Banner - Hide this banner





Author Topic: 31 with Knee Arthritus - what to do Help!  (Read 1468 times)

0 Members and 1 Guest are viewing this topic.

Offline gamwah

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 0
31 with Knee Arthritus - what to do Help!
« on: February 01, 2012, 03:18:40 PM »
I am a 31 years old rugby player from the UK I have been told I have arthritis the size of a tic tac on the medial side of my left knee. I simply cannot run anymore and am getting very frustrated with doctors as they tell me the only or best option I have is to have my leg broken and repositioned as I have a slight misalignment of my leg which COULD have caused my Arthritic knee..... I have previously had micro fracture surgery on the area, but I was given poor advice by my doctor and this has failed.

Is there any other options open to me so I can run or even play rugby again??? I have read about PRP or HRH as a treatment is this available in the uk???

Offline Kimberly 77

  • Forum Faithful
  • ****
  • Posts: 296
  • Liked: 1
Re: 31 with Knee Arthritus - what to do Help!
« Reply #1 on: February 01, 2012, 04:25:29 PM »
You would meet the criteria for having a cartilage transplant. I think they call it ACI, (articular cartilage implant) this is for active young patients that have a localized defect no bigger than 2.5 cm. This is a 2 surgery procedure they will go in arthoscopically and remove some healthy cartilage and send it to a lab and grow it in a petri dish for 6 weeks and then implant it in your knee. Long recovery period and lots of theraphy after. Can't weightbearing for like 6 to 8 weeks. Better outcomes are associated with young patients with small defects. Honestly since the microfracture has failed I think it is your only option.
Right leg amputee.
Osteoarthritis in left knee.
Medial femoral condyle defect, arthoscopy 8-2-10
Grade 3 defects, patella, medial femoral condyle, tibia scoped1-12-2011
Physical theraphy and awaiting microfrature 2-1-12

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4954
  • Liked: 420
  • Neelie knee!
Re: 31 with Knee Arthritus - what to do Help!
« Reply #2 on: February 01, 2012, 08:36:44 PM »
Hello there

As Kimberley says, there are cartilage repair / transplant techniques, but they are not a quick or easy fix (these are usually big open surgeries, with at least 12-18 months before you would even be considering impact sport realistically, if at all).  Nor are they easily accessed in the UK, even if you have private insurance, let alone on the NHS.  There are probably only 10 large centres in the UK where the more cutting edge surgeries (like MACI) are done.  Presumably there is a reason why the surgeon (how many opinions have you had by the way?) thinks that you are misaligned and would potentially benefit from the suggested surgery (called an osteotomy) - have you had x-rays, or a CT scan done?  Is this the same surgeon who was remiss about the microfracture?

Have a read here about the different options.  http://www.kneeguru.co.uk/KNEEnotes/node/1839

This is interesting and informative too

http://www.kneeclinic.info/download/CKC_GNHFT_ACI_RehabGuide_101106.pdf

As well as the implant described by Kimberley, there is also a procedure called OATS/mosaicplasty, where a bit of cartilage is taken from a non weight bearing part of the knee and inserted into the defect - this is good for small 'punched out defects' of the type you prescribe.  One thing to be aware of is that the success rate with these procedures is documented to be lower where a previous repair has failed, also they may not work if you are malaligned as suspected and you may still need the osteotomy. 

I was in a similar situation to you around a year ago (albeit I am rather older and no sportswoman, leisure cycling & gym for me) and started down the MACI road, had the first op (scope) but the surgeon discovered damage to both the femur, the repair site (1.5cm2 defect, which is filled with fibrocartilage following the trauma, DIY mfx ;D ) and the tibia opposite.  He would not do the transplant as the chance of success is low as I am knock kneed, and would need an osteotomy first.  My knee is now really pretty good after a year of strengthening on the bike and physio (ok I can't kneel but hey).  Perhaps a solid targeted physio and non impact exercise programme would benefit you?  Perhaps your rugby club can recommend someone you could see privately?

Where are you in the UK? - someone will be able to recommend a cartilage specialist to get an opinion from - you may have to pay privately depending on how agreeable your GP is (usually a couple of hundred for the initial consult).  You probably won't be in a position to pay out of pocket for MACI, it is likely £10-15k (seriously) but there is the possibility of having it on the NHS.

I think PRP is possibly available in the UK but it's seriously expensive.  I have tennis elbow and my consultant suggested it, but it costs £700 every time...and no insurer nor the NHS will fund.  I am sceptical that it works personally, hyaline cartilage cannot be regrown properly.  If the mfx failed, you may not be a good grower of fibrocartilage (unlike me it seems!)

Have a read of articular cartilage repair forums (note, de novo isn't available in the UK so reading those threads won't help) and also the 'changing forces' for osteotomy info (and also this)

http://www.kneeguru.co.uk/KNEEnotes/node/1840

You may find an unloader brace helps, physio should be able to advise

Good luck :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline gamwah

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 0
Re: 31 with Knee Arthritus - what to do Help!
« Reply #3 on: February 02, 2012, 09:38:59 AM »

Thanks for your responses much appreciated. I will look into a cartilage transplant, my consultant didnít mention this as an option but I defo look into it!

I have had alignment X-rays and a MRI ( I think this is the same as a cat??) scan performed, but this is a different surgeon/consultant who performed my original surgery. He basically said I should never have had Micro fracture without having these test performed first which the first surgeon never even mentioned........the first surgeon who performed the surgery went in to have a look at my knee as I couldnít run and was having pain etc and then told me he had performed the micro fracture and sent me on my way without any real follow up or advice, just you should be up on your feet in a couple of weeks! I was trying to squat weights after 2 months which as I have found out after research is the worst thing you can do!!

I should have researched more on microfracture and rehab etc so I can't blame the surgeon entirely just annoyed that the aftercare support was so bad!!

I live just outside London so hopefully there may be a cartilage specialist somewhere not too far away, I have been seeing a physio and am really trying to build my leg muscles via swimming and cycling. Might just have to accept I am not going to be able to run as I used to and find other hobbies....


Thanks for all the advice I will look into whats been recommended and good luck with your knee sounds like you are in a good place at the moment with it all!



















Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4954
  • Liked: 420
  • Neelie knee!
Re: 31 with Knee Arthritus - what to do Help!
« Reply #4 on: February 02, 2012, 10:10:24 AM »
There is a major cartilage repair centre at the Royal National Orthopaedic Hospital at Stanmore in Middlesex (you don't know in which direction outside London you live - that's North-Westish).  The surgeons there are extremely experienced - it was one them who treated me (they have private practices nearby too)

Running is often not good for knees especially if wonky, sounds like your defect is on a weight bearing surface

Shout if you have any further questions
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline seantomtom

  • MINIgeek (20-50 posts)
  • **
  • Posts: 30
  • Liked: 1
Re: 31 with Knee Arthritus - what to do Help!
« Reply #5 on: February 26, 2012, 08:54:28 AM »
As an ex rugby player myself i know the feeling of wanting to play again,its a game you have to love to play.But i am now 50 and currently in full leg cast following high tibial otsoctomy,its a slippery slope  next tkr,hopefully not for a few years,but it will be needed.i would say dont try to get back to  playing rugby,just play the drinking games instead.had i stopped at the first knee injury (acl) i might not be here now.good luck whatever you do.excuse me but must get on with me knitting

Offline captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: 31 with Knee Arthritus - what to do Help!
« Reply #6 on: February 27, 2012, 10:12:46 PM »
If you are going to need a TKR at 50, I would seek multiple opinions.  I was talked into a TKR at 47 only to have complications.  I am worse after the TKR or should I say TKR's than I was prior to the surgery.  Two years of operations, two years without working, and I am worse now than prior to the first TKR.

I would LOVE to go back to my condition two years ago.  I am not saying TKR's are not justified or that all surgeons make mistakes, but it does happen and if you are one of the few, it does not matter that a large percentage of them are successful.  The only important point is I am disabled.

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?















support