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Author Topic: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2  (Read 231507 times)

Offline lucha86

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1470 on: February 10, 2017, 08:58:17 PM »
Hey nick long time since i posted lol  :P
i do agree with vickster dont rush into things, surgery is last resort i had a thought, which may explain some issues and i do agreed with vickster on this

i think crucially its finding a surgeon that deals with hips and knees,  but when you said its a problem with the hip and knee have you ever been checked for a connective tissue issue the reason why i say this is knee instability and the hip issues are common under this and that i remember i think you said your quite tall also? have you ever been checked under rheumatology ? they specialise in disorders of joints muscles and ligaments?

have they tested your base line of beighton and brighton criteria?? which checks if your hypermobile? which can be an issue for joints?

as i am very tall also and scored high on the beighton and brighton criteria i had some issues with my hip but most generally in knee.....

after my years of surgery im glad i have a doctor within rheumatology as its a bit of a cross over with orthopaedics and rhuematology is more holistic approach....... im no doctor but i thought it may be some advice, but i do agree with vickster .......

Offline Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1471 on: February 18, 2017, 07:50:18 PM »
18/02/17 30 Months Day 956 Post Op

I finally got internet access at home so no more trips to the public libraries with dirty keyboards and food stains. It like having main services at home of electric, gas and water. It took a while to convince my mum to start using the worldwide web after being told she can keep in contact with family and friends on Skype at no extra cost with WiFi connection.

Came back from Saturday's autism playgroup, it is hard not to take part physically, it a great way to engage with the kids. The Sports Medicine Doctor is right in his latest report that my right hip is now more painful than my right knee. He has written 3 reports since my last monthly update with 2 of the reports referring to my right hip for a referral to see a OS that specialised in young adult hip pain for a management plan for my right hip problems.

I will share the concerns highlighted on one of the paragraphs.

As promised I discussed your MRI of your right hip with my colleagues. There was agreement that there was a small amount of swelling within your hip and there appeared to be a small labral tear. The labrum is the rubber rim that lines your hip joint. We had also noted that you may be more susceptible to to this because we have noted small bony bumps associated with the head/neck junction of your thigh bones (femur on the right) This is a cam type of femoroacetabular impingement.

The 2nd report last paragraph.

I do feel his right hip is now affecting the function of his knee. However I am convinced that the arthrofibrosis which has occurred after previous right knee surgery will also have had a biomechanical effect of overloading his right hip over the last few years.

Hopefully it can be managed ok when I see the OS that has a high reputation treating children and adults under 59 with hip complaints. I am seeing the right OS at the hospital. I am feeling happy and content doing whatever he suggests when I see him for the 1st time in the next couple of weeks.

Now for the main report that also refers to my right knee problems.

Dear Martyn,

I would be most grateful if you could review Nicholas, whom we both know well. He has undergone quite an extensive tendon loading programme and shockwave therapy which has not changed his knee symptoms at all. I have undated his MRI right knee imaging and I not think his imaging to my eyes had changed significantly in the last two years (report awaited). Nicholas has discussed that you mentioned previously about an accessory pole excision and decompression. He is keen to explore this with you. I have emphasised, in the presence of Nicholas' mother, that I am not convinced that further surgery can reliably guarantee resolution of his symptoms or improvement of functionly

Nicholas has started to develop some right lateral hip pain associated with some clicking over the last 6 months. This is particularly painful whilst driving and lifting. At times his hip symptoms are worse than his knee symptoms. He has a positive hip impingement signs. I wonder whether his right knee mechanics has had an effect on his gait and therefore his right hip. I have MRI'd this area - There is a small joint effusion and a possible labral injury to my eyes. However I will discuss his images with the radiology team to see if they feel a labral tear is present. I will write after his MRI has been reviewed to plan his future hip management.

Your review with regards whether any further surgery is much appreciated. If you don't feel it is then a pain clinic review may be appropriate.

Many thanks

Yours sincerely,

*** *****

Consultant in MSK and Sports Medicine

I totally in agreement with what the Sport Medicine Doctor advice. I do hope I can see Prof Snow for another consultation and review and chat over my patella tendonitis and arthrofibrosis, I am fully aware that both conditions are hard to get right again. I might have to accept that I may never be able to run again during the rest of my life on this planet. It is always hard to accept if you enjoy long distance running. I have always be passionate about that was favourite hobby until aged 34 that I shall greatly miss thanks to the evil condition of 'arthrofibrosis' that's the culprit to my chronic patella tendonitis.

Lucha, Thank you for giving me some good constructive guidance and not forgetting Vicky. You have both got great knowledge when it comes to joint problems and what treatment options to to consider.

Of course it up to the professionals to decide what management plans they have in mind by doing what they suggest and recommend as the next course of treatment options.

[email protected]
« Last Edit: February 18, 2017, 09:44:19 PM by Clarkey »
RK: PFS, Maltracking & arthrofibrosis
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline Puffy the Knee Slayer

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1472 on: February 19, 2017, 01:38:02 PM »
Hi Nick,

Sounds complex, once we have one problem we end up with others due to compensation, overloading etc and then it is so hard to sort out if they can't work out what is causing what.

I do hope the new hip specialist is able to help.
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Offline Clarkey

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08/03/17 30 Months Day 974 Post Op

I have both dates confirmed for my right knee and hip, the knee consultation with Prof Snow is next week Wednesday 15/03/17 @15:00 that has always been morning or lunch time with my previous consultations. My hip assessment and consultation is Friday 07/07/17 @10:00 which is a long time to wait. 18 weeks waiting time after receiving both letters last week Friday. I did not think hip injuries and problems are more common than knee problems or the waiting list would be less.

Will keep the OS I am seeing private who is one of the top hip surgeons to see in the midlands region for young adults and children who does paediatric surgery so is on high demand, I know many young people at the clubs I volunteer at with dodgy hips. Maybe this is why I have to wait 18 weeks to see him which is worth waiting for. My left hip is also at times painful it is best to get it checked out as he says on a YouTube video that too many patients come and see him when the damage has already been done. It easier if patient’s come at the early stages before they notice an increase in pain.

I am one of them as I always thought it was due to my right knee injury impacting the right hip that highly plausible as AF in the kneecap also has negative side effects on the hip joint hence why there is a tear and impingement of the hip. My mum and sister that works in orthopaedics both think my right knee needs to be addressed first before looking into treatment options for the hip. The Sports Medicine Doctor thinks it is the right hip that’s the main culprit to the cause of my anterior right knee pain. I am not so convinced he right as I think there could be damage to the cartilage with arthritis setting in that can often be clouded or not seen on MRI scan images.

Who knows when I see Prof Snow next week Wednesday he might have spotted something new on the latest MRI scan in comparison to last one done in December 2015. The Sport Medicine Doctor only had a quick glance at one frame of the patella tendon comparing the two. One needs to methodically go through each image before ruling out a positive result.

I know it a cardinal sin after all the pre-warnings from KG members to go for surgical intervention! I just like something done now at this stage post op. What I have in mind is the surgery called ‘Arthroscopic Confluence Coblation Surgery’ that a less invasive and safer surgery to go through then ‘Arthroscopic Infrapatella Pole Surgery’ Mr Hardy has come up with this procedure that no other OS's seem to be looking into as the next option if ESWT Therapy fails to improve patellar tendonitis.

http://www.johnhardy.co.uk/Publish/information/patella_tendonitis.pdf

Mr Hardy’s team will advise you on the benefits and the complications depend on the type of surgery undertaken. Largely the risks are small but include the risks of recurrence, infection, tendon rupture and thrombosis. The Arthroscopic Confluence Coblation is a minor procedure performed under a light sedation anaesthetic with local anaesthetic and takes 20 minutes.

Would it be ok if I mention this procedure next week to Prof Snow he should be able to perform an Arthroscopic Confluence Coblation surgical procedure with his vast experience. He even said in his last report when I last saw him that he is happy to go ahead with surgery if the Sport Medicine Team can offer no more methods of conservative treatments. What I rather have done at this stage is a ‘diagnostic arthroscopy’ that I talked about previously on my post-op dairy. It will make me feel more relaxed and at ease knowing I have done all I can to ease my right anterior knee pain. I would feel less anxious and stressed out at this stage opting for surgery.

My career in supporting young people with autism is on hold right now! I need to tell the manager something is being done to my right knee rather than mentioning PT exercises that I am doing on a daily basis with no significant improvements. I am also thinking in the same way as Puffy with her knee injury that the NHS are saving money not acting on patients with long term chronic knee problems who is also thinking about having surgery to repair her torn cartilage after a guy at her gym told her his trimming made a big difference. On KG Bulletin Board members join that have had bad experiences with surgery when there are thousands of patients out there where surgery has been successful that do not require advice from KG.

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« Last Edit: March 08, 2017, 05:08:53 PM by Clarkey »
RK: PFS, Maltracking & arthrofibrosis
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline Puffy the Knee Slayer

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I was told that arthroscopy is more likely to be of use if there is a clear target rather than them just going in to have a look, and that a lot of patients say after arthroscopy that their knee never felt right again.

I do hear your frustration however with things not improving and MRI not showing much and having to do endless physio that isn't achieving very much.

I don't see the harm in mentioning the arthroscopic confluence coblation surgery and asking if that would be an option for you. It may not be available on the NHS though. I was thinking of seeing John Hardy a while back as he seems to have a good understanding of fat pad issues.

Very difficult to know if your hip is causing your hip or vice versa. Good luck with your appointment next week. I hope something shows up that can be fixed.

I really hope my OS is going to sort my tear out if it does not get better with conservative treatment - especially as it's likely (though they will never admit it) that it was caused by the steroid injection they gave me!
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Offline Clarkey

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15/03/17 30 Months Day 981 Post Op

Had a positive consultation this afternoon leaving content and happy knowing that my long winded right knee saga is coming to a conclusion. Something significant has come up on the MRI and also when doing a physical examination effusion in the knee around the fat pad region. Looks like scarring around the fat pad that would require a clean up during an diagnostic arthroscopy. The effusion is new conclusive evidence to go ahead with surgery that will not happen until I have had my right hip seen to by the hip surgeon.

Prof Snow spent a good amount of time with my mum and I listening to my concerns and has kindly made a referral to have a right hip x-ray guided injection that might make a difference to the knee anterior knee pain. If the knee pain remains the same then I can go back to Prof Snow and go ahead with surgery to clear out any scar tissue build up and other areas that need clean up and trim. The cartilage looks all intact and normal on the latest MRI scan. This is good news but one can never tell if it is really intact until the kneecap is scoped.

I mentioned the confluence coblation surgery showing the article that would not be of no benefit or would be a common surgical procedure with no benefits towards the scarring around the patella tendon. Basically it is a magic zapping wand that has little benefits with only a small percentage with a positive outcome.

I was thinking a few days ago that another AIR surgery might be beneficial after the PT I saw 3 weeks pre-op after scope #2 made me do too much in one session, this wrecked the surgery! if I go ahead with scope #3 I would get the proper after care and guidance to prevent scar tissue building up excessively.

Filled in the pre-op form to have the x-ray guided injection into the right hip, hoping it is not done under GA that was mentioned in the form for injections that said surgery on it. Should be done under local and not general? I have heard mixed views on the procedure some say you are knocked out completely others say semi sedation or are fully awake aware of what is going on. Anyone know what might happen I am not fazed in anyway I just like to know what will happen that day.
 
Knowing something is going to happen is a stress release lowering my anxiety and stress levels greatly after such a long winded ordeal scope #2 post-op diary will end when it reaches day 1000 post op. Will start a pre-op dairy scope #3 if surgery was to go ahead, there is a significant amount joint effusion showing up white on the latest MRI images showing there is fluid inside the knee, something is not right that needs investigating closely at this point in time.

[email protected] 
« Last Edit: March 15, 2017, 10:40:11 PM by Clarkey »
RK: PFS, Maltracking & arthrofibrosis
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline Clarkey

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18/03/17 31 Months Day 984 Post Op

I have now been given a slightly earlier appointment for the consultation on my right hip 16/06/17 @10:30 rather the original date given on 07/07/16. 12/07/17 will be decision day if I will be put on the waiting list to investigate the knee joint effusion that has increased since MRI scan that was done in December 2015. I did have a feeling that the sports medicine doctor did not have the expert knowledge that Prof Snow has saying it looks the same my January MRI scan comparing it to the patella tendon images.

I should be pleased that I am now getting towards what I always thought would happen a 3rd diagnostic arthroscopy. It is the financial stress now that hurting with my savings fast running low, I would have to rely on my mum’s widow pension to live on. I am lucky to live with her as it good for her to have company in the house, she had two falls so far she was lucky that she was ok. Pleased I am there for her as she been widowed since November 2005 after my Dad passed away from leukaemia.

I now have almost 2 years experience volunteering on a weekly basis in south and north Birmingham as a  Playworker for autistic young people at the Saturday Club. I been told by playworkers and leaders that I capable to do the job role that's now on hold due to my right knee and hip pain. I can join physical activities by defending as a goalkeeper blocking, throwing and kicking and acting like a big kid at times. It does seem to go into my hip and knee limiting what I am able to do which is frustrating.

September is a realistic target after all treatment has been given to apply for a job position. At both the clubs I attend staff have left and been replaced that should have been me if it was not for my right knee and hip pain limitations. I knew my right knee had deteriorated even more when my walking pace slowed down and limped more since hearing a loud clunking and popping sound. Might be something that needs to be surgically fixed that the MRI scan is missing out on an accurate positive result. Joint effusion was the turning point to show that my knee is getting worse rather than better.

Now is the waiting game to see what happens next, 2017 will be a year when I be going in and out of hospital. X-ray guided hip injection is the next course of treatment that looks like a minor surgical procedure that is performed and done in theatre according to what I seen online. Saying different options of either spinal, local or general. Gas and air would be a more straight forward option used if you having a dislocated shoulder put back into its socket as an example. It is only a few seconds when the needle goes into the hip rather than sedation methods.

[email protected]
RK: PFS, Maltracking & arthrofibrosis
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Online Vickster

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Nick, I think the injections might be done in theatre (in the NHS) as it's a sterile environment to minimise the risk of infection which exists with any injection. I'd be surprised if they knock you out for a steroid injection, the steroid is usually mixed with the local to reduce the potential pain associated with steroid flare?

Good luck for everything.
« Last Edit: March 18, 2017, 10:57:16 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

 

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