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Author Topic: Choices Given by OS...Need Help  (Read 1785 times)

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Offline Kris

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Choices Given by OS...Need Help
« on: May 01, 2006, 02:37:53 AM »
I finally got a phone call from the last OS I was consulting with.  The last 4 have recommended a Patello-femoral joint replacement, this fifth one after talking with my original OS and looking at bone scans and X-rays has decided against it.  Not because of the scans or consultation with the OS, but because of my age.  He's basically nervous about doing the procedure on someone almost 28 and have it fail, which in turn leads to a total knee replacement.  He's given me a three options. 

       Option #1:  Pain Management and Extensive Therapy ---Been doing it for years, no relief

       Option #2:  Scope it and take a peak at what's in the knee to get a better idea at what he could do.
             This will lead to either Microfracture surgery (drilling wholes to produce cartilage-I suppose) or Cartilage transplant

      Option #3: He knows I guy in Kentucky that deals a lot with problem kneecaps---John Fulkerson (heard that name before).  I             could give him a call.  I've already been to 5 doctors about this issue and I don't think my insurance will support that.



I've looked up a little about Microfractures, but I still would really like to know much more about it.  What is the recovery routine after surgery?  Hospital stay, crutches, brace, etc.  All details welcomed with this.  I haven't looked up the cartilage transplant stuff at all, so if anyone can help with this as well I'd be very thankful. 

I can honestly say that I'm very scared about having to make this decision.  I'm afraid it'll be wrong and I'll be stuck another year trying to struggle through the pain.  IT was almost unbearable this year with teaching.  I am leaning towards the arthoscopic procedure to look around.  He said he would go ahead and do whatever other procedure he felt would benefit my case during this same surgery.  I have to call them back tomorrow morning.

Kris




 
Right  LR on 2/8/02,  7/11/03, and 11/5/05
Left leg LR on 5/02, 4/05
Right achilles tendon lengthened on 2/01.   Synvisc injections on 2/17/03. 
Cortisone on 12/03 and 3/04, 12/05. 
Proximal Reallignment Right 5/23/05
R Microfracture 5/19/06
PFJR 6/20/07

Offline Doc79316

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Re: Choices Given by OS...Need Help
« Reply #1 on: May 01, 2006, 09:48:09 AM »
Hey,

This type of surgery is usually very successful but you shouldn't have any procedure doen if you think it's going to fail to begin with. Bear in mind that people here are in the minority and are still looking for answers to their knee problems.
People such as Tiffnay (DeGraff), Nancy (Quill) and Mr. F (Adam) I believe have already had this procedure so it may be worth reading some of their posts.
I know that Mr. F is very happy with his and would recommend it. But at the end of the day it's your decision as it's you knee.
This procedure has also been offered to me by my OS if the surgery i had in January doesn't work. If it has been unsuccessful. I woudn't think twice about it - I would have ti done. But that's just me based on how I feel about my knee right now.
Let us know what you decide to do.

Take care,

Laura x
« Last Edit: May 01, 2006, 09:49:50 AM by laura79316 »
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline blackbeltgirl

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Re: Choices Given by OS...Need Help
« Reply #2 on: May 01, 2006, 01:59:46 PM »
Personally,  I can't imagine choosing a joint replacement (of any sort) without first trying something like microfracture.  Yes, it cuold postpone true relief for a year.  YOu won't know unless you try.  BUT, you could also postpone TKR for 5, 10, 20 years or even longer, meaning the total benefit over the course of life is huge.

If your OS goes in to look around, he will be able to determine where the lesion is exactly, the size of the lesion, and the depth.  He will also be able to determine if there are any additional lesions, and if there is any bone involvement.  Without scoping the knee, the best an OS can do is make a guesstimate from mris, which are notoriously inaccurate when it comes to articular cartilage.  (I'm assuming you've also had a variety of x-rays, including standing hip to ankle views and the merchant/sunrise view).

If you only have 1 lesion on the back of the patella, and they microfracture it, it will probably still be an outpatient procedure.  You may be on crutches for up to 6 weeks, but usually if it's just the patella you will be put in a hinged brace with limited ROM, and be free to walk around on it.  Microfracture is not an easy recovery - rehab is critical, and patience is critical.  It takes about 5-6 months for most people to feel like things are getting better.  And if you're not informed of that up front, around months 3-5 it can get pretty frustrating.

Have you had any surgeries yet?  Why were all those surgeons recommending the PFJR without checking out your knee to see if you can't be helped with something less significant, that leaves you more treatment options in the future?  (And I'll be honest, if they made their decisions based on the MRIs, I'd RUN, not walk to get away from these guys.  Not because they're not good surgeons, or even because they've offered the wrong treatment.  But because they're making a diagnosis and treatment decision from an image that doesn't show articular cartilage well.)

Hope this helps-good luck.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline Janet

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Re: Choices Given by OS...Need Help
« Reply #3 on: May 01, 2006, 02:10:28 PM »
Kris:

Jess is right that the only way to really know the state of the cartilege in your knee is through an arthroscopy. That way, the OS can look around and assess the exact damage.

Is your cartilege defect on the back of your patella only? That is my problem. The rest of my knee is fine. I have been referred to a replacement specialist for a possible PFJR and have an appointment on May 23. I'm at that in-between age....49....too young for a TKR, but having too many problems to wait another 10 years. I was told that microfracture doesn't work on the patella. I'd be interested to hear more of your story.

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 Kris

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Re: Choices Given by OS...Need Help
« Reply #4 on: May 02, 2006, 03:20:54 AM »
I have very significant damage to both the underside of the patella and the trochlear groove of the femur.  This was confirmed in my last surgery a year ago from the reports.  I've had nurmerous surgeries, injections, X-rays, bone scans, and MRI's on the leg to find options.  I have scheduled my surgery for May 16th, but it's not quite official yet.  The nurse has to call hospital and the insurance company before it's official.  She said she'd call me back tomorrow.   

I'm not exactly sure what everyone is talking about when they say "lesion".  When I hear it I think of a cut.  I can't visualize it in the knee when I hear it.  I know I have severe arthitis in both knees and my right knee has grade 4 chrondomalacia (sp).  In numerous places the patella is bone on bone with the groove which I was told may be the cause of the "sticking" when the joint moves.  All I would like is to somehow create a smooth area that the patella can move on and lessen the pain.  Whatever does it, I'll do.  There may be a chance that he sees the damaged mentioned by the other surgeon and actually perform the PFJR.  It's possible, doubt it though. 

With these other surgeries, would doctors keep a patient overnight if he knows that the patient lives hours away?  I was just wondering because I have no idea how to travel 3-4 hours after a surgery.   Last time I was sick for 2 days afterwards.  Thanks for the responses.

Kris
Right  LR on 2/8/02,  7/11/03, and 11/5/05
Left leg LR on 5/02, 4/05
Right achilles tendon lengthened on 2/01.   Synvisc injections on 2/17/03. 
Cortisone on 12/03 and 3/04, 12/05. 
Proximal Reallignment Right 5/23/05
R Microfracture 5/19/06
PFJR 6/20/07

Offline Nettan

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Re: Choices Given by OS...Need Help
« Reply #5 on: May 02, 2006, 06:35:51 AM »
Kris, so you got the phone call at last. Staying over night, you'd better ask the OS about it.
If you explain how you normally react I'm sure things can be arranged.
I would agree with the others..scope the knee to find out how it looks will give you the best result of surgery.

HUGS NETTAN  8)
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline blackbeltgirl

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Re: Choices Given by OS...Need Help
« Reply #6 on: May 02, 2006, 01:17:20 PM »
The terms chondromalacia and osteoarthritis are a bit confusing, and, depending on who you talk to can have slightly different meanings.

Chondromalacia, literally, means softening of the articular cartilage.  It is graded on a 4-point scale, grade 4 meaning the cartilage has worn away all the way down to the bone.  Depending on the physician, osteoarthritis may be used to describe the same situation, with the addition of bone spurs (your body's attempt to repair itself).  Or the dr may start calling it OA when the joint continues to wear away, now damaging the bone since the cartilage is gone. 

OR, if the damage is isolated, they may call it chondro, and if it affects an entire compartment of the joint, or all compartments, they may call it OA.  The term lesion means hole in the cartilage, basically.  A focal lesion is basically a pothole, fixable.  But to be fixable, there has to be healthy cartilage surrounding the hole.

It sounds like you don't have any area of healthy cartilage on the back of the patella, at least from your description.  It's entirely possible that the damage to the trochlear groove is only a focal lesion, and that the combination is whwat is causing you so much pain.  The trochlear is "easier" to repair than the patella, and can at least prevent bone from rubbin gon bone.  You'd be back to bone on cartilage.

Good luck with your surgery - I hope it works for you.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline shade

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Re: Choices Given by OS...Need Help
« Reply #7 on: May 02, 2006, 01:28:46 PM »
Kris,

Here is an article that shows images of articular cartilage lesions.  Might make it easier to understand what your doctor is talking about.

http://www.allaboutmydoc.com/surgeonweb/surgeonId.2729/clinicId.1432/theme.theme3/country.US/language.en/page.article/docId.41126

Good luck.  ~Shade
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline Janet

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Re: Choices Given by OS...Need Help
« Reply #8 on: May 02, 2006, 02:11:44 PM »
Kris:

Am I right that part of your problem is that your current OS is not the one who did your last surgery, so he doesn't have any personal knowledge of what your knee looks like "inside"? That happened to me when I changed doctors and I did have further surgery which cleaned up scar tissue and smoothed the patella again. But now (three years later) my OS doesn't feel he needs to "go in" again to know that my patella cartilege problems have worsened. He said the MRI and x-rays support what he already knows about my knee. I'm not sure how I'd feel in your situation about having another surgery just to see the condition of the cartilege after you've been through so much already and your previous surgeries support the diagnosis of severe cartilege loss.

I don't know what to tell you to do. You're really in a tough situation. It's awful that there's not some kind of relief for young people with a serious problem like yours. I wish you the best of luck figuring this all out. Please keep us informed.

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 blackbeltgirl

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Re: Choices Given by OS...Need Help
« Reply #9 on: May 02, 2006, 03:08:01 PM »
I don't know if this will prove helpful in the long-run, but for any arthroscopic procedure, ask them to record the surgery.  Since they're using a video camera to do the surgery, they can save ot to a cd or dvd.  I asked them to record my last surgery, and brought the disc with me when I went to see a new OS.  As a result, he was able to look inside my knee without additional surgery.  From comments others have made when they first switched to this same OS, for cartilage issues, that show up so poorly on film, he doesn't like to commit to a treatment plan without knowing the true state inside your knee.  So I basically saved myself an exploratory scope bu having the cd.

Not saying you'll be switching doctors again.  But since you've seen so many, and the OS you seem to be choosing at the moment wants to do an exploratory, the disc may give you more optiosn in the future.

Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline Kris

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Re: Choices Given by OS...Need Help
« Reply #10 on: May 02, 2006, 11:16:03 PM »
I actually do have the tape of the last surgery, only the part of it that was scoped.  I never thought of bringing it to him.  I do know that he and the last surgical doctor who did my knee talked extensively about my case (over an hour by phone).  I have two different surgeons who looked into my knee.  Both surgical reports mention Grade IV areas in it.  There is a year or two difference between them, so currently more areas of Grade IV have developed.  I hear that mircofracture surgery isn't as successful in the patella region...is that true?  How would the doc fix the groove?  Is this where he'd do the microfracture surgery.  I feel kind of stupid asking questions when I have no idea what he is actually going to do to me...actually the doctor doesn't know either so we're both in the same boat.  I have two weeks before the big decision is known.  However, I got a call from the nurse today and my insurance is out of network.  I'm not exactly sure what that means.  She'll call again tomorrow to tell me what's up with my insurance.  I just hope it's good news.  I could really hear some good news about now.

Kris
Right  LR on 2/8/02,  7/11/03, and 11/5/05
Left leg LR on 5/02, 4/05
Right achilles tendon lengthened on 2/01.   Synvisc injections on 2/17/03. 
Cortisone on 12/03 and 3/04, 12/05. 
Proximal Reallignment Right 5/23/05
R Microfracture 5/19/06
PFJR 6/20/07















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