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Author Topic: Not sure how I should proceed... Osteotomy, PKR, so fed up with the knee.  (Read 2263 times)

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Offline RMK79

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Hi,

I definitely haven't posted a lot, although I have read through lots of peoples profiles and comments. Until a week ago I was positive that something would work for me, and now I feel so hopeless.

I am 33, live in Canada, and am currently waiting to see my OS in June. The last time I saw him he told me that I didn't have enough of a valgus deformity to perform the Osteotomy, so I need to wait to get worse before he can do anything. Another option was a lateral knee replacement, but he then informed me that they don't do these in Canada.... another option was a TKR but I am too young and will end up an amputee.

I have had the opportunity to share my information with a really good OS in Germany. He wants me to come there for an assessment. In Germany they offer cartilage replacement (don't do it in canada), and worse case scenario, partial knee replacement. He told me that they use "customized" system. They send your images off to a lab and have the replacement built just for you. He again said "worse case scenario". Also, if I am now indicated for an distal femoral osteotomy, they can do that there with cartilage replacement.. I have read about this being a good alternative.

I think I am going to go, to at least see what he has to say. I can't live like this anymore. Everyday is a struggle to get though, and I know my parents are worried sick about me. My left knee has been acting up, my PT is positive that it is mostly due to compensation.. tight IT band, tight Quad, Tight hamstring is irritating the lateral side of my left knee. I hope she is right. I have never had any problems before with the left knee. They scoped it years ago to make sure my that I didn't have a discoidal meniscus in that knee as well. The surgeon said it was fine. My x-rays also always indicate that there is nothing wrong. If it is just IT band pain, I hope it goes away with all I am doing.

Any advice would be appreciated. I use to be so active, healthy and happy. Now I can barely do anything. I live in my unloader brace and on NSAIDs and other pain medication. I can honestly say, I have never been so scared. I feel like I am in a nightmare.. and just can't wake up.

Thanks for any advice,
Ry :)
1990 RK lateral meniscus removed
2005 RK pain kicked in, RK scoped
2007 Meniscus replacement - a few good years
2011 Lateral meniscus removed, microfracture....
2012 Microfracture failure, waiting on options, lots of pain

Offline seantomtom

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Hi
So sorry to hear your problems,i am currently 4 months post op HTO and already much better than i was before the operation,before i had it done i could only get around on crutches,i may never run a marathon again but at least i will be living a life without the problems i had before.
This site is good for advice,its also good for scaring you to death,you need to listen to the advice of your surgeon,they know more than most people on here.I know the decision is not easy,i went for the HTO because like you i am too young for TKR,its not been easy but as i am now coming out the other end its worth it,it will get better.My advice would be to talk to your surgeon,make you decision,have the op,then come back to this site,some of the stories i read on here would have given me too many sleepless nights if i had not done it that way.
Sorry if this upsets some people on the site but thats the way i feel,the site has been fantastic for my recovery reading peoples post op blogs has been invaluable in my recovery,which is still ongoing,but the decision on which way to go should be made with the professionals.
Good luck with everything,it will get better,even if at the moment i does not feel like it.
sean :)
 

Offline emergRN

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RMK79,

I too live in Canada!  If your surgeon thinks that you need a partial knee replacement, and it is not available in Canada, you can apply to your provincial health plan to see if you can get the procedure covered out of country.  Your surgeon would need to write a letter for this.  Another member of this forum managed to get out of country surgery covered by OHIP in Ontario.  His screen name is YB.  He may be able to offer some advice on how he went about this.

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline aaa

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Hi RMK79,

Yes, if a treatment is unavailable,  and it is necessary for you to prevent longer-term damage and disability then it can be funded out of country.

I live in Ontario, for Ontario the form is here  - http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWE&TIT=4520&NO=014-4520-84

For me it involved getting assessments out of country and then having an OS here do the paperwork.  It sounds like its already established for your that the lateral knee replacement isn't done?  The next thing would be to establish it really is needed as part or all of your treatment.

I'm not sure how to advise you, but prior to exploring out of country I would try the following.  I'm in Ontario so I can only advise about what I know here:

- Try to get a referal to see Dr. Cameron at Sunnybrook.  http://sunnybrook.ca/team/member.asp?t=16&page=388&m=273

Dr. Cameron does quite advanced osteotomy around the knee, and would probably be able to take care of it.  It doesn't sound right to me that your OS understands its getting worse but then doesn't want to correct it?  I think getting a second opinion is a good idea.

I think Sunnybrook is also quite far ahead in terms of cartilage transplants / grafts so they may be able to do something for you as  partial replacment.  Dr. Cameron even does meniscus transplants! 

Hmm ... thinking more, I have heard of compartmental replacments around the knee being done in Canada.  I've heard Toronto Western Hospital does them, and I think Sunnybrook as well. 

There are a lot of good Docs in Canada, its just sometimes we do seem to lag behind in some areas.  I'm hoping that you'll be able to get it taken care of here.  Getting things done out of country presents its own challenges, and additional costs (they typically will not cover travel, for example)

Hope this helps.

EDIT: if you happen to be on the opposite side of Canada, towards B.C.   I'm sorry I don't know anybody there, but I would explore getting in touch with Dr. Jamali.  He's in California, I know thats really far but not as far as Germany :)

http://www.hipandknee.net/DrJamali.html

He will very likely speak to you over the phone without any formal arrangement.  He also has a good network of people, and he would probably be able to find someone for your in your area.

« Last Edit: May 18, 2012, 02:29:44 PM by yb »

Offline RMK79

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Thank you all so much for your words of advice. I am finding so frustrating dealing with the canadian system right now. My Doctor here has been unresponsive to me at the moment, but I do have an appointment with him on June 20th.

I was treated by Dr. John Cameron before I moved to BC (its been 5 years). He did my lateral meniscus replacement. My doctor here told me he was going to send my file to him, a referral, to see if he could help me (this was almost 3months ago). I called Dr. Cameron's office the other day and my referral had never been sent??? My doctor here pretty much left me with no options except wait until you get worse, maybe candidate for osteotomy, or TKR. His words... I thought he would try to investigate other surgeons for me, but he obviously has not. I understand his time constraints as a busy doctor, but I deserve some attention. I am young, rely on my legs to work,  and now am in such pain I can hardly think straight most of the time.

I am going to Germany, for a consultation. I do know I am taking a big chance, but I think it's the right thing. I have no choice and I am not going to wait until my condition is even worse then it is. My whole body is suffering due to compensation. If they can offer something our canadian system can not, then I am willing to take that chance. I will present this information to my Dr. when I get back and see what he says. If he is supportive then hopefully he will fill out the application for me to have the surgery funded by BC. I don't want a TKR, not if there is something else that can be done.  :)

Wish me luck,

Ry
1990 RK lateral meniscus removed
2005 RK pain kicked in, RK scoped
2007 Meniscus replacement - a few good years
2011 Lateral meniscus removed, microfracture....
2012 Microfracture failure, waiting on options, lots of pain

Offline dm

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  • I hate my knee!! :(
I totally feel for your situation. I'm 40, too young for a TKR I'm told, even here in the US, have had 6 ops already in the last 12 years, the last the most serious, have yet more damage, and am told I need #7, another meniscus tear and my repaired acl has retorn. I'm told they'd just deal with the meniscus tear and leave the acl as is. My Patellofemoral compartment is grade 3/4 so and HTO won't help my medial side issues - I've an OCD lesion that was microfractured and I was told that after nearly 18 months the defect looks on mri like it's filled in - the scope they want to do would bear out the truth of that when they look at the bone, I guess. The slack in my knee because my acl is junk is another issue... I live in my G2 about 18 hrs a day... and pain every day from the kneecap grating, and the medial side pain....because my kneecap has no articular cartilage left I'm not a candidate for an HTO to loadshift off the medial side... so not much can help me but a tkr, or to just treat symtomatically and live in hardware...

I'm waiting to see what a new OS who's never seen this knee says tomorrow.




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.

Offline RMK79

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Good Luck!! I hope he can offer you some positive options!!!

Knee issues are so frustrating, especially when there seems to be no clear answer. Going through this has really opened my eyes to how much I took for granted with regards to my health. If I can get out of this unloader brace and out of extreme pain, I will take much better care of what I have.... if I only swim and cycle for the rest of my life, that is good enough for me.

keep me updated on your progression!!
Ry :)
1990 RK lateral meniscus removed
2005 RK pain kicked in, RK scoped
2007 Meniscus replacement - a few good years
2011 Lateral meniscus removed, microfracture....
2012 Microfracture failure, waiting on options, lots of pain

Offline Adobec

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Very interested in this dicussion.  My recovery from microfracture isn't going so well and I will consider PKR if my patellofemoral symptoms persist.
1991 - R ACL patellar tendon, med. meniscus removed (50%)
2002 - R ACL revision, cadaver, lat. meniscus removed (50%)
2011 - L ACL patellar tendon, med. and lat. meniscus REPAIR. 
3/2012 - L Medial meniscectomy (didn't heal from 2011), microfracture
11/6/12  - L TTT (maquet). Micro fully healed

Offline RMK79

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I see the German OS in about two weeks. I will post what information the shares with me. I am hopeful that he has some solutions to my problem, to give me a better quality of life. Living in this much pain is draining and I am fed up with the Canadian health care system.  When I had Micro-fracture I thought the recovery was brutal. I did have about two months of pain free living and then it all went down hill from there. I think I just was not the right candidate for the procedure. I mean I have no meniscus and limited joint space, the chances of it being some what successful where low.

talk soon,
Ry
1990 RK lateral meniscus removed
2005 RK pain kicked in, RK scoped
2007 Meniscus replacement - a few good years
2011 Lateral meniscus removed, microfracture....
2012 Microfracture failure, waiting on options, lots of pain

Offline dm

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Hi guys, saw the new OS, ironically enough, he knows the one I've been seeing, says the guy's a good doc who's known as "by the book". That's at least encouraging to hear from an unknown quantity that the guy I've been seeing for a decade has a good rep. So.. on to the appt....

First off... took in 2 mri scans from  5/2011 and 3/2012, my last scope pics from 10/2010 for him to see. He also took standing xrays, including the bent-knee kneecap view, which so few docs seem to do. He took a look at everything, then came in and examined my knee. He felt how loose my joint is, with it straight and how it wobbles side to side, and with it bent and how the tibia slips forward out from under the femur. Definitely have trashed the acl repair that was done oct 2010 - that only lasted 14 months! - he felt around my kneecap and asked how painful it was, and I iterated how getting up and sitting down hurts, etc, and that things like pushing down on it and wiggling it around don't feel good.

He then proceeded to tell me that he felt that he only saw 3 options, and that he would rule out one of them because of the kneecap damage - a PKR isn't a good idea with the patellofemoral issues I've got.  He said we could try Hyalgan injections and see if they help, and if the series of 5, and possibly a steroid booster after, doesn't help, then the only other option would be a TKR, given that the medial side of my right knee is just shot. He says that the area where my OCD lesion was, where the microfracture was done, which has taken about 18 months to fill in, is the small "island" of the most decent bone material on that side of the joint.

He also says that at 40, I'm not too young for a TKR, if that was the route that needed to be taken, and that his choice would be a mobile bearing platform knee. I brought up the subject of the recalls that I've heard about of late - even had talked to someone locally whose friend had had a recalled implant put in - and he says that besides checking for that, he hasn't been using implants from Stryker - one of the ones with the recent recall problems.

So, I'm going to try the shots, I've got nothing to lose besides a couple months' delay, plus the fact that in order to get the insurance to pay for the TKR, I'll most likely have to do the shots anyhow as the "process", given my age, so that they can document that all the "reasonable" alternatives have been tried.

Doc says that in cases like mine, even though my "old" OS wants to do another scope for a suspect meniscus tear on the bad side again... that'd be surgery #7, he says it'd be a waste of time given the damage already existing on that side. That makes sense. Even if they trimmed up the bits making the clicking, they still wouldn't be fixing the bone damage that's causing the ongoing pain problems. He commented that the guy I've been seeing is known for going "by the book" but he's found that there's times to go with experience vs the book (to get the desired outcome, obviously)
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.

Offline Silkncardcrafts

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Very interesting discussion. I am in a bind with my knee. Just don't know what options I have left.

Had two bad dislocations in the last five weeks. Hoping to see my knee surgeon soon.

My knee cap just came out again. I could scream !
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline dm

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seems like LRs were the worst thing they could do to you with dislocation issues... seems like you need a PF specialist at this point to see what the heck is up. Have they done "skyline" xrays to see where your kneecaps sit when you bend your knees? it's a special xray they do where the film plate is held parallel to the femur, and the xray camera shoots from below the knee. You have to have the knee bent around 90 deg for them to take the shot, and I had to hold the xray plate. If yours keeps coming out... seems like you need this special view done. If yours are riding too far one way or the other, they should be able to see that, I'd think!
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.