Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary

[lucha86]

Hey nick long time since i posted lol 
i do agree with vickster dont rush into things, surgery is last resort i had a thought, which may explain some issues and i do agreed with vickster on this

i think crucially its finding a surgeon that deals with hips and knees,  but when you said its a problem with the hip and knee have you ever been checked for a connective tissue issue the reason why i say this is knee instability and the hip issues are common under this and that i remember i think you said your quite tall also? have you ever been checked under rheumatology ? they specialise in disorders of joints muscles and ligaments?

have they tested your base line of beighton and brighton criteria?? which checks if your hypermobile? which can be an issue for joints?

as i am very tall also and scored high on the beighton and brighton criteria i had some issues with my hip but most generally in knee.....

after my years of surgery im glad i have a doctor within rheumatology as its a bit of a cross over with orthopaedics and rhuematology is more holistic approach....... im no doctor but i thought it may be some advice, but i do agree with vickster .......

[Clarkey]

18/02/17 31 Months Day 944 Post Op

I finally got internet access at home so no more trips to the public libraries with dirty keyboards and food stains. It like having main services at home of electric, gas and water. It took a while to convince my mum to start using the worldwide web after being told she can keep in contact with family and friends on Skype at no extra cost with WiFi connection.

Came back from Saturday's autism playgroup, it is hard not to take part physically, it a great way to engage with the kids. The Sports Medicine Doctor is right in his latest report that my right hip is now more painful than my right knee. He has written 3 reports since my last monthly update with 2 of the reports referring to my right hip for a referral to see a OS that specialised in young adult hip pain for a management plan for my right hip problems.

I will share the concerns highlighted on one of the paragraphs.

As promised I discussed your MRI of your right hip with my colleagues. There was agreement that there was a small amount of swelling within your hip and there appeared to be a small labral tear. The labrum is the rubber rim that lines your hip joint. We had also noted that you may be more susceptible to to this because we have noted small bony bumps associated with the head/neck junction of your thigh bones (femur on the right) This is a cam type of femoroacetabular impingement.

The 2nd report last paragraph.

I do feel his right hip is now affecting the function of his knee. However I am convinced that the arthrofibrosis which has occurred after previous right knee surgery will also have had a biomechanical effect of overloading his right hip over the last few years.

Hopefully it can be managed ok when I see the OS that has a high reputation treating children and adults under 59 with hip complaints. I am seeing the right OS at the hospital. I am feeling happy and content doing whatever he suggests when I see him for the 1st time in the next couple of weeks.

Now for the main report that also refers to my right knee problems.

Dear Martyn,

I would be most grateful if you could review Nicholas, whom we both know well. He has undergone quite an extensive tendon loading programme and shockwave therapy which has not changed his knee symptoms at all. I have undated his MRI right knee imaging and I not think his imaging to my eyes had changed significantly in the last two years (report awaited). Nicholas has discussed that you mentioned previously about an accessory pole excision and decompression. He is keen to explore this with you. I have emphasised, in the presence of Nicholas' mother, that I am not convinced that further surgery can reliably guarantee resolution of his symptoms or improvement of functionly

Nicholas has started to develop some right lateral hip pain associated with some clicking over the last 6 months. This is particularly painful whilst driving and lifting. At times his hip symptoms are worse than his knee symptoms. He has a positive hip impingement signs. I wonder whether his right knee mechanics has had an effect on his gait and therefore his right hip. I have MRI'd this area - There is a small joint effusion and a possible labral injury to my eyes. However I will discuss his images with the radiology team to see if they feel a labral tear is present. I will write after his MRI has been reviewed to plan his future hip management.

Your review with regards whether any further surgery is much appreciated. If you don't feel it is then a pain clinic review may be appropriate.

Many thanks

Yours sincerely,

*** *****

Consultant in MSK and Sports Medicine

I totally in agreement with what the Sport Medicine Doctor advice. I do hope I can see Prof Snow for another consultation and review and chat over my patella tendonitis and arthrofibrosis, I am fully aware that both conditions are hard to get right again. I might have to accept that I may never be able to run again during the rest of my life on this planet. It is always hard to accept if you enjoy long distance running. I have always be passionate about that was favourite hobby until aged 34 that I shall greatly miss thanks to the evil condition of 'arthrofibrosis' that's the culprit to my chronic patella tendonitis.

Lucha, Thank you for giving me some good constructive guidance and not forgetting Vicky. You have both got great knowledge when it comes to joint problems and what treatment options to to consider.

Of course it up to the professionals to decide what management plans they have in mind by doing what they suggest and recommend as the next course of treatment options.

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[Puffy the Knee Slayer]

Hi Nick,

Sounds complex, once we have one problem we end up with others due to compensation, overloading etc and then it is so hard to sort out if they can't work out what is causing what.

I do hope the new hip specialist is able to help.

[Clarkey]

08/03/17 31 Months Day 962 Post Op

I have both dates confirmed for my right knee and hip, the knee consultation with Prof Snow is next week Wednesday 15/03/17 @15:00 that has always been morning or lunch time with my previous consultations. My hip assessment and consultation is Friday 07/07/17 @10:00 which is a long time to wait. 18 weeks waiting time after receiving both letters last week Friday. I did not think hip injuries and problems are more common than knee problems or the waiting list would be less.

Will keep the OS I am seeing private who is one of the top hip surgeons to see in the midlands region for young adults and children who does paediatric surgery so is on high demand, I know many young people at the clubs I volunteer at with dodgy hips. Maybe this is why I have to wait 18 weeks to see him which is worth waiting for. My left hip is also at times painful it is best to get it checked out as he says on a YouTube video that too many patients come and see him when the damage has already been done. It easier if patient’s come at the early stages before they notice an increase in pain.

I am one of them as I always thought it was due to my right knee injury impacting the right hip that highly plausible as AF in the kneecap also has negative side effects on the hip joint hence why there is a tear and impingement of the hip. My mum and sister that works in orthopaedics both think my right knee needs to be addressed first before looking into treatment options for the hip. The Sports Medicine Doctor thinks it is the right hip that’s the main culprit to the cause of my anterior right knee pain. I am not so convinced he right as I think there could be damage to the cartilage with arthritis setting in that can often be clouded or not seen on MRI scan images.

Who knows when I see Prof Snow next week Wednesday he might have spotted something new on the latest MRI scan in comparison to last one done in December 2015. The Sport Medicine Doctor only had a quick glance at one frame of the patella tendon comparing the two. One needs to methodically go through each image before ruling out a positive result.

I know it a cardinal sin after all the pre-warnings from KG members to go for surgical intervention! I just like something done now at this stage post op. What I have in mind is the surgery called ‘Arthroscopic Confluence Coblation Surgery’ that a less invasive and safer surgery to go through then ‘Arthroscopic Infrapatella Pole Surgery’ Mr Hardy has come up with this procedure that no other OS's seem to be looking into as the next option if ESWT Therapy fails to improve patellar tendonitis.

http://www.johnhardy.co.uk/Publish/information/patella_tendonitis.pdf

Mr Hardy’s team will advise you on the benefits and the complications depend on the type of surgery undertaken. Largely the risks are small but include the risks of recurrence, infection, tendon rupture and thrombosis. The Arthroscopic Confluence Coblation is a minor procedure performed under a light sedation anaesthetic with local anaesthetic and takes 20 minutes.

Would it be ok if I mention this procedure next week to Prof Snow he should be able to perform an Arthroscopic Confluence Coblation surgical procedure with his vast experience. He even said in his last report when I last saw him that he is happy to go ahead with surgery if the Sport Medicine Team can offer no more methods of conservative treatments. What I rather have done at this stage is a ‘diagnostic arthroscopy’ that I talked about previously on my post-op dairy. It will make me feel more relaxed and at ease knowing I have done all I can to ease my right anterior knee pain. I would feel less anxious and stressed out at this stage opting for surgery.

My career in supporting young people with autism is on hold right now! I need to tell the manager something is being done to my right knee rather than mentioning PT exercises that I am doing on a daily basis with no significant improvements. I am also thinking in the same way as Puffy with her knee injury that the NHS are saving money not acting on patients with long term chronic knee problems who is also thinking about having surgery to repair her torn cartilage after a guy at her gym told her his trimming made a big difference. On KG Bulletin Board members join that have had bad experiences with surgery when there are thousands of patients out there where surgery has been successful that do not require advice from KG.

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[Puffy the Knee Slayer]

I was told that arthroscopy is more likely to be of use if there is a clear target rather than them just going in to have a look, and that a lot of patients say after arthroscopy that their knee never felt right again.

I do hear your frustration however with things not improving and MRI not showing much and having to do endless physio that isn't achieving very much.

I don't see the harm in mentioning the arthroscopic confluence coblation surgery and asking if that would be an option for you. It may not be available on the NHS though. I was thinking of seeing John Hardy a while back as he seems to have a good understanding of fat pad issues.

Very difficult to know if your hip is causing your hip or vice versa. Good luck with your appointment next week. I hope something shows up that can be fixed.

I really hope my OS is going to sort my tear out if it does not get better with conservative treatment - especially as it's likely (though they will never admit it) that it was caused by the steroid injection they gave me!

[Clarkey]

15/03/17 31 Months Day 969 Post Op

Had a positive consultation this afternoon leaving content and happy knowing that my long winded right knee saga is coming to a conclusion. Something significant has come up on the MRI and also doing a physical examination effusion in the knee around the fat pad region. Looks like scarring around the fat pad that would require a clean up during an diagnostic arthroscopy. The effusion is new conclusive evidence to go ahead with surgery that will not happen until I have had my right hip seen to by the hip surgeon.

Prof Snow spent a good amount of time with my mum and I listening to my concerns and has kindly made a referral to have a right hip x-ray guided injection that might make a difference to the anterior knee pain. If the knee pain remains the same then I can go back to Prof Snow and go ahead with surgery to clear out any scar tissue build up and other areas that need clean up and trim. The cartilage looks all intact and normal on the latest MRI scan. This is good news but one can never tell if it is really intact until the kneecap is scoped.

I mentioned the confluence coblation surgery showing the article that would not be of no benefit or would be a common surgical procedure with no benefits towards the scarring around the patella tendon. Basically it is a magic zapping wand that has little benefits with only a small percentage patients with a positive outcome.

I was thinking a few days ago that another AIR surgery might be beneficial after the PT I saw 3 weeks pre-op after scope #2 made me do too much in one session, this wrecked the surgery! if I go ahead with scope #3 I would get the proper after care and guidance to prevent scar tissue from building up excessively.

Filled in the pre-op form to have the x-ray guided injection into the right hip, hoping it is not done under GA that was mentioned in the form for injections that said surgery on it. Should be done under local and not general? I have heard mixed views on the procedure some say you are knocked out completely others say semi sedation or are fully awake aware of what is going on. Anyone know what might happen I am not fazed in anyway I just like to know what will happen that day.
 
Knowing something is going to happen is a stress release lowering my anxiety and stress levels greatly after such a long winded ordeal scope#2 post-op diary will end when if surgery scope#3 goes ahead, there is a significant amount joint effusion showing up white on the latest MRI images showing there is fluid inside the knee, something is not right that needs investigating closely at this point in time.

Puffy, I hope you can make some progress soon with your knee injury and small tear and the cortisone injection could have caused it to tear!

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[Clarkey]

18/03/17 32 Months Day 974 Post Op

I have now been given a slightly earlier appointment for the consultation on my right hip 16/06/17 @10:30 rather the original date given on 07/07/16. 12/07/17 will be decision day if I will be put on the waiting list to investigate the knee joint effusion that has increased since MRI scan that was done in December 2015. I did have a feeling that the sports medicine doctor did not have the expert knowledge that Prof Snow has saying it looks the same my January MRI scan comparing it to the patella tendon images.

I should be pleased that I am now getting towards what I always thought would happen a 3rd diagnostic arthroscopy. It is the financial stress now that hurting with my savings fast running low, I would have to rely on my mum’s widow pension to live on. I am lucky to live with her as it good for her to have company in the house, she had two falls so far she was lucky that she was ok. Pleased I am there for her as she been widowed since November 2005 after my Dad passed away from leukaemia.

I now have almost 2 years experience volunteering on a weekly basis in south and north Birmingham as a  Playworker for autistic young people at the Saturday Club. I been told by playworkers and leaders that I capable to do the job role that's now on hold due to my right knee and hip pain. I can join physical activities by defending as a goalkeeper blocking, throwing and kicking and acting like a big kid at times. It does seem to go into my hip and knee limiting what I am able to do which is frustrating.

September is a realistic target after all treatment has been given to apply for a job position. At both the clubs I attend staff have left and been replaced that should have been me if it was not for my right knee and hip pain limitations. I knew my right knee had deteriorated even more when my walking pace slowed down and limped more since hearing a loud clunking and popping sound. Might be something that needs to be surgically fixed that the MRI scan is missing out on an accurate positive result. Joint effusion was the turning point to show that my knee is getting worse rather than better.

Now is the waiting game to see what happens next, 2017 will be a year when I be going in and out of hospital. X-ray guided hip injection is the next course of treatment that looks like a minor surgical procedure that is performed and done in theatre according to what I seen online. Saying different options of either spinal, local or general. Gas and air would be a more straight forward option used if you having a dislocated shoulder put back into its socket as an example. It is only a few seconds when the needle goes into the hip rather than sedation methods.

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[vickster]

Nick, I think the injections might be done in theatre (in the NHS) as it's a sterile environment to minimise the risk of infection which exists with any injection. I'd be surprised if they knock you out for a steroid injection, the steroid is usually mixed with the local to reduce the potential pain associated with steroid flare?

Good luck for everything.

[Clarkey]

03/04/17 32 Months Day 990 Post Op

I was hoping by now that I could post my latest report after seeing Prof Snow 15/03/17 usually have the report within 2 weeks with all my previous consultations and treatments. I can mention it tomorrow at the hospital that I am still waiting for the consultation report.

I had a phone call last week Wednesday from the hospital saying their has been a cancellation and can fit me in 04/04/17 for an x-ray guided cortisone injection into my right hip. Of course I accepted the appointment as I want to get it out of the way so I do not have time to worry about it too much.

It looks like it will be done using a local anesthetic/steroid injections and not a general which was a concern of mine that Vicky has already kindly informed me using the theatre to stop any viral infections injected area of the hip.

I have to rest for up to one an a half hours and also cannot drive for 48hrs and will get a lift to and from the hospital from my sister that lives locally. I remember when I had my botox injection on my upper right leg muscle that there was an anaesthetist on standby with the anesthetic machine on standby. It might be a precaution they have to take and hope he/she will not be needed.

Right knee is still a hindering which has not stop me from getting a job group interview on Friday for the autism young peoples group I have been volunteering at since April 2015. They will fit me around any future treatment plans as they have seen how good I am with the young people and other Playworkers.

Here a link to another forum showing how I overcame being labelled negatively for actions that was out of my control with a wrongful conviction when I was in not fit state to go through the British Justice System.

http://miscarriageofjustice.co/index.php?PHPSESSID=umb1ovknbufdmp962jgl745pu1&topic=5460.msg394562#new

I am happy to share what my family and I had to go through, I was not in the wrong, hope to overturn an unjust conviction while I was on too many meds and was self medicating! Want to take it to the ECHR that goes against the human rights act, I should never have been given a life long criminal record. I worked hard to show I am safe and capable to help support young people with autism.

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[Puffy the Knee Slayer]

Hi Clarkey,

I hope your injection went smoothly and that you are recovering nicely. Hopefully it will help you.

That's great news about your interview    and that they will fit you around any further treatment. Good luck on Friday, I hope you get it.

[Clarkey]

04/04/17 Right Hip Cortisone Injection

After all the scare stories I have been hearing the actual injection into hip was not that bad pain wise. 1st an antiseptic solution was applied around right hip then a Marcaine injection to numb the pain that was a sharp prick into the groin by the hip joint then the Kenalog injection 0.25%.

My sister gave me a lift with my mum for moral support, I was fine to go into the Admission and Day Case Unit (ADCU) alone which they prefer leaving my mum and sister to go for a cup of tea and slice of cake at the hospital cafe. I got use to the procedures at the ACDU and the nurse responsible said jokingly I am a veteran to treatment when she asked me if I had injections on the past saying 5 cortisone into my right knee and 2 surgeries.

Was booked in for 13:00, was called in at 13:30 with a long wait for the actual injection going into the injection suite at 14:50. The procedure was quick and did not even have to wear a gown or take off my trousers just loosen them and lye on the couch on my back and left it to the Doctor to do what he paid to do after signing the consent form.

Twenty minutes later after a cup of coffee and a pack of 3 ginger biscuits I was discharged after complementing one the nurses singing to Smooth FM (other nurse said sounded like she being strangled on her high notes) as she disinfected the chairs and table the patients had been using. I was 2nd last into the injection suite with fantastic nurses and doctors as usual having friendly banter with other patients.

It's good to have a good laugh when feeling nervous and apprehensive, I had my iPhone headsets listening to Coldplay as I pre injection entertainment. I then had the lovely nurse singing away as post injection entertainment.

Taking it easy tonight, can drive again tomorrow just slight tenderness around the injected area. Was ok after all and glad I am now making progress towards finding a way to ease both hip and knee pain. The knee feels sore still and not stable, doubt the hip injection will help ease the pain and discomfort. If it eases the hip pain then it has done the job it meant to do.

Puffy, I have to go through a formal interview if I am successful during the group interview. I hope to get the job as I worked hard to get there proving that I am safe to help and support autistic young people or would not be doing one to one on a Saturday morning at the Playgroup higher needs autism group.

There are so many jerks out there that work in health and social care, not where I help out at all the staff are lovely. There is a guy that's a care worker at a young adult college for students with additional need who is so full of himself being rude to my friend who works as a teaching assistant.

Saw him a few times taking students to the pub when I lived in Birmingham coming across cocky and full of himself taking staff petty cash so he can buy himself a few drinks and snacks. He is never questioned or been suspended/sacked for stealing petty cash flow. Why I am annoyed having to prove I am fine for such a long time period with the likes of him!

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[Clarkey]

18/04/17 33 Months Day 1005 Post Op

I wish I could report some positive news for a change after the right hip cortisone injection that was done 2 weeks ago. The right hip pain has returned, I will see the OS for the very 1st time in June for a consultation, there are good and bad days when the hip pain is more intense as you would get with knee pain. At this point in time the only option left now is surgical intervention as the less invasive conservative methods of treatment have failed to improve the anterior knee pain and discomfort I am experiencing right now.

The link below relates to the problems I am experiencing with the anterior knee pain around the bottom of the kneecap around the tibia region. It mentions the fat pad and patella tendon that have been picked up as potential problems thats causing all the pain and discomfort. Scarring of the deep infrapatellar bursa could be the cause of the pain and discomfort. No mention of Osgood-Schlatter disease that not shown up on the MRI scan. It does not have to be only patient's with Osgood-Schlatter disease to cause 'deep infrapatellar bura' of the knee.

http://drrobertlaprademd.com/wp-content/uploads/2015/07/anatomy-of-the-deep-infrapatellar-bursa-1998.pdf

Reading through the medical journal a lot what has been mentioned relates to my ongoing knee problems. I know it is not always wise to suggest surgical procedures when the OS is the expert. Patients now have the World Wide Web to search how they can find ways to treat their ongoing medical problems if other option of treatments have failed.

I am not able to take part as I would like to be able to at the autism groups I help out at, last week at the under 8s I was restricted in what I could do. Have to sit on low single benches and kneel down putting a strain onto my right knee and hip, kids like to run and not able to. A young person at the Saturday Club had a meltdown outside and ran off who was close to me and could have ran to grab him gently to take him to quite area to calm down again. All I would like to be more mobile so I can run or jog a few yards rather than long distance running.

Something needs to be done now at this stage, it has been dragging out now for too long.

[email protected]

[Clarkey]

18/05/17 34 Months Day 1035 Post Op

I am still waiting for my report after my last consultation on March 15th and called Prof Snow Secretary on Tuesday morning, she said it will be sent in the post so should arrive before the end of this week. I got the call I was waiting for yesterday morning from the Manager that interviewed me on Friday 5th May saying I have got the job position as a play/youth worker for autistic young people. I know he is concerned that my right knee problems stops me from be able to run and take part in physical activities. 

There is a safeguarding concern that I am not able to run when a service user runs off in a public place as their key worker! I cannot jog or walk at a quick pace. I told the Manager that I am seeing my OS in July that mentioned doing a 3rd scope of fat pad excision if my right knee has not improved.

I am being told not to have surgery staying well clear! Others are saying it would be good to go ahead with surgery to show the autistic organisation that I am doing all I can to get back try and resolve the knee problem or improve it. I am prone to excessive scarring having AIR surgery during scope #2 after scope#1 fat pad trim and medial plica excision caused the excessive bleeding!

The knee pain is not too bad it is the limited mobility that the real downside as I cannot even run a few yards as I feel anterior knee pain and pressure at the bottom of the kneecap by the tibia. If I was coming to retirement age I would not have any surgery until one day when I might need a TKR. Aged 38 accept may never be a competitive long distance runner that I was before scope #2. It would be great if I was able to take part in physical activities at the club and keep up with the kids that like to burn off a lot of energy running around playing football and other popular games. kids like it when adults join that is a good way to engage with them.

What I think happened after scope #2 was seeing a PT that ruined my whole surgery! 3 weeks post up he was making me do full leg calf raises up to my buttocks! I was in agony after and was on the gym bike pedaling at a moderate pace and gradient for 45 minutes. My right knee kept on giving out when I was walking followed by intense pain for several weeks afterwards.

I think the scar tissue is attacking the patella tendon and fat pad and may need another AIR surgery to remove the scar tissue? I am happy to pay to see a top physiotherapist to stop the scar tissue building up excessively again. Or try a none surgical option 1st seeing a physiotherapist with a top class reputation rather than a physiotherapist from a local leisure centre that's clueless about what to do after AIR surgery, pushing me too hard! A mistake that many physiotherapists seem to be doing.

My personal feelings is to go for a 3rd diagnostic arthroscopy to have a full assessment, so Prof Snow can investigate fully that MRI scans can often miss out on. I am happy to risk a 3rd surgery in the hope it can improve my limited mobility, paying privately going to Droitwich Knee Clinic.

The link has two experienced Physiotherapists rather than travelling to another City or County for treatment plans.

http://www.kneeclinics.co.uk/page/Physiotherapists/45/#.WRrU7P5hnIU

Would Plicetomy be something to pay towards if I went ahead with surgery as I want to have a good post-op programme regime.

http://www.kneeclinics.co.uk/page/Plicectomy/32/#.WRrVC_5hnIU

Droitwich Knee Clinic was one of the best clinics to go to in the 90's and early 00's that shrunk a lot with only two OS's working under the original brand name.

If scope #3 was to go ahead I would want to have proper post-op care plan to stop the scar tissue from building up excessively. Paying private for PT and deep friction massage and patella mobilisation and PT to build up the quads again strong. It is easier if someone else is doing it for you that is trained in scar tissue breakdown techniques.

[email protected]

[Clarkey]

08/06/17 34 Months Day 1056 Post Op

Back in August 2014 when I saw a new physiotherapist for the very 1st time after I was told how good he was with high praise from satisfied patients. It was 5 weeks post-op when I saw him and not 3 weeks as I originally thought until I read back in my dairy pages 80 to 81 will see that my symptoms worsened after the intense physio session.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=43471.1185

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=43471.1200

25/08/14 Day 38 Post Op

I have had a brief chat with my sister who is an orthopaedic nurse and say it important to keep on top of the PT to get the quads firing again.

I do think my new Physio made me do too much in one session. I know he was overworked as he was overbooked seeing other patients while I was at the gym and doing 5 sets of 30 squats and leg raises 5 times was too much! Ending the session lying on my front and lifting my right leg right up to my buttock!

I can take pain well with a higher pain tolerance and forcing my leg by bending it through uncomfortable pain was a bit drastic and less then 5 weeks post op! I know he was under pressure as he was going away on holiday on Friday as it the Bank Holiday weekend in the UK and does not like to turn away patients.

It a great shame that my usual Physio is away overseas as he was less aggressive when I had problems with scope #1 doing friction massage therapy and massaging quads with oil and using a ultra sound machine with gel and not a full gym workout.

I think many Physios out there do not know much about Arthrofibrosis and not to overwork the knee if the patient is prone to scarring! I think forcing my knee through the pain has not helped, I hope it has not caused scar tissue to return!

Pain is more intense around the medial portal and my mum thinks I should see Mr Snow, I am happy to wait as I am visiting my sister on Wednesday. She is working next day at the hospital and could maybe could ask her OS during a break my type of surgery and brief history and my symptoms and if I should get it checked or will it go away with rest?

nickwclarke2014BhamUK 

The physiotherapist was given a 3 year caution by the The Health Professions Council (HPC) in 2012  for swearing at colleagues and putting patients at risk at a private hospital, he then set up his own clinic independently. I was left unsupervised while he attended another patient when I paid privately for the session. It was rude and irresponsible to leave me for 10 minutes in the gym unsupervised that he also did while working at the private hospital that he was disciplined for by the HPC.

Some of the notes during on my last consultation in March.

At his previous arthroscopy he had a very tight plical band which was rubbing on the medial femoral condyle causing bone marrow oedema. This was resected with good effect but unfortunately following aggressive physiotherapy has recurred.

I think the only option left to Nicholas would be a further anterior release and excision of accessory pole of the patella. If it wasn't for the recurrent effusions I would not recommend this but in the presence of such a significant finding it does suggest there is a therapeutic target.

It is very frustrating that scope #2 of AIR was ruined by a physiotherapist that had no no idea about how to manage arthrofibrosis clean out post-op that might have been a successful surgery if I did not go through the intense physio session. Hopefully get off lightly with no damage to the cartilage and patella tendon and a clean out of the scar tissue will hopefully release restriction around the patella tendon and tibia. Got use to walking at a slower pace until I am over taken by many pedestrians in the street and some are a lot older than me.

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[Clarkey]

16/06/17 Right Hip Consultation One

Saw my new OS for my right hip pain this morning his clinic running late. I was scheduled to see him at 10:30am that was clearly stated on my letter. I waited for the 30 minutes to pass till 11am that was the time he was running late, the nurse said are you booked for 11:30am and said no I have been booked in for 10:30am that is clearly stated on my letter. The appointments apartment must have made an error putting in the wrong time an hour too early. I would have filled in a complaints sheet but had to rush to my car as the time was about to expire after paying £3.80 for 2 hours parking in the hospital grounds.

I was finally called in at 11:50am and was tactful about it when he said sorry for the delay saying my letter said 10:30am and its now nearly midday that's not your fault its the appointments department fault. I was asked questions about the hip pain and told him it is not too bad at the moment and the injection has eased the pain. I felt some pain around the groin during the examination and also felt pain in my left hip! I have been booked in for some physiotherapy to improve the hip pain. In 6 months time seeing the OS again to see if the cortisone injection is wearing off and if PT has improved the pain and discomfort.

Not too long for my consultation with Prof Snow the final decision day to do a 3rd scope to remove scarring around the patella tendon, hopefully he will find other problems once inside that can be fixed to improve my knee condition. I will take a gamble and risk at this stage on Wednesday 12th July after less invasive methods of treatment have made no difference. My knee is clearly getting worse rather than better. Hopefully if the knee surgery is a success 3rd time round my hip pain will improve when I see my hip surgeon in December.

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