meniscus surgery - what to expect (Page 3)

Yes I also think trying to more ice for that.

mine was also posterior horn/body of the medial but i do still have all of the rim intact. I think a lot of the issues come from the fact they have to torque the leg a bit to get at the spot to do the trim as all around the lateral side of my knee along the IT band is still pretty bruised and tight feeling which certainly feels ligament stretch type thing.

Currently stretching a bit along with 15-20 mins @ 60-70 rpm zero resistance on the bike along with very shallow wall squats with the gym ball behind my lower back as i need my quad to build back up. This time my VMO survived but VL didnt which is the opposite to first time around!

well i REALLY wish this thread would end for me but alas not. I am now 6 weeks out from my second procedure and walking is still VERY painful most of the time. I have good ROM but still some residual swelling above the knee and one of the portals, the one on the medial side, is giving me grief as there is a ball of something under it thats attatched to a band of something else that sometimes feels good to massage and sometimes feels not good at all, although compared to my main issues thats minor!

It seems that for me trimming the meniscus, twice, has left me far worse of than the pain i was in before at least in terms of basic functioning of the knee. My first tear was very 'ragged' which to me points to wear and tear rather than a trauma and seen as how i am 'only' 36 this wear and tear seems premature to me. According to my 2nd Ortho i have "A natural 5 degree varus, which seems to be mainly due to tibial bowing" which reading between the lines i think means i am a bit 'bow legged' which also i think expains the wear to the meniscus but also more importantly why removing some of it makes the situation worse rather than better.

What to do about it is something i need to discuss with my Ortho as i know my articular surfaces were very good 6 weeks ago but what i have been feeling recently makes me think things have gone south rapidly. Its a bit of a cr*ppy situation to be in but hey we are dealt the cards that we are so if i ever find a reasonable solution to be able to run, or frankly walk pain free again, then i'll say so but the thought of more surgery makes me feel drained right now. I am guessing my options are scaffold/transplant or osteonomy or PKR or a combination of the above, either way seems a long haul!

The last 6 months i feel like i have aged 30 years

does the hardware from the osteotomy not interfere with a later PKR or TKR? Having said that i imagine you can only go from osteotomy to TKR as if it fails the 'other' compartment will be the one to fail and so you end up with no good bits.

i read of people in their 60's who had double TKR's who are hitting singles court tennis like they were in their twenties and makes me think that hey being 36 now in 20 years when hardware advances are even better sure revisions will be even easier. I dont want hardware but this situation cant really go on, i am going to look at MT i think as not sure how a scaffold would hold up to the bowleggedness although that of course depends on the state of the articular surfaces.

Does anyone know if its 'normal' for scars to get more sensitive as 6 weeks out the feeling from the medial portal is just wierd and after significant walking, and pain, the medial jointline is also sort of numb feeling.

Ortho on Monday morning....

No. Osteotomies are not going to interfere with later procedures. Some surgeons take the hardware out as soon as possible, actually. Some say leave it in unless it's an issue or you're having something else done and they can just pull it out then.

Sort of. There are many ways for an osteotomy to fail ;-) If the correction isn't...correct...you could either NOT unload the affected compartment enough, and so not really change anything, or you could over correct too much and damage the other compartment quickly. (Which is why you need to find a surgeon who knows what he's doing when it comes to the procedure...and you need to interview a lot of folks and really know what you're looking for out of it).

Eventually, for many people, the osteotomy "wears out"--or, rather, the unaffected side grinds down enough from bearing all the load. The timeline and prognosis depends on a lot of factors (age, weight, alignment, activity level/load, etc.) and differs for types of osteotomies and all that jazz.

Off the top of my head, the most recent study I read for lateral defect corrections (distal femoral procedures) was something like a survival rate of 80% at 15 years, and then it drops off to about a quarter after 20+. (This, mind you, is for medial closing wedge DFOs. An open wedge can be a bit trickier and can have issues with non-union, etc. I don't think it's been used as much in the past, so there are probably fewer cases to study. Tons of data on HTOs though, if you're poking around. Like I said, it varies... and IIRC, DFOs have a higher survivorship than HTOs, but again...depends on the angle etc. And I'm not looking at any data, just recalling, so grain of salt and all that sheit.)

The goal of the procedure is not to set you up for life, but rather to keep you at (or near) normal levels of activity for another 5-10-20 years, before a replacement is a necessity. And by then, one hopes, technology in joint replacement will be even better. It's also for younger folks, for whom a PKR isn't feasible anyway, as the number of revisions you can do is sort of limited right now.

Some surgeons will combine cartilage work and an osteotomy in one procedure, others won't. (Mine do not--they feel that the body heals better with only one "trauma" to handle at a time. Not that I was a candidate anyway, but if I were, they would have separated them out.)

As far as scarring...I can't tell you what's "normal", since I'm only one person (socks might have a better sample size for you :-)), but most of my scarring is sort of "off". I can get a "zing" if I touch certain areas, but a lot of it never regained full sensation. And yet other parts of the leg are now hypersensitive, compared to t he right leg.

As a nurse need to clarify something RE: Osteotomy...My 21 year old daughter was also slightly "bow legged" and had multiple incidents of her kneecap dislocating until the problem was officially solved with the osteotomy. (Actual medical label for her particular surgery, which may be different somewhat from what you discussed= Fulkerson Osteotomy.

http://www.youtube.com/watch?v=zCMYw6_x_yQ

My daughter, although cured now, was non-weight bearing for 8 weeks. That is obviously not the case for most orthopedic procedures. The amount of rehab required for this is intense. It would have been easier to have a total knee arthroplasty, but it wasn't needed in her situation. I just wanted to show from personal experience that the osteotomy is a huge decision, and rehab although worth it, a big committment...

http://www.webmd.com/osteoarthritis/osteotomy-for-osteoarthritis

re: I guess it depends on the actual location of the osteotomy. I read this about the high tibial osteotomy:

"For medial compartment osteoarthrosis of the knee, closing wedge osteotomy of the tibia, just below the joint surface, is a well-established technique. Alignment of the leg is altered from a 'bow-legged' or varus alignment, aiming for a 'knocked-knee' or accentuated valgus position. The weightbearing forces will preferentially be directed through the preserved lateral compartment.

Pre-requisites for this procedure are complete preservation of the lateral compartment, approximately 25-50% preservation of the medial joint space, intact ligaments. It is quite an involved procedure: the tibia (shinbone) is cut across twice with a saw, after which a wedge of bone is removed. This space is closed by bringing the leg over into the desired position. This is then maintained by a fixation device, usually staples or a plate. The bone then needs to heal, just like a fracture, which takes usually 6-8 weeks. Complications can occur, these can be serious.

Concerns regarding closing wedge osteotomy include the following:

1. The accentuated valgus position is not always well tolerated, both from a functional and from a cosmetic perspective.
2. The lateral compartment is relatively overloaded (full weight through approx 50% of the original weightbearing surface), and is subject to further wear, often within 5-10 years. If the knee becomes painful because of the development of significant arthritis in the lateral compartment, total knee replacement would be the next step.
3. Total knee replacement after high tibial osteotomy, closing wedge, if/when necessary, has proven to be more difficult than a primary total knee replacement, and the results are not as good. The outcome is more like that of a revision of a total knee replacement to another total knee replacement. This is an important consideration when deciding between a unicompartmental (partial) knee replacement and a closing wedge osteotomy in the treatment of medial compartment osteoarthritis of the knee:
   • a) partial knee replacement has a 90-95% probability of good function at 10 years. If conversion to a total knee replacement is needed, this is more involved than a primary knee replacement, but with results very similar to a primary total knee replacement.
   • b) closing wedge osteotomy has a 40-50% probability of good function at 5-8 years. If conversion to total knee replacement is needed, this more like a revision total knee operation, with results inferior to a primary knee replacement.

In my practice, closing wedge osteotomy has not been used in the last 5 years. Osteotomy may be a reasonable option for a patient who cannot accept the restrictions in activity after a unicompartmental knee replacement."

When you were saying "PKR" were you referring to partial knee replacement or partial knee resurfacing ?

regarding 'PKR' i was talking about partial knee replacement however i was looking last night about resurfacing as i know of someone in their 30's who has their hip resurfaced and is doing excellent so i thought something similar might exist for the knee, and seemingly it does.

Seems there options and osteonomy although one of them would not be my first choice, i think i may be a candidate for one of the more 'biological' replacement procedures so thats the avenue i am progressing at this time.

There are tons of different types of osteotomy (between my father and I, we've had four--all in different parts of our bodies)...a fulkerson is just one, as is a lateral, open wedge, DFO. The term itself just means a cutting of bone.

That being said, among knee geeks...UKR/PKR generally stands for partial/unilateral knee replacement.

Then you've got your arthrosurface/hemicap stuff.