UPDATE: Day 11 LTKR and R patellar avulsion fracture; 9 weeks after RTKR.
I had a good chat with my (very experienced and respected) surgeon yesterday, to talk through what might have happened to cause my right kneecap to fracture on the day of my left knee replacement, and discuss my options and the implications…
He’s mortified. He said he’s carried out more than 2000 knee replacements, and this is the first broken kneecap he’s ever had. He can’t be certain why it happened, but he identified some possible contributing factors… The kneecap was in a very bad state: it had osteophytes growing behind it and it was about 6cm out of place, slipped down, as part of what was going on with my R severe valgus deformity. When he had shaved the osteophytes off it, he reinforced it with a ‘button’ - which is like a plastic press-on stud cemented to the back of the knee cap. So the front of the patella was/is my own bone, and the back is cemented plastic. The break has occurred pretty much at the edge of the plastic - the top bit where the ligaments attach has snapped off. He thinks this was due to a combination of the thinner, weakened bone and sudden force - basically me getting up after surgery and putting all my weight down that nonsurgical leg, perhaps also with extra pressure/restriction on the posterior cruciate ligament from the hard edge of the bed.
He said revision would be difficult and dangerous… Basically, the fact that the kneecap fractured proves that it’s very thin and fragile, so nothing further could be done to it other than removing it completely. This is not a good option now because removing fractured bones at an early stage - when the inside of your knee is still full of blood, swollen and bruised - means that there’s a high chance that fragments get missed and left behind, and so your risk of infection is really high. Removing the kneecap later is safer, but still not a good option. It’s better, my surgeon says, to brace now and see how the body repairs itself - it might mend better than surgery could ever achieve. So we have agreed to try this. If it doesn’t work, we’ll look again at other options.
Because it happened in hospital, I was braced almost straight away, and hardly moved it or put any weight on it unbraced. This means I haven’t caused any further damage to it, and it stands a reasonably good chance of healing naturally.
I had full extension and about 120° flexion before it happened, but of course it is hard to tell what my extension and flexion are like now, because of the brace. I could get my own leg up onto the bed unaided after a day or two, and hold it up in the air for a very, very short while after about a week, which my surgeon says makes him hopeful I will eventually achieve full function. He cleared me yesterday to do static quads and leg raises with the braced leg - I can’t, yet, but it will come…
The other brand new 11 day-old knee seems to be recovering okay, though it’s more painful than the first knee was, presumably because it’s doing so much more work. I’m having to do the rehab for my left knee ON my left knee - hooray for morphine!! I have hardly been able to think about how it is doing, because the broken kneecap has taken all my attention. It’s ironic that a knee that was replaced just 11 days ago is my ‘good’ knee!
I’m now medically well enough to go home, but I’m waiting for carers to be arranged, because my bedroom and bathroom are upstairs, and I’m going to have to live downstairs for a couple of months, so I’ll need help with emptying the commode, washing and so on … I can’t do anything that requires me to bend my knee or stand for more than a very few minutes. It’s going to be a long, tiresome summer…