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Author Topic: Preop & poss. bone graph.Advice?Also Marie....  (Read 1886 times)

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Offline ~*Heather*~

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Preop & poss. bone graph.Advice?Also Marie....
« on: July 20, 2004, 02:13:40 AM »
Hi all!

I had my preop for my screw removal today and my surgery will be August 11th. My OS also mentioned doing a possible bone graft (sp?) to fill in the space where the bone did not fill in after my TTT. He said it would be 'inert' material that my body would either accept and use as it's own or if it rejected it, it would be absorbed by my body over time and no harm done. Basically it would improve the appearance and seeing as this BETTER be the last intervention on knee, I'm thinking I may do it because it does look awful ugly. Infection risk is only 1-3% doing both procedures.

The procedure(bone graft) is not that involved, but recovery would be a few weeks longer. I was hoping someone had some information or experiences with this. Any advice/comments are welcome!

MARIE~

I only need Heavy sedation w/ a local anesthesia on the knee. 7-10 days before I can resume normal activity and 1 month before i can do anything that has impact....like running/jumping....which I can't/don't do anyway.

I can weight bear right away was told that this will be nothing compared to the TTT in terms of pain or recovery. No need for PT on my end either.

Hope that helps you a little with your screw removal questions... ;) If you have any more, let me know cuz I asked a bunch!


Oh, Also if i do choose the bone graft too, I would still only need to be heavily sedated w/ local.


Thanks everyone!

Heather B.


R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline missmyknee

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #1 on: July 20, 2004, 04:33:11 AM »
Hi Heather

When I had my DeLee osteotomy for my patella baja, the doc also did a bone graft using bone from the tissue bank to fill in where the bone was cut. I had no problems with it taking. The doctor took repeated xrays to check the progress of the graft along with the osteotomy. You can tell where I have it because it has a more whitish appearance on xrays.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline ~*Heather*~

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #2 on: July 20, 2004, 04:42:34 AM »
Thanks Pam!

Now I wish I had asked him to define "inert" in more specific terms. He made it sound like it was a material of some sort. He said it can be positioned and shaped into the contours and such. That led me to think it was a material substance. Now that look it up and see what most people have had or are using, it seems they are auto or allo graphs. Hmmm?

Anyone know if there is a material "filler" that can be used or is it always donated bone?

R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #3 on: July 20, 2004, 05:02:04 AM »
Not to gross you out or anything, but when I talked to the doctor who apparently invented the DeLee Osteotomy (named after the Fellow assisting the surgery where they improvised in this particular way) I was told that they would either do a bone graft from my hip or a bone graft made out of a bio-substance that could include bovine bone (look, it rhymes!).  It's perfectly safe and is very well tolerated--it also beats the heck out of doing an autograft from your own hip.  People who I've talked to who had the hip graft said that site hurt worse than the knee surgical site!

Whatever it is, it's got a very high success rate--I think it's better than allograft.  

Good luck.

So does this mean that the patella baja is no more...?  Or should I know better than to ask?  Mine's getting to the point of being unliveable....

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline ~*Heather*~

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #4 on: July 20, 2004, 08:19:55 AM »
Thanks Heather, I appreciate the response. I am planning on calling tomorrow to find out exactly what he will be using and I'll let you know if it's something different than what has been discussed here. Also I'd want to know if you've heard of it if it does happen to be different since you are so well versed w/ all this stuff!  ;) ;D ;)

My kneecap has indeed lowered but my OS is standing firm that it will not return to the degree that it was this time last year, so in that, I take comfort. The kneecap still catches at times, however, he chalks that up to matracking due to weak quads. He's hoping that I will be able to strengthen and get that kneecap tracking right again.  

His concern w/ the whole surgery deal is the first cortisone injection gave me temporary relief and the second did not, that it may not be my screws causing all the pain. The pain is localized mostly over the turbercle and radiates horribly down my shin at times. Mostly when I go in the ocean about ankle deep while there is a strong current. I just basically walk along to get that resistance burn. Oh how I love to make that quad burn. :P It also bothers me with my regular routine and has been happening more and more often. He also said  the negative feedback from the injection could be that he might have missed where it should have gone. HONESTY! WHAT A GREAT OS! I LOVE HIM!!!!

He does think that the screw removal will help as the screws are backing out and the bone is very well healed (just sunk in where it did not fill in). He left the removal up to me solely because he could not gaurantee results based on the injections. I gladly opted for it because the pain I get in the shin has halted my workouts in many aspects.

I have noticed when I decrease the times I lift a week (leg press, etc) that I actually can put out much better results and longer workouts so that's great, but then if the shin starts up then I'm done for about a week or longer which isn't so helpful.

I may not opt for the "cosmetic" enhancement because of the time I'll have to be out of the gym. I've gained a lot w/ the quad and don't want to lose it for "looks" so to speak. Functionality is most important to me after the road I've traveled but down the road when I'm all better (*fingers crossed*) I don't want to be repulsed by the appearance and have the stares that I have come to know so well from strangers.

My quad tendon will always remain thin where the connection was redone due to the scarring of the tendon that occured when the old OS made his mess in there. I think that also contributes to the lowering kneecap. My biggest fear was (and still is) that the patella tendon will contract further if I don't keep the quad up, however, my OS says it can't contract anymore. So does that mean my quad tendon is stretching out???? I mean he admits it IS lower. He initially repaired it too high to give it some play, but it's lower than he expected. I guess once you are cursed w/ baja you simply will live in fear no matter what you are told. I know you can understand that one!

Thanks again for your reply and insight. It's very much appreciated and I will let you know what the OS's secret ingredients are....LOL!


Hugs and Happy knee days,
Heather

P.S. I'm going Thursday to my PCP to get another referral for the other knee. I can't deal w/ the tracking and the IT Band mess anymore on my own. It's popping to the sides now and it's just a mess. I know I will have to get another OS for this as the military base now has their own OS. (I thank God that they didn't have one when I went for the baja or else I wouldn't be where I am today because they automatically referred me out). I am hoping the base OS is all booked up so I get referred to a civilian out in town again, but I know it won't be Dr. A since he is a specialist so far away and IT Band/ maltracking would/will not warrant his expertise.      
« Last Edit: July 20, 2004, 08:28:47 AM by Heather »
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #5 on: July 20, 2004, 08:39:54 AM »
When you next see your doctor, I was wondering  if you could ask him something along the lines of what you already mentioned--about the patellar tendon shrinking down further.  He said yours was as contracted as it could get.  I've heard the same.  What I was wondering is if the TTT/realignment of the insertion point of the patellar tendon can be successfully done once the tendon has shrunk all it can.  I mean, Dr. S. told me that patellar tendon transplants or lengthening procedures didn't work reliably because the patient's immune system could attack and go into overdrive, and the inflammatory response would be the same as what happened to my original tendon--i.e. it would contract and shrink.  But according to him, my own patellar tendon is as shrunken and contracted as it can get.  Your OS says yours is too.  Does that mean that if the Tibial Tubercle were realigned at this point, that the tendon couldn't contract any further and thus the baja can be resolved?  I hear about someone developing patella baja after a Maquet procedure and I'm baffled, because that's the surgical SOLUTION for patella baja in many cases.  So all I can think is the tendon wasn't shrunk down as much as it could be, and it contracted further after the procedure was done in response to the trauma.  But ostensibly my tendon just can't get any more fibrotic, shrunken, and contracted...so does this mean that TTT or distal realignment would be effective in my case??

It's so tough to figure all this stuff out.  Some of my very worst pain is at the attachment of the IT band, the attachment of the patellar tendon, and the fibula head.  This is the pain that I can't rub away, can't massage to make better, etc.  So the last doctor I saw said Maquet procedure, DeLee osteotomy etc. wouldn't help me because my painful places wouldn't be addressed by the surgery (i.e. the TTT wouldn't affect the IT band area, fibula head, etc.--I think it would address my tibial pain since that is from my kneecap striking the tibial plateau in a lovely kissing lesion).  

Anyway, if you could pick your doctor's brain on that it would be very helpful.  I would think if the patellar tendon can't contract any further, then the TTT would be the idea procedure--mechanically, it just makes sense.  So why didn't it help people like you, and Sharon, and Pam...?  Is the pain from patella baja and the resulting cartilage damage just so insidious that only a TKR will help?  And how will that help, anyway, since you KEEP your patella and patellar tendon with a TKR???

Sigh.  My head hurts from trying to figure this stuff out.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Marie

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #6 on: July 27, 2004, 06:18:40 AM »
Heather,

Thanks again on the specifics of what to expect.  :)  I'll ask my OS friend about the bone grafting fillers, too.

Marie
24y/o - had subluxing right patella, frequent dislocations, osteoarthritis.
Sept26/03 - TTO, scope, LR, medial plication & microfracture (right).  
Slow ROM recovery (126).
My new PT is awesome!!!

Offline Sharon

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #7 on: July 27, 2004, 06:47:02 AM »
I just wanted to add to what Heather M. was saying about the TKR.  When I saw both Dr. Fulkerson and the doctor who sent me to him, they both told me something along the lines of a TKR won't work on me because you keep both your patella and patellar tendon and mine is in such a low position that it's likely that a TKR wouldn't be able to address my main problem. The thing with my patella baja is that in my mind it really got bad AFTER my TTT revision. I think that's when the majority of scar tissue developed around my tendon and pulled my patella down so low. I think my case is very similar to both of yours in that I've been told that my tendon is probably as contracted as it can get. The majority of my pain is directly under my kneecap right where I've been told that it's probably bone on bone, right at the bottom. So anyway, if you do ask your doctor and get some answers out of him, I'd love to hear them because this whole patella baja thing is just so confusing to me and so utterly frustrating!!

:)
Sharon
Left knee:
LR-5/99 & 9/01
Distal realignment and LR 7/02
TTT revision 6/03
screw removal/MUA 10/03
d/x with severe patella baja
7/05 patellar tendon replacement w/piece of quad tendon
4/07 OATS

Offline ~*Heather*~

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #8 on: July 27, 2004, 07:28:31 AM »
I will definitely ask! I am currently playing phone tag with my OS's PA. My OS is out of the office on vacation this entire week and must have left right after my pre op appointment. I'm still deciding on the bone graft issue. I want to know what the material is first and run it by you guys  ;D before I decide. Hopefully his PA can answer that for me but I'm sure she'll refer me back to him as usual. I'll keep you guys posted!

R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline missmyknee

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #9 on: July 27, 2004, 09:31:48 AM »
Hi Guys

Just thought I would add to the TKR discussion and the baja.

I just saw Dr Noyes at Cincinnati Sports Med in June. As you all know I had a De Lee osteotomy for baja 2 1/2 yrs ago and so glad I did it. The damage from the baja caused all my problems and put me thru chondroplasties, several adhesiolysis, fat pad removal, cortisone shots, iontophoresis, synvisc and extensive rehab. He looked over all my xrays, took new xrays, surgery photos, MRI's, did a thorough exam and asked many questions and watched me walk. He said my patella damage from the baja was to severe and large and that I had 3 options available but 2 of them were out of the question. 1) was a pallectomy which won't be done for the obvious reasons   2) ostrachondral allograft.....I would need a donor graft big enough to cover entire back of patella and only 50/50 chance , so that was out. He said I need a TKR. He can do it even though I had the osteotomy and might revise it some. He rated me zero on his knee scale and said he could get me 2 steps up so I have can walk 4/6 hrs day on it and get back to golf and cycling. He does TKRs on young pts to give them quality of life even pts in their 20's. He uses a rotating platform implant used on young and active pts. It lasts longer than fixed bearing implants. He explained the whole procedure and showed me the implant and how it works. I was very impressed with him. My knee is no longer salvagable according to him. I just saw my home OS today and he concurred. He said there are no more salvage procedures to be done the damage is too large. He said I needed the TKR too. He said the osteotomy can be revised and I still had a little baja but would be OK. I am tired of not being able to walk but 2 hrs /day and no life and the pain. I can't play with my kids and grand kids  . I will have Noyes do it then follow up with my OS here at home. I will probably do this sometime in the next 6 mos. I've had enough. I've read several success stories on another forum with this implant and look forward to getting back to living life.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline ~*Heather*~

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Re: Preop & poss. bone graph.Advice?Also Marie
« Reply #10 on: August 05, 2004, 05:40:12 AM »
Hey everyone~

Looks like I wont be able to see my OS until probably the postop since they normally have me on "happy jucie" before I see him for surgery. (sx is the 11th)

His PA did call me back and explained the bone graft material. She said each company makes it with different components using basically the same concept. She also said it's my OS's call which type he'd use for my particular knee so she couldn't really tell me the exact ingredients. It is a material that looks like tiny bone chips/shards. He uses them to fill the area then shapes the area the way he wants it. That's about all I got out of it. I will definitely ask my OS this because I'm really curious.

I also asked if there would be any benefit down the road, such as my tibia being any stronger saying the bone graft did take. She said it does add an element of strength but not enough to make a considerable difference.  So there you have it...

I'm not doing it. It's purely cosmetic....and I'm sure that Tricare will have a field day denying that claim. They still havent paid for my TTT because the diagnosis code my OS wasn't suitable to them....I'm not fighting another surgery with Tricare....lol! If my knee works fine and only looks ugly who really cares? I have fun making up off the wall stories to tell strangers who ask me, "OMG! WHAT HAPPENED TO YOUR KNEE?" Gotta love those type of folks!

Looks like it will only be the screw removal so recovery will be a breeze as my tibia was totally healed about 3 months after my TTT.

Heather M. ~

I will address your question to my OS most likely on my post op which is Sept. 23rd.


Hope everyone is having happy knee days! ;D  
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04















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