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Fusion Long ride to a successful Fusion

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No, Audrey....Jo's avatar is of one of our dear BoneSmarties who is not well right now....NancyO. Some of our older members will remember Nancy, I'm sure.
 
Thanks for the beautiful pics. You are a beautiful woman...and have beautiful animals, that I know you love so much. I'm kinda jealous you live in such a pretty place. I keep trying to not type beautiful so much. But, it just is. Again, thanks for sharing.

Helen
 
Audrey,

You have some beautiful horses! I love the dog, and the picture with your husband was cute too! :biggrin:

I will pray that you find the answers you are looking for regarding your knee!:friends:
 
Very anxious to have my second opinion on Friday! Out of the blue, my band director from High School caught up with me on FB and low and behold...the doctor that I'm seeing for the 2nd opinion is his hip replacement Dr.! He said he's wonderful and that I will like him very much. He's very thorough and gives options, but the final decision is mine to make. Isn't it amazing how people come into (or back into!) your life just when you need them the most, and least expect it! I always say..."things happen for reasons".
We are getting another pony tomorrow! She is "Gracie's" grandmother and is 17 years old. Very excited! It's a long drive down Route 1 (the coastal route) but it's going to be worth it. The barn will be full after "Caseo" a.k.a. "Cassie" gets here!
Family bbq tonight (groan...the "ex" will be there as well:gaah:!!!!!!) for my son, so I'm taking it easy this afternoon before the big gathering. We are meeting his girlfriend's parents for the first time. They've been dating for about a year. I think I'll need a glass (or two!) of wine to get through this! LOL :cheers_wine:
 
Whoa....Audrey, you are a real peach to do this for your son. But it is good....even if it is something I never did very well with my hubby's ex-wife. We mostly never spoke to each other for a very long time. I'm proud of you!!!
 
Just popping in to say good luck tomorrow! I really hope all goes well and SOMETHING happens. My worst doctor visits were ones where I went and they just shrugged their shoulders and went "mmmmm?". Or ones where they would just say "well what do you expect, you DO have AVN." HOwever, you sound prepared and ready to ask questions and advocate! yay advocating!

Sending you my best wishes!
 
Hi everyone! Well....I survived the "gathering" last night...phew!!!!...and my son was very grateful and thanked me for being a "good sport" about putting up with the "X-man", as he calls it! Too funny!!!!! :hysterical:
The new pony (Caseo) is here, and she's a peach!!! What a sweetie! All 3 of them are getting along. Good luck runs in 3's right? so....
I NEED ALL THE LUCK I CAN GET FOR TOMORROW, SO KEEP THOSE FINGERS CROSSED that the doc sees that I'm ready, willing and able to handle a knee fusion! :thumb:
I will probably post on Saturday, as we are getting back late tomorrow night.....
 
Hi everyone! Well...I'm back from Portland...FINALLY! (I hate the drive to get there) Hubby went with me, and we saw Dr. McGrory at OA. He's a nice fellow, but we both knew he was the "2nd opinion" doc, so we summed up the past 2 years in a nutshell. He was also reading the op notes and xrays on the computer while we talked. He's a nice guy, but Dr. Kelly and I are very detailed in our thinking, and I think that's why understand each other well. No second guessing...just the facts, maam! LOL

He had me walk with my cast on, then walk with it off (that's a joke!) and then he decided to poke and prod my knee. OUCHIE! Well..it had to be done, so I just gritted my teeth. He asked me what I knew about fusion, and I think he was quite impressed with the information I told him and the research I've done. Pretty much, I think this 2nd opinion was to be sure I wasn't going "cookoo bird" on Dr. Kelly and just looking for a quick fix...and not realizing what the outcome would be...as in permanent.
We just talked for about 15 minutes, and I told him my frustrations, the good, the bad and the ugly and how much better my life has been since "Peg" has been around. (that's the cast, for anybody that didn't know)
He told me that he was sure I had RSD, but go figure....my leg didn't turn that ugly purply-red color that is often does, even after he poked, prodded and tugged. He also said he was sure I had PTPD (post-traumatic pain disorder)...new one on me! But if the shoe fits.....LOL.....and it certainly does!
To sum it all up, he believes that a fusion would be my best option for stability and less pain and a more active life. We discussed the types of fusion, and he said that he was sure Dr. Kelly would use the metal plates, but to discuss that with him. He said he didn't think they would use the rod, as it could really reek havock with the RSD, and the risk of infection would be greater. (Input, please!!!!) He said he would talk to Dr. Kelly on Monday and let him know that I'm mentally stable and know the risks and what life is going to be like with a fusion. He did say that my leg would be 3cm to 4cm shorter than the other one, but lifts in shoes, or addition to soles of shoes will help with that. Also back pain and ankle pain...heck...I've got that already! He wasn't sure if the fusion would take away ALL the pain, as there have been too many surgeries done to my poor 'ole knee and it's had enough. The RSD would probably still be there, but would come in spurts like it does now, but not so severe. But....nobody really knows. It's the given outcome that I have to be able to handle, and I'm sure I can do that.

I know complications can arise, but the only alternative would be to live my life in a brace (don't know what kind, or how cumbersome) and I don't want to do that. I have (2) very "nice" braces now, and neither one gives me confidence in the wintertime, nor stops the twisting and turning of the knee. Again....OUCH!

We did discuss having nerve blocks (again) and going that whole route...of course, we had to discuss ALL options. I told him I'm done jumping through hoops and living the "maybe" life. He agreed that I've been through a lot with the knee and sometimes you just have to say "enough is enough" and make the decision that is right for YOU. Very well said, I might add!

So...if anybody want to give me input, thoughts, advice, info....PLEASE do so!!!! He did say he (and Dr. Kelly) would not do the external fixation method, as that is mostly done for patients who have had severe infection. (?) also...the "rod" would not be an option as well, for reasons I've written about above. I'll check in tomorrow. THANKS EVERYBODY!!! :ThankYou:
 
Well all in all, a pretty good outcome then. I am pleased for you.

The issue he was referring to with the intramedullary rod and infection, don't know how he thinks the risk of infection would be greater. That's a bit of a gloomy outlook. As for it wreaking havoc with the RSD, I couldn't say about that.

And the Ilizarov is certainly not "mostly done for patients who have had severe infection"! What nonsense! Nearly all of the Ilizarov's we did at my local hospital were for cases with lots of tissue damage and/or comminuted fractures (lots of bits) and situations that couldn't adequately be secured with internal fixation such as spastic limb corrections. He mustn't have had a lot of experience with external fixators! :wink1:

However, the plates are okay. All those options are okay really. Gotta pick one so ..... !
 
that's exactly what I thought too, Jo. ...a bit of "mumbo jumbo" worked into the conversation, for sure. The 2nd opinion doc did say he hadn't done many fusions, so I'm glad he won't be doing mine!
I'll be having a long talk with Dr. Kelly about how many he has done. I don't want to have the fusion done with the option that is "easier" for the doc...I want the one that will be the best for me. I'll go to Boston if I need to, but there is a Dr. White ( I believe that's what I was told yesterday) that does more fusions in Portland. The doc yesterday told me that probably Dr. Kelly would work with him to come up with the best solution and option for me.
Like I said...Dr. Kelly is one-of-a-kind. If he feels he shouldn't do the surgery, then I know he will refer me to somebody who is capable.
I've seen xrays of these "plates" and it's pretty intense. Jo...can you tell me how long it takes for the bones to fuse (generally speaking) using the plates, and how long I would be in a "cast" or immobilizer?
 
Audrey, it does seem like you can now take a small step forward to getting the fusion and a more comfortable life with your knee. I definitely like your idea to search for the RIGHT doctor to get the surgery, though. You do want the solution that's right for you...not convenient or easiest for the doctor. You have your stuff together, girl....and I know you are going to make the right decision which ever way you go.
 
I doubt you'll find many doctors who have done a lot of fusions as it's a very uncommon procedure - but then you know that!

When you say you've seen the plates, you mean something like this?

[Bonesmart.org] Long ride to a successful Fusion
 
awolfpaw said:
I miss riding a bike (if anyone has any hints, I would LOVE them!)
Click to expand...

Ashley, there is a company in Germany that makes an aiding tool for bikes for people who have a complete knee fusion, look at

https://www.falisomed.de/Pr400.pdf

It is not cheap, they want around 400 Euros, I guess this is more than 450 USD. But with that thing you can ride a bike again and can rest your straight legt. I don´t know if they deliver to the US. I do not have suche a device, so I have no information from own use!
 
Yes, Jo....those are the same xrays I found on the internet of "plates". Is this what they look like, or have they come up with a different kind of "plate" that isn't as big? When I saw the xrays, I was a bit shocked that they were soooo big. For some reason, I thought they were oblong and about 5" in length. I don't know where I came up with that "vision", but that's what I thought of when I thought of "plates". It looks like there are a zillion screws that hold the plates....can you elaborate on how plates are used in knee fusion? Have you ever seen a surgery done like this? The doc yesterday told me that after a year, if I wanted the plates removed, I could do so.....holy cow!!!!!! It looks almost impossible to remove something that big!

I'm thinking of calling Dr. Kelly and getting in sooner than the end of August....just to talk about this face-to-face and see what HE has to say. Seems that since I got the second opinon, there really isn't any need to wait another month to see him...unless, of course, he's on vacation or the schedule is booked. I'll call the office on Monday.....
 
It's all about the leverage and the purchase of the screws in the bone. Screws in bone don't work quite like screws in wood. The wood is dead and static in nature so once screws are put in they are there for good unless the wood gets dry rot or something. Bone isn't static, it is a living structure doesn't much care for pressure being applied by metal devices and has a tendency to die back if too much pressure is placed on the screw threads. Thus it's best to have lots of long screws with wide threads to spread the load. This being supplied in the modern fracture repair equipment called A/O.

Plates must be at least that long with a plate on either side of the bone to resist all the shear forces of flexion, lateral and medial angulation and rotation. Compared to the overall bulk of your leg, they really aren't that big!

Those plates are A/O broad compression plates and have special shaped holes that cause the screws to move towards the centre, thus causing the spot where the bone meets to be under compression which encourages healing. They can also be contoured with special (and very large) bending presses so they exactly fit your bones.



The screws (and plates) are polished stainless steel and the drill holes in the bone are tapped (a thread precut in them) so months or even years later, they come out very easily. You will note they also use a hexagonal screwdriver which makes it even easier!

It's always good to remove such ironmongery when the bone is healed as there is something that happens called 'stress shielding'. I may have mentioned before that bone requires loading to be healthy and strong which is why inactivity isn't good for bone and as well as for muscles. But when you put implants in them, the loading is redirected from the bone and into the metal device. This means there is a risk that density of the bone underneath a plate may become poor. Well, that's the theory, anyway. Oh yes, and where the plates are put, they are mostly very superficial so only need a minimum incision to access the screw head and then pull the plate out at one end!

As you can tell, I've scrubbed for procedures like this several hundred times over the years!
Is this too much information yet? :wink1:
 
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