Tuesday, 20 May 2008

Its "OK 4 GO" in T - 2 months ( and counting!)

Just got back from the follow up Orthopaedic Out Patient Clinic.
The questions were answered after a brief hands on exploration of the right thigh confirmed no apparent infection remained.

A 2nd stage Operation was still on, there would be no need for prophylactic anti biotics leading up to the operation as the joint would probably be cemented and or bone allograft with a cement collar at the junction with remaining bone above the knee. Progress after the operation would be normal ( all being well) and if cemented I would be weight bearing straight away although assisted with crutches/ walking stick(s) initially.

The operation will be scheduled within 2 months in preparation for which I had some blood taken to assess current inflammatory markers (CRP and ESR levels) and will be invited to another pre-op assessment.

The advice about weight bearing was interesting - I was still to work on the assumption of no more than 20% weight bearing. When I asked how can I tell the answer was blindingly self evident - in retrospect - "Stand on some scales with both feet then place the good foot on the ground and put pressure through the bad foot until 20% of the previous weight registers" - Of course - but why is this technique not known more widely e.g. by physiotherapists. Even armed with the knowledge of how to measure a percentage of weight bearing my muscle feedback mechanism is not that finely attuned yet to assess the difference between 10% and 20% so it still remains a very subjective (touchy feely) measurement.

We tried to export the X-Ray image to a memory stick and although the software allowed for this and the consultant was happy to give it a go we only succeeded in setting up an empty folder. Plan B was to take an image or two with a hand held digital camera. You can see the result. Both my wife and I realised that there was significantly more of my own femur in place than we had been told. It now appears that I have just under half of my own femur in place. The surgeon said that they also thought they had been more radical and that it is not easy to judge in the heat of battle (my phrase not his!). I expect one other reason for the inaccurate estimate is that I have relatively long legs for my height another is that they would not want to peel away more tissue than necessary just to get an accurate assessment.
Having said that the x-ray shows the metal rod fixed into the remaining bone and around which a cement version of the head of femur was constructed, so I assume it would have been possible to know how much of this rod had "disappeared" into my remaining length of bone. All academic really I suppose. The metal rod is the important thing here. The cement being formed into a temporary bone was more to store the slow release gentomycin to fight infection and to act as a spacer to stop leg length shortening. It did not matter that the junction between cement and bone was displaced as pressure would be through the rod not the cement.

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