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Author Topic: Immobile fat pad and unable to walk. What do I do next?  (Read 1269 times)

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Offline DogfacedGirl

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #15 on: April 05, 2022, 02:28:55 PM »
Hi Amy,

I think it's very likely that you have both an inflamed and fibrotic fat pad, including the nerves it contains, and an inflamed nerve/s outside the joint.

I happened to be chatting to a pain specialist today and ran your symptoms past him. He suggested that nerve ablation is the usual method used, using radiofrequency ablation, although cryotherapy is also possible but not in any way better, and requires a much larger needle that is inserted.

From what he told me there are a few problems with ablation: one being that the nerve can re-grow, along with the pain, and also that it's difficult to locate the nerve to ablate it. There is also a small risk of more inflammation occurring in that nerve, but apparently this is more likely if the nerve is cut. I understand a nerve block is done before ablation. A nerve block (anaesthetised nerve) on it's own will only last a few hours.

We discussed the usual medications for neuralgia, and he mentioned that there is a nerve stimulation treatment. From what I gathered they place a needle next to the nerve and stimulate it to de-sensitise it. It might be worth seeing a pain specialist to discuss this. However, the mechanical pain from the Hoffas being pinched will still be there, unfortunately. The only way that this will go is for the fat pad to settle right down and for the fibrosis to resolve, but being where it is, this is very difficult - as you know.

You could also ask about Vagus nerve stimulation. Several variations of this are being trialled for other pain pathologies, some involve implanting a device at the base of the neck. I don't know if it would be suitable, but it's worth asking about.

Regarding aspirin, low dose is 80 to 100 mg/day, and it can be bought in a capsule that is easier on the stomach. And yes, ask your doctor.

I would think that being pregnant on it's own would be a reason for your GP to order tests for essential vitamins and minerals. Good luck with it.

I personally feel that it's not worth wasting your time and money on either PRP injections or Hyaluronic Acid injections. There is no sound science supporting these methods and they are a huge money maker. There is also an infection risk (has your knee been tested for infection?) and sometimes PRP is prepared in the back room without proper sterile technique and equipment. On top of that, the "growth factors" that are supposedly concentrated from your blood and re-injected in PRP treatments are the very factors that are causing your fibrosis, and you don't need more of them. It would be a different matter if you had a broken bone that wouldn't heal.

I have heard stories about shockwave therapy making the situation worse, but I'm not an expert on this. However, I can see that it may upset the nerves more.

I don't know any surgeons or physios in the UK, but I know there is the Newcastle Fibrosis Research Group. I don't know this group personally.

All the best,
Kay




1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #16 on: April 05, 2022, 03:02:01 PM »
Hi Kay

All super helpful advice again. thank you for talking about my case with a pain specialist today- very kind of you. Everyone really is supportive on this forum, wish I had joined in sooner!

Yes I wasn't 100%sure about PRP either and just generally having another needle stuck in my knee for something that isn't proven to work. Shockwave does seem to be pretty aggressive so I think I will steer clear and I really don't want to upset the fat pad nerves anymore.

The nerve ablation seems worth considering and seriously looking into.... as does finding out more about the nerve stimulation treatment with the needle and Vagus nerve stimulation. Thank you

Am I right in thinking to get rid of the mechanical pinch in the fat pad I need to reduce inflammation and pain signals and in turn that may allow the fibrosis to go away? I was going to try Diclofenac for a few months once safe to, I was on 1500mg of Naproxen for around 3 month last year but this didn't help I don't think. I try to tape the patella off the fat pad but this is a bit hit and mis to how well it works and 90% of the time pain is there. I think the slight maltracking is due to loss of muscle as I never ever had any problems like that before when I was strong- so this adds to the vicious cycle of pinching as well.

Is my best line of attack, in your opinion, to try and settle the pain with the meds/patches and possibly nerve ablation.. so I can do some physio to strengthen the knee so stop the pinching/allow the fibrosis to heal possibly? Or am I too far down the line for a full recovery maybe now...

Amy :-)




Offline DogfacedGirl

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #17 on: April 06, 2022, 02:28:27 PM »
Hi Amy,

Yes, reducing inflammation and pain signals is a necessary first step in resolving fibrosis. However, after a certain time these factors "feed" each other and it becomes extremely difficult to break the cycle.

Unfortunately, most quad exercises upset an inflamed fat pad and patellar tendon more, and this is a major cause of problems. In my opinion, quad exercises other than very gentle ones should be left until the pain has gone, and even then you will need to be very careful for a considerable time. I don't know if you are too far along for full resolution, but in any case minimising the symptoms is obviously desirable.

Diclofenac and Naproxen are both NSAIDS, and in the longer term (most likely longer than a week) the evidence suggests that NSAIDS other than aspirin increase fibrosis. This is why there are warnings about the risk of heart and kidney disease on these products - these diseases should be called heart fibrosis and kidney fibrosis. The cause of this is that the gene that the NSAIDS inhibit is necessary for producing the molecules that reduce inflammation, called resolvins (and others). However, aspirin increases the amount of resolvins the body makes, which is why people with heart disease are frequently prescribed low dose aspirin and fish oil, which provides the building blocks of resolvins.

Kay

1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #18 on: April 07, 2022, 01:00:11 PM »
Hi Kay

Thank you. It sounds like the low dose of Aspirin and the Magnesium is the best way forwards to hopefully help with the inflammation. I have been able to do the recumbent bike with no resistance for 5 mins the past two days. Its not much but better than nothing.  I will also continue the hydrotherapy twice a week for movement.

My maternity consultant actually assured me it was safe to use the 5% lidocain patches a few days ago, although they cross the placenta they are deemed to not be harmful to the baby. I put one over where the radiating extreme constant nerve pain was on the outside of me knee yesterday morning as I couldn't cope with the drilling throbbing pain (it had kept me awake all night and I was beside myself) I was so disappointed as they didn't work at all. Last year when I used them they were really good at numbing the pain... I kept them on for the full 12hrs but didn't get any relief at all. I will try again tonight..

I suppose people in my position who have been unable to really do proper physio (other than the hyrdo) consider the fat pad trim eventually as they see no other option. I know my situation is pretty sever as I cant walk or stand and have been this was for a good year . I wasn't as bad as I am now following the Meniscectomy, the crouching in the shower really put the nail in the coffin. I know most people on here advise against a fat pad trim as it can make things worse and more painful- Is there a time limit you would put on eventually trying a fat pad trim? For example- Should I give it another 6-8 months trying to reduce pain and infalm and very gradually could some leg strength? Its so hard being this immobile, in pain and unable to do anything around the house to help my partner...

I feel completely stuck in a rut.... I cant live like this forever... My GP said the other day- worse case scenario I could have a TKR!!!

Thanks

Amy



Offline DogfacedGirl

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #19 on: April 08, 2022, 09:36:53 AM »
Hi Amy,
I hope the lidocaine patch works the next time!

It's good that you can at least do some peddling, even if it doesn't feel like much, it's helpful.

Personally, I would investigate every other avenue before turning to more surgery, for example, the nerve ablation and vagus nerve stimulation. Also you could have tests for autoimmune disease, if this hasn't been done, including ANA (antinuclear antibody) test and MBL deficiency.

A TKR is not going to solve your Hoffas fat pad problems - it was what badly inflamed and scared my fat pad in the first place, and the surgery is well known as a cause of arthrofibrosis. It's very major surgery and is only indicated if your cartilage, or actually lack of it, is causing major issues.

If this is not the case then it is very ill advised to go down that rabbit hole. What often happens then, in the presence of ongoing issues which you will almost certainly have, is a revision TKR, and the loss of more bone etc, even if the original TKR was performed perfectly and there is nothing wrong with it. It simply doesn't make any sense when you know what the underlying pathology is. It sets up a cycle of more surgery and problems.

Take care,
Kay
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #20 on: April 08, 2022, 10:46:20 AM »
Hi Kay

Thank you for your honesty. The GP said they would take the fat pad out but when  I've looked into this is doesn't seem like it's the best way to do a TKR anyway. I think this is a very extreme suggestion and that the GP doesn't understand Fat pad issue. He openly admitted I'm the only person he's ever come across with a fat pad problem.

With the nerve ablation approach I get confused, I understand that if it works it should stop the pain, but wouldnt I still pinch the enlarged fat pad them by walking on it and doing all the physio exercises? Or does the nerve ablation itself reduce inflammation and fibrosis enough that it no longer gets pinched with weight bearing /physio?

I know in a previous post you said your knee was doing okay now.. does that mean you have managed to get the Arthrofibrosis under control now enough that you can functional normally for daily activities? What did you find worked well? ....dare I even ask how long it's taken? I suppose I'm worried as my symptoms are getting worse not better so sometimes I panic I'm going to be stuck like this forever. Are others you've come across in constant pain even at rest and when they wake up before theyve walked on their knee?! Some I read about on here are able to walk but are not able to run or do sports, mine situation seems very extreme compared to others...

In your opinion the fact that I still have okay ROM albeit it painful is a good thing surely? But it is uncomfortable and flares pain/inflammation letting the leg sit in full extension or sliding it back into full flexion. I can not hold my heel behind me like I used to pre injury to do a quad stretch.. if I did this I think it would truly bugger the knee up.
Am I doing the right thing by letting the leg go into full flexion and flexing toes to stretch back of leg and making it go into flexion every day to keep the ROM, despite it being painful?

I will definitely try and nerve ablation and Gabapentin etc and not rush into surgery, I also would like to get full bloods done and a new MRI/possibly a bone scan done aswell. The only problem is I can get these done until after the baby, and my GP is suggesting I could get the nerve ablation done before the baby is born... wouldnt it make more sense to see the new MRI first?

I keep meaning to ask, what part of the world are you in?

Amy :-)

Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #21 on: April 08, 2022, 11:13:24 AM »
One other quick question... have you used a CPM machine before and do you think this could be a good idea for a few months? I do leg slides but I'm using my muscles to do those... I've ready that some people use it for quite a few hours of the day to keep the joint moving? Does the leg going into full extention/full flexion over and over again not inflame the fat pad more ?  :-)

Offline DogfacedGirl

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #22 on: April 09, 2022, 03:08:49 AM »
Hi Amy,

Yes, I think it's likely that the fat pad would still cause problems after a nerve ablation due to the mechanical issue there. And yes, removing the fat pad is detrimental to the patella tendon and other structures, it's very important to the knee, unfortunately.

Being in constant pain could mean that the stretching and other things that you're doing is upsetting the knee and it's not getting a chance to resolve the inflammation. You describe "letting the leg go into full flexion and flexing toes to stretch back of leg and making it go into flexion every day to keep the ROM, despite it being painful". While I understand the desire to maintain ROM, by doing these stretches you're pinching the fat pad and upsetting it more, and it will continue to get worse while you're doing the stretches or anything else that pinches the fat pad.

You can achieve good results with a CPM without pain. A CPM will stretch the tissues by the same amount (depending on your settings), but because it's passive motion instead of active (using your muscles) there isn't the pressure between the bones that pinches the fat pad. Have a read of this page https://arthrofibrosis.info/key-points/ under "Go Deeper" it describes how to use a CPM. A computer controlled one is a must.

It's not unusual for somebody with fat pad problems to be in constant pain. It's a sign that they have overdone something, which may be a simple as standing and chatting for too long. The only way to avoid this is by using crutches (use the elbow ones) or staying off your feet, as you've been doing so that you have fine control of the amount of bend and extension.

If you're diagnosed with an autoimmune disease then you'll have access to things like Simponi. This is is an antibody that blocks TNF-a, one of the key cytokines the body makes to create inflammation. If you have elevated TNF-a then this can really help to reduce pain, and help you to sleep.

I still use a CPM twice a day to maintain my ROM in a region that is just functional. If miss CPM for a day it takes time to get the ROM back, and it's more uncomfortable. As mentioned, you need to use a CPM in the pain free zone, but some discomfit is OK. Think of the discomfit of stretching a finger backwards until it stops. That's OK, but if you push past that point it becomes pain because tissues are tearing. And you don't want that!! There is research that suggests that CPM also helps to reduce inflammation.

I still need to carefully monitor and control how long I spend on my feet, and I don't use that leg for getting into and out of a chair or for steps because my fat pad still pinches. So my situation isn't ideal, but I can still be active to some degree. In addition to CPM I do restricted time eating - I only eat for 8 hours in a day, and fast for the other hours, and I occasionally do some multi-day fasts with only water, but this definitely isn't recommended for somebody who is pregnant!

I live in Australia. I spend as much time outdoors as I can because the infrared radiation from the sun is powerfully anti-inflammatory, and in addition Vit D is essential for the immune system, but I'm careful not to get sunburnt. Infrared radiation penetrates cloths, hats and sunblock, but not heavily insulated jackets. It also penetrates the skin and placenta is very beneficial to a developing foetus, including brain development. I find that I can be more active in summer than in winter, and it seems to me that the increased levels of infrared radiation in summer are an important part of that. It might even be worth buying an infrared radiation light for winter, but I haven't looked into which ones actually have the output (wavelengths) that they're advertised to have. Infrared radiation is invisible, so you can't tell by looking.

Kay


1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #23 on: April 09, 2022, 05:39:36 PM »
Hi Kay

The sunshine sounds lovely. My Auntie and Uncle live in Austrailia, they've been there for over 30yrs now, in Perth.

I will perhaps try and few weeks avoiding the extremes of extention and flexion sgain and see if that helps reduce the pain, although I did only start doing these about 5/6 weeks ago, on advice from a PT.  Because I had not let my leg go into full extention since when I hurt it in the shower end of last March, and she was worried that if I didnt donit a bit the leg might not be able to donit fully if I left it too long.

I've been on my crutches for about 6 weeks now, maybe longer, I occasionally walk slowly to to loo without them and have been resting and walking less than 150steps a day for over 3 months again... at one point I was walking approx 400/500 steps a day I think, maybe 600 on a good day but oy really is nothing at all. I was also walking a bit in the pool a few times a week then but doing a lot less now. I have lost so much muscle from being so immobile for so long... this worries me the longer it goes on?

I could cry because today I have gone over on my ankle walking to the loo without my crutches, we have a small
step in the house and I went over on it good and proper on my bad leg. Now stuck on sofa icing it and unable to move. I'm assuming that because I've not walked properly or been comfortable enough the weight bare properly for the past 15months my ankle and hip has also become weak along with the weak knee that's slightly wobbly now due to lack of proper use and muscle.. I'm extra gutted as I'm now unable to go to the pool tomorrow or Tuesday(or possibly Thurs either) and that's one thing that at least allows me to do some gentle walking and hip movements in the pool and helps my back. Maybe I only need a week off the pool, god knows, but the ankle is throbbing !

I understand I need to get the inflammation and pain down, but how do I get my leg strong again when it's still painful to stand and walk normally , I sit to brush my teeth then just the standing for 20secs to rinse my mouth I'm mostly stood on good leg as it just doesnt like me standing on it and even then I'm keeping a soft knee and cant lock it straight (I could physically do this but it would cause pain and aggravate it)

Is there a difference between an impingement and inflammation in the fat pad? My MRI showed Oedema in apex of fat pad (I thought this was under my knee cap at the top when looking at the fat pad side on.. but now I'm not sure if the apex is lower down towards the back where the shin and thigh bone meet? Do you know?

If it's a mechanical impingement that developed from crouching in shower and causing trauma that has now started to turn into fibrosis, is calming the inflammation down and getting the muscles in the leg and hip strong again the best way and only way forward? It seems nearly impossible to do this, despite the amount of time I've stayed off the knee (and because its painful so I'm governed by that) Is getting the leg strong alone enough to get back to walking and standing pain free and doing normal daily jobs again?

The surgery obviously started a fat pad problem on the lateral side but I was still able to put my leg into full extention without pain. I believe if I had rested further and done more PT and  not crouched in shower I probably would have recovered, albeit slowly and it might have taken a good few months more. Now I'm wondering if the creaking fluid/fibrosis tissue in the knee (that was not there prior to crouching, post op) is ever going to go away with just getting the leg stronger?

I'm glad you are able to live an active life to some extent still, how many steps do you do a day? Are you able to do the food shopping etc/ jobs around the house/ swim etc?
I can't even do my own washing, cooking or cleaning and this worries me as I need to be able to do those basic things and to be a mum. I suppose the nerve ablation and Gabapentin are suppose to ease the pain to create a window of opportunity to strengthen the leg, but after 15 months of not being able to walk normally I'm hoping that the muscle atrophy isnt irreversible? I have gone to the pool and done the bike on and off but mostly on during those 15months...

Amy


Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #24 on: April 09, 2022, 05:45:59 PM »
Forgot to say I will look into hiring a CPM machine, how long should I use it for.. a month? Two months? Longer..

I also meant to ask.. Is arthrofibrosis more when the soft tissue has become hard which is why is causes ROM problems? Is my knee heading that way? Does arthrofibrosis show up differently on an MRI, I.e they call it arthrofibrosis not oedema for example?

Thanks


Offline DogfacedGirl

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #25 on: April 12, 2022, 12:00:29 PM »
Hi Amy,

I'm in Perth too  :)

I'm so sorry about your bad ankle sprain!! I hope the pain has eased off a bit. A CPM would really help you right now, the sooner you can obtain one, the better. I think you would need to allow a number of months using one, and it might be cheaper to buy a second hand one from a hospital. Ebay sells them, but make sure it's digitally controlled.

Arthrofibrosis simply means scar tissue in a joint, which is usually diagnosed by a lack of ROM. Oedema is swelling, and if the whole joint is swollen this can cause a lack of ROM, but the cause is evident in that case. Scar tissue in a joint usually causes a lack of ROM right from the start, but where it forms causes somewhat different symptoms and some people lack ROM only on extension or flexion. Any of the soft tissues in a joint can become fibrotic, and in time the scar tissue becomes strongly cross-linked (hardened) and very difficult for the body to break down.

The Hoffas fat pad will swell, "puff up" and stick out between bones if there is significant inflammation in it, and when it's pinched it can lead to more inflammation, fibrosis and impingement. Oedema is a sign of inflammation but not fibrosis, that is usually commented on separately but is not usually referred to as arthrofibrosis on an MRI report.

I'm not familiar with the term "apex" of the fat pad, but as you say, they likely mean at the top, and swelling there would cause impingement between the patellar and femur when the leg is in full extension. This is likely why it's painful for you to make your leg go straight. It's also common for the fat pad to impinge between the femur and tibia (the major leg bones) as well, or instead. You likely have impingement at both sites, given your symptoms of pain in both flexion and extension. Many MRI reports miss or don't report fibrosis, it's often difficult to see.

In my opinion getting your leg back to full strength can wait until your pain has improved, because, as you say, you can't walk or exercise effectively without making your knee worse. So, I personally would focus on getting your inflammation and pain down first, muscle can always be rebuilt when you're ready, it won't vanish entirely.

As mentioned, it's good to keep the leg moving and if you can do some CPM and gentle exercise like pool walking and stationary bike, then that's great. I don't know how well behaved your horses are, but when your ankle has healed you might be able to mount your horse from a chair or something similar, lengthen the stirrup for your bad leg so you aren't putting any tension through it, and go for a walk. That will help your hips, back and muscles, and also how you feel I hope.

Kay



1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #26 on: April 17, 2022, 09:15:42 AM »
Hi Kay

Sorry for the long delay in response. I suddenly started to get severe sharp lower back pain and pain into my right buttock Thursday with certain movements and ended up in A&E on Friday screaming with the pain everytime I try to move or shift my weight in a chair or to stand. I thought maybe severe sciatica but it's not shooting down my leg..?! I have been weight bearing on that leg an awful lot over the past 15months and esp the last few months on the crutches and whenever I have to stabd for a few seconds so could have compressed something in my sacrilliac. Its excruciating  :'(

I had just had a CPM machine delivered and used it once on Thurs am. The physio had also given me an electrical stims that goes on my quads and makes the muscle lift and engage to use dialy for 30mins.  I used it twice and notice it still made the fat pad move the tendon forwards when muscle was fully engaged.

I'm not really unsure of what to do as the lack of movement for over a year being housebound and sofa bound and compensating on my good leg so much has really taken an effect on the rest of my body.. I'm stuck in bed now and wheeled to the toilet and even that it a massive effort and incredibly painful. I'm hoping the pain might improve after the baby a little but I've been sat/stood so wonky for so long now. They are going to do a back MRI today hopeully to see if it's my joint or a disk..

I had to have IV morphine into my arm the first day and I could not believe it but I could still feel the nerve pain in my fat pad!!! I felt high but that pain was still present... it also comes on at rest, even after I've not been wait bearing for a day or so. Have said no to any more morphine because of the baby now anyway.

I can feel the fat pad pad creaking when my hand is over it, its definitely fuller/larger than the other normal knee.. and hasnt really changed in so many months despite all the rest and crutches, but the nerve pain that comes on isnt always mechanical, but is aggravated by mechanical movements and weight bearing.

My partner thinks I should try the Gabapentin and the nerve ablation and surgery if not as he said I cant stay bed bound for the rest if my life. My hips/back and legs have become so weak esp now I've been in a bed for 4 more days.. but I know that a fat pad operation wont guarantee I will 'just be able to walk again' and be pain free. I have an new knee MRI booked for mid June after the baby is here. I keep questioning myself if I had just had the fat pad trim last year I might not be in the state where I've lost so much muscle and have had to compensate so much. But it's the unknown of course and you get to a point where you become desperate.

The physio suggested not too long on the CPM, so I did around 40mins between 15 and 100, my plan is to get back to that whenever I'm out in a few days if my back/buttock pain will allow. Would you say once or twice a day to use it? I have it on hire for 5 weeks..
Unfortunately pool and sitting on horse in walk gently and bike is out of the question now ( I have been getting someone to bring my old quiet horse to mounting block and getting from my scooter straight onto him for 15-20mins very gentle walking 4/5 times a week, most weeks unless too bad since June last year to help keep my back and hips going and for my brain but even with a long stirrup I can feel the knee with that minimal amount of weight bearing an my toe just resting. Although I've not been able to do that for the past few weeks as the knee has been to painful.

My body is falling apart, at 33yo about to become a mum I'm pretty terrified how I'm ever going to get myself right again and be able to walk around normally. The longer this goes on the more muscle I'm losing, the harder it is to recover and the more major problems I keep having. If the june MRI showed a large oedema still /impingment would you still avoid the surgery knowing the nerve pain I have already isnt only mechanical? Weight bearing does make the knee worse and the joint is very very weak now, same as my hips  they clunck when I try to move in bed.

Hope you are well, sorry for the essay!! The ankle seems fine now but then I've not stood on it other than front he wheel chair to get on and off the loo/bed.

Amy


Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #27 on: April 17, 2022, 04:19:28 PM »
I meant to ask how much you know about the Anakinra injection? Do they give it into the fat pad or joint,wondering if this could reduce my inflammation /size of the fat pad...?

Offline DogfacedGirl

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #28 on: April 18, 2022, 02:26:06 PM »
Hi Amy,
My goodness, youíre having a rough time!! Iím very sorry about your lower back pain! All the best for the MRI, I hope that it shows a way forward with treating it. As you know, a bulging disk causing sciatica would be one of the things they will be checking for.
Anakinra is usually injected into the joint, but given your situation you could make a good argument for injection into the fat pad. Being an antagonist of one of the major inflammatory cytokines (IL-1) it should help to settle the inflammation, but some people tell me they are helped by it and others not. You may well need a series of injections. It might also be difficult to find a surgeon who is willing to work with you on this. If it did help you would still need to rest the knee while the scar tissue is causing the fat pad to impinge.
Iím glad that you have a CPM now, itís especially important while youíre not moving under your own steam. Some surgeons prescribe staying on a CPM all day and even overnight immediately post op, and it seems that you canít overdo the time, but you can overdo the amount of bend/straightening if you push too hard, as mentioned before. So, as long as youíre not in pain while youíre using it, and it doesnít flare up as a result of using it, the longer that youíre on it, the better. Increase the amount of bend/straightening when you feel comfortable to do so. Try to do some exercises with your good leg and upper body when your back permits.
Given your back situation and that you still feel the fat pad pain even on morphine, itís perhaps a good time to consult another neurologist or pain specialist. They may be able to help with your back at the same time since there will be inflamed nerves there that may benefit from treatment as well. And personally, I would be asking for another knee MRI now to understand the situation better. Not knowing is not a comfortable place to be.
Iím glad youíve been able to get out on one of your horses, and I really hope that youíll be able to get back to that soon. Sometimes even very severe back pain from a disk (if that is the cause) can mend within a week or two with gentle movement after the first two days, so there is hope  :)
I personally would consult a neurologist and a rheumatologist before starting to think about knee surgery. I like to have all the facts before me, including blood tests, autoimmune tests, an inflammatory cytokine panel test etc, if you can persuade the specialist to do these. I feel that a test for connective tissue autoimmune disease should be done considering your knee, ankle and back have all caused major problems.
Itís good that your ankle seems to be healing!
Some interesting work is coming to light with hyperthermia directly applied to muscle groups leading to similar hypertrophy (muscle building) as exercise for people who canít exercise. Whole body hyperthermia like a spar or hot bath is more effective if done carefully, but itís definitely not something you would do while pregnant. However, the single muscle heat treatment might help.
 Please let me know how things go, you might want to Private Message me.
Kay
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline amy

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Re: Immobile fat pad and unable to walk. What do I do next?
« Reply #29 on: April 21, 2022, 01:14:34 PM »
Hi Kay
Thanks for all the info again.
Can I private message if I dont have 20 posts?
I'm still in hospital but did have back and hip MRI yesterday, waiting for report from neurosurgeon at present but should be going while today I hope!
Thanks
Amy















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