High Tibial Osteotomy It’s Done! From Revision to Tibial Tubercle Osteotomy

[skigirl]

I am also sorry to hear about these problems. Will the doctor give you more pain relievers? Perhaps tramadol?

 

[bibi]

I was referred back to pt... Today was my first visit. Much better than the previous pt. ROM was measured at 70. Extension 12. Yes my gait is poor and the pain can become extreme. Therapist want me to return to the walker to assist with my walking.
Fears I may have a lot of scar tissue. I am one year out from my tkr revision.

 

[bibi]

It's been a little over a year since I had my TKR revision. It's been quite a journey. In the weeks and months following the surgery I was diagnosed with psoriasis and there is a suspicion my osteoarthritis is actually psoriatic arthritis. My ROM never went past 75 and extension is 30. Yes 75/30. PT was stopped after a couple of months and my OS basically said I was in the small statistics where TKRs do not work.

Two months ago I had enough and contacted my OS who gave me a referral for additional PT. This time I chose a different PT. The last one was more concerned on how much pain they could inflict before I would cry "Uncle!". When I had my pre-evaluation the therapist looked pretty concerned and stated as much. ROM was 70 extension 30. There was no give when she tried to manipulate my knee. It was extremely tight! I walked in on a cane but she told me to go back to my walker.

Fast forward a month. Re-evaluation I only gained 5 in my flexion, none on extension. She said we will continue with the therapy. It's not painful at all. I come in with pain. The pain has never gone away.

She told me to make an appt with my OS. I told her he has been treating me over a year and things are getting worse. Make a long story short I asked if she could recommend someone. She did. Different hospital and when I read his bio he is quite impressive.

However, my appt is not until July 19th. Praying he can help!

I did ask my PT if she has ever seen a case such as mine. No.

 

[bibi]

Question: How many revisions on the same knee is considered too many? I have an appt for a second opinion my ROM and extension is terrible! 90 flexion and 22 extension. Unfortunately this is not a typo.

PT's opinion excessive scar tissue. Unable to move knee cap. Knee is extremely stiff and painful. I think I may be a candidate for another revision. Appointment is July 19. New doctor and new hospital. Is experienced in revisions.

Any insight will be helpful and appreciated!

 

[KarriB]

Have you discussed an Open Lysis of Adhesions before another revision?

 

[bibi]

No. What exactly is an Open Lysis of Adhesions? What is the recovery time. I will investigate.
Thanks

 

[KarriB]

@skigirl had an open lysis of adhesions so you can check her thread because she may be away from the forum for a week or so. Also @swmrgirl just went through it also, so another thread you can read. I didn't see anything in our library about it, but I'll keep looking.

 

[Pumpkin]

Open lysis of adhesions is when your knee is opened up along your TKR scar, and the adhesions are removed freeing up your knee. Some OS's do lysis of adhesions with an arthroscope. Skigirl needed her spacer exchanged, they had to open her knee in any case.
Recovery time varies, it is important in the early weeks to let the inflammation from the surgery settle down before resuming activity.
Hope that helps.

 

[swmrgirl]

As Karri mentioned, I just had open lysis of adhesions and a spacer exchange. The OS removed an overgrowth of tissue in the joint and around my patella and put in a larger spacer to take up some of the slack in the joint. I have already seen an improvement in my extension, not sure about the flexion because it's too soon. I'm not suggesting that you have the same thing going on, but it's well worth asking your surgeon about it. Best of luck!

 

[bibi]

Thank you everyone! I will definitely ask if this is my most viable option.

 

[bibi]

Update: Still waiting patiently for my second opinion later this month. No changes. PT was stopped. Wanted to save the allowable visits in case it is determined I may need another procedure.

Question: My hamstrings are extremely tight. I don't think my knee is swollen. When I look down it looks swollen. But, when I am standing my daughter says both knees look the same size?

Anyway my question: is it ok to apply heat to my knee? In particular the hamstrings? I am at the moment lying down with an electric heat pad wrapped around my knee It feels good but I want to make sure if this is the correct protocol?

Any advice will be extremely helpful!

 

[Pumpkin]

bibi,
Glad to hear your second opinion appointment is coming up later this month.
You are far enough out, heat is OK. With a heating pad you have to be careful to not fall asleep and accidentally burn yourself.

 

[bibi]

Hi! After reading posts in another thread, I am almost sure I may have an infection in my TKR. About 2 months ago a large boil emerged on my stomach under my breast. I went to my primary care who put me on an antibiotic and referred me to a surgeon to have it lanced. The boil erupted and began draining before my appointment. Now two months later it is still draining. I change the dressing twice a day.

My knee while it has always been sore is much sorer now. I am also experiencing pain behind my knee and the front of my knee moving down towards my toe.

I ruled out infection because I wasn't experiencing seepage (I am 14 mos out from my revision). My knee does feel swollen however my daughter says she doesn't see a difference from both knees.

 

[Celle]

Hi @bibi - you will see that I have moved your post into your own thread.
I think it is better here, because we can look back and see your past history, and also discuss your problem, without disrupting the other thread.

Apart from being sore, does your knee look inflamed at all? Does it feel warmer than usual? Do you feel it's more swollen?

I think your surgeon needs to see your knee.

Since your abscess has not cleared up yet - it should have by now - has your own doctor taken swabs to see if there is still infection there? Were swabs ever taken? Did you ever see the surgeon about it? Are you still taking antibiotics?

 

[Jamie]

Bibi, who is this second surgeon you are going to see and where does he practice? With your history, you need a specialist and I'd like to take a look to ensure this person has the qualifications you need.

If you had an infection in your knee, a boil on your stomach would not be an indicator. You'd have pain, heat and redness in your knee. Sometimes the incision opens up and drainage starts. You'd likely be running a fever.

Please try not to jump to conclusions when you read others' stories. Self diagnosis (even for those of us who know a thing or two about joints!) is usually not a good idea.

 

[bibi]

@Celle thank you! Yes it is really sore especially the back of the knee. There is some swelling. Slightly. My knee at times does feel warm.
The reason I brought up the abscess is because if it is an infection it could invade the implant. I did visit my PC who said it was infected. I was prescribed erythromycin for 10 days. It was never swabbed.

 

[bibi]

Hi @Jamie...The OS' name is Dr. Theodore Manson, University of Maryland Hospital Orthopedics (Timonium). I am known by family and friends to self diagnose!! Thank you!

 

[Jamie]

He sounds like a good choice for you from what I read about him. Please let us know how the appointment goes.

 

[Celle]

@bibi , I'm still trying to understand the course of events here. I wonder if you would clarify things by answering these questions?

• Your thread title says you have a staph infection, but how was that diagnosed if no swab was taken?
• Did your PCP prescribe the course of Erythromycin when you first saw him, before the boil had burst?
• Since the boil hasn't cleared up yet, have you been back to your PCP?
• Did your PCP say the boil was infected, or did he mean your knee was infected?
• If your PCP said your knee was infected, what did he advise you do about it?

 

[bibi]

Sorry. I did not change my thread name. My original name was Down But Not Out. Yes my pcp prescribed the antibiotic before it burst. When he examined the boil he said it was infected. No swabbing was performed.