Managing Chronic Knee and Spine Pain After Surgery: Expert Insights

Q: Managing Chronic Knee and Spine Pain After Surgery: Expert Insights

Hello： Due to your multiple severe fractures, particularly the fracture of the twelfth thoracic vertebra, there are many potential sequelae. <br>Regarding the displaced patellar fracture (which I believe is a 0.2 cm discrepancy), the risk of developing osteoarthritis significantl

Spinal knee pain

I had an accident a year and a half ago that resulted in fractures of my right knee and the twelfth vertebra, requiring surgery and fixation devices.
The steel pins in my right knee were removed a year ago, and the spinal fixation device was removed before the Lunar New Year.
However, both areas continue to cause persistent pain, significantly affecting my daily life.
An X-ray examination revealed a displacement of the patella by about two centimeters.
The doctor indicated that this might be the reason I am unable to kneel and experience pain even with slight climbing.
After taking medication for over six months without improvement, the doctor suggested considering "arthroscopy and bone smoothing" surgery, but there is no guarantee of how much improvement can be expected post-surgery.
Additionally, if my spine is not kept in a very "upright" position, even slight forward bending, such as while eating or writing, causes severe pain that requires me to lie down and rest.
1.
What is "bone smoothing," and is it very painful? Will it really improve the pain and weakness in my right knee?
2.
Besides medication, what other methods can help alleviate my back pain? What additional examinations can be done? (Generally, how long does it take to recover to a state of less pain after the removal of fixation devices?) Should I follow the doctor's advice to continue taking medication for another six months and then reassess the situation?
3.
These pains severely impact my daily activities.
Could you please provide some more appropriate suggestions? Thank you!

Zhen'er, 30~39 year old female. Ask Date: 2005/04/02

Dr. Shi Qiming reply Orthopedics

Hello: Due to your multiple severe fractures, particularly the fracture of the twelfth thoracic vertebra, there are many potential sequelae.
Regarding the displaced patellar fracture (which I believe is a 0.2 cm discrepancy), the risk of developing osteoarthritis significantly increases with a displacement greater than 0.1 cm.
Therefore, the use of arthroscopic bone smoothing surgery to reduce patellar wear is a viable option (arthroscopic high-speed smoothing).
The inability to straighten the spine after a thoracic vertebra fracture will depend on the extent of spinal damage and whether there is a kyphotic angle affecting the normal curvature.
These conditions require a detailed examination in the outpatient clinic for proper assessment.
Please visit the outpatient clinic for a thorough diagnosis and treatment.
Thank you.

Reply Date: 2005/04/02

More Info

Managing chronic knee and spine pain after surgery can be a complex and frustrating journey, especially when previous interventions have not yielded the desired results. Based on your situation, it is crucial to understand the underlying issues and explore various management strategies.

Understanding Bone Grinding (磨骨)
Bone grinding, or "milling," is a surgical procedure often performed using minimally invasive techniques, such as arthroscopy. This procedure aims to smooth out rough surfaces of bones, particularly in cases of osteoarthritis or other degenerative conditions. The goal is to reduce pain and improve joint function. While the procedure itself may not be excessively painful due to the use of anesthesia, the recovery process can involve discomfort as the body heals. The extent of improvement in knee function and pain relief can vary significantly among individuals, and it is essential to have realistic expectations. Discussing these expectations with your orthopedic surgeon can provide clarity on what you might achieve post-surgery.

Managing Back Pain
For your back pain, which seems to be exacerbated by certain postures, there are several strategies to consider beyond medication:
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your spine, improve flexibility, and teach you proper body mechanics to reduce strain on your back. A physical therapist can tailor a program specific to your needs and limitations.

2. Pain Management Techniques: Techniques such as acupuncture, chiropractic care, or massage therapy may provide relief. These alternative therapies can help alleviate muscle tension and improve circulation, potentially reducing pain.

3. Posture and Ergonomics: Since you mentioned that certain positions trigger pain, focusing on your posture during daily activities is crucial. Ergonomic adjustments to your workspace or using supportive seating can help maintain a neutral spine position and reduce discomfort.

4. Mind-Body Techniques: Practices such as yoga, tai chi, or mindfulness meditation can help manage pain by promoting relaxation and reducing stress, which can exacerbate pain perception.

5. Diagnostic Imaging: If your pain persists, further imaging studies such as MRI or CT scans may be warranted to assess for any underlying issues that were not previously identified. This can help guide further treatment options.

Recovery Timeline
Regarding the recovery timeline after hardware removal, it can vary widely based on individual factors such as age, overall health, and the extent of the surgery. Generally, it may take several weeks to months to feel significant improvement after hardware removal. It is not uncommon for patients to experience residual pain as the body adjusts to the absence of the hardware and heals from the surgery.

Recommendations
Given the chronic nature of your pain and its impact on your daily life, here are some tailored recommendations:
1. Consultation with Specialists: If you have not already, consider seeking a second opinion from a pain management specialist or a spine surgeon who can provide insights into your condition and potential treatment options.

2. Comprehensive Pain Management Plan: Work with your healthcare team to develop a comprehensive pain management plan that includes medication, physical therapy, and alternative therapies.

3. Regular Follow-ups: Keep regular appointments with your healthcare providers to monitor your progress and make necessary adjustments to your treatment plan.

4. Lifestyle Modifications: Incorporate low-impact exercises such as swimming or cycling into your routine, as these can help maintain joint mobility without putting excessive strain on your knees or back.

5. Support Groups: Consider joining a support group for individuals with chronic pain. Sharing experiences and coping strategies with others facing similar challenges can provide emotional support and practical advice.

In conclusion, managing chronic knee and spine pain after surgery requires a multifaceted approach. By exploring various treatment options, maintaining open communication with your healthcare providers, and actively participating in your recovery, you can work towards improving your quality of life.

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