Patient Stories & Case Studies

 

Case studies from across the broad spectrum of patients showing an idea of what to expect in varying scenarios.

Kaye was an active 40 year old playing competitive netball numerous times a week. She also enjoyed climbing, salsa dancing and horse-riding, until 2011 when she injured knee **SPECIFIC INJURY DETAIL** during a netball game. From the time of injury she experienced grinding and swelling and on occasions her knee would ‘lock’. Kaye had surgery on her knee in Blackburn and due to the level of damage from the injury she had a large amount of her left lateral meniscus removed.

Following her surgery in 2011 Kaye was advised to refrain from any sports and activity to prevent further ‘wear and tear’ to her already slightly damaged bone surfaces. Kaye described her feelings at this point, ‘I felt my whole life had fallen apart. As a sporty lady the prospect of walking with a stick and being struck with arthritis was an image I struggled with’.

In 2014, a work colleague suggested Kaye seek another opinion on her knee and she visited Mr Spalding in Warwickshire to discuss the possibility of meniscal transplant surgery. Kaye was keen to get back to some sort of activity and decided to go ahead with a meniscal allograft transplant. Being an active woman focussed on her own recovery, Kaye embraced a pre-operative exercise regime to build the strength in her leg muscles. The surgery went well and the rehabilitation programme commenced under guidance of specialist physiotherapists.

Kaye remembers ‘Recovery was hard, but I was surprised to find that in some ways it was better than the recovery I had after the total menisectomy. I prayed the graft would take, and I worked hard at rehabilitation. I couldn’t believe how well I was doing. At eight weeks I was full weight bearing, walking without any limp. At twelve weeks, I was cycling and gradually building up the bend in my leg.’

Twelve months on from surgery, Kaye is continuing to progress ‘I have no pain, no restriction and full range of movement.’ Highlights to date since her surgery include climbing a cliff face in Scotland, a few games of tennis, joining in on parents vs children’s rugby charity game and a walking holiday to Fife. Above all, ‘I have my knee back and can do the things I love’

KS Riding Horse

What were the main problems you had with your knee before your surgery?

Before surgery I experienced a lot of pain down the left side of my leg below my knee. It would often impact me when working out at the gym and my knee would become really swollen after exercise or a lot of walking. Generally my knee would be quite painful on a day to day basis and would often catch or lock. Prior to this surgery, I had 3 separate arthroscopy procedures all completed in my local hospitals. Each time it felt like it was just getting worse. My expectations were to improve my general daily activity, be able to work out in the gym without constant pain, swelling and to reduce the amount of future surgery as this will be ongoing for myself for a number of years.

How did you find the surgery and rehabilitation process?

Initially I struggled with the TROM leg brace weighing down on my leg and I was unable to manage the stairs for a couple of weeks, because of this I moved back home with my parents as they have downstairs facilities, toilet etc. Due to the length of my surgery I was very weak and it took some time to build my strength back up, things like walking around the local supermarket on crutches were very tiring, so I couldn’t be out for long periods of time during my initial recovery period. I attended physio 2-3 times per week to help build my strength back up as quickly as possible. Another thing that I struggled with was gaining full extension (getting my leg to go fully straight). This was because as well as the Lateral Meniscal Transplant I also had a Distal Femoral Varus Osteotomy procedure which meant that I was non weight bearing for 6 weeks and during this time my leg was also locked in a leg brace at 20-90 degrees. I returned back to work after 15 weeks off still on crutches and wearing my TROM leg brace. 3 weeks later I returned to Rugby hospital to have my leg put in a straight cast for a couple of weeks to obtain full extension. This was extremely difficult on a daily basis as I was in a straight cast from the top of my thigh to my ankle, the cast would drop down and rub on the top of my foot which was very sore as the cast was sharp at the bottom. During this time I was still going to work on reduced hours. After the straight cast was removed I was given another TROM leg brace and further rehabilitation to stop my leg from springing back and losing full extension. Looking back now I wish that I had gone into the straight cast earlier before being signed back to work as I had to rely on my partner and family to take me to and from work and colleagues to help me around the building whilst I was at work. My leg is still getting stronger and I am continuing with my rehabilitation. I have also had further surgery 17 months after my Lateral Meniscal Transplant to remove the TOMOFIX locking plate that was put in during the Distal Femoral Varus Osteotomy procedure as this was catching on tendons and causing me a lot of pain because the TOMOFIX locking plate had to be put lower down than usual due to the deformity in my knee (flat on one side). When Mr Spalding removed my TOMOFIX locking plate he also did an arthroscopy to take a look at the Lateral Meniscal Transplant to see how things were looking post-surgery. Overall he was extremely pleased with how the Lateral Meniscal Transplant was sitting.

How is your knee now?

I am pleased that I have had the surgery as my day to day activity has improved and I am able to do more in the gym now than previously without any swelling. I still get some pain and discomfort at times but nowhere near as bad as it was prior to surgery. Mr Spalding and his team have been absolutely fantastic throughout the whole process from meeting them to see if I would be suitable for the operation to post operation follow ups etc. Mr Spalding and his team have made me feel confident throughout as their knowledge and expertise is incredible.

Is there anything you wish you had known prior to the surgery?

Knowing the facts and figures for the TOMOFIX locking plate failure rates. Also knowing the possibility of being put in a straight leg cast if full extension wasn’t achieved by a set timescale.

DCIM100GOPRO

What were the main problems you had with your knee before your surgery?

Before the surgery, I suffered from constant knee pain. My knee hurt every single moment of my life, when I sat, when I walked, when I slept. It woke me up at night. I struggled to walk up the stairs; sitting on bended or crossed legs, running and jumping was impossible for me for most of my life. I struggled to walk short distances. I had to take many pain killers. I often felt sensations of grinding or cracking in my bad knee, although it hadn’t locked, it had seemed to be stiff and very unpleasant. had limped as well. I had four arthroscopies which left me with many adhesions and extra pain and discomfort.

How did you find the surgery and rehabilitation process?

The surgery was absolutely fine. Although, I was really scared of it, I went through it without any complications or unbearable pain.

The hospitalization was very quick; after the surgery I felt well, despite having a brace on my bad leg. The swelling on my knee was not as huge as I thought it will be. Soon I was shown how to operate the brace and how to move with it around.

I saw my surgeon few days after my surgery and then again few weeks later. I could contact him via email or phone. I felt safe. I did not struggle with the pain so I did not even finish my prescribed painkillers.

I had some more difficulties with rehabilitation. I wasn’t an easy patient as I had problem with rotating my bad leg. However, I had the best physiotherapist in the entire world. I was taught how to walk properly in order to release me from additional pain. This process was very slow and I was progressing slowly but surely.

How is your knee now?

At the present moment, I am pain free. I am more active. I do not feel depressed anymore because of the constant pain. I sleep well at night. I can kneel and I can cross legs. I feel more confident when I walk as my leg is stable and doesn’t bend on uneven surface. I do not need to focus on my knee any more when walking as I can rely on it. Squats, walking up and down stairs is not a problem for me. I am feeling very grateful and I would highly recommend any person to go for the meniscal transplant as you can get your life back! To me it means more activity. Although I decided not to be second Usain Bolt as I want to look after my knee in order to have the best outcome after the transplant surgery, I still can cycle, walk about, play badminton and attend he fitness classes keeping in mind to exercise gently.

Is there anything you wish you had known prior to the surgery?

I truly wish I had known how fabulous opportunity I have been given to have this surgery.

What were the main problems you had with your knee before your surgery?

Minimal cartilage left following minor surgery in 1996.
Permanent swelling and stiffness, unable to run or jump and occasional locking of the knee with significant pain.

How did you find the surgery and rehabilitation process?

I didn’t have any significant problems following the surgery itself, the pain relief was effective and I only had a couple of uncomfortable night’s sleep in the first week or so. I was able to sleep in the spare room by myself for the majority of the first few weeks of recovery, which I think was helpful and would recommend to others having the surgery if it’s feasible.
I quite enjoyed the non-weight bearing element of the recovery, watching a lot of TV series and movies rather than being at work! Although appreciate this would be more frustrating with a less supportive employer or for the self-employed. The biggest challenge in this regard was the reliance on other members of the family in preparing meals and dealing with children and the extra stress for my wife in having another dependent.
It was certainly very odd having a completely straight leg for the first few weeks post-surgery and more challenging to manoeuvre on crutches than if you’re able to bend the knee but I had no problems with the brace, which worked well.
It was harder than I thought it would be to put weight through my foot again after being non-weight bearing for so long but this was more of a mental barrier and quickly passed. Rehabilitation was inevitably somewhat frustrating but I saw gradual progress aside from a couple of falls on slippery surfaces. In terms of others having similar operations I wouldn’t underestimate how long it takes to have full 360 degree confidence/stability in the knee again, whilst it might feel fine working in straight lines up and downhill and on uneven surfaces if your foot slips it takes a long time to be able to catch yourself quickly and regain your footing. My falls were on a white line in a car park and some moss on a wooden bridge, both flat surfaces and catching me completely unaware.

How is your knee now?

Definitely glad it was done, I don’t have any pain and there is minimal swelling within the knee and without the operation my problems would only have been getting worse!
I’m avoiding running, based on the advice that it is only likely to accelerate future wear on the implant, but aside from that I can pretty much do what I want to do. Moreover, I would be confident in running linearly if I had to, the only thing that I wouldn’t be confident in is sharp changes of direction and that is probably down to a lack of practice and no requirement to do so.
The only thing that I am still conscious of on a day to day basis is going downstairs where the movement within the knee still isn’t as smooth as would be ideal. Having said that I’m still noticing improvements in that regard, along with comfort at extreme range of movements – sitting on heels for example.
I’m sure I could have been in my current position with my knee sooner, given more time in the day, and in terms of others having the operation they need to be realistic in their expectations. They are only likely to get the recovery timelines you see in professional athletes if you are able to have a full time focus on rehab and that is pretty unlikely for the majority.
In addition, my recovery after the first six months or so has also been more about the compensations you create elsewhere in your body than the knee itself, tightness in the lower back because the knee hasn’t worked quite has smoothly as the other side for a long time, changes to the way you walk etc. That inevitably takes time to correct and I’d encourage others to work hard on putting equal amounts of weight through both feet as well as working on hip and ankle mobility even before having the operation.
One final point is that I have done quite a bit of leg strength recovery on a watt bike, which has been great in the sense that you can monitor output on each leg, and I’m aware that you encourage the use of cycling as part of the rehab. The one thing that I noticed with cycling was the tension that I built up in my IT band. For the first year after my operation I didn’t actually try to reduce any stiffness that directly linked to the knee, on the basis that my body was generating a certain amount of stiffness to protect the knee whilst it recovered. However, the stiffness in my IT band is now the main thing that is preventing my knee from working as smoothly as I would ultimately like, when walking downstairs etc as noted above. I’m not sure if this is something that you’ve heard of/considered before but I mention it as it has probably been the hardest thing for me to balance as part of my recovery.

Is there anything you wish you had known prior to the surgery?

The only thing that I can think of is that I had a bit more swellingthan would have been ideal at the point that I started to weight bear again. I got rid of this quite quickly using a Game Ready and it would have been great to know about this at the outset so that I could have used it sooner. It’s not going to be for everybody because it’s reasonable expensive to rent and I think you typically do this on a monthly basis. Using it as late as I did I probably only got around 10 days of benefit from it.