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Author Topic: Thanks, Dr Grelsamer ....  (Read 1296 times)

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Offline MHB

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Thanks, Dr Grelsamer ....
« on: September 26, 2004, 12:05:53 AM »
Dear Sir,

Have mostly recovered from fractured patella ORIF (hardware remains) with pleasant outcome -- no pain, full ROM, full knee function. A fortunate situation for which I am grateful.

However, I do have two questions relating to a small amount of swelling/heat/inflammation that remains 6 months after knee surgery. I ask the questions because research and reading during recovery time have led me to think that ongoing heat/inflammation supports continued scar tissue production, and also that its byproducts may eventually attack articulate cartilage and over time, soften, then invade, causing chondral lesions. For these two reasons, would very much like to dispel remaining heat/swelling/inflammation.

I think I'm correct in stating that the trauma injury/surgery has damaged this knee's circulation, and one reason for the continuing inflammation might be the presence of "foreign bodies" -- the hardware. (surgeon, whom I trust implicitly from experience, prescribes waiting until a full year passes to remove hardware, if needed.)

In the meantime, would very much like to know if there's anything I can do to help stop the cycle. Getting a handle on which is the chicken and which is the egg -- damaged circulation/inflammation, or whether such a relationship between the two actually exists-- seems to evade me.

Have tried various combinations of regimens including icing, exercises, elevation, massage, supplements, non-prescription nsaids, and most recently, after a "check in" visit with the performing surgeon earlier this week, am giving Celebrex (200 mg/dy) a trial run.

On rising each day, the knee is cool with decreased swelling, normal color, not stiff or painful at all. Standing or sitting seems to start the cycle for the day.

Daily exercises (non-weightbearing strength building stuff, walking a couple of miles over hilly terrain, Nordic tracking, stretching) dispel heat but not swelling. Most of it concentrates below the patella beneath the patella tendon area and above the tuberosity. The bulge can be "moved" from one side of the joint to the other by simple manipulation, so maybe it's inside the capsule. The heat/swelling causes no pain in usage or soreness to touch.

Hints about how to improve the recovered knee's circulation and/or any suggestions about what I can do to help decrease heat/swelling will be greatly appreciated.

Thanks very much for your time -- MHB
« Last Edit: October 02, 2004, 10:47:17 PM by HHB »
4/4/04 - Horizontal patella fracture
4/5 - ORIF 2 screws, figure8 wire, immobilizer, walker
4/16 -  cane
5/10 - no immobilizer
PT -- 5/17 to 6/8
OS Release - 7/12/04

Offline RGrelsamer, MD

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    • Ronald P. Grelsamer, MD
Re: Rehab Question for Dr Grelsamer
« Reply #1 on: September 27, 2004, 11:14:57 PM »
No pain and good ROM!
Hallelujah!
The little swelling/inflammation can go on a long time and is not serious!
I can certainly understand your being puzzled by it. I don't think there's anything you can do that will make a difference. Fortunately, you'll do well either way.
R Grelsamer, MD
www.KneeHipPain.com

"Due to time and legal restrictions Dr. Grelsamer can respond just once to queries on the Bulletin Board. Thank you for your understanding".
R Grelsamer MD
 www.KneeHipPain.com

Due to time and legal restrictions Dr. Grelsamer can respond just once to queries on the Bulletin Board. Thank you for your understanding.

Offline MHB

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Thanks, Dr Grelsamer
« Reply #2 on: October 02, 2004, 10:31:49 PM »
Thank you for the reply.

Ironically, after two weeks on the small daily dosage of Celebrex, knee heat has almost disappeared and swelling decreases a small but noticeable amount each day. Of course, with all the variables at work, both known and unknown, it's impossible to determine whether it's the Celebrex (especially since pain wasn't the issue) or simply more time passing that is making the difference.

Will continue on with the Celebrex until the month's supply is gone. Beyond that, have decided to concentrate on enjoying both the fortunate outcome -- a  knee that works as well as it did pre-injury -- and also the smiles of fresh gratitude that appear every time I think about it.

Thanks again for your time -- MHB

« Last Edit: October 02, 2004, 10:47:44 PM by HHB »
4/4/04 - Horizontal patella fracture
4/5 - ORIF 2 screws, figure8 wire, immobilizer, walker
4/16 -  cane
5/10 - no immobilizer
PT -- 5/17 to 6/8
OS Release - 7/12/04

Offline larry_marty

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Re: Thanks, Dr Grelsamer ....
« Reply #3 on: October 10, 2004, 07:06:07 AM »
Tibeal Plateau...plate, 6 screws, implant (cadaver bone)
6 months post surgery today.....
Full Rom,
Stiffness for about a minute after being motionless or awakening after sleep,
Still have a limp,
Minor pain when walking and standing,
More pronounded pain going up stairs,
Even more pronounced pain going down stairs.
Have difficulty with balance on uneven ground or specifically going down hill,
After being on my feet for an extended period of time or walking, I have slight swelling then more stiffness than usual after resting,
The heat in my knee has finally dissapated, (about one month ago)
Riding my bike with vigor (12 miles a stretch) with ease,
Stretching, doing leg presses, squats, balance excerises.

Note:  I never thought it would take me this long to accomplish as much as I have.  I am overwhelmed that I am not completely recovered by now.  I simply was not prepared not told by my doctor.  I am apparently healed completely, as the doctor has given me no restrictions at all.  One leg feels longer than the other (injured leg) but could be that I prefer it.  My doctor plans to remove the hardware about 1 year from the surgery or later.  If it is not giving me any problem, he said he will not remove it.

2nd Note:  My foot hurts as bad as my knee.  Seems it simply is not used to bearing my weight.  It is a big problem for me, and my foot swells more than my knee.

I appreciate all the posts...... you guys and gals are wonderful.

larry marty

Offline MHB

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Re: Thanks, Dr Grelsamer ....
« Reply #4 on: October 11, 2004, 09:37:04 AM »
Congratulations, Larry, for making it all the way up the road to recovery -- feels so good, doesn't it? Our injuries were different, but the time frame appears to be about the same. Getting there takes a while, that's for sure.

Ya know, in the past 3 weeks, the heat/swelling in this knee has been decreasing steadily. Don't know if it's the Celebrex (which appeared to make no difference for the first two weeks) or just more time passing, but certainly am enjoying it! Very nice not to have to notice/think about the knee during waking hours.

Best of luck on finishing it off, Larry. Your biking must be helping a lot. And good luck with the foot, too, but most of all, congratulations on being where you are. Can imagine all the hard work you've put in ....

MHB
4/4/04 - Horizontal patella fracture
4/5 - ORIF 2 screws, figure8 wire, immobilizer, walker
4/16 -  cane
5/10 - no immobilizer
PT -- 5/17 to 6/8
OS Release - 7/12/04