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Author Topic: Is it time for surgery?  (Read 1755 times)

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Offline Worn Out

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Is it time for surgery?
« on: July 21, 2010, 04:18:22 AM »
Hello fellow "knee pain prisoners" ;D

I am pouring through websites, medical studies, chat boards.  I am at the end of my rope....I Think?

Here is my story...as many of you I have spent most of my life doing sports to "The Extreme"  I started weight lifting at 14...totally addicting for me.  Lots of heavy squats, lunges etc.  Went to PT about 10 yrs ago for patella pain some crepitus.  Did well got through it back to my life.  Got heavy into road cycling  about 250-300 miles a week, did triathlons and a marathon. 

My knee pain was pretty manageable up until 1 year ago.  While on vacation I decided to do some 3 mile bridge runs. After 2 workouts I was totally debilitated.  For the past year I have suffered with chronic knee pain, swelling, and loss of mobility.  I had a cortisone injection right after the initial onset, it did not work.  Went to PT which also failed. Anti-inflammatories do nothing at all.  In the past year I have had some glimpses of normal function maybe a week or so at most.  Then I will do something like go for a walk with my son at the park and be totally a mess for a month. I cannot walk up or down stairs without excruciating pain. 

Recently my last OS told me to follw some basic stretches, do some swimming and the elliptical.  I was feeling pretty good on the 1st of July so I went on the elliptical. I used NO resistance NO ramp angle and VERY low intensity.  I have now been out of commision for 22 days.  I cannot even bend my knee enough to put on pants or get into my car without a major struggle. I am now totally depressed.

Just had an MRI arthrogram (NOT pleasent)  Here is what is said.
Grade 4 chondromalacia of trochlea
Grade 4 fissure of patella
sprain of MCL
Grade 2 chondromalacia of Medial compartment
Large joint effucion (UMM my knee looks like a balloon)
Large partially ruptured bakers cyst
I also have a huge bone spur on outer head of my femur

I have read that most conservative treatments such as synvisc or the like, debridement of patella and LR really do not help this problem.  I am 39 and have lost all normalcy in my life. I do not want to prolong the inevitable... I want my life back. I get the impression from my OS he is not even thinking of any type of knee replacement yet.  He wants to drain it and inject more cortisone,  then mabey go in and "Clean it up" ...I have read from so many this can make things worse.  Mentally I feel ready for either a PFJR am I rushing?  It just seems like that is really the only TRUE solution.  I want to get back to a normal life.  HELP< ADVICE<Thanks!

Offline Blaise

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Re: Is it time for surgery?
« Reply #1 on: July 21, 2010, 07:38:08 AM »
Worn Out,

   I think the most important thing you can do and if available is to find multiple opinions.  In the last 20 months I have had 3 surgeries, a PFJR being the last...Also, I am only 32 years old.  Having the PFJR though only 2 months out, was the best decision I have made..Now granted I have other issues, my "knee cap" issues are better already.  Up until I found my most recent OS group, I had one doctor tell me, just do some quad strengthening and it will be fine....
  Also you know your body better than anybody else..I give this example of my situation...I was told that my MRI and X-Rays showed my trochela cartildge was intact....I was continually told by doctors I was wrong in "assuming" my cartildge was gone, and when they opened me up in May what ya know....No T-cartildge...
  Speaking from experiance...I have had cortisone and synvisc injections...they did nothing..And my current doctor feels the combination of the two hid the fact of some damage, and to be honest they really did little to help me.
   I wish it was just easy to just go for it...But its not, and many doctors will be hesitate to jump into such a major surgery.  Your MRI did not mention anything about mal tracking or alignment issues did it?  Also debridement, LR, or clean up in general could make it worse...A debridement will only remove the damaged cartiildge, as for LR they are rarely done as stand alone procedure, and simply going in to clean up can cause scar tissue actually causing your symptons to worsen(that happened in my second surgery.)
  Others thing of note..You say PT failed..Did you find the right PT?  For over a year I went to the same PT group, and unknowingly they treated my knee like a torn ACL completely different than that of Patellofemoral issues.  They would overload the joint, causing more damage then good...I found an individual who does one on one treatment and what a diffrence it has made.
   People on this site really know there stuff, and many have differing opinions....I hope that sharing what I know with regard to my situation can help lend itself to you making a decsion that is best for you....

Best of Luck,

Blaise
00-LK LR,chondroplasty
12/10/08-LK Chondroplasty,repair of mp-fem ligament,TTT
8/28/09-LK synovectomy, lysis of adhesions,chondroplasty
9/8/09-LK 100ml drain
10/8/09-LK cortisone
1/4/10-PFJR Consult
1/7/10-LK 15ml drain/synvsc-1
5/24/10- LK PFJR/TTT

Offline crankerchick

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Re: Is it time for surgery?
« Reply #2 on: July 21, 2010, 01:09:04 PM »
I second getting more opinions, preferably from doctors with a special interest in patellofemoral arthritis. A PFJR is great and all but a thorough exam to rule out any tracking issues needs to happen first, otherwise shiny new parts get replaced in a malaligned leg and the cycle of deterioration repeats itself.

Start with some more opinions and try not to be in a rush to jump on the first surgery train thrown your way by a seemingly well-meaning MD.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline TwoBadKneesUSA

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Re: Is it time for surgery?
« Reply #3 on: July 21, 2010, 01:45:18 PM »
Basically I second all that was posted before me.  Also if you decide that a partial is what you need, don't hesitate to fight for it.  I had one OS tell me wait 10 years and I'll replace the knee for you.  Not a helpful answer.  I was 39 when I had mine done.  Get a good idea of the root problems then do what you feel would work best for you.
'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47974.0
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.

Offline Worn Out

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Re: Is it time for surgery?
« Reply #4 on: July 21, 2010, 07:03:46 PM »
Thank you all for your input!  I do appreciate and respect your advice.  I am on my 4th OS since last year!  I am seeing a New doc on 7//29 he is a TKR and a PKR specialist this is all he does.  Hope he has some good ideas for me.  As far S tracking issues in my knee there does not seem to be anything.  I do understand how important it is to exhaust ALL viable options before surgery.  I just get so overwhelmed at times and want to fix it! Is it ok for me to ask for a scope?  I know MRI's are amazing but there is nothing like seeing what is going on first hand.  Finally I guess most of all I want to get well for my son... He is 5 and wonders why his mommy cannot play with him anymore :(