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Author Topic: TKR & patella baja  (Read 1685 times)

Offline neecypoo

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TKR & patella baja
« on: September 01, 2006, 05:37:52 AM »
I had a TKR in June of 2003 and have been unable to flex my knee much past 90Degrees. During my recovery in the hospital, my Dr did not have me use the Total Motion Machine (not sure of the proper name)  Knee was extremely stiff and painful as I went through the PT for several months.  I've never been able to get my knee 'around a bicycle' nor been able to totally straighten the knee. I would love to be able to squat down a little and use the bike.  I have a new HMO and when examined recently, was diagnosed with patella baja and arthoscopic surgery is recommended to remove scar tissue around patella.  I'm told it might get me a few degrees more flexion and a very remote possibility that the scar tissue could grow back more vigorously and I could have less flexibility than I do now.  I'm interested in any input about the possible cause of patella baja from TKR, the possibilities of worsening the condition and the successful treatment of the problem.  Thanks
Janice

Offline Jules

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Re: TKR & patella baja
« Reply #1 on: September 01, 2006, 08:03:12 PM »
Hi Janice,
I had TKR may 2006 and PFR 17 days ago.
But I would have thought if you have the scar tissue removed and then really rigorously do the bending exercises afterwards so the scar tissue doesn't get chance to build up so quickly, you should get more flextion back.
Jules
Apr 01 - bi-lat debride
Dec 01 - bi-lat mircrofracture & LR
Nov 02 - bi-lat debride & LR
Oct 04 - bi-lat A'scopy & harvest
Nov 04 - R ACI
June 05 - R A'scopy/shave
May 06 - R TKR
Aug 06 - L  PFJR
Jan 07 - L open LR
Oct 08 - L open LR
Feb 09 - L A'scopy/shave
July 09 - L TKR......
20 ops in 13 years

Offline Jaci

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Re: TKR & patella baja
« Reply #2 on: September 02, 2006, 01:53:45 PM »
Hello Janice,

I don't normally post much in this section of the board, but the words 'patella baja' caught my attention. I have not had a knee replacement, but I have had more than my share of problems due to excess scar tissue formation. Patella baja is a condition in which the patella tendon has shortened and pulled the patella into a lower than normal position on your knee. It is generally caused by excess scar tissue (arthrofibrosis) that developed following trauma i.e. injury or surgery. If scar tissue is not properly treated it can lead to shortening of the patella tendon. Both scar tissue and patella baja can inhibit knee motion. In some cases the lowering of the patella is due to adhesions  tethering the patella down to the tibia (shin bone), and no shrinkage of the tendon has taken place. Generally there is a relatively short window of opportunity (6 to 12 month from onset) in which scar tissue can be effectively dealt with to prevent permanent changes like patella baja from occurring, so it may be problematic that you've gone three years with less than full ROM which suggests that the scar tissue has been there for some time. Whether a scope at this point will help is hard to say, there probably is no way that anyone can make that prediction.

My recommendation is to do lots of research so you have a better understanding of the condition. That way you can at least make an informed decision on surgery. There is a great tutorial in on arthrofibrosis (excess scar tissue) on the main website. Here's a link to it:

http://www.kneeguru.co.uk/KNEEtutor/doku.php

Also, do some research in medical jounals using Google, Yahoo, or Pubmed (this searches medical journals). Look for information that deals specifically with arthrofibrosis/ scar tissue after total knee replacement.

Regards,

Jaci
« Last Edit: September 02, 2006, 03:40:35 PM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline neecypoo

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Re: TKR & patella baja
« Reply #3 on: September 08, 2006, 03:25:11 PM »
Hi Jaci,
Thanks for your information.  I will do the research and try to decide if its worth having another surgery.  I'm having a little trouble maneuvering this website, so hopefully I have replied to you correctly.

Janice
Hello Janice,

I don't normally post much in this section of the board, but the words 'patella baja' caught my attention. I have not had a knee replacement, but I have had more than my share of problems due to excess scar tissue formation. Patella baja is a condition in which the patella tendon has shortened and pulled the patella into a lower than normal position on your knee. It is generally caused by excess scar tissue (arthrofibrosis) that developed following trauma i.e. injury or surgery. If scar tissue is not properly treated it can lead to shortening of the patella tendon. Both scar tissue and patella baja can inhibit knee motion. In some cases the lowering of the patella is due to adhesions  tethering the patella down to the tibia (shin bone), and no shrinkage of the tendon has taken place. Generally there is a relatively short window of opportunity (6 to 12 month from onset) in which scar tissue can be effectively dealt with to prevent permanent changes like patella baja from occurring, so it may be problematic that you've gone three years with less than full ROM which suggests that the scar tissue has been there for some time. Whether a scope at this point will help is hard to say, there probably is no way that anyone can make that prediction.

My recommendation is to do lots of research so you have a better understanding of the condition. That way you can at least make an informed decision on surgery. There is a great tutorial in on arthrofibrosis (excess scar tissue) on the main website. Here's a link to it:

http://www.kneeguru.co.uk/KNEEtutor/doku.php

Also, do some research in medical jounals using Google, Yahoo, or Pubmed (this searches medical journals). Look for information that deals specifically with arthrofibrosis/ scar tissue after total knee replacement.

Regards,

Jaci

Hello Janice,

I don't normally post much in this section of the board, but the words 'patella baja' caught my attention. I have not had a knee replacement, but I have had more than my share of problems due to excess scar tissue formation. Patella baja is a condition in which the patella tendon has shortened and pulled the patella into a lower than normal position on your knee. It is generally caused by excess scar tissue (arthrofibrosis) that developed following trauma i.e. injury or surgery. If scar tissue is not properly treated it can lead to shortening of the patella tendon. Both scar tissue and patella baja can inhibit knee motion. In some cases the lowering of the patella is due to adhesions  tethering the patella down to the tibia (shin bone), and no shrinkage of the tendon has taken place. Generally there is a relatively short window of opportunity (6 to 12 month from onset) in which scar tissue can be effectively dealt with to prevent permanent changes like patella baja from occurring, so it may be problematic that you've gone three years with less than full ROM which suggests that the scar tissue has been there for some time. Whether a scope at this point will help is hard to say, there probably is no way that anyone can make that prediction.

My recommendation is to do lots of research so you have a better understanding of the condition. That way you can at least make an informed decision on surgery. There is a great tutorial in on arthrofibrosis (excess scar tissue) on the main website. Here's a link to it:

http://www.kneeguru.co.uk/KNEEtutor/doku.php

Also, do some research in medical jounals using Google, Yahoo, or Pubmed (this searches medical journals). Look for information that deals specifically with arthrofibrosis/ scar tissue after total knee replacement.

Regards,

Jaci


Offline Jaci

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Re: TKR & patella baja
« Reply #4 on: September 09, 2006, 07:10:43 PM »
Hello, Janice,

Patella baja is not very common. I'm actually surprised that your HMO doctor recognized the problem; many doctors would have no idea what it is. Your doc is correct that surgery is probably the only way to treat it.

I hope you're finding some information on the condition. I know from researching arthrofibrosis that it takes some work to find information, but it's imperative that you do your homework. So you can make informed choices about your treatment.

BTW, the easiest way to repond to a post is to click on the 'reply' button. You can find it either in the header or the footer of the thread you are reading on. You may have to scroll up or down a little to see the header or footer. You'll see 'notify' 'mark unread' 'send topic' and 'print' buttons next to it. I'm sure you'll get the hang of it in no time.

best wishes,

Jaci

10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline neecypoo

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Re: TKR & patella baja
« Reply #5 on: September 15, 2006, 02:38:50 PM »
Thanks for your response Jaci.

I've read the tutorial you suggested on arthrofibrosis.  It seems from my reading that an arthoscopic surgery to release? scar tissue might help to achieve more flexion, but can't really correct the position of the patella?

I'm in California and wondering after your comment on HMO docs if I should let him do the 'cleanup surgery'.  He was able to schedule the surgery within a few weeks of my initial visit.  Is there a way to check out a doctor to see how successful he has been or unsuccessful?  Thanks
Janice

Offline Janet

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Re: TKR & patella baja
« Reply #6 on: September 16, 2006, 03:50:18 PM »
If the scar tissue is removed quickly before it has hardened and permanently shortened the patella tendon, then yes, releasing the scar tissue can allow the tendon to return to normal length and the patella baja can be corrected. Since you have gone so long, my guess is that your tendon is permanently changed. However, releasing the scar tissue can relieve some of your pain and allow the knee to move in a more normal manner. This is what happened to me (although not following a TKR). My patella baja was not diagnosed until much later and is a permanent thing now, but the removal of the scar tissue allowed me to function much better.

Was there something in your original post-op period that may have contributed to the scar tissue? Did you have an infection or a blood clot that stopped you from moving your knee? How is your quad strength? That is also a factor in developing patella baja. Make sure to ask your doctor about the rehab protocol so the scar tissue does not return. It may need to be different now that you are known to produce excessive scar tissue.

Ask him how many patients he sees with this problem and what his treatment success rate is. Ask him if he will do anything different during this surgery to prevent the scar tissue from returning. (I have a history of arthrofibrosis and patella baja, and will have a TKR in November. My OS said he will use a combination of nerve blocks and injections so we can get the knee moving post-op with as little pain as possible. He also said if there is any sign that ROM is limited at the three-week mark, he will do a manipulation.) If you want to get a second opinion before going through another surgery, that would be reasonable, too. Good luck.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline Jaci

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Re: TKR & patella baja
« Reply #7 on: September 17, 2006, 12:03:33 AM »
Hi Janice,

Sorry for not responding sooner. I was out of town early in the week, then took a few days to catch up once I got home.

Janet did such a good job answering your post that there is little for me to add other than to emphasize what she said about asking what he will do differently during surgery and post-operatively through rehab, injections, and so forth to reduce or prevent scar tissue development.  The surgery is only part of the equation, so ask for a detailed plan of what will follow. If he doesn't mention things like using CPM, adequate pain control, immediate appropriate rehab (not forceful PT), ROM goals, and early intervention if goals aren't met, it may be a good idea to see someone else. One of the difficult things with scar tissue is that you have to go into your appointments with a list of questions already knowing the answers you want to hear. Those answers should include all the things that Janet mentioned in her post. If he doesn't mention those things, it may be a good idea to see someone else.

Also, if you feel things are moving too fast, request a later surgery date. A few more weeks to do research, get another opinion, and/ or feel comfortable with your decision will not make a huge difference at this point.

best wishes,

Jaci

PS-- I'm sending you a personal message. To check your inbox-- Look for the 'user info' box in the upper left-hand area of the page. You'll see "Hey, neecypoo, you have _____ meassages, X are new." Just click on the underlined number and it will take you to your messages.

10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS