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Author Topic: pattela femoral replacement  (Read 1489 times)

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Offline djsknees

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pattela femoral replacement
« on: May 12, 2006, 01:44:25 AM »
In the last 18 months I have had Patella femoral replacements on both knees, then about 3 months after I also had to have an arthroscope as the fat pad was catching in one knne. I had the PFR  due to ongoing knee problems, some 12 ops before PFR, both knees have had pattela realignment, osteocondal fractures, felt like they were trying to dislocate and had terrible arthitis "ache". On top of this I have also had several ops to remove damaged cartlidge, repair ACL and lat ligaments. I am only in my mid 30's. I had the Patella Femoral replacements after getting second and third opinions. I was even told that I would feel so good I would have to remind myself not to run! I wish. The PFR has gotten rid of most of my arthritis "ache" for which I am very grateful but I have been left with knees which give way at least 4 times a day and also have days where it feels like the button under my knee cap is grating along my patella tendon? This is excruciating, usually only happens in one knee at a time and can take quite a few days to settle down. I can't sit for longer than 10 minutes without having to lift my legs with my arms as it can be to painful to do it via moving my legs. I am OK if I sit with my legs out straight, most of the time. I also avoid stairs as they tend to either cause my knees to collapse more or cause bad flareups. I have had second opinions since the original op but yet again no answer. The most recent Xray of my right knee shows the button, under my knee cap, is "sticking out" 7 - 9 mm, which I assume is causing the "grating" sensation.  I haven't had an Xray of the left taking recently but I am sure it would show the same thing. My surgeon said its normal and has given my a cortisone inj to help control the "grating" with the injection I had about 1 months relief. I keep getting told that I need to build up my VMO to stop the collapsing but when I do this the "grating" senesation gets worse. I feel like I am going around in circles.  I can either have knees which collapse a lot and only a little pain or knees which collapse only a couple of times but a lot more pain? I feel like because my knees are not responding as most do after a PFR that no one really knows what to do. I have good days and bad but have so far manage to keep working full time although sometimes it has been a real effort. I have even resorted to getting cortisone inj in both knees to get through work when it is super busy. Cortisone is also not ideal for me as I have flare ups initally from it in which I can not put weight through the joint injected for up to 24 hours and it can be excruciating, the only reason I get the injections is I know that for 24 hours of horrible pain I may get a month withou much pain. I just want to get on with my life, my husbaand and I would like to start a family in the next year or 2 but with my knees I just can't imagine it.
What I would love to know is have other people had the same experience with their PFR? IF yes did it get better and what did they do to to have more functioning knees. or Am I expecting to much from my PFR?

Offline Heather M.

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Re: pattela femoral replacement
« Reply #1 on: May 12, 2006, 09:19:25 AM »
It sounds like you might need a dynamic or motion MRI so that you can try to get the knee to buckle/collapse/grate while a radiologist is looking inside it with imaging equipment to see what's going on.  That, and the fact that you've had a VERY new procedure at a very young age, means that your case is probably beyond the capabilities of all but a handful of surgeons.  I would seriously find some other doctors that are doing PFJR's (hopefully the same manufacturer) and who have state of the art diagnostic imaging available to them.  I can think of a handful--one in W. Washington state north of Seattle (can't recall the name but can get it if you want); Dr. Steadman in Vail, CO (where they have the 'kinematic' MRI or motion-based diagnostic imaging, as well as incredible diagnostic experience on the part of the surgeons and PT's); Dr. Noyes in Cincinnati, OH (great MRI's and expertise in knee mechanics); and potentially Dr. Blaha in Chicago (I think--not sure if he does PFJR's, tho, but he is a serious TKR expert).  Dr. Grelsamer is a PF expert and frequent poster on this board, so it would be worth contacting him and seeing him for a consult if you are in the NYC area--I just don't recall if he does PFJR's or not.   

I *know* there are others out there, probably in NYC and/or additional members of the International Patello-Femoral Study Group.  But those are the ones I can think of off the top of my head that do a) custom-made (high-end, high difficulty) PFJR prostheses, or b) have access to state of the art imaging systems that might shed some light on what's going on, or c) have significant experience with patello-femoral mechanics and serious ortho-diagnostic credentials.

You may want to also contact the manufacturer of your prosthesis and find out if this is a known problem with the implant you had put in.  And also find out if frequent cortisone injections are contra-indicated...I would think they'd be on the highly suspect list due to their suppression of the immune system and the risk of infection and also the risk of rupturing a tendon due to repeated injections.  But I'm NOT a doctor, those are just common-sense concerns that I'd raise based on my personal experience with cortisone and what I know about joint replacement in young patients.

There are a few joint replacement forums out on the web that I came across while doing research on whether this was an option for me.  20 minutes and a google browser window should point you in the right direction.  There's also a joint replacement discussion section on the main bulletin board of kneeguru's corner of the web--you should find it near the very bottom of the main bb page.  Not sure that there are a lot of PFJR's out there, but you should find a few.  From my research, I recall that you must have near perfect mechanics for the PFJR to work out, and so that rules it out for me....I'm not sure what having a prosthesis that buckles and collapses means, unless perhaps it is dislocating or not physically moving properly as you bear weight and go through your range of motion.  If the leg is buckling as a protective mechanism--your body attempting to avoid excruciating pain or limited range of motion, for example--then that would probably have different ramifications.  Or if your knee hyper-extends first, then dislocates, that would point in a different direction--weak quads and hamstrings, ligamentous laxity, etc.  Scar tissue and nerve damage can also wreak havoc in a joint, natural or artificial.  There are lots of possiblities, unfortunately....

Good luck and keep us posted.  Sorry I can't offer anything more concrete than suggesting names or specific experience with PFJR.  But I do have a lot of experience dealing with rare and exotic knee problems that most doctors are afraid to even let into their exam rooms....so you have my full sympathies.  The joint replacement is always held out to us younger patients as the thing that will fix it all, if only we were "old enough."  To find out that it has created a whole new set of problems must be devastating.  But there are a few good docs out there who deal with extremely tough knee cases, and they may be able to offer some insights.  Hopefully, the manufacturer of your implant will have these as well--you may spend a few hours trying to get the right person on the phone, though.  But it should be worth it.

Take care.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Janet

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Re: pattela femoral replacement
« Reply #2 on: May 12, 2006, 02:41:25 PM »
Sorry you're having so many problems. I don't have any answers for you besides what Heather has already said. This is such a new procedure, you need to find a doctor who has done lots and lots of them and may have seen some complications like yours. And FYI, Dr. Blaha is at the University of Michigan in Ann Arbor, Michigan. I have an appointment with him on May 23 to see about a possible PRF.

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 djsknees

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Re: pattela femoral replacement
« Reply #3 on: May 15, 2006, 04:48:57 AM »
Thankyou Heather and Janet for your reply. I have printed off your replies to take to my physio and GP as they are both on the quest with me to help solve my knee dilemmas.
Since my original posting my physio and GP  had a discussion re my knees and my physio has shown me how to tape my knees to try and “train” my VMO to work. Unfortunately I have sensitive skin and taping can cause a severe skin irritation. As a result I use Fixamol tape under the sports tape and at night take the tape off and apply a cortisone cream, to calm down the irritation. In the morning I put the tape on again. Working OK except my calves feel like they have had an extreme workout and not sure if my knees are not good because of taping or because work is getting busy.
This Tuesday I am seeing my GP who is going to cortisone both my knees, well hopefully. When I booked in for it she said she would although don’t know if she’s that keen on doing them both. Hopefully she will have also had a chance to catch up with my Orthopaedic surgeon which she promised she would try to do before she saw me. Unfortunately I have work for 12 days straight with a couple of 15 hour days thrown in, so it was a case of either pain medication or the injections. I have never had more than 3 lots of cortisone injections in a year as I am conscious of them not being the best for you when used continuously and as I react badly to it for the first 24 hours I only use it when I can’t see another way.
I have a lot of respect for my orthopaedic surgeon as he was the one who told me to get and second opinion and when the second opinion didn’t have an answer he presented my case to a group of 10 orthopaedic surgeons.  On a letter from the orthopaedic surgeon to my physio and GP I was labelled as diagnostically difficult.
Once again thanks for your replies I really appreciate it.

DJ

Offline Heather M.

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Re: pattela femoral replacement
« Reply #4 on: May 15, 2006, 06:18:26 AM »
DJ,

Do I have a tape for you!  I also can't use the regular PT tape on a regular basis, because my skin started turning red and getting ready to fall OUT in chunks--my body did not like the latex, apparently.  Anyway, I have no problems using this newer, better tape product that one of my PT's introduced me to.  It's called Kinesio Tex tape, it comes from Japan, and it is THE BEST stuff I've ever used on my knee!  It gives a very firm hold but still allows you full range of motion.  It even manages to hold my kneecap up in the proper position, which is no mean feat.  It takes a lot of strength to lever it up into the right spot, but the tape holds it.  And get this--when you want to take it off, it almost falls from your body--no lost hair, no lost skin cells, no burn, no rash.  Amazing. 

There are some techniques to learn in applying this tape, as it is single stick only--so you can't touch it with your fingers or it will stick to them, not your knee.  But I learne to just tear away the backing in a slice large enough to do the first contact bit of sticking on my knee, then I'd lever my kneecap into place and hold it with one hand as I pulled the rest of the backing away with the other.  I sat down with a roll and a pair of scissors and just kept at it until I could do it right.

The tape is expensive, but for those of us who need to use it on a regular basis, it is a lifesaver.  No rash, no irritation, no stinging on removal--it just comes right off using two fingers and a baby's breath amount of force--it's so easy.  I will never go back to that awful athletic tape that has to be worn with a liner underneath and is SO stiff you can't even bend your leg properly.  Forget it. 

I use the aqua blue waterproof tape as it is the most strong and long-lasting version.  I wish they made it in nude so I didn't have to wear this turquoise stripe on my knee in public (I live in Arizona, and shorts are worn pretty much year round!), but that's okay.  I can deal with the looks...the tape is that good.

I bought it from a PT clinic in New Mexico--purchased entirely online and sent via express mail with no problems.  I did a quick google search and now it's available via Amazon.com, so that's a possibility as well.  The PT clinic was helpful and gave me a booklet on how to use the tape (but I have an unusual problem so I use a 'customized' approach and the book wasn't very helpful....).

Check it out:  http://www.amazon.com/gp/search/ref=pd_sl_aw_tops-1_blended_14477749_1/002-8711269-0196818?search-alias=aps&keywords=kinesio%20tex   Here's the link I used to purchase my tape--from the manufacturer's web page:  http://www.kinesio-tape.com/KinesioTex1.html

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline pegleg78

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Re: pattela femoral replacement
« Reply #5 on: May 15, 2006, 08:06:12 PM »
I also use kinesio tape on a regular basis. I have been to a few conferences on how to use the tape and it is wonderful. I have 3 books that show you how to tape for different injuries as well as a videotape that explains how to properly apply the tap with the right amount of strech and tension. I would look into it is a great thinkg for my knee, I use it a lot and not just for my knee.
99 ACL, med, lat men repair
00 Med menisectomy, lat men repair
01 med, lat meniscus transplant, ACL rev, LR
01 chrondroplasty, manip & debrid
02 med, lat partial menisectomy
03 Arthrotomy,  LOA, LR
05 chrondroplasty, lat men repair, shrink ACL
05  med menisectomy, chrondropla
05 med PKR

Offline djsknees

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Re: pattela femoral replacement
« Reply #6 on: May 17, 2006, 03:45:30 AM »
Thanks for the info on the tape my physio is looking into it and if all goes well may even stock it. I saw my GP yesterday and she had spoken to the srugeon who said he didn't want her to do cortisone injections due to fear of infection with my implants. He has given me a cortisone injection since my implants though? Am no trialling another drug. We are aiming to try and drop pain to allow me to build up VMO. I have my doubts but am willing to try anything. I live in Australia but maybe a trip to the US is needed if only I could sit on the plane......
Once again a huge thanks to those who have responded and I will post any new developments.
Many thanks.
DJ















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