TKR Walking Post Op

[Josephine]

LOADs of people! Generally you have to wait until they extrude so they can be extracted.

 

[Pamjam68]

@Josephine thanks. This bump/puckering feels different than the sutures that protruded on bend on my knee which nurse took care of. It’s as if they are bunched up under the skin and puckering has got worse with time. I am 11 weeks post op so am wondering how long it takes for them to dissolve? Dr released me same day nurse removed rogue stitches and does not want to see me until 12 months check now. Thanks as always for your help.

 

[Josephine]

Oh they can take weeks and months to resolve. It also seems to me that sometimes the body just isn't resorbing them.

 

[Pamjam68]

@Josephine I was wondering about that. Is the suture make up standard I wonder. I had two different OS’s and had no issue at all with wound or sutures last time other than the healing process. My GP looked at both incisions and said he thought junior had been allowed to close on 2nd surgery. My GP did ortho experience under my 1st OS and be said he never got chance to close as OS insisted on closing himself and that was not the norm in his experience. Often closing left to junior Drs. I guess to those of you in the medical field this was common knowledge but not to me,

 

[Josephine]

Is the suture make up standard I wonder.

I remember when these synthetic absorbable sutures first came on the market - must have been around 1970! We were told that the gauges - thickness - of the sutures were the same as with catgut which came in sizes (thinnest) 3/0, 2/0, 0, 1 and 2.

Now at that time, we would use 1 for closing muscles and deep tissues. 0 for more superficial tissues and 2/0 for subcutaneous fat and fibrous tissues (under the skin). For skin we would use 2/0 silk or nylon. So we used the same gauges when we used the synthetics. The first one out was by a firm called Davis & Geck and was called Dexon. For some unknown reason they had dyed it green! But we quickly discovered that though the gauges were transferable, the dissolving wasn't and we had to get patients back into theatre for the 0 and 1 sutures to be removed. In vain I complained about to D&G but they insisted they had had no similar complaints from elsewhere.

But they underestimated the network of theatre nurses! We had a National Association of Theatre Nurses and our local branch met every month. It was at one of these meetings I raised this problem and found that every other hospital represented there agreed they were having the same issue and had received the same fob-off from D&G! Eventually, they decided to remove the green dye so it was provided in a beige colour but it made no difference. Shortly after that, Johnson & Johnson came out with their product called Vicryl which they died purple and exactly the same results ensued! It wasn't until surgeons in my sphere of contacts were persuaded to go down a size that this issue faded out. But it's my thinking that there are still an awful lot of of them are still using the larger sizes. I don't know this for sure, obviously, but it seems logical to me as most of these cases seem to be coming from the US and not the UK.

 

[Pamjam68]

@Josephine this is such an interesting history of sutures thank you. My OS came very early in the morning around 7 am the day after surgery to check my incision and remove the dressing and my nurse told me that was unusual as she usually got the job. He was very interested in looking at my wound but did not check the other patient he had done same TKR on in next room and I still wonder why. This scar is not going to be near as “pretty” as my first because that was was flawless with no issues. I do appreciate the benefit of the wealth of knowledge on Bobesmart. .

 

[Celle]

There's still plenty of time for your scar to flatten out and improve in appearance.
It's not the finished article yet.

 

[Pamjam68]

@Celle thank you for your encouraging words. I know I should not compare scars but it’s hard not to. Had no bumps and lumps with first surgery. I have learned so much about sutures from this enquiry. I am glad I am not a horse and only have two legs but I guess if I went for a third I would be even wiser

 

[Pamjam68]

I am now 4 months post op on 2nd TKR I had subcutaneous stitches pop at 6 weeks and Nurse “trimmed” it warning me it may surface again. The area where it was trimmed is still tender and has a small white scab with what appears to be stitch beginning to surface again.

My question is for those who have had similar stitch issues, how long is it going to be before I am done with “spitting stitches”? I had such a neat problem-free incision on first TKR I was hoping for the same this time. Unfortunately different surgeon and incision not nearly as neat and in addition this stitch issue has been a real nuisance.

Any input would be appreciated.

 

[Pumpkin]

Pamjam68 ,
The stitches will either re absorb, or keep being spit out, frustrating.
Let me tag @Josephine , she may be able to give you a clearer answer.

 

[Pamjam68]

@Pumpkln thank you so much. It is frustrating. I wonder is this is all part of same stitch and whether bathing it with warm water will help it dissolve quicker. I will look forward to hearing from Josephine. Thanks for your help . Bonesmart has been such a big help to ne this past twelve months

 

[Lindylee]

@Pamjam68 Hi, I had what looked like a stitch appear around 7 weeks post op after my last scab fell off. Your description sounds very similar. A GP I know took a look and advised I massage it gently with a moisturiser. I used Bio Oil twice daily and after 4 days I woke to find it had gone. It might be worth trying.

 

[Pamjam68]

@Lindylee thanks. I had just been using warm water thinking it would help dissolve it but that hasn’t worked. I will give your suggestion a try. My first surgeon’s glue job used nothing but glue. Second one put external stitches that need to be removed at top and bottom of incision and I wondered why that was as he said he also glued the incision post op. Then when this issue on the bend of my knee began three weeks post op had even more questions. I have wondered whether the very robust PT sessions where she was pushing heel to butt every visit had something to do with this issue. I wish I had been more proactive and told the PT no when she insisted on doing this on every visit. That was pain I won’t soon forget.

 

[Lemondrop]

Hi Pamjam68.
I had a breast reduction years ago and it took several months for the sutures to stop coming up through my skin. So I was not surprised when my OS and a few nurses warned me that I probably would have some sutures come out of my knee incision. I am at 6 weeks and feel and see a suture peeking at the top and bottom of my incision. I imagine they will have to be trimmed at some point.

Hang in there they will go away eventually.

 

[Josephine]

I had subcutaneous stitches pop at 6 weeks and Nurse “trimmed” it warning me it may surface again.

You may have seen this stitch as a subcutaneous level but it's clearly not a subcutaneous stitch, it's a deep one. in this image, the level marked 'fat' is subcutaneous, between the two levels of fat - yellow is subcuticular and green and deep.

I would image your stitch is coming from the muscle layer and that the knot is gradually unwinding and emerging from your leg bit by bit. It might seem obvious then, to pull the material out which is fine if the winding of the knot is all undone but if it's not, then it might not be that easy to pull it out. And the material is rough surfaced which would complicate that. Also after 4 months, it's probably partially dissolved and therefore enmeshed in the tissues. In light of that, I'd just live with it for as long as it takes, get yourself a nice small and sharp pair of scissors (off Ebay?!) and clean them with any soap and hot water and snip it yourself. It's not difficult to do. Cleanse the area with disinfectant before and after as well.

My first surgeon’s glue job used nothing but glue.

He wouldn't have done that. The internal areas would be stitched up as normal and just the skin would be glued.

Second one put external stitches that need to be removed at top and bottom of incision and I wondered why that was as he said he also glued the incision post op.

This surgeon would have used what we call a subcuticular stitch which is run just below the level of the skin and secure with a knot as each end. Some surgeons do then apply Dermabond surgical glue to the skin edges as well but it's not really necessary. Here's my subcuticular stitch I had on my arm but instead of running the suture just under the skin, he looped it from side to side in what we call an internal mattress stitch! Below is the stitch after it was removed!

 

[Pamjam68]

@Josephine thank you for your detailed response. The picture of sutures top and bottom of incision you show is exactly what TKR2 had. My first surgeon did not put any visible stitches in and his scar was much neater but also longer and right down middle of my knee cap, second one surgeon went off to the side . I realize all surgeons are different. Everyone’s input is very reassuring. Thanks,

@Lemondrop thanks for your encouraging words. Going to pack my patience and hope for the best.

 

[Josephine]

Going to oa k my patience

Pam, as you can see, I've edited your post a bit because of spelling, grammar and punctuation issues but this one I couldn't fathom! What did you mean to say here?

 

[Pamjam68]

Sorry Josephine ... Going to pack my patience.