Richard Haynes PTA/CPT - 3/22/2009

Question
QUESTION: Sir,
My brother has undergone -Patella removal surgery.
In X-ray there was horizontal fracture..we could detect 3-4 pieces.Firt I thought ...the Dr will join the patella...but during surgery they decided to remove patella...bcause there were many pieces(major part was crushed).
The operation notes document details are  are as follows-
Under SA,SaO2,Continous cardiac monitoring and tourniquet applied,Paintingand draping done with Pt.insupine position done.Vertical Incision taken.Skin & subcutaneous tissue dissection done.wash given.Patella fracture fragments identified and excised keeping soft tissues intact.Quadricepts expansion approximated in extension and sutured with Ethibond.Incision closed in layers with Vicry 1-0 & ethilon 2-0 for skin.Sterile dressing done,tourniquet removed.Pt.out of anaesthesia.Whole procedure uneventful.No post operative DNVC Pt shifted to ward.
....So this is about the operation notes/report
Now a plaster is put on his Left leg...right from toe to thigh.Dr has adviced him to walk a small distance for 2-3 times a day with the help of Walker....
Sir I am a bit worried because ....will his foot work normally without Patella also...How much time it will take for complete recovery.
Waiting eagerly for your reply Sir
Thank You
...Sandeep Chaudhari
(India)


ANSWER: Hi Sandeep,

Providing he did not injure any other area of his leg or hip he should be able to walk just fine.

Of course he will not be walking perfectly with the cast on but once its removed he will either start some physiotherapy or do the exercising himself. That will depend on the surgeon and your brother.

The fact that he had the patella removed will not hinder his walking.
Its there to protect the knee itself from head-on trauma and the patella acts as a leverage when you extend the leg.

He should be just fine.

Richard Haynes
Punta Gorda, Florida.
www.totaljointfitness.com
www.richardhaynes.com


---------- FOLLOW-UP ----------

QUESTION: PATELA REMOVL SURGERY..........
Hello Sir
His casting(plaster) and steetches of knee have been removed after 25 days.
There is sweeing near knee area..and hardness in the muscle in knee area.
The doctor has suggested him some exercise
1)Bending knee below slowly .....now he can bend it upto   25  to 30 degrees...that to with the support of other leg
2) Compressin and release of the knee muscles
..He can walk with the help of walker.
....How much time it will take him to bend his knee properly??
....How much time it will take him to walk on his own?
Can you give some guidance about exercise?
Waiting eagerly for your reply
.......Sandeep


Answer
Hi Sandeep,

The time frame as far as how long it will take to bend his knee will depend on  a couple of things.
1. How hard he works at it, in other words how diligent he is to do his exercises.
2. pain control if he has any.

have him try  a moist heating pad around the knee for 20-30 minutes prior to exercises. Most importantly right before he starts to bend the knee. That will help soften the tissue/muscles around the knee allowing them to bend further and easier.

As far as walking is concerned give it another two-three weeks to see how he progresses. The time frame will vary depending on the individual. Make sure he goes from using a walker then follow with a cane on the opposite side of the injury. trying to rush the walking aspect does not work and only causes more problems and swelling etc...

if he can a great exercise is to ride a staionary bike for 5-10 minutes a day. If cleared by the doctor, that is a wonderful way to get the knee to bend and helps with the speed and timing of the knee itself which, will reflect and help his walking.

The Doctor has given you one of the best exercises to bend your knee. The one where he sits in a chair, roll a towel under the affected leg to make sure his foot does not drag the floor, with the help of his strong leg he places gentle pressure on the front part of the ankle and pulls the affected leg back as far as he can then, hold the knee bent for a SLOW count of 5 then release it. Try this 15 times , 2 times a day. You should see results. It works everytime.

Good Luck
Richard Haynes
Punta Gorda, Florida. USA