Arthrosurface fail

[Peg Leg HCF]

I had this done February 2011 and at 8 months out I still have considerable pain and buckling in my left knee. I did everything i was supposed to do and still have bad pain and  buckling, popping, grinding. My doctor now wants me to have a nerve test after i had a bone scan that showed nothing, I am losing faith in this doctor. Know my knee is worse then it was before and i can't stand this anymore. Does anyone else's knee cap move to much now? Mine has at least a half inch movement now.

A little history i had a scope done in 2006 to clean up some small tears, Doctor at the time said i was to young for a replacement. In November 2009 i had a lateral release < wish i had never had done, Then in February i had the Partial replacement. Ive been through the ringer and am still not happy with my results and can't get my doctor to understand my problems. I think the bone scan & nerve test is a way to cover his butt so i don't know what to do now.

here is my video i made to show my movement in my knee cap:

http://www.youtube.com/watch?v=8TEwEpmTd4c

[Brambledog]

Hi Peg Leg HCF,

I watched your vid and your kneecap does seem to have a lot of movement. I read up on arthroplasty which I'd not heard of. A poster called 'rottenkid' had arthroplasty done and has quite a long thread on his progress. Could be worth a look. It's in the OA Dept, Unicompartmental joint area.

Sorry to hear of your troubles with the LR. I've got arthritis in my patellar femoral joint and had chondroplasty a few months ago, now my surgeon wants to do a lateral release (my kneecaps are only a bit tilted and have never dislocated) and possibly a separate medial plication if the LR doesn't work - I'm VERY wary of a LR, I've heard of too many failures, and my OS said there was only a 30-40% chance of it working - not good odds! I'd be interested to know why he did the LR on you and what he hoped to achieve.

I saw my OS again recently as my recovery is not going well, physio isn't working, pain not under control etc, and he too is going down the nerve problems route, so I totally understand your frustrations. Mine has diagnosed CRPS, and the symptoms I've had definitely point that way, but he seems to be excusing ALL my knee pain by saying its the nerve inflammation causing it, but I know that there are mechanical issues in there that I think need addressing. Unfortunately, until the CRPS is addressed, I can't tell which pain is which...

All you can do is keep on asking them to find out what's wrong and why you are still having problems. See what the result of your tests are - nerve troubles can cause a lot of symptoms, as some other posters on this site can testify, so it could be that it really is a factor, and when got under control with proper meds it may make a big difference.

If you are still not happy after these tests, then think about a 2nd opinion from another doc. Always worth a go if your faith in your OS has been shaken. I may have to go down that route myself.

Good luck and keep us posted.

Brams 

[Hicubus]

Dear Peg Leg HCF,
Sorry to hear about your issues.  If I understand your email you have an Arthrosurface HemiCAP PF (kneecap) replacement but still have issues with your kneecap being loose. I am a Director at Arthrosurface and would like to make myself available to you and to all of the others in this forum to help answer questions as best I can.   As you may know the PF joint (the area behind your kneecap where the kneecap moves up and down) is very complex.  Many things effect the movement here.  Our goal as a implant manufacturer is to restore the joint to a smooth and slippery and congruent surface.  The motion of the patella is largely controlled by soft tissue. SO the good news is that you might just need some attention to your soft tissue balancing.  Remember that most surgeons try to get the best result from doing the least amount of harm and damage.  Sometimes there needs to be more work done after the "next step" hasn't worked out.  The most important thing is that you ave NOT burned a bridge and still have lots of positive direction and decisions that can be made from here.  Be sure to discuss this with you doc and potentially ask to be referred to a surgeon that specialize in complex Patella anatomy.

PS:
Feel free to reach out to me or to anyone at Arthrosurface.  We realize we have taken on the challenge of treating patients that are the most active and have high expectations.  We do not take this challenge lightly and we are all learning together.  We are open to any and all discussions.  I simply hope I can keep up with the flood of email and phone calls I would expect from a learned group like this.  Let's keep moving and keep our lives active without pain.
Mike Nordling
Director of Marketing and Clinical Affairs
Arthrosurface

[Peg Leg HCF]

Dear Peg Leg HCF,
Sorry to hear about your issues.  If I understand your email you have an Arthrosurface HemiCAP PF (kneecap) replacement but still have issues with your kneecap being loose. I am a Director at Arthrosurface and would like to make myself available to you and to all of the others in this forum to help answer questions as best I can.   As you may know the PF joint (the area behind your kneecap where the kneecap moves up and down) is very complex.  Many things effect the movement here.  Our goal as a implant manufacturer is to restore the joint to a smooth and slippery and congruent surface.  The motion of the patella is largely controlled by soft tissue. SO the good news is that you might just need some attention to your soft tissue balancing.  Remember that most surgeons try to get the best result from doing the least amount of harm and damage.  Sometimes there needs to be more work done after the "next step" hasn't worked out.  The most important thing is that you ave NOT burned a bridge and still have lots of positive direction and decisions that can be made from here.  Be sure to discuss this with you doc and potentially ask to be referred to a surgeon that specialize in complex Patella anatomy.

PS:
Feel free to reach out to me or to anyone at Arthrosurface.  We realize we have taken on the challenge of treating patients that are the most active and have high expectations.  We do not take this challenge lightly and we are all learning together.  We are open to any and all discussions.  I simply hope I can keep up with the flood of email and phone calls I would expect from a learned group like this.  Let's keep moving and keep our lives active without pain.
Mike Nordling
Director of Marketing and Clinical Affairs
Arthrosurface

Talked to my physical therapist and he agrees it's not a soft tissue problem, I have had over 190 hours of PT and they said i have nearly no muscle weakness. Oh to update the nerve test was negative and they only tested my left leg (the one with the implant). @ Brambledog  i would be very leery of a LR cause now i wish i had never had it done. And thanks i read all of  rottenkid's post and i'm the same way, their is noway i can bend down and put any weight on this knee even with a pad. I go back to my DR the 29th this month but it might be next week cause i am having severe pain and popping, locking, grinding still. 

[Brambledog]

Glad the thread was of some use, but sorry you're still no better. Good luck when you see your surgeon, and be vocal when you see him - make him listen, and I hope you get some kind of way forward. If he still won't look at the knee properly or tries to fob you off, then go straight to your GP and ask for a second opinion from a specialist.

Let us know how you get on!

Brams 

[Peg Leg HCF]

Yes it was a great use to me thanks, At this point in time i just want relief from the pain, popping and grinding. I'm not knocking the implant company or my DR but not all things work for different people. I think at this point i want a TKR, cause i know at least 6 people that had it done this year at the same time i had my PKR and they are doing so much better then me.  I talked to Hicubus  on the phone and told him my story and he still thinks it's a soft tissue problem but my PT says it's fine so IDK. I did have a fall a month and a half after my surgery but my DR knows this and they x-rayed it to see if the implant dis lodged but it didn't. Even with all my problems i dread going under the knife again

[wyoknee]

Hicubus, like to hear from you.
AHicubus, like to hear from you.
Age 50, 4 years ago had 1st knee complication, local ortho diagnosed as torn meniscus in left knee, had trimmed and micro fracture. (at same time determined have arthritis in both knees) 3 years ago right knee went out ,local ortho believed would be the same, after arthroscopic found out meniscus was ok but femur had broken off a spot and his recommendations were to wait, not any good options at time. Did try the halo injections for reducing pain during running. Researching on internet found Arthro surface and ortho  doc in SD 150 mile away, after contacting new ortho determined I would be good candidate, 2 years ago he put in femur piece believing meniscus ok, after year pain not going away went back and had tibia piece put in,currently post op 4 months, still painful but seems to be getting better. Last week went back to local ortho for original  (left) knee locking up, after x-ray he saw Arthro surface I had in right knee and was visibly upset, stated the procedure was no good, not long lasting , and would not ever be able to have a uni-kmee if needed.
Very concerned if the sharp pain in center of knee joint with Arthro will ever go away and is this doctor correct about not being able to have uni-knee, had discussed this fully with doctor who put in Arthro, he had stated I would be able to have uni knee, and I also believe I had read that in some literature that a uni was an option after Arthro Surface.
Thanks, Wyoknee

[Hicubus]

Wyoknee,

Hi!   Thanks for reaching out to me.  I will try to point you in the right direction and pull the facts out from the hysteria from your surgeons.  First off we are very pleased to announce the over 30,000 patients have received an Arthrosurface implant and we now have over 100 published articles explaining the clinical benefits and data.  We are excited to put this in an upcoming press release.

That being said it should counter any surgeon that says this is not a good procedure.  Like ANY procedure, it is all in the indications.  Your primary surgeon has a tool to treat your focal defect and he used it in a proper manner.  You are young and active so it makes perfect sense to use it.  Now we do not claim to be the long term solution for every patient under 70 years old that has a cartilage problem but it is certainly a important consideration and outside of a very few it works great.  Unfortunately there are just some patients that do not respond to the surgery.  Take a look through the web and find all of the failed microfracture, carticel and allograft patients out there.  I think we are doing excellent amongst the other options.  So I say this to keep perspective for any surgery.  Keep in mind that a surgeon runs a business and his business is based on treating patients.  If a particular surgeon is not trained in a particular procedure then he may have a tendency to "shoot down" those procedures he cannot offer you.  I'm not saying that is the case in this instance but I definitely see that around.  Only the data can take the opinion out of comments like that.  See our website for our peer reviewed articles and data.  Remember (to use an analogy) our goal is to be the filling for a cavity and I don't think many of would say that dentists are doing no good in filling cavities and preserving your tooth.  That may be simplifying things but you get my point. 

I hope the community here sees these comments as providing a perspective for you all while you arm yourselves with information! 

As far as your case is concerned:  remember that this is a surgery so there are a lot of moving pieces to a recovery and while it can usually take 3-6 months to recover fully there are patients that might need a year to feel back to their old self!   This is something that you should discuss with your surgeon so he is aware of your progress.  Sometimes a cortisone shot will be effective in getting you "over the hump" in rehab.  4 months out is not that long and I would encourage you to stick with it.  I have seen a few patients that were in a similar situation even 1 year out that suddenly took a turn for the better.  See our website to hear this patient tell a similar story.  http://www.arthrosurface.com/patient-video-testimonials/knee-athletic-sportsman  (copy and paste into your web browser)

As far as revision to a bigger unicondylar goes it can certainly be done and I have personally seen it performed multiple times.  All of our implants are designed to be minimally invasive so you ARE left with options.  We have specific tools designed to accomplish the removal.  Again there are some cases that are more difficult (due to other circumstances) to revise but as a general rule it can be done.

I hope you find this information honest and helpful.
Please keep the questions coming!

Hicubus

[Peg Leg HCF]

Update JAN 20 2012 : Well its been a couple month with more test to see why i still have pain, popping, grinding, buckling DR thought i had a infection in the knee but all test came back negative. Had 4 more weeks of PT and the therapist defenaly says it's not a soft tissue problem, So as it stands right now my DR thinks it's two things. First scar tissue or the implant is to small so i will let him do a scope next month to see which one it is, oh i'm back using my cane and he gave me a temp handicap parking permit. Will update next month and see what i'm facing. 

[Peg Leg HCF]

A quick update on my knee, Will have a total replacement done May 23rd just hate starting all over.

[Brambledog]

Aww, Peg. That's such a shame, but at least you've got something definite to work towards now, and the other side of it should see things much improved from where you are now.

I'll keep an eye out for your progress with your TKR, and will have my fingers crossed for you. Hope the month of waiting flies by uneventfully!

Better to start again than keep banging your head against a brick wall. If that implant wasn't going to work then it's best off out of your knee.

Take care of yourself,

Brams 

[Peg Leg HCF]

Had my total replacement done May 22nd, spent 4 days in the hospital and start regular physical therapy in the morning. They sent me home with a CPM machine and i'm at  74% flexion, 5% hyper extension, so the long road to recovery begins.

[Brambledog]

Well all I can say is....

GOOD LUCK!!!!!!!!

I'll be rooting for you through the physio and recovery. Hope it goes well, odd hiccups aside...

Brams 

[Peg Leg HCF]

Thanks Brams, physical therapy was a nightmare i couldn't even do a leg lift. :|

[Brambledog]

Must be a nightmare  If you read other TKR threads, the first few weeks are very tough, and the physio very painful.....but it IS worth it, and it WILL get easier. Half of recovery is about the physio, you'll be glad of this hard work further down the road. Just keep up with your meds and give yourself a few precious treats on the really tough days!

We're rooting for you. Good luck with it all!

Brams