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Author Topic: Is there anyone who can give me some advice or share their experience? Photos  (Read 2067 times)

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Offline deb43

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I have grade IV patellofemoral arthritis.  I am 43, active and so confused and frustrated about what my future holds.  I had a scope done 2 days ago and had everything cleaned up.  I meet with him next week to discuss future options.  I just don't know what to do.  My joint is healthy, meniscus is healthy, but patella is not good.   I feel like I am stuck in limbo. If I continue to be active, I deal with the pain the best I can or I can go for a PKR.  Does anyone have any advice or thoughts that they're willing to share?  What did you do when faced with this situation? I want to be able to be active with my children when they're still living under my roof. So part of me says, do the PKR now and the other part of me says deal with it the best you can and push it out as long as possible.  I have attached my scope photos.
Thank you for listening.

Offline LindaM

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Hey there Deb,

Take a moment and slow down.  You are just finished with having a scope.  Why don't you wait a while to see what improvement you have before you jump to a PKR.  When you meet with you OS he will probably have some other options like a custom brace or PT or another more limited repair for you to consider as well as a PKR.  You don't want to give up being an active mom I understand, but you need to carefully consider that with the limited lifetime of a replacement there are only so many times they can do it over.  I am 62 and have 2 PKRs, but even I expect to have them redone some time (hopefully long) in the future.

 If it is impossible to work and function with the pain level you have, I understand you may want to have the surgery now.  Sometimes the pain is just too much.  My sister had two TKRs in her mid-forties and now 17 years later they are still in perfect shape even though she is an extremely large woman.  It can work, but try whatever options your doctor might suggest first.

Good luck on your recovery and on your decision-making.  Let us know how things go.

Linda
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline ShoeCrazy

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Hi Deb,

Although I cannot offer any personal experience info to answer your questions, I totally emphasize with you.
I also miss skating with my kids and everything else I used to do before I broke my patella.

I just had a scope today also(debridement & MUA). It went well and after waking up I have been feeling good.
Will hope this will continue....one never knows with knees. Did your scope go well? It is early and hopefully your OS will give you good advice for a plan for you.

Best of luck to you. I hope someone else with a similar experience can help you out.

SC
 
ps thanks for adding the pictures
« Last Edit: March 03, 2012, 06:28:11 AM by ShoeCrazy »
3/8/11 Broke right patella
5/8/11 Surgery- 2 pins, figure 8 wire, zimmersplint 24/7, no weight bear
17/8/11 Staples out
13/9/11 splint off, weight bear & start physiox2 week
17/11/11 OS recommends MUA on 5/12/11(canceled)
18/12/11  JAS
02/03/12  Scope, debridement & MUA
23/04/12  125 rom

Offline deb43

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Thank you both for replying.  Yes, Linda, I need to breathe and see how things go.  I think what I struggle with the most is the fact that I have done PT, I have done synvisc, I have done cortisone, I have a brace.  All things that have been palliative and helped some for brief periods, but haven't  corrected the issue, so it's just a never ending cycle.  As of today, I consider myself to be in pretty decent physical shape.  Despite the knee issue, I have been pushing through the discomfort and tried as much as possible to stay active.  As I get older and become less active due to increasing discomfort and my physicality deteriorates, I fear that my recovery will be more challenging. I wonder if doing a pkr now when I have great muscle tone/strength would be more beneficial?  I guess that's my biggest struggle in the decision making process.  I have been dealing with it for a while now and I know that I can continue to push through the pain if I need to.  I do know that pkr is coming at some point, I just need to figure out when that point should be.  SC, the scope went well.  He basically cleaned everything up and I feel about the same as I did before, but I am only 3 days post op. My biggest obstacle in the past and present seems to be my bending which has been an issue since last summer.  I cannot get the bend that I need for a quad stretch or to kneel, squat, etc.  The pain and swelling inhibit that, so I walk/function with a half bent leg most of the time, which cannot be good for my hips/feet/other knee, etc. Cortisone does help with that issue, but obviously cortisone cannot be a long term fix. Linda, I have a sis who has had 2 TKR, she is 38 and is doing well now.  Her issue was joint and not patellofemoral like mine.
Thanks again.
« Last Edit: March 03, 2012, 02:56:32 PM by deb43 »

Offline LindaM

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Hey Deb,

Isn't it a shame that we picked parents who set us all up for bum knees!  Good thing they were terrific in everything else.  I did the whole route (and the synvisc didn't work for me either) just like you. (This time before the second PKR my doctor tried cortisone because he was recently at a conference where he learned cortisone was better than synvisc)  It sounds as if you are limping pretty significantly, and yes, it will mess up some other things.  Between my meniscus repair and my first PKR I limped for 9 months as we tried the conservative treatments only to find in an x-ray that I had gone to bone-on-bone in the meantime.  All the limping didn't affect my strength too much because despite the pain I was teaching on my feet all day, but it totally screwed up my gait.  After surgery and PT I worked with an athletic trainer who did gait analysis.  He gave me additional exercises and and it still took a year to get my walking back to normal.

Have you been given isometric exercises as an alternative?  Have you tried additional ways to stretch the hamstrings which will have shortened up some due to walking with your knee slightly bent?  I have found that some of the pilates stretches are more gentle because the whole concept of pilates was to help injured dancers rehab.      Here is a site that has some information that is pretty good. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674181/

There are also specific sites to learn pilates exercises including a lot of youtube. http://www.youtube.com/watch?v=lCg_gh_fppI

 Hope you find something helpful.

Linda
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline Brambledog

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Hi Deb,

You sound just like me! And your photos are scarily similar to mine...lol. I know just what you mean. Had a conversation with my OS a couple of weeks ago and said if I had to have a PKR I wanted it now when 10-15 years of decent-ish knees could be enjoyed with my kids at home etc. I don't want to wait until I'm a pensioner and kids have left home before getting a pair of knees I can do things with!!

Saly it's never that straightforward. A PKR will only last so long before it needs revision, and there are only limited revisions they can do, so you might have to have a TKR after. Not a simple op after a PKR. Then your OS will be considering your probable lifespan and whether all the sums add up. I do sympathise, it's a very frustrating and painful  ::) situation, but you need to think long and hard about this and talk it all through with your OS.

If you can cope and carry on pretty well with life, put off the big ops as long as you can with injections, physio, brace etc. if your life has shrunk significantly, you cant function normally and the pain is getting out of hand, then lay it all on the line with your OS and see what they advise. There is always a point where something has to be done.  Just hope you are not there yet, and hopefully not for a long time!!

Good luck. PM me if can be any help lol!

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 deb43

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Thanks Brams,
I did write in my posts that a PKR has been brought up my by OS.  I should have said specifically a patellofemoral replacement.   I have done a lot of thinking over the weekend and I am almost 100% sure that I am going to do it.  I honestly don't have a lot to lose and I could have much to gain.  I know that it's going to happen eventually and if I can do it now when I am in great shape and preserve my other joints by not hobbling around and stay fairly active, then I think I should do it.  I basically have three options:  continue cortisone, try synvisc again, try  PT again.  While cortisone has been amazing, it is not good for long term use, synvisc did nothing to help me and the PT & exercises have strengthened my quad and has helped but I still have bone on bone and constant friction/inflammation/pain. I want to be active again with no pain. I have my appt. tomorrow, will update after that. Thank you all.
Deb
« Last Edit: March 05, 2012, 12:02:32 PM by deb43 »

Offline Brambledog

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Yes, you sound like a candidate for a PFJR.... ::) Sorry you've got to the point of constant pain where nothing works, but good to hear you have been able to strengthen those quads, that will be a big help if you do have the surgery done.

Will have fingers crossed for tomorrows appointment - make sure your OS talks you through everything in detail though so you've got all the info for that decision. Good luck and hope you come out with a course of action that gives you your life back!

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 Lottiefox

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The only thing I would add to the good advice so far is to make sure you know WHY your kneecaps have worn out at age 43. (Mine have too, but I am not even considering a PFJR at the moment as I am still very active and after hideous foot surgery complications I don't want a scalpel near me for many years).

To be a good PFJR candidate certain things need to be checked out and either addressed during the PFJR or beforehand. Check out the post op diaries of KW who is now on her second PFJR after the first knee was very successful and snorunner who has also had bilateral ones done but not without some issues. FMRCathelete is also a PFJR-er of fairly recent experience.  A good OS should be talking through with you why the kneecaps have worn - is it tilt on the kneecap, tilt and shift (where the kneecap sits laterally but also jumps slightly out of the groove), are there rotational issues, alignment of legs (valgus/varus) etc. Without knowing why the kneecaps have worn out you might not have a PFJR that works. Some people simply have kneecaps that wear prematurely and if their alignments are in tolerance then a PFJR can be fabulous. Ask plenty of questions!

Best of luck. Bum kneecaps are NO fun.

Lottie xx
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 deb43

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Met with my OS today. I asked him what % of my patella is grade IV and Hh told me  85%, lwith 15% bits and pieces of cartilage here and there. Llateral condyle is grade IV, middle is grade IV and medial condyle is partial grade 3/4.  He suggested continue PT to continue strengthening vastus medialis to try to get patella away from lateral side and closer to medial where there is some cushion and see how I feel  in 4 weeks which would put me 5 weeks post op from arthroscopic debridement.  Also going to do taping daily to see if it helps.  If no change by then, we will discuss pfjr. Thanks for the support.

Offline Brambledog

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Sounds like a good plan debs. Hope the strengthening can really help things. Ouch though  :-\, that is a lot of grade IV to have in all compartments. Have to say I'm surprised the PFJR is being mooted given your wear. I thought (apols if I'm wrong) that a PFJR was normally used for circumstances where the patella and trochlear groove were badly affected, but the other compartments were in pretty good shape. I'd have thought that with grade IV wear in the other compartments, you would have to address those pretty soon after anyway. Just something to check with your OS - the last thing you want is a surgery that only has a very short useful life before it has to be replaced with the full TKR.

I'm sure if I'm wrong here the KGs will correct me!!

Wishing you a successful strengthening month!

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 Lottiefox

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Do you mean the trochlear groove is grade 3-4 opposing the patella rather than the actual condyle? the condyle is the bit that sticks down opposite the tibia and the trochlear groove is the bit of the femur that is like the scoop for the patella to run in. Clearly if the medial and lateral bits of that are worn away then you have your bone on bone. Ouch. I have Grade 3-4 on the patella on medial and lateral lower aspects but groove is a funky Grade 2 - who knows how long those bits of fluff might stay on for! Taping never helped me, in fact it made things hurt more for some reason. The right PT has been a godsend for me, but I know I am on borrowed time...........

good luck and keep us posted! Did he say WHY you have the wear you have?

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 deb43

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Yes, Lottie, sorry.   I meant the lateral and medial sides of the femoral groove, not the actual condyles.  My issues stem from mild/moderate pronation, and tight lateral retinaculum (most specifically).  I have sisters with the same issues. Issues that could have been dealt with earlier in life had I known. 
« Last Edit: March 07, 2012, 07:21:07 PM by deb43 »

Offline dm

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  • I hate my knee!! :(
Your photos look pretty good. you should see some of mine... my knee's a mess. I've got 90% of my medial meniscus gone, my lateral meniscus is trimmed and is thinning, my patellofemoral compartment is all grade 4, my medial femoral condyle has a failed microfracture site and the surrounding articular cartilage now has chondromalacia grade 3/4, my patellofemoral fat pad is now full of scar tissue and it wasn't last year, my repaired acl has snapped and loosened if not gone completely leaving the knee unstable and hyperextending if I'm not careful. I've got chronic swelling and pain problems, and can't walk without a limp. In recent months my left hip and knee have been aching some from compensating for the bad right knee.

These are the pics from my last surgery... go here if you want to see them, there's also an image from last year's mri showing the bone intrusion then from the failed microfracture.
https://www.dropbox.com/gallery/40064007/1/knee?h=0cabc6

the knee is worse now... what I've described above is the latest mess. I refused last year to let them do a graft to a failed microfracture site, with donor bone from this same mucked up knee, with almost no medial meniscus. Didn't make sense to me to put in a bone graft to just have it hammered on because there's no cushion there between the bones at all where the damage is. sure enough, look what's happened, the articular cartilage has broke down more since the last scan 10-1/2 months ago.

I'm so tired of dealing with the pain, the disability etc, that I'm more than ready for them to just put in a new one and get it over with. Its so bad now I live in a full shell unloader brace, and probably should now be in a heavier combined instability brace - but no sense buying one if they're just gonna do the tkr in a few months once I can qualify for FMLA at work. At least the G2 I've got is solid, and is heavy enough that it keeps my knee from feeling like it's coming apart. I'm on my second one... and this one's 5/6 years old...

SO... I can totally feel for you in not wanting to put up with any more, when you've already put up with it long enough. Give your latest op 4-6 weeks or so to mend, so you can see if it's honestly made a difference, it'll take a minimum of that long just for the surgical portals and the shaved areas to mend some. If it helps enough that you can delay - that's to the good. If not, then you've lost nothing, because you'd have to wait for the surgical sites to heal up anyhow before they could go on to the next thing and give you the best chance for outcome, plus give you time to get your muscle strength back and build up some for the next one to lessen the atrophy later.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.















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