4. Pain medication vs nausea who will win?! Night 1 post MPFL and TTO

Whoa! my surgery is done and I'm back on the ward. If you think i am writing this directly after surgery you are wrong. I was flat out lifting my head off the pillow, 'I think i'm going to be sick' was a repetitive statement along with 'OMG that hurts'.
I have a drain coming out my knee, calf compressors going up and down my calves and I am sick of lying on my back...already!
I had some great nurses, pain relief...check, anti nausea medication...check, knee iced and elevated...check, and they would do it all again and again without question, i'm not sure what face they pulled as they left my room or what my handover report would have sounded like but these nurses tried to fix it, they tried to get the balance right between pain medication which is important but being able to tolerate oral fluids is also important. I ended up staying an extra night in hospital as the balance was tricky, i would sit up and have like a feeling of this isn't going to end well to being asleep in 2 minutes. The body has amazing measures to try and get you to rest.
Interesting as a nurse myself i have been under the misconception that just because you are asleep doesn't mean you don't actually have pain, sometimes i just had my eyes closed because i couldn't keep them open and other times i think i was asleep but was woken by pain. I cant describe the pain but throughout all my knee complaints this is the absolute worst pain i have ever had. I have had a normal vaginal delivery of my little boy 6 years ago and a caeserean for my little girl 8 years ago, I know pain but this pain, i don't think anything could have prepared me for this. The weird thing also though was i had a numbness all down the outside of my shin, the anaesthetist didn't mention doing any kind of nerve block so i was a little worried, i was reassured this was fine the i had a general anaesthetic and local anaesthetic block.
I think it is also important to mention that pre-op i really didn't have pain, occassionally yes, so panadol and nurofen ...every now and again was the most pain relief i have ever taken.
Pain score is a difficult measure and by all means your pain score compared to mine will be different.
But as much as I wanted pain relief to get my pain below the 4/10 that the nurses wanted, i was happy for it to be higher as i didn't want the nausea. You have to do what works for you and whilst i realised that i wasn't going to be up and walking about i took that on board, enjoyed the pain relief and the 'lost head' feeling and asked for anti nausea meds to combat the nausea.
It is a shame that for my 2 nights in hospital i had all meals prepared and i could hardly bare to look at it.
My husband and sister visited after surgery...i think....yes they did, I felt even worse as i couldn't even hold a conversation with them, but it was lovely to know they were there.

There was another issue on night one, i normally sleep on my belly, well if you don't normally sleep on your back this is very uncomfortable and i just wanted to get off my bottom for a little while. Those nurses again to the rescue and whilst i wanted to go up on my side they explained their concerns, the main one being i hadn't had a brace fitted and they weren't keen to move the leg. Ok i played the nurse card and threw out my concern i had been at least 8 hours on my back...pressure sore concern. So we compromised and put 2 pillows between my legs and rolled me onto my unoperated side...oh bliss!! THANK YOU NURSES!!

I was checked , rechecked, offered pain relief, offered anti nausea medications all night and i'm sorry to the nurse i upset as i only wanted dry biscuits and ginger ale as a post op meal, i promise that is all i wanted, it was all i felt like.

This post is a shout out to some amazing nurses on the orthopaedic floor of the hospital, your compassionate care and observation throughout the afternoon, evening and night, meant my almost unbearable night was bearable. THANK YOU xx

I wonder what is under the bandage and I hope i pass the physios crutches stair test to be able to go home....
Liss xx

3. Booked in and getting ready for surgery! 35klm walk first though :-)

It takes time to get organised prior to surgery but i thought i would do at least one thing, get used to crutches!!
Oh this isn't going to work i couldn't get from one end of the kitchen to the other without putting my foot down and i didn't even attempt stairs. I kept reading other people blogs and practice was the common thread and also non-weight bearing for 6 weeks! I googled how to use crutches safely watched videos learnt the phrase.. good leg goes to heaven bad leg goes to hell.
 I started to question how this was going to work as i couldn't do it pre-op so i had buckleys of getting it right after surgery, i was likely to end up with a broken ankle as well.
So as you learn everyone's experience and instructions post op are very different, luckily for me i confirmed pre-op that i could be weight bearing with crutches for 6 weeks post op...WOooHOoo happy dance, I could do that!!

So my booking to the hospital was complete, I was contacted by the anaesthetist's nurse to answer some health questions and a few weeks later we were driving 2 hours from home to the hospital.

I had one thing i wanted to complete prior to that trip to hospital and there is nothing more satisfying than saying I did it. I had entered a 35klm Charity walk from the beautiful Byron Bay to Ballina in NSW to help raise funds and awareness for the Westpac rescue helicopter. So 5 weeks before surgery I strapped my knee up, took some pre-emptive panadol and set of with a fabulous group of people that encouraged me to continue to reach the very end. Amazing that you can have such a 'dodgy' knee but determination is so powerful. I credit my determination and strength to the gym which i have been training at Ultimate Strength and Conditioning. I have done that walk twice before but this one meant alot and 51/2 hours later we all got to the finish line and it was awesome!

Me (in the middle), husband and sister with i think about 12klm to go!


It felt like i was about ready to have a baby the week before surgery, what i mean is when i was due to have my babies i nested, i threw things out, i cleaned, i washed, cooked meals to go in the freezer and made lists. 'Stuff' that absolutely had to be done, in hindsight it was me just keeping busy so i didn't have to think about it.

As we parked the car on the day of surgery it is hard to imagine the last time you will be able to walk for 6 weeks,is the steps that you take into the very hospital you will have surgery in. A cute little hospital buggy pulled up and asked if we wanted a ride up the hill, my husband said ' nah mate its ok its the last time she gets to walk without crutches for 6 weeks, she'll enjoy the hill' haha he thought he was hilarious, I didnt want to walk up the bloody hill i was happy to hop right into the hospital buggy, ahh well.


All checked into the hospital, my armband and legband is correct and a nurse calls my name. I'm up my turn to go, no turning back. Some goodbyes to my husband and niece and away I went into the land of sterility. As i changed into not so fancy hospital underwear and put a oversized paperish gown on, you feel very exposed without being exposed, no bra, no makeup no family with you and they took my belongings to be sent up to my room, WHAT ABOUT MY PHONE!! no access to the world how would i cope for 2 hours in a waiting room with people that looked as fashionable as me. Chatting with a lovely elderly lady sitting beside, I say thank you to her she was great value.

Questions on repeat, name, date of birth and surgery you are having, this was real. A quick hello from my surgeon and my anaesthetist asked if i have any further questions...Bam light's out and i wake saying 'Why dont I have a brace on?!' oh that poor recovery nurse, this nurse woke from her anaesthetic tired, cranky and in pain...oops! He thought he would keep me quiet with a lemonade icypole, he was wrong, I didnt sleep well last night did i mention that. Sorry Mr recovery nurse but I was disappointed that you didnt know more than just 'she had knee surgery' it was more than that it was a MPFL repair.....anyway clearly i needed rest and food and pain relief.

That's it.... surgery complete, easy right, sure, kind of, nope not at all..... night one i will never forget it was very very unpleasant.

Liss xx

2. GP appointments , orthopaedic surgeon appointments and scan results- all part of the process!

All part of the process is arranging and attending Gp's appointments, the following up with scans and then waiting for results, revisiting GP's, getting referrals and seeing the specialist.

Waiting, Waiting, Waiting!! an annoying part of the process of getting injuries sorted and a part that sometimes seems unnecessary in a world where everything is so at your fingertips electronically. Patience when you just want to get on with things can be very hard to muster.

Being a registered nurse i understand the process all to well and whilst i work along side Dr's i think it remains important to utilise your own GP.

However, Gp's can be difficult to get into so i attended an appointment with a GP that was not a regular GP but was easy to get into. All i was requesting was a referral to an orthopaedic specialist and MRI request form. I know this must be annoying to the GP ...a nurse arrives basically with her own diagnosis in her head and isnt interested in going down the path of 1. wait and see 2. physio 3. panadol and nurofen pain relief.

The wait and see approach i was already well past my post 'injury' time that it normally resolves in itself, physio completed as mentioned in previous post and i had no pain so didn't need pain relief which i explained.

It wasn't recommended I have an MRI by the GP as it was too expensive, i should wait until i see the specialist- you would think that would be my decision to make, if i have money and i'm willing to pay than i don't see an issue. Again that waiting thing if you see an orthopaedic specialist and you don't have appropriate scans than that is another appointment...more time. See the specialist yes that's a great idea...according to my not regular GP she was  unsure as to what they could offer me so she really didn't see the point. OHHH i should have just asked one of the Dr's i worked with for a referral!! and did i mention i wanted to see someone who wasn't a local specialist, disappointing i know that i didn't want to stay local, my choice as a private patient and this was also the Dr who did my original arthroscopy many many years ago...continuity of care rings some bells.

A nurse always gets what she wants though, i left that GP office with a referral to my Orthopaedic Surgeon and and MRI request form!!

So my MRI results are in and a subluxation of the patella, a floating ossified foreign bodies MPFL injury and advanced degenerative arthropathy at patellofemoral joint, and a moderate joint effusion.

In a way i was glad that there was so much wrong with the knee. I know that sounds awful but it was kind of one of those childish moments of 'see i told you so'! Also it is difficult for people to see and understand why every now and again when your tired you limp and every now and again you wince in pain as the knee caught as you turned too suddenly. Its not an external injury that can be seen so it is difficult to explain and understand. 

I rang to make an appointment with my OS and happened to get an appointment really quickly so a few weeks later saw him.

It all happened quite quickly from there and i was filling in paperwork to have a right knee arthroscopy, MPFL reconstruction with +/- tibial tubercle osteotomy +/- lateral release +/- foreign body removal.

I think trust is a big part of saying yes to any surgery and i knew that my surgery was necessary because it was explained in a way that totally made sense for the reasons for my symptoms,and that the outcome if i leave the joint to its own devices isnt in my best long term interest. It was an environment that i was free to ask questions and make contact at any time to confirm any information.

Yes... i said yes to surgery on the spot- i went there for his opinion and his option of surgical intervention seemed like my best chance at preserving my joint for long term and being able to get back to normal functioning in life without thinking about my knee every time i stepped.

There was a lot of pluses and minuses on the consent again this actually gave me the confidence knowing that only what needed to be done would be done. The TTO became my greatest concern as it involved bone being 'shuffled' to a better spot! 

This led onto my research, i wont lie i had googled my MRI results and had already read a few things on the above procedures so i already had an idea of what he would say, but i knew researching after my signing of consent forms wouldnt have stopped me asking more questions. It didnt matter though all of the questioned had already been answered.

I was asked to have a CT scan as a TT-TG measurement couldn't be gained from the MRI, this was to determine if the TTO part of the operation was necessary. I think the measurement had to be less than 20 and mine was 25 so you guessed it the +/- TTO became a definate after a phonecall from the Dr.

So from my first symptoms 24/1/2016 to my surgical date 1/7/16... 5 months to get it sorted.

With kids, work, family, husband and farm.... things do take time, priorities!

Alot of things went through my head now, 

* how will i use crutches- im so unco-ordinated

* NO driving - its never going to work

* 6 weeks off work- organising sick leave

* how will i go going back to work

* what if there is complications

plus so many more how will i look after kids, is it better to do it over school holidays, should i wait until kids have 6 weeks over xmas off, summer would be hot with a brace on so i should do it now in winter.....blah blah blah my head was full of the pre-surgery to do list!

Things all work out and there was a solution to every part of the list i was making!

Therefore SURGERY IS BOOKED AN CONFIRMED!!

Heres a copy of my MRI result

And a pretty picture !!

Its time to move that patella back to where it needs to be ....

Liss x

1. The history of my knee

Hi and welcome to my blog on my personal journey to having a Medial Patello-Femoral repair and Tibial Tubercle Osteotomy.

A little background on my knee to give you an idea as to what caused me to proceed to the surgical option for my knee.

Most people assume a knee injury must mean a sporting injury but as a young teenager my ultimate dislike was sport! So i would love to say yes it was a sporting injury and sometimes it is easier to agree, my actual first knee issue was playing touch football at school, running forwards and my first knee 'give way' feeling resulting with me on the ground. See it was sport!!
I am not sporty so it seems wrong to blame a sport on an injury which i played as a one off game, a few games of indoor netball and a season or two of playing backs in hockey.
I was 15 at this time and i dont remember any Xrays or MRI's but a limping leg a few weeks later lead to  look and see arthroscopy. The results of this i dont remember but mum thinks a partial meniscal tear that was tidied up.
Standing scrubbed for a 3hr operation as a theatre nurse , i was working with a 6ft 3inch surgeon and as i am only 5ft 2inch the result was me standing stationary on a stool for a long period then when i needed to turn , step and get something my knee didnt follow. Here was my next knee complaint, I was 24. This lead down the workcover road which in itself is a journey and a half. It was deemed clinically i had a partial posterior cruciate ligament tear a little time of work and i was back to normal.
Somewhere else following i had a ram bunt me up the back of my thigh again the feeling of 'giving way' following this incident, 6 weeks with RICE and i was back on track.
Funny how easily you lose track of time but again at work in recovery ward and sitting on a stool a side twisting action as i stood lead to that same familar feeling my knee just didnt follow. Again workcover related and a clinical diagnosis of partial posterior ligament tear.

3 years ago i noticed that knee feeling was becoming more common with simple things mainly walking down slopes and down steps, me worrying alot about whether it was or wasnt going to function properly and so sort a orthopaedic review privately, severe chondromalacia patella was diagnosed and i was advised that i had abnormal tracking of my patella. There was talk at this time of a partial joint replacement but as i was only 32 the recommendation for me was strapping and anti-inflammatory medications and to wait as long as i could before surgical intervention.

It always seemed post an injury 6 weeks of taking it easy, a little physio and strapping did the trick until the injury this time.

What injury- not sure 100% what happened 3 days before this issue i was doing CPR on a gent and i put my bad knee up on the bed and the natural rocking motion to do cardiac compression put alot of pressure on my knee, i have been doing new exercises at the gym - haha yes times change i found a 'sport' i love... strength and conditioning training and i had been preparing for a 35klm charity walk, so a few knee stressors there.
So on Australia day long weekend as we are about to pack the van and head to the beach i wake with a 'lock knee' alot of pain behind the knee mainly this time. Interestingly while we were away not wanting to miss out i attempted a bike ride and the knee felt somewhat better afterwards, swimming in the pool somewhat better afterwards....6 weeks later and i am still having issues which isnt normal. My physio at the time said there was no need for any surgical intervention and that the knee was good to keep strapping, it didnt feel right, it wasnt right.
So this is the beginning of my journey down the path of having a medial patello-femoral repair with hamstring harvest and tibial tubercle osteotomy.

A subluxing patella....a knee cap who has made its own decision to sit where it want to sit when it wants to sit there! Amazing how one little bone can be the cause of such grief!!

Off for an MRI, XRays and CT scans, i'll let you know how that goes,

Liss xx