Thursday, April 22, 2010

Welcome to the Bone Graft!

This time the title sounds like something from a Guns ‘N Roses speed metal wannabe. Perhaps a ballad by Metallica? Unfortunately, it’s also the next surgery I’m scheduled to undergo.

A few weeks ago, I met with Dr. Turgeon and Dr. Berman on consecutive days. Both offered the same opinion: I need a bone graft. In fact, Berman had stated back in December that I needed a bone graft.

Here’s the deal. The space above my tibia created by the osteotomy didn’t fill in with bone as expected. The medical term is, “non-union of the bone.” Basically, the bone splintered off by the osteotomy now forms a wishbone with my tibia. The two Home Depot screws are the only thing keeping the bone from snapping off. If that space doesn’t get filled in, there’s a decent chance the tibia or screws might shatter or crack, leaving fragments of bone scattered throughout my leg. Quoting WebMd, that would be a really, really bad thing.

The solution is to borrow some bone from my iliac crest (part of the pelvis), mix it with some protein-rich putty, and pack it into the open space. Just like that.

Sounds straight-forward, yeah? It’s supposed to be. In theory, of course. So let’s hope the surgery works as it should.

Now the bad part.

For starters, I’ll spend the night in the hospital, unlike the ACI surgery. Deep breath. My hip will hurt like a mother-f*cker, just like Bo Jackson felt after a 260-pound monster piledrove his hip into the AstroTurf. Worse, the pain will be felt immediately, also unlike the ACI surgery. Back then, the femoral nerve block delayed the pain 1 ½ days. Not this time. I’ll wake up really sore, and, I’m sure, really pissed off. I’ll need to load up immediately on some good-old fashioned meds. That means the family drug store will be back open for business. Whoo hoo. Let’s hope I can stop at the vicodin. I really don’t watch to mess around with the serious stuff, like morphine. Selling it, sure. Consuming it, not so much. Just kidding. I don’t deal morphine. Only Hillbilly Heroin.

How long will this surgery put me on the DL? Turgeon and Berman gave slightly conflicting recovery timelines. I’ll be on crutches 2-6 weeks, and in a hinged brace (not the mongo immobilizer I wore after the ACI surgery) for 6-10 weeks. I should be full weight-bearing soon after the surgery. My workouts likely will be restricted for 3-6 months, at least until X-rays show the bone has healed. I’ll probably have to channel my inner Michael Phelps and use the pool to keep in shape. Not good times.

The surgery will be huge for 2 reasons. One, obviously, is the need to repair the TTO. Hopefully the bone graft will firm up the tibia, eliminating the ultra-sensitivity and my fear that a 4-year old soccer player might accidentally kick me in the shin and turn me into Joe Theisman.

Second, and more importantly, Turgeon is also going to scope my knee. That’s right. I’ll receive confirmation whether the ACI graft worked. That’s even scarier than the bone graft. While the scope is the more “minor” surgery, it’s actually more revealing. I’ll learn whether all the rehab, pain, and uncertainty was “worth it.”

Now, as much as I’d like to know whether the ACI surgery “worked,” I wouldn’t get scoped just to check out the graft site. However, I’ve got a fair amount of crepitus, particularly at full extension, suggesting overgrowth at the graft sites and possible scar tissue which need to get trimmed. Interestingly, Berman mentioned that scraping away the overgrowth might stimulate further growth of cartilage and hardening of the existing stuff. A nice side benefit to the unpleasant surgery.

On the other hand, it’s possible the crepitus indicates that the graft hasn’t filled in or the new hyaline cartilage hasn’t matured yet, which would not be a good thing. I’ve also occasionally experienced twinges of discomfort on the inside part of my knee, so I’ll learn whether my Holiday Inn-inspired diagnosis of a medial meniscus tear is correct. And these past few weeks I’ve suffered a few random pinpicks around my knee, which scares the bejesus outta me. Because of my osteotomy issues, it’s tough to pinpoint the exact location of these sensations. Sometimes they feel like they’re coming from the medial meniscus area; other times from the patella; and still others feel like they’re at the TTO site.

I don’t want to envision the possibility that my knee still has unresolved defects, but I need to mentally steel myself for that possibility. That would be a really crappy thing to hear after waking up from surgery. Unbelievably demoralizing.

Regardless of what the surgery reveals, I’m facing another lengthy recovery. I’ve learned that rehabbing is a lot like practicing sports. And sometimes the hardest part of sports training is working on your weaknesses. Nobody likes doing stuff they suck at, me included. This is especially true for kids. For example, the hardest thing for young soccer players to do is kick the ball with their non-dominant foot. The kids often resemble newborn giraffes struggling to walk after leaving the womb. Well, after the surgery, I’ll be forced to re-train all those obscure muscles in my leg that will have atrophied for the second time in the past 18 months. Let’s be honest here. I hated exercising my legs when I was healthy. I really hate lifting legs when all I can do are a bunch of functional leg lifts with no weight. I’m a guy. Guys have massive egos. We like to lift heavy weights. Me Jim. Strong! Guys pick up the biggest dumbbells we can find– even if lifting them causes a hernia – grunt loudly, and then drop the weights to make the loudest possible noise so folks, especially chicks, can see we just lifted something enormous. For some reason, we think this is impressive. It’s not, of course. But we’re dumb. We just can’t help it. And after checking out who witnessed our feats of strength, we flex a few times in the mirror. That’s right. Check out the guns, ladies.

But lifting your leg with no weight? Lame. Really lame.

I haven’t picked a surgery date yet. I still need to discuss a few things with Turgeon. Berman recommended replacing the existing screws with a new, flat-head screw that won’t protrude as much. I also want to learn more about what Turgeon would do if the cartilage hasn’t filled in or hasn’t matured. And I have a few more questions about the incision near my hip, like which side of my hip? Same side as my knee?

Anyway, this wasn’t what I was expecting when I decided to roll the dice on ACI surgery a little less than 2 years ago. I can only keep my hopes up that the knee will continue to improve over time, particularly if the bone graft fixes my osteotomy issues.

Friday, April 2, 2010

The Osteotomy Blues

That title sounds like something B.B. King might sing about after visiting the ER. Ah, if only that were true. Well, I now know the source of most of my knee issues during the rehab. Or I should say, the source has now been confirmed.

A CT scan revealed that the bone graft from the osteotomy is not attached to my tibia. In medical terms, there’s non-union of the graft and the bone. The only reason the graft hasn’t floated away is because the two Home Depot screws are holding it together. Of course, these are the same screws that really ache and that I desperately want removed from my leg. Not surprisingly, this poses a major dilemma, which I’ll address in a moment.

Anyway, this discovery/confirmation explains my struggles to bend at the correct focal point; that my knee generally feels fine, but mechanically it functions differently, something I struggled to explain to folks, including Dr. T and Dr. Berman. I almost feel like the osteotomy defect has cheated me out a “true” ACI rehab experience. Ok, not really.

At least I know what’s wrong. And like the ending to the old G.I. Joe cartoons, “knowing is half the battle.”

So what does this mean? What’s next? Right now, I’m not sure. Presumably, I’ve got 3 choices: (1) do nothing, which means leaving in those f*cking screws and having an unattached bone wedge; (2) undergo a bone graft to fill in the “area of non-union” between my tibia and the wedge; or (3) see if the screws and the entire bone graft can be removed. None of these options is very good. All of them have drawbacks.

First, doing nothing means learning to live with the uncomfortable screws and a really sensitive shin. Plus, I can’t imagine having an unattached bone wedge inside my leg is a good thing.

Next, a bone graft means another major surgery. And several more painful months of recovery. And another several months of putting my life on hold. Not to mention there’s no guarantee the bone graft will work.

As for the final option, I have no clue whether it’s possible to remove the unattached bone wedge (along with the screws). In my non-medical mind, if it’s not attached, why not “take it out?” That seems logical, right? Besides, I don’t need the osteotomy anymore. The ACI graft has sufficiently matured, eliminating the need to alleviate the pounding absorbed by the patella. True, the osteotomy would alleviate pressure long-term, thus minimizing the risk that I’d re-injure my injury-prone patella. But since I don’t expect to play competitive sports anymore, I think the odds of a future injury are minimal.

Sometime soon I’ll discuss these options with Dr. T. And then I’ll seek out another opinion to be safe. Stay tuned.