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Knee & Hip Problems Message Board


Knee & Hip Problems Board Index


Hello,

I am a 40 year old female,and have had 4 knee surgeries in the past 16 months. The first was in January 2009, for a meniscus tear, and a little buckle of synovitis. Should have been pretty straight forward...right? No so much. After that surgery, my knee kept swelling, and continued pain. My surgeon told me I must be getting old (was only 39 at the time), and sent me to a rheumatologist for evaluation. Many, many blood tests were done, and nothing found by her. However, she felt I needed another scope on my knee, and after my refusal to see the same surgeon, she recommended a surgeon who runs a knee institute about 45 mins away. I had my 2nd scope in November 2009, and he found very extensive synovitis, and a plica. He removed both. The swelling and extreme pain continued, and fluid was removed from my knee 9 times from November to April. MRI, CT scan, and xrays revealed a kneecap tracking problem, lots of scar tissue, and worsening arthritis. Another scope was performed in early April, lateral release performed, and scar tissue was removed. I had scar tissue all over my knee, all the way to the tibia. When I woke from that surgery, the pain seemed extreme, but I thought I just did not understand how bad it would be, so I tried to muscle through. 6 days after surgery, my knee was about 3x's the size of the other, I was bruised all the way to my hip, and the pain was so bad, I could not move my ankle, stand, or walk to the bathroom without help, and bursting into tears. Now, I will tell you, I have battled advanced cancer, multiple surgeries associated with the cancer, so I am no wimp...at all. This was the worst pain I have ever experienced in my life. I called the surgeon, and when he looked at my knee, he immediately admitted me to the hospital, and had to perform emergency surgery for a large hematoma in my knee joint. It took him over two hours to remove the blood clot, and I was in the hospital for a few days with a drain in my knee. Since that time (April 17th), I have had blood and fluid aspirated from my knee twice, and the knee is still terribly swollen, has more fluid in it, I cannot bend it past about 60 degrees, and I have horrible sharp pains in it all of the time. This is truly a nightmare! I just do not understand, and nobody seems to have a good answer for the complications I have experienced with this knee. I am afraid the scar tissue is back. The top of my knee (above the kneecap) is thickened, and is a good part of the reason I physically cannot bend it (it will not bend). Besides the horrific pain when I try to bend my knee, it feels like something is blocking it from bending. I am afraid he will need to remove more scar tissue surgically, and I am afraid to have it operated on again, based on my past experiences. I am at the end of my rope here, and would like to know if anyone else has experience this, or the complications I have had? I am told that based on the complications, and having two surgeries on my knee within a week, I can expect to have a very long, hard recovery and rehab on my knee. The surgeon said it may be 6 months to a year before we even know if the surgery was a success. I have been on disability since November, and am not released back until at least mid July. I literally sit in a recliner all day, every day. The only time I leave the house (with my walker) is to go to the doctor, or PT. My physical therapist cannot get my knee to bend either, and she typically makes me cry trying to bend it. I have had a CPM machine, cold-compression machine, I have a home e-stim unit for quad shutdown, and I ice and elevate my knee constantly. Someone, please tell me you have experienced this, and it all turned out ok. I really need to hear from people who have gone through this.
Hi Jenny,

I am glad you are seeing the PA next week. If you have an infection, it needs to be treated as soon as possible; that is nothing to mess around with. I really love both PA's at my ortho's office. I actually told him how wonderful they are when I was there on Tuesday, and he was so pleased to hear such great feedback. I am completely comfortable with them both, and have total confidence in their ability to diagnose and assist with my knee issues.

I have had increased pain and stiffness since my knee was aspirated. This always happens when my knee is drained, and my ortho wants me completely off of it for about 48 hrs after an aspiration. My knee just is not handling anything very well, including aspiration. I have sharp pains in it today, which really stinks. The pain is on the lateral side, where they did the release, and it even hurts to put minimal weight on it. I talked with my PT yesterday, letting her know he wants some changes in the approach to my therapy. She was very receptive, and is going to call his office to see if he thinks laser light therapy might be beneficial. I guess a lot of research is pointing to laser light therapy helping with pain and swelling, so we will see. She said she has only worked with one other patient in her career that has had a knee like mine, and it took a very, very long time to get things to an acceptable level of pain and swelling. She noted that the patient ended up having a total knee, but had more complications, and is now pretty much immobile. I am praying things turn around soon. As it is, the fluid he removed on Tuesday is already coming back, which is what always happens. I just do not understand why my knee is so reactive to everything we try to do to help it?

Thank you so much for asking about my husband. His tendons were reattached sucessfully on Saturday. It was a very long day at the hospital; we were there over six hours. His surgeon was the only doctor doing surgery on Saturday, but it just seemed to drag on all day. We were both ready to go home, and my knee really took a bad turn with all the sitting around. I just wanted to get home, put up my knee, and pack it in ice. My husband has a splint and big bulky cast on his hand, to prevent him from moving his thumb. He went to work the next day (against my better judgement), but he is a trooper. He is a roofing contractor, and self-employed. If he does not work, he does not get paid. I worry about him up on a roof right now, with limited use of one hand, but he is determined to work. My husband does have rheumatoid arthritis (was diagnosed about 2 years ago), so he has a lot of off and on issues with that. He follows up with the surgeon on Tuesday, but he was told it would take 6-8 weeks for the tendons to scar over, and if he did too much bending of his thumb, he could re-break the tendons. They really do have it totally immobilized, so he cannot bend the thumb at all.

Looking forward to hearing how your ortho appt goes next week. I am very interested to hear what they figured out is going on with your knees. Do they still have blood/fluid in them both?

All my best.
Hi Jenny,

Good research work on your knee! I have also done investigation into my continued complications, but have not really turned up anything concrete. I agree that someone needs to do something for you, even it is a big surgery (or series of surgeries). At this point, you are having problems doing the things you want to do anyway, so recovering from surgery should be a breeze compared to your current struggles. I hope your surgeon gets ahold of you first thing next week, and you can share with him/her what your discovered in your research. I hope you have a good surgeon who does not bristle up when you make suggestions? I prefer doctors who realize they do not have all the answers, and some help from patients and other doctors is sometimes needed to figure out tough cases like yours and mine.

I am not really sure what type of hummingbirds we have here. The males have bright green bodies (not sure about the red on them), and the females are much more muted in color. It was such an awesome experience to have one hover by my face like that.

I wanted to ask you if you have ever had light therapy in PT for your knee? My PT is grasping at straws at this point, and tried it yesterday for the first time. My knee does not seem to be handling anything very well, and has become the subject of awe and confusion amongst the PT's. They can actually watch it swell during gentle PT? I think yesterday was one of the worst days in therapy I have ever had (and that is saying a lot). We did not do anything major (some gentle soft tissue massage, assisted straight leg raises, very gentle bending since I still have very limited ROM, and light therapy). About three straight leg raises in, I began getting terrible sharp pains below and on the lateral side of my knee, so we stopped with those. She then started the light therapy (should not be a big deal, just some infrared light on a wand), and when she lightly touched an area on the lateral side, it sent a deep, sharp pain straight through my knee. It felt like my knee and bone ached for several minutes afterward, and my knee has been horrible ever since. I cannot even lightly touch that area now; it feels like when I broke a bone a few years ago. That achy, sensitive bone contusion feeling is in my knee. To make matters worse, when I try to walk, it feels like something is trying to snap in that area. I am concerned, since it is around the area where the drain was in my knee, and the lateral release was done. Any ideas what could be going on at this stage? I am afraid if it snaps something in there, the bleeding will begin again. I am truly at the end of my rope. I walk on the outside of my foot, and hobble around like bambi. Any ideas you could offer would be truly appreciated.

It is warm here today, and my mom went to the local farmer's market and brought me locally grown strawberries. They are so delicious, it is like eating candy....yummy! There really is nothing like local produce when it is in season.

All my best to you.
Hello Pauline,

I have not had a TKR yet. I am going to copy a bit of what I originally posted about what is going on with my kneee. I have had 4 knee surgeries in the past 16 months. The first was in January 2009, for a meniscus tear, and a little buckle of synovitis. Should have been pretty straight forward...right? No so much. After that surgery, my knee kept swelling, and continued pain. My surgeon told me I must be getting old (was only 39 at the time), and sent me to a rheumatologist for evaluation. Many, many blood tests were done, and nothing found by her. However, she felt I needed another scope on my knee, and after my refusal to see the same surgeon, she recommended a surgeon who runs a knee institute about 45 mins away. I had my 2nd scope in November 2009, and he found very extensive synovitis, and a plica. He removed both. The swelling and extreme pain continued, and fluid was removed from my knee 9 times from November to April. MRI, CT scan, and xrays revealed a kneecap tracking problem, lots of scar tissue, and worsening arthritis. Another scope was performed in early April, lateral release performed, and scar tissue was removed. I had scar tissue all over my knee, all the way to the tibia. When I woke from that surgery, the pain seemed extreme, but I thought I just did not understand how bad it would be, so I tried to muscle through. 6 days after surgery, my knee was about 3x's the size of the other, I was bruised all the way to my hip, and the pain was so bad, I could not move my ankle, stand, or walk to the bathroom without help, and bursting into tears. Now, I will tell you, I have battled advanced cancer, multiple surgeries associated with the cancer, so I am no wimp...at all. This was the worst pain I have ever experienced in my life. I called the surgeon, and when he looked at my knee, he immediately admitted me to the hospital, and had to perform emergency surgery for a large hematoma in my knee joint. It took him over two hours to remove the blood clot, and I was in the hospital for a few days with a drain in my knee. Since that time (April 17th), I have had blood and fluid aspirated from my knee three times, and the knee is still terribly swollen, has more fluid in it, I cannot bend it past about 90 degrees, despite the extensive efforts in PT, and I have horrible sharp pains in it all of the time. It appears the scar tissue is back, and is wreaking havoc in my knee. The top of my knee (above the kneecap) is thickened, and is a good part of the reason I physically cannot bend it (it will not bend). Besides the horrific pain when I try to bend my knee, it feels like something is blocking it from bending. I have a large palpable band of hard scar tissue on the lateral side, and one of the scars on the medial side, as well as the drain scar on the lateral side are both sunk in, and alternate between throbbing and having sharp pains all day long.

When I first wake in the morning, I have a small window of time to do a couple of things before the swelling sets back in. By early afternoon, I cannot even put weight on my knee, and the swelling is extreme. When my knee is measured and compared to the good one, it is around 2 1/2 inches larger from my upper leg to just below my knee. In addition, my lower leg, ankle, and foot swell daily in response to the knee swelling.

I have my doubts about whether or not the manipulation will work, since my scarring may be deep in the knee, and he may be unable to break it up this way. My knee is so touchy, my PT really has not been able to do much to it at all during therapy. Even light soft tissue massage causes it to swell. The surgeon took me out of PT until after the manipulation, since it seems to making matters worse. The surgeon said that the more the swelling is down during the manipulation, the better, but that will be impossible. Just getting ready to go to the hospital, driving there, and walking in will cause the swelling to shoot out of control.

I am keeping my fingers crossed, but have a feeling he will need to go back in to correct the situation. I think that the complications I experienced after surgery, and subsequent inability to start PT right away let the scar tissue take hold again. After he removed the hematoma, I was not cleared for PT for about three weeks, because the swelling was so bad, it was tearing the drain hole open in my knee, and would not stop bleeding for about 2 1/2 weeks. I think that was enough to set things in motion with the scarring again. In response to the scar tissue problems, I feel like the synovitis is back again too, and I wonder if the manipulation will make that worse. The synovitis will likely need to be cut out again, as it would not correct itself in the past.

I understand what you mean about wanting so badly to do the things you enjoy. I cannot do anything I want without extreme pain, and swelling, so I sit here feeling depressed. Having joint issues like this is certainly a quality-of-life issue, and we all went through surgery (or mulitple surgeries in most cases) in an effort to gain our quality-of-life back again. It is terribly frustrating when the surgery is not successful.

Keep your chin up, and keep me posted on your progress. If you need a manipulation too, we can compare notes.

All my best,
VeryD.
I have not posted an update in a while, mostly because nothing has changed, except my level of frustration. Since my last post, I had the MUA, which helped, then I lost ROM, but have gained some back again. My kneecap is subluxing regularly now, catching, still swelling every single day, and the pain is terrible. I had a new MRI, and it showed that all the same issues were there from the time prior to the lateral release, but now I also have a bone contusion. After the MRI, my OS wanted a bone scan, so I had that done this week. X-rays indicate that my bone is thinning from the constant pain, and inability to put weight on it for such an extended period of time. The radiologist told me the whole knee was lit up, but something is wrong with my patella. He said it is “intensely abnormal”, and a “process”is happening. My patella was called a “hot spot” on bone scan. They could also see the bone bruise, and a spot in the soft tissue on the lateral side had increased uptake (likely the area of the lateral release). The lateral release seems to have shifted the tilt to a medial tilt, so it just reversed the problems. I think my current OS is a bit confused on what to do now to help me, and wants to scope the knee yet again to clean it up and evaluate it.

I had an appt yesterday with a patella-femoral specialist (big name mentioned on various sites) for a second opinion. It did not take him long after reviewing my piles of data and films to discover the problems with my patella instability, which has caused chronic patellar subluxation. He noted that the lateral-release made matters much worse, and should not have been performed as a stand-alone procedure for patella instability issues. My kneecaps have been the source of all this (and I already knew that), but may not have been dealt with appropriately. I have tracking issues, a terrible Q –angle, patella alta, etc. He said the 4 scopes (with varying procedures) over the past two years have caused my knee condition now to be a "great big mess". He wants to scope the knee, clean out all of the extensive scar tissue, repair the lateral release, medial soft tissue repair, then open the knee and do a tibia tubercle transfer. I am so confused now, and do not know what to do? I see my original surgeon next Tuesday for his plan, now that the bone scan is complete, and I am interested to see how his opinion for treatment differs from the patella specialist. The new doc can do this surgery on September 27, and expects I will return to work in 6-8 weeks afterward, which would be a blessing, since I have been on disability since last November.

How can two good, experienced surgeon be worlds apart on treatment?

He mentioned me having a femoral nerve block and general anesthesia, which is good, but I have never had a femoral nerve block before. Can anyone tell me what it is like? Does it get rid of ALL the post-op pain, or were other methods of pain relief needed in addition to the block? He said it could provide pain relief for up to 24 hours. Any information on this is appreciated.
Hey kiddo...I've been wondering what happened to you and your knee. Hate to say it but I seem to recall I said that you needed to go elsewhere...that someone screwed up.

I had a tibial tubercle transfer done way back in 1970 for lateral tracking. It was the first treatment for it and now has become the fall back for major problems. They cut out the entire area of bone from the area below the knee where the patellar tendon attaches and they move it over a centimeter or 2. They make a wedge cut so they just slide it over. It is sometimes done along with the lateral release in bad cases and I think that is what the new doc was saying...you should have had the combo surgery right from the beginning. Because I only had the one...the TTT, I also did not do well...I needed the combo too but the lateral release had not yet been invented and that is why my knee went downhill so fast after surgery. It's like we each got half of what we needed.

From what you said about the test results, you kneecap has lit up like a firecracker and that means it's falling apart. You'll have no kneecap if they don't fix it. The lateral release made it worse, just like the TTT did for me. Some of us need both....a total approach.

So see what your doc has to say but be aware that the specialist is saying he screwed up and failing to fix his mistake is what has kept you in so much pain and is destroying your knee.

I'm so sorry it has come down to this. More surgery. But you might want to even consider one more doc...a knee specialist who works at a major medical center on knee reconstruction. Since the second doc specializes in knee caps(essentially)you would expect him to come up with a kneecap correction for the problem. But my concern would be that you have endured so much that the rest of your knee joint may now be compromised and asking for a full evaluation of the joint might be the last step before you sign on to more surgery. But if you are comfortable with this guy, then do the TTT. I really do think ortho #1 did mess up...your knee tells me so.

So sorry you've had to go through all this.

giant gentle hugs............Jenny
Hi Jenny,

It is so great to hear from you, and I pray you are doing well? What has been happening with you?

I am sorry I dropped off the board for a while, but I did not have much to report, as I was going through more tests again, and waiting for results.

I have known all along that my issues did derive my patella, everyone knows, and I was led to believe that the lateral release would be the golden ticket to the relief I need. If my thoughts were amplified while I walk, with every step you would hear me say "ouch! ouch! ouch!" Everything has always been focused on my patella, as it should be. I had to grab the films from my bone scan, and my patella took up so much dye in one pic, that it is completely see-through on the film. It was so lit up, a couple of the other radiologists came in the room and were staring at my scan. My current OS was trying to rule out osteonecrosis, which the bone scan did. He wants to scope it again (he already told me that prior to the bone scan), and clean out the scar tissue. I am terrified to let him do that, as I just do not think it will be enough to offer me any real relief. Since my lateral release, you can push my kneecap all the way to the outside of my knee, it is so lax. This shifting has now caused medial side problems, and the new doc said my kneecap is now tilted medially. I have been a very compliant patient through all of this, but when the doc wanted to start trying the same things over again, that have not helped in the least in the past, I had to tell him I would not do it. I will be interested to hear what he has to say on Tuesday, and how it compares to what the other OS said. I am very confused and cautious about all of this. I am not convinced I will have the surgery yet, as I am scared of more issues. The new doc did say that since my knee is such a mess, and the bone is now turning over so fast and thinned, it may take longer to heal than normal.

Did you have a femoral block with any of your surgeries?


VeryD.
Hi V...thought it might be partial re-construction. I had both my kneecaps "capped" when the joints were replaced...had a polyethylene disk put on the back as there wasn't much left to them. Osteonecrosis is when the blood supply is lost and they may not be able to determine that until they get in there. I flirted with that at one time too. Was off my feet for weeks trying to get the blood supply re-established. Managed to keep the joints going for another 4 years but the destruction really speed up. You know how in the x-rays you can see that notch in the femur where the ACL is? By the time I had the replacements done, I had worn off so much bone that notch was flat against the tibia.

I think this new doc needs to go in and rebuild what needs to be re-built. If the lateral release only made the patella looser, then it's been running over the top of your knee joint like a clove of garlic over a grater. But in this case, the grater(your knee) may have suffered too. And your patella is mush.

I'd leave it to the new doc. And I have reason for saying this. Orthos are a pretty close knit group and they never criticize each others work. I had one absolutely butcher one surgery and the next doc fixed it but never spoke badly about this other guy or his work despite the amount of work he had to do to fix my knee. This new guy has said it was done wrong and that is really not something I'd expect anyone to say unless it really has been messed up. The fact that he would say anything means it was worse than you know. That is really not done in ortho circles. They all know each other.

Let me know what the first doc says..if he says anything thing about his work messing it all up. A good doc admits his mistakes. A bad doc keeps trying and trying to fix it without ever admitting he did something wrong or is in over his head.

Let your very intelligent and astute brain lead you on this one.

Back blew up again Friday AM.....bladder and bowels stopped working again. Seeing new neuro on Tuesday. Hey doctors.....I'd really like to take a dump....would someone please fix this???? Please????? I'd like to pee too!!!!

Just how long do I have to wait?

hugs..............Jen
Hi Jenny,

I sure hope you can get in touch with your neuro today, as it sounds like you were suffering some pretty severe issues over the weekend. Losing the ability to use the restroom must be just terrible, and I hope they can get to the bottom of this (I just made a little joke) :) Seriously though, has this happened to you in the past with your back problems, or is it in response to medication?

I agree about the close-knit ortho theory. I have had difficulties with this myself. After my first surgery with a local surgeon (who I did not like at all), I wanted to see a different ortho in the area, but none of them would touch a patient that another ortho already did surgery on. In addition, I was told that all the orthos in the immediate area trained under each other, and think exactly the same as each other. I ended up having to leave the area totally via a recommendation from the rheumatologist, which is how I found my current doc. When I bled into the joint after the lateral release, and my current doc's PA thought I might have a septic joint, she advised me by phone to go to the nearest ER, which I did. When I arrived at my local ER (not the hospital my current OS is affiliated with), none of the orthos would even attempt to drain it for me, since it was not their knee. In addition, my OS did not want them to touch it, and I had to wait to see him in the morning. I was immediately admitted to the hospital, and he had to perform emergency surgery to get the hematoma out of my joint. I was in more pain than I have ever experienced in my entire life, and due to ortho crap, had to wait until the following day to have that emergency taken care of. I was very surprised when the new doc said he knew my current OS, and sounded like he liked him, but them went on to make unfavorable comments about the decisions he made regarding my care.





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