Patellofemoral Instability: Part Two

Knee pain, knee problems, pain medications, Patellar Tapping techniques, Physical Therapy...you've done it all just like I have and nothing has worked. So now, your orthopedic surgeon suggests surgery; a surgery called Tibia Tubercle Transfer with a combination of an Osteotomy, and Arthroscopy Surgery. Just hearing the name makes you say "huh?"

Medically speaking, a Tibia Tubercle Transfer, also known as TTT, is when the bony portion underneath the kneecap is cut and moving it or realigning it. Osteotomy is when a bone is cut to change its alignment and an Arthroscopy is when a small incision is made into the skin and your surgeon inserts a very small pencil sized instrument that has a small lens and a light on it so he or she can view, magnify, and light up the joint structures. Having an Arthroscopy is safe. Less than 1% of those those have had an Arthroscopy have ran across complications such as infection, blood clots and nerve damage.

When my orthopedic surgeon suggested the TTT surgery, I was immediately scared. My orthopedic surgeon advised me that the procedure was going to consist of the tibia, the main bone of the lower leg being broken to realign the knee cap and screws are inserted to hold it in place. I personally did not like the breaking leg idea or the screws idea.

My first question was the success rate of having a TTT. The odds were 70% success, which honestly seems pretty good. My next question was what if it doesn't work. The answer was that my condition would be the same as it was before or worse.

Another thing that stuck out in my head is what complications are possible. My orthopedic surgeon advised me that infections and blood clots are possible but are few and far between.

At this point, I was tired of the constant pain so I agreed to the surgery. The week before the surgery I was given my instructions: no alcohol for 24 hours prior to surgery, no food or water after midnight, when showering the night before I was instructed to scrub my bad leg with antibacterial soap and do the same again prior to going into surgery. They also had advised me to pack an overnight bag as well as a baggy pair of sweatpants because I was going to be wearing a bulky brace when leaving the hospital.

When arriving at the hospital the say of your surgery, be prepared to wait about two hours while you're being processed and prepared. You will be asked a lot of family medical history and nurses checking your vital signs. You will also meet with your anesthesiologist, the surgeon assisting your orthopedic surgeon, as well as speaking with your own orthopedic surgeon.

As for the other before surgery processes, you of course receive an IV and a sedative right before they wheel you into he operating room. The sedative put me out like a light. One thing I highly suggest is to use the restroom before you get the IV, because you may have a hard time using the restroom right after surgery.

The TTT surgery took about two hours. That entire day you'll be on an IV, antibiotics, and morphine. The pain is pretty bad, your leg will be elevated and the morphine would only be triggered if you press a button. You can not over dose on it and it will not give you the morphine if you had already pressed the button within a certain time period. About 10 minutes after pressing the morphine button you were out like a light anyway for about 4 hours, at least I was.

For about four hours after you wake up from the surgery, you will be given ice chips to munch on. Since you are given a breathing tube during the surgery your throat will be so unbelievably dry for about two days.

You will not be allowed to leave the bed, so either gets used to using a bed pan or you may have to get a catheter like I had to. A catheter for us females doesn't hurt at all, it just feels awkward.

Your second day at the hospital, your incision will be cleaned, gauze changed and a hinged knee brace put on. Nurses will also get you up out of bed and down to a Physical Therapy session after taking you off of the IV, antibiotics, and morphine.

The Physical Therapy was to teach you home therapy exercises, which are the same as mentioned in my "Part One" of this article. The Physical Therapy exercises for you to do at home are as follows:

Ankle Pumps - Lie down or sit in a chair with your feet on the floor. I suggest lying down for this. You want to point your toes up and then point your toes down. You want to repeat this about ten to twenty times. Make sure you perform with both legs simultaneously.

Glut Sets - Lie flat on your back, keep both legs straight then squeeze your buttocks together as tightly as possible. Hold for about five seconds and repeat in sets of ten.

Quad Sets - Lie down flat with both legs straight. Tighten your thigh by pushing the back of your knee to the ground. Hold for about five seconds and then relax for a few seconds. Repeat this set about ten times.

Heel Slides - Lie down on your back and slide your heel towards our butt and make sure you keep your foot on the floor, bed or couch. The more you bend the better. Repeat this in sets of ten or more.

5. Straight Leg Raises - Lying down with one knee bent at 90 degrees, lift your straight leg upwards till it's even with the height of your opposite knee. Repeat this about ten or twenty times then switch legs.

The Physical Therapy will also teach you how to use a walker and how to use crutches to get up and down stairs. Personally, crutches did not work for me. I'm 5 foot 3 and weight 10 pounds and it was very difficult to hop the stairs. During the therapy I accidentally douched my foot down and the pain was so bad I think my scream woke up the entire hospital. So you want to be very, very careful.

When you are released form the hospital they gave me gauze, saline solution, and tape to change the dressings as well as a prescription for vicodin. There will be no weight bearing on the leg at all, you'll need help going up or down stairs, and you're not allowed to drive and you have to sponge bathe only.

Caring for your wound isn't hard at all, change the dressings daily and pat wish a wash cloth dipped in the saline solution and apply the dry sterile dressings. The brace has to be worn at all times and you do not want to apply any lotions, creams, ointments, or powders to your incision area. Doing this will increase your chance of infection.

I highly suggest that you have someone strong enough to lift you and ore help you maneuver after leaving the hospital to get you settled in comfortably at home. Since your going to be bed bound for a good while, you may want to make your life and your loved ones life easier by investing in a cheap mini-fridge by your bed. Make sure that you remove any loose carpeting, throw rugs, and electrical chords so you do not trip and fall.

I was given vicodin for the pain, and I can tell you that you will be taking it a lot for the first two weeks. My doctor suggested taking Ibuprofen in between vicodin doses. Personally the Ibuprofen didn't work at all , but everyone is different. With all of the medication that has been put into your body you may want to also get ex-lax. Your body, well at least mine, had a hard time working properly in that area. I also noticed that I had a very hard time concentrating and or focusing on anything for a good three weeks.

Prior to the surgery make sure that you ask all the right questions. My doctor did not tell me that the incision that was made cut the nerve that ran across my leg causing a very large area of my leg to become numb. My orthopedic surgeon advised me that the numb feeling would lessen with time but there is no way to repair cut nerves. Of course I was not happy to hear that, but was assured by a few of my friends that have had nerves cut before that they have grown back for them in about a year, but again everyone is different.

Keep your legs elevated at all times, doing this makes your leg a lot more comfortable but you r food does fall asleep a lot. Speaking of sleeping, you have to sleep on your back. If you have problems sleeping on your back then, like me, your gong to really have a hard time sleeping for the first month.

Two weeks after your surgery your follow up appointment will consist of getting the staples out, x-rays, and your orthopedic surgeon checking your range of motion. Getting your staples out doesn't hurt, it just pinches a lot. They don't numb you and by this time the staples are already working their own way out.

At one month after your surgery your orthopedic surgeon will giver you a prescription to start Physical Therapy and start becoming more active and gradually adding weight on the leg.

So this is exactly where I am at now. Four weeks after the surgery I am able to bend my knee 30 degrees and the pain had gone down a lot. And most of all, my knee is bending normally on track!

This is going to be a long recovery process and everyone out there should be aware of everything and be properly prepared. This surgery is something that will change your life forever and I wish everyone the best of luck and urge anyone to contact me if you have any questions.

I am not an orthopedic surgeon, just a victim of severe knee problems and a patient of TTT surgery.

Physical Therapy is right around the corner!

For everyone out there considering this procedure, consult your orthopedic surgeon and research and prepare yourself. I wish you all the best of luck!