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TKR Fractured patella/quad repair 3 years post TKR
- Thread starter Poohstew
- Start date
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Poohstew
junior member
My x-rays look ok, no sign of obvious fracture or loosening, and all structures after in place, but he said there is obviously something going on. I barely have any control over my quad muscle and have severe pain when trying to lift. Have to come next Tuesday for a bone scan, to check for infection or loosening. Injections of contrast at 10 am, then wait 3 hours and scan at 1 pm. Then I will come back for appt with my surgeon the next day at 1:50.
Until then, ice or hear, whichever feels best, and had Labs drawn today as well.
Until then, ice or hear, whichever feels best, and had Labs drawn today as well.
SusieShoes
Former BoneSmart staff member
Agree you should do what feels best, for now. It sounds like your surgeon is determined to get to the bottom of whatever is going on. That's not always the case, and you're in good hands. Find out what the problem is, because you clearly should not be in so much pain or be having so much trouble. Hope you get some answers!
OP
OP
Poohstew
junior member
3 years post TKR broken patella after traumatic fall....
Hello all, visiting the forum here again.
I had both my TKR in 2016, 12 weeks apart. Overall, healed well, with some residual patella pain, bilateral, presenting in the last year or so.
Yesterday morning, I was walking out of my bedroom, and I turned to kiss my fiance good morning. As I turned, I planted my right foot firmly on a wrapper for a 4x4 gauze square, and went down, doing the splits. My right leg torqued laterally, and either from the force, or possibly contact with the metal bed frame, my patella cleaved in two. (I believe it was the sheer force of the twist, as I had no bruising until much later, and then only a small amount)
Immediately I knew something was very, very wrong, and had honestly felt as though my implant dislocated. The knee was obviously deformed. I had a "ledge" above the knee, and then a huge indentation. I spent 20 minutes trying not to pass out or throw up, and after that, somehow I got off the floor and up into the bed. (I made the decision to attempt to make it to the car...my surgeon was.an hours drive South, and wanted to be in his hands.)
Long story short...
I cleaved my kneecap in two. The lower 2/3 was below where it should be, and the upper 1/3 still had my quad muscle attached to it, but it was no longer anchored to anything else, so I had zero control over my lower leg.
Open reduction internal fixation of the patella was this morning. Even my Ortho surgeon wasnt totally sure how he to was going fix it. 9
Turns out, the remaining bit of the patella with my quad attached was not large enough to anchor with the larger piece. He ended up anchoring the quad directly to the lower 2/3rds of the patella. My "button" from the TKR was still intact. I believe he said he ended up anchoring the quad (wires? sutures?) in 4 places to the piece of patella remaining. I have not spoken directly to the surgeon yet...that will be in the morning, so this is 2nd hand through my Mother. Currently in a pieced plaster cast from my toes to my tush, with room for expansion due to swelling.
Initial thoughts are 2-4 weeks immobilized at least, depending on healing, then therapy. He said it is a fine line between starting movement too early or too late with this type of injury.
I cannot even begin to describe the pain when this occurred. I had spinal anesthesia with intrathecal pain relief that should last close to 24 hours. Good pain control today, but just starting to sneak up on me just now. Norco 5/325 for pain relief. Dilaudid if needed.
Ahh. What a world. Did not expect to be doing this for the next several months. When asked, Doc gave a 60-70% chance of this working well. Said in his 25 years of being a surgeon, he had never seen anything quite like it. Likely could be more surgery in the future, and/or some degree of hmm....crippling? My words, not his. Thinking positively.
Thoughts? Advice?
Glad you are all here!
Kim
Hello all, visiting the forum here again.
I had both my TKR in 2016, 12 weeks apart. Overall, healed well, with some residual patella pain, bilateral, presenting in the last year or so.
Yesterday morning, I was walking out of my bedroom, and I turned to kiss my fiance good morning. As I turned, I planted my right foot firmly on a wrapper for a 4x4 gauze square, and went down, doing the splits. My right leg torqued laterally, and either from the force, or possibly contact with the metal bed frame, my patella cleaved in two. (I believe it was the sheer force of the twist, as I had no bruising until much later, and then only a small amount)
Immediately I knew something was very, very wrong, and had honestly felt as though my implant dislocated. The knee was obviously deformed. I had a "ledge" above the knee, and then a huge indentation. I spent 20 minutes trying not to pass out or throw up, and after that, somehow I got off the floor and up into the bed. (I made the decision to attempt to make it to the car...my surgeon was.an hours drive South, and wanted to be in his hands.)
Long story short...
I cleaved my kneecap in two. The lower 2/3 was below where it should be, and the upper 1/3 still had my quad muscle attached to it, but it was no longer anchored to anything else, so I had zero control over my lower leg.
Open reduction internal fixation of the patella was this morning. Even my Ortho surgeon wasnt totally sure how he to was going fix it. 9
Turns out, the remaining bit of the patella with my quad attached was not large enough to anchor with the larger piece. He ended up anchoring the quad directly to the lower 2/3rds of the patella. My "button" from the TKR was still intact. I believe he said he ended up anchoring the quad (wires? sutures?) in 4 places to the piece of patella remaining. I have not spoken directly to the surgeon yet...that will be in the morning, so this is 2nd hand through my Mother. Currently in a pieced plaster cast from my toes to my tush, with room for expansion due to swelling.
Initial thoughts are 2-4 weeks immobilized at least, depending on healing, then therapy. He said it is a fine line between starting movement too early or too late with this type of injury.
I cannot even begin to describe the pain when this occurred. I had spinal anesthesia with intrathecal pain relief that should last close to 24 hours. Good pain control today, but just starting to sneak up on me just now. Norco 5/325 for pain relief. Dilaudid if needed.
Ahh. What a world. Did not expect to be doing this for the next several months. When asked, Doc gave a 60-70% chance of this working well. Said in his 25 years of being a surgeon, he had never seen anything quite like it. Likely could be more surgery in the future, and/or some degree of hmm....crippling? My words, not his. Thinking positively.
Thoughts? Advice?
Glad you are all here!
Kim
Last edited:
Hi. Kim, I’m so sorry this happened. I’m sure that was quite the ride to your surgeon! Hugs and prayers for a good recovery. 
If the X-ray is actually a photo of the X-ray, reduce the size of the photo and you should be able to post it fine.
Here’s a refresher course of our Guidelines:
Each article is short but very informative. Following these guidelines will help you have a less painful recovery.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
3. Do what you want to do BUT
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?
There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.
While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
If the X-ray is actually a photo of the X-ray, reduce the size of the photo and you should be able to post it fine.
Here’s a refresher course of our Guidelines:
Each article is short but very informative. Following these guidelines will help you have a less painful recovery.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
5. At week 4 and after you should follow this
6. Access to these pages on the website
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?
There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.
While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
@PolarBear60 had a cracked patella
Here’s her recovery thread:
https://bonesmart.org/forum/threads/polarbear60s-stryker-triathalon-journey-left.29934/
And @Motherbone had her patella break 3 weeks post op.
https://bonesmart.org/forum/threads/motherbones-recovery-thread.50696/
There are probably others but those are the only ones I can think of right now.
Here’s her recovery thread:
https://bonesmart.org/forum/threads/polarbear60s-stryker-triathalon-journey-left.29934/
And @Motherbone had her patella break 3 weeks post op.
https://bonesmart.org/forum/threads/motherbones-recovery-thread.50696/
There are probably others but those are the only ones I can think of right now.
I’ll tag @Josephine. She’s off line for a few days but she’ll catch up with you when she gets back.
I agree. Let us know what you’d like it to be.
Irish471
senior
You have all my prayers!!!
OP
OP
Poohstew
junior member
- Joined
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@Poohstew
I've changed your thread title for you, if you would like it changed in the future, just post what you would like here, and a moderator will change it for you.
@PegGar16 had a quad repair, she had quite a time, she has now recovered and has her life back.
Be very kind and gentle with your knee while it is healing.
I've changed your thread title for you, if you would like it changed in the future, just post what you would like here, and a moderator will change it for you.
@PegGar16 had a quad repair, she had quite a time, she has now recovered and has her life back.
Be very kind and gentle with your knee while it is healing.
Oh my gosh, you poor thing. Something like this can happen so quickly, just in the blink of an eye. I am praying for your complete recovery.
OP
OP
Poohstew
junior member
Thank, ladies. Oh my, this is going to be a long long recovery I think.
The weight of this plaster cast is killing me. My hip and lower back are suffering, as the only way I have of moving that leg forward while using the walker is to swing from the hip.
And the ITCHING! Lord, the back of my knee is driving me nuts! So itchy! I cannot fathom staying in this full leg cast for 2 weeks. Eesh. I have zero control over it. The quad muscle just isn't responding.
I am having random muscle twitches and sort of electric shock type sensations where he reattached the quad to the remaining patella. Ugh. Those take me by surprise. Eight now. It takes two other people to help get me from place to place. One person to lift/hold/lower my leg, and another to swing a pillow/footstool, etc under the leg. My Mom goes home Monday, so we'll have to figure out a better way to do this.
Currently, back and forth between 2 of the 10/335 Norcos. Yesterday was 2 at a time, so far today 1 pill every 4 hours, plus an extra boost of Tylenol. Will probably take 2 before bed again tonight.
My fiance, Dave, he is currently dealing with an infectious diabetic ulcers on both of his big toes, and isn't even supposed to be out of bed.
Guess it makes us stronger somehow.
Kim
The weight of this plaster cast is killing me. My hip and lower back are suffering, as the only way I have of moving that leg forward while using the walker is to swing from the hip.
And the ITCHING! Lord, the back of my knee is driving me nuts! So itchy! I cannot fathom staying in this full leg cast for 2 weeks. Eesh. I have zero control over it. The quad muscle just isn't responding.
I am having random muscle twitches and sort of electric shock type sensations where he reattached the quad to the remaining patella. Ugh. Those take me by surprise. Eight now. It takes two other people to help get me from place to place. One person to lift/hold/lower my leg, and another to swing a pillow/footstool, etc under the leg. My Mom goes home Monday, so we'll have to figure out a better way to do this.
Currently, back and forth between 2 of the 10/335 Norcos. Yesterday was 2 at a time, so far today 1 pill every 4 hours, plus an extra boost of Tylenol. Will probably take 2 before bed again tonight.
My fiance, Dave, he is currently dealing with an infectious diabetic ulcers on both of his big toes, and isn't even supposed to be out of bed.
Guess it makes us stronger somehow.
Kim
- Joined
- Oct 27, 2011
- Messages
- 29,465
- Location
- United States, West
- Gender
- Female
- Country
- United States
A friend of mine recently had his patellar tendon repaired, it took awhile for his quad to start working.
After an injury like yours, the muscles around the knee are inhibited to keep you from moving around. As you heal the muscles will come around.
After an injury like yours, the muscles around the knee are inhibited to keep you from moving around. As you heal the muscles will come around.
Josephine
NURSE DIRECTOR EMERITA
Oh my goodness! That's some injury.
But I have to tell you that in these circumstances, it's unlikely the patella will heal because the secondary fragment is so small and the distance between the two fragments is considerable.
![[Bonesmart.org] Fractured patella/quad repair 3 years post TKR](https://bonesmart.org/forum/attachments/upload_2019-5-19_16-11-59-png.73091/ "[Bonesmart.org] Fractured patella/quad repair 3 years post TKR")
More likely wires than sutures - they would just break.
But I have to tell you that in these circumstances, it's unlikely the patella will heal because the secondary fragment is so small and the distance between the two fragments is considerable.
