on: August 13, 2014, 08:00:47 AM »
Still on this subject:

Manual goniometers (ebay list), you can find good deals for less than 5 dollars:

http://www.ebay.com/sch/i.html?_trksid=p2050601.m570.l1313.TR0.TRC0.H0.Xgoniometer.TRS0&_nkw=goniometer&_sacat=0&_from=R40

I believe the longer ones even a bit more expensive help giving a better measure, but you can perfectly do the job with a cheaper short one.
« Last Edit: August 13, 2014, 08:03:29 AM by MDAL »

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #10 on: August 13, 2014, 09:40:57 AM »
Interesting question daihard. I did a brain dump here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=64628.0

2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #11 on: August 13, 2014, 10:34:46 AM »
Quote
Twinkeelfool
People see me walking pretty much normally and think I'm fully recovered, but until I can surf, or run, I still feel restricted. I'm grateful for being mobile for sure, but I want to move freely, and at speed.
I had the same comments when people saw me, if they only knew the reality. It was always clear I'd need my hardware removed,  since I have more than most people (4 k-wires and 2 tension bands) and 3 OSs told me the same.
But given how the wires and tension bands are placed (gory details here  https://www2.aofoundation.org/wps/portal/surgery/?showPage=redfix&bone=Knee&segment=Patella&classification=34-C1.3&treatment=&method=ORIF+-+Open+reduction+internal+fixation&implantstype=Tension+band+wiring&redfix_url=1285238823429)
I would have thought that it would cause problems for everyone. Since the accident I always had weakness on doing leg extension exercises due to pain at the top of the patella, and while its still early days I now feel that that pain less. I guess I'll know for sure in a few weeks.

cheers,
Mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline Twinkeelfool

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Re: Early Hardware Removal
« Reply #12 on: August 13, 2014, 11:28:50 AM »
My surgeon won't take them out til the 12 month mark, so march next year. I kind of expected that, and it sucks but at least I have a timeframe now. I'll have to suck it up and squat like a mofo til then. I'll hopefully be able to surf my longboard at least on small days to get my saltwater fix. In the grand scheme of life another 6 months won't kill me. I think...
No, a snapped knee cap is not the same as a TKR for the 3rd time!!!!

Offline jacobj

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Re: Early Hardware Removal
« Reply #13 on: August 14, 2014, 05:37:46 AM »
Hi all,
9 and a half months after fracturing my patella, the time has come to have the hardware removed. Only 6 sleeps to go in fact. My surgeon recommended early removal because it appears that the pins are shifting and causing me a fair amount of pain at the top and bottom of my knee. I went for my first bike ride (on an actual bike) last weekend to test out the knee so that I can have a point of reference before and after surgery. Cycling up hill was a definite no no, the pain was just too much. I'll add my removal story here once it's done!

Cheers

Jacob

Offline Twinkeelfool

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Re: Early Hardware Removal
« Reply #14 on: August 15, 2014, 04:57:41 AM »
Good luck Jacob!. Let us know how it goes.
No, a snapped knee cap is not the same as a TKR for the 3rd time!!!!