Post-Op Trochleoplasty

[HR1994]

Hi all,

I'm 7 weeks post knee operation (I'm 28M, I had a left knee trochleoplasty and Tibial tubercle transfer (TTT) performed on the 1st Feb). Recovery has been tough and painful. My quad muscles atrophied after surgery and they didn't activate till 3rd/4th week after surgery. Also, a week post-op, I had really bad tenderness in my left calf which prevented me from moving around.

I started PT 4 weeks after my operation (ideally I wanted to start it sooner but with the current state of the NHS in the UK, there was a delay to start of the PT). I've been having 1/2 PT sessions a week since.

Majority of my swelling has gone (not all yet as I can't see my patella move when I tense my quad), I'm elevating and icing my knee regularly. I'm doing my exercises 6/7 times a day. PT says I'm doing all that I can. I'm still using both crutches at this point. Activity wise, I'm walking around the house fine and can sit on sofa/chairs but can not tackle stairs yet.

I can see improvement in muscles as they start to rebuild, although still very weak, my knee feels stronger and stable as everyday goes by. My biggest worry is my ROM. My extension is almost 0 degrees which is great, but my flexion is around 55-60 degrees. It's been at this point for the last 3-4 weeks and no matter how much I keep bending and doing my exercises, it just won't budge.

It's got me feeling pretty low. I'm seeing the consultant in a few days for my first catchup and I'm worried, he is going to mention an MUA. 55-60 degrees after 7 weeks isn't great and given it's not really budged for the last few weeks.... it's making me feel like giving up but I know need to keep going.

Any advice from anyone? Or if you went through a similar phase?

 

[benne68]

Welcome to BoneSmart, @HR1994. I'm sorry to read that you are struggling.

Please give us the exact date of your procedure and whether it was left or right knee.

While I don't personally have any experience with this surgery, but I'm sure other of our members will come along to share what they know. You can also try putting Trochleoplasty into the Search box on the far right of the blue tool bar and see is any of the posts are helpful.

Meanwhile, I will leave you BoneSmart's Knee Surgery Recovery Guidelines. Although you are 7 weeks post-op, I think you will still find some of the articles helpful. Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[HR1994]

Thanks. I had a left knee trochleoplasty and TTT performed on the 1st Feb 2023. Trochleoplasty is considered a rare surgery still. I've had issues of several subluxations and dislocations in the past. This was due to my patella sitting on the edge of my trochlea.

The trochlea was deepened and my patella moved into it. My incision is similar to those who have TKR performed.

Thanks for posting the advice above.

 

[Jaycey]

@HR1994 Welcome to BoneSmart!

I'm doing my exercises 6/7 times a day.

Please give that knee a chance to heal! Way too much exercise. Unfortunately you need the knee to settle before you work on building strength.

Right now you don’t need lots of exercises, just move your knee gently to keep it mobile, take short walks around the house every hour or 2 that you are awake.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[HR1994]

Thanks Jaycey, I went to PT today and he relayed a similar message.

But what a difference 24 hours makes. I was very low last night. I went to physio today and the PT (who's the head clinician) measured my ROM at 76 to 80 degrees (at 7 weeks post op). Much higher than what I was measuring at home (I was probably doing it wrong).

He was happy with the progress I've made as I've gained 24 degrees in 2 weeks - aim is to push for 90 degrees by the next two weeks.

I still can't do a SLR yet but quads are slowly getting there after being completed wasted following surgery.

I'm also down to one crutch now. I'm walking very very slowly on it but atleast I've ditched one crutch now.

Overall, PT was happy with progress and noted I'm going in the right direction and told me to keep it up.

I'm seeing the OS on Monday, so will see what he says but he'll most likely tell me to keep pushing for more bend.

 

[Jaycey]

aim is to push for 90 degrees by the next two weeks.

No forcing the knee! It is always counterproductive. Forcing results in more swelling meaning ROM is limited. Gentle bends will work and get you the results - when that knee is ready.

 

[HR1994]

Definitely! The PT team I've been working with have been good in that sense too. PT has been challenging but they haven't forced anything or pushed me to do anything that causes pain.

 

[HR1994]

So, I went to see the OS today and he was accompanied by a physiotherapist who works with him (my OS works in a different city to where I live).

They agreed my knee bend was a bit stiff at this point but I'd done well considering I've only had 2/3 weeks of PT.

I made them aware my active ROM is 76°, which increased by 24° in 2 weeks. They said I'm going in the right direction, to keep at it and the bend will come. They said I also need to work on my quads to get to that SLR.

No mention of MUA, which I was happy about! My next check up is in 6 weeks, to which they said they want to see more bend and being able to lift my leg up using muscles by then.

 

[HR1994]

So, I can walk on one crutch but very slowly and I feel like it causes my knee to flare up when I do.

Do I switch back to two crutches to minimise the swelling or continue to use one crutch?

 

[Jaycey]

Do I switch back to two crutches to minimise the swelling or continue to use one crutch?

Switch back to two crutches. There is no rush to get rid of walking aids. Keep using them until there is no discomfort and you are feeling totally confident transitioning.

 

[Layla]

Hi there
It is two months to date since your surgery. I hope you're having a good week and eased back into two crutches with comfort. Wishing you a happy anniversary and a great month of April.
@HR1994

 

[HR1994]

Thanks. Yep, switched back to two crutches! I had a go with one crutch yesterday and was more comfortable but I'll still stick with two crutches for now.

I can do more on my own now and do some daily activities but still a long way to go with building my very wasted quad muscles and working on ROM!

 

[HR1994]

Had another PT session today, reached 80 degrees at almost 9 weeks, so a bit of improvement.

I've been referred for hydrotherapy now but could be a few weeks till I get an appointment depending on wait times.

PT is happy with progress and told me to keep going.

 

[sistersinhim]

I've been referred for hydrotherapy now but could be a few weeks till I get an appointment depending on wait times.

Be very careful in water. The movements seem so much easier, but in reality, your knee is moving against the resistance of the water. This is like using weights on it and very easy to anger your knee. You won't feel it in the pool, but boy will you feel it that night and the next few days!

At 4 months I finally decided to get back into the pool at the Y. All I did was walk to the swim lap, do one lap and walk back out and into the changing room. It took at least a 4 days to get over it. I didn't go back for another month. Then I did the same thing and was OK. I slowly increased my swim time until I felt no added pain afterward. So, using my experience, please be careful that first time in the water!

 

[HR1994]

Thank you for the heads up. I spoke to PT today, I think my first hydrotherapy appointment is still 3-4 weeks away.

PT pushed me hard today, not too much pain till he started to bend my knee back too much and I told him to stop, which he did.

I did hit 85 degrees today though at almost week 10 post surgery! The magic 90 mark is almost there.

 

[HR1994]

Another PT session today. Managed to get it past 90, I think it goes close to 95 even.

But I finally managed to do a full rotation of the pedal on the bike!!

I also was able to walk without the crutches without much pain. PT said I should be able to phase off the crutches in a couple of weeks, I just need to get used to bending the knee a bit more.

Quads still have a 10 degree lag when trying to do a straight leg raise but it's improving.

 

[Jockette]

Congratulations on the bike rotation!

Don’t rush to get off your crutches. Your confidence with them, and the safe help they provide, are important.

 

[EalingGran]

Be very careful in water. The movements seem so much easier, but in reality, your knee is moving against the resistance of the water

Agree. I did a spa day with my daughter recently and I did some very gentle exercises in the shallow end of the pool whilst she swam 20 lengths. I was amazed at how much I felt it afterwards. More than walking 10000+ steps.

 

[HR1994]

Thanks for the advise! I will keep it in mind.

Yesterday's PT session was tough. Fatigued and in some pain today. I think I'll be taking my first rest day and do nothing!

 

[sistersinhim]

Yesterday's PT session was tough. Fatigued and in some pain today. I think I'll be taking my first rest day and do nothing!

It sounds like you did too much. You shouldn't end up in pain after a PT session. While you are resting today, add in lots of icing and elevating to try and get the inflammation back down.