TKR Nearly 28years post Tibial Plateau fracture

SkiBum

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I've been lurking for a couple of days... I guess it's time to chime in. 27 years ago I suffered a tibial plateau fracture with torn up lateral meniscus in the right leg. I had bone graft and cartilage repair done. After 6 weeks non weight bearing and about 4 weeks partial weight bearing I was standing back on a pair of skis 3.5 months after the accident. I had the hardware removed 10 months after the surgery because my bone had remodeled too well and had to be shaved down a bit as it was causing discomfort.

About 10years ago things started to deteriorate in that knee... 7 years ago I had it scoped and yes it did help. Since then it's been slowly getting worse and the HA injections stopped working. I now have limited range of motion (about 100 flex, and about 10 degrees of contracture). Needless to say last ski season was kind of miserable. I don't want to suffer any more miserable ski seasons.. not to mention the higher risk of further injury while skiing so gimped up.

I met with a surgeon today.... RTKR it will be. I'll get a date after my blood work comes back. Here are my questions/concerns, and yes I've read through the guides on this site. My surgeon says that ROM prior to surgery predicts ROM after and he wants me to do the "forced" flexion and extension exercises prior to surgery. Bonesmart seems to believe that if it hurts don't do it... these exercises do hurt but I don't disagree with the surgeon. ROM is my primary goal since right now I can't ride a bicycle or retract my leg well enough to ride a low ski lift or ski steep terrain. In addition, without full extension my hip and back (which is already very arthritic) are the next problems. The second conflict for me is the rehab timing.... while my surgeon admitted that full recovery takes a year or better... he also seemed optimistic that 3 or 4 months is realistic for a return to skiing. I've read the success stories of people who have done that so I believe it's possible. However this site has created some doubt. I would have done this surgery much earlier in the summer except it took 3 months to get in to see the surgeon and I didn't finish skiing for the season until late April this year. So I'm between a rock and a hard place on the timing... and no I won't easily accept a year off of skiing again since this is a voluntary surgery after all. I will accept the 1 year sabbatical I'll likely have to take from teaching skiing. That way I can go back to it at my pace. My goal is to be skiing again by January and big mountain skiing (inbounds) again by next March /April.

Realistic expectations?????
 

Roy Gardiner

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:welome: to BoneSmart.
My surgeon says that ROM prior to surgery predicts ROM after and he wants me to do the "forced" flexion and extension exercises prior to surgery
Well in my case it wasn't true. Pre-surgery my left leg in particular was very restricted in bend. Now, both at 135 or thereabouts.

I strongly doubt the truth of his statement. I'd want to see the scientific evidence, or hear his reasoning. ROM is determined by soft tissue flexibility, which can always be changed with exercise, IMO.

Bonesmart seems to believe that if it hurts don't do it... these exercises do hurt but I don't disagree with the surgeon
Post-op that is indeed the BoneSmart view. Pre-op exercise is always good, but again I doubt it will make any difference to post-op outcomes.

As to rate of healing, it won't be you who decides that. It will be your knee. And the healing process cannot be sped up, but can be worsened by trying too hard. Be warned!

I my case (see my recovery diary in my signature, below) I was off my bike completely for about 2 months, back to half-decent riding in about 4 months. I have no idea if skiing and cycling compare.

But again, if you try and do too much too early, you will set your recovery back. Let your knee tell you - and it will!
 
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Jaycey

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Realistic expectations?????
I think by asking this question you already know the answer. Yes, your expectations are not realistic. It will be your knee deciding when it is ready for activity - not a calendar.
no I won't easily accept a year off of skiing again since this is a voluntary surgery after all.
This may be elective surgery but that has absolutely no impact on your recovery rate.

You might want to spend some time reading in the recovery area. These articles might also help you reset your expectations:
Activity progression for TKRs
Chart representation of TKR recovery
Healing: how long does it take?
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
 

Ayse

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I had the hardware removed 10 months after the surgery because my bone had remodeled too well and had to be shaved down a bit as it was causing discomfort.
I can't advise on the TKR, but I'm a fellow tibial plateau girl and from what I can understand you've done really well to last so long before having a replacement. I'm still suffering 8 months after my fracture and may need TKR soon. One of my many problems is also the bone has grown excessively. How was the plate removal and bone shaving? I need to get mine done as soon as I'm able. Best of luck with everything x
 
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SkiBum

SkiBum

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I can't advise on the TKR, but I'm a fellow tibial plateau girl and from what I can understand you've done really well to last so long before having a replacement. I'm still suffering 8 months after my fracture and may need TKR soon. One of my many problems is also the bone has grown excessively. How was the plate removal and bone shaving? I need to get mine done as soon as I'm able. Best of luck with everything x
I didn't have a plate... just 2 screws... they had to be dug out of the bone. I don't remember much about the second surgery..I don't think it was any worse than the scope I had 7 years ago. The arthroscopy was more work than the screw removal. The weird part is that the screws left metal fragments that make it appear like they are still there in a regular MRI. I have a haunted knee... cadaver bone was used for the graft... and ghost screws are present to this day..LOL.
 
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SkiBum

SkiBum

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I found this study comparing 2 different models of rehab after surgery ... it is small but interesting. It supports what you guys are saying about ROM after surgery. But seems to give the nod to doing more exercise....at least in the short term. Just food for thought. See next post for link
 

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