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Author Topic: X-rays show Patellofemoral Osteoarthritis at age 30. What can I expect?  (Read 4102 times)

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Offline bekim

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A few weeks ago I had x-rays done on my right knee, showing that I have some patellofemoral osteoarthritis. At 30 years old that sort of scares the s**t out of me.

My big question is, what should I expect in the future? 10, 20, 30 years from now...

Here are the x-rays:

(larger image: http://mikebeauchamp.com/dump/knee1.jpg)

(larger image: http://mikebeauchamp.com/dump/knee2.jpg)

The x-rays were described by my sports physician as "showing some irregularity of the contour of the posterior aspect of the patella in the region of the median ridge, and also some bony irregularity at the medial aspect of the right femoral trochlear."


Here is my knee history:

- 1995 (age 15) -  I had a patellofemoral dislocation playing ice-hockey.
- 1995 - I had a lateral release done.
- 1996/1997 - My kneecap dislocated several more times.
- 1997 - I had a pretty major surgury that seems to be the "Hauser procedure" (based on the description of it from this website). That is, they removed the bone with the patellar tendon attached and screwed it back in more on the inside.

At that time, I stopped doing most activities like running and bicycling. Starting around 2002 I started to get back into bicycling and I noticed a bit of catching in my knee, and a slight amount of "grinding". I questioned my family doctor (a different one since the surgeries) about this, and he dismissed it as "runner's knee" and told me not to bother doing anything about it.

Several years later (lets say 2006) I noticed my knee was getting worse (more catching and more grinding). Again, my family doctor dismissed it and told me the grinding was "gas escaping from the cartilage". My uneducated guess at the time was that there was "bits" floating in the knee, so I strongly requested x-rays to see. The x-rays didn't show any bone bits floating, so the doctor told me that there was no trouble.

In 2008 I moved to New Zealand from Canada and got back into hiking and mountain biking. My knee felt like it was getting worse and walking down the steep streets made it painful, especially since it was catching more severely.

In 2009 I went to see a physiotherapist here and told him about some of the problems. To diagnose what I had, he simply manipulated my kneecap while I laid down, and concluded that everything seemed smooth and gave me some exercises to do.

I wasn't convinced, and in 2010 I went to see a sports physician. He also tried manipulating my kneecap, but this time I recommended that he do it while I keep my leg bent at the angle that the kneecap usually catches at. This time, he felt some definite grinding and sent me for x-rays where I suggested that they be taken at the same angle. These x-rays came back to show that the back of my kneecap was actually touching the bone behind. Both areas looked worn away with little bone spurts on the edges. When going over the results, I asked the doctor what I can do and his actual answer was "just give it heaps" (New Zealand talk for "don't worry about it, and live your life"). This doctor also suggested I see a physiotherapist to build up some leg muscle, and that I see a podiatrist to see how I'm walking. We didn't go over any surgical options, because I can't afford them here. When I return to Canada in 12-20 months, my top priority is to find a good Orthopedic Surgeon and discuss what my options are.

And that's pretty much exactly how it stands right now. I'm very confused about what will happen to my knee in the next years of my life, and if/when I may be at a point where I'll require a large surgury like a total knee replacement, etc.

At this point in my life, I'm as healthy as I've ever been. I currently walk and bike a lot (including long bike tours), but now I'm avoiding hiking if it requires any down-hill and I'm also avoiding going down stairs and any other things that immediately "piss off" my knee. I can feel a dull pain in my knee pretty much all the time now, but the biggest concern I have is about my future quality of life. Obviously I need to get it looked at by an Orthopedic Surgeon, but can I wait 1-2 years?

Can anyone with a similar knee problem share an approximate time-line? What procedures helped, how long they lasted, etc? I'd also be curious about what sort of a life you can have with patellofemoral osteoarthritis, especially as it gets worse... can you walk, stand, sit, can you live without pain medication, etc?

Sorry about all the questions, and thanks for any information! I also want to say that I've just spent a lot of time reading this board and you guys are amazing. My knee is probably pretty good compared to a lot of you reading this, and I can only begin to understand what you might be going through. Some of your stories had me in tears, and it's amazing to see the strength you have and the support you have for one another.

Mike

Offline kscope09

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It doesn't sound too my left knee which has been doing too much work sicne I had problems with the right.  It feels like it catches at certain angles, like the kneecap is running over a little bump and when it clicks it sounds like a gun shot.  My right knee used to catch much worse though because I had a fragment of acl stuck down the side and I got a loud click with every single extension. Pre-op I saw 3 gps and 3 physios and they all dismissed the loud clicks and cracks, they did their tests that said the tracking was off and when i got it tacking again on it didn't feel much different.  They would always use he test that they'd been taught to feel for catching, which I assume are the same ones you've had, where you lie on your back and they put a hand on your kneecap.  These never showed anything but but if I sat on a chair and moved moved my leg back and forth the kneecap seemed to jump all over the place.  When I asked them to feel it in this position, they said it wouldn't show anything and wouldn't do it.  Mris didn't really show anything and I've never had an xray, but it might be time to ask for one.  I'm 29 in a couple of months and like you I'm terrified of the long term problems, but if I can get fixed up for now and get a good 10 years doing most of the things I want then I'll be happy to get knee replacements.  You should ask your surgeon if you are a candidate for any of the resorative surgeries like OATS or ACI.  There's plenty of people here who can tell you aobut them.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline bekim

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It doesn't sound too my left knee which has been doing too much work sicne I had problems with the right.  It feels like it catches at certain angles, like the kneecap is running over a little bump and when it clicks it sounds like a gun shot.  My right knee used to catch much worse though because I had a fragment of acl stuck down the side and I got a loud click with every single extension. Pre-op I saw 3 gps and 3 physios and they all dismissed the loud clicks and cracks, they did their tests that said the tracking was off and when i got it tacking again on it didn't feel much different.  They would always use he test that they'd been taught to feel for catching, which I assume are the same ones you've had, where you lie on your back and they put a hand on your kneecap.  These never showed anything but but if I sat on a chair and moved moved my leg back and forth the kneecap seemed to jump all over the place.  When I asked them to feel it in this position, they said it wouldn't show anything and wouldn't do it.  Mris didn't really show anything and I've never had an xray, but it might be time to ask for one.  I'm 29 in a couple of months and like you I'm terrified of the long term problems, but if I can get fixed up for now and get a good 10 years doing most of the things I want then I'll be happy to get knee replacements.  You should ask your surgeon if you are a candidate for any of the resorative surgeries like OATS or ACI.  There's plenty of people here who can tell you aobut them.

Thanks. I think OATS and ACI require that the cartilage be undamaged and not worn at all, but I'm pretty sure my xrays show a narrowing of that gap, meaning some cartilage has been worn away.

Mike

Offline kscope09

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I don't really know much about theprocedures but it sounds like ACi has hadsome good results.  There's also cartifil which sounds promising.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Lottiefox

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Hi Mike

Sorry you're having some issues - I can sympathise with the whole PF OA thingy striking - both of my knees have their own special "patella issues". It sounds like you've had surgery to help the patella alignment in the past which is clearly a good thing and hopefully might address some of the biomechanics. It is a hard question to know how far and how fast degeneration will progress. I think laying off the impact work is a good move but similarly, staying as active as you can and keeping those leg muscles strong is also essential. The progress in each person is different, but my OS did say it was SLOW and not an overnight thing. I think basic self help like using a good glucosmanine and chondroitin supplement, eating well, and so on can help general OA symptoms if they work for you. I also introduced rosehip supplements which certainly didn't do any harm and helped the general *gnaw" when the weather was cold. I try and avoid painkillers unless the flare is bad. I would ceratinly agree that a GOOD physiotherapist can help with specific leg exercises that don't stress the patella joint and a podiatrist can look at your gait. Be careful of randomly prescribed orthotics - I had some 3/4 length last year and they made my knees a million times worse. On the flip side my friend (a runner) had some custom made soft full length ones and they've transformed her ITB syndrome and knee pain..).

There are cartilage repair procedures out there and they are progressing. The PF joint is hard to repair and as you correctly say there needs to be some good cartilage left to work with. An X-ray can show joint space narrowing but when the actual cartilage wear patterns are observed on MRI it might not be as bad as it looks! I have joint space narrowing but some fairly localised defects on the medial and lateral lower portions - the rest of the knecap is OK although the noises it makes would indicate heaps of missing stuff! OATS on the patella isn't commonly done, not enough depth/blood supply to work with. ACI also requires some existing cartilage and isn't recommended for general OA problems, however there are people who have had results with it on the patella. You mention bone on bone contact - I assume that means the trochlear groove is also wearing, so this indicates "kissing lesions" and as such ACI might not be suitable. Only a specialist PF OS would know for sure. MRI scans would show the size and depth of the lesions in more detail. There is also Cartifill, a new approach for lesions under 3cm which combines microfracture and a special collagen paste - currently being trialled in the UK in Kent. Its supposed to be good for patella defects as it hardens rapidly. Next year it will be available through a scope procedure so I am hanging on for that being available. Again, you'd need decent T2 MRI images to establish if this might help you. On the longer side...people on here have had PF joint replacements. They can now replace the trochlear groove and the rear of the patella. Its a big operation and not something you need at the moment, but advances are happening all the time.

I think it is scary being told at 30 you have OA. But you are doing the right things and if you research your options now, and keep your knee as healthy as you can, you should get many more years out of that joint.

Good luck

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Fridge197

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Re: X-rays show Patellofemoral Osteoarthritis at age 30. What can I expect?
« Reply #5 on: December 25, 2012, 01:51:13 AM »
Hey,

I know your pain, I'm 32 and was booked In to have a lateral release and clean up on my left knee last month. I went in had everything done and then next morning awoke to my OS telling me that what he had done was probably not going to prove successful as he found that I'd worn all the cartilage away from my patellofemoral join.

I've never been someone who gets down on anything and always look for the positive in everything. This time though It was such a shock that I've been a little depressed about it all since.

To know that at 32 I'm stuck with a left knee that is virtually useless and a right knee that isn't far behind ( the same lateral release procedure is booked for 6 months away after the left is fully healed and strong ) is depressing.

Guessing that realistically my next option is to go for a TKA or a UKA and hope for the best.

Offline captainruss

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Re: X-rays show Patellofemoral Osteoarthritis at age 30. What can I expect?
« Reply #6 on: December 26, 2012, 04:46:00 AM »
Bekim and Fridge,

I shudder at the thought that you might be thinking of a TKR or PF replacement anywhere in your near futures.  I am in the small percentage of those (disclaimer) who have had TKR's and suffered complications.  If I could go back, I would.  I have more pain and less function after the TKR than I did before.  The OS should have told me that I was working full time and active, that I should have stopped whining about the pain and swelling and opted for the TKR when I could no longer function on any level.  Alas, he did not do that......no one here would answer me early on and so I just kept making the same mistakes over and over with new doctors.

I am not clear on medical availability in New Zealand, but I would suggest getting as many opinions as possible.  I did not and again paid for my mistakes.  In this forum, you cannot send private messages (PM) until you have 20 posts.  If you go to the game section you can obtain those 20 posts and I would be happy to send you my extensive diatribe on why TKR's and PF Replacements are risky. 

I would explain here.....but I get chastised for making lengthy posts about my mistakes.  Now many TKR's are very successful.  The hard part is they usually do not last much past 10 years if you are active.  The same is true about PF Replacements.  You guys are 30 & 32 respectively......that is a lot of decades to go with a joint replacement of any type.  In my biased opinion, these surgeons should be telling patients that they must consider their quality of life.  If you are functioning at all, you need to wait.

Infection and AF (Arthrofibrosis) which is just a long word for scar tissue that grows in some knees (small percentage) due to the knee trying to protect itself.  The human body senses danger, so in some people it immediately grows large amounts of scar tissue that keeps the knee from bending (protection).  If you search Dr. Frank Noyes AF on this site, he has a great paper on that and also PF issues.  Missmyknee has a great blog also with huge amounts of information so search her name also!

Send me a PM if you have questions as I must sign off now....the KG Storm Troopers are watching me!!!  Merry Christmas!

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?