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Author Topic: Partial Knee pitfalls?  (Read 3793 times)

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Offline NJDan

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Partial Knee pitfalls?
« on: August 16, 2002, 06:00:48 PM »

Can anyone out there tell me what I should do?  I had a patellectomy in 1998 due to having been hit by a car in 1996.  Since then I have had 5 scopes to remove cartilage and am now facing consntant pain, swelling and inability to stand or walk very long.  I am 35, in good shape and try to be active.  I just moved to New Jersey and the ortho I am seeing here is very good.  He has recommended either a partial Knee replacement or OATS.  From what i can see, partial is better for me.  I wonder if at 35 i am crazy to have this done yet?  I simply want to be able to walk and do stuff with out paying for it big time later...there are days when I can hardly walk after doing too much, and most nights I inhale pain killers trying to get to sleep.  If anyone has suggestions or imput please share.

Thanks

Dan
Patellectomy 1999, right knee following a car pedestrain accident.  5 subsequent scopes.  Chondroplasty Oct 2002.  TKR and Quad realignment Jan 2004.

Offline Heather M.

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Re: Partial Knee pitfalls?
« Reply #1 on: August 16, 2002, 08:13:11 PM »
Dan,

Does your doctor believe that the source of your pain and fatigue is not having a kneecap?  Will this partial knee replacement involve a prosthetic kneecap?  

Also, what is the state of your articular cartilage (I assume it's damaged because of the OATS)?  I think it might help to have answers to those questions in order for you to make a better decision.

As for the age thing...I was told I'll need a knee replacement eventually, and I'm 32.  The surgeon who told me this is the type that won't touch me until I'm either crippled or at least 55 years old, which I think is just silly (the age thing, not the crippled part).  In my opinion, quality of life is important, but you do have to consider what will happen down the road if the PKR fails--your options are extremely limited after that.  It's so final (kind of like having your patella removed) that you have to be absolutely sure it's the best thing to do.

As for me, I find it really difficult to believe that waiting until I'm 'old enough' for a TKR is my only option, so I'm hoping to hold out until ACI technology improves a bit, because I would be a good candidate for that.  Has your doctor talked to you about it?  Check out the arthritis section on this discussion board.

One other thing I've learned is not to make decisions when I'm in pain.  When your knee is flared and making your life horrible, you'll do anything to get rid of the pain.  At least that's what I've found.

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
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Offline NJDan

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Re: Partial Knee pitfalls?
« Reply #2 on: August 16, 2002, 10:09:43 PM »
Thanks Heather - had not heard of the procedure you mentioned.  My pain is due to a degenrative disease that causing crystals to embed in the cartilage and erode it away.  As such, most of my inner cartilage is either very rough or gone.  This also affaected the kneecap and eroded the cartilage away to the point where my kneecap was worse in than out.  the whole disease was likely caused by the car accident..no one knows for sure.  I have an appt to see the ortho on Sep 5, we'll see then.  He already sad that he will scope it and do whjat he has to when he is in, either OATS of PKR?!  I hate that part as I will be asleep and not able to ask questions or know!  As to the pain being a driver, it is constant, even at rest.  My knee is unstable and sore and there is a lot I cannot do.  The reason he told me he is unwilling to do a TKR is that with each one the success goes down a lot..so after like 3 your success rate is only 60%...we'll see.  the younger you are the faster the implant breaks down...Thanks for your reply.

Dan
Patellectomy 1999, right knee following a car pedestrain accident.  5 subsequent scopes.  Chondroplasty Oct 2002.  TKR and Quad realignment Jan 2004.

Offline Deborah

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Re: Partial Knee pitfalls?
« Reply #3 on: August 16, 2002, 11:08:02 PM »
NJDan,

I have had a TKR following a partial (only the patella portion ... extremely rare).  Without a patella, your chance at a good result is fair to poor, whether you have a TKR or PKR.  There is no patellar prosthesis, only a resurfacing button affixed to the back the your existing patella.  I do know of one woman (she posts here from time to time) who had had a patellectomy, and it took her a long time to find a surgeon who would do the replacement, but the OS she did find, fashioned a patella of sorts from the bone removed for the prosthesis.

Once the patella is out, you lose 40% of your quad strength, and since the patella acts as a stabilizer,  it's extremely difficult to crack through this permanent loss of strength.  If he does a PKR, have you asked him how he will make it work without your patella?  It's almost as if you're setting yourself up from having the best result possible when you lose the patella, and if the OS has a plan for some sort of substitute, it may be better for you.

I'm 38, and had my TKR when I was 37 (I've had 8 procedures, mainly open, on my left knee).  The only reason for a PKR is that you have disease in only one compartment, but if both your compartments are damaged, you will do better having the TKR, and an even better shot if your OS can fashion some sort of new patella (not likely, but you may have a surgeon willing to try).  It won't be as good as the one you lost, but it will help stabilize the knee and allow you to regain more normal leg strength.  As you can see, you have a lot of questions to ask your surgeon.  Quality of life is important, and if all the compartment within your knee are compromised, a TKR is a more humane choice.  As for revisions: Yes, I've had my worries, and I need my right knee done at some point, but I'm working at keeping that further on up the road, but the field of joint replacements is growing by leaps and bounds, and there may be hope.  I decided I'd rather gamble with having a TKR at 37 than have the less than zero quality of life I was having because of the severe pain and disability.

Feel free to email me, if you want.  You can also read my story on the "Patient Sories" link of the KneeGuru home page.  It's slightly inaccurate, and I haven't sent them the corrections yet, but it does allow you to see why I feel somewhat qualified to answer your questions.

                   [email protected]

I wish you luck in making your decision, and that the decision, once made, is the right one for you.

Deborah
Manip arthro adhes 1/02; TKR 10/01; vmo rep, med reef, chondro, LR 11/00; pat resurf LR 2/00; arth let meisc (80%)1/99; TTT, chondro 8/98; LR(open), med menisc, chondro 6/97; arth med men, OCD les rem

Offline Sandy_F

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Re: Partial Knee pitfalls?
« Reply #4 on: August 17, 2002, 05:46:53 PM »
I have had a TKR after a patellectomy.  Your situation is not an easy one.  I had many salvage procedures on my knee with the last one being the patellectomy.  If I had known then what I know now about the long term ramifications of the patellectomy I would not have had it done.  You are left with leg strength loss and fatigue forever.  Your knee will always be weak.  The TKR is not optimum for this situation.  There is no artificial patella at this point so replacing that is not an option.  I was 43 when I had my first TKR.  This joint is very fragile and a continuing problem.

I had a give way episode a while ago and the knee has been painful every since.  I just changed OS and he is doing tests to see if we can diagnose the problem.  I am back in PT and was told that I would probably always need PT to keep the patella-less leg is shape.  I am schedule for a whole mess of x-rays of knees, hips and pelvis and also a bone scan.  I have lucked out and found a wonderful PTist that understand the change in mechanics of a knee without a patella.  

You have a difficult decision and a hard route to travel.  Work with you OS and find a good PTist and together you will be able to decide the best route for your knee and lifestyle.  
Right knee - 14 surgeries including a fulkerson, patellectomy and finally a TKR.  Left knee - Lateral release, microfracture, TKR, then another LR, spacer replacement.

Offline wendy

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Re: Partial Knee pitfalls?
« Reply #5 on: August 18, 2002, 01:57:39 AM »
I know you are in a difficult position. The OS I grew up going to and who has done all my previous surgeries has talked to me in length. Now I am in a different part of the country and can't travel to him to have him try to help my knees.

REMEMBER: MOST OF US ON THIS BOARD HAVE HAD BAD EXPERIENCES THERE ARE MANY WHO ARE OK AND DON"T POST(I am all for this board, but I continually remind myself of the people I have talked to who have found results with these procedures)

Anyways, he felt I needed a patellectomy and than he would do a TKR down the road. He has done this on about 10 patients and 7 of them live a very active normal life(one running marathons)

I have opted to only have a PKR(which may become a TKR if things don't look good in the OR). Try to get some referrences from the OS of people who have had similar things done. There seems to be no real fix for the knee joint.

Good Luck and try to keep your head up.

Wendy
began running long distances at age 7. Now I have two knees that have given in to my abuse! 3 scopes, LRs, Patella tendon repositionings, and years of pain. PKR on both. Diagnosed with RSD 3/4/2003.















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