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Discussion in 'Knee Replacement Pre-Op Area' started by Matandas, Feb 13, 2018.

  1. Matandas

    Matandas new member
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    Good morning, I stumbled on this forum and thought I might try and get some advice.

    My orthopedic issues started in 2011. I was hit by a car on my motorcycle and had an open spiral fracture of my right Femur, left tibial plateau fracture, fractured right ankle, and my right toes were shredded. When I was hospitalized they said risk of infection was too high to operate at the moment so instead put me in a rehabilitation hospital to learn how to operate in a wheelchair.

    About a month and a half later they operated and pieced my femur back together with a large metal plate and about 12 screws. Bone grafts from my hip were used to fill the cracks. I had a transmetatarsal amputation on my right foot as the toes weren't salvageable. My other bones were healed with surgery as well.

    I was told that I may never get full use of my leg again and that if I walked it would still be assisted. I didn't understand or accept that. I worked in PT for months and was finally able to walk, albeit assisted. I then had a nerve release surgery to ease some of the drop foot effects on my left leg. Fast forward a year and I could walk at a brisk pace without much issue. Still in pain though. I stopped taking the ample opiods prescribed to me when I began to notice the effect it had on my life long term.

    Fast forward a few years. My knee has gotten consistently worse. Loud cracking sounds when bending it. Pain is worse and now my femur hurts not just my knee. First doctor I went to in year 2 said it was crepitus and harmless. 2nd doctor in year 4 said that there was bone loss but that more PT is all that's needed. Did that and it didn't help.

    Year 6. I'm walking with a cane. My leg hurts whether I am standing or sitting. It radiates from below my hip to below my knee. I've now had countless x-rays and an MRI. My cruciate is stretched so far that it doesn't really offer any support now but my doctor is not wanting to operate. Keep in mind this is a second opinion - first opinion suggested SURPRISE... more PT. Said he would have to remove the screws in my knee to do any kind of work and removing those would cause even more instability in the bone. Even to repair my cruciate he would need to remove at least one which he wants to avoid at all costs.

    I am at the end of my rope. I am 27 and have the legs of a 70 year old. I can't do the things someone my age is supposed to do. It's affecting every aspect of my life. I don't know what to do. My doctor says my best bet is to continue steroid treatments in my knee and manage the pain pharmacologically but I know prolonged use of steroids can cause further bone loss and I'm not too keen on pain killers or pain clinics.

    Does anyone have any advice? Any would be appreciated.

    Pic is lower half of femur. Not all the issues but definitely the main one.


    femur xray.jpg
     
  2. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I'm sorry to read you've been through so much with your leg.
    I'm going to ask @Josephine , our forum Nurse Director, to advise you. She has many years of experience in orthopaedic matters.
     
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  3. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Oh my goodness! It looks as if you were lucky that bone healed at all!

    One thing we now know about metal ware in bones is that it's really not a good idea to keep such a plate in place as it results in something called stress shielding. Let me try to explain this.

    Bone is a dynamic material and it's growing all the time, mostly from within out. New bone cells are created inside in the bone marrow, by cells called osetoblasts and get added to the hard bone. Cells in this hard bone gradually work their way from the inside to the outside of the bone. On the outside of the bone are cells called osteoclasts which absorb the now ageing bone cells so the bone is remodelled throughout the person's life. This activity is very much dependent upon loading, or weightbearing. It's what keeps our bones healthy and strong.

    However, if we put metal plates or rods in the bone, it interferes with this process and the bone underneath can become soft and osteoporotic. This is known as stress shielding, meaning the normal stress or weightbearing is not passed down the length of the bone but is being absorbed by that big plate.

    Now I mention this because looking at your xray, I can see that there are areas where the bone was obviously shattered but it should have healed better than that. The reason it hasn't is because the plate has been left in all these years. Usually any metalware like that has a planned removal for that very reason.

    I'm not sure how it would be if the plate was removed now but my feeling is that it needs to be to allow the bone to strengthen. The fractures all look well healed by now. And another thing is that you seem to be in need of a knee replacement but the metalware will have to be removed before that can be done.
    I really don't agree with this. Those screws and the plate all need to be removed as I said before.

    I don't know what kind of surgeons you've seen so far, by which I mean were they knee specialists, trauma specialist or what? The kind of situation you are in at the moment would be more suited to the opinion of a trauma surgeon, I think. Anyway, that's my opinion!
     
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  4. Toddlermom

    Toddlermom graduate

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    @Matandas :hi: Lady, you have got some killer hardware. So sorry that you are in pain at such a young age. I am a hippie chick (ortho started in my 20's but first operation in my 30's). In my 20's, I accepted one docs opinion for WAY too long and regretted it. :dubious: You might try to research trauma and ortho specialists in your area and check out the opinions of several. When I started exploring choices in my early 30's, I was surprised that there were several different opinions. And I had wished that I had asked for the thoughts of 3-4 well respected docs. After all, would you pick a favorite restaurant without sampling a variety of choices/options? :bored: I did! Figure out you choices. Look for specialists who also teach at med schools. Good luck! You are on the hip discussion board.....you might ask to move into the knee discussion boards for some additional experience. Hugs from Texas!
     
  5. NickUK

    NickUK junior member

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    While I cant offer any medical opinion I can make a suggestion.

    My niece at the age of 17 was a passenger in a car involved in an accident which left her with a broken back, two broken legs, a broken arm and a pelvis in over 37 separate pieces. At some point she had a metal plate in her arm and one leg and her pelvis is still held together with a metal frame.

    While initially the priority was to stabilise her she searched long and hard for a surgeon who specialised in this sort of work. She found someone who was prepared to listen to what she wanted and where she wanted to be and is working with her surgically to achieve this.

    All I can say is that first and second opinions are fine but it is often worth searching on and further to get someone who is prepared to work with you.

    I am in the UK not the US but I am sure there are people who would work on this for you.

    Best of luck!
     
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  6. Matandas

    Matandas new member
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    Thank you so much for all the replies. Thank you Josephine for explaining that. I feel more confident about going to a different Dr for new opinion now. It just seems crazy to me that there isn't more that can done. I'l keep yall updated
     
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