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Fusion Long ride to a successful Fusion

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Jo...I highly agree with you. I believe Coachie's implants are loose as well. Damn those un-cemented pieces! The more I did with my leg/knee before the revision, the worse the pain got, and the more damage I did to the surrounding tissue/ligaments, etc. I don't have a lot of faith in the x-rays taken at the OS office when you go back for a check-up. Dr. "M" took several each time I went, and said they were "perfect" and there was no looseness. I don't believe a simple x-ray...no matter what view...will show looseness unless it's EXTREME. Even the slightest looseness will cause pain, and no drug or pain killer will take the pain away. The pieces are loose! Like I've said before....Dr. Kelly was shocked that the pieces fell off into his hands when he opened up the knee for the revision. So....for an entire year, I did PT and pretty much tortured myself with exercises to get my knee to work right. PT and exercises can't fix loose pieces. AND...if the do start to adhere, are they adhering to the correct spot? Yup...I agree. The pieces are loose and a revision needs to take place.
 
thanks for joining my thread, Damask! I am ready, willing and able to deal with life with a fused knee. I used to be a very active individual. Rode horses, enjoyed snowmobiling, skiing...you name it. My world came crashing down in October 2009 and it hasn't been the same since. I've had to sell my riding horses. I've been told I will never ride again. (Do you think I could with a straight leg?) I now have 2 wonderful ponies and mniature horse, as I just could not end my love of horses because of this knee thing. People don't call me anymore to do things. They feel if they ask me, I'll be upset because I can't go. (Riding in a car for over an hour is really hard for me...lots of pain due to the jiggling). My girlfriends from High School ...we all turn 50 this year! We had planned a trip to NYC for 4 days, hoping that my knee would be better. No trip for me. I can't even walk a half city block, let alone get in and out of cabs, walk here and there, etc. etc. I can't even goo up to the barn and brush my ponies becasue if the side-step towards me, I can't pull my leg backwards to catch myself. If I do? MAJOR PAIN!
I can climb and descend stairs...one at a time. Is that what you do? it's not big deal to me anymore. I'm used to it. Slow...but used to it. How can you ride a bike without bending your knee? I am amazed! Do you have any bend to your leg at all? My Dr. said he would consider fusing it at 10 degrees. My leg would be shorter than the other, so I would walk with a limp. Big deal. I can deal with that as well. Sure...my back hurts from "limping" and the awkward gait...but I can deal with that also.
I got up this morning and tried to walk around without putting the cast on. I was in tears. The pain, the instability...all came right back the second I started to walk. I've got the cast on now, and no pain, and no instability.
I LOVE THIS CAST!!!! Nobody will ever tell me that "I can't do this or that". Believe me...I'm like you. Out to prove them wrong. I'll find a way to do what I want to do and live a full life. I'm gonna be a grandmother someday, and I'd like to be able to pick them up and play with them without pain or worrying that if I'm holding them, I will fall down due to the instability. Nope...not gonna happen.
Do you think that not having a functioning quad muscle will affect the results of the fusion? I'm hoping for the same results as when I'm in this cast. Less pain, function and stability.
My hubby wants to know if it's possible to bend the knee after it is fused. I'm guessing he's thinking not by choice...as in having an accident....and what would/could happen. (If I were to ride horses again, and I had a fall, and landed on that leg, forcing it to "bend"...would it break?)
 
Audrey, loosening can be seen on an xray, it just takes an experienced eye to see it. Regular hip surgeons don't have that experience which is why I am always urging people to see a really good and experienced revision surgeon because they have that eye. I've spotted loosenings on a few xrays members have posted here that their surgeons have already declared to be "fine"! Possible because I've been in on so many revisions in my time I guess I've developed the 'eye' in a small way! Plus the real tell-tale is the history and symptoms but I think these guys aren't prepared to admit their work is faulty. I think it's a man thing! :wink1:
 
Too funny, Jo! Yup...I agree with the "man thing"...sorry to the guys out there. And yes....an experienced and caring surgeon can spot loosening on an x-ray, as long as they are open to the possibility. Certainly, Dr. "M" was not.
Coachie: Thanks for the PM. Let's continue to post on the thread from now on unless it's a personal issue with names, etc. I know there are people out there that want to see what is going on with both you and I, so let's share. Remember....BoneSmart people are there for you and me! :friends:
 
Hi Audrey, those are all good questions and I will give you my honest opinion on all of them. As for riding horses, it's not something that I ever really did so I can't say for certain. A couple years back I went to Cuba and I went on a horseback riding tour and I was able to do it although the horses were just walking. If the horse was to start running it might be a tad difficult but I have no experience so you may well be able to develop a technique that works. I will say it did feel a bit awkward not being able to bend my one leg but I think it could be fixed if the one stirrup was longer on the saddle. Could you get hurt due to your leg being fused? Unfortunately in our world Audrey that is always a possibility. I have been hurt many times because of my leg.

Based on what you have said it's clear you still have lots of pain which will take time to go away. This will also hinder some of the things I will tell you but it will come with time I gaurantee it. Going up stairs I usually take two stairs with my good leg and then one with the bad and repeat. I developed this more to not be slow and hinder people behind me. My fiancee gets mad at me because I'm always trying to be considerate for others and she feels it should be the other way around. But, bare in mind my good leg is much stronger because it is basically doing two legs worth of work. Especially, over 20 years it has had time to get strong. Going down stairs, I do a kind of hip hop step which I also developed to be speedy. I will try and put some video clips together to show you better. Josephine mentioned you can upload you tube links so maybe I will try that.

Ah yes, the trusty bicycle. As a kid I loved riding my bike, it was my favourite thing to do. I remember being in the doctor's office before it got fused and I asked the doctor if I could still ride my bike. My doctor told me I would never ride a bike again. I was crushed!:cry:My knee was fused weeks later and my leg was in a cast for four months. When they took off the cast and I was off crutches and could somewhat walk again the first thing I did was head to the garage and grab my bike. I remember saying to myslef, "I'm going to ride this thing!" I developed the right heel tap which did the job. I will say this quickly as I will touch on it after with the quad muscle question but your hip and ankle are going to become very strong and play a huge role in your life going forward. My right hip is very strong. Your hip will be a major part of riding a bike if you choose to. First, you need to be able to hold your leg up in the air which will make your hip sore and tired in the beginning until you get stronger. After that it's just basically a case of as the right pedal reaches the bottom of its rotation I hit it with the back of my shoe to help it go back up. It's looks funny and I got stared at like crazy but I didn't care I was riding my bike!:thumb: Once again video would do it more justice. I even have a technique for going up hills too.

My knee has absolutely no bending. It is straight as a board. I believe when they fused my knee they actually cut the tops off of my bones and let my femur and fibula/tibula grow together. My right leg is essentially one bone now I believe. Have I ever bent it after the fact? Yes, a few times and it sucked big time each time it happened. It hurts like hell and I would recommend not doing it but sometimes things can't be avoided. Most were sports related which means they could have been avoided if I wasn't playing sports but that wouldn't be my style. My mom developed lots of grey hair. I did however have a bad car accident in Portugal in 1991 and did some serious damage to it. I broke the fuse along with damaging the growth plates in my bones so my right leg stopped growing like my left. This resulted in me needing leg lengthening surgery (ilizarov surgery) and orthotics which I still wear as my right leg is still a bit shorter.

As I mentioned above, your hip and ankle will become very strong and also become very important in your mobile life going forward. I can't tell you how many times I have rolled my ankle because I can't bend my right knee. It doesn't take much either. Due to the fusion, my right leg is considerably smaller than my left. My right foot is one shoe size smaller because I tend to stand on my good leg. I basically have a small quad and hamstring. it's hard to work them when you can't bend your leg. Leg raises anyone!!!!!! My right butt cheek is even smaller than the left. However, my lower leg (calf) looks exactly the same as my left.

I'm really starting to see that maybe tkr isn't for me. I have done so much in my life with my knee and leg they way they are. I don't know if I got it done and I encountered problems like you I could handle it. To go backwards would be a huge blow to me and what I have accomplished. But, you must always look at all the options and go from there. Let's see what the future holds. I'm always a type away so please feel free to keep asking me things. I will try and get those video clips as seeing is believing. Good luck Audrey and keep staying positive! Pain heals!
 
Wow! Thanks for the info. Damaso! That's a lot of typing, and I really, REALLY appreciate it! I can see you riding your bike just the way you explain it. Might look "funny", but...you ARE riding your bike! I can also (or used to) ride a unicycle! I've ridden one since I was 10 year old. My husband didn't believe that I could ride one, so he bought me one for my birthday when I was 42. It took me about 5 minutes to get the hang of it again, but I was peddling down the driveway and up the road. He was shocked! Won't be riding a unicycle again, I'm sure....just wanted you to get a visual! .......I've been riding horses since I was 8 years old. I've showed equitation and gamed (barrel racing, etc.) and lots and lots of trail riding. I'm gonna bet that if I can find myself a really good instructor who is willing to work with me and not worry about liability, I can get back on and learn how to ride/balance with one straight leg. I KNOW I CAN after reading about you. Again...THANKS! Maybe I should change my BoneSmart name to "Gonna ride"!!!!!!
I can see how easily it would be to "roll" your ankle, as I've almost done it while in the cast. I've got to reaaallllllyyyyy be careful when walking on uneven ground. My right leg (the good one!) is really strong. I am afraid of over-working the knee joint on the right, as I do have degenerative joint disorder (DJD) and don't want anything to happen to THAT knee. I need it!
Can you be more specific about what happens to your fused knee/leg when you have an accident? Does it "bend" or just feel like it does? Do you wear any sort of brace on it "just in case"? My left leg (the bad one) is already shorter than the right one, and it has been mentioned that I might need a lift in that shoe so that both legs are the same length, so to speak. I do several leg lifts (off to the side) during the day (now that I have the cast on) in order to strengthen my hip and outer thigh muscle. I can't tell you how WONDERFUL it is to be able to exercise and not have instability and pain!
Jo...and any others....do you know why the surgeons most always wait a year or more before they will do a revision or another type of surgery on the affected knee? I've been told several different reasons like infection, time to heal, etc. etc. Are there other reasons? As in my case, why couldn't I have this fusion done in a couple of months, rather than next spring? I don't have an infection, and I really don't see my knee getting any better...hense the cast. I'm sure Coachie would like some opinions on this as well.
The only thing I'm apprehensive about having the fusion is if I have some sort of accident and it (the fused knee) tries to "bend". I'm looking forward to seeing what you have to say on this, Damaso.
I have mentioned to Dr. Kelly (my OS) that I would REALLY, REALLY like to have this fusion surgery in September, but he says there is no way he will go into the knee until Spring of 2012. Bummer.......
 
The reason they wait a year is because most issues will resolve, or show signs of resolving, up to a year after surgery. What ever is left after a year is most probably permanent.

As regards the 'bending', what Damaso says is correct, the tibia and femur essentially become one bone so, assuming the fusion is successful and complete, there is no bending and no danger of bending.

The fusion Damaso describes is an old procedure called a Charnley arthrodesis where the end of the femur and the top of the tibia is trimmed (as per red lines) and then the two bones are clamped together with devices that hold them firmly whilst the bones heal together like they have been superglued!

[Bonesmart.org] Long ride to a successful Fusion


However, you've already had that trim so the surgeon will just freshen up the surfaces of the bone and possibly put bone graft into the holes where the implants were.

Another process they use instead of the compression clamps is to put in a long metal intramedullary rod which will do the same job.

[Bonesmart.org] Long ride to a successful Fusion
 
boy, do I LOVE graphics! Thanks so much, Jo! You echo exactly what Dr. Kelly has been saying (about waiting a year). ....Do they still use the "clamp" technique? I've seen a few pics of a fused knee using metal plates on the sides instead of the clamps. Dr. Kelly hasn't mentioned how he may/could do this one me, as we've only started to discuss the option. Which was is most common now? The rod? The metal plates? The clamps? (I'd hate to walk around with a metal frame around me knee for several months!)
 
Glad it was useful. As they say, one picture is worth a thousand words!

I wouldn't go so far as to say any procedure is 'common' in knee arthrodesis these days as the procedure itself is so uncommon. I doubt the Charnley compression clamps are much in use, however, as they date back to the 1960-70s and they weren't without their problems! But they might use the modern day equivalent which looks even more scary but is much, much more efficient!



I've seen pictures of plates having been used but to be honest, I would imagine there would be problems with that approach. There is a lot of leverage centred around the knee and, IMHO, attempting to secure the joint during the 12-16 weeks healing with just two plates wouldn't be reliable as bone plates can bend and screws can loosen and tear out of the bone.

No, I think the fixation of choice would most likely be an intramedullary rod, especially as there are firms manufacturing extra long rods for just this situation! :wink1:

Here's some professional articles on the subject
Duke's Orthopaedics: knee arthrodesis
Joint Arthroplasty: abstract
Medscape
 
Jo:
Boy does that ever look scary!

Wanttoride!
I am so pleased to hear you sounding so optimistic. I have been following your saga and I shudder to think of what you have been through- and where you are headed.

At least you know what works to get rid of your pain!!!
Best,
Sandy
 
You should try scrubbing for the 3-4 hours those things take to assemble, Sandy! Mechano isn't in it!
 
Thanks for posting another picture, Jo. And "trainwreck"...thanks for following my posts. I can only hope they have done somebody else some good by reading and learning from my unfortunate experience. You never know when you are going to fall into that "less than 5% category". No matter what you do, it's always a risk of some sort. Yes...the mechanics look scary, but I have a very good friend who's daughter has/had MS and her legs were lengthened when she was 6 years old. (She's 20 now) I've never seen ANYBODY with that much courage and strength as that little girl...especially when her Mom had to turn the screws a 1/4 turn every few days. Note: this brave young lady is now a Junior at Bentley College in Boston double-majoring in business law and hosptial administration! She weighed only 3 pounds at birth and had many, many problems with walking and growth during her life. She is SUPER smart, and when I get really down, I call her and she tells me I can do it!
My daughter and I had a WONDERFUL day today shopping for antiques and having lunch. I haven't been able to do that in a long, LONG time! She (my daughter) can't believe the change in me both physically and mentally since I've had this cast on. She even had a hard time keeping up with me in the grocery store! :dancy: So....yup....I'm really hoping for a fusion when the time is right. In the meantime, more research and information gathering!
 
Jo....if they chose to put in the "rod", would the contraption you posted be used while the bones heal? If not, would my leg be in a cast?
 
No to both. The intramedullary rod would be used with transfixion screws similar to the image which will keep everything straight and tight. That's what the frames are intended to do. (of course, the image is just for a femur!)

[Bonesmart.org] Long ride to a successful Fusion
 
LOL Janlyn48! I'm hoping that the information on my thread will not only help me, but others as well. Thanks again, Jo, for posting pics.
I've had a pretty good weekend....as long as I've got my leg in the cast. I had a boo-hoo moment about an hour ago when I was out on the deck "walking" and my leg gave out. I had taken off the cast about 15 minutes prior, and was just standing outside, listening to the birds chirping and my ponies muching on hay. I started to walk inside, and out it went. I HATE it when that happens. It makes me catch my breath, and scares anybody who's around me. And...I'm REALLY careful after I take the cast of, as I know it's been supported all day, and it's not used to being "free". It just snaps me back into reality that my knee is in definite trouble and not going to get any better without another surgery of one kind or another. Damn...wish I didn't have to wait that "mandatory" year. Right, Coachie? Uggghhhhhh.....
 
I am almost positive I saw a guy in Walt Disney World this last summer who had aknee fusion. While I was gimping along with my walking pole, he was hopping all over the place!!!
Audrey,
at least you know this will work for you. I am sorry you will need another surgery, but lets hope it is your last!
I have a perfectly set aligned joint and I still have the most annoying pain in the back of my knee, relieved only by stretching the crazy thing out (hard to do while I'm running around all day at work).
I'm hoping that it works itself out soon!
Sandy
 
Hi Sandy! Oh boy...I can relate to that "back of the knee" pain! I'm assuming you are talking about the hamstrings and tendons back there? I know of several elderly patients (over the age of 65) who have had TKR's and they complain of the same problem/pain. Every time they sit down for any length of time (me included in this also) and then stand, those hamstrings just seize up or something, and there's the pain. I've tried rubbing, massaging, you name it. Nothing helps. If I have my leg straight for a period of time, I'll get the same pain. It's not debilitating...just a very aggravating "pain". I tried stretching out my leg, toes pointed, trying to get to "0" degrees extension, and I got a charlie horse/cramp in that leg. Oh, I can tell you...I won't be doing THAT again! Yeeeooooowwwww!!!! :hate-shocked:
I'm confused about the hamstring pain, as many people have this, and even with PT, it doesn't seem to go away, even with exercise/heat/cold...whatever they try. By having my knee fused, I'm hoping that the hamstring/tendon pain will go away, since they won't be used. :scratch: Any thoughts on that possibility anyone? Is anyone else having these same issues with "back of the knee" pain in the hamstrings/tendons? Keep the info. com'in!!!!
 
Most of the major muscles in the leg work the joints above and/or below the knee so they'll not be totally inactive!
 
This wait is horrible, huh?!

I had hamstring pain with my left tkr, but it was because when I was about 3 months out, I overdid it and ended up with a slight strain. I rested it for a few days and it got better. With my right tkr, I haven't had what feels like a whole lot of muscle/tendon pain, but instead have had what feels like deep bone pain. It's a totally different pain.
 
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