Yesterday, I went for my 10 day appointment. The nurse took out my sutures-which hurt a bit-but not badly! Sylvia, who is Dr. Gillogly's assistant, seems to be a pro at removing them. Dr. Gillogly has fellows working for him. Dr. Shue has been his fellow since I have been going to that office and for both surgeries. She assisted on both surgeries, although he said that fellows do not do the ACI's, only him. She probably did some of my osteotomy this last time though. She is finishing her fellowship and will work for Kaiser here in Atlanta, where they are starting an Orho program (or an enhanced one-something is new about it) and she seems excellent. I was sorry to say goodbye to her because she always comes by during PT and seems very smart and is also warm and friendly.
They confirmed that it is fine for me to do the high degree of range of motion on the CPM machine-no risks for to the patella graft. They explained why, but I don't clearly remember the details-it related to where the graft is.They recommended I continue on the CPM for 4 hours a day. I already have max ROM, but it is good for scar tissue and also, there is a belief (per Dr. Gillogly and I also read this) that the cells learn from the CPM movement, where the cells should settle to accommodate bending and normal movement of the knee. This is a theory that I don't think they know the exact reason for. I can use the brace at home, but don't always have to. I do not have to sleep in it, although I can if I toss and turn alot. The movement I must avoid is going from a bent to a straight knee. For example, if I am sitting with my leg dangling and then straighten my leg. I must use my other leg to straighten it, but coming under the leg and using it as a support. The brace can be uncomfortable and so I will use it less, although I am nervous about inadvertently twisting or unbending, so I won't stop using it completely at home.
The protocol for me has been surprisingly different from the Cartilcel/Genzyme packet I received, from protocols online such as the Brigham and Women's rehab (http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Knee-Autologous%20chondrocyte%20implantation.pdf), and from the link that Vickster shared here, as well as the protocol described by Grace. This could very well be because the patella ACI is one of the newer ones (of a new surgery!) but also perhaps Dr. Gillogly is using more aggressive rehab that he has found works well. He has been doing alot (relatively) of the patella ACI's. So the higher range of motion, not sleeping in the brace, weight bearing soon after surgery, etc. Because I have been doing so well in terms of pain and range of motion (sorry I keep repeating this), I may be able to drive next week. I would use my left (good) leg for brakes, to protect the graft on the right.
The hardest thing about this surgery for me, in light of the fact that my recovery has been very easy so far-minimal pain, good range of motion-is waiting to see if the "graft" worked. I was discussing my hopes for the 2nd knee and Dr. Gillogly said that I have to make certain that this surgery worked for me. He is in general very encouraging and positive-but that is a fact. I had an xray yesterday and saw the screws from the osteotomy and everything looks great, but the xray does not show the cartilage. Dr. G said there is a type of MRI that shows the cartilage clearly from a procedure like this one, but it is not widely available and insurance won't cover it. So, most of the diagnosis of the success of an ACI is from the patient's functioning: ie a poor outcome would be if the patient has difficulty walking later in the process, etc.
I do have confidence in Dr. Gillogly. He is a respected surgeon and also has a very nice manner - easy to talk to and does not seem in a rush from the first time I met him. I personally do not mind that he has fellows helping him. To me that shows that he is dedicated to teaching and if I were at Emory here in Atlanta or at another teaching hospital, fellows would be involved too. This also means that he has to keep up to date on the latest research and techniques since he is teaching new practitioners.
The last thing I will add is despite a low level of pain, I still do take pain medicine throughout the day-mainly for exercise, particularly for the CPM machine, and also to sleep. Last night, I tried to go to sleep without meds and ended up taking them. I may be able to move to just Alleve, but at present I am taking one one 325 mg Hydrocodone and one Alleve(which is supposed to last 12 hours). I don't worry about overusing meds for any reason except that I have a sensitive stomach and have already had a bleeding ulcer-and both the prescription and non prescription meds can cause stomach issues! Also, in my first or second post op post, i said that I wished I had practiced with the crutches. I think my problem the first couple days was more weakness from having had surgery. After those first days and since, using the crutches has been a breeze. I do not have any steps though in my house which helps.
They confirmed that it is fine for me to do the high degree of range of motion on the CPM machine-no risks for to the patella graft. They explained why, but I don't clearly remember the details-it related to where the graft is.They recommended I continue on the CPM for 4 hours a day. I already have max ROM, but it is good for scar tissue and also, there is a belief (per Dr. Gillogly and I also read this) that the cells learn from the CPM movement, where the cells should settle to accommodate bending and normal movement of the knee. This is a theory that I don't think they know the exact reason for. I can use the brace at home, but don't always have to. I do not have to sleep in it, although I can if I toss and turn alot. The movement I must avoid is going from a bent to a straight knee. For example, if I am sitting with my leg dangling and then straighten my leg. I must use my other leg to straighten it, but coming under the leg and using it as a support. The brace can be uncomfortable and so I will use it less, although I am nervous about inadvertently twisting or unbending, so I won't stop using it completely at home.
The protocol for me has been surprisingly different from the Cartilcel/Genzyme packet I received, from protocols online such as the Brigham and Women's rehab (http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Knee-Autologous%20chondrocyte%20implantation.pdf), and from the link that Vickster shared here, as well as the protocol described by Grace. This could very well be because the patella ACI is one of the newer ones (of a new surgery!) but also perhaps Dr. Gillogly is using more aggressive rehab that he has found works well. He has been doing alot (relatively) of the patella ACI's. So the higher range of motion, not sleeping in the brace, weight bearing soon after surgery, etc. Because I have been doing so well in terms of pain and range of motion (sorry I keep repeating this), I may be able to drive next week. I would use my left (good) leg for brakes, to protect the graft on the right.
The hardest thing about this surgery for me, in light of the fact that my recovery has been very easy so far-minimal pain, good range of motion-is waiting to see if the "graft" worked. I was discussing my hopes for the 2nd knee and Dr. Gillogly said that I have to make certain that this surgery worked for me. He is in general very encouraging and positive-but that is a fact. I had an xray yesterday and saw the screws from the osteotomy and everything looks great, but the xray does not show the cartilage. Dr. G said there is a type of MRI that shows the cartilage clearly from a procedure like this one, but it is not widely available and insurance won't cover it. So, most of the diagnosis of the success of an ACI is from the patient's functioning: ie a poor outcome would be if the patient has difficulty walking later in the process, etc.
I do have confidence in Dr. Gillogly. He is a respected surgeon and also has a very nice manner - easy to talk to and does not seem in a rush from the first time I met him. I personally do not mind that he has fellows helping him. To me that shows that he is dedicated to teaching and if I were at Emory here in Atlanta or at another teaching hospital, fellows would be involved too. This also means that he has to keep up to date on the latest research and techniques since he is teaching new practitioners.
The last thing I will add is despite a low level of pain, I still do take pain medicine throughout the day-mainly for exercise, particularly for the CPM machine, and also to sleep. Last night, I tried to go to sleep without meds and ended up taking them. I may be able to move to just Alleve, but at present I am taking one one 325 mg Hydrocodone and one Alleve(which is supposed to last 12 hours). I don't worry about overusing meds for any reason except that I have a sensitive stomach and have already had a bleeding ulcer-and both the prescription and non prescription meds can cause stomach issues! Also, in my first or second post op post, i said that I wished I had practiced with the crutches. I think my problem the first couple days was more weakness from having had surgery. After those first days and since, using the crutches has been a breeze. I do not have any steps though in my house which helps.
« Last Edit: July 06, 2013, 09:52:31 PM by ozzie »
ACI patella surgery and Fulkerson with Dr. Gillogly June 25, 2013
Extensive cartilage damage in both knees due to misalignment of patellas
Extensive cartilage damage in both knees due to misalignment of patellas
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