The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: kscamper on July 24, 2004, 06:32:46 AM

Title: Knee Cap replacement
Post by: kscamper on July 24, 2004, 06:32:46 AM
I have been told that I may have to have a knee cap replacement.  Has anyone had one?

Title: Re: Knee Cap replacement
Post by: ELF on July 24, 2004, 08:41:53 AM

You didn't  really say why you would need one and how old you are, that's important.

I had a kneecap removed [patellectomy] many years ago, it was crushed beyond repair, so I've had more than a casual interest.

In my research I've found, replacements are rarely very successful due to the fact that they usually wear out quite fast, 6 mo. or so depending on activity. [of coarse, if one were older and more immobile that would be a factor]

I can tell you a couple things from personal experiance. Knee cap removal should an absolute LAST RESORT! Not because you really need a knee cap to walk, you don't. The problem is without it you greatly reduce your quadricep [thigh] muscles [by 20% to 50% depending on who you ask] , due to a loss in mechanical advantage.
This is despite the most rigorous physical therapy.

Please check with more than one OS before proceeding for other possible options! [Even if you wanted to continually replace worn out replacements, I think there is a limit to how many they can do]

The positive side is, if the knee cap must be removed, I was able to resume a relatively active life without one.

Good luck!
Title: Re: Knee Cap replacement
Post by: kscamper on July 24, 2004, 07:56:31 PM
I guess I should have told my story first, huh?  
I am 53 years old (female) and have been very active all my life...softball, aerobics, golf, skiing...etc.  2 years ago this coming December I fell and hit my right kneecap directly on the edge of a cement step.  Had a couple of stitches and didn't think much more about it till a couple of months later when I kneeled down on it and felt extreme pain.  I dealt with it for almost a year until it got to the point that every step I took it would "catch" and pain like crazy.  I went thru weeks of PT which made it worse. Finally had an MRI that showed "small joint effusion in the patellofemoral joint area with fluid along the anterior aspect of the ACL.  No visible tears but disruption of a few fibers."  I had a cortisone injection at that point.  The pain subsided for about a week and was back in full force.  Then I was told it was arthritis.  Have been on steriod medication, anti-inflamatory meds....all of which have done nothing to take care of the pain.  I had another cortisone injection with aspiration of fluid in mid June this year....that one lasted about 3 weeks.  I have pain when I walk, sit, drive, stand....constant.  Another MRI and cortisone injection this past week.  Evidently there is alot of degeneration on the underside of my kneecap.  The doctor suggested a Patella Replacement....removing and putting in a plastic one or something like that.  He mentioned total knee replacement later down the line.  

I am just not real sure what to do since I have been unable to find any information on this procedure.  My quality of active life is non-existent...if I take a walk I am down for 1 day.  If I play golf I am down for 2-3 days.  I have never been one to sit and this is driving me absolutely nuts.

Thats pretty much it.
Title: Re: Knee Cap replacement
Post by: ApplePie on July 24, 2004, 10:39:27 PM

At 22 years old, I was told that I was too young to have a knee cap replacement since it would need to be replaced every 10 years or so. Too much rehab for such a young age I guess.  :P
Title: Re: Knee Cap replacement
Post by: Heather M. on July 24, 2004, 11:57:49 PM
I think the procedure your doctor is talking about is called a Patello-femoral joint replacement, and it is one of several kinds of partial knee replacements.  In this procedure, the back of the patella and the trochlear groove in which the patella moves are resurfaced.  It does not have quite the high success rate that a total knee replacement does, but it is indicated for someone like you with no previous tracking or mechanical problems who suffered a traumatic, focal lesion in the cartilage.  This means that your damage is likely limited to the back of the kneecap.

One thing that is usually done before a major open procedure is an arthroscopy to clean things up.  It may be that the rough cartilage is what's irritating your knee, or you could have a loose body or knee mouse floating about in there really inflaming things.  Likely, if you went in for a PF joint replacement it would start as an arthroscopy to take a look at things.  Then, if there is nothing otherwise evident, often the doctor will move on to a PF joint replacement.  You may want to talk to your doctor about the possibility of a diagnostic arthroscopy first, and then rehabbing and seeing if the scope and cleanup helped at all.  You also may want to consider visiting a doctor who does a LOT of these PF joint replacements and seeing if he agrees you are a candidate for this procedure as well.

It sounds like you are in good hands, PF joint replacement is pretty cutting edge and can actually forestall a total knee replacement for several years--even ten--if the patient is properly selected, has a good body mass index and good mechanics (overweight patients do poorly, darn it, as do those with bad knee mechanics or maltracking kneecaps, darn it.  There goes my chance...sigh).

Some good information can be found on this web page in the patello-femoral joint section, and in the partial knee replacement sections.  But not a lot of people have had this procedure, and not many on this page.  I think that's because people with severe tracking problems and bad mechanics tend to congregate on this web page.  We are absolutely not good candidates for this procedure, although most of us do have the exact same damage you do--I know that is the problem with my kneecap, anyway.

Another good resource is a publication by Grelsamer and McConnell-- The Patella:  A Team Approach.  It used to be on a web page, but that seems to have been shut down.  The publication is out there if you look, though.  Proed Inc has it listed on their web page, so you may be able to get a copy there.

Good luck.

Title: Re: Knee Cap replacement
Post by: kscamper on July 25, 2004, 01:15:29 AM


Thank you for the excellent information!  My doctor did say he would start with arthroscopiic surgery to clean things up first and the proceed with the kneecap replacement.  I am just hoping against hope that the cortisone injection I got on Thursday will kick in soon and alleviate the problem (not looking real good at this point tho!).

Thanks again for your info.