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Old 07-15-2004, 07:55 AM   #1
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Question What does it feel like to be in a cast? - patella realignment procedure

Hi all!
Well, last october I fell directly onto my right knee in a bowling tournament. I've been through lots of physical therapy for my patella femoral problems caused by a fall while bowling. Therapy didn't help much, the only improvement that anyone saw was loosened hamstrings. Because the PT wasnt experienced with knee problems like mine so she was giving a lot of the wrong exercises. I guess loosened hamstrings are a good thing though. In the process of figuring out whether or not I actually needed the patella realignment surgery, I was also diagnosed with plica syndrome. There's conflicting answers from doctors about whether I have it or not. Anyways, I had another appointment yesterday at the childrens hospital of phila******a. The doctor was really good. I felt really comfortable with him. He explained that I had an increased Q angle (which no one had ever looked at before). I guess it's supposed to be like 14-20 degrees in women, and mine was 32 degrees. He also discussed that as you grow that the bottom of the kneecap forms to your patella femoral groove. Ideally it should be a "V", where mine is an "L". Also that that tuberical (something or other) tendon is inserted toward the side of hte knee. So basically said that I would be a really good candidate for a patella realignment procedure. He explained that I would be in a full leg cast for 4-6 weeks after the procedure. And then probably 6 months of physical therapy to get all of my strength back. I'm going to be having the pre-op and surgery some time in August (not sure of the exact date). The thought of being in a cast after the surgery kind of scares me. What does it feel like? Is my foot going to go to sleep like crazy because i wont be able to move it? Am i going to be in a lot of pain afterwards and in those 4-6 weeks? I have had surgery before (a breast reduction) but this isn't at all like that. How am I supposed to get around? Will i be in a wheel chair or on cruches or what? How am i supposed to put my pants on if i can't bend my leg? I have lots of questions that will most likely be answered in my pre-op appointment, but anyone whose had this procedure done or something similiar or has been in a cast, please feel free to share your experiences. Thanks so much!
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Old 07-15-2004, 07:08 PM   #2
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Re: What does it feel like to be in a cast? - patella realignment procedure

Being in a cast isn't that bad but it can be frustrating. I was in a full leg cast for 6 months and have been braced many times. If you've ever been braced with an ACL type brace it is similiar except you can't bend your foot and it weighs a bit more.

The biggest thing is itching and sweating, it will happen especially if it is hot out. If you can't reach the itch with a blunt thin object (never stick a sharp object in a cast) then try taking some benadryl. Some talc powder near your foot and top thigh, after you've healed, can help elimiate some of the itching.

If you start getting leg / foot cramps try eating banana's, the potassium in them will help with the leg cramps and charlie horses if you get them. I can't tell you the exact amount because I don't know but I'd say a few a day if you enjoy eating them.

Clothing - wear sweat pants or shorts, jeans won't work unless you wear really baggy ones. Put your cast foot in the appropriate leg first then slip your other foot in and just pull it. It's not so hard just takes a bit of getting used to.

Walking - you will probably be on crutches, they will teach you how to walk with them. The biggest thing will be is the cast may see somewhat heavy but it's something you adjust to. Also be VERY careful walking up and down stairs. In fact, if you can avoid them all together for the first few weeks the better off you will be. Nothing like loosing your balance and falling down some stairs. The hospital should teach you how to work stairs, if not ask when you go in for pre-testing.

The doctor may not let you walk much the first week. You may not even feel like walking much. Keep your leg elevated when resting.

Bathing - Chances are you wont be able to take a bath or shower for the entire time the cast is on. Sponge baths will be the alternative. You could be creative and try to tape a garbage bag over the cast but I wouldn't suggest it. If you get a leak and it goes down into the cast and to where your operation occured it is going to smell really bad and could possibly induce an infection.

Sleeping - With a full leg cast it can be uncomfortable to sleep, if you can't sleep on your back try sleeping on the side the cast is on, if it doesn't hurt that much and put a pillow between your legs, your other knee rubbing on the cast will irritate you. If you can't manage that try sleeping on your good side with a pillow, just know the cast may be a bit heavy and your leg may be weak from the surgery so it might be hard to manuever it in this position.

After the surgery - If possible try to get someone to care for you at least the first few days, you will be in pain and can use the extra hand. You didn't indicate how long you'd be in the hospital but most surgeries are a day or two. If you have small children see if it's possible for someone to care for them for the first few days you are home. Trust me you are going to want to rest alot. Any surgery will do this to you. Anethesia generally takes a week to wear off.

Meds - If you are put on pain meds and prescribed a schedule try to stick to the schedule at first, do not wait until the you are in pain before taking meds by then they won't be as effective.

Car riding - oh this is almost as bad as doing stairs. Obviously you will not be able to drive the entire time, in fact, in some states it would be illegal to drive with such a cast. Before getting into a car make sure the front passenger seat is totally moved back, if you are of short stature you should be fine and can fit. If you are tall or long legged you may have to opt for the back seat of a car. If you own a truck you should also be fine because the seats sit up much higher than a car.

Temp disability card - ask your doctor if he thinks it is ok for you to get a temporary disability parking permit before you have surgery. He can fill out the form and state the dates on it and you can get issued a temp handicapped parking card. You will want to have this if you plan on going to the store or something. Speaking of stores, always use a wheelchair if your store offers it so you don't tire yourself.

Drink TONS of water the first week, you will get dehydrated and that's normal, again from anethesia.

That's about all I can think of offhand and it's probalby more info than you wanted.
I've not had the surgery you have had but I have had my cartilage completely removed, had my ACL reconstructed and my PCL released because my kneecap was tracking in the wrong direction. I've had 4 knee surgeries total and they are no fun. You do heal up fairly quickly but expect the first week to be rough. The more you prepare yourself mentally for it and prepare your home the better off you are.

Good luck with your surgery I hope it works out.

- Barbie

 
Old 07-15-2004, 10:38 PM   #3
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Cool Re: What does it feel like to be in a cast? - patella realignment procedure

Wow! That was great info! Thank you so much!

Well, I guess I should give you some more information. I'm a 17 y/o female. So I'm living at home with my parents so they'll be there for me after the surgery. My dad got the surgery date today. I have my pre-op on August 2 and the surgery will take place on August 12. I'm really nervous about it. I think it's mostly because they'll be cutting the bone. Moving the tibial tuberical tendon over medially while also doing a lateral release. I've looked up patella realignment surgeries online, and there's like 3 or 4 different ways to do it, I'm not quite sure yet which I'm going to have, but none sound too fun! One is like they cut the bone where that tendon inserts and screw it back on along with the tendon in a different place. One they cut the bone vertically and put a wedge in there, another is the same but htey also move the tendon. But I think that one of my big concerns is that I'll be having hte surgery exactly 2 weeks before going back to school for my senior year, so i'll be in school for that first 2-4 weeks with the cast. Like I'm not sure how that will really work with carrying books and everything. My principal is really supportive though, and he'll find a way to accomodate me. I'm sorry, this is kind of all over the place, I'm reading your response, and adding stuff in at the same time. Anyways, I'm really not sure how long I'll be in the hospital. I guess I'll find that out during my pre-op. Stairs will definately be a problem. My house is split levels. So if i sleep on a certain floor then I'd have to either go up or downstairs to use the bathroom, and if i stay on the lower floor id have to go upstairs to go outside or to the kitchen. I'm definately not planning on driving! Especially since the surgery is on my right knee. I've tried driving with my left leg for kicks in an empty parking lot before, and trust me! Its not pretty! Thank you again for all of the information and advice. It really put me at ease. I've been really nervous all day about it, and this is probably the most relaxed that I've been. Feel free to tell me more if anything comes to mind. Thanks again!

Jessica
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Old 07-16-2004, 07:19 AM   #4
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Re: What does it feel like to be in a cast? - patella realignment procedure

One thing to check with your doctor or ask about is if he will use Titanium Screws. Many people are allergic to surgical steel and it can have some implications later on. Most doctors use Titanium now a days because of problems in the past but it doesn't hurt to ask. Be insistant on it, I'm sure your doctor will comply if he doesn't already use it.

I've had the lateral release done, I hurt for several days. What you are having is a little more intense so expect about a week of recouperating.

As far as at home, I'd find the floor with the least amount of stairs or no stairs at all, even if it means sleeping on the sofa. You will not want to climb stairs, especially in the first week. One thing you can do is slide yourself up and down the stairs while sitting. I had to do this for my ACL repair because my bedroom was on the top floor and my leg was so swollen up I could barely walk.

Schools are usually pretty helpful. I had 3 operations during my school years and was in a brace a few times. Probably the principal will assign someone to help you carry books etc or get a friend to. If that's not possible get a bookbag.
One thing my doctor did for me pretty much my entire school years from 4th till I graduated was write a note saying that I could leave class 5 minutes early to get to my next destination so that I wasn't trumpled in the all between periods. Ask your doctor if he would do that for you while you are in the cast, chances are he will.

Make a list of questions you have as they come to mind about the surgery before you go to your pre-op and take it with you. This will help alot, especially if this is your first major surgery. This will help you in the long run to know what you could expect.

One thing I'd ask the doctor is if after the cast is removed will you be in any type of bracing just so you have an idea what to expect after the cast removal.

Good luck, I'm sure you will be fine. Just remember it will be hard the first week but it does get better. If you focus on the getting better part you'll go through it with flying colors.

 
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