Monthly Archives: August 2011

Knee Recovery Week 19

Almost 6 weeks off crutches and if anybody has gone through this procedure or planning it, either Osteotemy or meniscus transplant I will continue to share my experience.

No PHYSIOTHERAPY yet..

I haven’t had any physiotherapy I visited the physio once and he looked at my knee and was not too sure how to proceed with my rehab until I had the all clear from my Surgeon Mr James Robinson who performed the surgery. Mr Robinson was interested in how I felt it was going, preferring not to offer any advice, other than he felt I had made a great recovery so far and would like to see me again in 12 weeks. We discussed the option of re-straightening my osteotemy with an opening wedge at a further stage so I that am biomechanicaly the same as before because I have been having back pains walking. However this early stages in the recovery and my back pains may settle.  However we agreed this would be decided on the results of an arthroscopy possibly December 2012 to see how the graft has settled and healed.

I havent booked any physio appointments for these reasons so far.

I have had 7 previous knee surgeries before  from an injury to each knee that needed fine tuning during recovery. My right knee meniscus was removed as I injured it aged 18 skateboarding. Left knee later ruptured 4 main ligaments and tore meniscus age 25 BMX riding. I have now had 4 surgeries each side, and have found what I am about to describe below has usually got me back to strength after each one.

CYCLE EVERYWHERE EVERYDAY

I do not drive anywhere, cycle everyday, always choose the routes with the steepest hills and put my bike in a hard gear and ride up as fast as possible standing out the saddle. Ignore the small lazy pains and go until my lungs feel like I am going to be sick. I have found my knees maybe swell a tiny bit in the evening but legs always feel stronger the next day as a result. My meniscus transplant has settled in well and I am cycling everywhere with a reduced amount of pain each day. However I am still very much in pain but nowhere near as much as post op. I do not think about the pain though but get the occasional reminder usually when sitting for long periods of time.

WALK UP STAIRS EVERY DAY,

multi story car parks and lift shafts, also fire exits provide lots in one go!

TIP TOES

When waiting for anything, trains buses queues etc. Stand on tip toe on my weak leg and do calf raises up and down until a white hot pain begins to build in the belly of my calf muscle. This pain usually takes 4-5 days to leave but it seems to be the only way to get my calves to respond. Calf muscles do not return to size quickly. Any body builder will tell you how easy it is to end up barrel chested and chicken legged due to this. I do this about once every 10 days as it hurts for a while…maybe once every 5 days I will now aim for

Ok so that is working well on my thighs and calves…

BALANCE

For my balance and all my fast twitch reflex muscles I have been balancing on parking chains that span between concrete posts. Usually when I walk along the Harbourside in Bristol City centre as there are a few. Its is not an easy task with a good set of knees, However I did try last month and I was able to stand for about 30 seconds on my post op knee two weeks after I came of crutches. Continued for about another 30 seconds with both feet on the chain then a few more times swapping from leg to leg without stepping off. This is not easy it is similar to a slackline and can spit you on your face or back just as quick. This is the best reason to learn how to balance as it hurts when it goes wrong.

If you try this method for your balance recovery you have to be able to fall off and prevent any shock or trauma to you weak leg, so try on low chains first 6 inches to 12 inches off the ground. It is also great fun, takes a heap of concentration, doesnt cost anything and keeps the inner child in you well and truly alive.

So that is it so far, my quadriceps are filling up and beginning to split into 4, calf muscles are filling out, and balance is returning. I also had a quick roll around the skatepark on a skateboard this week just to see how it felt. Balance and ability still feels intact however I will wait at least 6-8 months and with the surgeons approval before I consider “properly going for a skate”

EXPECT PAIN MILD SWELLING AND ACHES

I am very pleased with the results 5 months post op, however I am still in pain each day and flexion is stopping at 130 degrees I do not do any flexion work at all. I am letting that return when it wants too I believe it will. I am happy with the pain and no longer take painkillers or anti inflamatories. I have been drinking glucosamine sulphate liquid every day 3000mg which is 3 times the normal dose and this seems to have a great effect. When I run out and do not take for 2 days I feel a noticeable difference.

DIET KEEP IT RAW AS POSSIBLE

Finally the biggest single factor that has the greatest effect on my recovery has been my diet. When I stopped making smoothies each morning and eating fresh fruit and veg all day for at least 5 days a week I noticed a big change in my energy levels. I slipped back into a habit of eating bread and cakes and coffee in coffee shops, and eating pizzas occasionally and standard restaurant meals. This has been smashing my energy levels, giving me bloating, gas, and putting fat around my mid rift. Going to turn this around again. In the UK it is difficult to get good organic fruit and veg raw foods when in the middle of the city when the cycling hunger pangs kick in!

Ok that is my recovery so far it ha s been a relatively uneventful,. I have been recently co authoring a book on Graffiti and Street Art Techniques with a friend, hence the time spent eating cakes in coffee shops. These prolonged laptop spells in soggy sofas have been giving me back ache so I have to remind myself to keep moving. The more I move the better me and my knees feel. I am sure you will find this too if you slouch for a long time. The recovery is not work but you have to work through the pain. However  I know from many times before that it does go in the end, and that it is just my knees know have a lot more to talk to me about and this time they have demanded that I listen or they will stop working for good..

OH Just remembered…

Fell off my bike going down hill pretty fast last week 2am Fri night on the way home on a wet road when I turned and then hit an oil patch. I came off at full speed onto my surgery side, received a big graze and bruise on my thigh, cut my knuckles and hand. However knee is still absolutely fine. Hand is sore though. I am more aware of oil patches in the wet now…

 

Knee Recovery week 1-12

This was my Right knee before the Transplant fully bone on bone arthritis.. As you can see in the x rays above they have now managed to create some space between my bone surfaces again, although this is somewhat deceptive as I am standing straight legged which affects the view a bit. But the meniscus which does not show up on xray is definitely creating a space that was not there before. I am going to do everything I can to strengthen this and let it heal as well as possible

As you can see My left knee has 8 screws which are anchors for the 4 main structural ligaments in my knee ACL, PCL MCL Cruciate ligaments and posterolateral quarter ligament,..include torn meniscus that is also beginning to go bone on bone and you have a pretty destroyed knee joint. However I did the injury in one severe hyperextension aged 25 and now aged 40 it still feels good and strong. So if you have torn an ACL or PCL do not worry. So for me God willing I am hoping that when the right knee is recovered hopefully its game on again skateboarding!

 

Week 1

Hospitalised Morphine 4 days intravenous
knee brace 0-90 degrees in bed super painful
catheter following op

vomited 6 times day after surgery
medication after

Week 2 -Week 6

Crutches non weight bearing status brace every day and evening
tubigrip doubled over mid shin to mid thigh

Medication

Tramadol 50mg x2 4 x day
100mg paracetemol x2 4x day
400mg ibuprofen 3x a day.

exercises limited to bending and straightening knee 0-90 with contraction of quads through out the day.

Dressings, Tubigrip full length doubled over

Staples from femoral osteotomy and stitches for keyhole surgery removed on day 10. However wound from osteotemy was not completely healed and needed redressing with steer strips for a further 7 days.

Mild swelling and fluid would accumulate in top of knee capsule ofter quad contraction in extension and in order to bend knee again I would have to massage
fluid manually and push to lower half of knee capsule either side of patella. I could see the fluid move and feel a release which allowed me to bend my knee freely again.

I would experience swelling if I spent too much time during the day walking on crutches. If I slept with my leg raised the swelling would greatly reduce.

Leg (quad and calf ) contractions including walking on crutches with a 5% weight bearing  heel toe strike on the floor (to continue natural walking range of motion)  were the only exercise for 6 weeks.

Other body exercises

I would lean against a wall with my crutches and perform 3 sets 0f 10 reps bent and straight leg raises to my chest to exercise and strengthen my core. However not everyday just when ever I felt strong and full of energy.

Scar tissue.

At week six consultation

4 of 5 entry points into my knee for keyhole surgery had healed well and skin was moving freely over knee. However I entry point on the lateral side where the damaged meniscus was replaced. The scar had fused all the way down to the bone and when my knee would swell would take on the appearance of a “potato eye” This was also painful area and restrictive. I massaged this scar tissue for 7 weeks post up and on approx week 8 I pushed it really hard down towards my foot and I felt it tear and begin to release with bait more of a push with two pop pop it released completely and my skin over my knee has been moving freely since pain free. A very satisfying moment in my recovery.

Week 6 Consultation,

all had healed well weight bearing x rays and concerns from Mr James Robinson Southmead Hospital that he felt that he had over corrected my leg on the ostotemy  in to valgus (bow leg) status by a few too many degrees. He explained the knee was far more damaged than he had expected and wanted to protect the new meniscus transplant by removing the weight/ load forces through the joint as far to the medial compartment as possible. He decided to correct my alignment with a 10mm wedge removed from my femur then plated and screwed. This combined with the new meniscus opening up the joint space somewhat as well has moved my foot approximately 5-5.5 inches over to the left from where it was previously aligned. This has successfully transferred the load bearing well over to the medial side. However he feels the aim to have it through the centre of the knee would be better.

I personally am happy to try for a year and will decide if I experience ankle hip or back pain then I will be prepared to undergo an opening femoral osteotemy with a 5mm wedge to realign my bio mechanics to their optimum. However I feel there is no rush to do this because the longer the meniscal transplant has to heal with a reduced load and force through it is actual y more beneficial. However if upon my return to increased activity I feel pain in other areas this will be essential to re correct my biomechanical alignment.

Week 6 -12 Partial weight bearing 0-90 degree rom in brace

At my physio appointment  I was told to stand with my well leg on the floor and my post op leg on a floor scale and was told to weight bear until I understood what 50% weight bearing felt like. In my case this was 50% my body weight that day 40kg. I discovered I had gained about 3 kilos in 6 weeks from inactivity.

Week 6-9

Knee brace 24 hours a day, taken off when resting on sofas and seats. exercise same as week 0-6 just muscle flexion and contractions.

Scar tissue healing nicely, uneventful period, not much swelling.
week 10- 12 I had a general feeling that I wanted to increase my weight bearing progressively each day so that at week 12 the full weight bearing stage in my recovery it would be a smooth transition to removing the knee brace and crutches and walking without them. This progressive weight bearing was basically walking to the toilet and kitchen at home without crutches.

Week 11

I was walking up and down stairs with a brace but no crutches however walking up felt fine but walking down was not one at a time rather foot to foot, meeting on each step.

Pain has decreased through out this period slightly each day and I had a struggle coming off tramadol at week 8, reduced dose to two a day for about a week then two every other day for about 5 days. Highly physiologically addictive with withdrawal symptoms simulate to other opiates such as heroin and morphine according to the research I read.

The pain in my knee increases if there is swelling after activity of any kind and feels sore all over with sharpness occasionally in the lateral compartment where I had the transplant. This does worry me sometimes however the pain does move location so I think its a general result of the trauma from surgery 5 hrs total rather than any acute knee problem.

Week 12.

Off crutches, knee brace returned to the hospital. range of motion unassisted is approximately 125 degrees with no pain. Now full weight bearing and learning to walk with a correct gait pattern. I feel stiffness in full extension which makes me walk with a slight unevenness not quite a limp.

Week 13-14

walking for 30 minutes twice a day, cycling for 30 minutes every other day, Cycling painful in the upper part of the pedal stroke as knee is bent at 125 degrees and feels stiff, however I feel much stronger the following day so I am continuing. Cycling standing up eg. up hills is still painful and I chooses to lower my  gear ratio and cycle uphill sitting or walking.

Started stair training in the multi story car park 10 flights of stairs (18 steps each flight) walk up stairs 2 seeps at a time 10 flights, take elevator/lift to ground floor then repeat. Managed  to do this 6 times had to stop because my friend Avril kept complaining she was tired. I wanted to do 10 times 100 flights total and I think I could have but she had the car keys so I stopped.. Knee feels ok the day after

Knee surgery…

just returned from Southmead Hospital Bristol after 51/2 hrs of surgical intervention to my right knee.
This was a biological knee resplacement or also known as a meniscus transplant from a donor to the lateral(outside ) compartment of my right knee. I have also had a Femoral Osteotomy, which is the surgeaon breaking the lower half of my right femur bone, removing a wedge and rejoining it with screws and a plate. This will give me a 10 degree correction to my knee and weight bearing correction from the new transplant lateral side to the medial side which has stable healthy meniscus still in tact.Basically my right knee has gone from being slightly knock kneed into a more bandy or bow legged knee. Finally the third part of my surgery was to drill multiple holes through the end of my knee into the bone marrow to release stem cells to the surface where I have worn away all the articular cartilage on my bone ends. Thids is in the how to try and regenerate some meniscus growth on my femoral and tibial bone ends as not to wear out the newly sutured meniscus transplant.

I was in Hospital a total of 5 days on a Morphine PCA drip and I was discharged once i had shown sufficient stability on crutches. The whole experience was a positive one and my spirits feel high and hopeful. The surgeons assistants have visited me and said that the surgery was a complete success on every level. However I have a very slow and painful recovery ahead of me. 6-10 weeks on crutches non weight bearing followed by partial weight bearing for another month, then the beginning of flexion and strengthening exercises to bring my knee and general fitness levels back to and hopefully beyond my preoperative state.

I plan on turning my blog into a recovery diary for this period..

This is a quick video clip of the effects of morphine on a pca drip and having my dressings removed 3 days following surgery..

Knee transplant surgery dates

20th Oct 2011 I will be having meniscus transplant surgery on my right knee courtesy of the National Health.. Pioneering surgery in the Uk by Dr James Robinson Southmead Hospital. He is a long standing reputable knee surgeon and just been trained in this newish technique and I will possibly be his first patient to undergo this surgery..Hopefully happy days to follow as my knee is painful as all hell at the moment..