Fusion Long ride to a successful Fusion

[wanttoride]

Hi! I'm back from my Dr. appt where we talked about knee fusion. Here are the details:

1. We talked for about 45 minutes and discussed the type of fusion, the advantages, disadvantages and complications during and after surgery.

2. He would use what they call an indramudular (sp?) nail, not the rod. This rod would go into the femoral and tibial bone canals.

3. Removing the existing compon...ents is not an easy job. The femoral component is easier than the tibial.

4. My tibial component already has a rod in it, so removing it hold a high chance of bone fracture.

5. The surgery takes about 3 hours.

6. There could be a higher than normal blood loss during a fusion surgery, as the "canal" within the bone holds a lot of blood vessels and using a turniquette for 3 hours is too long.

7. Normal blood loss during a TKR is about 1 unit....a fusion could be as much as 3 units.

8. IF there is a problem with blood loss during the surgery, he would stop and continue a day or two after, once I was stable.

9. My leg could be as much as 1.75 inches shorter than the other, which would require a lift in my shoe.

10. Because I have RSD, the fusion could make it worse....could.

11. I will not be completely free from pain because of the RSD.

12. I would be on crutches for about 6 weeks, depending on how the surgery went and IF the tibial bone fractured during the fusion.

We also discussed my inactive quad muscle, so for the next month, I am going to try to see if I can get it to be more active. I'll do this by wearing my cast (got a new one today...it's blue and set at 5 degrees extension instead of 15) and lifting my leg up and down while I'm in the cast. I also need to build up my hip muscle, so I'll be doing a lot of side leg lifts as well.

I talked to him about the sharp pain behind my knee that seemed to be in my hamstrings and while I was getting my new cast made, he came in and said he had just been on the phone with a colleague and was somewhat surprised when the colleague said "maybe it's the "popatielle tendon" and it's catching on one of the components. This is VERY rare, but given my history, I just laughed and told him "well..if it's gonna happen to somebody, it's gonna happen to me!"....he gave me a steroid shot right into this tendon and we'll see what that does for the next week. IF the pain goes away, I have to call him and he'll do outpatient surgery to release the tendon. If not, then we are back at square one on that subject.

The other thing I have to have is a bone scan. This is because he needs to know if there is enough bone left to do a fusion. He won't do it if it's going to make my leg more than 2" shorter than the other. Also, the bone scan will tell him how strong my tibia and femur are and if they can withstand the surgery without fracture, or minimal fracture. I should have the bone scan next week.

It's been a long day, so I can elaborate on anything if you don't understand....but I'll do that tomorrow! I've gotta catch some zzzzzzzzzzzzz's!

Oh....and my horseback riding days are done. The risk of falling is too great, and the risks of having something happen to the knee/leg is too much also. I could be in worse shape than I ever thought of being in, so "wanttoride" will have to be happy with her ponies...which I am...and watching my daughter ride. I can always give riding lessons, and someday, I'll be a Grandmother and can enjoy my grandchildren riding! I'm ok...really I am. I'm just glad I've got my ponies in the backyard!!!!

 

[Jamie]

Wow, that's a lot of information to process. But you certainly have a roadmap to go forward. I certainly wish you the best of luck with all this, Audrey.

 

[wanttoride]

Thanks Jo...have you ever heard of the "popateille tendon" causing problems before? Also...can anybody tell me about having a bone scan? I was told they inject radioactive material thru IV in order to do it. I've never had one.....

 

[Coachie]

Audrey-
My popliteus tendon/muscle has been an issue from day one. My original ortho told me in September that he possibly damaged it in surgery and that it would take a lot of time to heal. It no longer hurts horribly, just feels kind of tight sometimes.

How did you get checked before in order to know about your revision? A ct scan?

Bone scans aren't that bad. I am assuming you'll have yours at EMMC and the radiology department there is super nice (I'm a little biased as my nephew works for radiology there!) You'll go in and they'll scan you and then inject some dye. You'll then have a couple of hours to hang out, go to the mall, whatever and then you'll go back and they'll scan you again. One thing they will advise it to drink A LOT of fluids as it helps wash the stuff out of your system.

Sounds like you have a lot to think about with your leg. Hang in there!

 

[wanttoride]

Hi Coachie! In my situtation, it's the popliteal tendon, not the poplieus muscle. I do believe the two are different. Jo.....can I have input? I've been reviewing anatomy pics most of the morning!
If you remember, Dr. M would do nothing to help me, so I sought out my second opinion at OA by myself. I saw Dr. K and he ordered the CT scan from the hip to the knee to the ankle, as he suspected malrotation (due to the fact that my left foot pointed to the 9-10 'o'clock position instead of pointing straight ahead) and possible non-adhering of the non-cemented pieces. The CT scan did NOT show non-adhering, but showed the malrotation. Only when he went in to do the revision did he find the pieces did not adhere...they fell out in his hands!
Yes, I'm having the bone scan done at EMMC...still waiting for a call-back for an appointment. If I don't hear by 3:00 today, I'll be calling to find out!
Do you have an appt. for your revision yet? Did they make an appointment in the calendar when they have availability anyway? If not,you want them to do that so that you at least have a date. Don't rely on them to call you with a cancellation date. BE PRO-ACTIVE! I learned my lesson big-time about being on the "call" list for a surgery date....never got one and should have had a date on the calendar no matter what! Have you definetely decided that Dr. W is going to do the revision? Where does HE do his surgery....EMMC or St. Joes?

 

[Jamie]

Audrey....I'll tag Jo so she sees your specific question. @Josephine:

 

[Josephine]

have you ever heard of the "popateille tendon" causing problems before?

It's the popliteal tendons! It's the two short, strong tendons behind the knee joint and yes, they are every bit as capable of getting inflamed, tight or loose as any other tendon.

Also...can anybody tell me about having a bone scan? I was told they inject radioactive material thru IV in order to do it. I've never had one.....

"They will giveyou an injection of a radioactive tracer (a radioactive substance that the camera follows as it moves through your body) in a vein in your arm. The injection of the tracer will feel like a small sting, but there is no burning or other sensation as the tracer moves through your body. The tracer takes one to four hours to move through your body.

While the tracer circulates, you will need to drink as many as six glasses of water. By urinating frequently, you will remove any of the radioactive material that has not collected in your bones."


I got this information from here.

 

[wanttoride]

Well, the shot of steroid Dr. K put in my popliteal tendon has almost worn off completly. It was nice while it lasted. He thought it might be catching on "something" (the prosthetic maybe?) and thus, causing the sharp "kill me now" pain I get after I've bent my knee and then straighten it again. Would you say that since the injection worked to stop the sharp pain for a day or two, that there IS a problem with the popliteal tendon rubbing or catching on something? I've got to call the office again tomorrow and tell them it's not working anymore...I wonder what I'm in for next! ...still waiting to here when I am going to have the bone scan. My next appt. with Dr. K is on Sept. 15th. We'll have the bone scan results and report by then, so I'm sure we'll have a lot to talk about and discuss. Any input would be great! Keep the advice and info. coming!!!!

 

[Josephine]

Well, it would certainly indicate that the problem is in your popliteal tendon though exactly what is causing it is another question entirely!

 

[wanttoride]

Bone scan tomorrow and I'm seeing Dr. K earlier than Sept. 15th...they called and want me in Sept. 1st. A rainy day in Maine today....
Jo..he said maybe the popliteal tendon was "catching" on something????

 

[Josephine]

Yes, that can be so - as you said, could be the implant.

 

[PhoenixS]

Thanks for the thought. I also have had bad hamstring and bad back of knee pain since my surgery. I'll mention it to my pain people once we can get my back to cool off.

 

[wanttoride]

Well, Phase 1 of bone scan is done...heading back to hospital in a few for Phase 2. They said they can already see some "pooling" of blood around the implant. No pooling on the "good" knee. I wonder what THAT means! More later.....
Sandy...I'd check that out. Could be those tendons back there are catching or might be too tight? Has anybody else had a thread going about having tendons loosened behind the knee after a TKR, or trouble with tendons catching? I'd be interested in knowing! (more work for Jo!)
:biggrin:

 

[wanttoride]

Phase 2 done. I have the CD to take to Dr. K, and the report will be ready in about a week. Apparently, they need x-rays taken AFTER my last TKR (done Sept. 2010) to compare to the bone scan done today to make determinations, findings, diagnosis (?). I was able to watch as the "tracing material" went through my body. VERY interesting! On Phase 2, it was pretty apparent that there was a big difference from the good leg to the one with the TKR. They told me that was to be expected, as the bone was still healing from the surgery almost a year ago. He also explained that having a bone scan BEFORE a year (or sometimes longer) isn't recommended for that exact reason. Healing and/or building of bone. You can get false readings if done too early. Ok...so I guess I don't understand WHY many of these docs order bone scans before a CT scan if there is an indication of trouble before the year marker. Makes no sense to me.....does it to anybody?

 

[wanttoride]

I've been going through a bunch of pics....thought you all would like to a pic of me riding, and that is what I really want to do again. It doesn't look like it's going to happen, but I've got the memories and pics to remember the good times. My new pic is of me and "Cash". "Cash" was put down last fall. He was 25 years old. ....I've got my ponies now, and that makes me happy! Maybe I'll start to teach riding lessons next year...that would be fun!

I am also doing some photography when my leg feels good enough to spend a couple of hours shooting pics. I've named my amateur business "Dragonfly Photography". I just did a shoot at a game show (riders and horses running barrels, etc.) my daughter attended last weekend. You can view all the pics I've done on the FB link below. I just wanted everybody to know that no matter what....you've got to find something to occupy your time and your mind when you are in pain or recovering from surgery. Enjoy the pics! https://www.facebook.com/pages/Dragonfly-Photography/160074627379849?sk=photos

 

[Jamie]

You certainly have some great ideas, Audrey!! I just love your positive spirit. And you also have a talent for photography too.....who knows what doors are going to open for you in the months and years to come. The sky is the limit!!!

 

[Josephine]

 

[RestAssured]

Audrey,

Regarding the Bone Scans; I had two done before the year marker to determine how much infection was present. It was very helpful to see where the infection was hiding, and the difference between 3 and 6 months. :biggrin:

 

[wanttoride]

I'm new at the "bone scan" stuff! I didn't realize that if the doc knows there is an infection, that a bone scan would show that. What else are bone scans used for (to diagnose and determine)?

 

[wanttoride]

Just got the report from my bone scan. Can anybody interpret, please?

Findings:

Arterial phase: ther is minimal increased uptake surrounding the femoral compnent minimally tibial plateau. Within the soft tissue phase also,there is minimal uptake surrounded the femoral components and minimally at the region of the anterior knee and patella.

The Bony scan demonstrates minimal uptake surrounding the patella, femur and tibia, minimally along the laterl site of the tibialis*____ in the upper most part of the tibialis component. The knee replacement was 2009 with a revision as in it might be a normal uptake which is seen in cemented knee arthroplasty*_____, cannot completely exclude loosening, and clinical correlation and comparison with plain films is also suggested at the time of surgery and revision.

Impression: Minimal uptake surrounding the left knee arthroplasty within the femoral and tibial components may be due to recent surgery or very minimal loosening. Less likely to be infectious (but this can be ruled out with a white blood cell bone scan).

Does anybody know what "minimal uptake" means, what it refers to, and if that's a good or a bad thing? I'm guessing it's not a good thing....also....how can a cemented knee be "loose"?