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Author Topic: PFArthritis post-arthroscopy surgery notes confusion - HELP!  (Read 776 times)

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Offline Brambledog

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PFArthritis post-arthroscopy surgery notes confusion - HELP!
« on: October 29, 2011, 02:57:47 PM »
If someone could shed some common sense on this I'd be very grateful.

I had an arthroscopy in early August, dx on follow-up was patellar femoral arthritis. Said biopsies where normal, had tidied up the cartilage, but it wouldnt give any long-term benefit. Plan was physio for 6 months then review. Talked about MFX but said unlikely to be successful in my case, hoped to strengthen leg muscles enough to delay further surgery.

Obviously I'm not going to name names here, so I shall refer to the main surgeon as Mr X, and one of his registrars as Mr Y.

Prior to my surgery I only saw Mr Y, he was the one who took a sample of fluid from my knee and did the corticosteroid injection (he was very good with the needle!), and also he who recommended the arthroscopy to find out what was really going on in there. After the surgery, I have only seen Mr X, and thought that this was because he was the surgeon who had done it. He was always referred to as 'Mr X The Surgeon'. Both I and my husband have referred directly to him being the one who 'did' the surgery, and he has never corrected us or commented further.

You can see where this is going... I got my medical records that I requested.

On my theatre details from the arthroscopy, the surgeon is listed as Mr Y. Mr X is scribbled on the notes as 'unscrubbed in theatre'. Which I gather from google means that he is in theatre but some distance from the table, not one of the scrubbed surgery team, and only there for advice if his trainee Mr Y asks for it.

On the surgery report it clearly shows a drawn diagram of my knee showing scribbled feathering on the back of the patella listed as Grade 3/4, a scribbled area on the lateral side of my tibia listed as Grade 2, and a smaller scribbled area listed as Grade 1 on the corresponding lateral side of the femoral head (the two patches would meet on standing). It also says 'some synovial tissue in supra patellar pouch. Biopsy taken. No loose bodies'.

On the next page where each section of the knee is listed separately:

Medial compartment: medial meniscus probed intact,

PFJ: grade 3/4 changes. Patella chondroplasty done.

Notch (?): ACL probed intact.

Lateral compartment: lateral meniscus intact. Grade 2 changes tibia, grade 1 changes femur.

I have 6 photos from the arthroscopy. One of them shows some pretty large and jagged shredding of the cartilage, but it's difficult to tell which area it is. Another shows what I think looks like the back of the patella looking pretty rough but not as shredded.

***

So what is going on? I have so many questions...

- Why did Mr X not tell me when I directly referred to HIM being the one 'inside my knee' that he had not been the actual surgeon?
- Why have I only see Mr X since the surgery and not Mr Y (who was the only one I saw before it)?
- Why, when the report clearly says grade 3/4 changes in the PFJ and patellar chondroplasty done, did Mr X say last week that all they really found was 'some cartilage softening', take the two biopsies and wash it out? When I said about the resurfacing (which both he and the assistant during surgery told me had been done), he said 'well, not really' and talked about maybe doing it if they have to go back in for anything. Which was different to what he'd told me at three weeks post-op when giving me the Dx.
- Why, when I saw Mr X again this week as I was concerned that my pain is still high and physio not really progressing (he had my MRI up on screen showing a slight tilted patella), is he now keen to do a lateral release possibly followed by a medial plication if LR alone is unsuccessful? A tilt was not mentioned post-op and any further surgery then was more likely to be MFX (although he didn't think it was likely to work). MFX was not mentioned in the latest consult at all - he said LR was the only thing they could do now.

I am very confused!  ::)

Brams.  ;)
2009 - diagnosed coeliac
Aug 2011 - L knee arthroscopy
Aug 2011 - diagnosed PF arthritis L knee
Nov 2011 - diagnosed CRPS L knee
Dec 2011 - MRI R knee, PFOA is worse than L!
June 2012 - no surgery 'til TKR's
Nov 2012 - CRPS spread to L foot/thigh, increasing pain
- Worsening pain/symptoms R knee
;-)

Offline brianwith2ndknee

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Re: PFArthritis post-arthroscopy surgery notes confusion - HELP!
« Reply #1 on: October 29, 2011, 03:22:17 PM »
Hello Brams ,

This scenerio does sound alittle scary . My wife works for my OS , so I will show him your scenerio to see what his thoughts on it are . My thought is you need to find another OS and get a second opinion . It almost sounds like they are doing guess work inside your knee , which can possibly cause you issues down the road which Im sure you are aware of .
Knee Scope and Microfracture 03-2010
OAT's procedure , Reconstruction , Femoral nerve block 10-2011


Wishing everyone a healthy speedy recovery and good luck to all...
Brian S

Offline Brambledog

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Re: PFArthritis post-arthroscopy surgery notes confusion - HELP!
« Reply #2 on: October 29, 2011, 04:00:06 PM »
Thanks so much brianwith2ndknee, it would be brilliant to get another OS' opinion on it. If he says it's perfectly normal procedure then that's fine, but I have to admit my confidence in mine has been shaken.

If it helps, there's more detail in my post-op diary about everything, especially the consult I had with him a few days ago that so confused me when it was almost as though he were talking about a completely different knee...

Brams  ;)
2009 - diagnosed coeliac
Aug 2011 - L knee arthroscopy
Aug 2011 - diagnosed PF arthritis L knee
Nov 2011 - diagnosed CRPS L knee
Dec 2011 - MRI R knee, PFOA is worse than L!
June 2012 - no surgery 'til TKR's
Nov 2012 - CRPS spread to L foot/thigh, increasing pain
- Worsening pain/symptoms R knee
;-)