TTT

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Topic Title: TTT
Created On: 11/04/2004 11:29 AM

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 11/15/2004 09:49 AM

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LAF

Posts: 26

Part two & a half I had an open lateral retinacular release (LR), arthroscopy and typical tibial tubercle transfer as a single operation Monday May 1 2000. Patella tendon moved 14mm, two stainless steel screws to secure, which are still in today. This was my first actual knee surgery, but I had had recurrent kneecap dislocations since 5 years old (with immobilisers, crutches, physio etc). I turned 29 six weeks before surgery. Prior to surgery: I had severely dislocated my left kneecay 21 August 1999, dislocated to top of my calf muscle at back of my leg, out for about 45 minutes. This was 8 1/2 months before surgery. Was bandaged, immobilised, used crutches, unable to weight bear... Immobiliser was from top of thigh to mid shin "Richard's Splint" type, did not allow any knee movement. 8 September 1999, 2 1/2 weeks post dislocation, 8 months before surgery, two blood clots (DVT - Deep Vein Thromboses) were confirmed in my left calf. DVTs still not resolved by 15 September 1999 (3 1/2 weeks post dislocation) so told to put full weight through leg as soon as possible, still wearing immobiliser. Hobbled without crutches with immobiliser 17 September, 4 weeks post dislocation, 7 1/2 months before surgery. Immobiliser removed 28 October 1999 (10 weeks after dislocation, 6 months before surgery). Still had support bandaging (and tubi-grips??) Started physio 5 November 1999 (11 weeks after dislocation, 6 months before surgery). Did a single day of work, light duties & still unable to drive manual car, 9 February 2000 (5 1/2 months post dislocation, 3 1/2 months before surgery) Resumed part time working with young children 7 March 2000 (6 1/2 months after dislocation, 2 1/2 months before surgery). Resumed full time work 5 April 2000 (7 1/2 months after dislocation, 8 weeks before surgery).
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 11/15/2004 09:39 AM

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LAF

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Part 4: E-mail me if you want to know more about physio and exercises. Try & imagine what it will be like to live in your current home on crutches. Especially consider how you are going to shower etc (I borrowed two plastic chairs, one for me to sit on and one to prop my leg on). Also consider going to toilet - it's convenient to have a crate or box about the height of the toilet seat to rest your leg on, if there's not much room, and you have normal (not elbow) crutches, you can turn one crutch upside-down and put your foot on the bottom of the handle (sticking through the crutch) - so long as your foot is not too wide. This is great too if you have to sit in waiting rooms etc. For your normal chairs at home, work out how you can elevate your leg, what you can use. Find or make a box to cover over your leg so your bedlinen doesn't weigh down on your knee, you may not need it, but it's a lot easier to make before you're on crutches. Work out how you are going to turn the light off and make it into bed without falling over (eg use touch lamps, find a torch you can carry on crutches, clear a wide path to your bed...). Prepare some meals in advance & freeze them. Organise someone to shop for you or stay with you initially if possible. Make sure you have all phone numbers easily accessible. Make sure you have painkillers or whatever - get whoever takes you home from hospital to get them for you. Make sure you have ice-packs etc. Try and be prepared as much as you can - it makes a big difference. Trust this is helpful, Liana. Feel free to e-mail me.
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 11/15/2004 09:38 AM

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LAF

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Part Three: SURGERY: Had pre-admission appointment Tuesday 11 April - 3 weeks before surgery. Initial paperwork, general information, preparation for surgery info (fasting, not use deodorant day of surgery etc). Fast Sunday April 30/ Monday May 1. Think was no food from Sunday evening and no water from Monday morning. Monday 1 May - day of surgery. Arrived about 8am. Completed final paperwork, changed into hospital gown, shaved leg over knee area, drew a large red cross on my left thigh (instructed by nurse - to ensure they operate on correct leg!!). I chose not to take pre-op sedative. Had general anaesthetic (needle) in crook of elbow. Operated on late afternoon. Woke with: - drip in back of left hand; - pethadeine infusion pump (Patient Controlled Analgesia - press to deliver metered dose into drip, locks out if pressed too frequently); - leg hugely bandaged 3x normal diameter; - immobiliser over huge bandaging; - call bell buzzer (to signal nurse if nec); - drain tube in thigh near knee with round flat vacuum flask attached, with drained bloody fluid. (Drain leaves small circular scar similar to arthroscopy scars.) Think my leg was elevated on pillows and had a box over my knee so bed linen didn't add pressure. I did not have my leg in traction or on a passive motion machine. I only slept for about 15 minutes at a time, mostly because unfamiliar environment, nurses do regular obs (initially every 20 minutes?), and noise from nearby babies' ward. I did not take any painkillers that night. I kept absolutely still to minimise pain to leg. Morning after operation, Tuesday 2 May, I wanted to go to toilet and not use a bed pan. I took pethadeine before preparing to move. I was helped to transfer into a wheelchair. I felt nauseous and asked for a basin. The drain bottle (inserted into my thigh) was propped on my lap, a nurse transferred the drip bag to a mobile drip stand, the nurse pushed the drip stand to outside the toilet cubicle while I wheeled the wheelchair. I vomited before I got to the toilet, and again afterwards (dry reach because had not eaten since fasting). Nausea from pethadeine. Went to toilet, helped back into bed. Vomited again. I was given Maxalon (?) to stop vomiting (think directly into drip). Stopped me vomiting but I did not take any more pethadeine because I was too apprehensive about being nauseous (whole body moves when vomit, so it hurts your leg more too). Think I had drip and drain removed midday (1 day post op), may have been following day. Later in the day (2 May 1999, 1 day post op) they took x-rays of my leg to check position of screws etc. I put some weight (10%?) through my leg with pain, with leg in immobiliser and using crutches, day after op (Tuesday afternoon 1 May). I left hospital midday Wednesday (2 days post op). Still very dependent on others (meals, cleaning, showers, transport etc). Had near-faint ("pre-syncope secondary to pain") Saturday 6 May 2000 (5 days post op). Because of previous DVTs I was instructed to put as much weight through my leg as I could tolerate (told day after surgery). I had got up late that morning and had not yet taken any painkillers that day (just got up) had been putting weight through my leg - still using crutches and leg still immobilised, and nearly collapsed. Felt faint, eyes light sensitive, vision severely distorted/ hallucinated, sense of panic... Back to hospital (different hospital) but not admitted, was just my body wanting to faint because of pain. Had stitches out Thursday 11 May (10 days post op). Scar about 12cm (5&half") long. Stopped using crutches Monday 15 May 2000 (2 weeks post op), still had immobiliser all the time, inclulding when sleeping etc. Because of set up of our bathroom, I still couldn't shower by myself (couldn't turn taps on or off), still couldn't drive, long way off from working, but could do most other things. Stopped taking painkillers altogether Tuesday 16 May (2 weeks post op). Had been taking Panadeine Forte (5ppmg codeine, 500mg paracetamol) at maximum dosage of 8 per day. I stopped gradually (not want repeat of pre-syncope). Started physiotherapy Monday 29 May (4 weeks post op). New x-rays taken Friday 9 June (6 weeks post op) and follow-up appointment with surgeon same day. Check screw position and bone uniting. Hard to tell about tracking properly because leg still very stiff - can not bend 90 degrees. Still in brace most of time, able to stop wearing for sleep. Didn't record when I stopped wearing brace altogether, think end of July so about 12 weeks post op, may have been earlier. Resumed work Monday 21 August (16 weeks or 3 1/2 months post op).
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 11/15/2004 09:35 AM

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LAF

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Part two: I'm not familiar with the procedure you have already had, or the specifics of your knee pathology, but I offer the following as a general guideline for TTT operations for recurrent kneecap dislocations, and offer my own experience. Most people seem to have very good outcomes with the TTT - ie no further dislocations. Most people can do strenuous activity long term after the TTT. I did have a major dislocation 2 and a half years post TTT surgery, and did have to change to more sedentary work. Long term returning to work depends on your knees, but even if you do experience problems post surgery, you may be able to minimise those problems by wearing a flexible knee support (e-mail if you want info on available types etc). The surgery itself shouldn't hinder your work after the initial rehabilitation period. Most people experience difficulty kneeling post surgery, often long term. Removal of the screws usually helps, screws may also be removed because of unusual sensations or bruise pain at the screw sites. Surgery may increase risk of arthritis long term, but the dislocations can too. Dislocations also can cause cartillage damage which can be very painful and difficult to manage long term.
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 11/15/2004 09:33 AM

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LAF

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Hi, I'll try sending in bits. Part one: I'm not familiar with the procedure you have already had, or the specifics of your knee pathology, but I offer the following as a general guideline for TTT operations for recurrent kneecap dislocations, and offer my own experience. Most people seem to have very good outcomes with the TTT - ie no further dislocations. Most people can do strenuous activity long term after the TTT. I did have a major dislocation 2 and a half years post TTT surgery, and did have to change to more sedentary work. Long term returning to work depends on your knees, but even if you do experience problems post surgery, you may be able to minimise those problems by wearing a flexible knee support (e-mail if you want info on available types etc). The surgery itself shouldn't hinder your work after the initial rehabilitation period. Most people experience difficulty kneeling post surgery, often long term. Removal of the screws usually helps, screws may also be removed because of unusual sensations or bruise pain at the screw sites. Surgery may increase risk of arthritis long term, but the dislocations can too. Dislocations also can cause cartillage damage which can be very painful and difficult to manage long term.
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 11/15/2004 09:31 AM

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LAF

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Hi, I've tried to post whole message to you by cutting and pasting in, but it would not properly send. I then re-typed about 5 pages of text and got same error message and can not face typing it all out again. Very frustrating... I have had this kind of posting error come up before, advised the site administrator and had no response, I will advise again but won't hold my breath. If you wish to leave an e-mail address I will e-mail you the info (assume will e-mail okay). I'm sure you will find the info helpful if I can get it to you. Sorry, Liana.
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 11/04/2004 11:29 AM

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capesy96

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I have had so many dislocations of my right knee it is impossible to count. I had a capsualorophy (think that's spelt right), March 2002, which involved tightening the ligaments around my patella. This gave me some relief for around one year, until I slipped on a wet floor and my knee gradually returned to it's usually state! Am now schedualed for a Tibial tuberosity transfer on the 31st of December of all days and am scared! I am a qualified nurse of one year, wondering if my knee will recover enough for me to work again long term. I'm only 22! Anyone who can give me any info, would be greatly appriciated!
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