I hate my knees

[loopylizbristol]

Hello everyone, im new to this so you'll have to excuse any mistakes etc

I'm feeling rather depressed at the moment, I have my pre- op appt next week and am not loooking forward to it at all.

back in the good old days (i feel really old now) when I was 26 (2005) i had my first knee op, after many years of pain and discomfort and many dislocations i had trochleoplasty surgery from johnathon eldridge, my 10cm scar is fantastic!!  this was great and it seemed to work until 2009, when my leg gave way and all the pain came flooding back

after seeing the gp and being referred back to the hospital i was scheduled for another op.. this time (sorry i dont know the procedure name) i had keyhole surgery (still left me with 3 new 3cm scars) where Dr Eldridge took the ligaments and tendons???, pulled them up and screwed them to my knee cap, again, worked great.
for a year
during this time i even managed a sponsored skydive for charity
and then i fell, and have been in pain since the beginning of 2011, after ct scans and xrays physiotherapy saying that there was nothing they could do, and hydrtherapy sessions, i was allowed a consultation with Dr eldridge...... however what i got instead was a junior doc that was working with mr eldridge... i was quite sad and annoyed

however, as he was junior and i was a puzzle to him (his words) he did a thorough examination of my right leg, bending pulling twisting getting me to stand etc he went away to speak to mr eldridge. he came back and apologised that maybe, when they had done the trochleoplasty they MAY have put my knee cap too high thus causing it to rub against my tendons causing tendonopathy, he gave me two choices.. live with the pain or go for an operation (again, i dont know the name ) he told me they would 'go in and look at the kneecap placement, lower it, break my shin bone to re-allign it with the knee, tighten it all up and have me pinned up and in a leg brace for 6 weeks'

so i sat in the hospital close to tears thinking i really dont want to live in constant pain, im 32, i have 3 children and i cant run with them, i cant get on the floor and play with them, i cant even go for a bike ride with them so i agreed i wanted the op, but now with the pre op next week and the op date (aug 3rd) is creeping ever closer i am 'bricking it' to put it politely

i just feel really down and i hate being out of control and having to rely on others.
does anyone else feel the same???

liz

[The KNEEguru]

Hi
Firstly, I am going to move this new thread to the patello-femoral section, where there will be more people that understand the problems you have gone through.

Secondly, It will be good if you ask for your operation notes for the first and second procedure, and put the dates and the procedure names into the 'Signature' of your Profile here on KNEEgeeks. Without knowing what the second procedure was our advice may be limited. Presumably you initially had 'trochlear dysplasia'? (See http://www.maitrise-orthop.com/viewPage_us.do?id=1053)

A trochleoplasty may be a 'sulcus deepening' one as shown in that paper above, where the centre bit is lowered, or a 'lateral facet elevating' one, where the lateral (outer) wall of the groove in which the patella should run is elevated (see http://www.kneecourse.com/download/seminar_2010/friday/LANDREAU%20Trochleoplasty.pdf). I wonder which trochleoplasty procedure you had?

The results of trochleoplasty are known to still not be that good, and I am surprised that you undertook a skydive, because this knee was clearly structurally a problem from the beginning.

Was the patella dislocating before the trochleoplasty? And which way, if it was (to the outer lateral side or to the inner medial side)?

[loopylizbristol]

thank you so much, i will ask for notes when i go for my pre op on thursday,

before my trochleaplasty my knee cap would dislocate inwards towards my groin if that makes sense, but at a downwards angle..
i have been told that they had to remove quite a bit of cartiledge and my knee cap sits quite high up on  my knee 'joint'

thanks again for the advice, i will seek answers on thursday... wish me luck !

liz

[The KNEEguru]

my knee cap sits quite high up on  my knee 'joint'

I imagine that what you mean is that you have 'patella alta' (high riding patella) - did the OS use that term?

[The KNEEguru]

before my trochleaplasty my knee cap would dislocate inwards towards my groin if that makes sense, but at a downwards angle..

These photos
- http://www.rheumors.com/kneeexam/patellar_dislocation.jpg
- http://www.raems.com/dislocated%20patella.jpg
show  'lateral' dislocation of the patella, which is the common kind of patellar dislocation. What you seem to have described appears to be the opposite of this - am I right?

[Silkncardcrafts]

Knee guru,

I think you are misinformed about Trochleoplasties.

If done for the right reasons they can be very successful. I am one of those. Unfortunately there are a lot of myths about Trochleoplasties.

It is important that the right type of imaging is done first before an evaluation can be done.

Liz, I would be getting another opinion. Would demand to see Mr Eldridge first before committing to any surgery.

[lisa424]

I think the concern is that we don't know about the long term outcomes/effects. I'm sure it also depends on the skill level of the surgeon.

[Silkncardcrafts]

Well, that is very different.

There are studies being done all the time and are very promising.

It is imperative that detailed and appropriate scans are done before considering a trochleoplasty. My surgeon is a well renowned surgeon in Melbourne, Australia specialising in patella problems. He only considered it as a last resort after doing detailed and specific CT scans.

[The KNEEguru]

Hi
I can only say that I attended a lecture by Dr David Dejour at the European ESSKA conference earlier this year, where he told us that the results of trochleoplasty, even in the best hands, were still not good. He did qualify that, and said that they were much better in the younger patient.

[lisa424]

That's interesting to hear.

[aaa]

Very interesting information in the links above.  I wonder if certain classifications, such as type C/D, would be harder to correct?

[The KNEEguru]

yb - I do not know, but here is another paper for you out of interest.

This paper will be a bit complicated for most of the KNEEgeek readers, but I am adding the link anyway - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307428/?tool=pubmed

In this paper Dr Beaufils is suggesting that the 'recession wedge trochleoplasty' is a more appropriate procedure for the older patient.

[Silkncardcrafts]

There are lots of differing opinions about the Trochleoplasty. My surgeon said a lot of the myths about Trochleoplasty are not true.

As far as I am aware there is no evidence supporting Dr De Jour's view. All the studies I have read on Trochleoplasties are very encouraging. I think we need to remember that this is a rare operation.

My surgeon has a lot of success with Trochleoplasties.

[CariG]

Hi Liz, firstly....big hugs!!! You deserve them and more....I was in tears as I read your entry...mainly as you described so many emotions that I myself experience. Some daily...some a little less frequently.  I'm 39, can't get about and teach my 3 yo granddaughter how to jump in puddles properly ( none of this little splashing business!) can't get on the floor to cuddle up with my Godson or nephews....can't dance with my ever patient & loving man, unable to walk around and hold any of the babies in our life.....ugh, that's a lot of not's/can'ts isn't it!!
My friends and family are very understanding, and supportive, but their level of understanding is different.....there are days when I just want to yell and scream at how unfair it is that I've lost my independence, and how on earth can I be a positive role model to my daughters when I feel as useless as breasts on bulls??? I then get told in no uncertain terms that I AM A POSITIVE ROLE MODEL to my daughters, friends, and even to my partner, as I don't give up...I still manage to face off with my exercise/torture equipment daily, I still persist in doing some of the housework (might take me an hour or two to do a five minute task) and I'm stubborn enough to insist on still being feminine. Sometimes that positive reinforcement when you least expect it is the best medicine. None of this replaces what you've lost in the interim, and I hope that you will shortly gain some relief. Good luck with your upcoming procedures.